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Question: With regards to HEPA filtration units – is there anything specific to look for in purchasing one? Is there a recommended brand? Will anything labeled HEPA work?

Answer: (Based on guidelines as of 9.24.20) Generally yes, if it has a HEPA rating it will work – specifically looking for filtration with a rating of MERV 13 and higher or H10 and higher. The unit used should be sized for the room they will be used in. As an example, around 240 Square Feet is equivalent to a 16' x 16' room which this portable Dayton unit portable Dayton unit available at Grainger could filter or for larger spaces, such as around 750 Square Feet or a 25’ x 30’ room, this Dayton unit would be more appropriate. I would suggest each room have its own unit in it. Based on a review of the available specs - the Dayton units have a sufficient filter rating of 0.997 efficient. Here is another option that would appear to work based on the literature. Large spaces may require professional assistance for correct sizing and power requirements We do not have experience with actual performance of the above units and do not recommend only considering these. They are intended as examples of ones that may work.

Answer provided by:

Todd Keiser, Director of Medical School Facilities Hackensack Meridian School of Medicine SME, Reopening America Project

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Question: Generally, is CDC the best / most reliable source to reference?

Answer: (Based on guidelines as of 9.24.20) The reference source you should use depends on the category of recommendation you are seeking. The Centers for Disease Control and Prevention (CDC) is the main reference for general and clinical/infection prevention recommendations for the state and federal governments. Although most governments follow CDC guidance, some state and federal guidelines may be more stringent. For example, the NJDOH and State Executive Orders tend to be extra cautious and more strict. However, it is important to know that NJDOH and State Executive orders “trump” CDC recommendations. Also, NJ DOH and Executive orders sometimes don’t cover all COVID-19 related topics. In these cases, the CDC is the main level of reference for general and clinical/infection prevention recommendations. Other sources of information include: a. World Health Organization (WHO) – tends to be more liberal in recommendations b. Business- specific recommendations – is aligned with the specific business and is generally guided by state and CDC recommendations. c. OSHA and ASHRAE guidance is based on the type of recommendation that is desired.

Answer provided by: Suelyn Boucree, MD, MBA, FACP Medical Director of Quality, HMH Network Chair CIN Quality Committee Co-Chair: Northern Regional Governance Committee SME, Reopening America Project

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Question: An employee tested positive for COVID-19 on Tuesday. He was in the office on Monday with no symptoms, however symptoms started to surface on Tuesday. Besides sanitizing the office, what else can I advise others that may have been in contact with him to do as a precaution. I am going to ask him to trace his time here to advise us of those who may have had direct contact with him.

Answer (as of 9/16/20, updated 12/20/20)

  • The Individual:
    • A person who tests positive for COVID-19 will have a 10-day isolation period that starts the day of symptom onset or the day that a test was taken, if asymptomatic. The person must also be fever free for at least 24 hours without the use of fever-reducing medication and other symptoms must improve before returning. If still febrile (having a fever) or heavily symptomatic after 10 days, isolation may need to extend to 20 days. A medical consult may be warranted if symptoms are severe. In this case, the person must remain in isolation until fever free for at least 24 hours without the use of fever-reducing medication and other symptoms have.
  • Close Contacts (being within 6 feet of someone with the virus for a cumulative total of 15 minutes (or more) over a 24-hour period, as per CDC and NJDOH):
    • Person(s) must be notified of exposure. Do not provide any confidential information regarding the infected individual.
    • A person who is exposed to COVID-19 must follow the CDC quarantine protocol for asymptomatic close contacts (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html). Symptoms should be monitored while quarantining.
    • If symptoms develop or the person tests positive, they will need to follow the guidelines mentioned above for “The Individual.” • Allow close contacts to work from home, if possible.
  • Other Individuals That Might Have Been in Contact but Not Close Contact:
    • They should be notified of positive case. Do not provide any confidential information regarding the infected individual.
    • They need to self-monitor for signs and symptoms. If any signs/symptoms develop they should say home and notify employer.
    • Individuals exhibiting symptoms should reach out to their healthcare provider to determine if testing is warranted and to obtain recommendations on next steps.
    • If the individual is diagnosed with COVID-19, they will need to do as stated above for person who tested positive.
    • Comply with all precautionary measures (mask, hand hygiene, social distancing).
  • The Environment:
    • Clean surfaces with EPA-Approved disinfectants –allowing for appropriate dry times. If any cloth surfaces- make sure to clean and disinfect appropriately
    • Assuming the individual has not re-entered the space since Monday the risk of transmission through air or surfaces would be minimal at this time point.
    • To minimize additional exposures through environment all working spaces are best served by proactively having air systems with MERV 13 or higher filtration in them or Portable HEPA filtration units of sufficient size for the space they are used in.
    • Workspaces would benefit from outside air introduction either through windows or more likely mechanical systems to provide as much fresh air dilution as possible.
  • Your Local HealthCare Officials:
    • Will likely be in contact with the infected individual to ask questions on close contacts and provide guidance.
    • Might reach out to you for information (employer for information) -- Employers may need to work with local health department officials to determine which employees may have had close contact with the employee with COVID-19, and who may need to take additional precautions, including exclusion from work and remaining at home.
    • Most workplaces should follow the Public Health Recommendations for Community-Related Exposure and instruct potentially exposed employees to stay home for 14 days, telework if possible, and self-monitor for symptoms. (Centers for Disease Control and Prevention, 2020) Answer provided by: Suelyn Boucree, MD, MBA, FACP Medical Director of Quality, HMH Network Chair CIN Quality Committee Co-Chair: Northern Regional Governance Committee SME, Reopening America Project

Answer provided by: Suelyn Boucree, MD, MBA, FACP Medical Director of Quality, HMH Network Chair CIN Quality Committee Co-Chair: Northern Regional Governance Committee SME, Reopening America Project

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