Key Points

• In 2020, countries reported on average, about half of essential health services were disrupted -WHO “pulse survey“external icon
• Pursue telehealth as an alternative to face-to-face healthcare services, commonly used pre-pandemic, to:
  • Reduce unnecessary exposure to COVID-19,
  • Help mitigate the spread of the virus, and
  • Reduce surges in hospitals and clinics.

This guidance document is developed to encourage healthcare providers to explore ways of meeting the essential healthcare needs of the community using innovative telehealth modalities and technologies; and expand the use of telehealth in the care of patients, and telemedicine in the care of COVID-19 and other non-COVID-19 patients.

What is Telehealth?

Telehealth is remote patient care and monitoring. It allows direct transmission of a patient’s clinical measurements from a distance to their healthcare provider and may or may not be in real time. The telehealth session may also be facilitated by a Healthcare Professional (to other healthcare professionals), Village Health Volunteer -VHV, a Community Health Worker -CHW visiting the patient, or by the patient him/her-self, a parent or a legal guardian. Telehealth can be any combination of healthcare services including telemedicine. Some healthcare specialties default to “referring to all of such services” as telehealth. “TeleCOVID-19” care is Telemedicine.

Examples of Telehealth Care include:

• Screening for COVID-19, testing recommendations, and guidance on isolation or quarantine
• General health care (i.e. wellness visits, blood pressure control, advice about certain non-emergency illnesses, like common rashes)
• Non-emergency follow-up clinics
• Prescriptions for medication
• Nutrition counseling
• Mental health counseling
• Physical therapy exercise
• Teleradiology
• Tele-intensive care (in infectious disease hospitalizations)
• Telemedicine

Telehealth  decreases contact with healthcare facilities, other patients, and healthcare staff in order to reduce the risk of COVID-19 spread in the community.

Generally, Telehealth Modalities include:  

• Synchronous: Real-time telephone or live audio-video interaction, typically with a patient, using a smartphone, tablet, or computer.
  • For example: In some cases, peripheral medical equipment (e.g., digital stethoscopes, otoscopes, ultrasounds) can be used by another health care provider (e.g., nurse, medical assistant) physically with the patient, while the consulting medical provider conducts a remote evaluation.
• Asynchronous:The provider and patient communication does not happen in real time.

For example, “store and forward” technology allows messages, images, or data to be collected at one point in time and interpreted or responded to later. Patient portals can facilitate this type of communication between provider and patient through secure messaging. Other examples of telehealth modalities developed/used by American College of Obstetricians and Gynecologistsexternal icon include:

1. Live, two-way (or real-time) synchronous audio and video allows specialists, local physicians, and patients to see and hear each other in real-time to discuss conditions e.g. via phone or computer (also defined above).
2. Store-and-forward, also referred to as “asynchronous telemedicine,” sends medical imaging such as X-rays, photos, ultrasound recordings, or other static and video medical imaging to remote specialists for analysis and future consultation (also defined above).
3. Remote patient monitoring collects personal health and medical data from a patient in one location and electronically transmits the data to a physician in a different location for use in care and related support.
4. mHealth is a general term for self-managed patient care using mobile phones or other wireless technology and does not necessarily involve monitoring by a physician. It is most commonly used to deliver or reinforce patient education about preventive care and provide medication reminders, appointment reminders, and other essential self-care steps that patients should undertake to maintain their optimal obstetric health.

What is Telemedicine?

Telemedicine is the use of electronic information and telecommunication technology to get needed health care while practicing physical distancing.  This encourages meaningful use of patient health measures to help guide the engagement of patient in care.

Telemedicine goals for Developing Countries should includeexternal icon, but not be limited to:

• Remote diagnosing and teleconsulting* system. Data (including signals and images) are locally (patient-side) acquired and stored, and then forwarded to the main hospital, where physicians can analyze those data. The remote (physician-side) hospital will then send back the diagnosis.
• Remote diagnosis performed with patient assisted by nurses. If no physician is in the neighborhood: such a situation typically occurs in rural locations of developing countries, and in some cases a preliminary diagnosis is locally performed by the aid of a decision support system (DSS).
• Remote monitoring system. The patient is monitored in the remote location, his/her signals are continuously acquired, forwarded to the main hospital, and possibly, locally analyzed by a DSS. Alarms are remotely detected and transmitted back to the patient-side. The monitoring system can be managed and locally controlled by a physician or by a nurse.
• Remote intervention system. The patient enters the operating room, the intervention is performed through a local (patient-side) robot that is remotely controlled by a physician in the main hospital. The remote intervention requires that some local assistance is performed by a physician or by a nurse.
• Remote education (e-learning) system. Students or caregivers (mostly physicians, nurses, and technicians) attend classes taught from remote academic institutions, and possibly by a bi-directional communication interact with the teacher by making up questions. Remote education can be locally assisted by a local tutor, during and/or after the classes.

*Note: Teleconsulting, i.e., expert second opinion, is performed among physicians, where a non-specialist physician requires a remote consultation with one or more specialist physicians: typically, such a situation occurs in emergency centers of rural locations or in minor hospitals of developed countries, or in any location of developing countries.

Potential Limitations of Telehealth

Adaptations to telehealth may need to be considered in certain situations where in-person visits are more appropriate such as:

• Due to urgency, a person’s underlying health conditions, or the fact that a physical exam or laboratory testing is needed for medical decision making.
• If sensitive topics need to be addressed, especially if there is patient discomfort or concern for privacy.
• Limited access to technological devices (e.g., phones, tablets, computers) or connectivity. This may be especially true for those living in rural settings.
• When healthcare workers or patients may be less comfortable with using the technology, and may prefer an in-person visit.
• When virtual visits are not readily accepted in lieu of in-person visits by healthcare workers or patients.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/telehealth-covid19-nonUS.html

The federal government is committed to ensuring that residents and staff in long-term care (LTC) settings, such as nursing homes, assisted living, residential care communities, group homes and senior housing, have access to COVID-19 vaccines to receive primary series and booster shots. For additional examples of LTC settings, see COVID-19 Vaccine Access in Long-Term Care Settingsexternal icon.

The goal is to continue to protect those who are disproportionately affected by COVID-19—especially residents of LTC settings. All LTC settings that request assistance accessing COVID-19 vaccines for their residents and staff will receive the support they need.

Many LTC providers have already identified strategies and partnerships to obtain and administer COVID-19 vaccines for residents and staff. These include:

• Working with established LTC partners and retail pharmacy partners
• Coordinating with state and local health departments

Long-term care providers are encouraged to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, either in the local community or on-site. Additional details on these options are available on the pages linked below.

https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships/administrators-managers.html

https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships/jurisdictions.html

Additional Information COVID-19 Vaccination Recommendations

COVID-19 vaccination is recommended for all people ages 5 years and older in the United States for the prevention of COVID-19. COVID-19 vaccines currently approved or authorized by FDA are highly effective in preventing serious outcomes of COVID-19, including severe disease, hospitalization, and death. Efforts to maximize the proportion of people in the United States who are fully vaccinated against COVID-19 remain critical to ending the COVID-19 pandemic. At present, people with moderately to severely compromised immune systems should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses.

CDC now recommends that certain people receive a COVID-19 booster shot. For more information, visit Who is Eligible For a COVID-19 Vaccine Booster Shot?

In addition, COVID-19 vaccines may now be administered along with other vaccines. This includes simultaneous administration of the COVID-19 vaccine and other vaccines such as the flu vaccine on the same day, as well as coadministration within 14 days. For more information, see Interim Clinical Considerations for Use of COVID-19 Vaccines.

To learn more, please visit https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships.html.

During National Nurses Week, take time to celebrate the founder of modern nursing, Florence Nightingale! Her endeavors to improve the aspect of healthcare has greatly shaped the quality of care by nurses in the 19th and 20th centuries. 

Currently, there are nurses all around the world putting their lives on the line to help stop the spread of COVID-19. It’s clear that Florence Nightingale’s impact on healthcare also helped pave the way for modern-day nurses and healthcare professionals to follow suit.

“With nurses around the world on the front lines of a global pandemic, it’s a poignant time to reflect on how Nightingale’s legacy laid the groundwork for their heroic work in hospitals today.” Says Greta Westwood, CEO of the Florence Nightingale Foundation. “She never took no for an answer – anything was possible.”

Also known as “The Lady with the Lamp”, Florence Nightingale started her nursing career in London, and later became appointed as the head nurse of the 1854 Crimean War. Nightingale’s passion and determination set her apart from others and got her the famous nickname “Lady with the Lamp” for checking on her patients via lamplight during the war. Not only did she care for her patients’ health, but she also often wrote letters to soldiers’ loved ones on their behalf.

The “Angel of the Crimea” made it her goal to lower death rates by improving hygiene practices in hospitals. She created numerous patient services that improved each patient’s quality of care while admitted in the hospital. She oversaw “invalid’s kitchen” where she set out food plans for patients that had dietary requirements. She also secured a laundry area so patients could have clean bed sheets and towels.

After the Crimean War, Nightingale wrote a book called Matters Affecting the Health, Efficiency and Hospital Administration of the British Army to share her observations and experiences while tending wounded soldiers. In 1857, the War Office’s administrative department was completely reconstruction due to Nightingale’s book and her experiences during the Crimean War, reforming several military hospitals that were under very poor conditions. (History.com Editors 2009)

In August of 1910, Nightingale became ill and was battling with heart failure. She died a week later at her home in London, bringing her life to an end at 90 years old. (History.com Editors 2009) Two years after her death, the Florence Nightingale Medal was created by the International Committee of the Red Cross, dedicated to be given to exceptional nurses every 2 years. In 1965, International Nurses Day was also created, residing on Nightingale’s birthday to continue celebrating her accomplishments. (Alexander 2018)

Despite her unexpected death, her legacy continues to live on at the Florence Nightingale Museum, which is located at the exact same spot of the original Nightingale Training School for Nurses. The museum holds over 2,000 artifacts to memorialize the mother of modern nursing. (History.com Editors 2009)

Florence Nightingale’s legacy is important to note during significant time for nurses courageously fighting on the frontlines during the pandemic. Notes Westwood, “Florence would be so proud of what nurses have managed to achieve during the pandemic.” (Haynes 2020)

References:

https://time.com/5835150/florence-nightingale-legacy-nurses/

http://history.com/topics/womens-history/florence-nightingale-1https://www.womenshistory.org/education-resources/biographies/florence-nightingale

We are preparing for an amazing celebration of National Nurses Week this year! Many companies are showing their gratitude for nurses and healthcare workers by offering awesome deals and freebies during Nurses Week and throughout the year. Whether you are a healthcare worker looking for a good deal or you’re shopping for a healthcare hero in your life, check out these great deals valid for the entire month of May for Nurses Week 2022!

Food & Drinks

• Mrs. Fields – Take a look online at this sweet selection of cookies in the Heroes Collection of cookie tins, which honors healthcare workers.
• Outback Steakhouse – Grab a hot meal and a big thank you! Show your industry identification to get 10% off your bill. The discount is not available via ordering online.
• Texas de Brazil – Enjoy a night or lunch out with a delicious selection of steaks (salads too!) and save 15% with a valid badge or ID.

Retail

• Amazon – Curl up with a selection of four free medical drama books, specially curated to celebrate nurses.
• Adidas – Receive 30% off in-store and on the Adidas website, and 20% off at factory outlet stores, when you verify your status as a nurse with ID.me.
• All Seasons Uniforms – Spruce up your closet with 20% off all medical apparel, such as scrubs, lab coats, and cleanroom clothing. Use discount code NURSE20.
• ASICS – Medical professionals and first responders, including nurses, physicians, police officers, and firefighters, can enjoy 40% off ASICS products. When you verify your healthcare worker status using SheerID, you will receive a on-time-use promo code.
• Brooklyn Bedding – Don’t snooze on this offer. Get 25% off and free shipping on your entire order of mattresses, pillows, sheets, and/or foundations. Verify your eligibility via ID.me during checkout.
• Lenovo – Need to upgrade your technology? Take an extra 5% off products sitewide, excluding doorbuster deals and select clearance products. Verify your healthcare worker status with ID.me during checkout.
• L.L. Bean – Enjoy 15% off one purchase after verifying your employment status through SheerID. This discount is valid on merchandise purchases are llbean.com, retail stores, or by phone.
• Lululemon – Receive 15% off in-store or online purchases.
• Nike – All medical professionals and first responders in the US are eligible for a 10% discount. Verify your profession as a nurse with SheerID to get a one-time-use promo code.
• Purple – Take 10% off any order purchased at purple.com or Purple retail showrooms, after verifying employment status through SheerID. Click on the “Verify Eligibility” button to start the process. Once approved, you will receive a single-use promotional code to use at checkout.
• Ring – Stay safe with a 20% discount savings on select Ring Doorbell products.
• Rothy’s – Enjoy some cool comfort with 20% off a pair of washable shoes. Verify your nurse status and claim the savings at online checkout.
• Under Armour – Take advantage of 20% off at UA.com and in UA Brand House stores. Choose the Military and First Responder Discount at checkout, and then verify your status as a nurse with ID.me.
• Verizon – You and your loved ones can get a Start Unlimited plan (with unlimited talk, text, and data) from $30 per line with four lines. That’s an offer the whole family can enjoy!
• Vineyard Vines – Save 15% on all apparel with a verified medical ID.

Travel

• Budget – Available through the ID.me shop, Budget is offering a discount of up to 25% for nurses. Create an ID.me account or sign in to enjoy this offer.
• Enterprise Rent-a-Car – Similar to the Budget discount, nurses, military members, and teachers can take up to 25% off their rental car costs with Enterprise. An ID.me account is required to access this discount.
• National – Rounding out the trio of rental car companies’ offers for nurses through ID.me, National “lets you choose any car in the aisle and go” with up to 25% off.

In addition to this month’s discounts and freebies, Majestic Care is proud to partner with Panda Perks to give our Care Team members 24/7 access to discounts and perks on the brands you love! Give us a call to learn more.

Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as post-COVID conditions (PCC) or long COVID.

People call post-COVID conditions by many names, including: long COVID, long-haul COVID, post-acute COVID-19, post-acute sequelae of SARS CoV-2 infection (PASC), long-term effects of COVID, and chronic COVID.

What You Need to Know

• Post-COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or years.
• Post-COVID conditions are found more often in people who had severe COVID-19 illness, but anyone who has been infected with the virus that causes COVID-19 can experience post-COVID conditions, even people who had mild illness or no symptoms from COVID-19.
• People who are not vaccinated against COVID-19 and become infected may also be at higher risk of developing post-COVID conditions compared to people who were vaccinated and had breakthrough infections.
• There is no single test for post-COVID conditions. While most people with post-COVID conditions have evidence of infection or COVID-19 illness, in some cases, a person with post-COVID conditions may not have tested positive for the virus or known they were infected.
• CDC and partners are working to understand more about who experiences post-COVID conditions and why, including whether groups disproportionately impacted by COVID-19 are at higher risk.

About Long COVID or Post-COVID Conditions

Post-COVID conditions are a wide range of new, returning, or ongoing health problems that people experience after first being infected with the virus that causes COVID-19. Most people with COVID-19 get better within a few days to a few weeks after infection, so at least four weeks after infection is the start of when post-COVID conditions could first be identified. Anyone who was infected can experience post-COVID conditions. Most people with post-COVID conditions experienced symptoms days after their SARS CoV-2 infection when they knew they had COVID-19, but some people with post-COVID conditions did not notice when they first had an infection.

There is no test to diagnose post-COVID conditions, and people may have a wide variety of symptoms that could come from other health problems. This can make it difficult for healthcare providers to recognize post-COVID conditions. Your healthcare provider considers a diagnosis of post-COVID conditions based on your health history, including if you had a diagnosis of COVID-19 either by a positive test or by symptoms or exposure, as well as doing a health examination.

Symptoms

People with post-COVID conditions can have a wide range of symptoms that can last more than four weeks or even months after infection. Sometimes the symptoms can even go away or come back again.

Post-COVID conditions may not affect everyone the same way. People with post-COVID conditions may experience health problems from different types and combinations of symptoms happening over different lengths of time. Most patients’ symptoms slowly improve with time. However, for some people, post-COVID conditions may last months, and potentially years, after COVID-19 illness and may sometimes result in disability.

People who experience post-COVID conditions most commonly report:

General symptoms

• Tiredness or fatigue that interferes with daily life
• Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
• Fever

Respiratory and heart symptoms

• Difficulty breathing or shortness of breath
• Cough
• Chest pain
• Fast-beating or pounding heart (also known as heart palpitations)

Neurological symptoms

• Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
• Headache
• Sleep problems
• Dizziness when you stand up (lightheadedness)
• Pins-and-needles feelings
• Change in smell or taste
• Depression or anxiety

Digestive symptoms

• Diarrhea
• Stomach pain

Other symptoms

• Joint or muscle pain
• Rash
• Changes in menstrual cycles

Symptoms that are hard to explain and manage

People with post-COVID conditions may develop or continue to have symptoms that are hard to explain and manage. Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other infections. People with these unexplained symptoms may be misunderstood by their healthcare providers, which can result in a long time for them to get a diagnosis and receive appropriate care or treatment. Review these tips to help prepare for a healthcare provider appointment for post-COVID conditions.

Health conditions

Some people, especially those who had severe COVID-19, experience multiorgan effects or autoimmune conditions with symptoms lasting weeks or months after COVID-19 illness. Multiorgan effects can involve many body systems, including the heart, lung, kidney, skin, and brain. As a result of these effects, people who have had COVID-19 may be more likely to develop new health conditions such as diabetes, heart conditions, or neurological conditions compared with people who have not had COVID-19.

People experiencing any severe illness may develop health problems

PICS refers to the health effects that may begin when a person is in an intensive care unit (ICU), and which may persist after a person returns home. These effects can include muscle weakness, problems with thinking and judgment, and symptoms of post-traumatic stress disorder (PTSD). PTSDexternal icon involves long-term reactions to a very stressful event. For people who experience PICS following a COVID-19 diagnosis, it is difficult to determine whether these health problems are caused by a severe illness, the virus itself, or a combination of both.

People More Likely to Develop Long COVID

Researchers are working to understand which people or groups of people are more likely to have post-COVID conditions, and why. Studies have shown that some groups of people may be affected more by post-COVID conditions. These are examples and not a comprehensive list of people or groups who might be more at risk than other groups for developing post-COVID conditions:

• People who have experienced more severe COVID-19 illness, especially those who were hospitalized or needed intensive care.
• People who had underlying health conditions prior to COVID-19.
• People who did not get a COVID-19 vaccine.
• People who experience multisystem inflammatory syndrome (MIS) during or after COVID-19 illness.
• Some people affected by health inequities including people from racial or ethnic minority groups and people with disabilities.

Health Inequities May Affect Populations at Risk for Long COVID

Some people are at increased risk of getting sick from COVID-19 because of where they live or work, or because they can’t get health care. Health inequities may put some people from racial or ethnic minority groups and some people with disabilities at greater risk for developing post-COVID conditions. Scientists are researching some of those factors that may place these communities at higher risk of both getting infected or developing post-COVID conditions.

Preventing Long COVID

Research suggests that people who are vaccinated but experience a breakthrough infection are less likely to report post-COVID conditions, compared to people who are unvaccinated.

Learn more about protecting yourself and others from COVID-19.

Living with Long COVID

However, people experiencing post-COVID conditions can seek care from a healthcare provider to come up with a personal medical management plan that can help improve their symptoms and quality of life. Review these tips to help prepare for a healthcare provider appointment for post-COVID conditions. In addition, there are many support groups being organized that can help patients and their caregivers.

Although post-COVID conditions appear to be less common in children and adolescents than in adults, long-term effects after COVID-19 do occur in children and adolescents.

CDC is working to:

• Better identify the most frequent symptoms and diagnoses experienced by patients with post-COVID conditions.
• Better understand how many people are affected by post-COVID conditions, and how often people who are infected with COVID-19 develop post-COVID conditions afterwards.
• Better understand risk factors, including which groups might be more at risk, and if different groups experience different symptoms.
• Help understand how post-COVID conditions limit or restrict people’s daily activity.
• Help identify groups that have been more affected by post-COVID conditions, lack access to care and treatment for post-COVID conditions, or experience stigma.
• Better understand the role vaccination plays in preventing post-COVID conditions.
• Collaborate with professional medical groups to develop and offer clinical guidance and other educational materials for healthcare providers, patients, and the public.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/whats-new-all.html.

For people who are more likely to get very sick from COVID-19 infection, medications are available that can reduce your chances of severe illness and death. Other medications can help reduce symptoms and help you manage your illness.

Here’s what you need to know.

Treating COVID-19

If you test positive and are more likely to get very sick from COVID-19, treatments are availableexternal iconexternal icon that can reduce your chances of being hospitalized or dying from the disease. Medications to treat COVID-19 must be prescribed by a healthcare provider and started as soon as possible after diagnosis to be effective. Contact a healthcare provider right away to determine if you are eligible for treatment, even if your symptoms are mild right now.

Don’t delay: Treatment must be started within days after you first develop symptoms to be effective.

People who are more likely to get very sick include older adults (ages 50 years or more, with risk increasing with older age), people who are unvaccinated, and people with certain medical conditions, such as a weakened immune system. Being vaccinated makes you much less likely to get very sick. Still, some vaccinated people, especially those ages 65 years or older or who have other risk factors for severe disease, may benefit from treatment if they get COVID-19. A healthcare provider will help decide which treatment, if any, is right for you.

The FDA has issued emergency use authorizations (EUA) for certain antiviral medications and monoclonal antibodies to treat mild to moderate COVID-19 in people who are more likely to get very sick.

• Antiviral treatmentsexternal icon target specific parts of the virus to stop it from multiplying in the body, helping to prevent severe illness and death.
• Monoclonal antibodiesexternal icon help the immune system recognize and respond more effectively to the virus. They may be more or less effective against different variants of the virus that causes COVID-19.

The National Institutes of Health (NIH) provides COVID-19 Treatment Guidelinesexternal icon for healthcare providers to help them work with their patients and determine the best treatment options for them. Several options are available for treating COVID-19 at home or in an outpatient setting. They include:

• Nirmatrelvir with ritonavir (Paxlovid)external icon is an investigational antiviral treatment used in adults and children ages 12 years and older. It is taken at home by mouth (orally). It should be started as soon as possible and must begin within 5 days of when your symptoms start.
• Remdesivir (Veklury)external icon is an antiviral treatment used in adults and children. Treatment requires intravenous (IV) infusions at a healthcare facility for 3 consecutive days. It should be started as soon as possible and must begin within 7 days of when your symptoms start.
• Bebtelovimabexternal icon is an investigational monoclonal antibody treatment used in adults and children ages 12 years and older. A healthcare provider gives bebtelovimab as a single IV injection. It should be started as soon as possible and must begin within 7 days of when your symptoms start.
• Molnupiravir (Lagevrio)external icon is an investigational antiviral treatment used in adults ages 18 years and older. It is taken at home by mouth (orally). It should be started as soon as possible and must begin within 5 days of when your symptoms start.

Some treatments might have side effects or interact with other medications you are taking. To find out if medications to treat COVID-19 are right for you, you have options:

• Talk to your healthcare provider
• Visit a test to treat locationexternal icon
• Contact your local community health center or health department

If you are hospitalized, your healthcare provider might use other types of treatments, depending on how sick you are. These could include medications to treat the virus, reduce an overactive immune response, or treat COVID-19 complications.

Managing COVID-19 Symptoms

Most people with COVID-19 have mild illness and can recover at home. If you are worried about your symptoms, the Coronavirus Self-Checker can assist in the decision to seek care. You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better. Learn more about what to do if you are sick.

Preventing COVID-19

COVID-19 vaccines available in the United States effectively protect people from getting seriously ill, being hospitalized, and even dying—especially people who are boosted. As with vaccines for other diseases, you are protected best when you stay up to date. CDC recommends that everyone who is eligible stay up to date on their COVID-19 vaccines, including people with weakened immune systems.

Preventive Medications

The FDA has issued an EUA for tixagevimab plus cilgavimab (Evusheld)external icon, an investigational medicine used in adults and children ages 12 years and older. Evusheld consists of 2 monoclonal antibodies provided together to help prevent infection with the virus that causes COVID-19. A healthcare provider gives Evusheld as 2 separate consecutive intramuscular (IM) injections at a doctor’s office or healthcare facility. If you are moderately or severely immunocompromised or severely allergic to COVID-19 vaccines, you may be eligible for Evusheld. Talk to a healthcare provider to determine if this option is right for you.

The right medications for COVID-19 can help. People have been seriously harmed and even died after taking products not approved for use to treat or prevent COVID-19, even products approved or prescribed for other uses. Talk to a healthcare provider about taking medications to treat COVID-19.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html

CDC uses Travel Health Notices (THNs) to alert travelers and other audiences to health threats around the world and advise on how to protect themselves.

On April 18, 2022, CDC updated its COVID-19 THN system. Level 4 will no longer be based on COVID-19 incidence or case count alone. It will be reserved for special circumstances, such as rapidly escalating case trajectory or extremely high case counts, emergence of a new variant of concern, and healthcare infrastructure collapse. Levels 3, 2, and 1 will still be primarily determined by 28-day incidence or case counts as outlined below.

COVID-19 Travel Recommendations can be found in two places:

• Interactive world map showing COVID-19 travel recommendations by destination
• CDC’s COVID-19 Travel Health Notice webpage

The 4-level system categorizes international destinations into the following levels:

Level 4: Special Circumstances / Do Not Travel

• Do not travel to this destination.
• If you must travel, make sure you are up to date with your COVID-19 vaccines before your trip.

Level 3: High Level Of COVID-19

• Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
• If you are not up to date with your vaccines, avoid travel to this destination.
• If you have a weakened immune system or are more likely to get very sick from COVID-19, even if you are up to date with your COVID-19 vaccines, talk with your clinician about your risk and consider delaying travel to this destination.

Level 2: Moderate Level Of COVID-19

• Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
• If you have a weakened immune system or are more likely to get very sick from COVID-19, even if you are up to date with your COVID-19 vaccines, talk to your clinician about what additional precautions may be needed before, during, and after travel to this destination.

Level 1: Low Level of COVID-19

• Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.

Level Unknown: Unknown Level of COVID-19

• Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
• If you are not up to date with your vaccines, avoid travel to this destination.
• If you have a weakened immune system or are more likely to get very sick from COVID-19, even if you are up to date with your COVID-19 vaccines, talk with your clinician about your risk, and consider delaying travel to this destination.

Travel Health Notice Thresholds

CDC reviews case data reported to the World Health Organizationexternal icon to determine a destination’s COVID-19 THN level.

Level 4 Travel Health Notices

Level 4 will be reserved for special circumstances, such as rapidly escalating case trajectory or extremely high case counts, emergence of a new variant of concern, and healthcare infrastructure collapse. Other factors that may be considered include information such as vaccination rate and hospitalization rate. CDC works with country authorities through CDC country or regional offices to gather additional data as appropriate.

Level 1-3 Travel Health Notices are determined as follows:

Primary criteria for destinations with populations over 100,000

1. Incidence rate (cumulative new cases over the past 28 days per 100,000 population)
2. New case trajectory (Have daily new cases increased, decreased, or remained stable over the past 28 days?)

Primary criteria for destinations with populations of 100,000 or less

1. COVID-19 case counts* (cumulative new cases over past 28 days)
2. New case trajectory (Have daily new cases increased, decreased, or remained stable over the past 28 days?)

*CDC does not count identified imported cases (i.e., cases in travelers who were exposed in another country) against a destination’s total.

Secondary Criteria for Determining Travel Health Notice Levels

Reported case counts and incidence rates depend on testing capacity. CDC assesses testing capacity using two secondary criteria metrics: population testing rate and test-to-case ratio. The population testing rate is the number of tests conducted per 100,000 people over 28 days. The test-to-case ratio is the number of tests conducted for each case reported during the same 28-day period. Testing data are obtained from multiple sources, including Our World in Dataexternal icon, Foundation for Innovative Diagnosticsexternal icon, and country ministries of health.

Travel Health Notice levels 1 through 3 for destinations with a population more than 100,000 people. Levels are based on combined 1) incidence rate (primary criteria) and 2) testing data (secondary criteria)

*Incidence rate is the primary criteria for destinations with a population more than 100,000 people. Testing data are the secondary criteria and that data includes both the testing rate (column 1) and test-to-case ratio (column 2). The resulting THN levels are shown in rows 3–11 of columns 3–5.

Travel Health Notice levels 1 through 3 for destinations with a population of 100,000 people or fewer. Levels are based on combined 1) case count (primary criteria) and 2) testing data (secondary criteria) *

*Case count is the primary criteria for destinations with a population fewer than or equal to 100,000 people. Testing data are the secondary criteria and that data includes both the testing rate (column 1) and test-to-case ratio (column 2). The resulting THN levels are shown in rows 3–11 of columns 3–5.

Population testing rates of more than 1,500 tests per 100,000 people over 28 days are considered sufficient to provide an accurate representation of COVID-19 in the destination. Rates less than or equal to 1,500 tests per 100,000 people over 28 days may signify concerns that testing is insufficient and may not provide an accurate representation of the incidence rate in the destination. The cutoffs for evaluating population testing ratesexternal icon have been adapted from the WHO guidelines.

The WHO determined a test-to-case ratio greater than or equal to 10 as the minimum indicator of sufficient surveillance capacity. A test-to-case ratio of less than 10 tests per case might indicate restrictive testing, or that only symptomatic people are being tested and undercounting the incidence rate (primary criteria). The preferred level is a test-to-case ratio of more than 30. The cutoffs for evaluating test-to-case ratios pdf icon[PDF – 18 pages]external icon have been adapted from the WHO guidelines.

When both the population testing rates and test-to-case ratios are high, CDC has confidence in a destination’s reported incidence. If either the population testing rate or test-to-case ratio is low, CDC has less confidence that the reported incidence accurately depicts the COVID-19 situation in the destination. In this situation, CDC adjusts a destination’s THN level as shown in the tables above. Countries with low incidence and testing rates are classified as unknown as well as countries that report data infrequently.

Level Unknown Travel Health Notices are determined as follows:

If a destination has insufficient data to make a THN level determination, its THN level is designated as “unknown”. Insufficient data means that the destination does not provide data or that the provided data are non-representative of the COVID-19 situation in the destination, making an accurate THN level determination difficult. This situation includes destinations with low COVID-19 incidence and low reported COVID-19 testing levels.

Raising a Travel Health Notice

CDC raises a destination’s THN level when the incidence rate (or case count) and testing metrics meet the THN threshold for a higher level and remain at that level for 14 consecutive days. The THN level may be raised before 14 days if there is a large increase in COVID-19 cases reported.

Lowering a Travel Health Notice

CDC lowers a destination’s THN level when the incidence rate (or case count) and testing metrics meet the THN threshold for a lower level and remain at that level for 28 consecutive days. Vaccination coverage rates and case trajectory will be considered when determining if the THN level can be lowered before 28 days.

For more information, visit How CDC Determines the Level for COVID-19 Travel Health Notices | CDC

Boyd Nursing and Rehabilitation recently had the pleasure of caring for Mrs. Linda Leforrest. This was not the first time that Linda had come to Boyd Nursing for rehabilitation, as she had visited us a few years ago with successful results and therefore chose to come to us again for her rehab needs.

This time was a little different, and perhaps more challenging because she was recovering from an extended and complicated hospital stay due to COVID-19 and pneumonia. Linda, with her vigorous personality, proved how strong she was by regaining the mobility and independence that she lost during that extensive hospitalization. Linda says that she is ready to return home to her little dog, Ruby, and get back to enjoying shopping and going out to eat with her daughters and granddaughters. We wish you the best return home and know that you are always welcome back to our home when you need us. Congratulations to Linda and her Care Team on their success!

Diagnostic Testing

Diagnostic testing is intended to identify current infection in individuals and should be performed on anyone that has signs and symptoms consistent with COVID-19 and/or following recent known or suspected exposure to SARS-CoV-2.

Examples of diagnostic testing include:

• Testing anyone with symptoms consistent with COVID-19
• Testing vaccinated and unvaccinated people who were exposed to someone with a confirmed or suspected case of COVID-19

Screening Testing

Screening tests are intended to identify people with COVID-19 who are asymptomatic and do not have known, suspected, or reported exposure to SARS-CoV-2. Screening helps to identify unknown cases so that measures can be taken to prevent further transmission.

Examples of screening include testing:

• Employees in a workplace setting
• Students, faculty, and staff in a school setting
• A person before or after travel
• Someone at home who does not have symptoms associated with COVID-19 and no known exposures to someone with COVID-19

Public Health Surveillance Testing

Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice. See CDC’s Introduction to Public Health Surveillance.

Public health surveillance testing is intended to monitor community- or population-level outbreaks of disease, or to characterize the incidence and prevalence of disease. Surveillance testing is performed on de-identified specimens, and thus, results are not linked to individual people. Public health surveillance testing results cannot be used for individual decision-making.

Public health surveillance testing may sample a certain percentage of a specific population to monitor for increasing or decreasing prevalence, or to determine the population effect from community interventions such as social distancing. An example of public health surveillance testing is when a state public health department develops a plan to randomly select and sample a percentage of all people in a city on a rolling basis to assess local infection rates and trends.

Regulatory Requirements for Diagnostic, Screening, and Public Health Surveillance Testing

Any laboratory or testing site that performs diagnostic or screening testing must have a Clinical Laboratory Improvement Amendments (CLIA) certificate and meet all applicable CLIA requirements. For more information, see the Centers for Medicare & Medicaid Services CLIA websiteexternal icon. Tests used for SARS-CoV-2 diagnostic or screening testing must have received an Emergency Use Authorization from the U.S. Food and Drug Administration (FDA) or be offered under the policies in FDA’s Policy for COVID-19 Testsexternal icon.

Tests used for SARS-CoV-2 public health surveillance on de-identified human specimens do not need to meet FDA and CLIA requirements for diagnostic and screening testing.

Reporting Diagnostic, Screening, and Public Health Surveillance Testing Results

Both diagnostic and screening testing results should be reported to the people whose specimens were tested and/or to their healthcare providers.

In addition, laboratories that perform diagnostic and screening testing must report positive diagnostic and screening test results to the local, state, tribal, or territory health department in accordance with Public Law 116-136, § 18115(a), the Coronavirus Aid, Relief, and Economic Security (CARES) Act. As of April 4, 2022, laboratories are no longer required to report negative results for non-NAAT tests (rapid or antigen test results). The Department of Health and Human Services published guidance on COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115pdf iconexternal icon that specifies what data, in addition to test results, laboratories and testing sites should collect and electronically report.

Public health surveillance testing results cannot be reported directly to the people whose specimens have been tested and are not reported to their healthcare providers. Public health surveillance testing results (test results that are de-identified) can be reported in aggregate to local, state, tribal, or territory health departments upon request. Results from testing that is performed outside of a CLIA-certified facility or without an FDA-authorized test can only be reported to a health department if those results are used strictly for public health surveillance purposes, and not used for individual decision making.

Summary of Testing for COVID-19

	Diagnostic	Screening	Public Health Surveillance
Symptomatic	Yes	No	N/A
Unvaccinated or vaccinated with known or suspected exposure	Yes	No	N/A
Unvaccinated and Asymptomatic without Known or Reported Suspected Exposure	No	Yes	N/A
Characterize Incidence and Prevalence in the Community	N/A	N/A	Yes
Testing of Personally Identifiable Specimens	Yes	Yes	No
Results may be Returned to Individuals	Yes	Yes	No
Results Returned in Aggregate to Requesting Institution	No	No	Yes
Results Reported to State Public Health Departments	Yes	Yes	If requested
Testing can be Performed in CLIA-Certified Laboratory	Yes	Yes	Yes
Testing can be Performed in a Non-CLIA-Certified Laboratory	No	No	Yes
Test System Must be FDA Authorized or be Offered under the Policies in FDA’s Guidance	Yes	Yes	No

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/sars-cov2-testing-strategies.html

To help prevent the spread of COVID-19 and help our country cope during the pandemic, CDC has occasionally issued legally binding orders and regulations.

• Face Masks Required on Public Transportation and at Transportation Hubs

People must wear face masks in indoor areas of public transportation traveling into, within, or out of the United States and indoors at U.S. transportation hubs, including airports.

• Negative COVID-19 Test or Documentation of Recovery Needed to Board a Flight to the US

Air passengers, 2 years or older, traveling to the United States from another country must present a negative COVID-19 test result or documentation of recovery from COVID-19 before boarding their flights. Regardless of vaccination status, passengers ages 2 or older are required to present a negative COVID-19 viral test result from a sample taken no more than 1 day before travel. Alternatively, passengers may present documentation showing that they tested positive for COVID-19 on a sample taken within the past 90 days and have been cleared to travel (documentation of recovery).

• Order Implementing Proclamation on Safe Resumption of Global Travel During the COVID-19 Pandemic

CDC issued an Order to implement the President’s direction on safe resumption of global travel during the COVID-19 pandemic and provided guidance to airlines, other aircraft operators, and passengers in Technical Instructions and Frequently Asked Questions.

All non-U.S.-citizen, non-immigrants, with limited exceptions, traveling to the United States by air must be fully vaccinated and show proof of vaccination.

• Order Requiring Airlines to Collect Contact Information for All Passengers Arriving into the United States

CDC issued an Order on October 25, 2021 requiring airlines and other aircraft operators to collect contact information for passengers before they board a flight to the United States from a foreign country. The purpose of collecting this information is to identify and locate passengers who may have been exposed to a person with a communicable disease for public health follow-up. Airlines will retain the information for 30 days and transmit the information to CDC upon request for contact tracing and public health follow-up to keep people safe.

• Public Health Determination and Order Regarding the Right to Introduce Certain Persons from Countries Where a Quarantinable Communicable Disease Exists pdf icon[534 KB, 30 pages]

Following a public health determination, the CDC Director is terminating the Order under 42 U.S.C. §§ 265, 268 and 42 C.F.R. § 71.40 suspending the right to introduce certain persons into the United States. The implementation of the termination of the Order will be on May 23, 2022.

CDC considered multiple factors in its public health assessment and finds that, at this time, the available COVID-19 mitigation tools, as well as the fact that 97% of the U.S. population lives in a county identified as having “low” COVID-19 Community Level, will sufficiently mitigate the COVID-19 risk for U.S. communities and make an order under 42 U.S.C. §§ 265, 268 and 42 C.F.R. § 71.40 no longer necessary. This Termination will be implemented on May 23, 2022, to enable the Department of Homeland Security (DHS) to implement appropriate COVID-19 mitigation protocols, such as scaling up a program to provide COVID-19 vaccinations to migrants, and prepare for full resumption of regular migration processing under Title 8 authorities.

The initial CDC Order Suspending Introduction of Certain Persons from Countries where a Communicable Disease Exists was issued on 3/20/2020 pdf icon[2.1 MB, 43 pages], extended on 4/22/2020external icon and extended and amended on 5/19/2020 pdf icon[136 KB, 12 pages]. The Order was replaced with the Order Suspending the Right to Introduce Certain Persons from Countries Where a Quarantinable Communicable Disease Exists on 10/16/2020external icon and replaced again on 8/2/2021 pdf icon[296 KB, 24 pages]. This Order and accompanying public health determination terminate all previous orders.

• Public Health Reassessment and Immediate Termination of Order Suspending the Right to Introduce Certain Persons from Countries Where a Quarantinable Communicable Disease Exists with Respect to Unaccompanied Noncitizen Children pdf icon[370 KB, 21 pages]

During the COVID-19 pandemic, CDC issued an order suspending the right to introduce certain noncitizens attempting to enter the U.S. from Canada or Mexico (regardless of country of origin) at or between ports of entry. CDC has terminated the Order with respect to unaccompanied noncitizen children.

To learn more, please visit https://www.cdc.gov/coronavirus/2019-ncov/cdcresponse/laws-regulations.html.