The Coronavirus outbreak originating in Wuhan has about 20% severe cases and 2% deaths. A typical incubation period is 3 days but it may extend to 14 days, and reports exist of 24 and 27 days. It is highly contagious with an increase from day to day of 50% in new cases (infection rate R0 of about 3-4) unless extraordinary interventions are made. If it becomes a widespread pandemic or endemic it will change the lives of everyone in the world. It is imperative to act to confine and stop the outbreak and not accept its spread. We provide these guidelines for individual, community and government action.
In areas of heightened risk where the government isn’t taking adequate action, protecting a family, or group, is challenging. The spread of fire requires a trail of combustibles. Similarly, the contagion of COVID-19 requires a chain of susceptible individuals. The solution is to:
Reduce contact between the family and others, and provide for essential needs, and as the risk increases
Create a safe circle of people that protects those who are in it by shared agreement not to be in unprotected physical contact with others or with surfaces that are touched by others.
The safe circle also curbs contagion because those in the safe circle don't participate in disease transmission. Members of one safe circle can combine with others to carefully expand the safe circle or create new ones. Below are our guidelines for families.
Reducing contact between the family and others:
Carefully read our guidelines for individuals and share it with family members. Discuss with them how to reduce their contact with others.
Shift family gatherings to be virtual. The current outbreak will either be defeated or will become widespread. In the former, a few months from now will return to normal. In the latter, different actions will be needed.
Ensure that you and members of your family have necessary supplies, including prescription medicines. Consider vulnerable members of the family including elderly, but also anybody over 50, and those with chronic health conditions, as to the risk of contact with others. Reduce their contact, provide support that enables them to stay at home and not go into public spaces.
Consider temporarily moving individuals who are in collective housing (retirement communities, assisted living facilities, etc.) to more isolated accommodations, including private homes, or small group facilities.
Where it is not possible to reduce contacts, talk with those who are responsible for collective facilities to increase the level of precautions against transmission.
Avoid public gatherings and places including events and restaurants, especially those in confined spaces.
Creating safe circles under high risk conditions:
The main purpose of a safe circle is for a group of people to form a solitary unit that reduces physical contacts to external individuals to a minimum while being able to self-sustain and self-support.
Individuals don’t have to wait for government-guided, top-down safety actions. In the absence of aggressive, systematic intervention, self-organized bottom-up safe-spaces also help individuals. By progressively scaling up, the safe-zones can slow or even stop local outbreaks.
Safe circles can start from family or group of people sharing a single lodging. Multiple dwellings can be combined, including travel between them (e.g. walking or driving), if safe protocols are established and adhered to. To successfully establish a safe circle, EVERY participant has to agree to the principles of minimizing external physical contact and adhere to it. There also have to be clear instructions about how to act and cooperate. Members of the same safe-space should be candid about travel history and health conditions, and be responsible for each other's health.
In order for individuals to commit to a shared space, arrangements may need to be made with work, schools, family and friends. Staying home from work with approval of an employer, or taking a leave of absence, may be necessary.
Planning an extended period of time (at least one or more weeks) in a safe space should be done in advance, including obtaining supplies, but while procuring necessities exercise extra caution given the potential exposure to crowds. Survivalist strategies may be helpful in this context. Knowing to plan ahead for necessities is critical as each trip to obtain them involves some risk.
Where possible, arrange for deliveries of items, including food so that trips to the grocery store are limited. Some care must be taken as any item that is delivered had to be handled by someone. Unless there is agreement with the provider to use gloves, washing or disinfecting items is advisable in areas of active transmission.
For essential activities, including shopping, during which some external physical contact is inevitable, members should plan ahead to act efficiently and minimize the duration and extent of contact. Leaving and returning to the safe space involves precautions. Use appropriate personal protection, including gloves or disposable items (paper towels) for grabbing or manipulating items that should not be touched, sanitizer or alcohol for use on hands, and masks. Returning to the space requires washing or disinfection before (preferred) or upon entry.
Promote internal communication and mutual care to keep members of the space in positive relationships and mentally healthy. Recognizing that the current emergency requires extraordinary actions and sacrifices is essential. While it may mitigate, it cannot replace the importance of mutual support.
The safe circle members should obtain information on the actions to be taken in case one or more members show infection symptoms. The actions vary based on countries/states/locations, and they're also dynamic. Members should inform everyone in the group of the latest contingency plan and contact info. In case any member shows typical symptoms, others should act quickly to help him/her get tested and perform precautionary isolation before results are obtained.
As an outbreak progresses hard decisions will inevitably arise about whether to exit the safe space in order to help family or friends that are not in a safe circle. Individuals should be prepared to make such decisions.
At a time of high risk, there will be actions taken by mistake that may compromise safety. To avoid over reaction to an individual event, it is important to realize that any single act has a low probability of harm. However, when multiple actions are taken the risk increases dramatically. Ensuring that lessons are learned is more important than accusation, blame or punishment.
Individual and Community Guidelines
Take responsibility for your own health and share responsibility for the health of your neighborhood with awareness and discipline
Practice social distancing
Avoid touching surfaces in public or shared spaces
Avoid gatherings
Avoid direct contact with others, wash hands regularly, and wear masks when in close quarters with others who may be infected
Cover coughs/sneezes
Monitor for temperature or other early symptoms of infection (coughing, sneezing, runny nose, sore throat)
Practice self-isolation if you have early symptoms
If symptoms continue to develop, arrange for safe transportation to medical facilities following government recommendations; avoid public transportation, wear masks
In areas of heightened risk provide necessities for members of your community without personal contact; supplies can be left outside doors
Collaborate with others to create safe zones / safe communities. Discuss safety with family and friends, talk about safety guidelines, know who's following safe guidelines, set shared policies, follow-up and share with each other needs, concerns as well as opportunities.
Be critical of rumors and don't spread misinformation
Community and Government Guidelines
Where proximate to communities or countries with active infections, set up border checks for symptoms
Conduct 14 day quarantines for at-risk individuals entering into infection free areas
In areas of heightened risk coordinate neighborhood teams for community door-to-door monitoring for symptoms using infrared (IR) thermometers and personal protective equipment (PPEs)
Neighborhood teams going door to door should also identify individuals who are in need of support services
Government Guidelines
Prepare in advance strategic resources like masks, PPEs, and test kits, and establish distribution routes
Identify areas where infections are confirmed or suspected
Stop non-essential transportation between infected and uninfected areas
Isolate individuals with suspected and confirmed infections separately for care in designated facilities with adequate medical resources, including Personal Protective Equipment (PPE)
People with symptoms should use a specially designed process to be taken to the designated health facilities for testing, avoiding public transportation or cabs
Quarantine and test all suspected cases in the vicinity of an identified case
Promote public awareness:
Typical symptoms and possible means of transmission
Emphasize its high rate of contagion and usually mild symptoms to encourage individuals to seek medical care
Encourage better individual hygiene, including frequent hand washing, wearing masks in public areas and avoiding contact between individuals
Stop public gatherings
Pay special attention to prevent or monitor the health of people going in/out of high-density confined facilities like prisons, medical, rehab and assisted living facilities, nursing homes, retirement communities, dorms and hostels.
Promote Community Responsibilities in infected areas
In each neighborhood/community, select a group of people whose daily job involves frequent human contact. Monitor their condition daily to help detect infections and prevent contagion
Engage in communication and distribution of resources to remote areas
Coordinate with international communities and WHO to share information about case identification, patient travel history, treatments, prevention strategies, and shortages of medical supplies
Plan for treatment of patients with similar symptoms that are not COVID-19 infected
In areas with active transmission
Close places of worship, universities, schools and corporations
Restrict people to homes and provide support for necessities to be delivered without contact
Perform door-to-door searches for individuals with early symptoms and needs for services, with necessary PPE precautions, and with community engagement in the effort
Business Guidelines
Below is a list of various actions businesses can take to prevent the spread of Coronavirus. We include special considerations for Retail and Hospitality as well.
Note: The French International Chamber of Commerce is using these guidelines.
General
Promote understanding among employees and their families of Coronavirus transmission and prevention.
Develop customized organization policies to reduce transmission and arrange for meticulous implementation.
Ensure employees know that when they have even mild symptoms they should not be at work locations or in-person meetings and they will not be penalized for sick days. Set up a reporting system for any cases.
Ensure employees have appropriate health insurance policies so that they will not be afraid to seek out care when they have symptoms, even mild ones.
Engage with local medical facilities to coordinate early rapid testing of employees for Coronavirus
Prepare essentials (hand sanitizer, alcohol, masks, Infrared contactless forehead thermometers) in case the conditions deteriorate and employees don’t have access to those items.
Strengthening the weakest links of the organization reduces vulnerability.
Meetings, Travel and Visitors
Replace in-person meetings with virtual
Arrange for workers to work from home where possible
Restrict travel to higher risk Zones (Red, Orange, and even Yellow)
Eliminate non-essential travel
Change ways of doing business to make seemingly essential travel unnecessary.
Limit visitors and set policies to inquire and rule out visitors based upon their residential Zone status and business Coronavirus prevention policies. Check visitor symptoms upon arrival.
Workplaces
Promote flexible work hours, staggered hours, and shifts to decrease density in the workplace. The density should be reduced to less than 50 % capacity at a given time
Employers should ask employees returning from places with confirmed cases, or having uncertain contacts during travel, to self-quarantine for 14 days before coming to the office. Employers should keep close track of their health condition, and report and seek medical care.
Entry points should be manned with individuals having Infrared contactless forehead thermometers.
Measure body temperatures of employees daily and provide them with masks where proximity with others cannot be avoided [1]
Reroute traffic into the building to promote hand washing on entry and place hand sanitizer at the entrance of the office.
Arrange employees to avoid clustering in elevators. Elevators should not take more than half of their carrying capacity
Make sure each employee’s working space is separated by at least 3 ft, and each individual working space should be at least 25 square feet. For offices with large numbers of people, these minimum guidelines should be further increased
Disinfect public areas, locales with heavy traffic, surfaces frequently touched
If A/C must be used, disable re-circulation of internal air. Weekly clean/disinfect/replace key components and filters.
Scatter dining, keep 3 feet distance while dining and avoid sitting face-to-face. Separate utensils and frequently disinfect. Cafeteria staff must be frequently checked for health
Promote meal delivery rather than going out for meals. Arrange help for calls for food delivery and a location for contactless drop off and pickup of food in a hygienic area without lines.
Consider how employees get to work locations and develop recommendations including avoiding public transportation, or careful hygiene including avoiding touching surfaces, hand washing and wearing masks in areas of increased risk
The responsibilities of ensuring workplace policies on Coronavirus safety should be clear and accountable
Retail and Hospitality
High contact industries may be severely disrupted. Early and effective interventions may mitigate but will not eliminate the risk unless they are society wide
The importance of making sure individuals with even mild cold symptoms from work involving contact with others cannot be overemphasized.
Keep a clear log of each day’s contacts. So that if an infection is identified the business can alarm all possibly exposed to minimize risk and mitigate harm to employees and customers.
No-contact methods for doing business should be developed and implemented including:
Walk up window pickup and drop off service including ensuring adequate spacing in lines
Drive by service
No-contact home delivery
1. The use of masks is debated, we note that: (1) Any individual who has even mild symptoms should avoid contact with others and should wear a mask while in necessary public or private contact with others. (2) Wearing a mask should be accepted in public settings to prevent those who are sick from hesitating to or feeling stigmatized by wearing a mask. (3) While masks do not guarantee safety for a healthy individual and their availability may be limited because of higher priority need in medical settings, using masks where proximity to others who may be infected can’t be avoided dramatically reduces the risk of infection. (4) For those who are over 50 or have preexisting health conditions, as well as for those in areas of heightened risk, the large cost of being infected justifies the use of a mask. While not ideal, reusable washable masks can be made by hand, and they are needed for protection in hospitals, nursing homes, rehab centers, group homes and other group settings.
Early Outbreak Response Guidelines
The Coronavirus outbreak originating in Wuhan has about 20% severe cases and 2% deaths. A typical incubation period is 3 days but it may extend to 14 days, and reports exist of 24 and 27 days. It is highly contagious with an increase from day to day of 50% in new cases (infection rate R0 of about 3-4) unless extraordinary interventions are made. If it becomes a widespread pandemic or endemic it will change the lives of everyone in the world. It is imperative to act to confine and stop the outbreak and not accept its spread. We provide these guidelines for individual, community and government action.
In areas of heightened risk where the government isn’t taking adequate action, protecting a family, or group, is challenging. The spread of fire requires a trail of combustibles. Similarly, the contagion of COVID-19 requires a chain of susceptible individuals. The solution is to:
Reduce contact between the family and others, and provide for essential needs, and as the risk increases
Create a safe circle of people that protects those who are in it by shared agreement not to be in unprotected physical contact with others or with surfaces that are touched by others.
The safe circle also curbs contagion because those in the safe circle don't participate in disease transmission. Members of one safe circle can combine with others to carefully expand the safe circle or create new ones. Below are our guidelines for families.
Reducing contact between the family and others:
Carefully read our guidelines for individuals and share it with family members. Discuss with them how to reduce their contact with others.
Shift family gatherings to be virtual. The current outbreak will either be defeated or will become widespread. In the former, a few months from now will return to normal. In the latter, different actions will be needed.
Ensure that you and members of your family have necessary supplies, including prescription medicines. Consider vulnerable members of the family including elderly, but also anybody over 50, and those with chronic health conditions, as to the risk of contact with others. Reduce their contact, provide support that enables them to stay at home and not go into public spaces.
Consider temporarily moving individuals who are in collective housing (retirement communities, assisted living facilities, etc.) to more isolated accommodations, including private homes, or small group facilities.
Where it is not possible to reduce contacts, talk with those who are responsible for collective facilities to increase the level of precautions against transmission.
Avoid public gatherings and places including events and restaurants, especially those in confined spaces.
Creating safe circles under high risk conditions:
The main purpose of a safe circle is for a group of people to form a solitary unit that reduces physical contacts to external individuals to a minimum while being able to self-sustain and self-support.
Individuals don’t have to wait for government-guided, top-down safety actions. In the absence of aggressive, systematic intervention, self-organized bottom-up safe-spaces also help individuals. By progressively scaling up, the safe-zones can slow or even stop local outbreaks.
Safe circles can start from family or group of people sharing a single lodging. Multiple dwellings can be combined, including travel between them (e.g. walking or driving), if safe protocols are established and adhered to. To successfully establish a safe circle, EVERY participant has to agree to the principles of minimizing external physical contact and adhere to it. There also have to be clear instructions about how to act and cooperate. Members of the same safe-space should be candid about travel history and health conditions, and be responsible for each other's health.
In order for individuals to commit to a shared space, arrangements may need to be made with work, schools, family and friends. Staying home from work with approval of an employer, or taking a leave of absence, may be necessary.
Planning an extended period of time (at least one or more weeks) in a safe space should be done in advance, including obtaining supplies, but while procuring necessities exercise extra caution given the potential exposure to crowds. Survivalist strategies may be helpful in this context. Knowing to plan ahead for necessities is critical as each trip to obtain them involves some risk.
Where possible, arrange for deliveries of items, including food so that trips to the grocery store are limited. Some care must be taken as any item that is delivered had to be handled by someone. Unless there is agreement with the provider to use gloves, washing or disinfecting items is advisable in areas of active transmission.
For essential activities, including shopping, during which some external physical contact is inevitable, members should plan ahead to act efficiently and minimize the duration and extent of contact. Leaving and returning to the safe space involves precautions. Use appropriate personal protection, including gloves or disposable items (paper towels) for grabbing or manipulating items that should not be touched, sanitizer or alcohol for use on hands, and masks. Returning to the space requires washing or disinfection before (preferred) or upon entry.
Promote internal communication and mutual care to keep members of the space in positive relationships and mentally healthy. Recognizing that the current emergency requires extraordinary actions and sacrifices is essential. While it may mitigate, it cannot replace the importance of mutual support.
The safe circle members should obtain information on the actions to be taken in case one or more members show infection symptoms. The actions vary based on countries/states/locations, and they're also dynamic. Members should inform everyone in the group of the latest contingency plan and contact info. In case any member shows typical symptoms, others should act quickly to help him/her get tested and perform precautionary isolation before results are obtained.
As an outbreak progresses hard decisions will inevitably arise about whether to exit the safe space in order to help family or friends that are not in a safe circle. Individuals should be prepared to make such decisions.
At a time of high risk, there will be actions taken by mistake that may compromise safety. To avoid over reaction to an individual event, it is important to realize that any single act has a low probability of harm. However, when multiple actions are taken the risk increases dramatically. Ensuring that lessons are learned is more important than accusation, blame or punishment.
Individual and Community Guidelines
Take responsibility for your own health and share responsibility for the health of your neighborhood with awareness and discipline
Practice social distancing
Avoid touching surfaces in public or shared spaces
Avoid gatherings
Avoid direct contact with others, wash hands regularly, and wear masks when in close quarters with others who may be infected
Cover coughs/sneezes
Monitor for temperature or other early symptoms of infection (coughing, sneezing, runny nose, sore throat)
Practice self-isolation if you have early symptoms
If symptoms continue to develop, arrange for safe transportation to medical facilities following government recommendations; avoid public transportation, wear masks
In areas of heightened risk provide necessities for members of your community without personal contact; supplies can be left outside doors
Collaborate with others to create safe zones / safe communities. Discuss safety with family and friends, talk about safety guidelines, know who's following safe guidelines, set shared policies, follow-up and share with each other needs, concerns as well as opportunities.
Be critical of rumors and don't spread misinformation
Community and Government Guidelines
Where proximate to communities or countries with active infections, set up border checks for symptoms
Conduct 14 day quarantines for at-risk individuals entering into infection free areas
In areas of heightened risk coordinate neighborhood teams for community door-to-door monitoring for symptoms using infrared (IR) thermometers and personal protective equipment (PPEs)
Neighborhood teams going door to door should also identify individuals who are in need of support services
Government Guidelines
Prepare in advance strategic resources like masks, PPEs, and test kits, and establish distribution routes
Identify areas where infections are confirmed or suspected
Stop non-essential transportation between infected and uninfected areas
Isolate individuals with suspected and confirmed infections separately for care in designated facilities with adequate medical resources, including Personal Protective Equipment (PPE)
People with symptoms should use a specially designed process to be taken to the designated health facilities for testing, avoiding public transportation or cabs
Quarantine and test all suspected cases in the vicinity of an identified case
Promote public awareness:
Typical symptoms and possible means of transmission
Emphasize its high rate of contagion and usually mild symptoms to encourage individuals to seek medical care
Encourage better individual hygiene, including frequent hand washing, wearing masks in public areas and avoiding contact between individuals
Stop public gatherings
Pay special attention to prevent or monitor the health of people going in/out of high-density confined facilities like prisons, medical, rehab and assisted living facilities, nursing homes, retirement communities, dorms and hostels.
Promote Community Responsibilities in infected areas
In each neighborhood/community, select a group of people whose daily job involves frequent human contact. Monitor their condition daily to help detect infections and prevent contagion
Engage in communication and distribution of resources to remote areas
Coordinate with international communities and WHO to share information about case identification, patient travel history, treatments, prevention strategies, and shortages of medical supplies
Plan for treatment of patients with similar symptoms that are not COVID-19 infected
In areas with active transmission
Close places of worship, universities, schools and corporations
Restrict people to homes and provide support for necessities to be delivered without contact
Perform door-to-door searches for individuals with early symptoms and needs for services, with necessary PPE precautions, and with community engagement in the effort
Business Guidelines
Below is a list of various actions businesses can take to prevent the spread of Coronavirus. We include special considerations for Retail and Hospitality as well.
Note: The French International Chamber of Commerce is using these guidelines.
General
Promote understanding among employees and their families of Coronavirus transmission and prevention.
Develop customized organization policies to reduce transmission and arrange for meticulous implementation.
Ensure employees know that when they have even mild symptoms they should not be at work locations or in-person meetings and they will not be penalized for sick days. Set up a reporting system for any cases.
Ensure employees have appropriate health insurance policies so that they will not be afraid to seek out care when they have symptoms, even mild ones.
Engage with local medical facilities to coordinate early rapid testing of employees for Coronavirus
Prepare essentials (hand sanitizer, alcohol, masks, Infrared contactless forehead thermometers) in case the conditions deteriorate and employees don’t have access to those items.
Strengthening the weakest links of the organization reduces vulnerability.
Meetings, Travel and Visitors
Replace in-person meetings with virtual
Arrange for workers to work from home where possible
Restrict travel to higher risk Zones (Red, Orange, and even Yellow)
Eliminate non-essential travel
Change ways of doing business to make seemingly essential travel unnecessary.
Limit visitors and set policies to inquire and rule out visitors based upon their residential Zone status and business Coronavirus prevention policies. Check visitor symptoms upon arrival.
Workplaces
Promote flexible work hours, staggered hours, and shifts to decrease density in the workplace. The density should be reduced to less than 50 % capacity at a given time
Employers should ask employees returning from places with confirmed cases, or having uncertain contacts during travel, to self-quarantine for 14 days before coming to the office. Employers should keep close track of their health condition, and report and seek medical care.
Entry points should be manned with individuals having Infrared contactless forehead thermometers.
Measure body temperatures of employees daily and provide them with masks where proximity with others cannot be avoided [1]
Reroute traffic into the building to promote hand washing on entry and place hand sanitizer at the entrance of the office.
Arrange employees to avoid clustering in elevators. Elevators should not take more than half of their carrying capacity
Make sure each employee’s working space is separated by at least 3 ft, and each individual working space should be at least 25 square feet. For offices with large numbers of people, these minimum guidelines should be further increased
Disinfect public areas, locales with heavy traffic, surfaces frequently touched
If A/C must be used, disable re-circulation of internal air. Weekly clean/disinfect/replace key components and filters.
Scatter dining, keep 3 feet distance while dining and avoid sitting face-to-face. Separate utensils and frequently disinfect. Cafeteria staff must be frequently checked for health
Promote meal delivery rather than going out for meals. Arrange help for calls for food delivery and a location for contactless drop off and pickup of food in a hygienic area without lines.
Consider how employees get to work locations and develop recommendations including avoiding public transportation, or careful hygiene including avoiding touching surfaces, hand washing and wearing masks in areas of increased risk
The responsibilities of ensuring workplace policies on Coronavirus safety should be clear and accountable
Retail and Hospitality
High contact industries may be severely disrupted. Early and effective interventions may mitigate but will not eliminate the risk unless they are society wide
The importance of making sure individuals with even mild cold symptoms from work involving contact with others cannot be overemphasized.
Keep a clear log of each day’s contacts. So that if an infection is identified the business can alarm all possibly exposed to minimize risk and mitigate harm to employees and customers.
No-contact methods for doing business should be developed and implemented including:
Walk up window pickup and drop off service including ensuring adequate spacing in lines
Drive by service
No-contact home delivery
1. The use of masks is debated, we note that: (1) Any individual who has even mild symptoms should avoid contact with others and should wear a mask while in necessary public or private contact with others. (2) Wearing a mask should be accepted in public settings to prevent those who are sick from hesitating to or feeling stigmatized by wearing a mask. (3) While masks do not guarantee safety for a healthy individual and their availability may be limited because of higher priority need in medical settings, using masks where proximity to others who may be infected can’t be avoided dramatically reduces the risk of infection. (4) For those who are over 50 or have preexisting health conditions, as well as for those in areas of heightened risk, the large cost of being infected justifies the use of a mask. While not ideal, reusable washable masks can be made by hand, and they are needed for protection in hospitals, nursing homes, rehab centers, group homes and other group settings.