Updated March 7th, 2020
Recommendations in this document for action by public health authorities applies primarily to US jurisdiction who do not have a sustainable community transmission. CDC will provide separate guidance for US jurisdiction with transmission of a sustainable society.
The CDC has provided separate guidance for
Revisions were adopted on March 14, 2020, to reflect the following :.
Revision conducted on March 7, 2020, to reflect the following:
revisions were made on March 5, 2020, to reflect the following:
The CDC is closely monitoring an outbreak of respiratory disease ( COVID-19) caused by a (SARS-CoV-2) which was first detected in Wuhan, Hubei Province, China. Chinese health officials have reported tens of thousands of diseases with COVID-19 in China and the virus is spreading from person to person in many parts of the country. COVID 19th case was also reported in more and more, some of which are ongoing or comprehensive community-level transmission from person to person. Case COVID-19 without a direct link to the trip has been reported and ongoing transmission occurs in some communities in the United States.
The purpose of the guidance of interim is to provide public health authorities and other partners within the jurisdiction of the United States who do not have the transmission of a sustainable society COVID-19 with a framework for assessing and managing the risk exposure of the potential for SARS-CoV-2 and apply public health actions based on a person’s risk level and clinical presentation. Public health measures may include monitoring or implementation of movement restrictions, including isolation and quarantine, if necessary to delay the introduction and spread of SARS-CoV-2 in this community.
recommendation in the guide apply to US-bound travelers who may have been exposed to SARS-CoV-2 and those identified through contact investigation of laboratory-confirmed cases. CDC recognizes that states and local jurisdictions might make risk management decisions that differ from those recommended here. public health management decision should be based on the situation in the jurisdiction and priority public health authorities. guidance will be updated based on the state of the epidemic develops.
This guide is designed for a “containment” in the continuing absence of SARS-CoV-2 transmission in US society to delay the introduction and spread of SARS-CoV-2. It focuses on reducing the risk of unrecognized cases imported from international locations with ongoing transmission and manage contacts from laboratory-confirmed cases. In the US jurisdictions that did not experience a sustainable community transmission, this activity is still important; However, resource-intensive approach that is focused on the detention of international travelers pose a risk of diverting resources from public health priority activities, including surveillance and case finding, contact tracing, and prepare the community mitigation measures. Let the health department the flexibility to prioritize public health measures in their jurisdictions allow judicious deployment of public health resources where they can have the most benefit based on the local situation. state and local health departments the best position to make such decisions within their jurisdiction.
In the US jurisdiction with a sustainable community transmission, shifted from containment to mitigation of public health conserve resources and direct them to where they can have the most benefit. In such jurisdictions, citizens may have the same risk of exposure to international travelers from countries with ongoing transmission; Therefore, applying the strict containment measures for international travelers (eg, stay home for 14 days) no longer have the benefit of public health and would be arbitrary in the context of the same risk, among others in the community. Applying containment measures such as (for example, ask people to stay at home) the general public will have a severe adverse effect on community infrastructure. When the SARS-CoV-2 spread in the community, it is also not feasible to identify all people with symptoms compatible with COVID 19th or identify all potentially exposed contacts. Applying strict containment measures for people who are tested and have laboratory confirmation and their contacts, but not for others who are not tested and their contacts, will have pUblic health benefits. Such an approach could hamper efforts to control and the ability of public health authorities to make decisions based on the data for the implementation of community mitigation measures. Separating the CDC guidance in development are aligned on who were tested and confirmed positive COVID-19 and others in the community are symptomatic but not tested, as well as their contacts.
Symptoms compatible with COVID -19, for the purposes of this recommendation, including the subjective nor measured fever, cough, or trouble breathing. means
Self-observation of the need to remain vigilant to subjective fever, cough, or trouble breathing. If they get a fever or develop a cough or difficulty breathing during the observation period themselves, they should take their temperature, self-isolate, limit contact with others, and seek advice by phone from a health care provider or local health department to determine if a medical evaluation is needed ,
Self-monitoring means people should monitor themselves for fever by taking their temperature twice a day and remain alert to cough or difficulty breathing. If they feel cold or have a fever measured, cough, or trouble breathing during the monitoring period themselves, they should self-isolate, limit contact with others, and seek advice by phone from a health care provider or local health department to determine if a medical evaluation is needed ,
self-monitoring by means of supervision is delegated, to group specific job (for example, some medical or laboratory personnel, crew member airline), the self-monitoring with supervision by the appropriate health work or infection control program is coordinated with the health department jurisdiction , The work of health or infection control personnel to employ organizations should establish a contact point between the organizations, self-monitoring personnel, and local or state health department with jurisdiction over the location where personnel will be over a period of self-monitoring. This communication should result in agreement on a plan for a medical evaluation of personnel who have a fever, cough, or trouble breathing during a period of self-monitoring. The plan should include instructions to notify the health of workers and local health authorities, and transportation arrangements to the pre-designated hospital, if medically necessary, with advance notice if a fever, cough, or trouble breathing occurs. Monitoring organization must keep in touch with through a period of self-monitoring personnel to oversee the self-monitoring activities.
Self-monitoring by way of public health control public health authorities bear responsibility for the supervision of the self-monitoring for specific groups of people. The ability of the jurisdiction to initiate or provide oversight continues to be dependent on other competing priorities (eg, tracking of contacts, the application of community mitigation strategies). Depending on local priorities, the CDC recommends that health departments consider establishing initial communication with these people, provide for the self-monitoring plan and clear instruction to notify the health department before people seek medical care if they develop a fever, cough, or trouble breathing. As resources permit, health authorities can also check out intermittently with these people during the period of self-monitoring. If tourists for whom the recommended public health surveillance identified at US ports entrance, CDC will notify state and territorial health departments with jurisdiction for the purpose of ending the travelers.
On monitoring means that the state or local public health authorities are responsible for establishing regular communication with people potentially exposed to assess the presence of fever, cough, or trouble breathing. For people with high risk exposure, the CDC recommends these communications occur at least once every day. , The communication mode can be determined by the state or local public health authorities and may include phone calls or electronic device or internet-based communication
Close contact is defined as:
a) be in more or less 6 feet (2 meters) of cases COVID-19 for a long period of time; close contact can occur when caring for, living with, visiting, or share the wellness area or waiting room the case COVID-19
– or –
b) have direct contact with secretions of infection of cases COVID-19 (for example, who coughed on) < p> command public health law directives implemented is issued under the authority of the relevant federal, state, or local bodies which, when applied to a person or group, can put restrictions on the activities carried out by individuals or groups, potentially including restrictions on movement or requirements for monitoring by public health authorities, for the purpose of protecting public health. Federal, state, or local public health orders may be issued to enforce isolation, quarantine or parole. The list order federal public health authorities defined by the Executive Order and including “acute respiratory syndrome.” COVID-19 meets the definition for “severe acute respiratory syndrome” as stipulated in Executive Order 13295, as amended by Executive Order 13375 and 13674, and, therefore, is a federal quarantinable infectious diseases.
Isolation means separation of a person or group of people known or reasonably suspected to be infected with an infectious and potentially infectious disease of people who are not infected to prevent the spread of infectious diseases. Isolation for public health purposes may be voluntary or forced by federal, state, or local public health order.
Quarantine in general means the separation of a person or group who is trustworthy has been exposed to a communicable disease but not the symptoms, of those who are not so exposed, to prevent the possible spread of infectious diseases.
Conditional release defines a set of legally enforceable conditions in which a person can be released from the more stringent restrictions on the movement of public health, such as quarantine in a secure facility. These conditions may include public health surveillance through in-person visits a health official or designee, telephone, or electronic means or internet-based communication specified by the Director of the CDC or state or local health authorities. A conditional release order may also place limits on travel or movement restrictions require someone outside their homes. involve
Controlled trip distance exception of commercial transport (eg, plane, boat, train, bus). For those subject to active supervision, each traveling long distances should be coordinated with public health authorities to ensure uninterrupted monitoring. Air travel is not allowed by commercial airlines, but may occur through commercial air transport was approved. CDC can use the public health or to enforce the controlled trip. CDC also has the authority to issue travel permits to determine the conditions of interstate travel in the US for people under the orders of a particular public health or if other conditions are met.
Gathered setting crowded public places where close contact with others can occur, such as shopping centers, theaters, stadiums.
Social distancing remaining way of a series of solid, avoiding mass gatherings, and maintain distance (about 6 feet or 2 meters) from others when possible.
This category of temporary and subject to change.
The CDC has determined the following categories of risk exposure to help guide public health management of the following persons of potential SARS-CoV-2 exposure in jurisdictions that did not experience a sustainable community transmission. This category may not include all potential exposure scenarios. They do not have to replace the individual assessment of risk for the purposes of clinical decision-making or management of individual public health.
All exposures valid for 14 days before the vote.
To country- level risk classification, see.
The CDC has provided separate guidance to.
Table 1. Categories of risk for Exposure Related to International Travel or identified for Contact Investigation Laboratory-confirmed case
(assuming there is no exposure in high risk categories) < p> (assuming there is no exposure in high risk categories)
* in general, geographical exposure category does not apply to travelers who are only transiting through the airport.
State and local authorities have primary jurisdiction for insulation and other public health orders in the respective jurisdiction. federal public health authorities which mainly extends to the international arrivals at ports entry and to prevent an infectious disease threats.
The CDC acknowledges that the decision and the criteria for the use of public health measures can vary by jurisdiction. Consistent with the principles of federalism jurisdiction, state and local governments can choose to make decisions about insulation, other public health orders, and monitoring that exceed those recommended in the federal guidance. As the country evolved COVID-19 situation, public health authorities must base their decision on the application level of the individual monitoring or restriction of movement on the situation in their jurisdiction, including whether a sustainable community transmission occurs and competing priorities.
issuance of public health orders should be considered in the context of other less restrictive means that could achieve the same public health objectives. People under the orders of public health must be treated with respect, fairness, and compassion, and public health authorities should take measures to reduce the potential stigma (eg, through outreach to affected communities, public education campaigns). Its pretty, thoughtful planning by public health authorities needed to implement true public health orders. In particular, measures must be in place to provide shelter, food, water, and other essentials to people movement is restricted under the orders of public health, and to protect their dignity and privacy.
recommendation CDC for public health management of international travelers with potential exposure to SARS-CoV-2 and those identified through the investigation of contacts of laboratory-confirmed cases, including the monitoring and implementation of travel or movement restrictions, summarized in ,
Additional recommendations in specific groups or settings are provided below.
The CDC and the Federal Aviation Administration have jointly provided. guidance FAA-CDC include recommendations for the flight crew to self-monitor under the supervision of the occupational health program their employers and to stay in their hotel room and practice of social distance when layovers overnight in the United States (applies to crews based in the US and crew based in other countries) or international (valid for crews based in the US). This recommendation was made because of the SARS-CoV-2 spread across international territories as well as in the United States. Also, the geographic risk assessment means that the situation is changing rapidly the state level can not be relied upon to accurately assess the risk to the crew in a particular location. As long as they remain asymptomatic, the crew can continue to work on the flight into, within, or departing from the United States. crew who follow their health plan operators work and guidance FAA-CDC was not subject to the restrictions applied to other travelers. If they have a fever, cough, or trouble breathing, the crew should self-isolate and removed from work on commercial flights immediately, and remain excluded until cleared to work with health programs and public health authorities of their work.
Regardless of residence or travel history, crew members who have known exposure to people with COVID-19 should be assessed and managed on a case-by-case basis.
Some of personnel (for example, emergency first responders) to fill the role of critical infrastructure (critical) in the community. Based on the needs of individual jurisdictions, and at the discretion of the state or local health authorities, the personnel may be allowed to resume work following potential exposure to SARS-CoV-2 (both related travel or close contact with a confirmed case), as long as they remain asymptomatic. The personnel are allowed to work following the exposure should self-monitor under the supervision of their employer occupational health program, including taking their temperatures before each shift to ensure they remain cold. In the days of these individuals are scheduled to work, occupational health program employers can consider the temperature gauge and assess the symptoms before they start work. health personnel affected are treated as part of the critical infrastructure should follow.
The CDC has established criteria to determine when an individual can be considered non-infectious to guide the termination or. While individuals are considered infectious, local or long distance trips that should happen only with medical transportation (eg, ambulance or air medical transportation) or private vehicles. Isolation and travel restrictions on a determination issued by public health authorities that the person is no longer considered contagious.
symptomatic people who meet the CDC definition of (PUI) should be evaluated by a health care provider in conjunction with local health authorities. Puis wait for the results to COVID-19 must remain in isolation at home or in a health facility until their test results are known. Depending on clinical suspicion COVID-19, Puis for whom the test RRT-PCR start is negative may be candidates for the elimination of any isolation and travel restrictions on the symptoms, but the limitation for people without symptoms according to the risk level determined to be valid , Puis decision of the management not being tested must be made on a case-by-case basis, using available epidemiological and clinical information, in conjunction with the CDC guidance.
The CDC did not recommend testing, symptom monitoring or management specifically for people affected by asymptomatic persons with potential exposure to SARS-CoV-2 (as in the household), namely, “the contacts;” these people are not considered to have SARS-CoV-2.
Table 2. Summary of CDC Recommendations Management People Affected by the Level of Risk and Attendance Symptoms
Public health measures recommended in the table below apply to people who have been determined to have at least some risk COVID-19. People who are managed as asymptomatic at the level of certain risk to develop signs or symptoms compatible with COVID-19 must be moved immediately to a group of symptoms at the same level of risk and managed accordingly. The risk level does not change if symptoms
EMS = emergency medical services .; HCF = health facilities; Pui = Person Under Investigation for COVID-19
1for the purpose of this document :. Subjective nor measured fever, cough, or trouble breathing
Note: The public health management recommendations made above are primarily intended for transmission jurisdictions do not experience a sustainable society. In jurisdictions do not experience sustainable community transmission, the CDC recommends that post-exposure for the public health management of asymptomatic individuals exposed continuously for up to 14 days after the last potential exposure; However, this decision should be made based on the local situation, the available resources and competing priorities. These factors also should guide decisions about managing people develop symptoms.
International travelers and other potentially affected individuals in jurisdictions experiencing sustainable community transmission should follow local guidance.
For country-level risk classification, see
The CDC has provided separate guidance for
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