later. Quarantine cannot be discontinued earlier than after day 7. Both options require that daily monitoring for fever and symptoms. CDC guidance includes the following information: • A resident can discontinue quarantine of either option described above only if the following criteria are also met: o No COVID-19 symptoms were detected by daily symptom monitoring during the entirety of the quarantine, including up to the time at which quarantine is discontinued; o Daily symptom monitoring continues through day 14; and o A resident is counseled about the need to adhere strictly through day 14 to all mitigation strategies, such as wearing a mask, avoiding crowds, practicing physical distancing, and practicing hand and cough hygiene. • Testing under option #2 above should be considered only if it will have no impact on community diagnostic testing. Testing of persons seeking evaluation for an actual infection must be prioritized. Continue to watch for symptoms until 14 days after exposure. If a resident develops symptoms, he or she should immediately be isolated, and the local public health authority or health care provider should be contacted. Follow all recommendations from the CDC on when to quarantine. Isolation - Once a case of COVID-19 is identified in the NF, immediate action must be taken to isolate the resident who is positive for COVID-19 away from other residents. Symptoms of COVID-19 can vary in severity. Initially, symptoms can be mild and not require transfer to a hospital if the NF can follow the infection prevention and control practices recommended by CDC. Residents with known or probable COVID-19 do not need to be placed into an airborne infection isolation room (AIIR) but should be placed in a private room with their own bathroom. If a resident requires a higher level of care or the NF cannot fully implement all recommended precautions, the resident should be transferred to another facility capable of implementation. Transport personnel and the receiving facility should be Page | 33 notified about the probable diagnosis prior to transfer. While awaiting transfer, symptomatic residents should wear a facemask (if tolerated) and be separated from others (kept in their room with the door closed). Appropriate PPE should be used by HCP when encountering the resident. [With PPE becoming more readily available, facilities should be able to care for a resident with COVID-19, if they are stable and do not require a higher level of care or hospitalization.] Any exposed roommates should be moved and monitored for fever and symptoms, per the CDC. Room-sharing might be necessary if there are multiple residents with known or probable COVID-19 in the NF. Public health authorities can assist with decisions about resident placement. Create a plan for cohorting residents with symptoms of respiratory infection and COVID-19, including dedicating HCP to work only on affected units, if possible. If the resident is transferred to a higher level of care, perform a final, full clean of the room, and use an EPA-registered disinfectant that has qualified under EPA’s emerging viral pathogens program for use against COVID-19. These products can be found on EPA’s List N. Source control. All residents who are ill should wear a facemask over both the mouth and nose as tolerated, when health care or other essential personnel enter the resident’s room per CMS and CDC guidance. Exceptions include when the resident is eating or drinking, taking medications, or performing personal hygiene like bathing or oral care. [Nursing facilities are healthcare settings, but they also serve as a home for residents and quality of life should be balanced with risks for transmission. In light of this, residents who are up to date with all recommended COVID-19 vaccine doses can choose not to use source control when in communal areas of the facility. Residents at increased risk for severe disease should still continue to practice physical distancing and use source control.] Cloth face coverings or facemasks should not be placed on anyone who has trouble breathing, or anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Personnel who enter the room must wear N95 respirators, if available and staff are fit-tested. Respiratory protection should be worn in addition to gown, gloves and face shield. Visitors, if permitted into the NF, should wear a cloth face covering, facemask, or any other appropriate PPE while in the NF, in accordance with CMS and CDC guidance. [Indoor visitation (in single-person rooms; in multi-person rooms, when roommates are not present; or in designated visitation areas when others are not present): The safest practice is for residents and visitors to wear source control and physically distance, particularly if either of them are at risk for severe disease or are not up to date with COVID-19 vaccinations. • If the resident and all their visitors are up to date with all recommended COVID-19 vaccine doses, they can choose not to wear source control and to have physical contact. Page | 34 • Visitors should wear source control when around other residents or HCP, regardless of vaccination status. Outdoor Visitation: Residents and their visitors should follow the source control and physical distancing recommendations for outdoor settings described on the page addressing Your Guide to Masks.] If