● COVID-19 is the abbreviation commonly used to refer to coronavirus disease 2019.

● COVID-19 is an infectious respiratory disease caused by the most recently discovered coronavirus that is officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

○ Viruses and the disease they cause, often have different names. For example, HIV is the virus that causes AIDS.

○ Viruses are named based on their genetic structure to facilitate the development of diagnostic tests, vaccines, and medicines. Diseases are named to enable discussion on disease prevention, spread, transmissibility, and treatment.

● COVID-19 is new, and not the same as the coronaviruses that cause mild illnesses like colds.

● COVID-19 was unknown before an outbreak began in Wuhan, China, in December 2019.

● COVID-19 was declared a pandemic by the World Health Organization in March 2020.

● Coronaviruses are a large family of viruses called Coronaviridae. There are many types of coronaviruses, and some can cause illness in animals or humans.

○ Several coronaviruses cause respiratory infections in humans, including the common cold, the Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS).

○ Sometimes coronaviruses that infect animals can evolve into a new coronavirus that makes people sick.

● Based on what is currently known, the time between when COVID-19 enters the body to when symptoms begin ranges from 1-14 days, and is most commonly estimated at about 5 days.

○ Symptoms begin gradually and are usually mild.

○ Children have similar symptoms as adults and generally have mild illness.

● The most common symptoms of COVID-19 are fever, tiredness, and dry cough.

○ The following symptoms may also be indicative of COVID-19:

• cough.

• shortness of breath or difficulty breathing.

• fever and chills.

• muscle pain or body aches.

• fatigue.

• nasal congestion or runny nose.

• sore throat.

• new loss of taste or smell.

• a rash on skin or discoloration of fingers or toes.

• diarrhea and nausea or vomiting.

○ Some people may not show any symptoms at all or feel unwell even though they have the disease and spread it.

● Most people (80%) experience mild cases of COVID-19, and recover without hospitalization.

○ People with minor symptoms, like slight cough or mild fever may not need to seek medical care. It is recommended to stay at home, self-isolate, and monitor symptoms.

○ If you live in an area where malaria or dengue is endemic, do not ignore symptoms of fever. Seek medical help.

● Around 1 out of every 5 people with COVID-19 become seriously ill and experience difficulty breathing.

○ Older adults, as well as those with pre-existing medical conditions—like high blood pressure, heart problems or diabetes—are more likely to become seriously ill. However, anyone can catch COVID-19 and become seriously ill.

○ People of all ages experiencing warning signs, which include: trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, loss of speech or movement, or bluish lips or face, should seek emergency care immediately.

○ If possible, call ahead to your facility or local emergency service to notify then you are seeking care for someone that may have COVID-19.

● If you have minor symptoms, such as a slight cough or a mild fever, there is generally no need to seek medical care. Instead, wear a medical mask, stay at home, self-isolate, and monitor your symptoms, unless you live in an area with malaria or dengue fever.

○ If you live in an area with malaria or dengue, do not ignore symptoms of fever. Seek medical help.

○ When you go to the health facility, wear a mask if possible and keep at least 1-2 meters (3 - 6 feet) from other people and do not touch surfaces with your hands.

○ If it is a child who is sick, help the child follow this advice.

● Self-isolation is when a person that is experiencing fever, cough, or other mild COVID-19 symptoms not requiring immediate medical attention stays at home and does not go to work, school, or public places to avoid spreading potential COVID-19 with others.

○ If you are self- isolating, follow the guidance provided by your national health authority. General guidelines provided by WHO include:

• Have a large, well-ventilated space with hand-washing and toilet facilities.

• If this is not possible, place beds at least 1 metre apart.

• Keep at least 1-2 meters (3 - 6 feet)* from other people; even from your family members.

• Monitor your symptoms daily,

• Isolate for 14 days, even if you feel healthy.

• Stay positive and energized by keeping in touch with loved ones by phone or online, and by exercising yourself at home.

• CDC guidelines on when it is safe to leave self-isolation are available below.

● You should seek immediate medical care if you have difficulty breathing or pain/pressure in the chest; new confusion or inability to arouse, and bluish lips or face.

○ Call ahead in advance if it is possible.

● No, both asymptomatic people (people who are infected, but never develop symptoms) and pre-symptomatic people (people who are infected, who have not yet developed symptoms but do go on to develop symptoms later) can transmit the virus that causes COVID-19.

○ Many people with COVID-19 do not feel ill and may only have very mild symptoms, especially in the early stages of the disease.

○ It is not yet known how often asymptomatic spread happens. See transmission and spread section below for additional details.

○ The main way COVID-19 is spread is through respiratory droplets released by someone coughing or someone who has other symptoms such as fever or tiredness.

● If you do not have symptoms of COVID-19 but think you may have been exposed, you can voluntarily separate yourself from others to prevent any potential spread.

○ This is known as self-quarantine.

○ During the time you are self-quarantining, monitor yourself for symptoms daily.

• Have a large, well-ventilated with hand-washing and toilet facilities.

• If this is not possible, place beds at least 1 meter apart.

• Keep at least 1-2 meters (3 - 6 feet) from other people even from your family members.

• Self-quarantine for 14 days, even if you feel healthy.

• If you develop difficulty breathing, contact your healthcare provider immediately – call them first if possible.

• Stay positive and energized by keeping in touch with loved ones by phone or online, and by exercising yourself at home.

● If you develop minor symptoms, such as a slight cough or a mild fever, there is generally no need to seek medical care. Stay at home, self-isolate, and monitor your symptoms, unless you live in an area with malaria or dengue fever.

○ If you live in an area with malaria or dengue fever do not ignore symptoms of fever- seek medical help.

• When you go to the health facility wear a mask if possible, keep at least 1-2 meters (3-6 feet) from other people and do not touch surfaces with your hands.

• If it is a child who is sick, help the child follow this advice.

● You were within 3-6 feet (1-2 meters) for a total of 15 minutes or more of someone who has COVID-19.

● You provided care at home to someone who is sick with COVID-19.

● You had direct physical contact with the person (hugged or kissed them).

● You shared eating or drinking utensils.

● They sneezed, coughed, or somehow got respiratory droplets on you.

● More information on contacts and contact tracking is available in this section.

● Thermal scanners are effective in detecting people who have developed a fever (i.e., have a higher than normal body temperature), however they cannot detect people who are infected with COVID-19.

● COVID-19 and influenza (flu) are both contagious respiratory illnesses, but they are caused by different viruses.

○ COVID-19 is caused by infection with a new coronavirus; and flu is caused by infection with influenza viruses.

○ Because some symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them and testing may be needed to confirm a diagnosis.

● Common symptoms of both COVID-19 and flu include:

○ Fever/chills

○ Cough

○ Shortness of breath or difficulty breathing

○ Fatigue (tiredness)

○ Sore throat

○ Runny nose

○ Muscle pain or body aches

○ Headache

○ Unique signs and symptoms of COVID-19, different from flu, may include change in or loss of taste or smell.

● For both COVID-19 and flu, 1 or more days can pass between a person becoming infected and when they start to experience symptoms. However, if a person has COVID-19, it could take them longer to develop symptoms than if they had flu.

○ Typically, a person with the flu develops symptoms anywhere from 1 to 4 days after infection.

○ Typically, a person with COVID-19 develops symptoms 5 days after being infected; ranging from as early as 2 days, to as late as 14 days, after infection.

● For both COVID-19 and flu, it is possible to spread the virus for at least 1 day before experiencing any symptoms. However, a person with COVID-19 may be contagious for a longer period of time than if they had the flu.

○ Most people with the flu are contagious for about 1 day before symptoms appear. They are most contagious during the first 3-4 days of their illness, and remain contagious for about 7 days.

○ While we are still learning about how long someone can spread COVID-19, it is possible for someone to be contagious starting 2 days before experiencing symptoms and remains contagious for at least 10 days after signs or symptoms first appear.

• If someone is asymptomatic, or their symptoms go away, they may remain contagious for at least 10 days after testing positive or COVID-19.

● Both COVID-19 and flu are acquired by contact, respiratory droplets and fomites (objects that could transfer disease if contaminated with infectious particles).

○ Both COVID-19 and flu spread:

• From person to person when they are in close contact (1-2 meters / 3-6 feet) with one another.

• By droplets made when people with the illness cough, sneeze, or talk. These droplets can land in the mouths or noses of others who are nearby, or inhaled into the lungs.

• It may be possible that a person can contract both viruses by physical human contact or by touching a surface that has a virus (flu or COVID-19) on it and then touching their own mouth, nose, or possibly their eyes

○ Both COVID-19 and flu can spread to others by people before they begin showing symptoms, with very mild symptoms, or who are asymptomatic (never show symptoms).

• The spread of flu is driven by pre-symptomatic transmission of the virus or transmission (before symptoms appear) during the first 3-5 days.

• In contrast, pre-symptomatic transmission is not currently thought to be a major driver of COVID-19, although the virus can be shed 24-48 hours before symptoms appear and may remain contagious for at least 10 days after testing positive for COVID-19.

● COVID-19 has been observed to have more superspreading events than flu.

○ This means the virus that causes COVID-19 can quickly and easily spread to a lot of people and result in continuous spreading among people as time progresses.

● The number of secondary infections generated from one person infected with COVID-19– is understood to be between 2 and 2.5, higher than for flu.

○ Estimates for COVID-19 and flu viruses are very context and time-specific, making direct comparisons difficult.

● Both COVID-19 and flu can result in severe illness and complications. Those at higher risk for both diseases include:

○ Older adults, people with certain underlying medical conditions, pregnant people.

○ Infants and children with underlying medical conditions.

○ The risk of complications for healthy children is higher for flu.

○ Young children are at higher risk of severe illness from the flu.

○ School-aged children infected with COVID-19 are at higher risk of Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but severe complication of COVID-19.

● Severe and critical infection for COVID-19 is higher than what is observed for flu infection.

○ For COVID-19, 80% of infections are mild or asymptomatic; 15% are severe infections, requiring oxygen; and 5% are critical infections, requiring ventilation.

● Both COVID-19 and flu can result in complications, including:

○ Pneumonia

○ Respiratory failure

○ Acute respiratory distress syndrome

○ Sepsis

○ Cardiac injury (e.g., heart attacks and stroke)

○ Multiple-organ failure

○ Worsening of chronic medical conditions

○ Inflammations of the heart, brain, or muscle tissue

○ Secondary bacterial infections

● Additional complications for COVID-19 include:

○ Blood clots in the veins and arteries of the lungs, heart, legs, or brain

○ Multisystem Inflammatory Syndrome in Children (MIS-C)

● Prescription influenza antiviral drugs are approved to treat the flu, but there are currently no drugs or other therapeutics approved to prevent or treat COVID-19.

○ It is recommended that anyone hospitalized with flu or at high-risk of flu complications with symptoms be treated with antivirals as soon as possible.

○ People at high-risk of complications or who have been hospitalized for COVID-19 or flu should receive supporting medical care to help relieve symptoms and complications.

● There are multiple, approved flu vaccines produced annually to protect against the three or four flu viruses that scientists anticipate will circulate each year, but there is currently no vaccine to prevent COVID-19.

○ While the flu vaccine is not effective against COVID-19, it is highly recommended to get vaccinated each year to prevent flu infection.

○ Vaccine developers and other researchers are expediting the development of a vaccine to prevent COVID-19.

● Despite the differences between COVID-19 and flu, many of the same public health measures, such as hand hygiene (washing hands with soap and water for 20 seconds or with an alcohol-based hand rub that is 60% ethanol, or 70% isopropanol) and good respiratory hygiene which is coughing into your elbow or into a tissue and immediately disposing of the tissue, are important actions everyone all can take to prevent infection.

○ See prevention measures for COVID-19 here.

● Yes. It is possible to test positive for influenza (as well as other respiratory infections) and COVID-19 at the same time.

● COVID-19 is spread through direct, indirect (through contaminated objects or surfaces), or close contact with infected people via mouth and nose secretions.

○ Nose and mouth secretions include saliva, respiratory secretions, or secretion droplets that are released when a person with COVID-19 coughs out, sneezes, exhales (breathes out), sings, or talks within a range of 1- 2 meters (3 - 6 feet).

○ Persons infected with COVID-19, but without symptoms, can transmit the virus.

● COVID-19 can be spread by aerosol transmission.

○ Some medical procedures produce very small droplets that are able to stay suspended in the air for longer periods of time.

• These very small droplets, called aerosols, can contain the COVID-19 virus and may be inhaled by others if they are not wearing appropriate personal protective equipment.

• It is essential that all health workers performing these medical procedures take specific airborne protection measures, including using appropriate personal protective equipment.

• Visitors should not be permitted in areas where such medical procedures are being performed.

○ There are reported COVID-19 outbreaks in closed settings, like restaurants, nightclubs, places of worship, or places of work where people may be shouting, talking, or singing.

• It is possible that aerosol transmission may occur in these indoor, crowded locations with inadequate ventilation and where infected persons spend long periods of time with others.

• More research is needed to understand transmission in these settings.

● COVID-19 may also spread when a person touches objects or surfaces that the released droplets land on and

then touch their eyes, nose or mouth.

○ This is not thought to be the main way COVID-19 spreads.

● It is possible for COVID-19 to spread from people to pet animals in some situations, mostly after close contact

with people with COVID-19. At this time, the risk of COVID-19 spreading from animals to people is considered to

be low.

○ More information on COVID-19 and animals is available here.

● COVID-19 is spread very easily and sustainably between people.

● No. Both asymptomatic people (people who are infected, but never develop symptoms) and pre-symptomatic people (people who are infected, who have not yet developed symptoms but do go on to develop symptoms later) can transmit the virus that causes COVID-19.

○ Many people with COVID-19 do not feel ill and may only have very mild symptoms, especially in the early stages of the disease.

● This is why it is so important that testing is used to identify those with COVID-19, so that all who are infected, even those without symptoms, can be isolated, and receive necessary care.

● This is also why it is always important to observe everyday preventive actions of:

○ Maintaining a physical distance of 1-2 meters (3-6 feet) from others

○ Wearing a cloth face covering where physical distancing cannot be implemented

○ Covering your mouth when you cough or sneeze with a bent elbow or tissue, disposing of the tissue and immediately washing your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Washing hands regularly throughout the day with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Staying home if you become unwell or if you are asked by a contact tracer or health professional.

● If you do not have symptoms, but think you could have been exposed to COVID-19 you can voluntarily separate yourself from others to prevent any potential spread.

○ This is known as self-quarantine. Recommendations for self-quarantine are provided in this section.

● Yes, both terms refer to people without symptoms of disease. The difference is that:

○ Asymptomatic refers to people who are infected, but never develop symptoms during the period of infection. It is still not clear to what extent asymptomatic transmission occurs and more research is needed in this area.

○ Pre-symptomatic refers to people who are infected, who have not yet developed symptoms but do go on to develop symptoms later.

● This distinction is important for public health strategies to control the spread of the disease.

○ Laboratory data suggests that people might be the most infectious at or around the time they develop symptoms.

○ This is why WHO recommends that people be considered ‘contacts’ if they had contact with a person infected with COVID-19 two days before symptoms began.

● Both asymptomatic and pre-symptomatic people are capable of spreading the virus.

○ Based on what is known right now, the risk of catching COVID-19 from a person with no symptoms is unknown.

○ Some reports have indicated that people with no symptoms can transmit the virus, but it is not yet known how often it happens.

○ It is possible to catch COVID-19 from someone who has very mild symptoms and may not feel ill or recognize they are ill.

○ Many people with COVID-19 do not feel ill and may only have very mild symptoms, especially in the early stages of the disease.

○ The main way COVID-19 is spread is through respiratory droplets released when someone with COVID-19 coughs, talks, or exhales, or sings.

● Based on what we currently know, transmission of COVID-19 is mostly happening when a person has symptoms, and just before they develop symptoms, when they are in close contact to others for prolonged periods of time.

○ While it is possible for someone who never develops symptoms to also pass the virus to others, it is still not known how commonly this happens.

● This is why it is important for everyone to practice prevention actions to break the spread of the disease:

○ Maintain a physical distance of 1 -2 metres (3-6 feet) from others

○ Wear a cloth face covering where physical distancing cannot be implemented

○ Cover your mouth when you cough or sneeze with a bent elbow or tissue, dispose of the tissue and immediately wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Wash your hands regularly throughout the day with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

○ Stay home if you become unwell or if you are asked by a contact tracer or health professional.

● There is no evidence that COVID-19 is transmitted through semen or vaginal fluids.

● However, having sex with someone means that you are very close to them. This puts one person at risk if the other person has COVID-19.

○ Masturbation does not involve another person, and carries no risk of COVID-19.

○ Having sex with a partner whom you are living with does not carry this risk if both of you are taking steps to protect yourself from COVID-19.

○ Make sure to use condoms and contraception to avoid sexually transmitted infections and unintended pregnancy.

● Yes, research indicates that children and adolescents are just as likely to become infected with COVID-19 as any other age group and can spread COVID-19.

● Evidence so far suggests that children and young adults are less likely to get severe disease, but severe cases can still occur in these age groups.

● Children and adults should follow the same guidance on self-quarantine and self- isolation if there is a risk that they have been exposed or are showing symptoms.

○ It is particularly important that children avoid contact with older people and others who are at risk of more severe disease.

● There are reports of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19.

○ Children with MIS-C can have problems with their heart and other organs and should receive medical attention.

● Children with MIS-C have symptoms like persistent fever with a variety of signs and symptoms including multi-organ involvement and elevated inflammatory markers.

○ Common symptoms include but are not limited to, irritability or decreased activity, abdominal pain without another explanation, diarrhea, vomiting, rash, conjunctivitis (pink or red eyes), poor feeding, red, cracked lips or a red bumpy tongue, and swollen hands and feet.

○ Not all children have the same symptoms, and symptoms may appear weeks after a child is infected with COVID-19. It is possible that children and caretakers did not know that the child was infected with COVID 19.

○ For children with high fever and symptoms, care takers should call their doctor. If the child is seriously ill, seek emergency care immediately.

○ MIS-C is not contagious, but it is possible that the child has COVID-19 or another infection that may be contagious.

● Please see this section in Part 4 of this document for additional information on MIS-C.

● Studies have shown that COVID-19 virus can survive for up to 72 hours (3 days) on plastic and stainless steel, less than 4 hours on copper, and less than 24 hours on cardboard.

● Surfaces can be easily cleaned with common household disinfectants (See guidance below).

● To avoid spreading COVID-19 you may come into contact with on surfaces:

○ Clean AND disinfect frequently touched surfaces daily (tables, doorknobs, light switches, counter-tops, handles, desks, phones, keyboards, toilets, faucets, and sinks).

○ Wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.*

• Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Wash hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Avoid touching your eyes, mouth, or nose.

● Cleaning with soap and water physically removes germs, dirt, and impurities from surfaces by using soap (or detergent) and water.

○ This process does not necessarily kill germs, but lowers their numbers and lowers the risk of spreading infection.

● Disinfecting kills germs on surfaces or objects by using chemicals.

○ It does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.

○ It is recommended to clean surfaces and objects using soap and water prior to disinfection.

○ Refer to guidance here on what disinfectants should be used.

● Daily cleaning and disinfection of frequently touched household surfaces such as doorknobs, light switches, toilets, and faucets is recommended.

● Cover your hands, if possible, with disposable gloves when cleaning and disinfecting and consider opening a window to increase ventilation.

○ This is particularly important if you are preparing chlorine (bleach) solutions at home. Chlorine solutions can cause irritations to skin and eyes.

○ Cleaning materials (cloth, gloves) can become contaminated and should be laundered or disposed of safely (as described below).

○ Read this section for comprehensive guidance on precautions using disinfectants.

● When cleaning general surfaces, first use regular household soap or detergent and water to remove germs and dirt, then disinfect to kill viruses such as COVID-19 on surfaces.

● Before disinfecting, read the instructions on the bottle or packaging of the product to make sure you take all safety precautions when applying the product and that you understand how to use the disinfectant correctly.

○ Some chlorine bleach (sodium hypochlorite) based household cleaners such as those suitable for use on colored clothing or for whitening, may not actually be effective for disinfection.

○ Unexpired household bleach will be effective against coronaviruses when properly diluted (see below).

● Household bleach should never be mixed with ammonia or any other cleanser.

○ Additional precautions and guidance on use of disinfectants is provided in this section.

● In non healthcare settings, an effective household disinfectant should contain sodium hypochlorite (bleach) at 0.1% (equivalent to 1000 ppm). To make this at home:

○ Mix 5 tablespoon (⅓ of an 8 ounce cup or 25 ml) of household bleach (like clorox) per gallon (128 fluid ounces/3785 ml) of water

OR

○ 4 teaspoons (20 ml) of bleach per quart (32 ounces or 946 ml) of water

○ If you are using a 20 liter jerry can, add 0.4 L (or 400 ml) household bleach to an empty jerry can. Fill the rest of the jerry can with water.

○ Alternatively, alcohol with 70%-90% concentration may be used for surface disinfection.

● The recommendation of 0.1% (1000 ppm) in the context of COVID-19 is a conservative concentration that will inactivate the vast majority of other pathogens that may be present in a health-care setting. However, for blood and body fluid large spills a concentration of 0.5% (equivalent to 5000 ppm or 1-part household bleach with 5% sodium hypochlorite to 9 parts water) is recommended for disinfecting surfaces in homes or healthcare facilities.

○ Instructions for home preparation of chlorine solutions at multiple levels of concentrations can be found here and here.

○ Additional information on environmental cleaning is detailed in Best Practices for Environmental Cleaning in Resource Limited Settings collaboratively developed by the Centers for Disease Control and Prevention (CDC) and the Infection Control Africa Network (ICAN).

● For surfaces such as carpet, rugs, or drapes:

○ Clean with soap and water or with cleaners appropriate for use on these surfaces.

○ Launder items, if possible, according to the manufacturer's instructions using the warmest appropriate water and drying the items completely. OR

○ Disinfect as directed above.

● For electronic surfaces such as tablets, touchscreens, keyboards, and remote controls:

○ Consider putting a wipeable cover on electronics if possible.

○ Follow the manufacturer’s instructions for cleaning and disinfecting. If no guidance is provided, use alcohol-based wipes or sprays containing at least 70% alcohol and dry the surface completely.

● For clothing, towels, linens, and other items:

○ If no one in the household is a suspected or confirmed COVID-19 patient, it is not necessary to use a washing machine or drier, or very hot water. Launder according to the manufacturer’s instructions using the warmest appropriate water and drying completely.

○ If someone has suspected or confirmed COVID-19, their clothes, towels and bed linens, should be washed separately from other people’s items.

• If possible, wear heavy duty gloves before handling the items.

• Do not shake dirty laundry.

• Never carry soiled linen against your body; place it in a clearly labeled, leak-proof container like a bag or bucket.

• Scrape off any solid excrement (feces or vomit) with a flat, firm object and dispose of it in the patient’s toilet before putting the linen in the container. If the patient's toilet is not in their room, you can scrape the excrement into a covered bucket.

• Machine wash at 60-90 C with laundry detergent or alternatively soak linen in hot water and soap in a large drum, using a stick to stir, avoiding splashing.

• If hot water is not available, soak linen in 0.05% chlorine for approximately 30 minutes. Rinse with clean water and dry in the sunlight.

● Instructions for home preparation of chlorine solutions at multiple concentrations can be found here and here.

• Remove gloves and immediately dispose of them and wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol right away.

○ Clean and disinfect any baskets, containers, or clothes hampers that held dirty clothes as directed above.

○ If you need to use laundry facilities outside of your home, take sensible precautions:

• Prepare laundry before leaving your home to help minimize the amount of time you spend outside.

• Try to go at a time when there are fewer people.

• Maintain physical distance to other people.

• Wear disposable gloves if available, disinfect the surfaces of all machines you use and don’t touch your face.

• For indoor laundry facilities, wait outside for your laundry to finish if you can.

• Fold your laundry at home.

• Wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol immediately afterwards.

• Wash or disinfect your laundry bag/hamper as well. Consider storing laundry in disposable bags.

● If you are cleaning and someone is ill in the home:

○ Only clean the area around the person who is ill when needed, such as when the area is soiled.

• You can provide tissues, paper towels, soap, water, and other cleaning and disinfectant supplies to the person who is ill if they feel well enough to clean their own space.

○ Ask the person who is ill to clean and disinfect the bathroom after each use if this is possible. If it is not possible, wait as long as possible before cleaning and disinfecting.

○ Wash dishes, forks, spoons, or other items using gloves and hot, soapy water or in a dishwasher.

• Wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol after taking off gloves or handling used items.

○ If possible dedicate a trash bin lined with a removable, plastic bag for the person who is ill to use.

• Use gloves when removing the garbage bag and disposing of the trash and wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol after disposing of it.

○ Additional information about caring for a loved one at home can be found below.

● If you are cleaning and disinfecting reusable medical equipment use ethyl alcohol 70%

● If you are cleaning surfaces soiled by body fluids, first clean with soap and water and then disinfect with sodium hypochlorite (bleach) at 0.5% (equivalent to 5000 ppm or 1-part household bleach with 5% sodium hypochlorite to 9 parts water) for disinfecting surfaces.

○ Instructions for home preparation of chlorine solutions at multiple concentrations can be found here and here.

● If you are cleaning in a setting where floors, walls and surfaces often consist of unfinished or natural materials such as wood, mud or plastic and availability of cleaning and disinfection supplies is likely to be limited recommendations include the following:

○ Where possible look at options for increasing the amount of water and soap available to households so that more regular wet cleaning is possible.

○ Practice handwashing with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol. In these settings it may be impossible to entirely prevent hands getting contaminated by surfaces but handwashing with soap can still interrupt transmission and prevent people becoming infected.

○ Help young children to wash their hands with soap frequently. This is important because young children are likely to come into contact with surfaces that are hard to clean (e.g. dirt floors) and then put their hands into their mouth.

○ Sweeping is a widespread cleaning practice, particularly in places where houses have dirt floors. The risk of COVID-19 transmission through aerosols generated by sweeping has not been directly evaluated. As a caution, however, wet cleaning practices should be encouraged whenever possible^.

○ Additional information on environmental cleaning is detailed in Best Practices for Environmental Cleaning in Resource Limited Settings collaboratively developed by CDC and the Infection Control Africa Network (ICAN).

● The risk of transmitting or spreading COVID-19 during vacuuming is unknown. At this time, there are no reported cases of COVID-19 associated with vacuuming.

● After cleaning and disinfection, the following recommendations may help reduce the risk to workers and other individuals when vacuuming:

○ Consider removing smaller rugs or carpets from the area completely, so there is less that needs to be vacuumed.

○ Use a vacuum equipped with a high-efficiency particulate air (HEPA) filter, if available.

○ Do not vacuum a room or space that has people in it. Wait until the room or space is empty to vacuum, such as at night, for common spaces, or during the day for private rooms.

○ Consider temporarily turning off room fans and the central HVAC system that services the room or space, so that particles that escape from vacuuming will not circulate throughout the facility.

● If vacuuming is necessary or required in a school, business, or community facility that was used by a person with suspected or confirmed COVID-19, first follow CDC recommendations for Cleaning and Disinfection for Community Facilities that apply, which includes a wait time of 24 hours, or as long as practical.

● No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body.

○ Such substances can be harmful to clothes or mucous membranes (for example, eyes and mouth).

● Spraying individuals with disinfectants (such as in a tunnel, cabinet, or chamber) is not recommended under any circumstances.

○ This practice is potentially physically and psychologically harmful, and would not reduce an infected person's ability to spread the virus as soon as they started speaking, coughing, or sneezing.

○ Spraying with toxic chemicals like chlorine can lead to eye and skin irritation.

○ Large scale spraying may prevent resources from other important interventions like drinking water treatment and environmental disinfection of health care facilities.

● Follow appropriate preventive measures (see Prevention Section) to protect yourself against COVID-19.

● Public water pump handles can be contaminated by users' hands.

○ The following measures are recommended to keep handles clean:

• • 1. 1. • • • • Installation of a handwashing facility next to the pump so that users wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before using the water pump.

                • Cleaning and disinfection of the water pump handles as frequently as possible following the procedure explained above for high-touch surfaces in households - i.e. application of 0.1% chlorine or 70% ethanol for 1 minute, ensuring full coverage of the pump handle surface with disinfectant.

                • Operators should wear gloves if possible.

● You can safely use community watering points by doing the following:

○ Practice physical distancing by getting water when fewer people are around. Avoid gathering in groups.

• Place visual cues such as taped or painted lines, rocks, stakes, or signs at the watering point to show were people should stand when waiting for water.

○ Remain in your vehicle if you do not need to get out to access the water.

○ Cover your mouth and nose with a cloth face cover if you need to get out of your vehicle, or are traveling on foot or bike.

○ Stay at least 1-2 meters (3-6 feet), about 2 arm’s length, from other people.

○ Use disinfectant wipes or spray to clean commonly touched areas such as the handle, spigot, hose, and/or card reader entry points.

○ Wash your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before and after using the water pump.

● In outdoor spaces, large-scale spraying or fumigation in areas such as streets or open market places for the COVID-19 virus or other pathogens is not recommended.

○ Streets and sidewalks are not considered as routes of infection for COVID-19. Spraying disinfectants, even outdoors, can be noxious for people’s health and cause eye, respiratory or skin irritation or damage.

○ This practice will be ineffective since the presence of dirt or rubbish, for example, inactivates the disinfectant, and manual cleaning to physically remove all matter is not feasible. This is even less effective on porous surfaces such as sidewalks and unpaved walkways.

○ Even in the absence of dirt or rubbish, it is unlikely that chemical spraying would adequately cover surfaces allowing the required contact time to inactivate pathogens.

● Wash your fruits and vegetables the same way you normally do.

○ Before handling fruits and vegetables, wash hands with soap and water for 20 seconds or with an alcohol based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

• Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Wash hands with soap and water when they are visibly soiled.

• When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ Then, wash fruits and vegetables thoroughly with clean water, especially if you eat them raw.

● Yes. Although COVID-19 can survive for a short period of time on some surfaces, it is unlikely for it to be spread from domestic or international mail products or packaging exposed to different conditions and temperatures.

● It may be possible to catch COVID-19 by touching a surface or object that has the virus on it and then touching your mouth, nose, or eyes, but this is not thought to be the main way it spreads.

● Practicing proper hand hygiene (washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol), cleaning and disinfecting frequently touched surfaces or objects are always important and effective ways to prevent the spread of COVID-19.

● While there is evidence that the virus may be present in feces of some COVID-19 patients, the risk of catching COVID-19 from the feces of an infected person is low.

○ Even low risk is a risk and reinforces the need to wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol, especially after using the bathroom and before eating.

• Use an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if hands are not visibly soiled.

• Wash hands with soap and water when they are visibly soiled.

  1. 1. • 1. • • • When washing hands with soap and water, it is preferable to use disposable paper towels to dry hands. If these are not available, use clean cloth towels and replace them frequently.

○ To date, there have not been reports of fecal-oral transmission of COVID-19.

○ Additionally, there is no evidence to date on the survival of the COVID-19 virus in water or sewage.

● Community spread means people have been infected with the virus in an area, including some that are not sure how or where they became infected.

● Community spread or transmission may be determined differently based on local conditions.

● Community transmission is generally split into three categories that help to guide decision-making for community leaders, businesses, and governments. These categories include:

○ Substantial community transmission: Large-scale community transmission, including in communal settings, like schools and workplaces.

○ Minimal-moderate community transmission: Sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases.

○ No-to minimal community transmission: Evidence of isolated cases or limited community transmission; case investigations underway; no evidence of exposure in a large communal setting.

● There are now known instances of animals and pets of COVID-19 patients being infected, however further evidence is needed to understand if animals and pets can spread the disease.

○ Several dogs and cats (domestic cats and a tiger) in contact with infected humans have tested positive for COVID-19. In addition, ferrets appear susceptible to the infection.

○ In experimental conditions, both cats and ferrets were able to transmit infection to other animals of the same species, but there is no evidence that these animals can transmit the disease to humans or play a role in spreading COVID-19.

○ Minks raised in farms have also been detected with the virus. Most likely, they have been infected by farm workers. In a few instances, the minks that were infected by humans have transmitted the virus to other people

● Based on the limited information available to date, the risk of animals spreading COVID-19 to people is considered to be low, however it is recommended that people who are sick with COVID-19 and people who are at risk limit contact with companion animals and other animals.

○ Treat pets as you would other human family members – do not let pets interact with people outside the household.

○ If a person inside the household becomes sick, isolate that person from everyone else, including pets.

● When handling and caring for animals, basic hygiene measures should always be implemented. This includes washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol after handling animals, their food, or supplies, as well as avoiding kissing, licking or sharing food.

● As the intergovernmental body responsible for improving animal health worldwide, World Organization for Animal Health (OIE) is developing technical guidance on specialised topics related to animal health, dedicated to veterinary services and technical experts (including on testing and quarantine).

● Universal measures for preventing transmission of COVID-19 that apply to all workplaces and all people at the workplace, such as employers, managers, workers, contractors, customers and visitors, include the following:

● Promote and practice regular and thorough hand washing with soap and water or with hand rub (sanitizer) that contains 60% ethanol or 70% isopropanol alcohol:

○ Do so before starting work, before eating, frequently during the work shift, especially after contact with co-workers or customers, after going to the bathroom, after contact with secretions, excretions and body fluids, after contact with potentially contaminated objects (gloves, clothing, masks, used tissues, waste), and immediately after removing gloves and other protective equipment but before touching eyes, nose, or mouth.

○ Hand hygiene stations, such as hand washing and hand rub dispensers, should be put in prominent places around the workplace and be made accessible to all staff, contractors, clients or customers, and visitors along with communication materials to promote hand hygiene.

• Make sure these dispensers are regularly refilled with hand rub (sanitizer) that contains 60% ethanol or 70% isopropanol.

○ Display posters promoting hand washing. Ask your local public health authority for these or look here.

● Promote respiratory etiquette by all people at the workplace. This includes:

○ Covering your mouth and nose with your bent elbow or tissue when you cough or sneeze; disposing of the used tissue immediately and washing your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

○ Ensuring that medical face masks and paper tissues are available at the workplace, for those who develop a runny nose or cough at work, along with bins with lids for hygienic disposal.

○ Developing a policy on wearing a mask or a face covering in line with national or local guidance.

○ If a member of staff or a worker feels unwell while at work, provide a medical mask so that they may get home safely.

• Where masks are used, whether in line with government policy or by personal choice, it is very important to ensure safe and proper use, care and disposal.

• Remind employees and customers that wearing cloth face coverings in public settings where other physical distancing measures are difficult to maintain, especially in areas of significant community-based transmission is recommended. Wearing a cloth face covering, however, does not replace the need to practice physical distancing.

● Introduce measures to keep a distance of at least 1-2 meters (3-6 feet) between people and avoid direct physical contact with other persons (i.e. hugging, touching, shaking hands), strict control over external access, queue management (marking on the floor, barriers)

○ Reduce density of people in the building and implement physical spacing at least 1-2 meters (3-6 feet) apart for work stations and common spaces, such as entrances/exits, lifts, pantries/canteens, stairs, where crowding or line formation of employees or visitors/clients might occur.

○ Minimize the need for physical meetings by using teleconferencing facilities.

○ Avoid crowding by staggering working hours to reduce congregation of employees at common spaces such as entrances or exits.

○ Implement or enhance shift or split-team arrangements, or teleworking.

● Defer or suspend workplace events that involve close and prolonged contact among participants, including social gatherings.

● Reduce and manage work-related travels (see this section for more information).

● Ensure regular environmental cleaning and disinfection (see this section for detailed guidance).

○ High-touch surfaces should be identified for priority disinfection (commonly used areas, door and window handles, light switches, kitchen and food preparation areas, bathroom surfaces, toilets and taps, touchscreen personal devices, personal computer keyboards, and work surfaces).

○ Disinfectant solutions must always be prepared and used according to the manufacturer’s instructions, including instructions to protect the safety and health of disinfection workers, use of personal protective equipment, and avoiding mixing different chemical disinfectants.

○ Routine application of disinfectants to environmental surfaces via spraying or fogging is generally not recommended for indoor workplaces because it is ineffective at removing contaminants outside of direct spray zones and can cause eye, respiratory, and skin irritation and other toxic effects.

○ In outdoor workplaces, there is currently insufficient evidence to support recommendations for large-scale spraying or fumigation.

○ Spraying of people with disinfectants (such as in a tunnel, cabinet, or chamber) is not recommended under any circumstances.

● Consider improving the engineering controls using the building ventilation system. This may include some or all of the following activities:

○ Increase ventilation rates.

○ Increase the percentage of outdoor air that circulates into the system.

● Provide posters, videos, and electronic message boards to increase awareness of COVID-19 among workers and promote safe individual practices at the workplace, engage workers in providing feedback on the preventive measures and their effectiveness.

○ Provide regular information about the risk of COVID-19 using official sources, such as government agencies and WHO, and emphasize the effectiveness of adopting protective measures and counteracting rumours and misinformation.

○ Special attention should be given to reaching out to and engaging vulnerable and marginalized groups of workers, such as those in the informal economy and migrant workers, domestic workers, subcontracted and self-employed workers, and those working under digital labour platforms.

● Ensure there is a plan in place to manage those with COVID-19 or their contacts.

○ Workers who are unwell or who develop symptoms consistent with COVID-19 should be urged to stay at home, self- isolate, and contact a medical professional or the local COVID-19 information line for advice on testing and referral.

• They should also stay home (or work from home) if they have had to take simple medications, such as paracetamol/acetaminophen, ibuprofen or aspirin, which may mask symptoms of infection.

• Make clear to employees that they will be able to count this time off as sick leave.

○ Standard operating procedures should be prepared to manage a person who becomes sick at the workplace and is suspected of having COVID-19.

• It is important to contact the local health authorities and to keep attendance and meeting records in order to facilitate or undertake contact-tracing.

○ If implementing in-person checks, conduct them safely and respectfully. Employers may use physical distancing, barrier or partitions, or personal protective equipment (PPE) to protect the screener.

• Reliance on PPE alone is a less effective control and is more difficult to implement, given PPE shortages and training requirements.

○ Complete the health checks in a way that helps maintain physical distancing guidelines, such as providing multiple screening entries into the building.

○ To prevent stigma and discrimination in the workplace, make employee health screenings as private as possible. Do not make determinations of risk based on race or country of origin and be sure to maintain confidentiality of each individual’s medical status and history.

● In addition to the above measures, additional considerations for medium and high risk workplaces can be accessed here.

○ As an employer, plan to respond in a flexible way to varying levels of disease transmission in the community and be prepared to refine their business response plan as needed.

○ Additional information relevant to Workplace, Business, Private Sectors and Workers Safety is provided in this section.

● No. To date there is no evidence to suggest that COVID-19 is transmitted by mosquitoes or ticks.

○ COVID-19 is a respiratory virus which spreads primarily through droplets generated when an infected person coughs, sneezes, sings or speaks.

● No. There is no evidence to suggest that COVID-19 is transmitted through houseflies.

○ The virus that causes COVID-19 spreads primarily through droplets generated when an infected person coughs, sneezes, sings, or speaks

● From the evidence so far, the COVID-19 virus can be transmitted in all geographic areas and climates, including those with hot and humid weather as well as those with cold weather.

○ Regardless of what climate you live in, you should adopt preventive measures (see Prevention Section below).

● Some viruses, like those that cause the common cold and flu, spread more during cold weather months but it is possible to become sick with them in other months.

○ Generally coronaviruses survive for shorter periods at higher temperatures and higher humidity than in cooler or dryer environments

○ However, we don’t have direct data for COVID-19, nor do we have direct data for a temperature-based cut-off for inactivation at this point.

● Exposing yourself to sun, high temperatures, cold temperatures, or snow will not protect you against COVID-19.

○ The normal human body temperature remains around 36.5°C to 37°C, regardless of the external temperature or weather.

● No. Viruses including COVID-19 cannot travel on radio waves or mobile networks.

● COVID-19 is present in many countries that do not have 5G mobile networks.

● COVID-19 is primarily spread through respiratory droplets when a person infected with COVID-19 coughs, sneezes, sings, or speaks.

● We are still learning about the immune response to COVID-19. The duration of immunity after COVID-19 infection is still unknown.

● After recovery, before your immune system returns to normal, you can be infected by not just COVID-19, but by regular colds and flu.

● This WHO scientific brief emphasizes that there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

● Refer to guidelines and interpretations of test results for COVID-19.

● Currently, there is no evidence that indicates that COVID-19 is spread through food.

○ Coronaviruses cannot multiply in food. They need an animal or human host to multiply.

● It may be possible that a person can get COVID-19 by touching a surface or object, like a packaging container, that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

● In general, because of poor survivability of coronaviruses on surfaces, it is very unlikely COVID-19 can can spread from food products or packaging.

● People are thought to be most contagious when they are symptomatic (the sickest). Patients who have recovered from their symptoms are thought unlikely to be infectious and thus unlikely to spread the COVID-19 to others.

● Additional information on WHO and CDC recommendations and criteria for safely ending isolation is provided in this section of the document.

● No. The likelihood of COVID-19 being spread on shoes and infecting individuals is very low.

○ As a precautionary measure, particularly in homes where infants and small children crawl or play on floors, consider leaving your shoes at the entrance of your home. This will help prevent contact with dirt or any waste that could be carried on the soles of shoes.

● Quarantine in the context of COVID-19 means separating a person or group of people who have been exposed to COVID-19 but who have not developed symptoms from others who have not been exposed, in order to prevent the possible spread of the disease.

○ For COVID-19, the period of quarantine is 14 days from the last date of exposure because the incubation period for this virus is 1 to 14 days.

● Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period.

● No. Blood centers do not routinely screen blood products for COVID-19.

○ Although RNA fragments of the virus causing COVID-19 were detected in the blood of symptomatic COVID-19 patients, this does not mean that the virus is viable/infectious.

○ In general, respiratory viruses are not known to be transmitted by blood transfusion.

● It is considered safe to donate blood as long as you thoroughly adhere to guidance of practicing physical distancing 1 - 2 meters (3 - 6 feet) between you and other people), and washing hands (with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol), and the center adheres to safety guidelines.

● CDC encourages people who are well to continue to donate blood if they are able.

● Two kinds of tests are available for COVID-19: viral tests and antibody tests.

○ A viral test tells you if you have a current infection.

○ An antibody test tells you if you had a previous infection.

• Antibody testing should not be used to diagnose acute infection. It is recommended to use a viral (nucleic acid or antigen) test to diagnose acute infection.

• An antibody test may not be able to show if you have a current infection because it can take 1-3 weeks after infection to make antibodies.

• No evidence exists yet to know if having antibodies to the virus can protect someone from getting infected again, or how long that protection might last.

● WHO recommends everyone who is suspected to have COVID-19 should be tested for COVID-19 using a viral test.

○ While the response activities (home care, hospitalization, isolation, etc.) are mostly the same for probable and confirmed cases, testing people who may have COVID-19 is still useful because it can exclude people as cases, reducing the burden of contact tracing and isolation recommendations.

○ If testing capacity is low and community transmission is high, WHO provides recommendations to prioritize testing for the following groups:

• • People at risk of developing severe disease and vulnerable populations who will require hospitalization and advanced care.,

  • Health workers, regardless of whether they are a contact of a someone with COVID-19 or presumptive for COVID-19 (to protect health workers and reduce the risk of spread).,

  • The first symptomatic individuals in an indoor setting (schools, long-term facilities, prisons, hospitals) to quickly identify outbreaks.

    • • • All other individuals with symptoms related to the indoor settings may be considered as someone with suspected or probable COVID-19 and should be isolated without additional testing if testing capacity is limited.

● Although supplies of tests are increasing, it may still be difficult to find a testing location.

● See testing guidance for health care professionals here.

● If you test positive for COVID-19 by a viral test, it means you are infected with COVID-19 and can spread it to others.

○ If you test positive for COVID-19 by a viral test, know what protective steps to take if you are sick or caring for someone with COVID-19.

● If you test negative for COVID-19 by a viral test, it means that you did not have COVID-19 at the time of testing. It does not mean you will not get sick but that you probably were not infected at the time your sample was collected.

● If you test positive or negative for COVID-19, regardless of the type of test you received, you should take preventive measures to protect yourself and others.

● Yes, it is possible to test negative on a test and positive on a later test for COVID-19.

○ You may test negative if the sample was collected early in your infection and then test positive later during your illness.

○ You could also be exposed to COVID-19 after the test, and then get infected at a later time.

● Antibody tests check your blood by looking for antibodies, which can show if you had a past COVID-19 infection.

○ Antibodies are proteins that help fight off infection and usually provider protection against getting that disease again (immunity).

○ Antibodies are disease specific.

● We do not know yet if having antibodies to COVID-19 can protect someone from getting infected again or, if they do, how long this protection might last.

● If you test positive, you have antibodies that likely resulted from an infection with COVID-19, or possibly a related coronavirus.

○ If you have no symptoms, you likely do not have an active infection and no additional follow-up is needed.

○ If you have symptoms, you need to get a viral test, as antibody tests cannot tell you if you are currently sick with COVID-19.

○ It’s possible you might test positive for antibodies without having ever experienced symptoms. This is known as an asymptomatic infection.

● If you test negative, you probably did not have a previous infection that has gotten better. However, you could have a current infection.

○ You could still get sick if you have been exposed to the virus recently, since antibodies don’t show up for 1-3 weeks after infection. This means you could still spread the virus.

○ Some people may take even longer to develop antibodies, and some people may not develop antibodies.

● Talk with your healthcare provider about your test result and the type of test you took to understand what your result means. Your provider may suggest you take a second type of antibody test to see if the first test was accurate.

● If you test positive or negative for COVID-19, regardless of the type of test you received, you should take preventive measures to protect yourself and others.

● There is no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

○ People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice and increase risk of transmission.

○ The use of the detection of antibodies to COVID-19 to serve as an "immunity passport" or "risk free certificate" is not recommended as it may increase the risk of continued transmission.

● No. At this time, routine testing of animals for COVID-19 is not recommended.

● Animals are only being tested in very rare circumstances, and testing for animals is only recommended for animals with COVID-19 symptoms that have been exposed to a person with COVID-19.

○ It appears COVID-19 can spread from people to animals in some situations.

○ Pets sick with COVID-19 may have:

• • • • • • • • • Fever

                • Coughing

                • Difficulty breathing or shortness of breath

                • Lethargy (unusual laziness or sluggish)

                • Sneezing

                • Runny nose

                • Eye discharge

                • Vomiting

                • Diarrhea

○ Follow all care instructions from your veterinarian if your pet has symptoms. If your pet develops new symptoms or seems to be getting worse, including trouble breathing, you should call your vet right away.

● You should restrict contact with pets and other animals while you are sick with COVID-19, just like you would with people.

● If your pet does receive a viral test for COVID-19 and is confirmed positive, there is no reason to abandon or surrender the pet.

○ Based on the limited information now, the risk of pets spreading COVID-19 to people is considered to be low.

● See guidance and information here on pets and COVID-19.

● Refer to the CDC guidance on how to take care of a sick pet and when to end home isolation for the pet.

● Additional information for vets is provided in Part 5 of this document.

● Most people (80%) experience mild cases of COVID-19, and recover without hospitalization.

○ About 1 in 5 people with COVID-19 become seriously ill and experience difficulty breathing.

○ Serious illness caused by COVID-19 can lead to death.

○ Older adults, as well as those at any age with pre-existing medical conditions—like cancer, high blood pressure, heart problems or diabetes—are more likely to become seriously ill.

● Typically people recover from COVID-19 after 2-6 weeks, however for some people, COVID-19 can result in prolonged illness, even in young adults and children without underlying chronic medical conditions.

● Some people with COVID-19 develop medical complications that may have lasting health effects.

○ Body systems and organs that can be infected include:

• Heart

• Lungs

• Brain and nervous system (loss of sense of smell, memory or concentration loss, or effects of heart attack or stroke)

• Mental health

• Musculoskeletal and others (joint and muscle pain and fatigue)

● Much is still unknown about how COVID-19 affects people over time and more research is needed. Everyone is encouraged to practice prevention behaviors.

● Since COVID-19 is a new disease, we are still learning about how it affects people.

● Based on what is known from the outbreak in multiple countries around the world, including the US, and what is known about other respiratory illness such as the flu, the following people have a higher risk of developing serious illness:

○ People of all ages with underlying medical conditions, particularly if not well controlled, including:

• People with chronic lung disease or moderate to severe asthma

• People who have serious heart conditions

• People with cancer

• People with severe obesity (body mass index [BMI] ≥40)

• People with diabetes

• People with chronic kidney disease undergoing dialysis

• People with liver disease

• People with sickle cell disease

● Generally, well-controlled means that your condition is stable, not life-threatening, and laboratory assessments and other findings are as similar as possible to those without the health condition.

● You should talk with your healthcare provider if you have a question about your health or how your health condition is being managed.

○ People aged 60 years and older with underlying health conditions.

○ People who live in a nursing home or long-term care facility.

○ People who are immunocompromised

• Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.

● Based on what we know at this time pregnant women might be at an increased risk for severe illness from COVID-19 compared to non-pregnant women and there may be an increased risk of adverse pregnancy outcomes, such as preterm birth.

○ Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.

○ Pregnant women or recently pregnant women who are older, overweight, and have pre-existing medical conditions such as hypertension and diabetes seem to have an increased risk of developing severe COVID-19. See this section for more detailed information on pregnancy, child birth and breastfeeding.

● Most people with disabilities are not inherently at higher risk for becoming infected with or having severe illness from COVID-19.

○ Some people with physical limitations or other disabilities might be at a higher risk of infection because of their underlying medical condition.

● If you are at higher risk of getting very sick from COVID-19, you should:

○ Stock up on supplies.

• Create a list of basic supplies you will need for at least 2 weeks. If you cannot get them delivered, ask family members, friends, neighbors or community leaders to help with delivery of groceries or prescription medications.

○ Continue your medications and do not change your treatment plan without talking to your health care provider.

• Have at least a 30-day supply of prescription and nonprescription medicines.

○ Take everyday precautions to maintain a physical distance of 3-6 feet (1 -2 meters) between yourself and others.

○ When you go out in public, keep away from others who are sick.

○ Wear a cloth face mask. If possible, avoid others who are not wearing cloth face coverings or ask others around you to wear cloth face coverings.

○ Limit close contact and wash your hands often with soap and water for 20 seconds or with an alcohol based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol.

○ Avoid crowds, cruise travel, and non-essential travel.

● If there is an outbreak in your community, stay home as much as possible. Watch for symptoms and emergency signs.

● Learn about the services available in your community.

● Make a list of emergency numbers and support contacts (and back-up supports).

○ If you live alone you may wish to share this list and ask your neighbors, family, or other support persons to be in touch regularly. .

● If you get sick, stay home and call your doctor for advice.

○ Do not delay getting emergency care for your underlying medical condition because of COVID-19.

○ Think about what matters most to you about your care if you become unable to make your own decisions. Work with your healthcare provider or someone you trust to develop about an advanced care plan. Write down your wishes and share them with people you trust.

● Most people with COVID-19 experience mild symptoms or moderate illness and recover after 2 to 6 weeks.

○ Approximately 10-15% of cases progress to severe disease, and about 5% become critically ill.

● COVID-19 can sometimes result in prolonged illness with symptoms that linger for weeks or months, even in young adults and children without underlying chronic medical conditions, and in people with mild disease. People are not infectious to others during this time.

○ Among those 18-34 year olds in good health, 20% (1 in 5) reported that some symptoms were prolonged.

○ In a telephone survey of symptomatic adults who had a positive test for COVID-19, 35% had not returned to their usual state of health when interviewed 2-3 weeks after testing.

● Symptoms that may persist include:

○ Fatigue

○ Cough, congestion or shortness of breath

○ Loss of taste or smell

○ Headache, body aches

○ Diarrhea, nausea

○ Chest or abdominal pain

○ Confusion

● Some patients develop medical complications that may have lasting health effects.

○ Body systems and organs that can be infected include:

• • • 1. 1. 1. • 1. • Heart

                    • Lungs

                    • Brain and nervous system (loss of sense of smell, memory or concentration loss, or effects of heart attack or stroke)

                    • Mental health

                    • Musculoskeletal and others (joint and muscle pain and fatigue)

● Much is still unknown about how COVID-19 affects people over time and more research is needed. Everyone is encouraged to practice prevention behaviors.

● Little is known about the clinical course of COVID-19 following milder illness.

● Risk factors for persistent symptoms include: high blood pressure, obesity, and mental health conditions.

● Long-standing systemic health and social inequities have put some members of racial and ethnic minority groups at increased risk of getting COVID-19 or experiencing severe illness, regardless of age.

○ Among some racial and ethnic minority groups, including non-Hispanic black persons, Hispanics and Latinos, and American Indians/Alaska Natives, evidence points to higher rates of hospitalization or death from COVID-19 than among non-Hispanic white persons.

○ As of June 12, 2020, age-adjusted hospitalization rates are highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons, followed by Hispanic or Latino persons.

○ Non-Hispanic American Indian or Alaska Native persons have a rate approximately 5 times that of non-Hispanic white persons.

○ Non-Hispanic black persons have a rate approximately 5 times that of non-Hispanic white persons.

○ Hispanic or Latino persons have a rate approximately 5 times that of non-Hispanic white persons.

○ Resources for monitoring the increased risk that racial and ethnic minorities face include:

• CDC COVID Data Tracker

• COVID-NET: A Weekly Summary of U.S. COVID-19 Hospitalization Data

• COVIDView: A Weekly Surveillance Summary of U.S. COVID-19 Activity

• The COVID Tracking Project’s The COVID Racial Data Tracker

• Emory University’s COVID-19 Health Equity Interactive Dashboard

● Health differences between racial and ethnic groups result from inequities in living, working, health, and social conditions that have persisted across generations. In public health emergencies, such as the COVID-19 pandemic, these conditions can also isolate people from the resources they need to prepare for and respond to outbreaks.

○ History shows that severe illness and death rates tend to be higher for racial and ethnic minority populations during public health emergencies than for other populations.

● Factors influencing racial and ethnic minority health include:

○ Living conditions can contribute to health conditions and make it harder to follow steps to prevent getting sick with COVID-19 or to seek care if they do get sick:

• People living in densely populated areas and crowded homes may have difficulty practicing physical distancing.

• Members of racial and ethnic minorities may be more likely to live in densely populated areas because of institutional racism in the form of residential housing segregation.

● Racial residential segregation is linked to health conditions, such as asthma and other underlying medical conditions, that put people at increased risk of getting severely ill or dying from COVID-19.

● Some communities with higher numbers of racial and ethnic minorities have higher levels of exposure to pollution and other environmental hazards.

● Some communities may lack running water or complete plumbing which may increase the difficulty of practicing prevention behaviors such as frequent hand washing.

● Many racial and ethnic minorities live in neighborhoods that are farther from grocery stores and medical facilities, or may have limited access to safe and reliable transportation making it more difficult to receive care if sick and stock up on supplies that would allow them to stay home.

• Multi-generational households may find it difficult to take precautions to protect older family members or isolate those who are sick, if space in the home is limited.

• Racial and ethnic minority groups are overrepresented in jails, prisons, and detention centers, where people live, work, eat, study, and relax in shared environments and common spaces.

○ Work circumstances: Members of some racial and ethnic minority groups are more likely to work under conditions or under workplace policies that put them at increased risk for COVID -19.

• The risk of infection may be greater for workers in essential industries, such as health care, meat-packing plants, grocery stores, and factories.

● These workers must be at the job site despite outbreaks in their communities, and some may need to continue working in these jobs because of their economic circumstances.

• Workers without paid sick leave might be more likely to continue to work even when they are sick. This may increase the workers’ exposure to coworkers or customers who may have COVID-19, or, in turn, expose others if they themselves have COVID-19.

● On average, racial and ethnic minorities earn less than non-Hispanic whites, have less accumulated wealth, have lower levels of educational attainment, and have higher rates of joblessness.

● These factors can each affect the quality of the social and physical conditions in which people live, learn, work, and play, and can have an impact on health outcomes.

○ Health and healthcare inequities puts racial and ethnic minority groups at increased risk of getting severely ill and dying from COVID-19 due to underlying health conditions and lower access to care:

• • • 1. 1. 1. • • • Some racial and ethnic minority groups are less likely to have health insurance which means they are unable to receive care see a doctor because of the cost of health care.

                   • Long-standing distrust of the health care system, language barriers, and financial implications associated with missing work to receive care may also prevent many people from receiving needed health care.

                   • Lower access to care can lead to serious underlying medical conditions that increase the risk of COVID-19 .

                   • Stigma and systemic inequalities may undermine prevention efforts, increase levels of chronic and toxic stress, and ultimately sustain health and healthcare disparities.

● To prevent the spread of COVID-19, everyone should practice every preventive measure whenever possible like hand washing with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol, wearing a cloth face covering, and practicing physical distancing.

○ If you, or someone you care for is at higher risk of getting very sick from COVID-19, take steps to protect them and you from getting sick.

○ If you think you have been exposed to COVID-19 and develop a fever, cough, or difficulty breathing, seek medical care.

○ Cope with stress to make yourself, the people you care about, and your community stronger.

● Addressing the needs of vulnerable populations in emergencies includes improving day-to-day life and harnessing the strengths of these groups. Shared faith, family, and cultural institutions are common sources of social support.

● Community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, policy makers, and others must work together to ensure that people have resources to maintain and manage their physical and mental health, including easy access to information, affordable testing, and medical and mental health care.

● Yes. Smokers are more likely to develop severe disease with COVID-19, compared to non-smokers.

○ Tobacco smoking is a known risk factor for many respiratory infections and increases the severity of respiratory diseases. COVID-19 is an infectious disease that primarily attacks the lungs. Smoking impairs lung function making it harder for the body to fight off coronaviruses and other respiratory diseases.

○ Tobacco is also a major risk factor for noncommunicable diseases like cardiovascular disease, cancer, respiratory disease and diabetes which put people with these conditions at higher risk for developing severe illness when affected by COVID-19.

● Tobacco smokers (cigarettes, water pipes, bidis, cigars, heated tobacco products) may be more vulnerable to contracting COVID-19, as the act of smoking involves contact of fingers (and possibly contaminated cigarettes) with the lips, which increases the possibility of transmission of viruses from hand to mouth.

● Smoking water pipes, also known as shisha or hookah, often involves the sharing of mouth pieces and hoses, which could facilitate the transmission of COVID-19 in communal and social settings.

● There is currently insufficient information to confirm any link between tobacco or nicotine in the prevention or treatment of COVID-19.

● WHO recommends that smokers take immediate steps to quit by using proven methods such as toll-free quit lines, mobile text-messaging programmes, and nicotine replacement therapies such as gums and patches.

● There is no evidence about the relationship between e-cigarette use and COVID-19.

○ However, existing evidence indicates that electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), more commonly referred to as e-cigarettes, are harmful and increase the risk of heart disease and lung disorders.

○ Given that the COVID-19 virus affects the respiratory tract, the hand-to-mouth action of e-cigarette use may increase the risk of infection.

● Using smokeless tobacco often involves some hand to mouth contact., which may increase the risk of hand-to-mouth transmission.

● Another risk associated with using smokeless tobacco products, is that the virus can be spread when the user spits out the excess saliva produced during the chewing process.

● If you smoke, use e-cigarettes or use smokeless tobacco, now is a good time to quit completely.

● Do not share devices like waterpipes and e-cigarettes.

● Spread the word about the risks of smoking, e-cigarettes and smokeless tobacco.

● Protect others from the harms of second-hand smoke.

● Know the importance of washing your hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol, maintain physical distance of 1 - 2 meters (3 - 6 feet) between you and other people, and not sharing any smoking or e -cigarette products.

● Do not spit in public places.

● People with hypertension (high blood pressure) may have an increased risk of severe illness from COVID-19.

○ Hypertension is more frequent with advancing age and among men, non-Hispanic blacks, and people with other underlying medical conditions such as obesity, diabetes, and serious heart disease that place them at higher risk of severe illness from COVID-19.

○ People with pulmonary hypertension are at an increased risk for severe illness.

● If you have high blood pressure, continue to take your blood pressure medications exactly as prescribed and make lifestyle modifications agreed upon in your treatment plan.

● At this time, it is unknown if the immunosuppression of HIV will put you at greater risk for COVID-19.

○ There is a small study among PLHIV (people living with HIV) with COVID-19 in China. In this study, there were similar rates of COVID-19 among PLHIV and the entire entire population. There was increased risk with older age, but not with HIV-related factors (CD4 counts, viral load levels, or antiretroviral regimens).

○ PLHIV who have advanced disease, low CD4 counts, and high viral loads—and those who are not taking antiretroviral therapy (ART)—have an increased risk of infection in general. This could also apply to COVID-19, but currently the evidence is limited.

● Until we know more, PLHIV who know their HIV status are advised to do the following:

○ Take the same preventive measures as the general population (see Prevention Section).

○ If you are taking antiretroviral therapy, ensure that you have at least 30 days and up to a 6 month supply of your medications.

○ Adequate supplies of medicines to treat co-infections and comorbidities and addiction should also be ensured.

○ Clinically stable PLHIV can benefit from simplified ART delivery models, which often include multi month prescriptions (3-6 month supply). This can reduce the frequency of visits to clinical settings, and ensures that treatment continues during the COVID-19 outbreak.

○ Ensure that your vaccinations are up to date (influenza and pneumococcal vaccines).

○ If you are not yet on ART, talk to your doctor about starting.

○ If you are living with HIV and have not achieved viral suppression through ART, you may have a compromised immune system that could leave you vulnerable to opportunistic infections and further disease progression.

● Please check here for evolving guidance on COVID-19, HIV and antiretrovirals. Additional technical and operational information for those implementing HIV programs with the President's Emergency Plan For AIDS Relief (PEPFAR) funding is available in Part 5 of this document.

● At this time, there is insufficient data to assess the effectiveness of LPV/r or other antivirals for treating COVID-19.

● Several randomized trials are planned to assess the safety and efficacy of using antiretroviral drugs – mainly LPV/r – for treating COVID-19, in combination with other drugs.

● There is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy.

● Although no vertical transmission has been documented, transmission after birth via contact with infectious respiratory secretions is a concern.

● Infants born to mothers with suspected, probable, or confirmed COVID-19 should be fed according to standard infant feeding guidelines, while applying necessary precautions for infection prevention and control.

● As with all people with COVID-19 or presumptive for COVID-19, symptomatic mothers who are breastfeeding or practicing skin-to-skin contact or kangaroo mother care should practice respiratory hygiene (which is coughing into you elbow or into a tissue and immediately disposing of the tissue at all times). They should also wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol before and after contact with the child, and routinely clean and disinfect surfaces with which the symptomatic mother has been in contact.

● CDC and WHO are currently not aware of scientific evidence establishing a link between NSAIDs (e.g. ibuprofen, naproxen) and worsening of COVID-19.

○ CDC, FDA, European Medicines Agency, and the WHO are continuing to monitor the situation and will review new information when it becomes available.

● Patients who rely on NSAIDs to treat chronic conditions and have additional questions should speak to their healthcare provider.

● Patients should use NSAIDs according to product labels and advice of their healthcare professional.

● People with moderate to severe asthma, particularly if not well controlled, might be at higher risk of getting very sick from COVID-19.

● According to the CDC, the selection of therapeutic options through guideline-recommended treatment of asthma is currently not affected by COVID-19.

● Continuation of inhaled corticosteroids is particularly important for patients already using these medications because there is no evidence of increased risk of COVID-19 morbidity with use of inhaled corticosteroids.

● Patients with asthma but without symptoms or a diagnosis of COVID-19 should continue any required nebulizer treatments.

○ Use of the nebulizer in a location that minimizes and avoids exposure to any other members of the household is preferable.

○ If using a nebulizer in a healthcare setting, remember to practice the necessary precautions when performing aerosol-generating procedures.

● Yes. It is anticipated that people ill with both TB and COVID-19 may have poorer treatment outcomes, especially if TB treatment is interrupted.

○ Older age, diabetes and chronic obstructive pulmonary disease (COPD) are linked with more severe COVID-19 and are also risk factors for poor outcomes in TB.

○ People ill with COVID-19 and TB show similar symptoms such as cough, fever and difficulty breathing.

● While both TB and COVID-19 spread by close contact between people, the exact mode of transmission differs, explaining some differences in measures to control the two conditions.

○ TB bacilli remain suspended in the air for several hours after a TB patient coughs, sneezes, shouts, or sings, and people who inhale them can get infected.

○ COVID-19 transmission is thought to be primarily due to the direct breathing of droplets expelled by someone with COVID-19, even if they do not have symptoms.

• • • 1. • 1. 1. • WHO states that COVID-19 respiratory droplets are too heavy to hang in the air and quickly fall on floors and surfaces.

                 • Droplets produced by coughing, sneezing, exhaling and speaking may land on objects and surfaces, and contacts can get infected with COVID-19 by touching them and then touching their eyes, nose or mouth. Handwashing with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol and respiratory precautions (covering mouth and nose with bent elbow or tissue when coughing or sneezing, then disposing of the used tissue immediately) are thus important in the control of COVID-19.

● No. The testing methods for TB and COVID-19 require different specimens.

○ See additional information about available COVID-19 tests here.

● Testing of the same patient for both TB and COVID-19 would generally be indicated for three main reasons, subject to the specific setting in each country:

○ Clinical features that are common to both diseases; or

○ Simultaneous exposure to both diseases; or

○ Presence of a risk factor.

○ As the pandemic advances, more people of all ages, including tuberculosis patients, will be exposed to COVID-19.

● PLHIV who present with fever, cough, shortness of breath or difficulty breathing should be referred for concurrent testing for both TB and COVID-19 based on national guidelines.

● No. In most cases, TB treatment is not different in people with or without COVID-19 infection.

● It is critical that TB services are not disrupted during the COVID-19 response.

○ TB preventive treatment, treatment for drug-susceptible or for drug-resistant TB disease should continue uninterrupted to safeguard your health, reduce transmission, and prevent the development of drug-resistance.

• • • 1. 1. • 1. • The risk of death in TB patients approaches 50% if left untreated and may be higher in the elderly or in the presence of comorbidity.

                 • Effective treatments to prevent TB and to treat active TB have been scaled up and are in use worldwide.

○ If you are in directly observed therapy (DOT), your health care worker might use the phone or video-assisted visits to assist with treatment.

○ No medication is currently recommended for COVID-19 and therefore no cautions on drug-drug interactions are indicated at present. TB patients on treatment should nonetheless be asked if they are taking any medicines, including traditional cures, that may interact with their medication.

● If you become unwell at home, you should first contact the health facility or community health worker by telephone, SMS, or WhatsApp to determine whether it is necessary to come into the facility for COVID-19 symptom screening.

● If an in-person visit is necessary, follow your health care provider’s procedures to protect the health of you and others at the health facility.

● Additional information on tuberculosis is available in this section.

● It is not yet known if children with complex, chronic medical conditions (including physical, developmental, behavioral, or emotional differences) are at higher risk for severe illness from COVID-19.

● Most illnesses for children with COVID-19 are not severe, but some children may experience serious illness that needs to be treated in the hospital.

● The majority of children who needed hospitalization for COVID-19 had at least one underlying condition. The most common underlying conditions reported among children with COVID-19 include:

○ Chronic lung disease (including asthma),

○ Disease, or

○ Conditions that weaken the immune system.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents.

● In addition to existing prevention recommendations, families should take extra steps recommended for children with higher risk of severe COVID-19 illness.

○ Identify potential alternative caregivers, if you or other regular caregivers become sick and are unable to take care of your child.

○ Try to have at least one month of medication and medical supplies on hand.

○ Review any care plans for your child, such as an asthma action plan, and make sure caregivers and backup caregivers are familiar with them.

○ If you do not have care plans or an emergency notebook, try to make them. They typically include:

• • • • • • • • Important information about your child’s medical conditions

              • How to manage those conditions

              • How to get in touch with your child's doctors

              • Allergies

              • Information on medications (names, dosages, instructions)

              • Preferences (food and other), and

              • Special needs, daily routines, and activities, friends and details about routines that are important to support behavioral and emotional health.

○ Learn if your child’s health care providers have new ways to be contacted or new ways of providing appointments. If they offer telemedicine visits, find out how those are arranged and any additional information you need.

○ If your child receives support services in the home that need to be continued, make plans for what you will do if those direct care providers get sick, or if people in your household are sick. Discuss with support care agencies and the providers ways to minimize risk for exposure to the virus that causes COVID-19.

• • • • • • • • • If your child or other persons in your home are sick with COVID-19 and are able to recover at home, inform your direct care providers and consider postponing or rescheduling services until the criteria for discontinuing home isolation have been met.

                • Ask service providers if they are experiencing any COVID-19 symptoms, or if they have been in contact with someone who has COVID-19.

                • Tell the service provider to:

● Wear a cloth face covering if they will be close (less than 6 ft) to you or persons in your household.

● Ask them to wash their hands with soap and water, or if unavailable, use hand sanitizer with at least 60% alcohol when they enter your home, before and after helping your child (dressing, bathing/showering, transferring, toileting and/or diapering, feeding), after handling tissues, and after changing linens or doing laundry.

• Service providers and families should routinely clean and disinfect frequently touched objects and surfaces and equipment such as wheelchairs, scooters, walkers, oxygen tanks and tubing, communication boards, and other assistive devices.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents.

● Helping children understand and follow recommendations, like physical distancing and wearing face cloth coverings, can be challenging if your child has intellectual disabilities, sensory issues, or other special care needs.

○ Keeping children at home and sheltering in place can lower stress created by physical distancing and cloth face covering recommendations. Reach out to others for help in running essential errands.

○ Behavioral techniques can be used to address behavioral challenges and to develop new routines.

• • • • • • • These include social stories, video modeling, picture schedules, and visual cues.

            • Try rewarding your child in small ways with his or her favorite non-food treat or activities to help switch routines and to follow recommendations.

○ Many of the organizations you turn to for information and support around your child’s complex, chronic medical condition may have information on their websites to help families address issues related to COVID 19.

○ Your child’s therapist(s) and/or teachers may also have resources to help successfully introduce new routines to your child.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents

● Supporting children with special healthcare needs can put additional demands and stress on families, especially during emergency situations.

● It is important to continue your family’s coping methods, including reaching out to other family members, friends, support groups, and organizations that have been helpful in the past.

● See additional guidance on stress management here.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents.

● If your child with special healthcare needs becomes sick with symptoms of COVID-19, contact your child’s healthcare provider.

● If your child has new or worsening emergency warning signs, such as trouble breathing, pain or pressure in the chest, confusion or inability to wake them up, or bluish lips or face, call 911 or your emergency medical services.

○ If you think your child may have COVID-19, notify the operator so that first responders may be appropriately prepared to protect themselves and others.

● Notify your child’s healthcare provider if someone else in your house becomes sick with COVID-19, so they can provide any advice specific for your child.

● See additional guidance on caring for someone with COVID-19 at home here.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents.

● Do not delay getting emergency care for your child’s underlying condition or complex medical condition because you are afraid of getting exposed to COVID-19 when visiting the healthcare setting.

○ Call your child’s healthcare provider if you have any concerns about your child’s medical conditions. If you need emergency help, call your country’s emergency services.

○ Emergency departments have infection prevention plans to protect you and your child from getting COVID-19 if your child needs care for medical conditions not related to COVID-19.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents.

● If your child’s healthcare provider tells you to go to the hospital for any health problem, including COVID-19,

○ Ask the healthcare provider to let the hospital know you are coming and to share the important information the hospital will need to know to care for your child.

○ Visiting policies may have changed due to COVID-19.

• If your child’s hospital policy does not allow an adult to stay with a child, ask your child’s healthcare provider for a statement explaining your child’s need for a familiar adult to be present.

○ Bring your care plans/emergency notebook with you along with paper and pen to write down questions you have during your time at the hospital.

● For comprehensive information regarding parenting children of all ages during COVID-19, refer to the Parents/Caregivers Section under School Administrators, Teachers, Parents/Caregivers and Children/Adolescents.