Los Angeles County Department of Public HealthAcute Communicable Disease Control Program

March 23, 2021

COVID-19 Updates for Community Care Facilities (Non-SNF Congregate Caregiving Facilities):

Vaccines, Visitation, and More

Disclosures

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There is no commercial support for today’s session.

Neither the speakers nor planners for today’s session have disclosed any financial interests related to the

content of the meeting.

This session is meant for community care facilities and is off the record. Reporters should log off now.

DISCLAIMER

• This is a rapidly evolving situation so the information being presented is current as of today (3/23/2021), so we highly recommend that if you have questions after today you utilize the resources that we will review at the end of this presentation.

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Presentation Agenda

• Current trends • Antigen testing: CDSS PIN 21-16-ASC (March 15, 2021)• Vaccine rollout updates

• Guidance updates following the release of the CDSS PIN 21-17-ASC on 03/19/2021 and the CDPH AFL 20-22.6 on 03/08/2021.

• Q & A

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LA County Current Trends and Vaccine Rollout Updates

5http://publichealth.lacounty.gov/media/coronavirus/data/index.htm

POC Antigen Testing • Provides guidance to licensees about POC antigen tests specifically Binax NOW test

• Refers to CDC and CDPH guidance on the use of POC antigen tests

• According to the EUA, only facilities with Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver, certificate of compliance or certificate of accreditation may use the test

• Forthcoming PIN will be issued by CCLD explaining how facilities who do not have a CLIA certification of waiver can begin receiving these tests

6https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/ASC/PIN-21-16-ASC.pdf

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http://publichealth.lacounty.gov/media/coronavirus/vaccine/vaccine-dashboard.htm

Adjusted Death Rate per 100,000 population by City/Community

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Limited Vaccine Supply Necessitates Equitable Prioritization Further

Equity Index (HPI) by City Boundaries

9http://publichealth.lacounty.gov/acd/ncorona2019/vaccine/hcwsignup/

LA County Vaccine Rollout Summary and Identifying Equity Gaps• Phase 1B Tier 1; with sector planning e.g., > 65-year-old• March 1 : Education, Food and Agriculture and First Responders• March 15 : >16-64 years with comorbid illnesses• Zip code and HPI directed roll out• The state has partnered with Blue Shield as a third-party administrator to plan and

manage a centralized vaccine allocation and distribution system

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DPH Weekly Survey of Medium and Large CCFs: Vaccine Responses

Guidance Updates Based on the CDSS PIN 21-17-ASC and the CDPH AFL 20-22.6

Definition of “Fully Vaccinated”

• 2 weeks after receiving the second dose of a 2-dose vaccine, such as the Pfizer or Moderna vaccines.

• 2 weeks after receiving the only dose of a 1-dose vaccine, such as the Johnson & Johnson Janssen vaccine.

• If not meeting these requirements, the individual is unvaccinated (never received any vaccine dose) or partially vaccinated (only received 1 dose of a 2-dose vaccine).

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CDC Definition of Fully Vaccinated

Communal Dining and Group Activities

• Still restricted to Green Zone residents only.• Still requiring physical distancing and face covering and hand hygiene.• Still ideally with the same group of people every time.• Still ceased for at least 14 days if any positive COVID-19 cases found in any resident.

May resume once there have been no new resident COVID-19 cases identified for 14 days.

• No change at this time, regardless of vaccination status or percentage in the facility.

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Visitation

• Outdoor visitation: open to Green and Yellow Zone residents and encouraged for safety. – Requirements for screening visitors for symptoms of and exposure to COVID-19,

face coverings, physical distancing, hand hygiene, staff monitoring, scheduled visits, and limited movement of visitors are still in place.

– Fully vaccinated visitors who are visiting fully vaccinated residents may engage in brief physical contact such as hugging, holding hands, and assisting with feeding and grooming. Both parties should participate in hand hygiene before and after contact.

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Visitation

• Indoor and in-room visitation: open to all Green and Yellow Zone residents regardless of vaccination status in all county tiers except Tier 1 (Purple), when the resident must be fully vaccinated.– Requirements for screening visitors for symptoms of and exposure to COVID-19,

face coverings, physical distancing, hand hygiene, staff monitoring, scheduled visits, and limited movement of visitors are still in place.

– Fully vaccinated visitors who are visiting fully vaccinated residents may engage in brief physical contact such as hugging, holding hands, and assisting with feeding and grooming. Both parties should participate in hand hygiene before and after contact.

– When the county is in Tier 1 (Purple), all visitors must have a negative PCR or POC COVID-19 test within 48 hours of visiting.

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Best Practices for Visitation• Shorter indoor visits and longer outdoor visits.• Limited number of visitors at any one time on the facility premises.• Designated separate facility entrance and exit.• Signage detailing visitation regulations and source control measures.• Education for visitors on monitoring themselves for COVID-19 symptoms.• Designated handwashing/antibacterial hand sanitizer stations or individual bottles.• Regular visitor testing with regular surveillance testing.• Visitor log• Residents with roommates having visits in separate indoor spaces or without

roommate present.• Frequent cleaning and disinfection, and cleaning after every visit.

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Resident Outings• Facilities should provide residents and their families/friends education on what

activities are safe.• Residents who are asymptomatic upon their return to the facility but have had close

contact with someone with COVID-19, should be placed in quarantine (Yellow Zone) for 14 days, regardless of vaccination status.

• Residents who are asymptomatic upon their return to the facility and have not had close contact with someone with COVID-19 should not be quarantined but should be monitored daily for COVID-19 symptoms.

• The same applies to residents who followed all of the guidelines: hand hygiene, physical distancing, face covering, no close contact with a COVID-19 positive person, and no gathering with more than 3 households or indoors.

• All residents that have gone out of the facility for a visit with family/friends should be screened for high-risk exposures while outside the facility when they return.

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Quarantine After Vaccination• If a staff member has been fully vaccinated and is exposed to someone with COVID-

19, they may return to work while appropriately practicing source control measures if they are asymptomatic.

• If a resident comes into close contact with someone with COVID-19, the resident must be quarantined for 14 days, regardless of the resident’s vaccination status or the vaccination status of the COVID-19 positive individual.

• Newly admitted residents or those transferred from another facility or readmitted from a higher level of care still need to be quarantined in the Yellow Zone for 14 days if they are unvaccinated or partially vaccinated.

• Newly admitted residents or those transferred from another facility or readmitted from a higher level of care do not need to be quarantined in the Yellow Zone for 14 days if they are asymptomatic and/or have not had close contact with a COVID-19 positive individual.

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Transporting Residents

• No change to previous guidance: appropriate PPE and control measures regardless of vaccination status of the resident or the transporter.

• Avoid prolonged transportation times if possible, to minimize intensity and duration of exposure

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https://www.cdc.gov/media/releases/2021/p0308-vaccinated-guidelines.html

Friday March 26th CDPH Noon Webinar and Q & A on CDSS PIN 21-17-ASC

Zoom Webinar Call Information: Friday, March 26, 2021; 12:00 PM – 1:00 PM

Please click the link below to join the webinar: https://ucsf.zoom.us/j/97628631488?pwd=WHdsY05aTXlPQ1JuclF2U1BYUmk0UT09Passcode: 093160Or iPhone one-tap:

US: +16692192599,,97628631488#,,,,*093160# or +16699006833,,97628631488#,,,,*093160#Or Telephone:

Dial (for higher quality, dial a number based on your current location):US: +1 669 219 2599 or +1 669 900 6833 or +1 213 338 8477Webinar ID: 976 2863 1488; Passcode: 093160

Panelists: Louise Aronson, MD, MFA, Professor, Division of Geriatrics, UCSF, Clinical Lead, SFDPH Senior HubJosh Allen, RN, Principal, Allen Flores Consulting Group

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CCF Resources

• CCF Webpage and Guidance:– Webpage: http://publichealth.lacounty.gov/acd/ncorona2019/healthfacilities/ccf/– Guidance: http://publichealth.lacounty.gov/acd/docs/CCFGuidance.pdf

• CDPH AFL 20-22.6: https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-22.aspx

• CDSS PIN 21-17-ASC: https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2021/ASC/PIN-21-17-ASC.pdf

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COVID-19 Vaccine Online Resources• Los Angeles County DPH

– COVID-19 Vaccine Acceptance: http://publichealth.lacounty.gov/acd/ncorona2019/healthfacilities/ccf/#vaccine-resources

– COVID-19 Vaccine Provider Information Hub: http://publichealth.lacounty.gov/acd/ncorona2019/vaccine/

– Guidance for Allocation of Phase 1a COVID-19 Vaccine:http://publichealth.lacounty.gov/acd/docs/LACPhase1AFullGuidance.pdf

• CDPH COVID-19 Vaccination Program– https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/COVID-19Vaccine.aspx

– California Immunization Registry (CAIR): http://cairweb.org/enroll-now/

• CDC: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html

– HCP: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/hcp.html

– LTCF: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/LTCF-residents.html

• PALTC/AMDA (Society for Post-Acute and Long-Term Care Medicine) COVID-19 Vaccine Resources: https://www.caltcm.org/covid-19

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Questions and Answers

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