● CDC created the Air Travel Toolkit for Airline Partners to help them reach their travelers and employees with COVID-19 prevention messaging. This toolkit includes:

○ Fact sheets for airline customer service and gate agents; airport baggage and cargo handlers; airport custodial staff; airport passenger assistant workers; and aircraft maintenance workers

○ Public service announcements for travelers returning home; COVID-19 readiness; general prevention messages; and a COVID-19 airport announcement.

○ Electronic messages for airport kiosks.

○ Sample blogs for airlines to communicate with passengers and crew.

○ Social media content.

○ Print resources.

● The International Civil Aviation Organization (ICAO) Council Aviation Recovery Task Force (CART) has developed the CART Take-Off Guidance with detailed information for Airport Guidelines, Aircraft Guidelines, Crew Guidelines and Cargo Guidelines.

● Specific guidance on treatment of sick passengers on board of airplanes is available on the International Civil Aviation Organization website and the International Air Transport Association website.

● CDC’s interim guidance specific for airlines and airline crew in the context of COVID-19 recommends the following:

○ Report travelers with the following symptoms as soon as possible before arrival:

• Fever (person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100.4°F [38° C] or higher) that has persisted for more than 48 hours

OR

• Fever AND one of the following:

● Persistent cough

● Difficulty breathing

● Appears obviously unwell

○ Guidance on how to report to CDC is provided here.

● In the event of a respiratory illness in flight, the following immediate steps may be taken to reduce exposure and limit transmission to other passengers or aircraft crew:

○ Designate one cabin crew member to look after the ill traveler, preferably one who has previously interacted with the passenger.

○ Minimize contact of the cabin crew and passengers with the ill person, ideally ensuring a distance of 1-2 meters (3-6 feet) if possible.

• In all cases, the adjacent seat(s) of the patient should be left unoccupied, if feasible.

• Passengers seated in the close vicinity should have their information on itinerary and contact details recorded for further follow up, as potential contacts. This information may be collected on a voluntary basis for the remaining passengers.

• The patient on the aircraft should adhere to respiratory/cough hygiene either by wearing a medical or surgical mask (if available and tolerated) or covering their mouth and nose with their bent elbow or tissue when and then disposing of the used tissue immediately and washing hands. Proper hand hygiene 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.

● 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

• If the patient cannot tolerate a mask, healthy travelers adjacent to the ill traveler may be offered masks.

○ Treat all body fluids such as snot or saliva, diarrhea, vomit, or blood, as infectious.

• Use appropriate personal protective equipment (PPE) when dealing with symptomatic patients (medical or surgical mask, hand hygiene, gloves, eye protection, and gown to cover clothing as available).

○ Take care to remove gloves and other PPE carefully 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 alcohol after removing PPE.

○ Handle any blankets, trays, or other personal products used by the patient with respiratory symptoms carefully.

○ Handle all waste in accordance with regulatory requirements or guidelines:

• Dispose of all items that came into contact with the sick person and any body fluids in a biohazard bag or in a secured plastic bag labeled as biohazard.

○ In case of presence of spills (vomits, blood spills, secretions or others), practice environmental cleaning and spills-management:

• Clean porous (soft) surfaces (e.g., cloth seats, cloth seat belts) at the seat of the symptomatic passenger(s) and within 6 feet (2 meters) of the symptomatic passenger(s) in all directions.

• Clean porous (soft) surfaces (e.g. seat covers and carpet) by removing visible contamination if present and using appropriate cleaners that are compatible with aircraft surfaces and components in accordance with the manufacturer’s instructions.

● For items that can be laundered, use the warm setting and dry items completely on high heat.

• Clean non-porous (hard) surfaces (e.g., leather or vinyl seats) at the seat of the symptomatic passenger(s) and within 1-2 meters (3-6 feet) of the symptomatic passenger(s) in all directions, including: armrests, plastic and metal parts of the seats and seat backs, tray tables, seat belt latches, light and air controls, cabin crew call button, overhead compartment handles, adjacent walls, bulkheads, windows and window shades, and individual video monitors.

• Clean non-porous (hard) surfaces with disinfectant products with approved emerging viral pathogens claims that are expected to be effective against COVID-19 and ensure these products are compatible with aircraft surfaces and components.

● All products should be used according to label instructions (e.g., concentration, application method and contact time, PPE).

• Clean lavatories used by the symptomatic passenger(s), including: door handle, locking device, toilet seat, faucet, washbasin, adjacent walls, and counter.

• Properly dispose of any items that cannot be cleaned (e.g., pillows, passenger safety placards, and other similar items).

• Ground and cleaning crews should not board the plane until all travelers have disembarked.

● Airlines should train ground and cleaning crews on and require that crew members demonstrate an understanding of when to use PPE, what PPE is necessary, how to properly don (put on), use, and doff (take off) PPE.

• Ventilation systems should be kept running while cleaning crews are working aboard the airplane.

• If visible contamination (e.g., a body substance such as blood or body fluids) is present, routine airline cleaning procedures should be followed based on blood or body substance spill management.

• Airlines should ensure workers are trained on the hazards of the cleaning chemicals used in the workplace.

• Cleaning crew should wear recommended PPE for cleaning:

● Disposable gloves that are recommended by the manufacturer of the disinfectant should be worn.

● Disposable gowns should be worn while cleaning the cabin and lavatories.

● If splashing is possible, eye protection, such as a face shield or goggles and face mask may be required according to the manufacturer’s label.

● Cleaning staff should immediately report breaches in PPE (e.g., tear in gloves) or any potential exposures (e.g., contact with blood or body fluids without wearing appropriate PPE) to their supervisor.

● Cleaning staff should dispose of PPE and other disposable items used in cleaning following the airline’s routine procedures.

● Ground crews assigned to wastewater management operations should follow routine procedures.

○ Notify the health authority at the point of arrival. The health part of the aircraft general declaration (Annex 9 of IHR) can be used to register the health information onboard and submit to point of entry health authorities, when requested by the country.

○ Ensure the flight crew maintains continuous operation of the aircraft’s air recirculation system (HEPA filters are fitted to most large aircraft and will remove some airborne pathogens, depending on the size of the particulate or microorganism).

● As an airport passenger service worker, potential sources of exposure can occur from assisting, transporting, or escorting a person with COVID-19 and their belongings or by touching your mouth, nose, or eyes.

● To protect yourself:

○ Limit the amount of time you are in close contact with others including passengers.

○ Provide a face mask to any visibly sick person you assist.

• If the patient cannot tolerate a mask, healthy travelers adjacent to the ill traveler may be offered masks

○ Practice routine cleaning and disinfection of frequently touched surfaces.

○ Apply proper hand hygiene practices following the guidance and at key times such as before and after work shifts, preparing food, providing assistance to passengers, using the toilet and so on. Proper hand hygiene includes:

• 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.

● To protect staff:

○ Develop a COVID-19 health and safety plan and share it with coworkers.

○ Take steps to help prevent the spread of COVID-19 if an employee is sick.

○ Provide information on who to contact if employees become sick.

○ Implement flexible sick leave and supportive policies and practices.

○ Provide employees with accurate COVID-19 information, appropriate PPE and access to disinfectant and hand sanitizers.

○ Provide employees with access to soap, alcohol-based hand sanitizer and disposable disinfectant wipes at their worksites.

○ Conduct frequent cleaning of employee break rooms, rest areas, and other common areas.

● WHO released interim guidance concerning COVID-19 and it is recommended that this guidance be used in conjunction with the WHO Handbook for management of public health events on board ships.

○ WHO also provides guidance for shipowners, seafarers, unions and associations and competent authorities for health and transport on protecting seafarers working on cargo ships and fishing vessels from and management of COVID-19.

● CDC provides interim guidance specific for cruise ship crews in any international, interstate, or intrastate waterways subject to the jurisdiction of the United States to help prevent, detect, manage and mitigate confirmed and suspected COVID-19 infections during the period of the No Sail Order.

○ This guidance is not intended as, and does not constitute, a comprehensive statement regarding a cruise ship operator’s duties and obligations under the No Sail Order.

○ Cruise ship operators should carefully consider and incorporate this interim guidance in developing their own plans.

● Passenger ships sailing on an international voyage should develop a written plan for disease outbreak management that covers the definitions of a suspected case of COVID-19, the definition of close contacts, and an isolation plan. The outbreak management plan should include descriptions of the following:

○ Location or locations where suspected cases will be isolated individually until disembarkation and transfer to a healthcare facility.

○ How the necessary communications between departments (for example, medical, housekeeping, laundry, room service) about persons in isolation will be managed.

○ The clinical management of suspected cases while they remain on board.

○ Cleaning and disinfection procedures for potentially contaminated areas, including the isolation cabins or areas.

○ How close contacts of the suspected case will be managed.

○ Procedures to collect Passenger/Crew Locator Forms (PLF).

○ How food service and utensils, waste management services and laundry will be provided to the isolated travelers.

○ Staff on board should have knowledge of the outbreak management plan and should implement it as required.

● CDC recommends the following preventive measures:

○ Relocating all crew to single-occupancy cabins with private bathrooms.

○ Implementing physical distancing of crew members when working or moving, and modifying meal service to facilitate social distancing.

○ Asking crew to members to wear a cloth face covering when outside of individual cabins.

○ Placing hand sanitizer (containing at least 60% ethanol, or 70% isopropanol alcohol) in multiple locations to encourage hand hygiene, which is:

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

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

• Washing 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.

○ Cancelling face-to-face meetings and events, and closing crew group settings.

○ Providing thermometers to the crew to enable them to perform twice daily temperature checks.

● CDC recommends adherence to the the following stipulations when disembarking asymptomatic crew for transfer or repatriation:

○ Before disembarking crew, give 72-hour advance notice to the local and state health departments with jurisdiction over:

• Port of disembarkation.

• State and county of residence for any US-based crew disembarking for repatriation.

○ Notify the respective national public health authorities and adhere to any testing requirements of receiving countries for any repatriated crew based outside of the U.S.

○ Cruise medical staff must screen disembarking crew members for symptoms compatible with COVID-19.

○ Ensure crew members with known exposures to COVID-19 are transported separately from those with no known exposure.

○ Provide face coverings to disembarking crew members or confirm that they have their own face coverings.

○ Instruct disembarking crew members to stay home for 14 days and continue to practice physical distancing after reaching their destination.

● Isolate crew with symptoms or confirmed cases, and quarantine asymptomatic crew of close contacts.

● Ask cruise ship medical centers to follow the operational guidelines to manage suspected or confirmed COVID-19.

○ Ships should carry a sufficient quantity of PPE, medical and laboratory supplies listed on CDC’s Interim Guidance for Ships on Managing Suspected Coronavirus Disease 2019.

● WHO provides Interim guidance on the management of ill travelers at international ports, airports, and ground crossings in the context of the current COVID-19 disease outbreak. This document provides critical information for:

○ Detection of ill travelers.

○ Interview of ill travelers to determine the possibility of symptoms of and exposure to the virus responsible for COVID-19.

○ Reporting cases with presumptive COVID-19 infection.

○ Isolation, initial case management and referral of those with presumptive COVID-19 infection.

○ Training of staff and essential safety equipment and practices.

● WHO Interim guidance on Controlling the spread of COVID-19 at ground crossings provides additional detail and advises countries how to reduce the spread of COVID-19 resulting from travel, transportation, and trade specific to and around ground crossings by:

○ Identifying priority ground crossings and communities.

○ Implementing key preparedness and response activities for priority ground crossings and communities including:

• Legal enforcement and planning

• Surveillance

• Interviewing and managing sick travelers with suspected COVID-19

• Acute emergency response during mass movement across the border

• Supplies of infection and control equipment and material

• Risk communication and community engagement

• Cross border collaboration

○ Monitoring risk and adapting health measures based on changing trends.

● WHO’s guidance on Promoting Public Health Measures in Response to COVID-19 on Cargo Ships and Fishing Vessels addresses challenges that cargo ships and fishing vessels currently face, and provides measures to manage COVID-19 and to protect seafarers from transmission of COVID-19.

○ Pre-boarding screening is advised for all persons to identify any symptomatic individuals or those exposed to COVID-19.

○ Onboard risk analysis should be considered to determine the type of PPE for ship personnel in each zone as described in Table 1 of this guidance.

• • • 1. 1. 1. • • Preventative measures including hand hygiene, respiratory etiquette, physical distancing and use of masks should be carried out. Hand hygiene is washing hands with soap and water for 20 seconds or with an alcohol-based hand rub that is 60% ethanol, or 70% isopropanol , and respiratory etiquette is coughing into you elbow or into a tissue and immediately disposing of the tissue.

                 • Shipowners and operators should have a contingency plan covering COVID-19 case management, surveillance, reporting and medical assistance.

○ Shipowners should coordinate with State authorities to implement public health measures as stated in the guidance to protect seafarers from COVID-19 when transferring between port and onshore accommodations.

○ Crew members should be trained on signs and symptoms of COVID-19, rules about isolation and self-isolation, high-risk groups, and all preventative measures.

○ Mental health and psychological support are critical to the well-bring of seafarers during this time.

● Ports of Entry (POEs) with large volumes of travelers or significant infrastructure (for example, airports) should have at least one healthcare worker on site who is designated to support staff in case they encounter ill travelers or cases of presumptive COVID-19 that require urgent clinical care.

● Staff should be trained in the following:

○ Conducting interviews.

○ Maintaining security.

○ Providing transportation to medical facilities for travelers who are being referred for further evaluation or treatment.

○ Perform hand hygiene, which is 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.

• 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 ,

○ Maintaining a physical distance of 1 - 2 meters (3 - 6 feet) from travelers at all times during the interview process.

○ Addressing the concerns of travelers and their companions.

○ Source control (that is, providing medical masks to travelers with respiratory symptoms before and during the interview process).

○ Instructing ill travelers to wear a mask, practice hand hygiene, and respiratory hygiene:

• Cover your mouth and nose with your bent elbow or tissue when you cough or sneeze.

• Dispose of the used tissue immediately and wash your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

● Staff should use handheld, no-touch thermometers or thermal imaging cameras.

○ DO NOT use manual thermometers that require contact with skin or mucous membranes.

● Ensure a sustained supply of equipment and materials needed to conduct interviews:

○ For hand hygiene, ensure there are adequate supplies of soap and water or an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol).

○ For respiratory hygiene, ensure there are adequate supplies of medical masks and paper tissues.

● Ensure that waste bins with liners and lids are available for disposing of medical masks and tissues; and ensure there is a plan for disposal of this waste in accordance with infectious waste regulations.

● Ensure that cleaning supplies are available, including household cleaner and disinfectant.

● Ensure that there are chairs or beds, or both, in the isolation areas.

● Develop a process to refer exposed travelers, including travel companions of symptomatic travelers with presumptive COVID-19 infection, to healthcare facilities for further assessment and treatment.

● Ensure guidelines are available in the interview area about how to clean and disinfect frequently touched surfaces and bathrooms.

● Cleaning should be done three times a day (morning, afternoon, night) with regular household soap or detergent first and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (that is, equivalent to 5000 ppm) should be applied.

○ Personnel who do the cleaning must wear appropriate PPE.

● Establish and maintain a POE public health emergency contingency plan, including nominating a coordinator and contact points for relevant POE, public health, and other agencies (for example, authorities for aviation, the maritime sector, refugees) and services.

● Identify transport that can be used for people who are presumptive for COVID-19 to the identified healthcare facilities.

● Identify a service provider who can apply the recommended measures to clean and disinfect areas at the POE and on board other conveyances and ensure that the provider manages infected waste properly.

● You can detect ill travelers through self-reporting, visual observation or via temperature measurement:

○ Self-reporting: with increased knowledge among travelers of COVID-19, including information communicated through active and targeted risk communications at POEs, individual travelers experiencing signs and symptoms of illness may approach POE authorities for assistance.

• Travelers who self-report their illness should be managed following the same procedures as used for those who are screened at the POE.

○ Visual observation: Ill travelers exhibiting signs suggestive of COVID-19 may be identified by POE personnel as they pass through the entry point.

○ Temperature measurement: For information about detection via temperature measurement for countries that choose to perform screening, please follow the Updated WHO advice for international traffic in relation to the outbreak of COVID-19.

● When travelers displaying signs of illness are detected by POE health personnel or through temperature measurement, or when travelers experiencing symptoms come forward to seek help from POE health personnel, they and their travel companions need to be advised to move away from other people, and they should be escorted to a dedicated physical structure at the POE for further assessment.

● Interviews with travelers should include the following:

○ Taking the traveler’s temperature using no-touch thermometer technology.

○ Assessing the traveler for signs and symptoms suggestive of COVID-19 only by interviewing and observing − that is, POE personnel should not conduct a physical examination.

○ Taking a travel and contact history through the traveler’s completion of the Public Health Declaration Form, and evaluating the answers provided on the form.

○ Making any additional observations noted by the interviewer.

● Signs or symptoms of illness suggesting respiratory infection should be evaluated, including:

○ Fever >38° C or the traveler mentioning feeling feverish

○ Cough

○ Breathing difficulties

● A history of possible exposure to the COVID-19 virus should be evaluated, including:

○ Travel to a country with ongoing transmission of the COVID-19 virus 14 days prior to the onset of symptoms.

○ A visit to any healthcare facility in a country with ongoing transmission in the 14 days prior to symptom onset; and/or close physical contact during the past 14 days with a traveler suspected or confirmed to have COVID-19 infection.

○ A visit to any live animal markets in a country with ongoing COVID-19 virus transmission in the 14 days prior to symptom onset.

● The following forms should be submitted to the POE health authority unless the State Party does not require their submission.

○ Aircraft General Declaration form

○ Maritime Declaration of Health

● Ill travelers with signs and symptoms indicative of fever or respiratory infection, or both, who have a history of exposure to the COVID-19 virus should be isolated at the POE until they are able to be safely transferred to a healthcare facility for further assessment, diagnosis and treatment.

● During the isolation period, place the traveler in a well-ventilated room (for example, with doors and windows open, weather permitting) that has been designated for patients presumptive for COVID-19.

● If more than one traveler with presumptive COVID-19 must wait in the same room, ensure there is a physical distance of 1 - 2 meters (3 - 6 feet) between individual travelers.

● Ideally, there should be a dedicated bathroom for use only by people with presumptive COVID-19.

● Provide information to patients and their family about the need for isolation, and address patients’ and families’ concerns.

● Point of Entry personnel should instruct those in isolation to:

○ To wear a medical mask while they are waiting for transport to the healthcare facility.

○ Not to touch the front of their mask (if they do touch the front of the mask, they must perform hand hygiene by washing their hands with soap and water for 20 seconds, or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol).

○ If the mask gets wet or dirty with secretions, it must be changed immediately.

○ Practice respiratory hygiene at all times. This includes covering your mouth and nose with your bent elbow or tissue when you cough or sneeze . Then you dispose of the used tissue immediately and 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.

● Not to share spaces with people who are not presumptive for COVID-19 (for example, travelers with other illnesses waiting for an interview).

● POE personnel should avoid entering the isolation area where presumptive cases are waiting for transport. If they enter an isolation area, they should:

○ Wear a tightly fitted medical mask that covers the nose and mouth when entering the room. The front of the mask should not be touched during use.

• If the mask gets wet or dirty with secretions, it must be changed immediately.

• After use, discard the mask in a waste bin, close the lid, and then perform hand hygiene by washing their hands with soap and water for 20 seconds, or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

● Tissues, masks, and other waste generated in the isolation area and by travelers with presumptive COVID-19 should be placed in a lined container with a lid in the isolation room and disposed of according to national regulations for infectious waste.

● Frequently touched surfaces in the isolation area—such as furniture, light switches, sinks and bathrooms used by travelers with presumptive COVID-19—need to be cleaned and disinfected three times a day (morning, afternoon, night) by personnel wearing appropriate PPE.

○ Cleaning should be done with regular household soap or detergent first and then, after rinsing with water, regular household disinfectant containing 0.5% sodium hypochlorite (that is, equivalent to 5000 ppm or 1 part to 9 parts water) should be used. Please also refer to the guidance here.

● Travelers presumptive for COVID-19 should remain in an area that has a comfortable temperature and good ventilation, chairs or other places to sit, and should be given blankets, as needed.

○ They should also be given food and water as needed and according to their ability to eat and drink; they must be kept in the most comfortable conditions possible. Please see this section for more information.

● Transportation of ill travelers presumptive for COVID-19 to healthcare facilities should occur quickly.

● Identify healthcare facilities that can provide evaluation for, diagnosis of and medical care for people with COVID-19.

● Ensure that safe transport by ambulance is available, if needed.

● Ensure that infection prevention and control precautions are in place, hand hygiene resources and PPE are available, and staff at the healthcare facility and those providing transport are trained in the correct use of PPE; establishing a process to inform the receiving healthcare facility about presumptive cases prior to their transfer.

● Address security issues that may arise during the transfer, if applicable.

● Ensure systematic recording of all personnel involved in screening and transporting travelers presumptive for COVID-19.

● Transport staff should routinely perform hand hygiene and wear a medical mask and gloves when loading patients into the ambulance.

● If the traveler presumptive for COVID-19 requires direct care (for example, physical assistance to get into an ambulance) then transport staff should add eye protection (for example, goggles) and a long-sleeved gown to their PPE.

● PPE should be changed after loading each patient and disposed of appropriately in containers with a lid and in accordance with national regulations for disposal of infectious waste.

● The driver of the ambulance must remain separate from the cases (maintaining a physical distance of 1 - 2 meters (3 - 6 feet).

○ No PPE is required for the driver if distance can be maintained.

○ If drivers must also help load cases into the ambulance, they should follow the PPE recommendations in the previous point.

● Transport staff should frequently clean their hands by:

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

○ 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.

● Ambulances and transport vehicles should be cleaned and disinfected, with particular attention paid to the areas in contact with the suspected case.

● Cleaning should be done with regular household soap or detergent first and then, after rinsing, regular household disinfectant containing 0.5% sodium hypochlorite (that is, equivalent 5000 ppm or 1 part to 9 parts water) should be applied. Please also refer to the guidance here.

● Establish a mechanism for communicating about presumptive COVID-19 cases between POE health authorities and transport sector officials (for example, representatives of the national civil aviation and maritime authorities, conveyance operators, and POE operators) and between POE health authorities and national health surveillance systems.

● The following procedures and means of communication should be established.

○ POE health authorities should receive health information, documents, and reports from conveyance operators regarding ill travelers on board, conduct preliminary assessments of the health risk and provide advice on measures to contain and control the risk accordingly.

○ POE health authorities must inform the next POE of ill travelers on board.

○ POE health authorities must inform the community, provincial or national health surveillance system about any ill travelers who have been identified.

● The U.S. Code of Federal Regulations [42 CFR 70.11 and 71.21] contains requirements for reporting deaths and illnesses to CDC that occur on domestic flights between U.S. states and territories, and on international flights arriving in the United States. More information is available here.

● The following are measures to be adopted before embarkation:

○ Advanced bilateral communication, coordination, and planning with the responsible authorities before departure.

○ The aircraft should be properly staffed with sufficient medical personnel to accommodate the number of nationals anticipated, and that they are outfitted with appropriate PPE and equipment/supplies to respond to illness in travel.

○ The non-medical crew of the aircraft should be properly briefed and outfitted, as well as aware of the signs and symptoms to detect symptomatic passengers for COVID-19.

○ Exit screening, for example temperature measurement and a questionnaire, should be conducted before departure for the early detection of symptoms. Screening results should be shared with the receiving country.

○ It is advised to delay the travel of the presumptive ill travelers detected through exit screening to be referred for further evaluation and treatment.

● Onboard the aircraft:

○ The seating location of passengers should be duly noted/mapped in case a passenger begins to display symptoms, so they can be isolated.

○ If presumptive cases are detected on the aircraft, the cabin crew should inform and seek advice from a ground based medical service provider at the POE.

● Quarantine:

○ If the country decides to put arriving passengers, those not displaying symptoms, in a quarantine facility, the following needs to be considered:

• Accommodation and supplies: travelers should be provided with adequate food and water, appropriate accommodation including sleeping arrangements and clothing, protection for baggage and other possessions, appropriate medical treatment, means of necessary communication if possible, in a language that they can understand and other appropriate assistance.

• A medical mask is not required for those who are quarantined. If masks are used, best practices should be followed.

○ Communication: establish appropriate communication channels to avoid panic and to provide appropriate health messaging so those quarantined can timely seek appropriate care when developing symptoms.

○ Respect and Dignity: travelers should be treated, with respect for their dignity, human rights and fundamental freedoms and minimize any discomfort or distress associated with such measures, including by:

• Treating all travelers with courtesy and respect.

• Taking into consideration the gender, sociocultural, ethnic or religious concerns of travelers.

○ Duration: up to 14 days (corresponding with the known incubation period of the virus, according to existing information), may be extended due to a delayed exposure.

● CDC interim guidance provides considerations for mass transit administrators to maintain healthy business operations and a safe and healthy work environment for employees, while reducing the risk of COVID-19 spread for both employees and passengers.

○ All decisions about following these recommendations should be made in collaboration with local health officials and other authorities who can help assess the current risks.

● CDC also created this Road Travel Toolkit for transportation departments and other partners to:

○ Support timely messaging to those traveling by road in the United States.

○ Share CDC resources and content with transportation partners.

○ Help transportation partners develop further COVID-19 materials.

● In resuming full service, CDC advises Mass Transit Authorities to:

○ Adjust routes between areas experiencing different levels of transmission, to the extent possible.

○ Provide employees from higher transmission areas telework and other options as feasible to eliminate travel to workplaces in lower transmission areas and vice versa.

○ Establish and maintain communication with local health officials to determine current mitigation levels in the communities served. Decisions about how and when to resume full service should be based on these levels.

○ Follow CDC’s guidance on what bus transit operators, rail transit operators, transit maintenance workers, and transit station workers need to know about COVID-19.

○ Consider assigning workers at high risk of severe illness duties that minimize their contact with passengers and other employees.

○ Conduct worksite hazard assessments to identify COVID-19 prevention strategies, such as appropriate use of cloth face coverings or personal protective equipment (PPE), and follow the prevention strategies.

● This guidance further details safety actions to:

○ Promote hand washing and good respiratory hygiene. Hand hygiene 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.

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

• Washing 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.

○ Respiratory hygiene includes:

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

○ Intensify cleaning, disinfection, and ventilation.

○ Promote physical distancing.

○ Train employees.

○ Check employees for signs and symptoms.

○ Plan for when an employee becomes sick.

○ Maintain healthy operations.

○ Adjusting Service.

● The WHO’s Interim Guidance provides practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19. It acknowledges the special role of religious leaders, faith-based organizations, and faith communities in COVID-19 education, preparedness, and response.

○ WHO provides this Risk Assessment tool to reflect new guidance on mass gatherings of religious events. Detailed instructions on how to use this tool is illustrated in this document.

○ This risk assessment should be used in conjunction with the practical considerations and recommendations for religious leaders and faith-based communities in the context of COVID-19 (listed in the first bullet point).

● The CDC FAQ for Administrators and Leaders at Community- and Faith-Based Organizations provides additional information .

○ CDC provides communication toolkit including posters and videos for community and faith-based organizations to communicate with their communities and protect their employees, volunteers and members.

● You play a major role in saving lives and reducing illness related to COVID-19.

● You serve as a primary source of support, comfort, guidance, as well as direct health care and social services for your communities.

● You can provide pastoral and spiritual support during public health emergencies and other health challenges and can advocate for the needs of vulnerable populations.

● By providing clear, evidence-based information to prevent COVID-19, you can promote helpful information, prevent and reduce fear and stigma, provide reassurance to people in their communities, and promote health-saving practices.

● Ensure that any decision to convene group gatherings for worship, education, or social meetings is based on a sound risk assessment and in line with guidance from national and local authorities.

● Ensure safe faith-based gatherings, ceremonies, and rituals when they do occur.

● Ensure that accurate information is shared with communities; counter and address misinformation.

● You can be a powerful resource for agencies and organizations that are communicating to protect your community from COVID-19.

● You have a particularly important role to play in bringing attention to and inclusion of, vulnerable populations (including minorities, migrants, refugees, prisoners and other people who are marginalized) by:

○ Providing supportive environments.

○ Advocating for their rights and access to diagnosis, treatment, and vaccines.

○ Sharing evidence-based accurate information.

○ Publicly standing against statements and acts that encourage violence and human rights violations against people.

● You can also work with health and development agencies to identify mechanisms to increase access to information and services for vulnerable communities, including those that are provided by faith-based organizations themselves.

● More information on stigma is available in this section.

● Community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, policy makers, and others all have a part in helping to promote fair access to health. More information is available in this section.

● Learn accurate information about how COVID-19 spreads and the appropriate actions members of your community can take to prevent COVID-19.

● Use faith channels such as organizational web pages; social media; newsletters; emails; phone tree; and faith publications, radio, or other broadcast media.

● Weave COVID-19 messages into sermons and prayers to be shared with communities. It will be important for community members to hear these messages and updates frequently on different channels and message platforms.

● Research and become informed on organizations presenting credible information in their communities and join with them, using and endorsing their messages (e.g. WHO, universities, nongovernmental organizations).

● Access guidance in formats and simple language that community members can understand. WHO’s guidance has been used this way.

● Become aware of the local and national health authorities websites and other information channels to access local guidance.

● If gatherings are permitted, you and your faith-based community should take the following steps to reduce the transmission of COVID-19.

○ Maintain at least 1 - 2 meters (3 - 6 feet) of distance between people at all times.

○ Prevent touching or kissing of devotional and other objects between people attending faith services by creating new ways for greetings such as replacing hugs, kisses and handshakes with a bow or peace sign.

○ Encourage effective hand washing among participants in faith services and other activities when gatherings are permitted.

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

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

• Washing 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.

○ Encourage participants to practice respiratory hygiene, which includes:

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

○ Frequently clean and disinfect worship spaces, sites, buildings, and often-touched objects such as door knobs, light switches, and stair railings.

● If you and your community are not able to perform these steps, then the planned physical gatherings should be cancelled.

● Use this decision tree to aid your decision making regarding hosting a religious event during the COVID-19 Pandemic.

● Use technology to maintain community and continue worship, for example:

○ Video or audio-tape worship services and ceremonies and broadcast or post them on social media.

○ Use a remote or virtual meeting platform or teleconference facilities for meetings or small group interactive prayer.

○ Expand use of television and radio channels.

● Use low-technology means to maintain faith-based practices in the community, for example:

○ Telephone calls between community members such as paired-prayer.

○ Communicating times when your faith community can observe religious practice remotely, such as prayer, at the same time every day or week, despite being physically apart.

○ Encouraging individual and household observance of prayer and other spiritual practices.

○ Compiling and circulating requests for prayers from the community to be supported by all members.

● Create relationships and connections between people across age groups, professions, and neighborhoods especially between those may be isolated during periods of physical distancing.

● Keep the community connected by checking in individual members, especially individuals who may be living alone, who are elderly, who have disabilities, preferably via phone.

● Create a “calling tree” in which individual members volunteer to phone several other members regularly to check on their well-being.

● Provide encouragement to prevent family separation and promote family based care options in situations where children are separated from their families.

● Promote the sharing of resources to provide for those whose livelihoods are disrupted and who cannot provide for themselves and their families.

● Encourage community members to seek information on the virus at a few, regular, select times a day, and point members to credible sources of information like WHO, CDC or national health authorities, and to maintain hope by reading sacred texts and guidance from their respective faith traditions.

● Help community members manage their stress during isolation by sharing members credible sources of information, and maintain hope by reading sacred texts and guidance from their respective faith traditions.

● Speak out against any gender based violence and provide support or encourage victims to seek help. In settings where movement restrictions are in place, there is the potential for an increase in violence, particularly against women, children, and other marginalized people.

○ See the guidance on gender based violence for more specific recommendations.

● Provide special prayers, theological and scriptural reflections and messages of hope and comfort for the sick and your community.

● Discourage non-essential physical gatherings and organize virtual gatherings through live-streaming, television, radio, social media, etc.

○ Local and national health authorities are the primary source of information and advice about COVID-19 in communities and can provide information about locally mandated restrictions on the movement of people, whether gatherings are permitted and, if so, of what size.

○ Those organizing a gathering should comply with guidance issued by national and local authorities and if a medium or large gathering is planned, the organizers should establish and maintain contact with the authorities in the buildup to and for the duration of the gathering.

● If gatherings are permitted, religious leaders and faith-based communities should take the following steps to reduce the threat of COVID-19 in their community and keep the duration of the gathering to a minimum to limit contact among participants.

○ Maintain at least 1 -2 meters (3-6 feet) of distance between people at all times.

• If a gathering is planned, consider holding it outdoors. If this is not possible, ensure that the indoor venue has adequate ventilation.

• Regulate the number and flow of people entering, attending, and departing from worship spaces to ensure safe distancing at all times.

• Gatherings with few people are better than crowded sessions. Religious leaders and communities of faith should consider multiple services with a few attendees, rather than hosting large gatherings.

• The numbers and flow of pilgrims at pilgrim sites should be managed to respect physical distancing.

• Seating or standing of participants in faith services should be at least 1-2 meters (3-6 feet) apart. Where necessary, create and assign fixed seating to maintain safe distances.

• Identify a room or area where a person could be isolated if he or she becomes ill or begins to develop symptoms.

○ Prevent touching between people attending faith services.

• Many worshippers share a “sign of peace” during services including handshakes and hugs. These are being replaced by, for example:

● Eye contact and a bow while saying “the peace” to others.

● A communal “sign of peace” offered in unison, orally, or through a bow, by the attendees in unison, while staying in place at a safe distance between each other.

● Any form of culturally and religiously sanctioned alternative that avoids physical contact.

○ Prevent touching or kissing of devotional and other objects that the community is accustomed to handling communally.

• COVID-19 can remain on surfaces such as devotional objects for hours or days. Religious leaders and faith-based communities need to protect their members from becoming infected by avoiding practices involving touching or kissing of such surfaces and helping members accept new ways to revere these objects and symbols safely:

● Bow before sacred statues or icons, instead of touching them.

● Receive a blessing from at least 1 - 2 meters (3 - 6 feet) away and avoid the distribution of Holy Communion that involves placing the wafer on the tongue or drinking from a common cup.

● Consider using individual pre-packaged boxes/servings of religious or ceremonial foods, rather than shared portions from communal containers.

● Empty fonts of holy water to prevent people from dipping their fingers into a common bowl.

● Eliminate rituals involving touching such as foot washing and substitute appropriate practices.

● Encourage worshippers to perform their ritual ablutions at home before attending the place of worship.

○ Encourage healthy hygiene among participants in faith services and other activities when gatherings are permitted.

• Help attendees maintain healthy hygiene practices by providing hand washing facilities for members before and after the service; feet washing facilities for places where worshippers enter barefoot; or by placing alcohol-based hand-rub (at least 70% alcohol) at the entrance and in the worship space.

• Place disposable facial tissues within easy reach and closed bins for used tissues.

• Ask worshipers to bring their own personal prayer rugs to place over the carpet for daily prayers.

• Encourage worshippers to avoid attending worship services if they have any symptoms of COVID-19 or if they have travelled recently to an area with community spread of COVID-19.

• When attendees enter a site or building barefoot, shoes and sandals should be placed separately and in bags.

• Provide visual displays of advice on physical distancing, hand hygiene, and respiratory hygiene. Hand hygiene 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.

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

● Washing 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.

• Respiratory hygiene includes:

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

○ Frequently clean worship spaces, sites, and buildings:

• Establish routine cleaning and disinfection of worship spaces, pilgrimage sites, and other buildings where people gather, to remove any virus from the surfaces.

• This routine should include cleaning immediately before and immediately after all gatherings.

○ If you are not able to perform these steps to keep your community safe, then the planned physical gatherings should be cancelled.

• Once decisions have been made, it may be helpful to describe any adjusted practices and measures and visibly present them at the entry of the place of gathering (in writing or drawing).

○ Plan for when a staff member or congregant becomes sick.

• Identify an area to separate anyone who exhibits symptoms of COVID-19 during hours of operation, and ensure that children are not left without adult supervision.

• Establish procedures for safely transporting anyone who becomes sick at the facility to their home or a healthcare facility.

• Notify local health officials if a person diagnosed with COVID-19 has been in the facility and communicate with staff and congregants about potential exposure while maintaining confidentiality as required by applicable laws and in accordance with religious practices.

• Advise those with exposure to a person diagnosed with COVID-19 to stay home and self-monitor for symptoms, and follow guidance if symptoms develop.

• Close off areas used by the sick person and do not use the area until after cleaning and disinfection.

● Ensure safe and correct application of disinfectants and keep disinfectant products away from children.

• Advise staff and congregants with symptoms of COVID-19 or who have tested positive for COVID-19 not to return to the facility until they have met criteria to discontinue home isolation.

● As a faith leader, you can play an important role in helping grieving families to ensure their loved ones receive respectful, appropriate funerals and burials rites.

● It is essential that you know how to safely plan and perform such funeral rituals and services to protect and comfort mourners while showing respect for those who have died without causing infection among mourners.

● When acceptable or appropriate according to respective faith traditions, embalming, burial, and cremation should be allowed for the remains of persons who have died of COVID-19.

● You can work with families to integrate appropriate religious and cultural practices with burial and funeral steps that reduce the chances of COVID-19 infection.

○ Any person (e.g. family member, religious leader) preparing the deceased (e.g. washing, cleaning or dressing body, tidying/shaving hair or trimming nails) in a community setting should wear gloves for any physical contact with the body.

• If splashing of fluids is expected, additional personal protective equipment (PPE) may be required (such as disposable gown, face shield or goggles and N-95 respirator).

• Clothing worn to prepare the body should be immediately removed and washed after the procedure, or an apron or gown should be worn.

• Anyone who has assisted in preparing the body should thoroughly wash their hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol when finished.

• All those involved in such burials should ensure individuals who are >60 years of age or with underlying conditions wear medical masks to carry out safe burials.

• A minimum number of people should be involved in such preparations.

● If the family of the deceased wishes to view the body after its removal from the medical facility where the family member has died, they may be allowed to do so, in accordance with local physical distancing restrictions, with no touching or kissing of the body and thorough hand washing before and after viewing. The proper steps include:

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

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

○ Washing 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.

● Those attending the viewing or funeral should:

○ Wear a cloth face cover in accordance with local guidance.

○ Limit the number of those attending in accordance with local guidance.

○ Those opening the coffin or shrouding for viewing or placing the coffin or body into the ground or on the pyre should use gloves and wash wash their hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol after gloves are removed.

● As you modify burial and funeral rites, ensure that those present take extra care to protect children and older adults in attendance.

● If/when health authorities issue guidance limiting in-person funeral prayers, extended family members and friends can offer funeral prayers in place of those who cannot attend.

● Additional information on grief, funeral services and safe handling of bodies of persons that have died with COVID-19 is available in this section in Part 2 and this section in Part 3 of this document.

● WHO provides Interim Guidance specific for safe Ramadan practices to highlight public health advice for social gatherings and religious practices and gatherings during Ramadan.

○ It highlights advice on conducting religious gatherings, overarching considerations, mitigation measures, charity, physical and mental well-being. The guidance can be applied across different national contexts.

● Cancelling social and religious gatherings should be seriously considered. WHO recommends that any decision to restrict, modify, postpone, cancel, or proceed with holding a mass gathering should be based on a standardized risk assessment exercise.

● If cancelling social and religious gatherings, where possible, virtual alternatives using platforms such as television, radio, digital, and social media can be used instead.

● If Ramadan gatherings are allowed to proceed, measures to mitigate the risk of COVID-19 transmission should be implemented.

○ National health authorities should be considered the primary source of information and advice regarding physical distancing and other measures related to COVID-19 in the context of Ramadan. Compliance with these established measures should be assured.

○ Religious leaders should be involved early in decision making, so that they can be actively engaged in communicating any decision affecting events connected with Ramadan.

○ A strong communication strategy is essential to explain to the population the reasons for decisions taken. Clear instructions should be given and the importance of following national policies reinforced.

○ The communication strategy should also include proactive messaging on healthy behaviours during the pandemic and use different media platforms.

● Considerations for physical distancing include:

○ Practice physical distancing by strictly maintaining a distance of at least 1 -2 meters (3 -6 feet) between people at all times.

○ Use culturally and religiously sanctioned greetings that avoid physical contact, such as waving, nodding, or placing the hand over the heart.

○ Stop large numbers of people gathering in places associated with Ramadan activities, such as entertainment venues, markets, and shops.

○ The following measures should be applied to any gathering occurring during Ramadan, such as prayers, pilgrimages, and communal meals or banquets.

• Consider holding the event outdoors if possible; otherwise, ensure that the indoor venue has adequate ventilation and air flow.

• Shorten the length of the event as much as possible to limit potential exposure.

• Give preference to holding smaller services with fewer attendees more often, rather than hosting large gatherings.

• Adhere to physical distancing among attendees, both when seated and standing, through creating and assigning fixed places, including when praying, performing wudu (ritual ablutions) in communal washing facilities, as well as in areas dedicated to shoe storage.

• Regulate the number and flow of people entering, attending, and departing from worship spaces, pilgrimage sites, or other venues to ensure safe distancing at all times.

• Consider measures to facilitate contact tracing in the event that an ill person is identified among the attendees of the event.

● Considerations for high risk groups include:

○ Urge people who are feeling unwell or have any symptoms of COVID-19 to avoid attending events and follow the national guidance on follow-up and management of symptomatic cases.

○ Urge older people and anyone with pre-existing medical conditions (such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer) not to attend gatherings, as they are considered vulnerable to severe disease and death.

● Muslims perform wudu before prayers, which helps maintain healthy hygiene. The following additional measures should be considered to encourage healthy hygiene:

○ Promote hand washing:

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

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

• Washing 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.

○ Ensure the availability of disposable tissues and bins with disposable liners and lids, and guarantee the safe disposal of waste. This will aid in respiratory hygiene which is:

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

○ Encourage the use of personal prayer rugs to place over carpets.

○ Provide visual displays of advice on physical distancing, hand hygiene, respiratory hygiene, and general messages on COVID-19 prevention.

● Frequently clean and disinfect worship spaces, sites, and buildings.

○ Enforce routine cleaning of venues where people gather before and after each event, using detergents and disinfectants.

○ In mosques, keep the premises and wudu facilities clean, and maintain general hygiene and sanitation.

○ Frequently clean often-touched objects such as doorknobs, light switches, and stair railings with detergents and disinfectant.

● Considerations for charitable giving include:

○ When the faithful give special attention to those who may be adversely affected while distributing their sadaqat or zakah during this Ramadan, consider the physical distancing measures in place.

○ To avoid the crowded gathering associated with iftar banquets, consider using individual pre-packaged boxes/servings of food.

○ These can be organized by centralized entities and institutions, which should adhere to physical distancing throughout the whole cycle (collecting, packaging, storing and distribution).

● Considerations for well being include:

○ No studies of fasting and risk of COVID-19 infection have been performed. Healthy people should be able to fast during this Ramadan as in previous years, while COVID-19 patients may consider religious licenses regarding breaking the fast in consultation with their doctors, as they would do with any other disease.

○ During the COVID-19 pandemic, many people are restricted in their movements; but, if restrictions allow, always practice physical distancing and proper hand hygiene even during any exercise activity. In lieu of outdoor activities, indoor physical movement and online physical activity classes are encouraged.

○ Proper nutrition and hydration are vital during the month of Ramadan. Encourage people to eat a variety of fresh and unprocessed foods every day and drink plenty of water.

○ Tobacco use is ill-advised under any circumstances, especially during Ramadan and the COVID-19 pandemic.

• Frequent smokers may already have lung disease, or reduced lung capacity, which greatly increases the risk of serious COVID-19 illness.

• When smoking cigarettes, the fingers (and possibly contaminated cigarettes) touch the lips, which increases the likelihood of the virus entering the respiratory system.

• When waterpipes are used, it is likely that mouth pieces and hoses are shared, which also facilitates transmission of the virus.

● Considerations to promote mental and psychosocial health include:

○ The critical importance of reassuring the faithful that they can still reflect, improve, pray, share, and care – all from a healthy distance, despite the different execution in practices this year.

○ Ensuring that family, friends, and elders are still engaged in light of physical distancing needs to be considered; encouraging alternate and digital platforms for interaction is paramount.

○ Offering special prayers for the sick, alongside messages of hope and comfort, are methods to observe the tenets of Ramadan while maintaining public health.

○ Religious leaders can actively speak out against violence and provide support or encourage victims to seek help.

● WHO provides Interim Guidance for Safe Eid al Adha Practices to highlight public health advice for social gatherings and religious practices and gatherings during Eid al Adha festival in the context of the COVID-19 pandemic.

● The Eid al Adha is a festival marked by social and religious gatherings where Muslim families and friends unite to pray together and give alms, especially in the form of sacrificed animal meat.

○ Social and religious gatherings and animal slaughter are central to Eid al Adha.

● Preventive measures, including risk communication and community engagement (RCCE) strategies directed towards individuals, families, communities and governments are required to promote behavioural messages and encourage adoption of key measures to prevent and minimize the spread of the infection.

● Cancelling social and religious gatherings should be seriously considered.

○ WHO recommends that any decision to restrict, modify, postpone, cancel, or proceed with holding a mass gathering should be based on a standardized risk assessment exercise, taking into account current epidemiological trends, capacities, and resources.

○ WHO provides this risk assessment tool for religious mass gatherings.

● A robust risk communication and community engagement strategy is essential to explain to the population the rationale, as well as to provide clear instructions for adhering to national policies or measures surrounding Eid al Adha.

○ The strategy should also include the active engagement with communities via tailored and innovative approaches and proactive messaging on the importance of practicing physical distancing and healthy behaviours during the pandemic, using diverse media platforms.

● Practice physical distancing by strictly maintaining a distance of at least 1-2 meter (3-6 feet) distance between people at all times.

○ If physical distancing cannot be achieved, wearing a cloth face covering is recommended.

○ It is critical to follow best practices on how to wear, remove and dispose of masks, 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 alcohol after removal.

● Use culturally and religiously sanctioned greetings that avoid physical contact, such as waving, nodding, or placing the hand over the heart.

● Prohibit large numbers of people gathering in public places associated with Eid activities, such as markets, shops and mosques.

○ If allowed, a mechanism should be in place to regulate such activities and avoid gathering of people.

● Restrict social gatherings, both public and private, and encourage the use of technology for meeting and greeting people to mitigate transmission.

○ Consider closing of entertainment venues, particularly indoor venues, during Eid to avoid the mass gathering of people.

○ Enforce routine cleaning of venues and disinfecting of often-touched objects and surfaces.

● Hold the venue for prayers outdoors if possible.

● Hold smaller services with fewer attendees rather than hosting large gatherings.

○ Shorten the length of the event as much as possible to limit potential exposure between people.

○ Encourage the use of personal prayer rugs to place over carpets.

○ Provide visual displays of advice on physical distancing, hand hygiene, respiratory hygiene, and general messages on COVID-19 prevention. Hand hygiene 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.

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

• Washing 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.

○ Respiratory hygiene includes:

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

○ Ensure hand washing facilities are adequately equipped with soap and water.

● Frequently clean worship spaces, sites, and buildings.

○ Enforce routine cleaning of venues where people gather before and after each event, using detergents and disinfectants.

○ Keep the premises and facilities clean and maintain general hygiene and sanitation.

○ Frequently clean often-touched objects such as doorknobs, light switches, and stair railings with detergents and disinfectant.

● Urge people who are feeling unwell or have any symptoms of COVID-19 to avoid attending events and follow the national guidance on follow-up and management of people who may have COVID-19.

● Urge individuals aged 60 years and older and anyone with pre-existing medical conditions (such as diabetes, hypertension, cardiac disease, chronic lung disease, cerebrovascular disease, chronic kidney disease, immunosuppression and cancer) not to attend gatherings, as they are at a higher risk of severe disease and death from COVID-19.

● Take strict measures around the selling and slaughtering of animals and the distribution of meat while ensuring that national food safety and hygiene regulations are enforced.

● Key considerations for animal management:

○ Encourage and enforce proper procurement of animals to abide by safety standards, especially for importation of livestock.

○ Allocate enough space in dedicated enclosures to safely house an increased influx of animals and avoid unsanitary overcrowding in anticipation of the slaughter.

○ Do not slaughter animals that appear sick, and plan for dedicated space for quarantine and isolation of suspected ill animals.

○ Perform adequate veterinary checks for livestock to mitigate other zoonosis and infection.

○ Always procure animals through a trusted official procedure.

● Key considerations for processing facilities:

○ Discourage slaughter at home and increase the number or capacity of slaughter facilities to encourage best practices and ensure safety and physical distancing standards, for both public and staff.

○ Slaughter facilities and equipment should be properly maintained and kept hygienic.Inspection of facilities should take place periodically to uphold standards.

• Ensure that facility staff are practicing physical distancing, hand hygiene, respiratory hygiene, and general messages on COVID-19 prevention. Hand hygiene 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.

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

• Washing 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.

○ Respiratory hygiene includes:

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

• Staff should be aware of COVID-19 signs and symptoms.

○ Waste management for unused animal by-products should be in place and facilities should have a contingency plan in the event of contamination or an outbreak.

● Key considerations for marketplaces:

○ Provide basic infrastructure to promote sanitation, such as toilet and hand washing facilities, safe water supplies, cleanable walls and floors, and drainage.

○ Ensure sanitation of stalls and equipment.

○ Ensure that all waste materials, including solid and liquid waste, are collected and disposed of regularly from the market, ideally at least once daily.

○ Protect market areas and food from environmental hazards, including rain, sun, dust, insects, rodents and other animals.

○ Increase the number and capacity of slaughter facilities to encourage best practices for both public and staff.

○ Maintain slaughter facilities and equipment properly and keep them hygienic.

○ Inspect facilities periodically to ensure safety, physical distancing and hygiene standards.

○ Ensure the marketplace is equipped with proper infrastructure to promote sanitation.

● Key considerations for meat distribution:

○ When the faithful distribute meat, consider the physical distancing measures in place and encourage nominating one household member to perform and order the sacrifice, preferably through centralized agencies or services.

○ To avoid the crowded gathering associated with distribution of meat, consider using centralized entities, agencies, and institutions, which should adhere to physical distancing throughout the whole cycle (collecting, packaging, storing and distribution).

● The risk of work-related exposure to COVID-19 depends on the probability of coming into close (less than 1 -2 meters (3-6 feet)) or frequent contact with people who may be infected with COVID-19 and through contact with contaminated surfaces and objects.

○ Low exposure risk is defined as jobs or work tasks without frequent, close contact with the general public and other co-workers, visitors, clients or customers, or contractors that do not require contact with people known to be presumptive for being infected with COVID-19.

• Workers in this category have minimal occupational contact with the public and other co-workers.

○ Medium exposure risk is defined as jobs or work tasks with close, frequent contact with the general public, or other co-workers, visitors, clients or customers, or contractors, but that do not require contact with people known to be or suspected of being infected with COVID-19. (e.g. food markets, bus stations, public transport, and other work activities where physical distancing of at least 1-2 meters (3-6 feet) may be difficult to observe), or work tasks that require close and frequent contact between co-workers.

• In areas without community transmission of COVID-19, this scenario may include frequent contact with persons returning from areas with community transmission.

○ High exposure risk is defined as jobs or work tasks with high potential for close contact with people who are known or presumptive for having COVID-19, as well as contact with objects and surfaces possibly contaminated with the virus.

• Examples of such exposure include the transportation of persons known or presumed to have COVID19 in enclosed vehicles without separation between the driver and the passenger and providing domestic services or home care for people with COVID-19.

● Preventive Measures for all workplaces include:

○ Promote and practice regular and thorough handwashing with soap and water or with hand rub (sanitizer) that contains 60% ethanol or 70% isopropanol alcohol: Hand hygiene:

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

• Washing 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.

• 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.

○ 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. Then dispose of the used tissue immediately, and wash your hands for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol.

• 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 cloth 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:

○ 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.

○ In indoor workplaces, routine application of disinfectants to environmental surfaces via spraying or fogging is generally not recommended 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 presumptive for 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.

● Specific measures for workplaces and jobs at medium risk include:

○ Enhanced cleaning and disinfection of objects and surfaces that are touched regularly, including all shared rooms, surfaces, floors, bathrooms, and changing rooms;

○ Where physical distancing of at least 1-2 meters (3-6 feet) cannot be put in place, workplaces should consider whether that activity needs to continue, and if so, take all the mitigating actions possible to reduce the risk of transmission between workers, clients or customers, contractors, and visitors such as:

• Staggering activities.

• Minimizing face-to-face and skin-to-skin contacts.

• Placing workers to work side-by-side or facing away from each other rather than face-to-face.

• Assigning staff to the same shift teams to limit social interaction.

• Installing plexiglass barriers at all points of regular interaction and cleaning them regularly.

○ Regular hand washing with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol including before entering and after leaving enclosed machinery, vehicles, confined spaces, and before putting on and after taking off personal protective equipment.

○ Provide personal protective equipment (PPE) and training on its proper use.

○ Provide face or eye protection (medical mask, face shields, or goggles) during cleaning procedures that generate splashes (e.g. washing surfaces).

○ Increase ventilation rate, through natural aeration or artificial ventilation, preferably without re-circulation of the air.

● Measures for workplaces and jobs at high risk include:

○ Assess the possibility of suspending the activity.

○ Adherence to hygiene before and after contact with any known or suspected case of COVID-19, before and after using PPE.

○ Use of medical masks, disposable gown, gloves, and eye protection for workers who must work in the homes of people who are suspected or known to have COVID-19. Training of workers in infection prevention and control practices and use of personal protective equipment.

○ Avoid assigning tasks with high risk to workers who have pre-existing medical conditions, are pregnant, or older than 60 years of age.

● CDC provides the following resources:

○ Interim Guidance for Businesses and Employers Responding to COVID-19 includes activities to:

• Prevent and reduce transmission among employees.

• Maintain healthy business operations.

• Maintain a healthy work environment.

○ Resuming Business Toolkit supports the Interim Guidance on Businesses reopening, and provides checklists to prepare the workplace for operations and a tool to navigate protective options for workers.

○ Prepare your Small Business and Top 10 Tips to Protect Employees’ Health has useful tips for protecting small business employees.

○ More information on General Workplace Readiness is also in Part 2 of this document.

● WHO provides Q&A: Consideration for the cleaning and disinfection of environmental surfaces in the context of COVID-19 in non-health care settings.

● CDC has supporting Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes and a CDC Guidance for Learning and Disinfecting Decision Tool.

● Detailed information on cleaning and disinfecting surfaces is also provided in this section.

● WHO provides an Asks’ document outlining the critical role the private sector can play in helping to protect communities and participate in the COVID-19 response locally, nationally, and globally. Links and resources are provided for each "ask," including:

○ Protecting your stakeholders

○ Protecting your business

○ Essential supplies

○ Financial support

● This CDC Worker Safety and Support webpage has a comprehensive list of includes guidance for specific occupations in the following categories including:

○ Transportation and Delivery

• Airlines and Airports

• Shipping

• Public Transportation

• Delivery and Ground Transportation

○ Personal Services

○ Food Services

○ Manufacturing and Industrial

○ Public Service and Sanitation

● Based on feedback and interviews, WHO’s Basic Psychosocial Skills A Guide for COVID-19 Responders includes five modules that address mental health and psychosocial support interventions for those working in food supply, distribution, law enforcement, health professionals, protection actors, transportation workers, managers and others involved in the COVID-19 response. Modules include:

○ Your well-being

○ Supportive communication in everyday interactions

○ Offering practical support

○ Supporting people who are experiencing stress

○ Helping in Specific Situations

● The CDC webpage How to Cope with Job Stress and Build Resilience During the COVID-19 Pandemic also provides information on recognizing stress and building resilience to manage job-related stress.

● Funeral home workers should follow their routine infection prevention and control precautions when handling those who died of COVID-19.

● Health care workers or mortuary staff preparing the body (e.g. washing the body, tidying hair, trimming nails, or shaving) should wear appropriate PPE according to standard precautions (gloves, impermeable disposable gown [or disposable gown with impermeable apron], medical mask, eye protection).

○ After cleaning and removal of PPE, perform hand hygiene by washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if soap and water is not available.

• Soap and water should be used if the hands are visibly soiled.

● If it is necessary to transfer a body to a bag, follow standard precautions, including additional personal protective equipment (PPE) if splashing of fluids is expected.

● For transporting a body after the body has been bagged, disinfect the outside of the bag. Wear disposable nitrile gloves when handling the body bag.

● Embalming is not recommended to avoid excessive manipulation of the body. If embalming is conducted:

○ During embalming, follow standard precautions, including the use of additional PPE if splashing is expected (e.g. disposable gown, face shield or goggles and N95 respirator).

○ Wear appropriate respiratory protection if any procedures will generate aerosols or if required for chemicals used in accordance with the manufacturer’s label.

○ Wear heavy-duty gloves over nitrile disposable gloves if there is a risk of cuts, puncture wounds, or other injuries that break the skin.

○ Additional information on how to safely conduct aerosol-generating procedures is in the CDC’s Postmortem Guidance.

● If the family wishes only to view the body and not touch it, they may do so, using standard precautions at all times including hand hygiene.

○ Give the family clear instructions not to touch or kiss the body;

○ Adults >60 years and immunosuppressed persons should not directly interact with the body.

● Safety procedures for deceased persons infected with COVID-19 should be consistent with those used for any autopsies of people who have died from an acute respiratory illness.

○ If a person died during the infectious period of COVID-19, the lungs and other organs may still contain live virus, and additional respiratory protection is needed during aerosol-generating procedures (e.g. procedures that generate small-particle aerosols, such as the use of power saws or washing of intestines).

○ Perform autopsies in an adequately ventilated room, i.e. at least natural ventilation with at least 160L/s/patient air flow or negative pressure rooms with at least 12 air changes per hour (ACH) and controlled direction of air flow when using mechanical ventilation.

○ Only a minimum number of staff should be involved in the autopsy.

○ Appropriate PPE must be available, including a scrub suit, long sleeved fluid-resistant gown, gloves (either two pairs or one pair autopsy gloves), and face shield (preferably) or goggles, and boots. A particulate respirator (N95 mask or FFP2 or FFP3 or its equivalent) should be used in the case of aerosol-generating procedures.

○ Additional information on how to safely conduct aerosol-generating procedures is in the CDC’s Postmortem Guidance.

● After cleaning and removal of PPE, perform hand hygiene by washing hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol if soap and water is not available. Soap and water should be used if the hands are visibly soiled.

● Cleaning the environment is paramount. The mortuary must be kept clean and properly ventilated at all times.

○ Lighting must be adequate.

○ Surfaces and instruments should be made of materials that can be easily disinfected and maintained.

○ Instruments used during the autopsy should be cleaned and disinfected immediately after the autopsy, as part of the routine procedure.

○ Environmental surfaces, where the body was prepared, should first be cleaned with soap and water, or a commercially prepared detergent solution.

• After cleaning, a disinfectant with a minimum concentration of 0.1% (1000 ppm) sodium hypochlorite (bleach), or 70% ethanol should be used.

● Persons that have died with COVID-19 can be buried or cremated, but check for any additional state and local requirements that may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.

● Additional information on funerals is included in this section of the document. Additional information on the safe handling of bodies is available in this section.

● WHO provides Interim Guidance for Operational considerations for COVID-19 management in the accommodation sector that are relevant to collective tourism accommodation establishments of all sizes, including hotels and similar establishments, holiday and other short-stay accommodation, and campsites.

○ Private tourism accommodation providers are invited to follow the operating guidelines to the greatest extent possible.

○ Public health authorities are also invited to use this document to respond to any public health event in hotels and other accommodation establishments.

○ This guidance addresses the following:

• Management Teams

• Reception and concierge

• Technical and maintenance team

• Restaurants, breakfast, and dining, rooms and bars

• Gym, beach, swimming pool, spa, sauna and steam bath facilities

• Recreational areas for children

• Cleaning and housekeeping

• Handling COVID-19 cases in hotels and tourism accommodation establishments

● WHO also provides information on this Q&A Page for those working in hotels and accommodation facilities to contain the spread of COVID-19.

● CDC provides Interim guidance for restaurants and bars and supplementary considerations for restaurants and bars to assist businesses in the food service industry, such as restaurants and bars, in making (re)opening decisions and providing safe operations during the COVID-19 pandemic.

● CDC provides guidance specific for protecting those experiencing homelessness or without shelter during COVID-19 by addressing the importance of identifying non-congregate settings and alternative homeless services.

● CDC provides interim guidance specific for homeless service providers to plan and respond to COVID-19 in community coalition, communication, supplies, staff considerations, facility layout and procedure considerations.

● Yes. Homeless shelters serve a critical function in our communities, and shelters should stay open unless homeless service providers, health departments, and housing authorities have determined together that a shelter needs to close.

○ Service providers should plan for how they can help people experiencing homelessness to isolate themselves while efforts are underway to provide additional support.

● Steps shelters can take for safe operation include:

○ Identifying locations to safely isolate those with known or suspected COVID-19 to prevent the spread of infection to others.

○ Screening incoming guests for any symptoms of COVID-19.

○ Providing any person with symptoms of COVID-19 with a face mask, if available, and then directing them to a predetermined place away from others.

○ Providing individual rooms for those staying at the shelter.

● Connecting people to stable housing should continue to be a priority, however, if individual housing options are not available, allow people who are living in encampments to remain where they are.

● Encourage people living in encampments to increase space between people and provide resources needed for proper hand hygiene. Hand hygiene 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.

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

○ Washing 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.

● Also see Migrant Camps and Other Fragile Settings.

● Use the “whole community” approach to involve partners in the development of response plans and to identify additional sites and resources.

○ A community coalition focused on COVID-19 planning and response should include:

• Local health authorities

• Homeless service providers and Continuum of Care leadership

• Emergency management

• Law enforcement

• Healthcare providers

• Housing authorities

• Local government leadership

• Other support services like outreach, case management, and behavioral health support

● Communicate clearly with staff and clients regarding hand hygiene, use of cloth face coverings and physical distancing, and make plans accordingly.

○ Use health messages and materials developed by credible public health sources, such as your local and state public health departments, CDC, or WHO.

○ Post signs at entrances and in strategic places providing instruction on hand washing and coughing etiquette, use of cloth face coverings, and physical distancing.

○ Provide educational materials about COVID-19 for non-English speakers or hearing impaired, as needed.

○ Identify platforms for communications such as a hotline, automated text messaging, or a website to help disseminate information to those inside and outside your organization.

○ Keep staff and clients up-to-date on changes in facility procedures.

○ Ensure communication with clients and key partners about changes in program policies and/or changes in physical location.

○ Identify platforms for communications such as a hotline, automated text messaging, or a website to help disseminate information to those inside and outside your organization.

○ Identify and address potential language, cultural, and disability barriers associated with communicating COVID-19 information to workers, volunteers, and those you serve.

● Staff considerations:

○ Provide training and educational materials related to COVID-19 to staff and volunteers.

○ Minimize the number of staff members who have face-to-face interactions with clients with respiratory symptoms.

• Staff and volunteers who are at higher risk for severe illness from COVID-19 should not be designated as caregivers for sick clients who are staying in the shelter.

• Identify flexible job duties for these higher risk staff and volunteers so they can continue working while minimizing direct contact with clients.

○ Put in place plans on how to maintain physical distancing between all clients and staff while still providing necessary services.

○ All staff should wear a cloth face covering. Staff who do not interact closely with sick clients and do not clean client environments do not need to wear personal protective equipment (PPE).

○ Develop and use contingency plans for increased absenteeism caused by employee illness or by illness in employees’ family members.

• These plans might include extending hours, cross-training current employees, or hiring temporary employees.

○ Staff should avoid handling client belongings.

• If staff are handling client belongings, they should use disposable gloves, if available.

• Make sure to train any staff using gloves to ensure proper use and ensure they perform hand hygiene before and after use.

• If gloves are unavailable, staff should perform hand hygiene immediately after handling client belongings.

○ Staff who are checking client temperatures should use a system that creates a physical barrier between the client and the screener.

• Screeners should stand behind a physical barrier, such as a glass or plastic window or partition that can protect the staff member’s face from respiratory droplets that may be produced if the client sneezes, coughs, or talks.

• If physical distancing or barrier/partition controls cannot be put in place during screening, PPE and a single pair of disposable gloves can be used.

• However, given PPE shortages, training requirements, and because PPE alone is less effective than a barrier, try to use a barrier whenever you can.

○ For situations where staff are providing medical care to clients with presumptive or confirmed COVID-19 and close contact cannot be avoided, staff should at a minimum, wear eye protection (goggles or face shield), an N95 or higher level respirator (or a face mask if respirators are not available or staff are not fit tested), disposable gown, and disposable gloves.

• Cloth face coverings are not PPE and should not be used when a respirator or face mask is indicated.

• Staff should launder work uniforms or clothes after use using the warmest appropriate water setting for the items and dry items completely.

○ Provide staff resources for stress and mental health coping.

● Facility layout considerations:

○ Use physical barriers to protect staff who will have interactions with clients with unknown infection status (e.g., check-in staff).

• For example, install a sneeze guard at the check-in desk or place an additional table between staff and clients to increase the distance between them to at least 1-2 meters (3-6 feet).

○ In meal service areas, create at least 1 -2 meters (3 -6 feet) of space between seats, and/or allow either for food to be delivered to clients or for clients to take food away.

○ In general sleeping areas (for those who are not experiencing respiratory symptoms), try to make sure the client's faces are at least 1-2 meters (3-6 feet) apart.

• Align mats/beds so clients sleep head-to-toe.

○ For clients with mild respiratory symptoms consistent with COVID-19:

• Prioritize these clients for individual rooms.

• If individual rooms are not available, consider using a large, well-ventilated room.

• Keep mats/beds at least 1-2 meters (3-6 feet apart).

• Use temporary barriers between mats/beds, such as curtains.

• Align mats/beds so clients sleep head-to-toe.

• If possible, designate a separate bathroom for these clients.

• If areas where these clients can stay are not available in the facility, facilitate transfer to a quarantine site.

○ For clients with confirmed COVID-19, regardless of symptoms:

• Prioritize these clients for individual rooms.

• If more than one person has tested positive, these clients can stay in the same area.

• Designate a separate bathroom for these clients.

• Follow CDC recommendations for how to prevent further spread in your facility.

• If areas where these clients can stay are not available in the facility, assist with transfer to an isolation site.

● Facility procedure considerations:

○ Plan to maintain regular operations to the extent possible.

○ Limit visitors who are not clients, staff, or volunteers.

○ Do not require a negative COVID-19 viral test for entry to a homeless services site unless otherwise directed by health authorities.

○ Identify clients who could be at high risk for complications from COVID-19, or from other chronic or acute illnesses, and encourage them to take extra precautions.

○ Arrange for continuity of and surge support for mental health, substance use treatment services, and general medical care.

○ Identify a designated medical facility to refer clients who might have COVID-19.

○ Keep in mind that clients and staff might be infected without showing symptoms.

• Create a way to make physical distancing between clients and staff easier, such as staggering meal services or having maximum occupancy limits for common rooms and bathrooms.

• All clients should wear cloth face coverings any time they are not in their room or on their bed/mat (in shared sleeping areas).

● Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

○ Regularly assess clients and staff for symptoms.

• Clients who have symptoms may or may not have COVID-19. Make sure they have a place they can safely stay within the shelter or at an alternate site in coordination with local health authorities.

• An on-site nurse or other clinical staff can help with clinical assessments.

• Provide anyone who presents with symptoms with a medical mask.

• Facilitate access to non-urgent medical care as needed.

• Use standard facility procedures to determine whether a client needs immediate medical attention. Emergency signs include:

● Trouble breathing

● Persistent pain or pressure in the chest

● New confusion or inability to arouse

● Bluish lips or face

• Notify the designated medical facility and personnel to transfer clients that the client might have COVID-19.

○ Prepare healthcare clinic staff to care for patients with COVID-19, if your facility provides healthcare services, and make sure your facility has supply of personal protective equipment.

○ Provide links to respite (temporary) care for clients who were hospitalized with COVID-19 but have been discharged.

• Some of these clients will still require isolation to prevent transmission.

• Some of these clients will no longer require isolation and can use normal facility resources.

○ Make sure bathrooms and other sinks are consistently stocked with soap and drying materials for handwashing.

• Provide alcohol-based hand sanitizers that contain at 60% ethanol, or 70% isopropanol alcohol at key points within the facility, including registration desks, entrances/exits, and eating areas.

○ Cloth face coverings used by clients and staff should be laundered regularly. Staff involved in laundering client face coverings should do the following:

• Face coverings should be collected in a sealable container (like a trash bag).

• Staff should wear disposable gloves and a face mask. Use of a disposable gown is also recommended, if available.

• Gloves should be properly removed and disposed of after laundering face coverings; wash hands with soap and water for 20 seconds or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol. 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.

○ Clean and disinfect frequently touched surfaces at least daily and shared objects.

● Yes. Please see CDC recommendations for cleaning and disinfection of Community Facilities. Other precautions include:

○ Setting up donation drop-off points to encourage physical distancing between shelter workers and those donating.

○ Laundering donated clothing, sheets, towels, or other fabrics on high heat settings, and disinfect items that are nonporous, such as items made of plastic.

● Food donations should be shelf-stable, and shelter staff should take usual food-related infection prevention precautions.

● Local public health and healthcare facilities will need to work together with homeless healthcare clinics and street medicine clinics to determine the best location for COVID-19 testing.

● In special populations, testing of asymptomatic individuals without known exposure to COVID-19 may allow early identification of COVID-19 cases and outbreaks, especially among people in congregating living settings.

○ If there is moderate or substantial transmission in the community, initial and regular facility-wide testing may be considered as approaches to limit COVID-19 spread in homeless shelters.

○ CDC does not recommend entry testing for homeless service sites and encampments at this point.

● It is important for homeless service systems, local health authorities, housing authorities, and healthcare facilities to plan and identify safe locations for those confirmed or presumptive for COVID-19 to isolate until they meet the criteria to end isolation.

○ Isolation housing could be units designated by local authorities or shelters determined to have capacity to sufficiently care for those experiencing homelessness in isolation to prevent the spread of infection.

○ If no other options are available, homeless service providers should plan for how they can help people isolate themselves while efforts are underway to provide additional support.

● Many of the recommended prevention behaviors may be difficult for a person experiencing homelessness to practice.

○ Homeless services vary by country and may often be provided in shared settings, which could facilitate the spread of infection.

○ People experiencing homelessness may have underlying medical conditions or that may cause them to be at higher risk for severe disease.

● Although it may not be possible for people experiencing homelessness to avoid certain crowded locations, actions that are important for people who are homeless to take are:

○ Trying to avoid other crowded public settings and public transportation.

○ Using take-away options for food, if possible.

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

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

○ Covering their coughs and sneezes and washing hands immediately after, if possible.

● If people experiencing homelessness have symptoms of COVID-19, they should alert their service providers such as case managers or shelter staff, or other care providers, so that these staff can help them understand how to find a place away from others to prevent the potential spread of the infection and identify options for medical care as needed.

● CDC provides a checklist for homeless service providers, along with resources to support people experiencing homelessness to support service delivery as the surrounding community reopens.

● Interim Guidance on Scaling-Up COVID-19 Outbreak Readiness and Response Operations Including Camps and Camp-Like Settings addresses people in humanitarian situations that may include internally displaced persons (IDPs), host communities, asylum seekers, refugees and returnees, and migrants when in similar situations.

○ It provides guidance on Coordination and Planning; RCCE; Surveillance, Case Investigation, and Outbreak Rapid Response Team; Individual Health Screening; Laboratory System; Infection Prevention and Control; Case Management and Continuity of Essential Health Services; and Logistics, Procurement, and Supply Management.

● This UNHCR guidance on camp level preparedness contains technical inputs from, and has been reviewed by, the Health, WASH, Protection, and Shelter Clusters, Gender Based Violence and Child Protection Sub-Clusters, and CwC/AAP Working Group. It links to technical guidance from other sectors, and is intended to be updated and recirculated as necessary.

● Interim Guidance on Localisation and the COVID-19 Response provides guidance as to how the international humanitarian community can adapt its delivery modalities in response to COVID-19 consistent with existing commitments on localisation of aid, strengthening partnerships with local and national actors, and operating effectively in an environment affected by COVID-19.

● Identify and work with local influencers in the site community (such as community leaders, religious leaders, youth and women leaders, health workers, community volunteers) and local networks (women’s groups, youth groups, traditional healers, etc.).

● Where and when possible, work with camp management teams, camp/site committees and/or community leaders to carry out consultations on risk assessment, identification of high-risk population group, existing trusted communication channels (formal and informal), and setting up of surveillance focal points per blocks and sections, as well as community task teams, etc.

● Provide clear and unequivocal messages focusing on what people can do to reduce risk or which actions to take if they think they may have COVID-19.

○ Do not instill fear and suspicion among the population.

○ Setting up well-designed hand washing stations makes it more likely people will wash their hands, a key prevention measure to reduce the spread of COVID-19.

• 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

● Perceptions, rumors and feedback from camp residents and host communities should be monitored and responded to through trusted communication channels, especially to address negative behaviors and social stigma associated with the outbreak.

● Awareness raising activities may also represent an opportunity to include joint messaging and an occasion for MHPSS actors to provide psychological first aid (PFA) to alleviate the stress and anxiety resulting from the situation.

● “Shielding approach” aims to reduce the number of severe COVID-19 cases by limiting contact between individuals of the “high-risk” population and the general population (“low-risk”). Failure to strictly adhere to protocol and evaluate the capacity may have adverse results to rapid transmission among the most vulnerable populations the approach is trying to protect.

○ Before effectively implementing “Shielding Approach”, be sure to review CDC’s guidance on implementing “Shielding Approach” in any humanitarian settings. Carefully read the prerequisites and take additional considerations to address the population demographics and characteristics, social/cultural/religious contexts, implementation timeline, safe environment and mental health aspects for the high-risk population.

● WHO published Interim Guidance specific for the preparedness, prevention and control of COVID-19 for refugees and migrants in non-camp settings.

○ This document offers guidance to Member States and partners to include refugees and migrants as part of holistic efforts to respond to COVID-19 and compliments the Interim Guidance for Scaling-up COVID-19 outbreak, readiness and response operations in humanitarian situations including camps and camp-like settings.

○ It includes tailored recommendations for promoting the health of refugees and migrants through:

• Coordination and planning.

• Surveillance, case investigation and management, and infection control.

• Points of entry screening and quarantine safeguards.

• Risk communication and community engagement.

• Occupational health and safety measures.

● Resettled refugees face many challenges due to their living, social and economic conditions, work circumstances, underlying medical conditions and lower access to care.

● CDC provides information on ways of helping newly resettled refugee populations as to public health professionals, community organizations, resettlement agencies, healthcare systems and providers.

○ This guidance includes a Welcome Booklet for Refugees that provides important information to help refugees and their families stay healthy during the COVID-19 pandemic after arriving in the United States.

• Local refugee health partners and resettlement agency staff should reiterate concepts in this booklet to newly arrived refugees, and provide them local and state COVID-19 information as well as contact information for healthcare providers. .

• The booklet has been translated into different language versions and can be found on the guidance website.

● This webpage provides interim guidance on management of COVID-19 for correctional facilities and detention centers, to ensure continuation of essential public services and protection of the health and safety of incarcerated and detained persons, staff, and visitors.

○ This guidance may need to be adapted based on individual facilities’ space, staffing, population, operations, and other resources and conditions.

● CDC offers Interim Considerations for correctional and detention facilities on the appropriate use of COVID-19 testing among persons incarcerated and staff.

○ It contains a checklist to assist facilities in their decision-making process about how and when to test broadly for COVID-19.

○ The testing implementation strategies described in this document should be used in conjunction with a number of other prevention and mitigation activities described in the above CDC interim guidance on management of COVID-19 in correctional and detention facilities.

○ Accumulating evidence supports ending isolation and precautions for persons with COVID-19 using a symptom-based strategy.

● WHO also provides Interim guidance to assist countries in developing specific plans and consolidating further action for prisons and other detention facilities in response to COVID-19 outbreak.

● WHO provides a policy brief on preventing and managing COVID-19 across long-term care services with 11 policy objectives and key action points to prevent and manage COVID-19 across long-term care.

○ Its intended audience is policy makers and authorities (national, subnational and local) involved in the COVID-19 pandemic.

○ The brief builds on currently available evidence on the measures taken to prevent, prepare for and respond to the COVID‑19 pandemic across long-term care services including care providers.

○ The COVID-19 pandemic has affected older people disproportionately, especially those living in long-term care facilities.

• In many countries, evidence shows that more than 40% of COVID-19 related deaths have been linked to long-term care facilities, with figures being as high as 80% in some high-income countries.

● CDC offers the following additional guidance:

○ Performing Facility-wide COVID-19 Testing in Nursing Homes. This document describes considerations for performing facility-wide testing among nursing home residents and HCP.

• Facility-wide testing involves testing all residents and HCP for detection of COVID-19, and can be used to inform infection prevention and control (IPC) practices in nursing homes.

• Testing Guidelines for Nursing Homes highlights the importance of testing in residential facilities in helping to support other infection prevention and control recommendations aimed at preventing COVID-19 from entering facilities, detecting cases quickly, and stopping transmission.

● CDC provides an Interim Infection Prevention and Control Guidance for Veterinary Clinics During the Covid-19 Response for veterinarians and their staff who may be treating or advising on companion animal medical care during the COVID-19 pandemic to

○ Facilitate preparedness and ensure practices are in place in a veterinary clinical setting to help both people and animals stay safe and healthy.

○ Protect staff and preserve PPE and supplies during the COVID-19 pandemic.

● Veterinary facilities have unique characteristics that warrant additional infection control considerations.

○ At this time, there is no evidence that animals play a significant role in spreading COVID-19.

○ Based on the limited data available, the risk of animals spreading COVID-19 to people is considered to be low.

○ We are still learning about this virus, and it appears that in some rare situations, people can spread the virus to animals.

○ Further studies are needed to understand if and how different animals could be affected by the virus, and the role animals may play in the spread of COVID-19.

○ CDC provides guidance for Evaluation for COVID-19 Testing in Animals. This contains a Criteria Table to guide decisions and help prioritize situations that may require testing in mammalian animal species given limited resources.

● As the outbreak has evolved, there are now known instances of animals and pets of COVID-19 patients being infected with the disease, 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 to be 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 and play a role in spreading COVID-19.

○ Minks, closely related to ferrets, raised on farms have also been detected with the virus. Most likely, they were infected by farm workers.

○ Several lions and tigers at a New York zoo tested positive for COVID-19 after showing signs of respiratory illness. Public health officials believe these large cats became sick after being exposed to a zoo employee with COVID-19. All of these large cats have fully recovered.

● It is still recommended that people who are sick with COVID-19 and people who are at risk limit contact with companions and other animals.

● More information is available at:

○ OIE website.

○ CDC’s COVID-19 and Animals Frequently Asked Questions and Webpage.

● The clinical spectrum of illness for COVID-19 remains largely undefined in animals.

● Clinical signs expected to be compatible with possible COVID-19 infection in animals may include:

○ Fever

○ Coughing

○ Difficulty breathing or shortness of breath

○ Lethargy

○ Sneezing

○ Nasal/Ocular discharge

○ Vomiting

○ Diarrhea

● Ask staff who are sick to stay home.

○ If symptoms appear upon arrival at work or staff become sick during the day, immediately separate them from other employees, customers and visitors and send them home.

○ Staff who are sick or who test positive for COVID-19 should isolate at home.

● Inform the staff’s team members if they have been exposed to a potential COVID-19 case, while maintaining confidentiality.

○ Staff who have been exposed to someone with COVID-19 should quarantine at home.

● Notify the local health authority of the potential exposure.

● Implement sick leave policies for your staff.

● Clean and disinfect areas the sick employee visited.

● To protect staff and preserve PPE, postpone elective procedures, surgeries, and non-urgent veterinary visits, and make a plan to support sick and injured pets through telemedicine and/or curbside services.

● Assess risk and recommend specific PPE based on situational risk factors of companion animal history.

● Screen clinic staff daily at the beginning of shifts prior to interacting with staff and clients.

● Screen companion animals to check if the pet has had any exposure to a person with presumptive or confirmed COVID-19.

● Minimize staff contact with all pet owners. Examples of actions to take to minimize contact with pet owners or other people include using telemedicine, scheduling drop-off appointments, communicating remotely, using online payment and billing.

● Have a plan in place to handle animals with confirmed or presumptive COVID-19 exposure, or potentially compatible clinical signs.

● Know actions to take if a pet owner has presumptive or confirmed COVID-19. Similar considerations apply for home visits.

○ Enter the home only if absolutely necessary. AVMA suggests that mobile and house call veterinarians consider examining companion animals in their vehicle, outside, or seek the assistance of a local clinic.

● Veterinarians should be aware of the current shortage of PPE due to the high demand for PPE in human healthcare settings.

○ Veterinarians should consider their current PPE supply and rate of PPE use and review Strategies for Optimizing the Supply of PPE. Consider using reusable PPE where possible.

● Veterinarians and their staff should review the concepts in the NASPHV Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel.

○ This document outlines routine infection prevention practices designed to minimize transmission of zoonotic pathogens from animals to veterinary personnel.

○ These guidelines are applicable regardless of ongoing infectious disease outbreaks but are especially important during an outbreak of an emerging infectious disease such as COVID-19.

● Critical workers, like veterinarians and their staff, can be permitted to continue to work following a potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the workplace.

○ Everyone who enters the clinic, including employees and visitors, should wear a cloth face covering over their nose and mouth to contain respiratory secretions, unless engaged in an activity that requires PPE.

● Veterinarians should contact their state public health veterinarian or other appropriate authority for their locality.

● CDC provides recommendations for pet stores, pet distribution facilities, and pet breeding facilities to:

○ Reduce the risk of COVID-19 spreading.

○ Act in accordance with local guidance when considering reopening or continuing operations.

● Routine testing of companion animals for COVID-19 is currently not recommended. Additional guidance on determining when testing a companion animal is recommended can be found on this website.

● People and animals in pet stores, pet distribution facilities and pet breeding facilities should review and adhere their biosafety and biosecurity practices, and take the following steps:

○ Encourage workers to stay home if they are sick.

○ Conduct daily health checks (e.g. symptom and/or temperature screening) of workers.

• Seek emergency medical attention if someone is very sick and if they have any emergency warning signs of COVID-19.

○ Workers who are exposed to sick people or animals may need to self-monitor for temperature and symptoms for a period of 14 days post-incident.

○ Limit the number of people in the facility, the time they can spend there, and keep physical distancing between workers, customers and animals.

○ Practice proper hand hygiene and use cloth face coverings.

○ Follow established guidance for cleaning, disinfection, and waste disposal.

○ Seek veterinary medical consultation for the establishment of an animal health and disease management plan specific to the facility.

○ Take enhanced precautions when introducing new animals or groups of animals to a facility.

● The following technical packages are provided by WHO. Please see here for a more comprehensive list of guidance documents and tools.

○ Interim guidance for Diagnostic testing for SARS-CoV-2: This document provides interim guidance to laboratories and other stakeholders involved in diagnostics for COVID-19. It covers the main considerations for specimen collection, nucleic acid amplification testing (NAAT), antigen (Ag), antibody (Ab) detection and quality assurance.

○ Interim Guidance for Antigen-detection in the diagnosis of SARS-CoV-2 infection using rapid immunoassays: A new technology for COVID-19 detection has become available that is much simpler and faster to perform that currently-recommended nucleic acid amplification tests (NAAT), like PCR. This method relies on direct detection of COVID-19 viral proteins in nasal swabs and other respiratory secretions using a lateral flow immunoassay (also called an RDT) that gives results in < 30 minutes. Though these antigen detection RDTs (Ag-RDTs) are substantially less sensitive than NAAT, they offer the possibility of rapid, inexpensive and early detection of the most infectious COVID-19 cases in appropriate settings. Acknowledging the inadequacy of current data on the performance and operational utility of these tests, this document seeks to provide guidance to countries on considerations for integration into COVID-19 outbreak management programs.

○ Laboratory biosafety guidance related to coronavirus disease (COVID-19): Provides interim guidance on laboratory biosafety related to COVID-19 to laboratories and stakeholders involved in COVID-19 laboratory work. This also includes the packaging and shipment requirements for sending specimens to WHO reference laboratories providing confirmatory testing for COVID-19. The latest update (13 May 2020) includes additional biosafety recommendations for the usage of Point of Care (POC) or near-POC assays that could be performed at patient care settings with certain precautions.

○ Emergency Global Supply Chain System (COVID-19) catalogue: lists all medical devices, including personal protective equipment, medical equipment, medical consumables, single use devices, laboratory and test-related devices that may be requested through the COVID-19 Supply Portal.

● This CDC page has information and resources for laboratory testing, biosafety and specimen handling, data reporting and laboratory Q&A in the context of COVID-19

● WHO provides guidance for decision makers regarding recommending the use of medical and non-medical masks by the general public here.

● CDC also provides information on the use of cloth masks.

● For more specific questions on the use of masks, please see this section of the document.

● WHO provides guidance for Member States to improve hand hygiene practices widely by providing universal access to hand hygiene locations in public and private spaces to help prevent the transmission of the COVID-19 virus.

● Provide universal access to public hand hygiene stations in public or private places and any public transport facility.

○ One or several hand hygiene stations (either for hand washing with soap and water or with an alcohol-based hand rub (sanitizer) that is 60% ethanol, or 70% isopropanol alcohol) should be placed in front of the entrance and exit of every public or private commercial building.

○ 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.

● Provide hygiene facilities at all transport locations, and especially at major bus and train stations, airports and seaports.

○ The quantity and usability of the hand hygiene stations should be adapted to the type and number of users to better encourage use and reduce waiting time.

○ The installation, supervision, and regular refilling of the equipment should be the overall responsibility of public health authorities and delegated to building managers.

● The use of public hand hygiene stations should be obligatory before passing the threshold of the entrance to any building and to any means of public transport during the COVID-19 pandemic.

● WHO’s Key planning recommendations for mass gatherings in the context of COVID-19 provides interim guidance for host governments, health authorities and national or international organizers of mass gatherings on containing risks of COVID19 transmission. It includes a risk assessment exercise based on the following:

○ Normative and epidemiological context in which the event takes place.

○ Evaluation of risk factors associated with the event.

○ Capacity to apply prevention and control measures.

● WHO provides this COVID-19 risk assessment and mitigation checklist for mass gathering. It includes an operational tool to guide mass gathering organizers and health authorities who hold meetings during this pandemic.

○ It should be read in conjunction with WHO’s key planning recommendations for mass gatherings, and should be accompanied by the WHO COVID-19 Generic Risk Assessment Excel file.

● Additional information on mass gatherings and risk assessment tools for sport and religious events are available in Part 2 of this document and a tool for religious events is in Part 5.

● Plan and develop innovative strategies to ensure as many eligible people as possible can access information and contraception during this period.

● Increase use of mobile phones and digital technologies to help people make decisions about which contraceptive methods to use, and how they can be accessed.

● Enable health care workers to provide contraceptive information and services as per national guidelines to the full extent possible. This is particularly important where pregnancy poses a high risk to health.

● Expand availability of contraceptive services (including both information and methods) through places other than healthcare facilities, such as pharmacies, drug shops, online platforms and other outlets. This can be with or without prescription depending on national guidelines and contraceptive methods.

● Relax restrictions on the number of repeat issues of prescription-only hormonal contraceptives that can be issued.

● Ensure access to emergency post-coital contraception, including consideration of over the counter provision.

● Enable access to contraception for women and girls in the immediate postpartum when they may access health services.

● Include violence prevention and response in pandemic preparedness and response plans and in risk mitigation communications. Ensure these activities are adequately resourced.

● Ensure prevention and response programmes and services for those affected by violence are maintained during lockdowns and adapt them as needed.

● Promote paid sick, medical, family leave and affordable child care for all essential workers.

● Inform the public about the availability of services to prevent and respond to violence via multiple channels (e.g. radio, television, notices in grocery shops or pharmacies) and in multiple formats, including Braille.

● Alert essential service providers in the community (mail carriers, meter readers, first responders, food delivery services) about signs that indicate violence, abuse or neglect (including self-neglect in older people), and what to do if help is needed by survivors.

● Alert older people and trusted others to the main types of financial scams being perpetrated and provide information on how to avoid them and what to do if targeted.

● Make provisions to allow those seeking help for violence to safely leave the home, even during lockdown.

● Keep existing helplines functioning or establish new ones where they don’t exist.

○ Ensure that helplines are free and can be reached by all survivors of violence (including older people).

○ Offer multiple means of contact for helplines, including phone and text message or chat, or silent calls.

● Work across sectors to track and update information about accessible referral services, and address violence.

● Additional information on gender based violence is available in Part 2.