It is easy to be overwhelmed or confused with the fast-paced change of well, life right now with CORVID-19 (coronavirus). There are easy steps we all can take to avoid and reduce the spread like frequent thorough hand washing followed by lotion to protect your hands from cracking and making an easy entrance point to allow infection.

Communities and other entities, however, have a more complex job of how to handle events that call for large gatherings. Below are the recommended strategies from the Michigan Department of Health and Human Services (MDHHS) that apply to every individual, organization, and community. They apply to businesses, workplaces, schools, community organizations, health care institutions, and individuals of all ages, backgrounds, and health profiles.

Community mitigation strategies are crucial to slowing the transmission of coronavirus disease 2019 (COVID-19) in Michigan, particularly before a vaccine or treatment becomes available. These strategies provide essential protections to individuals at risk of severe illness and to health care and other critical infrastructure workforces. Preventing a sudden, sharp increase in the number of people infected with COVID-19 will help minimize disruptions to daily life and limit the demand on health care providers and facilities. These recommended strategies apply at the individual, organizational, and community levels. They apply to businesses, workplaces, schools, community organizations, health care institutions, and individuals of all ages, backgrounds, and health profiles. Everyone has some measure of responsibility to help limit the spread of this disease. Even individuals who are healthy can help prevent the spread of COVID-19 to others.

Michiganders have been preparing for COVID-19 for weeks, and all individuals should continue to take the following basic personal-hygiene measures to prevent the spread of the virus:
• wash your hands often with soap and water or use hand sanitizer;
• avoid touching your eyes, nose, or mouth with unwashed hands;
• cover your mouth and nose with a tissue when coughing or sneezing;
• avoid handshakes;
• avoid contact with sick people who are sick; and
• stay home when you are sick.

Michigan must take further action, however. To help avoid a rapid increase of cases in the state, MDHHS recommends implementing now the following community mitigation strategies. Please note, guidance for health care providers is not addressed in this document but is available at www.Michigan.gov/coronavirus.

Individuals and families at home:
1. Learn about the signs and symptoms of COVID-19. Symptoms include fever, cough, and difficulty breathing.
2. If you have respiratory symptoms, STAY HOME WHEN YOU ARE SICK. Call your health care provider’s office in advance of your visit.
3. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches.
4. Communicate and reinforce best practices for washing hands and covering coughs and sneezes.
5. Be prepared if there is COVID-19 in your household or a disruption of daily activities in your community. For example, maintain a supply of medications, food, and other essentials in your house. Consider alternative shopping options such as curbside pickups or online deliveries.
6. Access services as much as possible online or by phone.

Individuals at risk of severe illness:
These individuals include, but are not limited to, older adults and persons of any age with underlying medical conditions, such as persons with a blood disorder (e.g., sickle cell disease or a disorder being treated with blood thinners), an endocrine disorder (e.g., diabetes mellitus), or a metabolic disorder (such as inborn error of metabolism); those with heart disease, lung disease (including asthma or chronic obstructive pulmonary disease), chronic kidney disease, or chronic liver disease; those with a compromised immune system (e.g., those who are receiving treatments such as radiation or chemotherapy, who have received an organ or bone marrow transplant, who are taking high doses of immunosuppressant, or who have HIV or AIDS); those who are currently pregnant or were pregnant in the last two weeks; and those with neurological or neurologic and neurodevelopment conditions.

1. Individuals at risk of severe illness should stay at home and keep away from others who are sick, except in exceptional circumstances. Wash your hands often, particularly after contact with high-touch surfaces. Avoid crowds and closed-in settings with little air ventilation as much as possible. Avoid cruise travel and non-essential air travel.

2. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches.

3. In households with individuals at risk of severe illness, provide a protected space for those individuals and have healthy people conduct themselves as if they were a significant risk to those individuals. For example, healthy people should wash their hands before feeding or caring for an at-risk individual.

4. Have a plan for if you get sick, and stay in touch with others by phone or email.

5. Watch for symptoms and emergency warning signs that require immediate medical attention.

6. Family members and caregivers can support older adults by knowing what medications they are taking and ensuring there is an extra supply on hand.

7. Family members and caregivers can support older adults by monitoring food and other necessary medical supplies (e.g., oxygen, incontinence, dialysis, and wound care supplies) and by creating a back-up plan for securing those essentials if they run out.

Assisted living facilities, adult day care programs, and senior living facilities:
1. Encourage personal protective measures among residents, clients, and staff, including handwashing and covering coughs and sneezes.
2. Encourage residents, clients, and staff to stay home (or in their private quarters) when sick and to notify program administrators of illness.
3. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards,
cell phones, and light switches.
4. Ensure hand hygiene supplies are readily accessible throughout the facility.
5. If caring for an individual living in a care facility, monitor the situation, ask about the
health of the other residents frequently, and know the protocol if there is an outbreak.
6. Implement social distancing measures as feasible, such as reducing large gatherings, altering meal schedules to reduce mixing, and limiting programs with external staff.
7. Limit visitors to only those who are absolutely necessary and implement screening of
visitors for temperature and respiratory symptoms.
8. Maintain contact with individuals at risk of severe illness who are no longer able to
attend day care programs.

Universities and colleges:
1. Educate students and the community about COVID-19 and preventative hygiene practices.
2. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches.
3. Encourage staff and students to stay home when sick.
4. Cancel or postpone large gatherings, conferences, and sporting events (e.g., greater than 100 people in a shared space).
5. Consider tele-learning opportunities, as feasible.
6. Communicate and reinforce best practices for washing hands and covering coughs and sneezes.
7. Students and faculty at risk of severe illness should implement plans for distance
learning.

Schools and childcare facilities:
1. Educate students and the community about COVID-19 and preventative hygiene practices.
2. Encourage staff and students to stay home when sick.
3. Report influenza-like activity, absenteeism, and potential school dismissals to public health officials.
4. Separate sick students and staff from others until they can go home. When feasible, identify a “sick room” through which others do not regularly pass.
5. Communicate and reinforce best practices for washing hands and covering coughs and sneezes.
6. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches.
7. Consider having students eat meals in their classrooms as opposed to a cafeteria-like setting, or alter meal schedules for smaller-group gatherings.
8. Limit large gatherings such as assemblies and limit inter-school interactions.
9. Alter schedules for recess and entry/dismissal to reduce the mixing of large numbers of students and staff.
10. Schools with students at risk of severe illness should consider implementing plans for distance learning for those students, to the extent feasible.

Workplaces:
1. Encourage employees to stay home when sick and to notify supervisors of illness.
2. Communicate and reinforce best practices for washing hands covering coughs and sneezes.
3. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches.
4. Ensure hand hygiene supplies are readily accessible throughout the workplace.
5. Encourage staff to tele-work when feasible, particularly individuals at risk of severe illness.
6. Implement social distancing measures as feasible, including limiting in-person meetings.
7. Limit large work-related gatherings (e.g., staff meetings and after-work functions).
8. Limit non-essential work travel.
9. Cancel or postpone large gatherings, conferences, and sporting events (e.g., greater than 100 people in a shared space).
10. Discourage employees from eating meals in a large group setting, such as a cafeteria.
11. Tailor continuity of operation plans to the COVID-19 threat.

Community and faith-based organizations:
1. Identify safe ways to serve those who are at high risk or vulnerable through outreach and assistance.
2. Encourage staff and members to stay home when sick and to notify the organization of illness.
3. Communicate and reinforce best practices for washing hands and covering coughs and sneezes.
4. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, cell phones, and light switches.
5. Ensure hand hygiene supplies are readily accessible.
6. Implement social distancing measures as feasible.
7. Reduce in-person gatherings and activities, especially for organizations with individuals at risk of severe illness. Consider offering video or audio of events.
8. Determine ways to continue providing support services to individuals at risk of severe illness while limiting group settings and exposures.
9. Avoid large gatherings (e.g., greater than 100 people in a shared space) or move to smaller and staggered gatherings.
10. For organizations that serve high-risk communities, cancel gatherings of more than people.

Other mass events:
1. Cancel or postpone large gatherings, conferences, and sporting events (e.g., greater than 100 people in a shared space).
2. Regularly clean and disinfect frequently touched surfaces, like doorknobs, keyboards, and light switches.
3. Communicate and reinforce best practices for washing hands and covering coughs and sneezes.

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