CDC Guidelines for COVID-19 Management
The CDC recommends a strategic approach to minimizing the impact of COVID-19 that relies on vaccination, multi-component prevention measures, and protecting high-risk individuals, with current guidelines focusing on understanding personal risk, using vaccines and therapeutics, testing after exposure, and isolating if infected. 1
Infection Control Measures
Personal Protection
- Universal masking:
- All unvaccinated persons should wear masks in public indoor settings
- Fully vaccinated persons should wear masks in public indoor settings in areas of substantial or high transmission
- Fully vaccinated persons with immunocompromised household members or those at increased risk should consider masking regardless of transmission level 2
Healthcare Worker Protection
- For healthcare workers performing aerosol-generating procedures on COVID-19 patients:
- Use fitted respirator masks (N95, FFP2, or equivalent)
- Wear additional PPE including gloves, gown, and eye protection (face shield or safety goggles) 3
- Aerosol-generating procedures include: endotracheal intubation, bronchoscopy, open suctioning, nebulized treatments, manual ventilation, physical proning, ventilator disconnection, non-invasive positive pressure ventilation, tracheostomy, and CPR 3
Facility Safety Measures
- Screen all patients for COVID-19 symptoms during scheduling
- Screen all patients, workers, and visitors for symptoms on building entry
- Create system awareness and flags identifying patients with recent COVID-19
- Develop protocols for managing individuals who screen positive
- Ensure sufficient PPE for workers and patients
- Implement universal masking of healthcare workers, patients, and visitors 3
Community Transmission Management
Social Distancing
- Enable social distancing in waiting rooms, hallways, and work areas
- Implement methods to minimize time in waiting rooms (e.g., waiting in cars)
- Restrict the number of visitors accompanying patients
- Prevent symptomatic visitors from accompanying patients 3
Workflow Optimization
- Optimize efficiency of every patient encounter
- Provide care in designated areas to patients with known or suspected COVID-19
- Clean and decontaminate patient care areas according to CDC guidelines
- Enable remote work when possible (e.g., home workstations)
- Enable telehealth when feasible (e.g., pre- and post-procedure visits) 3
Risk Assessment and Decision Making
Critical Factors for Local Decision-Making
- Level of SARS-CoV-2 community transmission
- Health system capacity
- COVID-19 vaccination coverage
- Capacity for early detection of increases in COVID-19 cases
- Populations at increased risk for severe outcomes 2
Engagement in Risk-Benefit Decision Making
- Consider benefits of care against risks from healthcare-acquired COVID-19
- Consider clinical acuity, risk factors, underlying disease, and risk from COVID-19
- Engage referring providers and stakeholders to safely triage non-urgent care
- Determine whether lower-risk diagnostic strategies can be pursued
- Coordinate re-engagement strategies with institutional plans 3
Vaccination and Therapeutics
Vaccination
- COVID-19 vaccination remains the most effective means to achieve control of the pandemic
- Available vaccines (Pfizer-BioNTech, Moderna, and Janssen) offer high levels of protection against severe illness and death from infection with circulating variants 2
Therapeutics
- For patients requiring oxygen or ventilatory support:
- Dexamethasone 6 mg daily for up to 10 days is strongly recommended
- IL-6 receptor antagonist therapy (tocilizumab) is conditionally recommended, particularly with elevated inflammatory markers
- Remdesivir should be initiated as soon as possible after diagnosis of symptomatic COVID-19
- Nirmatrelvir-ritonavir is suggested for patients at high risk of hospitalization 4
Current Priorities for Prevention
- Help individuals understand their personal risk
- Encourage protection through vaccines, therapeutics, and non-pharmaceutical interventions when needed
- Promote testing and mask-wearing after exposure
- Recommend testing for symptomatic individuals and isolation for ≥5 days if infected 1
Addressing Backlog of Care
- Consider extending hours of operation to improve access and preserve social distancing
- Determine if previously ordered care is no longer needed
- Implement strategies to safely shorten imaging examinations and procedures
- Consider modifying scheduling grids to promote social distancing
- Enable clear communication of examination acuity by referring providers 3
By following these evidence-based guidelines, healthcare providers can effectively manage COVID-19 while minimizing its impact on individuals, communities, and healthcare systems.