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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 21-49
December 8, 2021


TO:
Long-Term Care Facilities

SUBJECT:
Coronavirus Disease 2019 (COVID-19) Infection Control Recommendations during the 2021 Holiday Season


All Facilities Letter (AFL) Summary

This AFL provides COVID-19 infection control recommendations during holiday celebrations for residents, families, and facilities. This includes:

  • Guidance for private gatherings
  • Resident testing and placement after returning to the facility
  • Communal activities in facilities

Background

During the 2021 holiday season, residents may leave their facilities to celebrate with their families and friends. People at higher risk of severe illness or death from COVID-19 (such as older adults and people with chronic medical conditions) should consider not attending any gatherings outside the facility; however, if higher-risk individuals do attend gatherings, the California Department of Public Health (CDPH) is providing infection control recommendations for residents, families, and long-term care (LTC) facilities to safely celebrate the holidays.

Recommendations for Residents and Families

If a resident is considering leaving the facility and attending an in-person gathering, residents and families should review the following resources:

These resources provide considerations to help protect individuals and their families, friends, and communities from COVID-19. Factors to consider include the following:

  1. Community levels of COVID-19 – Consider the number and rate of COVID-19 cases in your community and in the community where you plan to celebrate. To check COVID-19 cases in California visit the Tracking COVID-19 in California webpage.
  2. Increase your protection – Consider activating the CA Notify smartphone application, which helps reduce the spread of COVID-19 by anonymously notifying individuals of a possible exposure to COVID-19.
  3. Location of gathering – Gatherings that occur outdoors are safer than indoor gatherings. If an outdoor gathering is not possible:
    • Avoid crowded, poorly ventilated, and fully enclosed indoor spaces.
    • Increase ventilation by opening windows and doors to the extent that is safe and feasible based on the weather.
  4. Duration of gathering – Shorter gatherings are safer than longer gatherings.
  5. Number or people at the gathering – Smaller gatherings are safer than larger gatherings.
  6. Locations attendees are traveling from – Gatherings with attendees who are traveling from different places may pose a higher risk than gatherings with attendees who live in the same area. Higher levels of COVID-19 cases and community spread in the gathering location, or where attendees are coming from, increase the risk of infection and spread among attendees.
  7. Preventative measures at the gathering – Gatherings with preventative measures such as social distancing (staying six feet apart), wearing a mask, hand washing, and other preventative measures pose less risk than gatherings with no preventative measures. 
  8. COVID-19 vaccination status of attendees – If all attendees are fully vaccinated[i] for COVID-19, masking is not required indoors.
  9. Get vaccinated for COVID-19 – Protect yourself and others by getting vaccinated for COVID-19. COVID-19 vaccines are safe, effective, and free. To schedule an appointment or to find more information about COVID-19 vaccines visit the MyTurn webpage or talk with your healthcare provider.
  10. Booster doses of COVID-19 vaccine – Booster doses may be given to any person 18 years of age and older if it has been at least six months since their second dose of Pfizer or Moderna vaccine, or at least two months since their single dose of J&J vaccine. It is particularly important that those 65 years of age and older, those with underlying medical conditions, and those who received one dose of J&J vaccine receive a booster.

During holiday gatherings, CDPH recommends:

  • Stay home if you are sick.
  • Clean hands often.
  • Wear facemasks, socially distance six feet apart, and keep gatherings short if COVID-19 vaccination status of all attendees is unknown, an attendee is immune compromised, or unvaccinated attendees are present.

People should not attend in-person holiday celebrations if they:

  • Have been diagnosed with COVID-19 and are being isolated.
  • Have symptoms of COVID-19.
  • May have been exposed to someone with COVID-19 in the last 14 days.
  • Are waiting for COVID-19 viral test results if symptomatic or if asymptomatic, after exposure.
  • Are not fully vaccinated and are at increased risk of severe illness from COVID-19.

Recommendations for Facilities

Communal Activities and Dining

Facilities may hold communal holiday activities and dining while adhering to the core principles of COVID-19 infection prevention:

  • Fully vaccinated clients/residents who are not in isolation or quarantine may eat in the same room without face masks or physical distancing.
    • If any unvaccinated clients/residents are dining in a communal area (e.g., dining room):
      • All clients/residents should use source control when not eating or drinking.
      • Clients/residents who are not fully vaccinated should keep at least six feet distance from others (e.g., limited number of people at each table and with at least six feet between each person).
  • Fully vaccinated clients/residents who are not in isolation or quarantine may participate in group/social activities together without face masks or physical distancing.
    • If any clients/residents who are not fully vaccinated are present:
      • All participants in the group activity should wear face masks for source control and
      • Unvaccinated patients/residents should keep at least six feet  distance from others.
  • Encourage as many of these activities to occur outdoors when feasible, especially when eating or drinking and face coverings may not be worn.

Residents Who Leave and Return to the Facility

Residents taking social excursions outside the facility should be educated about potential risks of public settings, particularly if they have not been fully vaccinated, and reminded to avoid crowds and poorly ventilated indoor spaces. They should be encouraged and assisted with adherence to all recommended infection prevention and control measures, including source control, physical distancing, and hand hygiene. 

If they are visiting friends or family in their homes, they should follow the source control and physical distancing recommendations for visiting with others in private settings as described in CDPH and CDC's Interim Public Health Recommendations for Fully Vaccinated People.

For residents returning to facilities from holiday celebrations, facilities should screen residents for signs and symptoms of COVID-19 based on the following criteria:

  • Residents who have prolonged close contact (within six feet for a cumulative total of 15 minutes or more over a 24-hour period) with someone with SARS-CoV-2 infection while outside the facility should quarantine in the yellow-observation area for 14 days and be tested immediately (but not within 48 hours of their exposure), at five to seven days after exposure, and again prior to return to their usual room in green-unexposed/recovered area, regardless of their vaccination status.
  • Fully vaccinated residents who leave for any duration and return to the facility do not routinely need to quarantine and be tested upon return to the facility.
  • Residents who are not fully vaccinated who leave the facility for:
    • Less than 24 hours and return to the facility should be tested five to seven days after their return.
    • More than 24 hours should be quarantined in the yellow-observation area for 14 days and tested prior to return to their usual room in green-unexposed/recovered area.

Facilities must prepare to implement transmission-based precautions as needed for residents returning to the facility.

If you have any questions about infection control concerns, please contact the CDPH Healthcare-Associated Infections Program at HAIProgram@cdph.ca.gov or novelvirus@cdph.ca.gov.

 

Sincerely,

Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director

 

Resources


[i] People are considered fully vaccinated for COVID-19 after two or more weeks since they have received the second dose in a two-dose series (Pfizer-BioNTech or Moderna), or two weeks or more after they have received a single-dose vaccine (Johnson and Johnson [J&J]/Janssen), or two weeks or more after receiving another vaccine authorized by the World Health Organization (WHO).



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