K-12 Schools
There is a lack of expert consensus and guidance on whether a nebulizer treatment constitutes an aerosol generating procedure in the setting of COVID-19. It is uncertain whether aerosols generated from nebulizer treatments are infectious and may contribute to the transmission of COVID-19. Given this uncertainty, school may consider reserving the use of nebulizers to instances where children cannot use inhalers, do not have access to an inhaler, or for children who are in significant respiratory distress while awaiting emergency transport. Instead, metered dose inhalers (MDIs) with spacers (with or without a face mask, according to each student’s individualized treatment plan) may be used instead of nebulizer treatments whenever possible in the school setting.
If a nebulizer treatment is necessary, schools may, out of an abundance of caution, consider treating it as an aerosol generating procedure. Schools may consider the following factors when determining the policies (including personal protective equipment required by staff) around nebulizer use: 1) the uncertainty about whether nebulizer treatments may general infectious aerosols, 2) the ability to assess if the student has suspected/confirmed COVID-19 infection, 3) level of SARS-CoV-2 transmission in the community, considering both local and school-based COVID-19 trends. For additional resources, please refer to the CDC Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic
People with certain medical conditions are more likely to get very sick with COVID-19. These individuals and/or their parents should discuss school attendance with their healthcare provider. Parents should provide the school with a healthcare provider’s documentation of the child’s healthcare needs and treatment protocols. This includes a healthcare provider authorization and parental consent to administer medication or treatments to students. Families are encouraged to meet with school staff, including teachers, school nurses, and administrators, to discuss safety measures and establish/update a Section 504 plan. Please discuss any concern you may have with your local school division.
Schools may consider providing remote learning exceptions and teleworking options for students and staff diagnosed with COVID-19 or who are at high risk of severe illness (as defined by the CDC). Please discuss any concerns you may have with your healthcare provider and local school division.
Healthcare Settings
Recommendations for how and when to use masks or other face coverings for source control are outlined in CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic.
Source control is recommended for individuals in healthcare settings who:
- Have suspected or confirmed SARS-CoV-2 infection or other respiratory infection (e.g., those with runny nose, cough, sneeze); or
- Had close contact (patients and visitors) or a higher-risk exposure (HCP) with someone with SARS-CoV-2 infection, for 10 days after their exposure.
Source control is recommended more broadly in the following circumstances:
- By those residing or working on a unit or area of the facility experiencing a SARS-CoV-2 outbreak; universal use of source control could be discontinued as a mitigation measure once no new cases have been identified for 14 days; or
- Facility-wide or, based on a facility risk assessment, targeted toward higher risk areas or higher risk patient populations during periods of higher levels of community SARS-CoV-2 or other respiratory virus transmission; or
- Have otherwise had source control recommended by public health authorities.
Individuals might also choose to continue using source control based on personal preference.
Note that CDC defines healthcare settings as “places where healthcare is delivered and includes, but is not limited to, acute care facilities, long-term acute care facilities, nursing homes, home healthcare, vehicles where healthcare is delivered (e.g., mobile clinics), and outpatient facilities, such as dialysis centers, physician offices, dental offices, and others.” A laboratory that only processes samples but does not have patient interactions would not be considered a healthcare setting. Additional considerations for determining when healthcare IPC recommendations apply to long-term care settings (excluding nursing homes) are outlined in the Long-Term Care section below.
More guidance on protection from COVID-19 by masks or other face coverings can be found on the CDC mask website.
For complete recommendations, see CDC’s Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2. This guidance describes conventional strategies, when a facility is not being impacted by staffing shortages due to COVID-19, for return to the workplace for HCP with SARS-CoV-2 infection or higher-risk exposures.
Additional CDC guidance addressing staffing shortages due to COVID-19 can be found here: Strategies to Mitigate Healthcare Personnel Staffing Shortages. This guidance describes contingency and crisis capacity strategies.
In general, CDC and VDH recommend facilities follow conventional strategies, the safest practice, when determining return to work criteria for healthcare personnel with SARS-CoV-2 infection.
If a facility is expecting or experiencing staffing shortages due to COVID-19 despite implementing recommendations from conventional strategies (e.g. employee COVID-19 vaccine, understanding staffing patterns/needs, communication with local healthcare coalitions and public health partners to identify backup HCP, etc.), CDC outlines mitigation strategies (contingency and crisis) a healthcare facility can consider.
Healthcare facilities should consider performing a risk assessment to determine their infection prevention and control recommendations, including when broader use of source control or universal use of personal protective equipment (e.g., eye protection for all patient care encounters) in the facility might be warranted.
Some factors to be considered are available local data metrics, including county-level SARS-CoV-2 hospital admissions data on the CDC COVID-19 Data Tracker, VDH emergency department visits for COVID-like illness, and facility-level information (e.g., recent transmission inside the facility, the population’s risk for severe outcomes from COVID-19, and facility characteristics that could accelerate spread) to determine when to add and remove prevention strategies.
Facilities could also follow trends of several respiratory viruses using VDH’s weekly influenza activity report or CDC’s RESP-NET interactive dashboard, to make decisions about broader use of source control based on reginal or national respiratory virus incidence. For more information, visit updated CDC COVID-19 Infection Prevention and Control guidance.
Long-Term Care Facilities
All healthcare facilities, including nursing homes, should have a mechanism in place to promptly identify if a patient/resident or staff member has signs/symptoms of any communicable disease. The mechanism and frequency of monitoring asymptomatic individuals is at the discretion of the facility.
If using crisis staffing standards that may jeopardize the health, safety, and well-being of residents of the facility, then nursing facilities licensed by the VDH Office of Licensure and Certification (OLC) and assisted living facilities licensed by the Virginia Department of Social Services (DSS) are required to notify their licensing entity (the OLC or the DSS regional licensing office, respectively) of the conditions and status of the residents and the physical plant as soon as possible.
In general, assisted living facilities whose staff provide non-skilled personal care (e.g., bathing, dressing) similar to what is provided by family members in the home should follow CDC respiratory virus guidance for community settings.
However, assisted living facilities that directly provide healthcare-related services or whose residents receive contracted healthcare services should follow CDC healthcare IPC guidance.
The Virginia Department of Social Services provides additional guidance for assisted living facilities and adult day care centers regarding implementation of CDC respiratory virus guidance in a memo issued on March 7, 2024.
LTCFs are recommended to use their regular facility-pharmacy operations to acquire the COVID-19 vaccine for their residents and/or staff. LTCFs should maintain open and constant communication with their contracted pharmacy providers to discuss meeting COVID-19 vaccine needs moving forward. If your LTCF does not have a contracted pharmacy partner, see FAQs below for how to access vaccine.
The VDH Pharmacy Team is working to improve access to COVID-19 vaccines in LTC settings. Facilities that order and offer vaccination by other means should utilize their standard channels. Facilities that otherwise do not have access to COVID-19 vaccines and require assistance with obtaining vaccine may reach out to COVIDPharmacySupport@vdh.virginia.gov.
The Federal pharmacy partnership program will not be reinstated by CDC for COVID-19 vaccine assistance. However, CDC has partnered with various pharmacies to ensure LTCFs are able to access the COVID-19 vaccine. For more information, visit the CDC pharmacy partner contact information page. If you require further assistance in coordinating vaccines for your facility, please contact your local health district or email COVIDPharmacySupport@vdh.virginia.gov.
Facilities are encouraged to enroll as a vaccine provider to be able to order and administer vaccines to staff and residents. For more information, visit the VDH Provider Enrollment Process Flow & Checklist.
If enrolling as a vaccine provider is not an option, you can consider identifying a local pharmacy to contract with.
LTCFs may also submit an off-site clinic request with pharmacies who may be able to assist facilities with their vaccination needs. For more information, visit the CDC pharmacy partner contact information page.
If you require further assistance in coordinating COVID-19 vaccines for your facility, please contact your local health district or email COVIDPharmacySupport@vdh.virginia.gov.
LTCFs are able to order and administer vaccines through VaxMaX if the facility is enrolled as a vaccine provider. For more information on how to enroll as a vaccine provider, visit the VDH Provider Enrollment Process Flow & Checklist.
Patient education about the COVID-19 vaccine can be found on the VDH website. These resources can be used to help educate LTCF residents and staff who remain vaccine hesitant.
If the adverse event occurs while the pharmacy team is on site, then they will report the adverse event to VAERS. If it occurs after the pharmacy team has left, then the facility should report the event to VAERS. Both the pharmacy and the LTCF can report adverse events to VAERS; there is no penalty for double reporting in the VAERS system. Information about how to report to VAERS can be found on their website. FAQs about VAERS reporting are also available.
- VAERS accepts reports from anyone. Patients, parents, caregivers and healthcare providers are encouraged to report adverse events after vaccination to VAERS even if it is not clear that the vaccine caused the adverse event.
- Healthcare providers are required by law to report to VAERS:
- Any adverse event listed in the VAERS Table of Reportable Events Following Vaccination that occurs within the specified time period after vaccination
- An adverse event listed by the vaccine manufacturer as a contraindication to further doses of the vaccine
- Healthcare providers are strongly encouraged to report:
- Any adverse event that occurs after the administration of a vaccine licensed in the United States, whether or not it is clear that a vaccine caused the adverse event
- Vaccine administration errors
- Vaccine manufacturers are required to report to VAERS all adverse events that come to their attention.
Additionally, the vaccine emergency use authorization fact sheet shared with vaccinated individuals contains information about post vaccination adverse event reporting.
There are multiple factors to be considered before deciding whether to conduct a vaccine clinic during an active COVID-19 outbreak.
- Individuals with active COVID-19 infection are not recommended to receive a vaccine.
- If the outbreak is under control and is restricted to one unit/area of the facility, the clinic can be conducted by following the recommendations from CDC infection prevention guidance (under “indoor visitation during an outbreak response”).
- If the facility’s current outbreak response plan includes expanding routine COVID-19 testing, it is prudent to reschedule the vaccine clinic to a later date.
- The facility should notify the clinic provider about the outbreak situation to discuss next steps.