COVID-19 protocols

COVID-19 protocols

Policies, procedures, and organizational algorithms for mitigating COVID-19 risk.

The pandemic of SARS CoV-2, a new virus which causes COVID-19, is a global public health crisis of far-ranging scope.

Based on prior experience with infectious disease outbreaks, governments, nonprofit organizations, and the private sector have responded to the pandemic by publishing handbooks and guides containing policies, procedures, and decision-making algorithms which can be used by individuals and organizations to reduce personal and community risk of the disease.

Non-pharmaceutical intervention (NPI)

Before vaccines are proven effective and become widely available, government, organizations, and individuals can implement strategies to reduce SARS-CoV-2 infection and the resulting COVID-19 disease. Non-pharmaceutical interventions (NPIs) include social distancing/physical distancing/ border closures, school closures, isolation of symptomatic individuals and their contacts and large-scale lockdown of populations. Most of these strategies involve behavior change. Evidence from prior pandemics, such as the 1918 influenza pandemic, suggest that behavior change is a necessary component of responding to the COVID-19 pandemic.

Allegrante et al published a review of U.S. CDC recommendations for individual behavior change to help reduce the spread of SARS-CoV-2. They suggest that adherence to these guidelines is dependent on an individual's relationship with multiple layers of society.

John P. Allegrante, PhD et al (May 2020) https://doi.org/10.1016/j.amepre.2020.05.004

Allegrante et al find:

Such multilevel studies are necessary to further understand the influences on protective behavior and evaluate the effect of novel behavioral interventions, especially those that are digitally mediated, to facilitate adoption and maintenance of COVID-19‒preventive behaviors.

Evidence from military training centers

A 2005 meta-analysis of non-vaccine interventions to prevent infectious acute respiratory disease (ARD) in military training centers found many types of policies and protocols which result in lower rates of infection. The meta-analysis, published by Terrence Lee et al, evaluated a sample of 38 population-based studies.

  • 9 of 12 studies into mask-wearing supported the intervention.
  • 10 studies into various administrative controls such as cohorting military training units to reduce contact between units (4 studies), providing adequate personal space to reduce crowding (5), and cloth barriers between beds (1); and 14 studies supported the use of engineering controls such as increased indoor air dilution and ventilation (2), dust suppression (4), and air sterilization (8).

Handbooks and guides

Public and private-sector organizations have published general handbooks and guides addressing a wide range of topics around how to mitigate the risk of catching and spreading the virus which causes COVID-19.

These high-level guides may cover systems and methods for disinfection, the use and possible re-use of personal protective equipment (PPE), overviews of relevant medical procedures and equipment, and best practices for responding to an array of incidents.

General guides

Title
Author(s)
Link
Type
Date

COVID-19 Healthcare Planning Checklist

Assistant Secretary for Preparedness and Response (ASPR)

PDF

Infection Prevention and Control for the safe management of a dead body in the context of COVID-19

World Health Organization (WHO)

PDF

March 24, 2020

Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic

U.S. CDC

Web/blog article

July 15, 2020

SARS-CoV-2 (COVID-19) Toolkit

Massachusetts General Hospital

PDF

February 2020

Hygiene protocols

In the mid-1800s, Ignaz Semmelweis introduced hand-washing into the standard medical protocol for reducing infection risk. By 1848, one year after instituting a hand-washing policy in an obstetric clinic in Austria, maternal death rate had declined by 87 percent.

A 2001 study of U.S. Army recruits found that hand-washing results in reduced outpatient visits for respiratory illnesses. A review of clinical records from 1996 through 1998 (representing 1,089,800 person-weeks) found that frequent hand-washers had fewer outpatient appointments for respiratory illnesses. After implementing a hand-washing program, researchers saw a 45% reduction in total outpatient visits for respiratory illness.

Personal hygiene practices such as thorough and regular hand-washing is associated with less risk of contracting or communicating infectious diseases such as SARS-CoV-2.

Guides to hand-washing, the use and formulation of hand sanitizers, and other guides about hygiene as a mode of risk reduction have been published by organizations around the world.

Hand hygiene protocols

Title
Author(s)
Link
Type
Date

Hand Hygiene in Healthcare Settings

U.S. CDC

Webpage

Hand Hygiene: Why, How, and When?

World Health Organization

PDF

Handwashing Compendium for Low Resource Settings: A Living Document (2nd edition)

Institute of Development Studies

Webpage and PDF

June 5, 2020

Prevent Worker Exposure to Coronavirus (COVID-19)

Protocol for hand hygiene using soap and water, or alcohol-based hand sanitizer

AAHA

Webpage

Reducing hand recontamination of healthcare workers during COVID-19

Giorgia Gon, PhD, Stephanie Dancer, PhD, Robert Dreibelbis, PhD, Wendy J. Graham, PhD, and Claire Kilpatrick, MSc

Journal article

April 6, 2020

When and How to Wash Your Hands

U.S. CDC

Webpage

Hand sanitizer protocols

Title
Author(s)
Link
Type
Date

Policy for Temporary Compounding of Certain Alcohol-Based Hand Sanitizer Products During the Public Health Emergency

U.S. FDA

Webpage

June 2020

Disinfection protocols

Disinfection of surfaces, fabrics, and other items which can be exposed to SARS-CoV-2 is another way to reduce the risk of community spread. Chemically neutralizing viral particles using context-appropriate disinfectants and sanitizers is a way to keep spaces safer for personnel.

Guides have been published about how to derive and formulate disinfectants, as well as the systems and methods by which they should be used.

Formulations

Title
Author(s)
Link
Type
Date

How to Make Strong (0.5%) Chlorine Solution from Liquid Bleach

U.S. CDC

PDF

Transportation

Transportation presents a set of risks and challenges during a pandemic. Moving people and goods which may carry SARS-CoV-2 is a way to accelerate the geographic spread of the virus. Confined spaces with many people kept in close quarters, such as on an airplane, train, or bus, present an elevated risk for infection.

Local, national, and international organizations have published guides and proposed policies for how to reduce the risk of viral spread via transportation. These guides may include instructions for how to manage crowds of people and protocols for disinfecting vehicles and equipment.

General

Title
Author(s)
Link
Type
Date

Corona Virus Travel Advice

Mayo Clinic

Web/blog article

June 12, 2020

GMR Air and Ground Vehicle COVID-19 Decontamination Standards

Global Medical Response

PDF

Updated April 20, 2020

Ground transportation

Title
Author(s)
Link
Type
Date

Best Practices in the Sterilization of Transit Property

Noel McCarthy

Web article

April 2020

Cleaning and Disinfection for Non-emergency Transport Vehicles

U.S. CDC

Website

April 2020

Air transportation

Title
Author(s)
Link
Type
Date

Aircraft cleaning and disinfection during and post pandemic

IATA

PDF

June 2020

Aircraft Maintenance: Disinfecting Aircraft to Protect Against COVID-19

AOPA

Web article

April 2020

Customer Service Advisory Wire: Airline Maintenance and Disinfection During COVID-19 Pandemic

Bombardier (OEM)

PDF

Disinfection of Aircraft

Joachim Klaus, Peter Gnirs, Sabine Hölterhoff, Angela Wirtz, Matthias Jeglitza, Walter Gaber, Rene Gottschalk

Journal article

October 2016

Embraer Cleaning Recommendations for Novel Coronavirus (2019-NCOV)

Embraer (OEM)

PDF

Guidance on Aircraft Cleaning and Disinfection in Relation to the COVID-19 Pandemic

European Union Aviation Safety Agency

PDF

June 2020

Guide to Hygiene and Sanitation in Aviation

World Health Organization

PDF

2009

Health Control Protocol for Restarting Aeronautical Activities In The Context Of COVID-19

Sistema Regional de Cooperación para la Vigilancia de la Seguridad Operacional

PDF

Infection Control Guidelines for Aerosol-Generating Procedures

Massachusetts General Hospital

PDF

May 2020

SAFO 20008, Transporting Cargo on Transport-Category Airplanes Configured to Carry Passengers.

Federal Aviation Administration

PDF

April 15, 2020

SAFO 20009, COVID-19: Updated Interim Occupational Health and Safety Guidance for Air Carriers and Crews.

U.S. Department of Transportation & The Federal Aviation Administration

PDF

May 2020

Service Advisory 2051: Cleaning/Disinfecting Guidance

Garmin Aviation

Web/blog article

Standard Maintenance Practices (ATA) – Aircraft Screening and Sanitizing Guidelines to Address the Coronavirus

Gulfstream (OEM)

PDF

Take Off: Guidance for Air Travel through the COVID-19 Public Health Crisis

International Civil Aviation Organization's Council Aviation Recovery Task Force (CART)

PDF

May 27, 2020

United Airlines to Maximize Ventilation System During Boarding and Deplaning

United Airlines

Press release

July 20, 2020

PPE protocols

Personal protective equipment such as respirators (N95 or equivalent), gloves, face shields, medical gowns, as well as commercially-produced or homemade cloth face coverings serve a role in preventing the spread of infectious disease while protecting the person wearing PPE.

The pandemic of SARS-CoV-2 created increased demand for PPE around the world. And it has prompted people who may never have used personal protective equipment to learn about and utilize PPE in the interest of protecting themselves and their community from the virus.

Guides have been published about the proper use of PPE. Strategies for reducing the use of scarce PPE, as well as protocols for safely reusing certain types of PPE have also been published in response to supply shortages. Some guides are targeted at medical audiences while others are aimed at people outside the medical profession.

Face coverings: Efficacy and guidelines

Title
Author(s)
Link
Type
Date

A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients

C. Raina MacIntyre and Abrar Ahmad Chughtai

Journal article

April 30, 2020

Considerations for Wearing Cloth Face Coverings

Center for Disease Control (CDC)

Web/blog article

July 16, 2020

Making sense of the research on COVID-19 and mask

Benjamin J. Abbott, Mitchell Greenhalgh, and Jonas Bush

Web/blog article

July 19, 2020

Masks and COVID-19

Wei Lyu & George L. Wehby

Journal article

June 16, 2020

Masks and Effectiveness

Mayo Clinic

Web/blog article

July 17, 2020

Why There Are So Many Different Guidelines For Face Masks For The Public

Huo Jingnan, NPR

Web/blog article

April 10, 2020

Conservation, extended use, and reuse

Title
Author(s)
Link
Type
Date

Decontamination and Reuse of Filtering Facepiece Respirators

U.S. CDC

Web/blog article

April 30, 2020

Optimizing Supply of PPE and Other Equipment during Shortages

U.S. CDC

Web/blog article

July, 16, 2020

Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings

U.S. CDC

Web page

Strategies for Optimizing the Supply of Eye Protection

U.S. CDC

Web/blog article

July 15, 2020

Strategies for Optimizing the Supply of Facemasks

U.S. CDC

Web/blog article

June 28, 2020

Strategies for Optimizing the Supply of Isolation Gowns

U.S. CDC

Web/blog article

March 17, 2020

Strategies to Allocate Ventilators from Stockpiles to Facilities

U.S. CDC

Web/blog article

March 20, 2020

Engineering controls

Engineering-based interventions, such as additions or modifications to HV/AC systems, implementation of dust suppression measures, and other solutions can be effective at limiting the spread of infectious respiratory diseases. Because they do not require behavior change on the part of individuals or oversight and enforcement measures by organizations.

Dust suppression

Dust suppression has been proven effective at reducing the number of airborne organisms. During World War I, sailors aboard U.S. Navy ships applied oil to floors and wool blankets to reduce the amount of dust in the air. Later studies indicate that the practice reduced airborne organisms by 75% to 90%. However, studies conducted on soldiers between 1944 and 1945 and on sailors between 1945 and 1946 failed to document a beneficial effect from oiling blankets and floors during outbreaks of acute respiratory disease.

Other risk mitigation protocols

Immunocompromised individuals: prevention and testing

Title
Author(s)
Link
Type
Date

If You Are Immunocompromised, Protect Yourself From COVID-19

CDC

Immunosuppressed Patient SARS-CoV-2 (COVID-19) and Respiratory Viral Testing Guidelines

University of Washington Medicine

PDF

Treatment protocols

Title
Author(s)
Link
Type
Date

MGH Guidelines for Performance of Tracheostomies during the COVID-19 Pandemic

Massachusetts General Hospital

PDF

Prone Positioning for Non-Intubated Patients Guideline

Massachusetts General Hospital

PDF

April 2020

Rationale for Consideration of Statins for COVID-19 Patients

Massachusetts General Hospital

Document

May 19, 2020

COVID-19 case investigation, response and disposition protocols

Title
Author(s)
Link
Type
Date

Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan

U.S. CDC

PDF

July 2020

2019-nCoV: The Identify-Isolate-Inform (3I) Tool Applied to a Novel Emerging Coronavirus

Kristi L. Koenig, MD, Christian K. Beÿ, BS, and Eric C. McDonald, MD, MPH

Journal article

March 2020

Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings (Interim Guidance)

U.S. CDC

Web/blog article

July 17, 2020

Timeline

People

Name
Role
LinkedIn

Further reading

Title
Author
Link
Type
Date

Handwashing and respiratory illness among young adults in military training1

Margaret A.K Ryan, Rebecca S Christian, Julie Wohlrabe

Web

Knowledge and Adoption of Community Mitigation Efforts in Mexico During the 2009 H1N1 Pandemic

Nancy J. Aburto, PhD, et al.

Web

2010

Laboratory biosafety guidance related to coronavirus disease (COVID-19)

WHO

Preventing COVID-19 and Its Sequela: "There Is No Magic Bullet... It's Just Behaviors"

John P. Allegrante, M. Elaine Auld, Sundar Natarajan

Journal

August 2020

Selected nonvaccine interventions to prevent infectious acute respiratory disease

Terrence Lee, Nikki N. Jordan, Jose L. Sanchez, Joel C. Gaydos

Journal

April 2005

Documentaries, videos and podcasts

Title
Date
Link

Companies

Company
CEO
Location
Products/Services

References

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