completed. Note: Please also read ‘Testing of asymptomatic residents or HCP as part of an outbreak response or those who are known close contacts of persons with COVID-19’ under the Antigen Testing section. Page | 36 [Residents who are up to date with all recommended COVID-19 vaccine doses including any booster dose] (asymptomatic) - Quarantine is no longer recommended for residents who are being admitted to a NF if they are: • [Up to date;] and • Asymptomatic This includes new admissions, readmissions, and a resident who was gone overnight; as long as the resident remains asymptomatic. These residents may be admitted into or return to the COVID-19 negative cohort (cold zone). In general, people are considered [up to date: after a person has received all recommended COVID-19 vaccines, including any booster doses when eligible.] If a newly admitted resident experience symptoms, regardless of their vaccination status, they should be clinically evaluated for COVID-19, including testing for COVID19, if indicated. As of now, the CDC has not set a time limit regarding how long those who have been [up to date with all recommended COVID-19 vaccine doses including any booster dose] may be exempt from quarantine. Testing for COVID-19 should continue per facility protocol and CMS requirements, including for those who are [up to date with all recommended COVID-19 vaccine doses including any booster dose]. [In general, testing is not necessary for asymptomatic people who have recovered from COVID-19 infection in the prior 90 days; however, if testing is performed on these people, an antigen test instead of a PCR test is recommended. This is because some people may remain “PCR positive” but not be infectious during this period.] Tuberculosis (TB) Testing and the COVID-19 Vaccine: The CDC issued new guidance on the interpretation of TB test results in vaccinated persons. The guidance includes clinical considerations for administering the COVID-19 vaccine to individuals who also need to be screened and tested for TB. The CDC guidance on TB testing and COVID-19 vaccination includes the following: • There are two kinds of tests that are used to detect TB: the TB skin test (TST), also called the Tuberculin Skin Test, and TB blood tests, also called interferon gamma release assays (IGRA). A positive TB skin test or TB blood test only tells that a person has been infected with TB bacteria. • Inactive vaccines, including the mRNA COVID-19 vaccines, do not interfere with the results from either of these types of TB tests. However, the reliability of a negative TST or IGRA result after COVID-19 vaccination has not been studied. • A TST or IGRA should be deferred until 4 weeks or more after the completion of COVID-19 vaccination. If testing requirements or policies cannot be modified for the COVID-19 pandemic to accept this delay in TST or IGRA testing, it should be understood that a false negative TST or IGRA cannot be excluded, and consideration should be given to repeating negative TST or IGRA tests at least 4 weeks after the completion of COVID-19 vaccination. Page | 37 For residents who might require TB testing at the same time they are receiving an mRNA COVID-19 vaccine: • Consult with the resident’s attending physician to weigh the risks and benefits of delaying TB testing to receive the COVID-19 vaccination. • Conduct the TB risk assessment and screening without delay and maintain documentation. • If delaying TB testing, document the reason for the delay. Please read the CDC’s TB Tests and mRNA COVID-19 Vaccines and Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States for more information for guidance on TB testing and COVID-19 vaccination. Note: More information on signs and symptoms of TB may be found here. HHS and DSHS also have a TB Symptom Screening Form. Background information on Tuberculosis (TB) Screening and testing for residents – For new resident admissions: • The NF must screen all residents for TB at admission in accordance with the attending physician’s recommendations and current CDC guidelines. Residents are not required to be tested for TB upon admission to a NF. For current residents: • A NF must consult with the resident’s attending physician and follow the attending physician’s recommendations regarding TB screening. • TB testing should only be considered when the resident displays signs or symptoms of TB, when the resident has a known exposure to TB, or when there is ongoing transmission of TB at the NF. • If TB testing is warranted, the decision to test the resident for TB, and the type of TB test used, should be based on the attending physician’s recommendation. Recovery - Establish a resident recovery plan, including when a resident is considered recovered and next steps for care. A recovery plan is the guidance for determining when to discontinue transmission-based precautions and continued care of a resident. The recovery plan may be different depending on whether a test-based or non-test-based strategy is used. Criteria should include: • Discontinuation of transmission-based precautions without testing. • Discontinuation of transmission-based precautions with testing. Residents who leave the NF - Encourage residents to wear a facemask or cloth face covering (as tolerated), in accordance with CMS and CDC