March 9, 2020 Updated March 9, 2020: Order Requiring Cancelation of Mass Gatherings of More than 1,000 Persons and New Recommendations from the County of Santa Clara Public Health Department to Protect Residents of the County from Coronavirus Disease 2019 (COVID-19) The County of Santa Clara’s Public Health Department is taking further steps to protect the health of our community by issuing an order canceling mass gatherings and making additional recommendations that will slow the spread of the novel coronavirus (COVID19) in our community, reduce the number of people infected, and, especially, to protect those who are most vulnerable to severe illness. The recommendations are effective immediately and may be updated upon further evaluation and public health need. The order will take effect at 12:00 a.m. on March 11, 2020. We understand the order and recommendations will have a tremendous impact on the lives of people in our community. Public Health is taking these steps in consultation with Centers for Disease Control and Prevention (CDC), based on the best information we have at this time, to protect the public’s health. The following order and guidance was created after significant deliberation. Health officials weighed the potential benefits to our community’s health with the significant disruptive effect that the order and recommendations could have. In consultation with the CDC, we developed the order and recommendations based on the rising number of cases in our County and the importance of taking these actions now to reduce the spread of COVID-19. Countywide Prohibition on Mass Gatherings of More than 1,000 People The County Health Officer has issued an order, effective at 12:00 a.m. on March 11, 2020, prohibiting public or private mass gatherings. A “mass gathering” is any event or convening that brings together one thousand (1,000) or more people in a single room or single space at the same time, such as an auditorium, stadium, arena, large conference room, meeting hall, cafeteria, theater, or any other confined indoor or confined outdoor space. A “mass gathering” does not include normal operations at airports, shopping malls and centers, or other spaces where 1,000 or more persons may be in transit. It also does not include typical office environments or retail or grocery stores where large numbers of people are present, but where it is unusual for them to be within arm’s length of one another. Page Updated Guidance for Persons Hosting Gatherings and Community Events of Less than 1,000 People At this time, we strongly urge postponing or canceling gatherings and community events where large numbers of people are within arm’s length of one another. If you can’t avoid bringing groups of people together, it is your responsibility to:       Stop anyone who is sick with fever or respiratory symptoms from attending. Encourage those who are at higher risk for serious illness to not attend. Find ways to give people more physical space so that they aren’t in close contact as much as possible. Ensure that there are adequate supplies of hand hygiene materials and urge attendees to wash their hands often with soap and water for at least 20 seconds. If soap and water are not available, alcohol-based hand sanitizer can be used. Direct attendees to: o Avoid close contact with other people. o Avoid touching their eyes, nose, and mouth. o Cover their cough or sneeze with a tissue - if available - or into their elbow. Clean surfaces with disinfecting wipes and other standard cleaners before, during, and after the event. Updated Guidance for Workplaces and Businesses Employers are responsible for taking steps to make it more feasible for their employees to work in ways that minimize close contact with large numbers of people. This guidance is designed to both protect employees and all members of the public with whom they come into contact at work. Employers should immediately:       Ensure employees who are sick do not come to work. Suspend nonessential employee travel. Minimize the number of employees working within arm’s length of one another. Cancel all large in-person meetings and conferences, or hold them via telephone or video conference. Maximize flexibility in granting sick leave so that sick employees are able to stay home. For service/retail industries, ensure updated procedures and protocols for frequent hand washing/sanitizing; enhance cleaning of high-touch surfaces and items with disinfecting wipes and other standard cleaners; ensure adequate 2    supply of soap and paper towels; ensure frequent emptying of waste bins; and post signage regarding these procedures for staff and patrons. Stop requiring a doctor’s note for sick employees, as healthcare offices may be very busy and unable to provide that documentation right away. Consider use of telecommuting options for appropriate employees. Consider staggering start and end times to reduce large numbers of people coming together at the same time. Updated Guidance for People at Higher Risk for Severe COVID-19 Illness The County Public Health Department strongly urges that persons at higher risk of severe illness to:    Stay home as much as possible Avoid traveling on cruises and airplanes. Follow all guidance for the general population including by staying away from gatherings of people.  Those at higher risk include: o People, regardless of age, with underlying health conditions including cardiovascular disease, diabetes, cancer, heart disease, or chronic lung diseases like COPD, as well as those with severely weakened immune systems. o Older adults. The risk begins to increase over 50 and increases significantly with age, with persons over age 70 and 80 in the highest risk categories. Updated Guidance for Childcare and Schools The County Public Health Department is not recommending closing schools at this time. If a staff member or student in a specific school is confirmed to have COVID-19, the Public Health Department will consider, based on the specific facts and circumstances of that case, whether closure of that school is warranted. The reason we are not recommending school closures at this time is because children have not been shown to be a high-risk group for serious illness from this virus. As much as possible, children should be allowed to carry on with their education and normal activities. We encourage all school officials to carefully review and follow the CDC’s guidance for K-12 schools and childcare centers, as well as our recommendations for canceling certain gatherings and events, which also apply to schools. Schools in our community will need to make decisions about postponement or cancelation of specific activities. Some children have underlying health conditions, such as severely weakened immune systems, that put them at higher risk. Caregivers of children with underlying health 3 conditions should consult with healthcare providers about whether their children should stay home from school. Schools are responsible for taking the following steps:      Teachers and staff with any fever and/or respiratory symptoms should not come to work. Teachers and staff should self-screen (i.e., check themselves for subjective fever and/or respiratory symptoms such as cough) for symptoms each morning before interacting with students. Ensure sick leave policies that allow teachers and staff to stay home if they have symptoms of respiratory infection. Implement staggered recess times to limit the number of students who are together; and, if possible, group recess by classrooms to reduce opportunities for mixing. Consider alternatives to group programming within the school including any large or communal activities such as assemblies and large-scale sporting events. Alternate approaches which limit close contact may include conducting assemblies via webcasts or intercom announcement and limiting the number of spectators who can attend sporting events. Limit visitors to the school by not allowing those with symptoms of fever and/or respiratory infection. Updated Guidance for People who are Sick Stay home when you are sick. Do not go out in public when you are sick and, especially, do not visit long-term care facilities, nursing homes, or hospitals (unless you are seeking care yourself). Avoid medical settings in general unless necessary. If you are ill with fever, cough, or trouble breathing, call your doctor's office first before going and let them know your symptoms. Updated Guidance for the General Public     Even if you are not ill, do not visit hospitals, long term care facilities, or nursing homes, or other settings with vulnerable populations. If you do need to visit one of these facilities, limit your time there and keep 6 feet away from all patients and employees of the facility at all times. Do not go to the emergency room unless essential. Emergency rooms need to be able to serve those with the most critical needs. If you have symptoms such as cough, fever, or other respiratory problems, contact your regular doctor first for instructions. If you are sick, stay home and away from others in your household to the degree you are able. Practice excellent personal hygiene habits including washing your hands with soap and water frequently, coughing into a tissue or your elbow, and avoiding touching your eyes, nose, or mouth. 4      Stay away from people who are ill, especially if you are at higher risk for serious illness. Clean frequently touched surfaces and objects (like doorknobs and light switches). Regular household cleaners are effective. Avoid touching your eyes, nose, and mouth unless you’ve just washed your hands. Get plenty of rest, drink plenty of fluids, eat healthy foods, and manage your stress to keep your immunity strong. Follow CDC’s recommendations for using a facemask.  CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.  Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a healthcare facility). Stay informed. Information is changing frequently. Check and subscribe to Public Health's website and social media pages: Website: http://sccphd.org/coronavirus Facebook: https://www.facebook.com/sccpublichealth/ Instagram: @scc_publichealth Twitter: @HealthySCC 5