CDC Managing COVID19 in Correctional Detention

CDC Guidance on Management of COVID-19 in
Correctional and Detention Facilities
This interim guidance is based on what is currently

known about the transmission and severity of
coronavirus disease 2019 (COVID-19) as of March 30,
2020.
The US Centers for Disease Control and Prevention

(CDC) will update this guidance as needed and as
additional information becomes available. Please check
the CDC website periodically for updated interim
guidance.
cdc.gov/coronavirus
Finding the CDC guidance
for corrections
https://www.cdc.gov/coronavirus/2019-
ncov/community/correction-detention/guidance-
correctional-detention.html
What types of facilities does the guidance cover?
Detention
Prisons Jails
Centers
Size
Onsite healthcare capacity

Navigating the CDC Guidance Document
1 2 3
PREPARE PREVENT MANAGE
Communications Hygiene Medical Isolation
Personnel Practices Cleaning Quarantine
Operations Screening for Symptoms Infection Control
Supplies Social Distancing Clinical Care
Make sure to look at recommendations from all phases, regardless of

whether you have cases
COMMUNICATE with local public health
IDENTIFY medical isolation and quarantine spaces

ahead of time
PREPARE PLAN for staff absences and encourage sick

employees to stay home
POST information around the facility on COVID-19

symptoms and hygiene
CHECK supply stocks (cleaning supplies,

hand washing supplies, medical supplies, PPE)
Communications Resources
https://www.cdc.gov/coronavirus/2019-ncov/communication/factsheets.html
A quick note on…SOAP
Make sure it is:
• Free
• Accessible
• Restocked continually
• Not irritating to skin
Alcohol-based hand sanitizer (at least 60% alcohol) is a good alternative when soap & water
aren’t available – consider loosening restrictions where feasible
RAMP UP cleaning schedule & hand hygiene reminders
LIMIT transfers between facilities
SCREEN everyone coming in for symptoms

(new intakes, staff, visitors)
PREVENT
IMPLEMENT social distancing
MAKE SURE everyone knows what to do if they have

symptoms
ENCOURAGE non-contact visits or consider suspending

visitation
Screening
• New intakes – AT SALLYPORT
• Incarcerated people leaving the facility
• Staff – daily on entry
• Visitors
1. Today or in the past 24 hours, have you had any of

the following symptoms?
• Fever, felt feverish, or had chills?
• Cough?
• Difficulty breathing?
2. In the past 14 days, have you had contact with a

person known to be infected with coronavirus
(COVID-19)?
3. Take the person’s temperature

Social Distancing
• Ideally 6 feet between people
(sick or not)
• Decrease frequency of contact
Reduces risk of
spreading disease
Social Distancing Examples for Corrections
NOT one-size-fits-all…each facility will need to choose what works for them
Common areas Recreation Meals

• Enforce increased space between people in • Choose spaces where people can spread out • Stagger meals
• holding cells • Stagger time in recreation spaces • Rearrange seating in the dining hall
• lines • Assign each housing unit a dedicated (e.g., remove every other chair and use only
• waiting areas such as intake recreation space to avoid mixing and cross- one side of the table)
(e.g., remove every other chair in a waiting contamination • Provide meals inside housing units or cells
area)
Group activities Housing Medical

• Limit their size • Reassign bunks to provide more space • Designate a room near each housing unit to
• Increase space between people between people evaluate people with COVID-19 symptoms
• Suspend group programs where people will • Sleep head to foot • Stagger sick call
be in closer contact than in their housing • Minimize mixing of people from different • Designate a room near the intake area to
environment housing areas evaluate new entrants who are flagged by
• Choose outdoor areas or other areas where the intake screening process
people can spread out
COMMUNICATE the reasons for social distancing

SUSPEND all non-medical transfers
INTEGRATE screening into release planning
COORDINATE with public health
MASK & MEDICALLY ISOLATE symptomatic people
MANAGE
IDENTIFY & QUARANTINE close contacts
WEAR recommended PPE
PROVIDE clinical care or transfer for care
COMMUNICATE clearly & often

MEDICAL ISOLATION QUARANTINE
Who: Symptomatic people Who: Close contacts of a known or

suspected case (staff or incarcerated)
What: MASK & separate from others
What: Separate from others
When: Immediately once symptoms Monitor for symptoms
appear
When: Once identified as a close contact
Where: Ideally, an individual cell
Where: Ideally, an individual cell
Why: Prevent exposing others (if incarcerated)
Evaluate, test if needed At home (if staff)
Give care
Why: Prevent exposing others if infected
How long: It’s complicated
(More on next slide) How long: 14 days
MASK for source control
Medical Separate from others (individually if possible) & restrict

movement
Isolation Provide with tissues, trash can, and hand hygiene supplies
Notify public health

Isolate anyone with
symptoms of COVID-19 Clean & disinfect thoroughly
Evaluate and test, if indicated
Give care (or transfer for care)

IDEAL: SEPARATELY
• Single cells with solid walls & solid door

• Single cells with solid walls
Options for NEXT BEST: AS A COHORT – use social distancing
Medical Isolation • Large, well-ventilated cell with solid walls & solid door
• Large, well-ventilated cell with solid walls
• Single, barred cells (ideally with empty cell between)
when multiple people need • Multi-person, barred cells (ideally with empty cell between)
to be isolated due to
LAST RESORT: TRANSFER
COVID-19
• Transfer to a facility with isolation space
(LAST RESORT due to possibility of introducing COVID-19 to

another facility)
CAUTIONS for Cohorting COVID-19 Cases
DO NOT COHORT CONFIRMED CASES WITH PRIORITIZE SINGLE CELLS FOR PEOPLE USE SOCIAL DISTANCING AS
SUSPECTED CASES AT HIGHER RISK OF SEVERE ILLNESS MUCH AS POSSIBLE
FROM COVID-19
DO NOT COHORT CASES WITH UNDIAGNOSED

RESPIRATORY INFECTIONS • Older adults
• People with serious underlying
medical conditions
When Does Medical Isolation End?
Test-based strategy
• Fever-free for ≥72 hours (without fever reducing medications) AND

• Respiratory symptoms have improved AND
• Tested negative in ≥2 consecutive respiratory specimens collected ≥24 hours apart
Symptom-based strategy
• Fever-free for ≥72 hours (without fever reducing medications) AND

• Respiratory symptoms have improved AND
• At least 7 days have passed since the first symptoms appeared
If the person had a positive test but never had symptoms
• At least 7 days have passed since the first positive COVID-19 test AND
• The person has had no subsequent illness
Identify close contacts
Quarantine Mask as source control, if PPE stocks allow
Separate from others (ideally individually) & restrict movement

A close contact is anyone who:
• Has been within 6 feet of a
confirmed/suspected case for Monitor symptoms 2x per day
a prolonged period of time
OR
If symptoms develop, immediately mask and medically isolate
• Has had contact with
infectious secretions from a
confirmed/suspected case
(e.g., coughed on) If cohorting and another case develops, 14-day clock restarts
Return to previous housing and lift movement restrictions after

14 days if no symptoms develop
IDEAL: SEPARATELY
• Single cells with solid walls & solid door

• Single cells with solid walls
Options for NEXT BEST: AS A COHORT – use social distancing
Quarantine •
•
Large, well-ventilated cell with solid walls & solid door
Large, well-ventilated cell with solid walls
• Single, barred cells (ideally with empty cell between)
• Multi-person, barred cells (ideally with empty cell between)
when multiple close • If a whole housing unit has been exposed: quarantine in
place, with no movement outside the unit
contacts of a COVID-19 case
need to be quarantined LAST RESORT: TRANSFER
• Transfer to a facility with quarantine space
(LAST RESORT due to possibility of introducing COVID-19 to

another facility)
CAUTIONS for Cohorting Close Contacts of
COVID-19 Cases
MONITOR SYMPTOMS CLOSELY, AND IMMEDIATELY PRIORITIZE SINGLE CELLS FOR PEOPLE AT DO NOT ADD PEOPLE TO AN EXISTING
PLACE SYMPTOMATIC PEOPLE UNDER MEDICAL HIGHER RISK OF SEVERE ILLNESS FROM QUARANTINE COHORT
ISOLATION TO PREVENT FURTHER SPREAD COVID-19
DO NOT MIX PEOPLE QUARANTINED

(14-DAY CLOCK RESTARTS) DUE TO EXPOSURE WITH PEOPLE
• Older adults UNDER ROUTINE INTAKE QUARANTINE
• People with serious underlying
medical conditions
Clinical Care for
Patients with COVID-19
• Refer to full CDC guidance at
https://www.cdc.gov/coronavirus/2019-nCoV/index.html:
• Evaluating and Testing Persons for Coronavirus Disease 2019
(COVID-19)
• CDC Interim Clinical Guidance for Management of Patients with
Confirmed Coronavirus Disease (COVID-19)
• Evaluate people for COVID-19 at the first sign of symptoms

• Include assessment of high risk status
• Test for other causes of respiratory illness
(e.g., influenza)
• Have a plan in place to safely transport cases to a local

hospital if they need care beyond what the facility can
provide
Infection Control & PPE
• Refer to full CDC guidance at
https://www.cdc.gov/coronavirus/2019-nCoV/index.html:
• CDC Interim Infection Prevention and Control
Recommendations for Patients with Suspected or
Confirmed Coronavirus Disease 2019 (COVID-19) in
Healthcare Settings
• NOTE: language is not specific for correctional settings –
implement as fully as able, may need to adapt
• Assess PPE needs based on the type of contact a person has

with a confirmed/suspected COVID-19 case (see full guidance
document and accompanying PPE table – details on next 2
slides)
• Minimize contact with a symptomatic person until that

person is wearing a mask (6 feet if possible)
• Clean duty belt, gear, clothing that comes into contact with a
symptomatic person
• Wash hands thoroughly after any contact

Infection Control & PPE
• Nationwide shortages are expected for all PPE
categories:
• Refer to CDC’s guidance on optimizing PPE supplies:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-
strategy/index.html
Some strategies include:

• N95 respirators: Face masks are an acceptable
alternative to N95 respirators when supplies are limited.
N95s should be prioritized for procedures expected to
generate infectious aerosols.
• Face masks: Extended use for multiple patients; use
beyond shelf life; reuse; prioritize for splashes/sprays;
increase ventilation; homemade masks
• Eye protection: Choose reusable options if available; use
beyond shelf life; extended use for multiple patients;
clean disposable units; prioritize for splashes/sprays
• Gowns: Cloth/reusable options; use beyond shelf life;
use gowns meeting international standards; prioritize for
splashes/sprays/high-contact; other garments
Recommended PPE
-
PPE recommended for staff and
incarcerated people depends on the
level of contact they have with
COVID-19 cases and/or
contaminated materials
2nd to last page of guidance

document
NOTE: Change to table

forthcoming – staff performing
temperature checks do NOT * If a facility chooses to routinely quarantine all new intakes (without symptoms or known exposure to a COVID-19
case) before integrating into the facility’s general population, face masks are not necessary.
need to wear gowns/coveralls. **A NIOSH-approved N95 is preferred. However, based on local and regional situational analysis of PPE supplies, face
masks can be used as an alternative when the supply chain of respirators cannot meet the demand. During this time,
available respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would
pose the highest exposure risk to staff.
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CDC Guidance on Management of COVID-19 in

Correctional and Detention Facilities

This interim guidance is based on what is currently

The US Centers for Disease Control and Prevention

Onsite healthcare capacity

Make sure to look at recommendations from all phases, regardless of

IDENTIFY medical isolation and quarantine spaces

PREPARE PLAN for staff absences and encourage sick

POST information around the facility on COVID-19

CHECK supply stocks (cleaning supplies,

LIMIT transfers between facilities

SCREEN everyone coming in for symptoms

MAKE SURE everyone knows what to do if they have

ENCOURAGE non-contact visits or consider suspending

1. Today or in the past 24 hours, have you had any of

2. In the past 14 days, have you had contact with a

3. Take the person’s temperature

Common areas Recreation Meals

Group activities Housing Medical

COMMUNICATE the reasons for social distancing

INTEGRATE screening into release planning

COORDINATE with public health

MASK & MEDICALLY ISOLATE symptomatic people

WEAR recommended PPE

PROVIDE clinical care or transfer for care

COMMUNICATE clearly & often

Who: Symptomatic people Who: Close contacts of a known or

Medical Separate from others (individually if possible) & restrict

Notify public health

Evaluate and test, if indicated

Give care (or transfer for care)

• Single cells with solid walls & solid door

(LAST RESORT due to possibility of introducing COVID-19 to

DO NOT COHORT CASES WITH UNDIAGNOSED

• Fever-free for ≥72 hours (without fever reducing medications) AND

• Fever-free for ≥72 hours (without fever reducing medications) AND

If the person had a positive test but never had symptoms

Quarantine Mask as source control, if PPE stocks allow

Separate from others (ideally individually) & restrict movement

Return to previous housing and lift movement restrictions after

• Single cells with solid walls & solid door

Options for NEXT BEST: AS A COHORT – use social distancing

• Transfer to a facility with quarantine space

(LAST RESORT due to possibility of introducing COVID-19 to

DO NOT MIX PEOPLE QUARANTINED

• Evaluate people for COVID-19 at the first sign of symptoms

• Have a plan in place to safely transport cases to a local

• Assess PPE needs based on the type of contact a person has

• Minimize contact with a symptomatic person until that

• Wash hands thoroughly after any contact

• Refer to CDC’s guidance on optimizing PPE supplies:

Some strategies include:

2nd to last page of guidance

NOTE: Change to table

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