Physical/Social Distancing, Isolation, and Quarantine
COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.
Based upon available information to date, those at high-risk for severe illness from COVID-19 include:
• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
o People with chronic lung disease or moderate to severe asthma
o People who have heart disease with complications
o People who are immunocompromised including cancer treatment
o People of any age with severe obesity (body mass index [(BM]I)≥40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with a severe viral illness, however, to date data on COVID-19 has not shown an increased risk
There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19).
The best way to prevent illness is to avoid being exposed to this virus.
The virus is thought to spread mainly from person-to-person.
• Between people who are in close contact with one another (within about 6 feet).
• Respiratory droplets produced when an infected person coughs or sneezes.
• These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
Social distancing is the practice of increasing the space between individuals and decreasing the frequency of contact to reduce the risk of spreading a disease.
Please practice Social distancing by increasing the space between yourself and other individuals and decreasing the frequency of contact with others to reduce the risk of spreading disease (ideally to maintain at least 6 feet between all individuals, even those who are asymptomatic).
Social distancing strategies can be applied on an individual level (e.g., avoiding physical contact), a group level (e.g., canceling group activities where individuals will be in close contact), and an operational level (e.g., rearranging chairs in the dining hall to increase the distance between them).
Although social distancing is challenging to practice, it is a cornerstone of reducing transmission of respiratory diseases such as COVID-19.
Avoid close contact
Social distancing avoids close contact with people who are sick.
Close contact is defined as—
a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-19 case
– or –
b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).
Put six feet of Social distancing between yourself and other people if COVID-19 is spreading in your community. This is especially important for people who are at higher risk of getting very sick.
Based on available information, adults aged 65 years and older and people of any age with underlying medical conditions included on the above list are at higher risk for severe illness and poorer outcomes from COVID-19.
The CDC is collecting and analyzing data regularly and will update the list when they learn more. People with underlying medical conditions not on the list might also be at higher risk and should consult with their healthcare provider if they are concerned.
We at Lessons for Legal Nurses encourage all people to practice social distancing, and regardless of risk, to:
• Take steps to protect yourself and others.
• Call your healthcare provider if you are sick with a fever, cough, or shortness of breath.
• Follow CDC travel guidelines and the recommendations of your state and local health officials.
Isolation is defined as the separation or restriction of activities of an ill person with a contagious disease from those who are well.
Patients with COVID-19 should be evaluated as to the need for hospitalization. If hospitalization is not medically necessary, home care is preferable if the individual’s situation allows.
In consultation with state or local health department staff, a healthcare professional should assess whether the residential setting is appropriate for home care.
Considerations for care at home include whether:
• The patient is stable enough to receive care at home.
• Appropriate caregivers are available at home.
• There is a separate bedroom where the patient can recover without sharing immediate space with others.
• Resources for access to food and other necessities are available.
• The patient and other household members have access to appropriate, recommended personal protective equipment (at a minimum, gloves, and facemask) and are capable of adhering to precautions recommended as part of home care or isolation (e.g., respiratory hygiene and cough etiquette, hand hygiene);
• There are household members who may be at increased risk of complications from COVID-19 infection (.e.g., people >65 years old, young children, pregnant women, people who are immunocompromised or who have chronic heart, lung, or kidney conditions).
Household members, intimate partners, and caregivers in a nonhealthcare setting may have close contact with a person with symptomatic, laboratory-confirmed COVID-19 or a person under investigation.
Close contacts should monitor their health; they should call their healthcare provider right away if they develop symptoms suggestive of COVID-19 (e.g., fever, cough, shortness of breath)
Close contacts should also follow these recommendations:
• Make sure that you understand and can help the patient follow their healthcare provider’s instructions for the medication(s) and care. You should help the patient with basic needs in the home and provide support for getting groceries, prescriptions, and other personal needs.
• Monitor the patient’s symptoms. If the patient is getting sicker, call his or her healthcare provider and tell them that the patient has laboratory-confirmed COVID-19. This will help the healthcare provider’s office take steps to keep other people in the office or waiting room from getting infected. Ask the healthcare provider to call the local or state health department for additional guidance. If the patient has a medical emergency and you need to call 911, notify the dispatch personnel that the patient has, or is being evaluated for COVID-19.
• Household members should stay in another room or be separated from the patient as much as possible. Household members should use a separate bedroom and bathroom, if available.
• Prohibit visitors who do not have an essential need to be in the home.
• Household members should care for any pets in the home. Do not handle pets or other animals while sick.
• Make sure that shared spaces in the home have good airflows, such as by an air conditioner or an opened window, weather permitting.
• Perform hand hygiene frequently. Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer that contains 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• The patient should wear a facemask when you are around other people. If the patient is not able to wear a facemask (for example, because it causes trouble breathing), you, as the caregiver, should wear a mask when you are in the same room as the patient.
• Wear a disposable facemask and gloves when you touch or have contact with the patient’s blood, stool, or body fluids, such as saliva, sputum, nasal mucus, vomit, urine.
o Throw out disposable facemasks and gloves after using them. Do not reuse it.
o When removing personal protective equipment, first remove and dispose of gloves. Then, immediately clean your hands with soap and water or alcohol-based hand sanitizer. Next, remove and dispose of facemask, and immediately clean your hands again with soap and water or alcohol-based hand sanitizer.
• Avoid sharing household items with the patient. You should not share dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items. After the patient uses these items, you should wash them thoroughly (see below “Wash laundry thoroughly”).
• Clean all “high-touch” surfaces, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables, every day. Also, clean any surfaces that may have blood, stool, or body fluids on them.
o Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during the use of the product.
• Wash laundry thoroughly.
o Immediately remove and wash clothes or bedding that have blood, stool, or body fluids on them.
o Wear disposable gloves while handling soiled items and keep soiled items away from your body. Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after removing your gloves.
o Read and follow directions on labels of laundry or clothing items and detergent. In general, using a normal laundry detergent according to washing machine instructions and dry thoroughly using the warmest temperatures recommended on the clothing label.
• Place all used disposable gloves, facemasks, and other contaminated items in a lined container before disposing of them with other household waste. Clean your hands (with soap and water or an alcohol-based hand sanitizer) immediately after handling these items. Soap and water should be used preferentially if hands are visibly dirty.
• Discuss any additional questions with your state or local health department or healthcare provider. Check available hours when contacting your local health department.
In hospital settings:
Hospitals will ensure rapid safe triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough). They will set up separate, well-ventilated triage areas, place patients with suspected or confirmed COVID-19 in private rooms with the door closed and private bathroom (as possible), prioritize Airborne Infection Isolation Rooms (AIIRs) for patients undergoing aerosol-generating procedures.
All visitors should perform frequent hand hygiene and follow respiratory hygiene and cough etiquette precautions while in the facility, especially in common areas.
Hospitals will implement mechanisms and policies that promote situational awareness for facility staff including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected COVID-19 patients and facility plans for response.
Quarantine refers to the practice of confining individuals to determine whether they develop symptoms of disease.
Persons who are close contacts of a confirmed or suspected COVID-19 case should be placed under quarantine for 14 days.
If an individual is quarantined due to contact with a suspected case who is subsequently tested for COVID-19 and receives a negative result, the quarantined individual should be released from quarantine restrictions.
If the person in quarantine develops symptoms during the 14-day period, the individual should be placed under medical isolation and evaluated for COVID-19. If symptoms do not develop, movement restrictions can be lifted, and the individual can return to their previous activities.
Keep a quarantined individual’s movement outside the quarantine space to an absolute minimum.
• Provide medical evaluation and care inside or near the quarantine space when possible.
• Serve meals inside the quarantine space.
• Exclude the quarantined individual from all group activities.
• Assign the quarantined individual a dedicated bathroom when possible.
As a measure to limit health care personnel exposure and conserve personal protective equipment, facilities could consider designating entire units within the facility, with dedicated health care personnel, to care for known COVID-19 patients. Dedicated means that health care personnel are assigned to care only for these patients during their shift.
Patients with known COVID-19 should be housed in the same room for the duration of their stay in the facility (e.g., minimize room transfers).
Patients should wear a facemask to contain secretions during transport. If patients cannot tolerate a facemask or one is not available, they should use tissues to cover their mouth and nose.
Restriction of all visitors is implemented. However, facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional well-being and care.
Physical/social distancing – In the context of COVID-19, an individual is considered a close contact if they have been within approximately 6 feet of another person.
Medical Isolation – Medical isolation refers to confining a confirmed or suspected COVID-19 case, to prevent contact with others and to reduce the risk of transmission.
Quarantine – Quarantine refers to the practice of confining individuals who have had close contact with a COVID-19 case to determine whether they develop symptoms of the disease. Quarantine for COVID-19 should last for a period of 14 days.
My friend Chou Xiong, a visual brand designer, has written a blog about social distancing: Social Distance & What You Can Do to Grow Your Business. Please go take a look.