Glungreaa of the Huiteh Estates Washington, ?01 213515 March 4, 2020 Dr. Robert R. Red?eld Director Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30329 Dear Director Redfleld, We write today on behalf of our state and local health departments that are on the frontline ?ghting Coronavirus Disease 2019 We request the change of the Interim Infection Prevention and Control Recommendations for Patients with suspected or con?rmed to Standard, Droplet, and Contact Precautions to include the use of masks, protection, gown, and gloves while using airborne precautions with use of respirators when performing aerosol-generating procedures as recommended by the World Health Organization, Infection Prevention and Control Canada, and other countries. We know now that is transmitted person to person through reSpiratory droplets created when individuals cough or sneeze similar to other respiratory viruses. Virtually all recent cases in Washington State are a result of community transmission of COVID-19 among people with no relevant travel history or contact with known cases. Our health departments and facilities also continue to see other respiratory viruses like in?uenza, that clinically present the same As a result, the number of patients that need to be seen is increasing, and we expect this number to grow significantly. Our system in Washington is feeling this pressure. Hospitals are already at or near capacity, and continuation of current CDC guidelines in this new phase of the disease presents substantial barriers to managing the increasing patient demand. There are limited airborne isolation rooms in both clinics and hospitals, and there are shortages in personal protective equipment (PPE). Furthermore, these facilities are anticipating imminent staff shortages to attend to patients under current guidance requiring exposed healthcare workers to stay out of work for 14 days from last exposure. While the initial guidance from the CDC with Standard, Contact, and Airborne precautions with protection made sense based on what we knew from an epidemiological standpoint and the status of the disease in the United States at that time, the anticipated large numbers in the coming days and weeks will overwhelm the system. Without taking additional action, our state could be facing a public health crisis. Given the current state of affairs and that we have con?rmed community spread via respiratory droplets similarly to other respiratory viruses, we urge the CDC to change the recommendations to use of Standard, Droplet, and Contact Precautions reserving airborne PRINTED ON RECYCLED PAPER isolation and use of respirators for aerosol-generating procedures as recommended by WHO, Canada, and other countries. Additionally, we urge you to consider allowing healthcare workers to continue to work while doing self-monitoring as we do with other respiratory viruses including in?uenza. Given how this disease is Spread, compounded with the state?s rapidly depleting workforce as a result of guidance requiring all exposed healthcare workers to remain in quarantine for 14 days, the current guidance is not sustainable. It is our upmost priority to keep frontline health staff safe and secure while on shift. Following in?uenza protocol would mean workers will be in protective gear of gloves and masks with a face shield, and strictly following infection control practices. This is the largest public health crisis that the state of Washington has faced in recent history. Actions taken now will help our healthcare system and dedicated healthcare workers safely manage, the increasing number of patients we will see in the coming days. Again, we urge you to change the recommendations to use of Standard, Droplet, and Contact Precautions and allow healthcare workers to continue to care for patients with appropriate self-monitoring for onset of Sincerely, - Jag/W u? Kim Schrier, M.D. uzan DelBene Member of Congress Member of Congress Rick Larsen 161an Member of Congress Member of Congress Denny HeckU Pramila ayapal Member of Congress Member of Congress