Coronavirus Disease 2019 (COVID-19) Infection Control Recommendations during Holiday Celebrations

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AFL 20-86.1 From the California Department of Public Health

November 20, 2020

TO: Long-Term Care Facilities

SUBJECT: Coronavirus Disease 2019 (COVID-19) Infection Control Recommendations during Holiday Celebrations
(This AFL supersedes AFL 20-86)

All Facilities Letter (AFL) Summary

  • This AFL provides COVID-19 infection control recommendations during holiday celebrations for residents, families, and facilities. This includes:
    • Guidance for private gatherings
    • Resident placement after returning to the facility
    • Communal activities in facilities
  • This revision provides additional guidance for intermediate care facilities for the developmentally disabled – habilitative, nursing, and continuous nursing (ICF/DD-H-N-CN).

Background

During the holidays, residents may leave their facilities to celebrate with their families and friends in accordance with CDPH Guidance for Private Gatherings. People at higher risk of severe illness or death from COVID-19 (such as older adults and people with chronic medical conditions) are strongly urged not to attend any gatherings; however, if higher-risk individuals do attend gatherings, the California Department of Public Health (CDPH) is providing infection control recommendations for residents, families, and facilities to safely celebrate the holidays.

Recommendations for Residents and Families

If a resident is considering leaving the facility and attending an in-person gathering, residents and families should review the following resources:

These resources provide considerations to help protect individuals and their families, friends, and communities from COVID-19. Factors to consider include the following:

  1. Community levels of COVID-19 – Consider the number and rate of COVID-19 cases in your community and in the community where you plan to celebrate. County COVID-19 tier information is available on the Blueprint for a Safer Economy website.
  2. Location of the gathering – Gatherings that occur outdoors are significantly safer than indoor gatherings.
    • All gatherings (involving different households)[i] should be held outside. Attendees may go inside to use restrooms as long as the restrooms are frequently sanitized.
    • If an outdoor gathering is not possible, avoid crowded, poorly ventilated, and fully enclosed indoor spaces. Increase ventilation by opening windows and doors to the extent that is safe and feasibly based on the weather.
  3. Duration of the gathering – Gatherings that last longer pose more risk than shorter gatherings. Gatherings should be two hours or less.
  4. Number of people at the gathering – Gatherings with more people pose more risk than gatherings with fewer people. Gatherings should not include more than three households. This includes everyone present, including hosts and guests.
  5. Locations attendees are traveling from – Gatherings with attendees who are traveling from different places pose a higher risk than gatherings with attendees who live in the same area. Higher levels of COVID-19 cases and community spread in the gathering location, or where attendees are coming from, increase the risk of infection and spread among attendees.
  6. Behaviors of attendees prior to the gathering – Gatherings with attendees who are not adhering to social distancing (staying at least 6 feet apart), wearing a mask, hand washing, and other prevention behaviors pose more risk than gatherings with attendees who are engaging in these preventative behaviors.
  7. Behaviors of attendees during the gathering – Gatherings with more preventive measures in place, such as mask wearing, social distancing, and hand washing, pose less risk than gatherings where fewer or no preventive measures are being implemented.During holiday gatherings, CDPH recommends:
    • Stay at home if you are sick
    • Encourage social distancing of at least six feet apart
    • Wear face masks
    • Clean hands often
    • Limit the number of people handling or serving food
    • Limit contact with commonly touched surfaces or shared items

People (including residents) should not attend in-person holiday celebrations if they:

  • Have been diagnosed with COVID-19
  • Have symptoms of COVID-19
  • Are waiting for COVID-19 viral test results
  • May have been exposed to someone with COVID-19 in the last 14 days
  • Are at increased risk of severe illness from COVID-19

Recommendations for Facilities

Facilities may hold communal holiday activities and dining while adhering to the core principles of COVID-19 infection prevention:

  • Residents who are not on isolation precautions or quarantine may eat in the same room with social distancing (e.g., limited number of people at each table and with at least six feet between each person). Facilities should consider additional limitations based on status of COVID-19 infections in the facility. Facilities should consider defining groups of residents that consistently participate in communal dining together to minimize the number of people exposed if one or more of the residents is later identified as positive. Facial coverings should be worn when going to the dining area and whenever not eating or drinking.
  • Group activities may also be facilitated (for residents who have fully recovered from COVID-19, and for those not in isolation or quarantine) with social distancing among residents, appropriate hand hygiene, and use of a face covering.
  • Encourage as many of these activities to occur outdoors when feasible, especially when eating or drinking and face coverings will not be worn.

Facility communal holiday activities and dining may not include visitors.

For residents returning to facilities from holiday celebrations, facilities should screen returning residents for signs and symptoms of COVID-19 and immediately test and isolate symptomatic residents in a single room pending results. SNFs should quarantine residents returning to the SNF from visits to settings in communities with substantial or widespread transmission based on the Blueprint for a Safer Economy website (or gatherings with participants coming from communities with substantial or widespread transmission) in the yellow-observation area (in a single room, if available) for 14 days, and test at the end of the 14-day period before returning to the general population or green-unexposed area.  SNFs must prepare to implement transmission-based precautions as needed for residents returning to the facility.

For Residents of ICF/DD – H/N/CN:

  • Overnight visits will not be permitted for residents seeking to visit communities with substantial or widespread transmission based on the Blueprint for a Safer Economy.  
  • For residents returning to facilities from holiday celebrations, facilities should screen residents for signs and symptoms of COVID and immediately test and isolate symptomatic residents pending results.  Facilities should quarantine residents returning to facilities from visits to settings in communities with substantial or widespread transmission (or with gatherings with participants coming from communities with substantial or widespread transmission) for 14 days, and test at the end of the 14-day period before returning to general population.
  • If facilities do not have the capacity to follow these isolation guidelines (due to space or staffing issues), absentee visitation will not be permitted. 

Questions

If you have any questions about infection control concerns, please contact the CDPH Healthcare-Associated Infections Program at HAIProgram@cdph.ca.gov or novelvirus@cdph.ca.gov.

Sincerely,

Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director

Resources:


[i] CDPH Guidance for Private Gatherings, November 2020 defines gatherings as “social situations that bring together people from different households at the same time in a single space or place.”

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