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Novel Coronavirus (COVID-19)
SARS-CoV-2
Virginia Department of Health
Cumberland Plateau Health District
Update as of 3/17/20**
**Data and information in this slide presentation is dated as of 3/17/20
Presenter
Presentation Notes
This was created on 1/31/20 – data will need to be updated on certain slides.
Novel Coronavirus (COVID-19)
SARS-CoV-2
Virginia Department of Health
Cumberland Plateau Health District
Update as of 3/17/20**
**Data and information in this slide presentation is dated as of 3/17/20
Refer Calls to:
• Robin Jackson, Nursing Supervisor 276 202 5291
• Delilah McFadden 276-415-3367 (office); 276-701-7330
(cell)
Public Health Emergency Coordinator
• Cindy Newman 276-889-7621
Population Health Manager
2
Refer Calls to:

Robin Jackson, Nursing Supervisor 276 202 5291

¢ Delilah McFadden 276-415-3367 (office); 276-701-7330
(cell)
Public Health Emergency Coordinator

Cindy Newman 276-889-7621
Population Health Manager

3
Reservoir appears
to be bats
96% identity with
bat SARS-like
coronavirus strain
BatCov RaTG13
Intermediate host
animal not yet
known
SARS-CoV-2
Initially referred to as 2019-nCoV
Presenter
Presentation Notes
Palm civet – SARS
Camels - MERS



SARS-CoV-2
Initially referred to as 2019-nCoV
Reservoir appears
to be bats eS
96% identity with ~|
bat SARS-like
coronavirus strain
BatCov RaTG13 — ~ ars.
Intermediate host || _>-— \ EAT SL-CoV
animal not yet
known
2019-nCoV
BAT-SL-CoV
How does a novel virus originate?
CoVID-19
4
Shift or spillover
Intermediate host is not
known yet for CoVID-19
How does a novel virus originate?
CoVID-19
Shift or spillover
Intermediate host is not
known yet for CoVID-19
Coronaviruses that Infect People
• 4 cause common cold
symptoms
• 2 (SARS and MERS) cause
severe lung infection
• Spread through coughing,
sneezing or close personal
contact
• Symptoms start 2-14 days
after exposure
COVID-19: still
learning about it
5
Coronaviruses that Infect People


4 cause common cold
symptoms


2 (SARS and MERS) cause
severe lung infection


Spread through coughing,
sneezing or close personal
contact


COVID-19: still

Symptoms start 2-14 days learning about it

after exposure
What is CoVID-19?
6
A respiratory illness in humans caused by a new
(novel) coronavirus.  Coronaviruses are a large
family of viruses. Individuals have no immunity to
the new virus.
Symptoms of new virus can include:
• Fever
• Cough
• Shortness of breath
Most (80%) cases not severe
Severe cases (20%) can cause pneumonia,
respiratory failure, need for ICU care and death
Symptoms may appear 2-14 days after exposure
to the virus.
What is CoVID-19?
A respiratory illness in humans caused by a new
(novel) coronavirus. Coronaviruses are a large
family of viruses. Individuals have no immunity to
the new virus.
Symptoms of new virus can include:


Fever


Cough


« Shortness of breath
Most (80%) cases not severe
Severe cases (20%) can cause pneumonia,
respiratory failure, need for ICU care and death
Symptoms may appear 2-14 days after exposure
« to the virus.
How Many People Are Sick?
Confirmed Cases as of  3/17/20
Reported by the World Health Organization
Total 188,321 cases; 7,499 deaths;
80,848 recovered; 99,974 active
cases; 6,491 serious/critical
China 80,881 cases; 3,226 deaths; 68,709
recovered; 8,946 active cases; 3,226
serious/critical
Outside of China 107,440 cases; 4,273 deaths; 12,139
recovered; 91,028 active cases; 162
countries
United States 4,744 cases; 93 deaths; 74
recovered 4,577 active cases; 12
serious/critical
7
Source: www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
How Many People Are Sick?
Confirmed Cases as of 3/17/20
Reported by the World Health Organization
Total 188,321 cases; 7,499 deaths;
80,848 recovered; 99,974 active
cases; 6,491 serious/critical
China 80,881 cases; 3,226 deaths; 68,709
recovered; 8,946 active cases; 3,226
serious/critical
Outside of China 107,440 cases; 4,273 deaths; 12,139
recovered; 91,028 active cases; 162
countries
United States 4,744 cases; 93 deaths; 74
recovered 4,577 active cases; 12
serious/critical
COVID-19 Signs and Symptoms among
Confirmed Cases Reported in China
8
Sign or symptom* %
Fever 87.9
Dry Cough 67.7
Fatigue 38.1
Sputum 33.4
Shortness of breath 18.6
Myalgia or arthralgia 14.8
Sore throat 13.9
Headache 13.6
Chills 11.4
Nausea or vomiting 5.0
Nasal congestion 4.8
Diarrhea 3.7
*Among 55,924 confirmed cases
COVID-19 Signs and Symptoms among
Confirmed Cases Reported in China
%
Fever 87.9
Dry Cough 67.7
Fatigue 38.1
Sputum 33.4
Shortness of breath 18.6
Myalgia or arthralgia 14.8
Sore throat 13.9
Headache 13.6
Chills 11.4
Nausea or vomiting 5.0
Nasal congestion 4.8
Diarrhea 3.7
*Among 55,924 confirmed cases
Key Findings from the WHO-China Report
(as of 2/20/20)
Location
and
Occupation
Hubei
Province:
77.0%
Farmers or
Laborers:
21.6%
Age
Median Age:
51 years
Range: 2 days
– 100 years
30-69 years:
77.8%
<19 years:
2.4%
Sex
Male: 51.1%
Female:
48.9%
Spectrum
of Disease
Mild: 80%
Severe:
13.8%
Critical: 6.1%
9 R0 = 2-2.5 in absence of interventions
Key Findings from the WHO-China Report
(as of 2/20/20)
Location
and Age Sex °P abel
Occupation
Median Age:
51 years Mild: 80%
Severe:
13.8%
Hubei
Province:
77.0%
Male: 51.1%
Range: 2 days

100 years

30-69 years:
Farmers or 77.8%
Laborers:
21.6% <19 years:
2.4%
= 2-2.5 in absence of interventions
10
Key Findings from the WHO-China Report
(as of 2/20/20)
Duration of
Illness
Mild Disease: ~2 Weeks
Severe or Critical
Disease: 3-6 Weeks
Onset to Severe
Disease: 1 Week
Onset to Death: 2-8
Weeks
Severe
Disease or
Death
Increased with Age
Case-fatality Rate >80
Years: 21.9%
Case-fatality Rate in
Males: 4.7%
Case-fatality Rate in
Females: 2.8%
Severe Disease <19
Years: 2.5%
Critical Disease <19
Years: 0.2%
Case-fatality
Rate by
Comorbidity
No Comorbidity: 1.4%
Cardiovascular Disease:
13%
Diabetes: 9.2%
Hypertension: 8.4%
Chronic Respiratory
Disease: 8.0%
Cancer: 7.6%
Key Findings from the WHO-China Report
(as of 2/20/20)
Severe Case-fatality
Disease or Rate by
Death Comorbidity
Mild Disease: ~2 Weeks Inereesee WANS
Case-fatality Rate >80 Cardiovascular Disease:
Years: 21.9% 13%
sexerclorcritical Case-fatality Rate in
Di: : 3-6 Week: A ii 9 9
iEEEES CaS ‘Males: 4.7% Diabetes: 9.2%
Case-fatality Rate in
Females: 2.8%
Duration of
Illness
No Comorbidity: 1.4%
Hypertension: 8.4%
Severe Disease <19 Chronic Respiratory
Years: 2.5% Disease: 8.0%
Critical Disease <19
Years: 0.2% Cancer: 7.6%
11
Which Countries Have Confirmed Cases?
Source: www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
Presenter
Presentation Notes
This map was as of 3/17/20
Which Countries Have Confirmed Cases?



IRAN BEA
LS. 14,900+
4400+ ae 1
JAP AR
CHI LBoo+
80, 800+
Gon Aninod oases. HC. eames agit
feat casas traveal
What Is the Current Risk for Virginians?
• As of 3/17/20, 4,744 cases in the United States, 93
deaths, 74 recovered, 4,577 active cases and 49
jurisdictions reporting infection (WV – no case)
• The potential public health threat posed by CoVID-
19 is very high, both globally and to the United
Sates
• Situation is evolving
• Future risk of infection depends on knowing the
current extent of infection, and thus the risk of
secondary infections associated with contact
(lack of access to testing is the factor here)
12
Source: www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
Presenter
Presentation Notes
https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
2)
What Is the Current Risk for Virginians?


As of 3/17/20, 4,744 cases in the United States, 93
deaths, 74 recovered, 4,577 active cases and 49
jurisdictions reporting infection (WV - no case)


The potential public health threat posed by CoVID-


19 is very high, both globally and to the United
Sates
¢ Situation is evolving
¢ Future risk of infection depends on knowing the
current extent of infection, and thus the risk of
secondary infections associated with contact
(lack of access to testing is the factor here)
How Is the U.S. Responding?
• Public health entry screening at 20 U.S. airports
• CDC Level 3 Travel Advisory - Avoid all nonessential
travel to China, Iran, South Korea, Europe (Schengen
Area): Austria, Belgium, Czech Republic, Denmark,
Estonia, Finland, France, Germany, Greece, Hungary,
Iceland, Italy, Latvia, Liechtenstein, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland,
Portugal, Slovakia, Slovenia, Spain, Sweden,
Switzerland, Monaco, San Marino, Vatican City, United
Kingdom and Ireland: England, Scotland, Wales,
Northern Ireland, Republic of Ireland
• Canceling gatherings of 50 or more (CDC guidelines)
13
How Is the U.S. Responding?
¢ Public health entry screening at 20 U.S. airports


CDC Level 3 Travel Advisory - Avoid all nonessential
travel to China, Iran, South Korea, Europe (Schengen
Area): Austria, Belgium, Czech Republic, Denmark,
Estonia, Finland, France, Germany, Greece, Hungary,
Iceland, Italy, Latvia, Liechtenstein, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland,
Portugal, Slovakia, Slovenia, Spain, Sweden,
Switzerland, Monaco, San Marino, Vatican City, United
Kingdom and Ireland: England, Scotland, Wales,
Northern Ireland, Republic of Ireland


Canceling gatherings of 50 or more (CDC guidelines)


How Is the U.S. Responding?
• Surveillance
• Diagnostic test developed
• Ongoing research for medicine to treat sick with COVID-
19
• In the safety testing stage of vaccine development
• Information and guidance
*https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
14
https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
How Is the U.S. Responding?


Surveillance


Diagnostic test developed


Ongoing research for medicine to treat sick with COVID-
19


In the safety testing stage of vaccine development
¢ Information and guidance


*https: //www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
How is VDH Responding?
• Engaging with clinical providers, other state
agencies and community partners to raise
awareness and provide most current
information
• Providing guidance for clinical providers and
local health departments for case investigation,
infection control and testing
• Using epidemiological interventions that are
known to prevent spread of respiratory
communicable diseases (i.e. contact tracing
and management, monitoring, and surveillance
etc.)—containment (as long as possible)15
How is VDH Responding?

Engaging with clinical providers, other state
agencies and community partners to raise
awareness and provide most current
information

¢ Providing guidance for clinical providers and
local health departments for case investigation,
infection control and testing
¢ Using epidemiological interventions that are
known to prevent spread of respiratory
communicable diseases (i.e. contact tracing
and management, monitoring, and surveillance
etc.)—containment (as long as possible)
15
How is VDH Responding?
• Education and information
• www.vdh.virginia.gov/coronavirus
• Press releases
• Statewide call center has been activated
• Targeted outreach and education
oColleges and universities
oDepartment of Education
oDepartment of Emergency Management
and local emergency managers
oVirginia Hospital and Healthcare
Association16
http://www.vdh.virginia.gov/coronavirus
How is VDH Responding?
¢ Education and information

www.vdh. virginia. gov/coronavirus

¢ Press releases
¢ Statewide call center has been activated

Targeted outreach and education
oColleges and universities
oDepartment of Education

oDepartment of Emergency Management
and local emergency managers
oVirginia Hospital and Healthcare
Association
Targeted Health Information
17
Targeted Health Information
it Coronavirus Disease 9 (COVID-19)
Travelers
Healthcare Professionals
Educational Institutions
Businesses
COMMUNITY MITIGATION
• Provides a framework for actions which persons and
communities can implement in the community to
both prepare for and mitigate/reduce community
transmission of COVID-19
• Actions vary depending on the community and its
population, risks, resources, etc.  But the goal is to
identify actions that persons and communities can
take to help slow the spread of respiratory virus
infections.
• Community mitigation is especially important
before a vaccine or drug becomes widely available.
18
COMMUNITY MITIGATION
e Provides a framework for actions which persons and
communities can implement in the community to
both prepare for and mitigate/reduce community
transmission of COVID-19
e Actions vary depending on the community and its
population, risks, resources, etc. But the goal is to
identify actions that persons and communities can
take to help slow the spread of respiratory virus
infections.
e Community mitigation is especially important
before a vaccine or drug becomes widely available.
19
19
Table 1. Local Factors to Consider for Determining Mitigation Strategies
Epidemiology * Level of community transmission (see Table 3)
= Number and type of outbreaks (¢.9_ nursing homes, schools, etc.)

impact of the outbreaks on delivery of healthcare or other critical infrastructure or services
Epidemiology in surrounding jurisdictions

‘Community + Size of community and population density


Level of community engagement/support


Size and characteristics of vulnerable populations


» Access to healthcare
» Transportation (¢.9. public, walking)
» Planned large events
» Relationship of community to other communities (e.g, transportation hub, tourist destination, etc)
Healthcare capacity | = Healthcare workforce
| = Number of healthcare facilities (including ancillary healthcare facilities)
*» Testing capacity
© intensive care capacity

Availability of personal protective equipment (PPE)

Public health capacity | « Public health workforce and availability of resources to implement strategies
| + Available support from other state/local government agencies and partner organizations
Effects of social distancing on 1918 flu deaths
250
deaths per
100,000 people
As the first cases of the 1918 flu
were reported in Philadelphia in
September 1918, authorities
played down the significance and
allowed public gatherings to
continue. Closures in Philadelphia
were only enacted once the virus
had spread. The first cases in
St. Louis were reported in early
October, with measures to contain
the spread enacted two days later.
This resulted in a slower spread
and lower mortality rate.
200
Social
distancing
iterventions
first enacted,
Oct. 3
100
Philadelphia
First case in St. Louis, Oct. S
Social distancing
enacted Oct. 7
50 First case in
Philadelphia,
Sept. 17
»t
Sources: “Public health interventions and epidemic intensity during the 1918 influenza
pandemic” by Richard J. Hatchett, Carter E. Mecher, Marc Lipsitch, Proceedings of the
National Academy of Sciences May, 2007. Data derived from “Public health interventions and
epidemic intensity during the 1918 influenza pandemic” by Richard J. Hatchett, Carter E.
Mecher, Mare Lipsitch, Proceedings of the National Academy of Sciences May, 2007.
SEPT ocT NOV DEC
1918
Flattening
Daily
the curve outbreak
Daily
number |
of cases Cases Reduction
without in peak of
protective outbreak
measures
Health care
system capacity
protective m
Time since first case
SOURCE: CDC CHRISTINA ANIMASHAUN/VOX
Activity Level
VDH Criteria
Internal VDH Actions
Community Mitigation
Strategies
No Community Trans!
Evidence of isolated cases,
case investigations underway,
no evidence of exposure in
large communal setting, e.g.
healthcare facility, school,
mass gathering.
Only cases with travel-
exposure to a location outside
of Virginia with sustained
COVID-19 transmission
(international or domestic)
OR
Cases that are in
close/household contacts to
confirmed cases
OR
1 case (not including
household/close contacts) are
acquired in the local community
and the source of exposure
cannot be determined
OR
1 case (not including
household/close contacts) are
acquired in the local community
and the source of exposure is
in a local communal setting,
like a healthcare facility,
school, mass gathering/event
Identify, isolate and monitor
cases.
Identify contacts to cases,
recommend specific control
measures, and monitor
contacts.
By phone, electronically or in-
person, contact persons
identified by CDC and sent to
VDH through Epix.
notifications (travelers and
interstate transfers) and
institute movement and
monitoring activities consistent
with CDC guidance
See “Actions to take DURING
the NO EVIDENCE of
COMMUNITY
TRANSMISSION” phase in
VDH community mitigation
interim guidance for different
settings.
Examples: Cancel
events/gatherings of >100
people or for events that serve
vulnerable populations, cancel
gatherings of more than 10
people.
VDE:
Topol ath and promot the
‘ll being ofall people Vig
Internal VDH Actions
Minimal Community Transmission
High likelihood of sustained
community transmission OR
confirmed exposure within
communal settings with
potential for rapid increase in
suspected cases.
Equivalent to CDC community
mitigation category: "Minimal to
Moderate”
A health district has reached
minimal community
transmission when:
2 to 4 cases (not including
householdiclose contacts) are
acquired in the local community
and the source of exposure
cannot be determined
OR
2 to 4 cases (not including
householdiclose contacts) are
acquired in the local community
and the source of exposure is
in a local communal setting,
like a healthcare facility,
school, mass gathering/event
Identify, isolate and monitor
cases.
Identify contacts to cases,
recommend specific control
measures, and monitor
contacts.
Using electronic means,
contact persons identified by
CDC and sent to VDH through
EpiX notifications (travelers
and interstate transfers) and
institute movement and
monitoring activities consistent
with CDC guidance.
If insufficient resources:
1 - Consult with the Central
Office.
2 - Prioritize case identification
and contact tracing over
traveler monitoring
3- Prioritize testing of high-
risk individuals
See “Actions to take DURING
the identification of MINIMAL
COMMUNITY
TRANSMISSION’ * in VDH
community mitigation interim
guidance
Examples: Cancel
events/gatherings of >50
people or for events that serve
vulnerable populations, cancel
gatherings of more than 10
people.
Short-term dismissals of
schools as needed for
cleaning and contact tracing,
Additional cleaning, consider
vulnerable populations, etc.
VDHete
Teopolect the ath and promot th
Vel. ofl people Vig
Activity Level
VDH Criteria
Mitigation
Substantial Commu
Large-scale community
transmission, healthcare
staffing significantly impacted,
multiple cases within
communal settings like
healthcare facilities, schools,
mass gatherings, etc.
Equivalent to CDC community
mitigation category:
“Substantial”
A health district has reached
substantial community
transmission when:
5 or more cases (not including
household/close contacts) are
acquired in the local community
and the source of exposure
cannot be determined
OR
5 or more (not including
household/close contacts) are.
acquired in the local community
and the source of exposure is
in a local communal setting,
like a healthcare facility,
school, mass gathering/event.
OR
Health district may self-assign
designation after consultation
with central office
Identify, isolate and monitor
cases.
Identify contacts to cases,
recommend specific control
measures, and monitor
contacts.
Discontinue monitoring of
persons identified by CDC and
sent to VDH through Epix
notifications (travelers and
interstate transfers)
If insufficient resources:
1 - Consult with Central Office
2 - Prioritize tracing of
contacts with high risk for poor
outcomes.
3 - Prioritize testing of high-
risk individuals.
See “Actions to take DURING
the identification of
SUBSTANTIAL COMMUNITY
TRANSMISSION’ in VDH
community mitigation interim
guidance.
Cancel/postpone events or
mass gatherings of any size
Broader or long-term school
dismissals, cancellation of
school-associated gatherings,
cancelling non- essential work
travel, etc.
VDHete
Teopolect the ath and promot th
Vel. ofl people Vig
Internal VDH Actions
Community Mitigation
Strategies
Substantial Community Transmission - Statewide
3 regions in the state reach
substantial community
transmission.
Identify, isolate and monitor
cases
Prioritize tracing of contacts
with high risk for poor
outcomes.
If insufficient resources:
1 - Consult with the Central
Office.
2 - Discontinue contact
tracing.
Statewide implementation of
“Actions to take DURING the
identification of
SUBSTANTIAL COMMUNITY
TRANSMISSION”
VDE:
Topol ath and promot the
‘ll being ofall people Vig
nmunity transm
‘Minimal to moderate
Individuals and Families
atHome
“What you can do to
prepare, if you ora family
‘member gets il or if your
‘community experiences
spread of COVID-19"
‘+ Know where to find local information on
COVID-19 and local trends of COVID-19 cases.
‘+ Know the signs and symptoms of COVID-19
and what to do if symptomatic:
» Stay home when you are sick
» Call your health care provider’ office in


Continue to monitor local information about
COVID-19 in your community.


Continue to practice personal protective
measures.


Continue to put household plan into action.


Individuals at increased risk of severe illness


advance of a visit should consider staying at home and avoiding
Limit ; i gatherings or other situations of potential
Limit movement in the community indding travel
» Limit visitors
‘+ Know what additional measures those at high-
tisk and who are vulnerable should take.


Implement personal protective measures
(eg, stay home when sick, handwashing,
respiratory etiquette, clean frequently touched
surfaces daily).


Create a household plan of action in case of


illness in the household or disruption of daily
activities due to COVID-19 in the community.
» Consider 2-week supply of prescription
and over the counter medications, food
and other essentials. Know how to get food
delivered if possible.
» Establish ways to communicate with others
(eg, family, friends, co-workers).
» Establish plans to telework, what to do
about childcare needs, how to adapt to
cancellation of events.
‘+ Know about emergency operations plans for
schools/workplaces of household members.


Continue to monitor local information.


Continue to practice personal protective
measures.


Continue to put household plan into place.


Allindividuals should limit community
movement and adapt to disruptions in rout
activities (eg, school and/or work closures)
according to guidance from local officials.


Workplace
“What workplaces can do
to prepare for COVID-19,
ifthe workplace has
cases of COVID-19, or
if the community is
experiencing spread of
coviD-19)"
Minimal to moderate


Know where to find local information on
COVID-19 and local trends of COVID-19 cases.


Know the signs and symptoms of COVID-19.
‘and what to do if staff become symptomatic at
the worksite.


Review, update, or develop workplace plans to
include:


» Liberal leave and telework policies
» Consider 7-day leave policies for people with
COVID-19 symptoms
» Consider altemate team approaches for
‘work schedules.

Encourage employees to stay home and
notify workplace administrators when sick
(workplaces should provide non-punitive
sick leave options to allow staff to stay home
when ill).

“+ Encourage personal protective measures
among staff (e.g. stay home when sick,
handwashing, respiratory etiquette).
*+ Clean and disinfect frequently touched
surfaces daily.

Ensure hand hygiene supplies are readily
available in building.

++ Encourage staff to telework (when feasible),
particularly individuals at increased risk of
severe illness.
» Increasing physical space between workers
atthe worksite
» Staggering work schedules
*» Decreasing social contacts in the workplace
(e.g, limit in-person meetings, meeting for
lunch in a break room, etc)
‘+ Limit large work-related gatherings (eg. staff
meetings, after-work functions).


Limit non-essential work travel.


Consider regular health checks (e.g,
‘temperature and respiratory symptom
screening) of staff and visitors entering
buildings (if feasible).


Implement extended telework arrangements
(when feasible).


Ensure flexible leave policies for staff who
need to stay home due to school/childcare
dismissals.


Cancel non-essential work travel.


‘+ Cancel work-sponsored conferences,
tradeshows, etc.
‘Schools/childcare
“What childcare
facilities, K-12 schools,
and colleges and
universities can do to
prepare for COVID-19,
ifthe school or facility
hhas cases of COVID-19,
or if the community is
‘experiencing spread of
‘coMD-19)"
None (preparedness phase)
to moderate
‘+ Know where to find local information on
COVID-19 and local trends of COVID-19 cases.
‘+ Know the signs and symptoms of COVID-19
and what to do if students or staff become
symptomatic at school/childcare site.
‘+ Review and update emergency operations
plan (including implementation of social
distancing measures, distance leaming if
feasible) or develop plan if one is not available.

Evaluate whether there are students or staff
who are at increased risk of severe illness and
develop plans for them to continue to work
receive educational services if there is
moderate levels of COVID-19 transmission or
impact.

» Parents of children at increased risk for
severe illness should discuss with their
health care provider whether those students
should stay home in case of school or
‘community spread.
» Staff at increased risk for severe illness
should have a plan to stay home if there are
‘school-based cases or community spread.


Encourage staff and students to stay home
when sick and notify school administrators of
illness (schools should provide non-punitive
sick leave options to allow staff to stay home
when il).


Encourage personal protective measures
‘among staff/students (eg, stay home when
sick, handwashing, respiratory etiquette).


Clean and disinfect frequently touched
surfaces daily.


“+ Ensure hand hygiene supplies are readily
available in buildings.

Implement social distancing measures:
» Reduce the frequency of large gatherings
(eg, assemblies), and limit the number of
attendees per gathering.
» Alter schedules to reduce mixing (¢.,
stagger recess, entry/dismissal times)
+» Limit inter-school interactions
» Consider distance or e-learning in some
settings
Consider regular health checks (e.g,
temperature and respiratory symptom
screening) of students, staff, and visitors (if
feasible).


Short-term dismissals for school and
extracurricular activities as needed (e.g.
if cases in staff/students) for leaning and
contact tracing.


Students at increased risk of severe illness

should consider implementing individual plans
for distance learning, e-leaming.


Broader and/or longer-term school dismissals,
‘either asa preventive measure or because of
staff and/or student absenteeism.


Cancellation of school-associated
‘congregations, particularly those with
Participation of high-risk individuals.


‘+ Implement distance leaming if feasible.
Community and faith-
bbased organizations
“What organizations
can do to prepare
for COVID-19, if the
‘organizations has
cases of COVID-19, or
ifthe community is
‘experiencing spread of
COVID-19)"
None (preparedness phase)
Minimal to moderate
Substantial


Know where to find local information on.
COVID-19 and local trends of COVID-19 cases.


Know the signs and symptoms of COVID-19
and what to do if organization members/staff
become symptomatic.


“+ Identify safe ways to serve those that are at
hhigh risk or vulnerable (outreach, assistance, etc).


Review, update, or develop emergency plans
for the organization, especially consideration
for individuals at increased risk of severe
illness.


Encourage staff and members to stay home
‘and notify organization administrators of
illness when sick.


Encourage personal protective measures
‘among organization/members and staff
(eg, stay home when sick, handwashing,
respiratory etiquette).


*+ Clean frequently touched surfaces at
‘organization gathering points daily.


Ensure hand hygiene supplies are readily
available in building.


Implement social distancing measures:


» Reduce activities e.g., group congregation,
religious services), especially for
‘organizations with individuals at increased
risk of severe illness.
» Consider offering video/audio of events.
‘+ Determine ways to continue providing support
services to individuals at increased risk of
severe disease (services, meals, checking in)
‘while limiting group settings and exposures.


Cancel large gatherings (e.g, >250 people,
‘though threshold is at the discretion of the
community) or move to smaller groupings.


For organizations that serve high-risk
populations, cancel gatherings of more than
10 people.


Cancel community and faith-based gatherings
of any size.


Assisted living facilities,
‘senior living falities and
adult day programs
“What facilities can
do to prepare for
COVID-19, if the facility
‘has cases of COVID-19,
or if the community is
experiencing spread of
COVID-19)"
None (preparedness phase)
‘Minimal to moderate
‘+ Know where to find local information on
COvID-19.
‘+ Know the signs and symptoms of COVID-19
and what to do ifclients/residents or staff
become symptomatic.
‘+ Review and update emergency operations
plan (including implementation of social
distancing measures) or develop a plan if one
isnot available.

Encourage personal protective measures
‘among staff, residents and clients who live
elsewhere (e.g, stay home or in residences
when sick, handwashing, respiratory
etiquette).

‘+ Clean frequently touched surfaces daily.
‘+ Ensure hand hygiene supplies are readily
available in all buildings.
*+ Implement social distancing measures:
» Reduce large gatherings (e.g. group social
events)
» Alter schedules to reduce mixing (e.g,
stagger meal activity, arrival/departure times)
» Limit programs with external staff
+» Consider having residents stay in facility and
limit exposure to the general community
» Limit visitors, implement screening


Temperature and respiratory symptom
screening of attendees, staff, and visitors.


Short-term closures as needed (e.g. ifcases in
staff, residents or clients who live elsewhere)
for cleaning and contact tracing.


Longer-term closure or quarantine of facility.


«+ Restrict or limit visitor access (e.g, maximum
of 1 perday).
Healthcare settings and
healthcare provider
(includes outpatient,
‘nursing homes/long-term
are facilities, inpatient,
teleheatth)
“What healthcare settings
including nursing homes/
long-term care facilities,
can do to prepare for
‘COVID-19, ifthe facilities
hhas cases of COVID-19,
or if the community is
‘experiencing spread of
‘comp-19)"
"None (preparedness phase)
Minimal to moderate
Substantial

Provide healthcare personnel [HCP], including
staff at nursing homes and long-term care
facilities) and systems with tools and guidance
needed to support their decisions to care for
patients at home (or in nursing homes/long-

‘+ Develop systems for phone triage and
telemedicine to reduce unnecessary healthcare
visits.
‘+ Assess facility infection control programs;
_assess personal protective equipment (PPE)
supplies and optimize PPE use.
‘+ Assess plans for monitoring of HCP and plans
for increasing numbers of HCP ifneeded.
‘+ Assess HCP sick leave policies (healthcare
{facilities should provide non-punitive sick leave
‘options to allow HCP to stay home when il).


Encourage HCP to stay home and notify
healthcare facility administrators when sick,


In conjunction with local health department,
identify exposed HCP, and implement


recommended monitoring and work
restrictions.
‘+ Implement triage prior to entering facilities
to rapidly identify and isolate patients with
respiratory illness (e.g., phone triage before
patient arrival, triage upon arrival)
‘+ Implement changes to visitor policies to
further limit exposures to HCP, residents, and
patients. Changes could include temperature/
Yor dahows, Eeitian st
movement in the facility, etc.

Implement triage before entering facilities
(eg. parking lot triage, front door), phone
‘riage, and telemedicine to limit unnecessary
healthcare visits.

‘+ Actively monitor absenteeism and respiratory
illness among HCP and patients.
‘+ Actively monitor PPE supplies.


Establish processes to evaluate and test large
‘numbers of patients and HCP with respiratory
symptoms (e.g, designated clini, surge tent).


Consider allowing asymptomatic exposed HCP
‘to work while wearing a facemask.


Begin to cross train HCP for working in other
Units in anticipation of staffing shortages.


Restrict or limit visitors (e.g., maximum of 1 per
day) to reduce facility-based transmission.


‘+ Identify areas of operations that may be
subject to alternative standards of care and
implement necessary changes (eg. allowing
mildly symptomatic HCP to work while
‘wearing a facemask).

Cancel elective and non-urgent procedures

‘+ Establish cohort units or facilities for large
‘numbers of patients.

Consider requiring all HCP to wear a facemask
‘when in the facility depending on supply.

Moderate
‘Substantial
Widespread and/or sustained
transmission with high likelihood or
confirmed exposure within communal
settings with potential for rapid increase
in suspected cases.
Large scale community transmission,
healthcare staffing significantly
impacted, multiple cases within.
communal settings like healthcare
facilities, schools, mass gatherings ete.

Continue contact tracing, monitor
and observe contacts as advised in
guidance to maximize containment
around cases.



Isolation of confirmed COVID-19 cases
until no longer considered infectious
according to guidance.


For asymptomatic close contacts
exposed to a confirmed COVID-19
case, consideration of movement
restrictions based on risk level, social
distancing.




Monitoring close contacts should be
done by jurisdictions to the extent
feasible based on local priorities and
resources.


Encourage HCP to develap phone
triage and telemedicine practices.


= Test individuals with signs and
symptoms compatible with COVID-19.

Determine methods to streamline
contact tracing through simplified
data collection and surge if needed
(resources including staffing through
colleges and other first responders,
technology etc.).


May reduce contact tracing if
resources dictate, prioritizing to those
in high-risk settings (e.g., healthcare
professionals or high-risk settings
based on vulnerable populations or
critical infrastructure).

» Encourage HCP to more strictly
implement phone triage and
telemedicine practices.

Continue COVID-19 testing of
symptomatic persons; however, if
testing capacity limited, prioritize
‘testing of high-risk individuals.


May reduce contact tracing if
resources dictate, prioritizing to these
in high-risk settings (e.g., healthcare
professionals or high-risk settings
based on vulnerable populations or
critical infrastructure).

» Encourage HCP to more strictly
implement phone triage and
telemedicine practices.

Continue COVID-19 testing of
symptomatic persons; however, if
testing capacity limited, prioritize
‘testing of high-risk individuals.

Appendix A: Underlying medical conditions that may increase the risk of serious COVID-19 for individuals
of any age.


Blood disorders (e.g., sickle cell disease or on blood thinners)


Chronic kidney disease as defined by your doctor. Patient has been told to avoid or reduce the dose of medications because
kidney disease, or is under treatment for kidney disease, including receiving dialysis


Chronic liver disease as defined by your doctor. (e.g, cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce the
dose of medications because liver disease or is under treatment for liver disease.



Compromised immune system (immunosuppression) (e.g., seeing a doctor for cancer and treatment such as chemotherapy
or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other immunosuppressant
medications, HIV or AIDS)


Current or recent pregnancy in the last two weeks



Endocrine disorders (e.g., diabetes mellitus)


Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)


Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)


Lung disease including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic
conditions associated with impaired lung function or that require home oxygen


Neurological and neurologic and neurodevelopment conditions [including disorders of the brain, spinal cord, peripheral
nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe
developmental delay, muscular dystrophy, or spinal cord injury].


Preventing COVID-19: What You Can Do
• Certain basic prevention measures that can help
people avoid illness with a number of respiratory
infections include:
• Wash your hands often with soap and water for
at least 20 seconds (or an alcohol-based hand
sanitizer if soap and water not available)
• Avoid touching your eyes, nose, and mouth with
unwashed hands
• Avoid close contact with people who are sick
• Cover your cough
• Stay home when sick
34
Presenter
Presentation Notes
Remember that there are certain basic prevention measures that everyone should use to avoid illness with respiratory viruses in general and that the risk of infection with certain viruses, like influenza, is much greater than that of novel CoV.  Basic precautions everyone should take to avoid illness with respiratory infections include:
Washing your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer
Avoiding touching your eyes, nose, and mouth with unwashed hands
Avoiding close contact with people who are sick
° Preventing COVID-19: What You Can Do
¢ Certain basic prevention measures that can help
people avoid illness with a number of respiratory
infections include:
e Wash your hands often with soap and water for
at least 20 seconds (or an alcohol-based hand
sanitizer if soap and water not available)
e Avoid touching your eyes, nose, and mouth with
unwashed hands
e Avoid close contact with people who are sick
e Cover your cough
e Stay home when sick
34
Take Home Messages
• Flu is still circulating in the community and there is a
vaccine available
• Rapidly evolving situation
o Case counts will grow in the coming days and weeks
o Interim guidance will change.
• Vigilance, frequent communication, and coordination across
healthcare, public health, emergency management and
other partners is critical
• More to learn about virus source, transmission factors and
risks
• Promote flu and respiratory infection prevention
• Updates will be communicated via
www.vdh.virginia.gov/coronavirus as more information is
available 35
http://www.vdh.virginia.gov/coronavirus
Take Home Messages
Flu is still circulating in the community and there is a
vaccine available
Rapidly evolving situation
o Case counts will grow in the coming days and weeks
o Interim guidance will change.
Vigilance, frequent communication, and coordination across
healthcare, public health, emergency management and
other partners is critical
More to learn about virus source, transmission factors and
risks
Promote flu and respiratory infection prevention
Updates will be communicated via
www.vdh.virginia.gov/coronavirus as more information is
available
What Can Partners Do?
• Review emergency Operations Plan, Pan Flu Plan and
Continuity of Operations Plan
• Support CoVID-19 Task Force/Emergency Support
Function (ESF-8) at the local or State level
• Work closely with the local health department on
containment strategies should they be needed in the
future.
• Review guidance on Preventing the Spread in
Communities
• Maintain situational awareness through trusted
sources
• www.vdh.Virginia.gov/coronavirus or 1-877-ASK-VDH3
36
http://www.vdh.virginia.gov/coronavirus
What Can Partners Do?
Review emergency Operations Plan, Pan Flu Plan and
Continuity of Operations Plan
Support CoVID-19 Task Force/Emergency Support
Function (ESF-8) at the local or State level
Work closely with the local health department on
containment strategies should they be needed in the
future.
e Review guidance on Preventing the Spread in
Communities
Maintain situational awareness through trusted
sources
www.vdh. Virginia.gov/coronavirus or 1-877-ASK-VDH3
Non-Pharmaceutical Interventions
37
Non-Pharmaceutical Interventions
Aa
{9
_E-LI)
Vaccination and Treatment
Clinical trials for treatment and vaccines in development
Treatment
• Currently no specific antiviral treatment
• Supportive care
• Research is ongoing
Vaccine
• Currently no vaccine
• NIH research and development ongoing
• Projected timeline = 12-18 months
List of treatments and vaccines in development
https://www.clinicaltrialsarena.com/analysis/coronavirus-mers-
cov-drugs/
https://www.clinicaltrialsarena.com/analysis/coronavirus-mers-cov-drugs/
Vaccination and Treatment
Clinical trials for treatment and vaccines in development
Treatment
¢ Currently no specific antiviral treatment
¢ Supportive care
e Research is ongoing
Vaccine
¢ Currently no vaccine
e NIH research and development ongoing
¢ Projected timeline = 12-18 months
List of treatments and vaccines in development
https://www.clinicaltrialsarena.com/analysis/coronavirus-mers-
cov-drugs/
Knowledge Gaps
• Source of infection
• The pathogenesis and virulence evolution of the
virus
• Transmission dynamics
• Role of aerosol transmission in non-
healthcare settings
• Role of fecal-oral transmission
• Viral shedding
• Risk factors for infection
• Asymptomatic infection
• Seasonality39
Knowledge Gaps
¢ Source of infection


The pathogenesis and virulence evolution of the
virus


Transmission dynamics


¢ Role of aerosol transmission in non-
healthcare settings
e Role of fecal-oral transmission
¢ Viral shedding
¢ Risk factors for infection
e Asymptomatic infection
Seasonality
Resources
Virginia Department of Health (VDH)
• 35 Local Health Districts
• www.vdh.virginia.gov/coronavirus
• 1-877-ASK-VDH3 (1-877-275-8343)
Lenowisco Health District
• http://www.vdh.virginia.gov/lenowisco/
Centers for Disease Control and Prevention (CDC)
• www.cdc.gov/coronavirus/2019-nCoV
World Health Organization (WHO)
• www.who.int/emergencies/diseases/novel-
coronavirus-2019
40
Presenter
Presentation Notes
http://www.vdh.virginia.gov/coronavirus
http://www.vdh.virginia.gov/mount-rogers/
http://www.cdc.gov/coronavirus/2019-nCoV
http://www.who.int/emergencies/diseases/novel-coronavirus-2019
Resources
Virginia Department of Health (VDH)
¢ 35 Local Health Districts
¢ www.vdh. virginia. gov/coronavirus
¢ 1-877-ASK-VDH3 (1-877-275-8343)
Lenowisco Health District
e http: //www.vdh. virginia. gov/lenowisco/
Centers for Disease Control and Prevention (CDC)
e www.cdc.gov/coronavirus/2019-nCoV
World Health Organization (WHO)
¢ www.who.int/emergencies/diseases/novel-
coronavirus-2019
Questions?
Questions?
Novel Coronavirus (COVID-19)�SARS-CoV-2
Refer Calls to:
SARS-CoV-2�Initially referred to as 2019-nCoV
How does a novel virus originate?�CoVID-19 
Coronaviruses that Infect People
What is CoVID-19?
How Many People Are Sick?
COVID-19 Signs and Symptoms among Confirmed Cases Reported in China
Key Findings from the WHO-China Report (as of 2/20/20)�
Key Findings from the WHO-China Report (as of 2/20/20)�
Which Countries Have Confirmed Cases?
What Is the Current Risk for Virginians? �
How Is the U.S. Responding? 
How Is the U.S. Responding? 
How is VDH Responding?
How is VDH Responding?
Targeted Health Information
COMMUNITY MITIGATION
Slide Number 19
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Slide Number 32
Slide Number 33
Preventing COVID-19: What You Can Do
Take Home Messages
What Can Partners Do?
Non-Pharmaceutical Interventions
Slide Number 38
Knowledge Gaps 
Resources
Questions?