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ACEP COVID-19 Field Guide

Table of Contents

Self-Isolation

Home Safety

How to self-isolate

Stay in your room or apartment. 

  • Do not go to work, classes, athletic events, or other social or religious gatherings.  

Ensure other household members stay in another room or limit contact with you as much as possible. Stay 6 feet away from other individuals at all times.

  • If available, household members should use a separate bedroom and bathroom.

Ensure that shared spaces in the home have good airflow whenever possible, such as via air conditioning or an opened window as weather permits.

Cover coughs and sneezes with your upper sleeve or a tissue. Then, discard the tissue immediately in a trash bin. Never cough in the direction of someone else. 

Avoid touching your eyes, nose, and mouth with unwashed hands.

Perform hand hygiene frequently, especially after coughing, sneezing, or throwing a used tissue in the garbage. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60% to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water are preferred.

Avoid sharing household items. 

  • Don’t share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. 
  • After using these items, wash them thoroughly. 

Keep your surroundings clean. 

  • Clean surfaces that you share with others, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables (or any other object that you sneeze or cough on) with a standard household disinfectant, such as Clorox® wipes. 
  • Wash your hands after cleaning the area. 

Guidance for Cleaning and Disinfecting

If and when available, follow the manufacturer’s instructions for all cleaning and disinfection products  for concentration, application method, and contact time, etc.

Hard (Non-porous) Surfaces

  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Clean hands immediately after gloves are removed.
  • If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.
  • For disinfection, most common EPA-registered household disinfectants should be effective. A list of products that are EPA-approved for use against the virus that causes COVID-19 is available here
     
    • Additionally, diluted household bleach solutions (at least 1000ppm sodium hypochlorite) can be used if appropriate for the surface. Follow manufacturer’s instructions for application, ensuring a contact time of at least 1 minute, and allowing proper ventilation during and after application. Check to ensure the product is not past its expiration date. 
       
    • Never mix household bleach with ammonia, or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.

Soft (Porous) Surfaces

  • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination, if present, and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:

    • Launder items as appropriate in accordance with the manufacturer’s instructions.
       
    • If possible, launder items using the warmest appropriate water setting for the items and dry items completely.
       
  • Otherwise, use products that are EPA-approved for use against the virus that causes COVID-19 and are suitable for porous surfaces.

Electronics

  • For electronics such as cell phones, tablets, touch screens, remote controls, and keyboards, remove visible contamination, if present.
     
  • Consider using wipeable covers for electronics.

  • If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.

Linens, Clothing, and Other Items That Go in the Laundry

  • Wear disposable gloves when handling dirty laundry from an ill person and then discard the gloves after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.
     
  • If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.
     
  • If possible, do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.
     
  • Launder items as appropriate in accordance with the manufacturer’s instructions.
    • If possible, launder items using the warmest appropriate water setting for the items and dry items completely.
       
  • Dirty laundry from an ill person can be washed with other people’s items.
     
  • Clean and disinfect clothes hampers according to guidance for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.

HVAC, ventilation, and filtration

Ventilation and filtration provided by heating, ventilating, and air-conditioning (HVAC) systems can reduce the airborne concentration of the virus that causes COVID-19, which can reduce the risk of transmission through the air. Running your HVAC system, using an air purifier or a portable air cleaner, and increasing ventilation are not enough to protect yourself and your family from COVID-19. 

  • Check to be sure your HVAC filter is correctly in place and consider upgrading the filter to the highest-rated filter that your system can accommodate (consult your HVAC manual or an HVAC professional for details).
  • HVAC systems only filter the air when the fan is running, so run the system fan for longer times, or continuously.  Many systems can be set to run the fan even when no heating or cooling is taking place.
  • When used properly, air purifiers can help reduce airborne contaminants, including viruses, in a home or confined space.
  • Improve ventilation with outside air to improve indoor air quality:
    • Open the windows, or screened doors, if possible.
    • Operate a window air conditioner that has an outdoor air intake or vent, with the vent open.
    • Open the outside air intake of the HVAC system, if yours has one (this is not common).
    • Operate a bathroom fan when the bathroom is in use or continuously, if possible.
    • Avoid these actions when outdoor air pollution is high or when it makes your home too cold, hot, or humid.
  • Care should be taken with portable ventilation equipment, for example, fans, to minimize air blowing from one person directly at another person to reduce the potential spread of any airborne or aerosolized viruses.
  • Use of ozone generators in occupied spaces is not recommended. 
    • When used at concentrations that do not exceed public health standards, ozone applied to indoor air does not effectively remove viruses, bacteria, mold, or other biological pollutants.

 

Additional information is available at: CDC Cleaning and Disinfection for Households. Interim Recommendations for U.S. Households with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19)

Discontinuing Isolation for Persons with COVID-19

CDC Recommendations for Ending Isolation

  • For most children and adults with symptomatic COVID-19 infection, isolation, and precautions can be discontinued 10 days after symptom onset and after resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.
  • For people who are severely ill or severely immunocompromised:
    • A test-based strategy can be considered in consultation with infectious disease experts.
    • Some people with severe illness (e.g., requiring hospitalization, intensive care, or ventilation support) may produce replication-competent virus beyond 10 days that may warrant extending the duration of isolation and precautions for up to 20 days after symptom onset.
    • Severely immunocompromised patients* may produce replication-competent virus beyond 20 days and require additional testing and consultation with infectious disease specialist to determine the appropriate duration of isolation and precautions.
  • For people who are asymptomatic (never develop symptoms):
    • Isolation and precautions can be discontinued 10 days after the first positive viral test.

* For the purposes of this guidance, moderate to severely immunocompromising conditions include, but might not be limited to, those defined in the interim clinical considerations for people with moderate to severe immunocompromise due to a medical condition or receipt of immunosuppressive medications or treatments. Other factors, such as end-stage renal disease, likely pose a lower degree of immunocompromise and there might not be a need to follow the recommendations for those with moderate to severe immunocompromise. Ultimately, the degree of immunocompromise for the patient is determined by the treating provider, and preventive actions should be tailored to each patient and situation.

Assessment for Duration of Isolation

  • Available data suggest that patients with mild-to-moderate COVID-19 remain infectious no longer than 10 days after symptom onset.
  • Most patients with more severe-to-critical illness or those who are severely immunocompromised likely remain infectious no longer than 20 days after symptom onset; however, there have been several reports of severely immunocompromised people shedding replication-competent virus beyond 20 days.
  • Patients who have recovered from COVID-19 can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset in concentrations considerably lower than during illness; however, replication-competent virus has not been reliably recovered and infectiousness is unlikely. The circumstances that result in persistently detectable SARS-CoV-2 RNA have yet to be determined. Studies have not found evidence that clinically recovered adults with persistence of viral RNA have transmitted SARS-CoV-2 to others. These findings strengthen the justification for relying on a symptom-based rather than test-based strategy for ending isolation of most patients.

Options to Reduce Quarantine for Contacts of Persons with COVID-19 Using Symptom Monitoring and Diagnostic Testing:

If sufficient resources and access to testing are available, testing may be useful to identify infected persons without symptoms for contact tracing efforts. The CDC recommend the following alternative options to a 14-day quarantine:

  • Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
    • With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
  • When diagnostic testing resources are sufficient and available (see below), then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
    • Testing for the purpose of earlier discontinuation of quarantine should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for infection must be prioritized.
    • With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.

Persons can discontinue quarantine at these time points only if the following criteria are also met:

  • No clinical evidence of COVID-19 has been elicited by daily symptom monitoring† during the entirety of quarantine up to the time at which quarantine is discontinued; and
    • Monitoring can be conducted using any method acceptable to local public health authorities and could include self-monitoring using an approved checklist of signs and symptoms, direct contact daily by public health authorities or their designates, or automated communications systems (e.g., on-line or texting self-checkers)
  • Daily symptom monitoring continues through quarantine Day 14; and
  • Persons are counseled regarding the need to adhere strictly through quarantine Day 14 to all recommended non-pharmaceutical interventions [non-pharmaceutical interventions (NPIs), a.k.a. mitigation strategies)], especially. They should be advised that if any symptoms develop, they should immediately self-isolate and contact the local public health authority or their healthcare provider to report this change in clinical status.
    • NPIs that can be practiced by individuals include the following: correct and consistent mask use, social distancing, hand and cough hygiene, environmental cleaning and disinfection, avoiding crowds, ensuring adequate indoor ventilation, and self-monitoring for symptoms of COVID-19 illness. 

Persons can continue to be quarantined for 14 days without testing per existing recommendations. This option maximally reduces risk of post-quarantine transmission risk and is the strategy with the greatest collective experience at present.

These recommendations for quarantine options shorter than 14 days balance reduced burden against a small but non-zero risk of post-quarantine infection that is informed by new and emerging science.

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