Guidelines Opening Up America Again
April 22, 2020
Proposed State or Regional Gating Criteria
(Satisfy Before Proceeding to Phased Opening)
SYMPTOMS
Downward trajectory of influenza like illnesses (ILI) reported within a 14 day period
AND
Downward trajectory of covid like syndromic cases reported within a 14 day period
CASES
Downward trajectory of documented cases within a 14 day period
OR
Downward trajectory of positive tests as a percent of total tests within a 14 day period (flat or increasing volume of tests)
HOSPITALS
Treat all patients without crisis care
AND
Robust testing program in place for at risk healthcare workers, including emerging antibody testing
*State and local officials may need to tailor the application of these criteria to local circumstances (e.g., metropolitan areas that have suffered severe COVID outbreaks, rural and suburban areas where outbreaks have not occurred or have been mild). Additionally , where appropriate, Governors should work on a regional basis to satisfy these criteria and to progress through the phases outlined below.
Core State Preparedness Responsibilities
TESTING & CONTACT TRACING
- Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results
- Ability to test Syndromic/ILI indicated persons for COVID and trace contacts of COVID+ results
- Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower income Americans, racial minorities, and Native Americans)
HEALTHCARE SYSTEM CAPACITY
- Ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need
- Ability to surge ICU capacity
PLANS
- Protect the health and safety of workers in critical industries
- Protect the health and safety of those living and working in high risk facilities (e.g., senior care facilities)
- Protect employees and users of mass transit
- Advise citizens regarding protocols for social distancing and face coverings
- Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity
Proposed Phased Approach
Based on UP-TO-DATE DATA and Readiness
MITIGATES risk of resurgence
PROTECTS the most vulnerable
Implementable on STATEWIDE OR COUNTY-BY-COUNTY basis at Governors’ discretion
Guidelines for All Phases: Individuals
CONTINUE TO PRACTICE GOOD HYGIENE
- Wash your hands with soap and water or use hand sanitizer, especially after touching frequently used items or surfaces.
- Avoid touching your face.
- Sneeze or cough into a tissue, or the inside of your elbow.
- Disinfect frequently used items and surfaces as much as possible.
- Strongly consider using face coverings while in public, and particularly when using mass transit.
PEOPLE WHO FEEL SICK SHOULD STAY HOME
- Do not go to work or school.
- Contact and follow the advice of your medical provider.
Continue to adhere to State and local guidance as well as complementary CDC guidance, particularly with respect to face coverings.
Guidelines for All Phases: Employers
Develop and implement appropriate policies, in accordance with Federal, State, and local regulations and guidance, and informed by industry best practices, regarding:
- Social distancing and protective equipment
- Temperature checks
- Testing, isolating, and contact tracing
- Sanitation
- Use and disinfection of common and high traffic areas
- Business travel
Monitor workforce for indicative symptoms. Do not allow symptomatic people to physically return to work until cleared by a medical provider.
Develop and implement policies and procedures for workforce contact tracing following employee COVID+ test.
Phase One
FOR STATES AND REGIONS THAT SATISFY THE GATING CRITERIA
Phase One – INDIVIDUALS
ALL VULNERABLE INDIVIDUALS* should continue to shelter in place. Members of households with vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. Precautions should be taken to isolate from vulnerable residents.
All individuals, WHEN IN PUBLIC (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Social settings of more than 10 people, where appropriate distancing may not be practical, should be avoided unless precautionary measures are observed.
Avoid SOCIALIZING in groups of more than 10 people in circumstances that do not readily allow for appropriate physical distancing (e.g., receptions, trade shows)
MINIMIZE NON ESSENTIAL TRAVEL and adhere to CDC guidelines regarding isolation following travel.
*See Appendix 1 for Definition of Vulnerable Individuals
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase One – EMPLOYERS
Continue to ENCOURAGE TELEWORK, whenever possible and feasible with business operations.
If possible, RETURN TO WORK IN PHASES.
Close COMMON AREAS where personnel are likely to congregate and interact, or enforce strict social distancing protocols.
Minimize NON ESSENTIAL TRAVEL and adhere to CDC guidelines regarding isolation following travel.
Strongly consider SPECIAL ACCOMMODATIONS for personnel who are members of a VULNERABLE POPULATION.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase One – SPECIFIC TYPES OF EMPLOYERS
SCHOOLS AND ORGANIZED YOUTH ACTIVITIES (e.g., daycare, camp) that are currently closed should remain closed.
VISITS TO SENIOR LIVING FACILITIES AND HOSPITALS should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene.
LARGE VENUES (e.g., sit down dining, movie theaters, sporting venues, places of worship) can operate under strict physical distancing protocols.
ELECTIVE SURGERIES can resume, as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines.
GYMS can open if they adhere to strict physical distancing and sanitation protocols.
BARS should remain closed.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase Two
FOR STATES AND REGIONS WITH NO EVIDENCE OF A REBOUND AND THAT SATISFY THE GATING CRITERIA A SECOND TIME
Phase Two – INDIVIDUALS
ALL VULNERABLE INDIVIDUALS should continue to shelter in place. Members of households with vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. Precautions should be taken to isolate from vulnerable residents.
All individuals, WHEN IN PUBLIC (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Social settings of more than 50 people, where appropriate distancing may not be practical, should be avoided unless precautionary measures are observed.
NON ESSENTIAL TRAVEL can resume.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase Two – EMPLOYERS
Continue to ENCOURAGE TELEWORK, whenever possible and feasible with business operations.
Close COMMON AREAS where personnel are likely to congregate and interact, or enforce moderate social distancing protocols.
NON ESSENTIAL TRAVEL can resume.
Strongly consider SPECIAL ACCOMMODATIONS for personnel who are members of a VULNERABLE POPULATION.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase Two – SPECIFIC TYPES OF EMPLOYERS
SCHOOLS AND ORGANIZED YOUTH ACTIVITIES (e.g., daycare, camp) can reopen.
VISITS TO SENIOR CARE FACILITIES AND HOSPITALS should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene.
LARGE VENUES (e.g., sit down dining, movie theaters, sporting venues, places of worship) can operate under moderate physical distancing protocols.
ELECTIVE SURGERIES can resume, as clinically appropriate, on an outpatient and in patient basis at facilities that adhere to CMS guidelines.
GYMS can remain open if they adhere to strict physical distancing and sanitation protocols.
BARS may operate with diminished standing room occupancy, where applicable and appropriate.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase Three
FOR STATES AND REGIONS WITH NO EVIDENCE OF A REBOUND AND THAT SATISFY THE GATING CRITERIA A THIRD TIME
Phase Three – INDIVIDUALS
VULNERABLE INDIVIDUALS can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed.
LOW RISK POPULATIONS should consider minimizing time spent in crowded environments.
Phase Three – EMPLOYERS
Resume UNRESTRICTED STAFFING of worksites.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Phase Three – SPECIFIC TYPES OF EMPLOYERS
VISITS TO SENIOR CARE FACILITIES AND HOSPITALS can resume. Those who interact with residents and patients must be diligent regarding hygiene.
LARGE VENUES (e.g., sit down dining, movie theaters, sporting venues, places of worship) can operate under limited physical distancing protocols.
GYMS can remain open if they adhere to standard sanitation protocols.
BARS may operate with increased standing room occupancy, where applicable.
EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID.
Appendix – Vulerable Individuals
1. Elderly individuals.
2. Individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy.
