Leading Harris County: Public Guidelines for a Healthy Community Message from Harris County Judge Lina Hidalgo During this uncertain time, we must do everything we can to put ourselves in the best position to succeed in our fight against COVID-19: manage the spread of the virus, keep the number of cases and deaths low, and keep our hospitals from becoming overwhelmed. Safety measures such as social distancing, wearing face coverings, and staying home from work, school, and social activities are difficult. But, if followed closely, these orders and policies can save thousands of lives. They can give us our best shot at reopening sustainably, rather than driving our community toward the breaking point time and time again, hurting our economy even more profoundly over the long term. We cannot, at least not now, go back to the way our lives were before COVID-19 emerged in Harris County. We must assess the risk for everything we do. Harris County Public Health has developed the recommendations published here to help us safely navigate our everyday lives and better manage the ebbs and flows in severity of the threat of COVID-19. We must remember that a resurgence of the virus that can knock us down and put us right back where we started, or worse, is right around the corner as long as a vaccine or treatment are not readily available. We all want to get back to work, see our friends, hug our family, go out to eat, and resume our livelihoods without limitations, but we still have a long road ahead of us to end this epidemic. Here in Harris County, we remain committed to taking whatever actions are necessary to save lives — not just the lives of people with the virus, but the lives of anyone requiring a hospital bed. We will continue this fight to keep you and your family healthy as long as we have to. Here in Harris County, we are in this together. Message from Dr. Umair Shah, Director, Harris County Public Health COVID-19 has had a devastating impact globally, nationally and locally here in Harris County. Currently there is no treatment or vaccine to prevent COVID-19, so prevention is the best way to reduce your chances of getting COVID-19. This includes tried and true actions such as maintaining social distancing from others (6ft or 2m), wearing facial coverings, proper handwashing, and staying home and away from others if you are sick. Extensive social distancing and these other types of interventions have shown to be successful in other countries to prevent or delay a rapid increase in the number of cases and deaths. However, these measures do not eliminate the threat COVID-19 poses within our community.   Social distancing has allowed Harris County to slow down rapid accelerations in the number of positive cases as well as hospitalizations, which has given our public health and healthcare systems more time to prepare for a potential surge of cases. To continue reducing spread and deaths from COVID-19, social distancing and other preventive measures must be sustained, and testing must be widely available until vaccine options are developed. Harris County Public Health (HCPH) is continually working to keep the community healthy and safe by conducting its epidemiology (disease detective) work including disease surveillance and investigations; building data and technology infrastructure; coordinating and providing testing, both in the community and at nursing homes and other group facilities; monitoring levels of important supplies and equipment in the healthcare system; and continuing to reach out to educate the community. HCPH has developed these local public health recommendations as a guide for residents to understand better state and local COVID-19 orders and guidance. It will take everyone in the community working as a team to continue to slow the spread of COVID-19 and ultimately stop this pandemic. We thank all our community, including businesses, faith-leaders, and other partners for continuing to do their part in reducing the spread of COVID-19 in Harris County. We must all come together to combat COVID-19 today and into the future. 1 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020 Levels of COVID-19 Risk and Considerations for Changing Community Action In alignment with federal and state guidance for reopening, we recommend a phased process for relaxing social distancing. The guidance below describes the considerations and indicators that help determine the current level of risk of COVID-19 transmission. The system includes four levels of risk: 1: red, 2: orange, 3: yellow, and 4: green. Local infectious disease specialists and public health experts will use the latest information on local disease activity and these indicators to advise county officials on the risk level that applies. The current level of risk and corresponding recommendations will be communicated clearly to the public on www.readyharris.org. Risk Level Level Description Considerations for Moving Forward1 Level 1: Severe Uncontrolled Community Transmission 1. Community outbreaks present and worsening. 2. Public health (testing and contact tracing) capacity strained or exceeded. 3. Healthcare surge likely. 1. 2. 3. 4. 1 14-day flat or decreasing trend in new COVID-19 cases in Harris County 14-day flat or decreasing trend in daily COVID-19 hospital population in Harris County 14-day flat or decreasing trend in daily COVID-19 ICU population in Harris County 14-day average of fewer than 15% of general population and ICU Level 2: Significant Uncontrolled Community Transmission Level 3: Moderate, Controlled Transmission 1. Significant community transmission with limited evidence of reduction due to public health measures and/or other factors. 2. Public health (testing and contact tracing) capacity likely sufficient. 3. Healthcare system within capacity and surge less probable. 1. Demonstrated reduction in transmission due to public health measures and/or other factors. 2. Public health (testing and tracing) systems within capacity. 3. Healthcare system within capacity with significant reserves. 1. 1. 2. 3. 4. 14-day flat or decreasing trend in new COVID-19 cases in Harris County 14-day flat or decreasing trend in daily COVID-19 hospital population in Harris County 14-day flat or decreasing trend in daily COVID-19 ICU population in Harris County 14-day average of fewer than 10% of general population and ICU Level 4: Minimal, Controlled Transmission 1. New chains of transmission are limited and quickly broken. 2. Public health and healthcare systems within capacity with significant reserves. OR 3. Effective medical countermeasures (vaccine and/or treatment) developed and widely deployed. 2. 3. 4. 14-day flat or decreasing trend in new COVID-19 cases in Harris County 14-day flat or decreasing trend in daily COVID-19 hospital population in Harris County 14-day flat or decreasing trend in daily COVID-19 ICU population in Harris County 14-day average of fewer than 5% of general population and ICU All considerations for moving forward must be satisfied in order to warrant a reduction in the current level of risk. 2 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020 beds in use by COVID-19 patients in Harris County beds in use by COVID-19 patients in Harris County beds in use by COVID-19 patients in Harris County AND 1. Considerations for Moving Back2 2 Widespread deployment of medical countermeasures (vaccine and/or treatment) Testing Testing Testing 1. 7-day average of greater than 100 1. 7-day average of greater than 50 1. new COVID-19 cases in Harris new COVID-19 cases in Harris County County 2. 2. 7-day increasing trend in new 2. 7-day increasing trend in new COVID-19 cases in Harris County COVID-19 cases in Harris County Hospitalization Hospitalization 3. 7-day increasing trend in daily 3. 7-day increasing trend in daily COVID-19 hospital population in COVID-19 hospital population in Harris County Harris County 4. 3-day average of greater than 15% 4. 3-day average of greater than 15% of current ICU beds in use by COVIDof current ICU beds in use by COVID19 patients in Harris County 19 patients in Harris County Equipment and Supply Chain Equipment and Supply Chain 5. Less than 30 days of projected 5. Less than 30 days of projected availability of personal protective availability of personal protective equipment within healthcare equipment within healthcare systems systems 7-day average of greater than 25 new COVID-19 cases in Harris County 7-day increasing trend in new COVID-19 cases in Harris County Any combination of considerations for moving back, or any significant healthcare or public health burden not represented by these considerations, may merit an elevation in the current level of risk. 3 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020 Levels of COVID-19 Risk and Guidance for Community Action Risk Levels Level 1: Severe Uncontrolled Community Transmission Level 2: Significant Uncontrolled Community Transmission Level 3: Moderate, Controlled Transmission Level 4: Minimal, Controlled Transmission Public Health Recommendations Minimize contact with others wherever possible and avoid leaving home except for essential needs. Practice social distancing and use face coverings. Minimize contact with others, but begin leaving the home for non-essential needs, except medium and large gatherings. Practice social distancing and use face coverings. 1. Stay home when possible. 2. Avoid and cancel medium (10-250 people) and large public and private gatherings (250+ people). 3. All vulnerable individuals (65+ or with preexisting health conditions) stay home when possible. 4. Self-quarantine responsibly for 14 days if in close and prolonged contact with someone who has COVID-19. 5. Wear face coverings to protect others. 6. Essential workers practice special precautions to prevent spread. 7. Avoid non-essential business and personal travel. Follow state guidance for quarantine after visiting certain locations. 8. Use public transportation with caution. Practice good hygiene and social distancing. Resume contact with others and resume leaving the home, even for larger gatherings. Practice social distancing and use face coverings. Resume normal contact with others unless sick. Daily Life 1. 2. 3. 4. 5. 6. 7. 8. 3 Stay home, except for essential activities3 . Avoid and cancel all gatherings of any size. All vulnerable individuals (65+ or with preexisting health conditions) stay home when possible. Self-quarantine responsibly for 14 days if in close and prolonged contact with someone who has COVID-19. Wear face coverings to protect others. Essential workers practice special precautions to prevent spread. Avoid non-essential business and personal travel. Follow state guidance for quarantine after visiting certain locations. Avoid public transportation where possible. 1. 2. 3. 4. 5. 6. 7. 8. Stay home when possible. Minimize attendance at medium (10-250 people) and large public and private gatherings (250+ people). All vulnerable individuals (65+ or with preexisting health conditions) stay home when possible. Self-quarantine responsibly for 14 days if in close and prolonged contact with someone who has COVID-19. Wear face coverings to protect others. Essential workers follow standard precautions. Limit visits to non-essential business and personal travel. Follow state guidance for quarantine after visiting certain locations. Continue to use public transportation. Practice good hygiene. 1. 2. 3. 4. 5. 6. Feel free to leave the house and resume in-person work schedules. Resume attending public and private gatherings freely. Vulnerable individuals (65+ or with preexisting health conditions) leave home as necessary. Good hygiene and social distancing are still recommended. Self-quarantine responsibly for 14 days if in close and prolonged contact with someone who has COVID-19. Resume non-essential travel. Avoid other states or countries where widespread transmission may still be occurring. Resume full public transportation use. Essential activities as defined in the County’s Initial Stay at Home, Work Safe order. 4 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020 Participating in Group Activities 1. 2. Cancel visits to nursing homes, long term care facilities, and hospitals. Avoid and cancel all gatherings indoor and outdoor, including concerts, rodeos, large sporting events, etc. Schools and after-school activities for youth close, as directed by educational authorities. 1. 2. Cancel visits to nursing homes, long term care facilities, and hospitals Avoid and cancel medium and large gatherings indoor and outdoor, including concerts, rodeos, large sporting events, etc. Resume activities for schools and after school activities following state and public health guidance. Continue to practice good hygiene and social distancing. 1. 2. 3. Avoid visits to vulnerable populations in nursing homes, long term care facilities, and hospitals. Attend gatherings indoor and outdoor, including concerts, rodeos, large sporting events, etc., with caution when activities follow any relevant guidance and capacity requirements. Resume activities for schools and after school activities following state and public health guidance. Continue to practice good hygiene. 1. 2. 3. Resume visiting vulnerable populations while practicing good hygiene and 6 feet of distance. Resume large gatherings indoor and outdoor, including concerts, rodeos, large sporting events, etc., and activities should follow any relevant guidance. Resume school and after school activities as normal. 5 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020 Public Health Guidance for the General Public The following public health guidance for individuals is available on hcphtx.org/nCoV. This guidance can be used to help you decide how to keep yourself, your family, and your community safe. Guidance is periodically updated, especially as trends in early warning signs change. General Public HCPH Guidance for General Public Using Gloves and Face Masks HCPH Guidance for Removing Gloves and Using Masks and Risk Factors Treating Mild COVID-19 Symptoms at Home HCPH Guidance for Treating Mild Symptoms at Home Apartment Residents HCPH Guidance for Reducing the Risk for Apartment Residents Cleaning, Disinfecting, and Laundry HCPH Guidance for Cleaning Products and Laundry and Cleaning and Disinfecting Safe Sex HCPH Guidance for Safe Sex Interactions Public Transportation HCPH Guidance for Public Transportation Grocery Shopping HCPH Guidance for Grocery Shopping Maternal Health and Pregnancy HCPH Guidance for Maternal Health and Pregnant Women Funerals HCPH Guidance for Funerals Parks HCPH Guidance for Activity in Parks and Recreation Pets HCPH Guidance for Pet Shelters and Owners Mental Health HCPH Guidance for Mental Health and Coping with Stress High Risk Individuals HCPH Guidance for People at Higher Risk and Reducing Risk for Older Adults Social Distancing and Self-Monitoring HCPH Guidance for Social Distancing and Self-Monitoring Domestic Violence HCPH Guidance for Domestic Violence Resources 6 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020 Lowering the Risk of Spreading COVID-19: Reopening establishments in a responsible way requires the Harris County community to work as a team – employers, employees; business owners, customers; establishments and community members alike. It is critically important for every person to pay attention to possible COVID-19 symptoms and keep track of close contacts. The virus that causes COVID-19 can be spread by infected persons who appear to have few or no symptoms. Even if an infected person is only mildly ill, the people they spread it to may become seriously ill or even die, especially if that person is age 65 or older with pre-existing health conditions which place them at a much higher risk. That means all of us have a part to play in making sure our community stays healthy and protected. If you believe you are sick, stay home, seek testing immediately, and treatment, if necessary. Before you engage with the public, do an honest self-assessment and screen yourself for COVID-19 symptoms: □ Cough □ Shortness of breath or difficulty breathing □ Chills □ Repeated shaking with chills □ Muscle pain □ Headache □ Sore throat □ Loss of taste or smell □ Diarrhea □ Feeling feverish or a measured temperature greater than or equal to 100.4 degrees Fahrenheit □ Known close contact with a person who is lab confirmed to have COVID-19 You can access free testing by visiting http://covidcheck.hctx.net or by calling 832-927-7575. FOR MORE INFORMATION: ● *Early warning signs aligned with Texas Medical Center’s COVID-19 Data Pack ● HCPH reopening resources ● Governor's Strike Force to Open Texas ● Texans Back to Work Task Force Report ● Executive Order by Gov. Greg Abbott EO-GA-21 ● Greater Houston Partnership’s Work Safe 2.0: 15 Principles to Guide the Safe Reopening of Houston Companies ● Baylor College of Medicine’s Guide to Reopening Businesses ● Southeast Texas Regional Advisory Council ● ● ● CDC Guidelines Americans with Disabilities Act ADA.gov U.S. Department of Labor OSHA 7 Leading Harris County: Benchmarks for a Healthy Community June 11, 2020