Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020

Margaret A. Honein, PhD; Athalia Christie, MIA; Dale A. Rose, PhD; John T. Brooks, MD; Dana Meaney-Delman, MD; Amanda Cohn, MD; Erin K. Sauber-Schatz, PhD; Allison Walker, PhD; L. Clifford McDonald, MD; Leandris C. Liburd, PhD; Jeffrey E. Hall, PhD; Alicia M. Fry, MD; Aron J. Hall, DVM; Neil Gupta, MD; Wendi L. Kuhnert, PhD; Paula W. Yoon, ScD; Adi V. Gundlapalli, MD, PhD; Michael J. Beach, PhD; Henry T. Walke, MD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(41):1860-1867.

Abstract and Introduction

Introduction

In the 10 months since the first confirmed case of coronavirus disease 2019 (COVID-19) was reported in the United States on January 20, 2020,^[1] approximately 13.8 million cases and 272,525 deaths have been reported in the United States. On October 30, the number of new cases reported in the United States in a single day exceeded 100,000 for the first time, and by December 2 had reached a daily high of 196,227.* With colder weather, more time spent indoors, the ongoing U.S. holiday season, and silent spread of disease, with approximately 50% of transmission from asymptomatic persons,^[2] the United States has entered a phase of high-level transmission where a multipronged approach to implementing all evidence-based public health strategies at both the individual and community levels is essential. This summary guidance highlights critical evidence-based CDC recommendations and sustainable strategies to reduce COVID-19 transmission. These strategies include 1) universal face mask use, 2) maintaining physical distance from other persons and limiting in-person contacts, 3) avoiding nonessential indoor spaces and crowded outdoor spaces, 4) increasing testing to rapidly identify and isolate infected persons, 5) promptly identifying, quarantining, and testing close contacts of persons with known COVID-19, 6) safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19, 7) protecting essential workers with provision of adequate personal protective equipment and safe work practices, 8) postponing travel, 9) increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and 10) achieving widespread availability and high community coverage with effective COVID-19 vaccines. In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic's economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool. Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible.

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*https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases.

Table. Individual- and community-level public health strategies to reduce SARS-CoV-2 transmission*
Recommended public health strategies	Individual- and household-level strategies	Community-level strategies (at state or local level)	Links to guidance
Universal use of face masks	Consistent and correct use of face masks, including within the household if there is a COVID-19 case or a person with a known or possible exposure in the household	Issue policies or directives mandating universal use of face masks in indoor (nonhousehold) settings	Considerations for wearing masks: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
		Plan for provision of face masks for specific populations if needed	Caring for someone sick at home, when to wear a mask or gloves: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html#face-covering
			Protect your home: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/protect-your-home.html
Physical distancing and limiting contacts	Maintain physical distance (≥6 feet) from other persons when possible, and limit number of contacts with persons outside the immediate household	Physical barriers and visual reminders might promote adherence to maintaining physical distance	Social distancing: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html
Physical distancing and limiting contacts			Personal and social activities: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/personal-social-activities.html
Avoid nonessential indoor spaces and crowded outdoor settings	Avoid nonessential indoor spaces and crowded outdoor settings	Issue policies or directives restricting some nonessential indoor spaces that pose the highest risk for transmission	Daily activities and going out: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/going-out.html
		Promoting flexible worksites (e.g., telework); apply limits to occupancy of indoor spaces and to the size of social gatherings	Considerations for events and gatherings: https://www.cdc.gov/coronavirus/2019-ncov/community/large-events/considerations-for-events-gatherings.html
Increased testing, diagnosis, and isolation	Persons with a known exposure to someone with COVID-19, with possible exposure, or who experience symptoms should promptly seek testing; symptomatic or infected persons should isolate promptly; exposed persons should quarantine	Increase access to testing, including expanded screening testing of prioritized persons/groups, prioritizing those with many interactions (or interactions with persons at high risk) based on their occupational or residential setting	Testing: https://www.cdc.gov/coronavirus/2019-ncov/testing/index.html
			Expanded screening testing: https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/expanded-screening-testing.html
		Promptly report test results to the person tested and to public health authorities	Isolate if you are sick: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html
			Guidance for health departments about COVID-19 testing in the community: https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/testing.html
Prompt case investigation and contact tracing to identify, quarantine, and test close contacts	Persons with diagnosed COVID-19 should provide names of known contacts; close contacts should anticipate a call from the health department, answer the call, adhere to quarantine, seek testing, and encourage their household members to quarantine	When incidence is high and overwhelms capacity, prioritize case investigation and contact tracing to promptly quarantine and test close contacts, based on time since sample collection and risk for spread to others (e.g., those working in high-density settings)	When to quarantine: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
			Contact tracing (your health): https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/contact-tracing.html
			Contact tracing (health departments): https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/contact-tracing/index.html
			Prioritizing case investigation and contact tracing: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/prioritization.html
			Quarantine: https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html
Safeguarding persons most at risk for severe illness or death	Persons with underlying medical conditions or risk factors that place them at increased risk for severe illness or death should minimize contact with nonhousehold members and nonessential indoor spaces	Protect persons most at risk for severe illness or death through 1) identifying populations at high risk in the community and 2) expanding access to testing, provision of support services, and messaging	People at increased risk: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html
Protecting essential workers	Essential workers should employ all available public health strategies to reduce their risk (e.g., wear face masks and keep physical distance)	Protect essential workers through policies directing administrative and structural prevention as well as expanded testing	Essential services and critical infrastructure: https://www.cdc.gov/coronavirus/2019-ncov/community/workplaces-businesses/essential-services.html
			COVID-19 critical infrastructure sector response planning: https://www.cdc.gov/coronavirus/2019-ncov/community/critical-infrastructure-sectors.html
			CISA guidance on the essential critical infrastructure workforce: https://www.cisa.gov/publication/guidance-essential-critical-infrastructure-workforce
Postponing travel	Travel should be postponed. Those who choose to travel internationally should be tested with a viral test 1–3 days before departure and retested 3–5 days after arrival; domestic travelers should also consider getting tested	Issue policies or directives mandating universal use of face masks on all modes of public transportation	Travel: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
	Travelers should stay home or reduce nonessential activities before and after travel and be diligent about mask wearing, physical distancing, hand hygiene, and symptom monitoring		When not to travel: https://www.cdc.gov/coronavirus/2019-ncov/travelers/when-to-delay-travel.html
			Wear face masks on public transportation conveyances and at transportation hubs: https://www.cdc.gov/coronavirus/2019-ncov/travelers/face-masks-public-transportation.html
			Mask and travel guidance: https://www.cdc.gov/quarantine/masks/mask-travel-guidance.html
			Domestic travel: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html
			Testing and international air travel: https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-air-travel.html
Increased room air ventilation, enhanced hand hygiene, and cleaning and disinfection	Increase room air ventilation	Enhance ventilation and cleaning and disinfection, particularly of essential indoor spaces	SARS-CoV-2 and potential airborne transmission: https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html
	Frequent handwashing	Ensure provision of adequate hand sanitation supplies	Ventilation: https://www.cdc.gov/coronavirus/2019-ncov/community/general-business-faq.html#Ventilation
			When and how to wash your hands: https://www.cdc.gov/handwashing/when-how-handwashing.html
			Cleaning and disinfecting: https://www.cdc.gov/coronavirus/2019-ncov/community/clean-disinfect/index.html
Widespread availability and coverage with effective vaccines	Seek vaccine when appropriate following ACIP recommendations	Plan for distribution and administration of vaccines to achieve high community coverage	Vaccines: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
	Continue to follow all mitigation measures until community vaccination coverage is adequate	Communicate that mitigation measures still need to be followed until community vaccination coverage is determined to be adequate	Vaccination planning: https://www.cdc.gov/vaccines/covid-19/planning/index.html

Abbreviations: ACIP = Advisory Committee on Immunization Practices; COVID-19 = coronavirus disease 2019.
*https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance-list.html.