Coronavirus disease 2019 (COVID-19) is a disease caused by a coronavirus called SARS-CoV2 that primarily affects the respiratory system. COVID-19 is spread from person via droplets in the air when a person coughs or sneezes. There are many types of human coronaviruses, including some that commonly cause mild upper respiratory tract illnesses. COVID-19 is a new disease, caused by a novel (or new) coronavirus that has not previously been seen in humans. Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness, fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting or diarrhea.

For the most up-to-date information please visit:
CDC – Number of coronavirus cases in the U.S.
WHO – Number of coronavirus cases globally

Currently, data suggest that certain people with underlying medical conditions are at a higher risk for contracting COVID-19, these include those with cancer, kidney disease, COPD, immunocompromised, and those that are obese. Additional, older people over that age of 65 years of age and certain minority populations (black, Hispanic, and American Indian/Alaska Native) are also at higher risk. See also Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19).

Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date.

No. Children with COVID-19 generally have mild, cold-like symptoms, such as fever, runny nose, and cough. Vomiting and diarrhea have also been reported in some children. Children may be at higher risk for severe illness, such as children with underlying medical conditions and special healthcare needs. Studies report some children are developing a condition called Multisystem Inflammatory Syndrome in Children (MIS-C) after becoming infected with COVID-19.

American adults of all ages—not just those in their 70s, 80s and 90s—are being seriously sickened by the coronavirus, according to a report on nearly 2,500 of the first recorded cases in the United States. Nationwide, the median age of COVID-19 cases declined from 46 years in May to 37 years in July and 38 in August. Similar patterns were seen for COVID-19–like illness-related ED visits and positive SARS-CoV-2 RT-PCR test results in all U.S. populations. During June–August, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. The southern United States experienced regional outbreaks of COVID-19 in June. In these regions, increases in the percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among adults aged ≥60 years by an average of 8.7 days (range = 4–15 days).

There is no need to panic. It is, however, important to understand the facts surrounding coronavirus.This document can help individuals understand information and resources needed to address COVID-19 in the United States. Lessons from other countries show that the more informed everyone is, the easier it will be to work together to slow the spread of coronavirus in the US. Everyone needs to understand that this is important and that working together will slow the spread.

• Stay home except to get medical care
• Call ahead before visiting your doctor
• Cover your coughs and sneezes
• Clean your hands often—soap and water are best, but alcohol-based hand-sanitizer should be used if you cannot wash your hands
• Avoid sharing personal household items
• Maintain a minimum of 6 feet between you and others while out in public places
• Clean all “high-touch” surfaces everyday

Call your doctor if you think you have been exposed to COVID-19 and develop a fever and symptoms,such as cough or difficulty breathing, call your healthcare provider for medical advice. You can also use the COVID-19 symptom self-checker. The self-checker helps users make decisions about seeking appropriate medical care. This system is not intended for diagnosis or treatment of COVID-19 or other diseases. Please also see this fact sheet on Information for People Who Have Had Close Contact with Someone with COVID-19.

Just because a person has been exposed does not mean that they will get sick. The purpose of self-quarantine is to keep exposed people away from well people so that if they do become sick, they do not spread their illness. Infected people may be able to spread the virus before the symptoms begin, people will become infectious two days before the onset of their symptoms This is why it is important that an exposed person limits contact with others in their household. While other members of the household do not need to do anything in particular, people under self-quarantine should:

• Practice social distancing with other household members, which means staying at least six feet away. If possible, stay in a separate room.
• Practice good hygiene with regular handwashing..
• Avoid sharing household items or eating utensils.
• Regularly clean high-touch surfaces, including phones, game controllers, remotes, light switches, faucets and toilet handles. But be mindful of using strong chemicals in enclosed spaces, as improperly used chemicals can cause eye or throat irritation or breathing problems.

If the person does not develop the disease within 14 days of exposure, the risk has passed, and the person no longer needs to self-quarantine.

If you have to take care of a sick family member, you must also protect yourself. There are additional things that both of you can do to protect your health:

• Isolate the sick person from other people in the household in a separate room if possible.
• Have only a single family member care for that person, minimizing the risk to other family members.
• In addition to everyone practicing regular hand–washing, the caregiver should wash their hands after any direct contact with the sick person.
• The sick person should cover their mouth and nose with a tissue when they cough or sneeze, then discard it.
• Don’t share household items or eating utensils.
• If the weather permits, open windows to increase ventilation.

You should continue these practices until the person is no longer infectious. Because testing may be difficult to obtain, you can stop these steps 72 hours after symptoms have resolved and at least seven days have passed since symptoms first appeared. Read more here, and see this fact sheet on Prevention Steps for Caregivers and Household Members of Individuals Diagnosed with COVID-19.

Practice everyday preventive actions to help reduce the risk of getting sick and remind everyone in your home to do the same. These actions are especially important for older adults and people who have severe chronic medical conditions:

• Avoid close contact with people who are sick.
• Stay home when you are sick, except to get medical care.
• Cover your coughs and sneezes with a tissue and throw the tissue in the trash.
• Wash your hands often with soap and water for at least 20 seconds, especially after blowing   your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.
• If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.
• Clean and disinfect frequently touched surfaces and objects (e.g., tables, countertops, light   switches, doorknobs, and cabinet handles).

Because the virus is already circulating within the US, containment is no longer possible. Mitigation, or slowing the spread of the virus, is the best strategy. This involves strict isolation and social distancing measures. We must “Flatten the Curve.” That means that we need to slow the rate of infection so that the number of people who need hospital services remains in the range that our healthcare system can supply. In mitigation we are no longer trying to contain the virus, we merely are trying to slow the rate of infection to keep the healthcare system from collapsing.

Everyone should follow suggested isolation measures. All non-essential contact (excluding grocery stores, pharmacy, etc.) should be halted completely. Limiting unnecessary social interaction will help lower the spread of disease, and ultimately save lives.

Yes, in early April, the Centers for Disease Control and Prevention (CDC) began recommending that everyone wear a cloth face covering in a community setting, such as grocery stores and pharmacies. These face coverings are not a substitute for social distancing. See the CDC’s questions and answers about cloth face coverings, and information about using cloth face coverings to slow the spread – including instructions for making your own cloth face coverings.

Please refer to this Care kit booklet from the CDC for recommendations.

The Federal Emergency Management Agency (FEMA) published a list of frequently asked questions about the current process for Tribal governments to request a Presidential emergency or major disaster declaration independently of a state. The resources below may be of assistance:

• Template: Administrative Plan for Public Assistance
• Fact Sheet: Coronavirus (COVID-19) Pandemic: Eligible Emergency Protective Measures

Test kits may be available through National Supply Service Center. If you have no kits, you may use CDC guidance for Dacron plastic swabs. The CDC has more information on Public Health Laboratory testing for COVID-19.

Click here for an example: Respiratory Protection Plan – Catawba Indian Nation.

Click here to view a template from Washington state: https://aihc-wa.com/incident-responses-and-other-news/.

A USDA Food Distribution representative informed USET staff on March 19 that the program is operating normally, and that USDA is not aware of any FDPIR food deliveries being affected by COVID-19. On a national call on March 18, a USDA representative stated that national warehouses are fully stocked and prepared to provide food for up to 3 months. However, if you are experiencing any challenges that the USDA FDPIR program needs to be aware of, please direct any questions to Kathy Stanley, USDA Food Distribution, at 540-226-1502.

IHS is encouraging all individuals to call their local IHS facility before seeking any care—this includes previously scheduled medical visits, mental health appointments, and surgical procedures. To locate your nearest IHS facility, please use the IHS Find Health Care website.

As of now, there is no indication that IHS pharmacies will need to alter their current practices for distributing prescription medicines. Should the CDC recommend reducing the number of patient visits to IHS facilities, the IHS Pharmacy Program will explore alternative delivery options for medications, such as the Consolidated Mail Outpatient Pharmacy Program.

IHS acknowledges that many American Indians and Alaska Native families live in multi-generational households. Elders and those who have chronic medical conditions such as heart disease, diabetes, or lung disease are at higher risk of contracting coronavirus. Please follow the CDC’s guidelines to prepare your households for the elderly and other vulnerable populations, and see the CDC’s checklist for older persons. If an elder begins to exhibit coronavirus symptoms, please contact your nearest IHS health facility for further assistance. Use the IHS Find Health Care website to locate your closest facility. Please also see this fact sheet of Common Questions and Answers for Tribal Elders and this information about Elder Mental Health during COVID-19.

Through the IHS National Service Supply Center or directly from the manufacturer.

IHS issued new Strategic National Stockpile guidance on 4/2.

Watch Video here from CDC: https://youtu.be/bG6zISnenPg

IHS issued new Strategic National Stockpile guidance on 4/2.

On March 28, IHS provided Federal, Tribal and Urban FEMA Guidance to the Strategic National Stockpile (SNS) & Healthcare Resource Request and a Resource Request Form. The IHS guidance explains that health care resources may be requested from the SNS only after other supplies and sources have been exhausted. Tribal Nations have two options for requesting resources: (1) directly contacting their FEMA Regional Tribal Liaison; or (2) contacting their IHS Area Emergency Management Point of Contact (EMPOC).

The IHS guidance provides that programs choosing to have IHS Area EMPOCs assist in the request for medical supplies will fill out the Resource Request Form and submit it to the IHS Area EMPOC. The IHS Area EMPOC will then review the request, enter it into IHS’s tracking system, submit it to FEMA, and work with the relevant FEMA and SNS staff to address the request.

On March 31, FEMA issued a stakeholder advisory regarding ventilator request. This advisory also encouraged Tribal officials to share the FDA’s Emergency Use Authorization (EUA) for Ventilators issued on March 24. The EUA allows anesthesia gas machines and positive pressure breathing devices to be modified for use as ventilators.

The Assistant Secretary for Preparedness also has information.

The Department of Homeland Security has an Enterprise License Agreement with the Environmental Systems Research Institute (ESRI) that allows DHS/FEMA the ability to extend that agreement to

governmental partners during an “incident of national significance.” The National Geospatial Intelligence Agency (NGA) has released all applicable licensed datasets to local, state, tribal, and territorial users with COVID-19 operational needs. NGA is providing access to non-federal governmental disaster/emergency response security agencies and personnel who are supporting Homeland Security/Homeland Defense missions per the current Homeland Infrastructure Foundation-Level Data (HIFLD) Data Use Agreement. The Federal Emergency Management Agency (FEMA) has allowed 6-month free access for Tribal Nations to Environmental Systems Research Institute (ESRI) software solutions for geographic information systems (GIS) supporting COVID-19 related activities.

• If you havean existing ESRI account there is no need to create a new one. NGA has automatically adjusted access for mission partners with a signed Data Use Agreement in place and no further action is needed. Please visit the Geospatial Information Infrastructure to interact with this data. Contact DHS_GCOE@hq.dhs.gov should you need assistance.
• If you needthe software and/or do not have an ESRI account, Go to the HIFLD Subcommittee Home Page and choose “Request Licensed Data.” Complete the Disaster Use Agreement using “COVID-19” as the reference number. Once approved by NGA, you will receive access within 24 hours. Please note, before you can complete a Data User Agreement and access this data, you must have valid Homeland Security Information Network credentials. Should you have questions, please contact HIFLD@hq.dhs.gov.

Please note this expanded access will expire once the current national emergency declaration ends.

The current formula being utilized for $200 million in COVID-19 relief funding is based on the Indian Housing Block Grant. Currently, 500+ federally recognized Tribal Nations are receiving this grant funding, and those are the only Tribal Nations that will receive funding under the $200 million COVID-19 relief funding.

In addition to the $200 million in funding that was announced by HUD an additional $100 million will be released by HUD using the Indian Community Development Block Grant (ICDBG). The ICDBG is published annually as a non-competitive grant (first-come, first-served basis) and has two options, the single purpose grant, and the imminent threat grant. The ICDBG is currently open and is using the formula under the imminent threat grant. HUD is currently developing the implementation guidelines and final guidelines will be available soon on HUD’s ICDBG webpage.

The clinical spectrum of COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and septic shock. There have also been reports of asymptomatic infection with COVID-19. See also Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19)

Based upon available information to date from the CDC, those at high-risk for severe illness from COVID-19 include:

• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
• People with chronic lung disease or moderate to severe asthma.
• People who have heart disease with complications.
• People who are immunocompromised including cancer treatment.
• People of any age with severe obesity (body mass index [BMI≥40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk.

• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk.

Many conditions can cause a person to be immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications.

Click here for the latest CDC At-Risk COVID-19 information.

The available data are currently insufficient to identify risk factors for severe clinical outcomes. From the limited data that are available for COVID-19 infected patients, and for data from related coronaviruses such as SARS-CoV and MERS-CoV, it is possible that older adults, and persons who have underlying chronic medical conditions, such as immunocompromising conditions, may be at risk for more severe outcomes. See also Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19)

A person become infectious two days before they begin showing symptoms. Available data indicate that persons with mild to moderate COVID-19 remain infectious no longer than 10 days after symptom onset. Persons with more severe to critical illness or severe immunocompromise likely remain infectious no longer than 20 days after symptom onset. Data to date show that a person who has had and recovered from COVID-19 may have low levels of virus in their bodies for up to three months after diagnosis. This means that if the person who has recovered from COVID-19 is retested within three months of initial infection, they may continue to have a positive test result, even though they are not spreading COVID-19.

Very limited data are available about detection of SARS-CoV-2 and infectious virus in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and SARS-CoV-2 has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in upper and lower respiratory tract specimens and in extrapulmonary specimens is not yet known but may be several weeks or longer, which has been observed in cases of MERS-CoV or SARS-CoV infection. While viable, infectious SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens, in contrast – viable, infectious MERS-CoV has only been isolated from respiratory tract specimens. It is not yet known whether other non-respiratory body fluids from an infected person including vomit, urine, breast milk, or semen can contain viable, infectious SARS-CoV-2.

Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to persons under investigation (PUI) for COVID-19. Healthcare personnel evaluating PUI or providing care for patients with confirmed COVID-19 should use, Standard Transmission-based Precautions. Until more is known about how the COVID-19 spreads, CDC and OSHA recommend using a combination of standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or face shields) to protect healthcare workers with exposure to the virus. See the Interim Guidance for Personal Protective Equipment. For more information about requesting items from the Strategic National Medical Stockpile, see this FAQ under “Information for Indian Country.”

Through the IHS National Service Supply Center or directly from the manufacturer.

IHS issued new Strategic National Stockpile guidance on 4/2.

Watch Video here from CDC: https://youtu.be/bG6zISnenPg

The CDC has provided strategies for optimizing the supply of facemasks, eye protection, isolation gowns, and N95 respirators.

Also see the CDC’s Decontamination and Reuse of Filtering Facepiece Respirators using Contingency and Crisis Capacity Strategies.

For a list of reputable manufacturers for a distributor to utilize, the CDC recommends this site.

The Occupational Safety and Health Administration (OSHA) published temporary guidance on N95 fit testing during the COVID-19 outbreak on March 14. OSHA also published a transcript from a training video on respirator fit testing.

Click here for an example: Respiratory Protection Plan – Catawba Indian Nation.

On March 17, the US Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency. This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19. In support of this action, OCR will be providing further guidance explaining how covered health care providers can use remote video communication products and offer telehealth to patients responsibly.

CDC has developed a form that provides a standardized approach to reporting COVID-19 cases
(individuals with at least one respiratory specimen that tested positive for the virus that causes COVID-19). The COVID-19 Case Report Form is designed to collect key information on COVID-19 case-patients, including:

• Demographic, clinical, and epidemiologic characteristics
• Exposure and contact history
• Course of clinical illness and care received

Additional resources to assist in the completion and analysis of the COVID-19 Case Report Form are available:

• COVID-19 Case Report Form Instructions
• Data dictionary

For jurisdictions that have the capacity to do their own laboratory testing: For reporting jurisdictions who are able to assign nCoV IDs for COVID-19 case-patients and use CDC’s electronic reporting system:

The jurisdiction should enter all cases into CDC’s electronic reporting system with the jurisdiction-issued nCoV ID, unless other arrangements to transmit data have been made and approved by CDC. At this time, we ask that jurisdictions prioritize case reporting. However, jurisdictions can use the CDC’s electronic reporting system to manage PUI data based on their local needs.

For reporting jurisdictions that are not yet able to assign nCoV IDs or use CDC’s electronic reporting system: The jurisdiction should call the CDC EOC Watch desk at 770-488-7100 to receive a CDC-issued nCoV ID, and to complete a PUI and Case Report Form.

For jurisdictions that do not have capacity to do their own testing and are sending specimens to CDC for testing: This document provides supplemental guidance regarding specimen collection, storage, and shipping to CDC laboratories.

Yes. Please see Resources for Heathcare Personnel.

IHS issued new Strategic National Stockpile guidance on 4/2.

On March 28, IHS provided Federal, Tribal and Urban FEMA Guidance to the Strategic National Stockpile (SNS) & Healthcare Resource Request and a Resource Request Form. The IHS guidance explains that health care resources may be requested from the SNS only after other supplies and sources have been exhausted. Tribal Nations have two options for requesting resources: (1) directly contacting their FEMA Regional Tribal Liaison; or (2) contacting their IHS Area Emergency Management Point of Contact (EMPOC).

The IHS guidance provides that programs choosing to have IHS Area EMPOCs assist in the request for medical supplies will fill out the Resource Request Form and submit it to the IHS Area EMPOC. The IHS Area EMPOC will then review the request, enter it into IHS’s tracking system, submit it to FEMA, and work with the relevant FEMA and SNS staff to address the request.

On March 31, FEMA issued a stakeholder advisory regarding ventilator request. This advisory also encouraged Tribal officials to share the FDA’s Emergency Use Authorization (EUA) for Ventilators issued on March 24. The EUA allows anesthesia gas machines and positive pressure breathing devices to be modified for use as ventilators.

The Assistant Secretary for Preparedness also has information.

The CDC issued Interim Guidance for Administrators of U.S. Childcare Programs and K-12 Schools.

The Department of Education has Resources for Schools and School Personnel and CDC resources include:

• Environmental Cleaning and Disinfection Recommendations – Community Facilities
• Interim guidancefor Administrators of US K-12 Schools and Childcare Program: Plan, Prepare, and Respond to COVID-19
• Guidancefor Schools and Child Care Programs

The CDC recommends that you prepare a bleach solution by mixing:

• 5 tablespoons (1/3^rd cup) bleach per gallon of water or
• 4 teaspoons bleach per quart of water

Products with EPA-approved emerging viral pathogens claims are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.). For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present
and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:

• If the items can be laundered, launder items in accordance with the manufacturer’s instructions using the warmest appropriate water setting for the items and then dry items completely.
• Otherwise, use products with the EPA-approved emerging viral pathogens claims (examples at this link) that are suitable for porous surfaces.