Preparing for COVID-19 Thought to Occur Mostly from Person-To-Person Via He American College Health Association Has Respiratory Droplets Among Close Contacts

MARCH 3, 2020

ACHA Guidelines

Preparing for COVID-19 thought to occur mostly from person-to-person via he American College Health Association has respiratory droplets among close contacts. Although the prepared these guidelines to help college health transmission dynamics have yet to be determined, CDC T staff and campus administrators prepare for currently recommends a cautious approach to persons coronavirus disease 2019 (COVID-19) and related issues under investigation (PUI) for COVID-19. Health care on their campuses. The guidelines are intentionally broad personnel evaluating PUI or providing care for patients so that each institution, small or large, can modify them with confirmed COVID-19 should use Standard based on existing campus and local resources. Moreover, Precautions, Contact Precautions, Airborne Precautions, each institution should seek guidance and coordination and use eye protection (e.g., goggles or a face shield). For from their local and state public health agencies. more information, see the CDC webpage “Interim Please keep in mind that the situation is rapidly evolving. Infection Prevention and Control Recommendations for Additional information about COVID-19 is available and Patients with Known or Patients Under Investigation for consistently updated from the following sources: Coronavirus Disease 2019 (COVID-19) in Healthcare U.S. Centers for Disease Control and Prevention (CDC) Settings” at https://www.cdc.gov/coronavirus/2019- www.cdc.gov/coronavirus/2019-ncov/index.html nCoV/hcp/infection-control.html. World Health Organization (WHO) While the first cases of COVID-19 seen in the U.S. were www.who.int/emergencies/diseases/novel-coronavirus-2019 associated with international travel, local transmission has been documented and more community-associated cases American College Health Association (ACHA) should be expected. COVID-19 is a concern for college https://www.acha.org/COVID-19 and university officials not only because of students, staff, faculty, and visitors traveling to and from COVID-19 Introduction affected areas, but also due to the potential for rapid COVID-19 is a respiratory illness that can spread from transmission in a congregate setting within campus person to person. A novel coronavirus called SARS-CoV- environments. These guidelines provide recommendations 2 is the cause of COVID-19 and the outbreak first for the student health service (SHS), the campus itself, and recognized in China in December 2019. The clinical members of the campus community. spectrum of COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory Student Health Services (SHS) illness to severe pneumonia with respiratory failure and septic shock. Frequently reported signs and symptoms Preparation include fever, cough, myalgia or fatigue, and shortness of Given the international focus of many U.S. colleges and breath at illness onset. The fever course among patients universities and the academic and personal travel of with COVID-19 is not fully understood; it may be domestic and international students, faculty, and staff, prolonged and intermittent. Sore throat has also been college student health services should quickly begin reported in some patients early in the clinical course. Less preparation for potentially infectious patients with commonly reported symptoms include sputum production, COVID-19. Although these preparations may vary headache, hemoptysis, and diarrhea. The incubation significantly depending upon the size and resources of the period is estimated at approximately 5 days (95% college health program, at a minimum, the SHS should confidence interval, 4 to 7 days). Some studies have adhere to basic infection control principles. Per CDC estimated a wider range for the incubation period. Data for interim guidelines, available at human infection with other coronaviruses (e.g., MERS- https://www.cdc.gov/coronavirus/2019-ncov/infection- CoV, SARS-CoV) suggest that the incubation period may control/control-recommendations.html, “Prompt detection range from 2-14 days. There have also been reports of and effective triage and isolation of potentially infectious asymptomatic infection with COVID-19. patients are essential to prevent unnecessary exposures among patients, health care personnel, and visitors at the Based on what is currently known about SARS-CoV-2 facility. All health care facilities must ensure that their and what is known about other coronaviruses, spread is Preparing for COVID-19 / page 2 personnel are correctly trained and capable of The COVID-19 Planning and Response Committee will: implementing infection control procedures; individual Identify the content of staff education and training and health care personnel should ensure they understand and arrange for the training. SHS personnel must be trained can adhere to infection control requirements.” and capable of adhering to and implementing infection control procedures. If possible, a staff member or Establish a Student Health Services COVID- community health care professional experienced in 19 Planning and Response Committee infection prevention and control training should instruct In most college health settings, the first step will be to SHS staff. establish a committee to lead the organizational response • At a minimum, non-clinical staff should be trained on to COVID-19. Health, counseling, and health promotion respiratory and hand hygiene, including cough program leaders should identify individual staff members etiquette, the proper techniques for using alcohol- (and, if possible, alternates) with either expertise in based hand sanitizers and washing hands with soap infectious disease planning and response or a willingness and water, and the use of standard facemasks and to study current CDC and WHO recommendations and social distancing. stay abreast of changing guidelines as the situation unfolds nationally and internationally. A team leader should be • Clinical staff should be trained on respiratory and identified, and specific duties and responsibilities should hand hygiene as well as correct use of personal be assigned to individual team members. Depending on protective equipment (PPE) including long-sleeved the size and complexity of the campus health and well- isolation gowns, gloves, and eye protection (goggles being program, one person may be filling more than one or disposable face shield); proper donning (putting of the committee roles. on) and doffing (taking off) of PPE; disposal of PPE; and the prevention of contamination of clothing, skin, The COVID-19 Planning and Response Committee could and environment during the doffing process. include the following: • Clinical staff should be medically cleared and fit- • a team leader: a medical/nursing staff member with tested for N95 respirator masks and trained in their leadership skills; ideally a clinical or nursing director, proper use as required by OSHA respiratory • an administrative leader in the SHS or college health protection standards. program, Prepare the SHS facility for triage and isolation of • an additional medical or nursing clinician, patients potentially infected with COVID-19. While • a health promotion professional with skills in ideally the SHS will be informed in advance of the arrival population health services and prevention campaigns of a patient with a potential COVID-19 infection, that will • a counseling/mental health professional, not always be the case. Therefore, appropriate measures should be implemented before patient arrival, upon • an information technology (IT) professional or a staff arrival, and throughout the duration of the affected member with a solid understanding of SHS and patient’s presence in the health care setting to protect the campus IT systems, patient, SHS staff, other patients, and visitors. The SHS • a member of the reception staff at the health center, should take the following steps: • an infection prevention and control coordinator • Share information about COVID-19 on the campus • the chief financial officer or a business manager and health services websites and through social • a marketing and communications representative media. Use visual alerts (e.g., posters, flyers) at the SHS entrances and other strategic places inside the • a materials/supply manager SHS (e.g., front desk, waiting room) asking patients • a lab representative to notify SHS staff prior to or immediately upon arrival if they are experiencing symptoms of • an environmental services/housekeeping/facilities respiratory illnesses (cough, runny nose, fever) and management representative, any travel history to areas with documented COVID- • a student member of the campus student health 19 transmission or close contact with an individual advisory committee, and diagnosed with COVID-19 within the past 14 days. • a local and/or state health department official(s), if With more cases of community transmission possible. occurring, COVID-19 must be considered with all respiratory illnesses without an identified source of exposure or an alternative explanatory diagnosis. Preparing for COVID-19 / page 3

• Place face masks, tissues, and alcohol-based hand • Prepare an internal alert system. sanitizers at the SHS entrances and other strategic . Develop a notification roster and checklist. places in the health center and ask patients presenting with respiratory symptoms to don a face mask upon . Include mobile and home phone numbers, pager entry into the facility and follow triage procedures. In numbers, and work and personal email facilities where it is feasible, considering segregating addresses of key SHS, counseling, and health the waiting area into “well” and “sick” sections. promotion personnel. • Identify a room in the facility most suited to isolating . Review the internal alert plan with SHS staff, a patient with potentially serious respiratory infection including designation of those individuals (including COVID-19) and take steps to ensure that responsible for implementing these only essential health care personnel wearing notifications. appropriate PPE enter the room. While some student • Prepare an external alert system. health services may have access to a negative- pressure isolation room (airborne infection isolation . Develop a notification roster and checklist. room or AIIR), it is likely that most will not. If an . Identify website addresses; home, mobile, and AIIR is not available, patients with a potential pager numbers; and email addresses of key COVID-19 infection should be transferred as soon as contacts, including: feasible to a facility where an AIIR is available.  university emergency preparedness team • Restrict visitors from entering the area of a suspected members COVID-19 patient. Appropriate signage should be  local and/or state health department/public prepared in advance and posted to inform people that health authorities the area is restricted for the purpose of infectious  university employee health service personnel disease control.  local hospital emergency departments • Upon the arrival of a patient with a potential COVID-  closest academic medical center 19 infection, immediately institute infection prevention and control procedures, including use of  emergency room PPE.  hospital epidemiology  infectious diseases consultant Develop SHS protocols for triage and evaluation of  severe communicable diseases unit (if The COVID-19 Planning potential COVID-19 patients. available) and Response Committee should consult current CDC guidelines regarding the assessment of potential COVID- . Review external alert plan with SHS staff, 19 patients. Details of appropriate protocols can be found including designation of those individuals at the CDC webpage “Evaluating and Reporting Persons responsible for implementing these Under Investigation (PUI)” at notifications. https://www.cdc.gov/coronavirus/2019-nCoV/clinical- criteria.html. Stock personal protective equipment (PPE) in accordance with CDC guidelines. The COVID-19 Relevant CDC protocols, flowcharts, and tools should be Planning and Response Committee should take steps to incorporated into a larger policy and procedure that ensure that the SHS has appropriate PPE available for identifies responsibility for screening and documentation, staff who may be providing treatment, care, or services to specimen collection, reporting, and data review. potential COVID-19 patients. Such PPE would include:

Develop an internal and external alert system • N95 respirators (with appropriate medical clearance regarding the arrival of a potential COVID-19 patient. and fit-testing of clinical staff) The COVID-19 Planning and Response Committee should • long-sleeved isolation gowns implement policies and procedures that promptly alert key individuals inside and outside the SHS about the arrival of • gloves a known or suspected COVID-19 patient. These • disposable face shields or goggles individuals will include key SHS clinical and frontline personnel, college/university emergency preparedness leadership, emergency department and hospital contacts, infectious diseases experts, and public health officials. Preparing for COVID-19 / page 4

Implement environmental infection control. SHS expertise and the authority to deploy resources and key should make efforts to implement environmental infection partners involved in providing care, treatment, or support control appropriate to emerging viral pathogens, including services. SARS-CoV-2, the virus that causes COVID-19. As per Potential members include: current interim CDC guidance: • the SHS director, medical director, or chief nursing • Dedicated medical equipment should be used for officer patient care. • the team leader of the SHS COVID-19 Planning and • All non-dedicated, non-disposable medical Response Committee equipment used for patient care should be cleaned and disinfected according to manufacturer’s • the university’s emergency preparedness team instructions and facility policies. • local or state health department consultants • Ensure environmental cleaning and disinfection • academic medical center consultants procedures are followed consistently and correctly and are appropriate for SARS-CoV-2 in health care • local emergency room/hospital/emergency medical settings. Products with EPA-approved emerging viral services partners pathogens claims are recommended for use against • SARS-CoV-2. international Studies Office/Study abroad programs representatives Develop a surge care plan. The SHS should consider • housekeeping/facilities management/environmental how to provide care in the event COVID-19 becomes services representatives more widespread, creating increased health care demand. • Actions could include: information technology representatives • • suspending routine care to focus on care for COVID- campus safety representatives 19 patients and other acute care. • counseling/psychological services representatives • exploring telehealth (and telephone) capabilities to • food service representatives assess and treat patients. • Housing/residence life representatives • developing continuity of operations plans to allow for continued services. • academic deans and/or advisors • exploring options for remote work in the event of • a representative from the Office of the President community social distancing. • a representative from the Vice President of Student For more detailed information about interim guidelines for Affairs Office preventing the spread of COVID-19 in a health care • a representative from the Vice President of Finance setting, read “Interim Infection Prevention and Control Office Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under • a representative from the Dean of Students Office Investigation for COVID-19 in Healthcare Settings” at • university relations/communications staff https://www.cdc.gov/coronavirus/2019- ncov/hcp/infection-control.html. • legal counsel/Risk management representatives • human resources representatives Campus Preparation • a student government representative, preferably one Preparation is key to an organized, effective, and efficient who was elected by students to their position campus-wide response to contagion and the disruption, Responsibilities of the campus COVID-19 work group misinformation, and chaos that could quickly ensue once a include: member of the campus community is diagnosed with COVID-19 or deemed a PUI. In addition to creating an • Reviewing the university’s emergency preparedness SHS COVID-19 Planning and Response Committee, the plan, SHS and local public health relevant protocols, campus should establish a working group to lead campus- communication plans, and relevant organizational wide efforts in preparing for COVID-19. At a minimum, charts. membership should include persons with relevant Preparing for COVID-19 / page 5

• Monitoring the CDC and WHO websites regularly . online instruction options, live feeds, for updated information on COVID-19, guidelines, recordings, or implement a note-taking program and travel advisories. for students. • Aligning campus policies and communications to . tutoring for those students after quarantine or ensure consistency and alignment with current public isolation. health guidelines. . student privacy and safety protection. • Coordinating decisions about cancellation or • Developing guidelines for campus events. Elements limitations on employee and student travel. could include: • Identifying or establishing a building or units on or . encouraging participants to stay home while off campus for students requiring isolation who sick through messaging and/or flexible refund cannot be isolated/quarantined at home. policies. . Consult with local or state health department . making hand sanitizer/handwashing facilities officials or local government officials to identify widely available. appropriate quarters that meet medical/public health requirements. . use of non-contact greetings. . Consult with legal counsel and procurement to . planning for the economic impact of event develop a memorandum of understanding cancellations. (MoU) with local apartment complexes or • Developing guidelines for employees, such as use of hotels. PPE, absences, and compensation/pay of employees • Supporting and caring for the student deemed a PUI. who are quarantined or asked to work from home. • Identifying the responsible individual or office for: • Developing and disseminating guidelines on environmental control, such as cleaning policies. . monitoring isolation compliance, such as the local public health department. Preparing a COVID-19 Event . enforcing isolation compliance, such as campus safety or city/county public safety, in Communications Plan conjunction with local/state health department. An important function of the campus COVID-19 work . ensuring the student dons a surgical mask during group will be the development and direction of campus transport to the isolation unit. communications. The group should: . monitoring the isolated student’s temperature • Define goals of communications plan for various and symptoms and determining if the student scenarios, such as case on campus, case in needs transfer to an appropriate hospital setting. community, travel restrictions, etc. Goals generally fall into one of three categories: . determining when the isolation period is no longer indicated. . Providing reassurance and information about personal safety • Developing policies and preparing academic . advisors, faculty, and financial aid staff to address Communicating action steps requested of students’ academic and financial concerns resulting community members from prolonged class absence or withdrawal. . General information • Developing a support program for students who are • Develop key messages. quarantined or isolated. The support program should . Define offices/subject matter experts to draft include: key messages on: . mental health support for students and parents  health via telehealth (telephone or online).  travel and immigration . a system to provide students with food and  business impacts supplies.  academic impacts

 environmental health  human resources policies and resources Preparing for COVID-19 / page 6

• Define approval/clearance process for messages. . Phone communications: Consider the need for rapid response and with  Plan hotline with appropriate staffing whom to coordinate/collaborate on messaging:  Plan answering machine messages to . communications office include timed updates . policy director/senior university leadership . Written communications: . subject matter expert  Develop patient education handouts • Develop capacity to translate information for target  Create and post flyers and posters audiences in languages that meet the needs of the campus community.  Share announcements in the student newspaper • Draft messages for potential future events. Campuses should consult with their campus Clery • Develop mechanisms to monitor and correct for Director or appropriate campus official to evaluate rumors and inaccurate information, including the need to send a Timely Warning if a case is monitoring social media. identified on campus. • Define internal spokesperson(s) for . first case/death on campus communications/education. Identify individual(s) to do presentations and answer questions in the . first case/death in community following settings: . university disruption/closure . residence halls • Define target audiences and key issues for . classrooms communications. . “town meeting” . students . employee work site  domestic  international . live social media events . faculty • Plan media relations communication. . staff . Identify university spokesperson(s) for external communications. . parents . Proactively engage campus/student media. . community members . Build relationships with local public • Define and develop communication mechanisms. information officers from public health and . Electronic communications: medical centers/groups.  Develop mass email capability to all . Funnel all media requests through the central students, staff/faculty, and parents (assure communications office. 24/7 access to IT individual who has access to these lists). University Business and Finance  Develop website announcement capability Continuity Plans including timed updates and FAQs. Business and finance continuity plans are an integral part  Develop designated a email address for of emergency preparedness and disaster recovery and questions from university community, should address both short term and extended scenarios parents, and members of the general public. including if community mitigation through social  Develop campus text alert capability. distancing is recommended. Departments should consider the following in their plans:  Develop social media capability, including channels unique to target populations. (e.g., • The potential financial ramifications of a campus WeChat for Chinese international students). COVID-19 outbreak and the estimated emergency funding to cover purchases and business

Preparing for COVID-19 / page 7

continuation. Departments highly reliant on • Identify students and/or scholars who have traveled international student tuition, international research within the past 14 days to countries assigned a and development, or visiting scholar or study Level 3 Travel Warning by the CDC. Institutions abroad programs may be significantly impacted. should coordinate closely with local public health authorities regarding recommendations on travel • The costs of stockpiling supplies (medical, food, and activity restrictions. All returning travelers paper products, and other consumables). from areas with community transmission should • Policies and procedures for rapid procurement and receive instructions and advised to actively monitor payment for supplies, equipment, and services. for symptoms of illness (fever and respiratory symptoms). • The continuation of payroll and accounting operations in the face of high employee • Students living in on-campus housing who have absenteeism. recent travel history to a Level 3 Travel Warning country and who may be subject to self-quarantine • Potential for campus closure on advice and will need special assistance as described in the consultation with local health department based Campus Preparation section. upon factors such as high rate of infectivity, high morbidity, serious mortality, absenteeism, and other • If a university or college official becomes aware of school system closure. an individual from a COVID-19 affected area who has developed a fever and respiratory symptoms, • Formulating and drilling plans to address appropriate campus health care personnel should be anticipated financial needs. notified prior to arrival at the SHS so that infection • Information technology needs and capabilities to control procedures can be implemented. support social distancing Notification of appropriate state or local health officials should also occur if COVID-19 is • Updating the plan to address departmental suspected. responsibilities and actions in the event of significant staff reduction or campus closure, • Additional educational steps may be taken by including mission essential functions (e.g., ongoing institutions to inform arriving students, scholars, research and research animals), mission critical and visitors from COVID-19 affected areas about employees, and alternative site possibilities. symptoms as well as preventative measures through various outlets including admission materials, • Informing community members about personal health forms, orientation sessions, and websites. preparedness. These materials should be available in different languages. Planning Related to Arrivals on Campus • ACHA recommends that institutional health from COVID-19 Affected Areas insurance policies be made readily available to The CDC has developed interim guidance for students and scholars upon arrival on campus to assure resources are available to care for suspected individuals arriving from COVID-19 affected areas COVID-19 cases. available at https://www.cdc.gov/coronavirus/2019- ncov/php/risk-assessment.html. Planning for University Students, Key points to consider: Faculty, or Staff Travelling • The situation continues to fluctuate as more is learned about the virus that causes COVID-19. It is Internationally important to check the CDC website for updated Universities should establish institutional policies or travel information and guidance. Travel to or from advisories for employees and students who travel outside some countries has been restricted, and guidance for the U.S. To quickly locate and communicate with returning travelers varies by country or region. In university-associated travelers, particularly during an some cases, this may include a need for quarantine emergency, a travel registry with mandatory registration or monitoring. should be considered.

Preparing for COVID-19 / page 8 Any university-related persons traveling internationally University-Related Persons Currently in should: Countries with New COVID-19 Activity • seek appropriate pre-travel guidance prior to travel. The CDC, WHO, and U.S. State Department have or Advisories developed guidelines for travelers to COVID-19 As COVID-19 continues to spread throughout the world, affected areas. The CDC has issued travel university-related persons may find themselves in advisories for countries where active outbreaks of countries with newly arising COVID-19 activity and COVID-19 are ongoing and the risk of exposure is advisories. During this worldwide outbreak, the traveler high. Non-essential travel to these countries is must remain vigilant and monitor current news and discouraged. See advisories. Guidance for the traveler will vary based on a https://wwwnc.cdc.gov/travel/notices. multitude of potential scenarios. At a minimum, • ensure that they are covered by adequate health and institutions of higher education (IHEs) should work with evacuation insurance for the duration of travel. travelers to: Communicable disease epidemic and pandemic • actively monitor the institution’s travel registry and events are frequently excluded by travel insurance take appropriate action as advisories arise. programs and travelers should be made aware of this. • establish and maintain a comprehensive bidirectional communication plan with the • register with the U.S. State Department Smart individual(s), their families and the institution of Traveler Enrollment Program: higher education (IHE). IHEs should designate a https://step.state.gov/step/ point person from the sponsoring • develop an action plan regarding potential scenarios program/department with whom travelers can including evacuation in case of active COVID-19 correspond. outbreaks arising in their destination; a robust and • familiarize themselves with the basics of COVID- accurate list of contacts (family, university, 19 prevention and symptom recognition as noted in insurance, embassy, etc.); and viable the previous section. communication plans. • establish a detailed plan for obtaining medical • remain current on the rapidly evolving travel evaluation and treatment. advisories issued by the CDC, WHO, and the U.S. State Department. • create and execute evacuation plans if necessary. • reevaluate travel plans if they involve travel • work with the U.S. State Department, appropriate (including interim itinerary layovers) to areas of embassies, and contracted insurance (medical, potential high risk. evacuation, travel, etc.) companies as appropriate. • actively and intentionally • make emergency funds available if necessary. . learn about and exercise appropriate • aid in repatriation efforts as appropriate. preventive measures to prevent COVID-19 infection; Xenophobia and Community Values . learn to identify Given the origins of COVID-19 in China and the recent  signs and symptoms of COVID-19 expansion of the CDC’s level 3 travel warnings to other infections countries, university leaders should be prepared for the  appropriate steps to take in the event of possibility of xenophobic responses within the campus developing any such symptoms (rapid community. Fear and anxiety can lead to social stigma evaluation at a health care facility, mask which may arise when people associate a specific illness use, social isolation pending diagnosis) with a population or nationality, despite the fact that not . monitor themselves for symptoms which could everyone in that population is at increased risk of having represent COVID-19 infection. These travelers the illness. This virus knows no geopolitical boundaries. should not embark on travels and consider Every effort should be made to dispel misinformation interrupting travel-in-progress if symptoms that COVID-19 is linked to individuals of a specific develop. ethnicity, race, or national origin. Preparing for COVID-19 / page 9

To advance and support a healthy campus climate of institutional office that supports international inclusiveness, respect, and diversity: students and scholars will likely have a registry of foreign nationals from affected countries; that office • Deliver community-level messaging (preferably from is likely familiar to these individuals and can send someone at the highest levels of authority) that targeted messages of support. reinforces the university’s shared values (e.g., mutual respect) within the context of the emerging threats. • Engage with stigmatized groups through channels This is an opportunity for leaders to frame the current that reach these communities. situation with a perspective that encourages • Leverage students to serve as advisory members to respectful behavior, minimizes microaggressions and pertinent boards or committees to vet or contribute to outright discrimination toward students, faculty/staff, policy and messaging. and visitors from COVID-19 infected countries or perceived to be descendants from those countries. People of Chinese descent might also be unjustly Conclusion blamed for “causing” this problem for the world. Be Much has been done to mobilize resources and expertise aware that attempts of using humor to defuse a tense to protect the public health during the COVID-19 situation may be interpreted as insensitivity, outbreak. This continues to be a fluid situation as new particularly among highly affected communities. information and cases arise throughout the world. This is • Messaging directly from senior leadership (e.g., the window of time to evaluate current emergency plans President, Provost, Dean) will likely have the and business continuity plans, educate and train the staff, greatest effect with regard to campus-wide response. stock supplies, and develop screening tools and clinical protocols. • Encourage individuals who experience discrimination to report these experiences to the Preparing a response to COVID-19 should be a priority appropriate office at the university (e.g., office of for campuses and a part of a larger plan for control of ombudsperson, equal employment opportunity, infectious diseases in college settings. This document affirmative action, diversity/inclusion, etc.). serves as a supplement to the guidelines available through the CDC and WHO and as a companion document to • Be aware of biases. In many countries, the wearing of surgical masks in public is a social norm, ACHA’s Emergency Planning Guidelines for Campus especially during cold and flu season. As such, Health Services: An All Hazards Approach, available at campuses should keep in mind that the wearing of a www.acha.org/EmergencyPlanning. mask by a community member should not be construed as a sign of infectiousness or an invitation to ridicule or avoidance. • Don’t limit travel histories or similar screenings only to individuals from a specific racial/ethnic background. Staff scripts should be explicit that such questions are being routinely asked of all patients; otherwise minority patients may interpret such questions as racial profiling. • Avoid imagery that reinforces stereotypes (e.g., if using images of people wearing masks, avoid photographs that exclusively show Asian faces). • Speak out against negative behaviors, stigma, and discrimination. • Keep in mind that some community members might have friends and family still living in regions that are most heavily affected by the outbreak. Social stigma can worsen the fear and anxiety among these people who are already under stress. Offer support through the counseling center, chaplain’s office, employee assistance program, or other similar resources. The Preparing for COVID-19 / page 10 COVID-19 Task Force These guidelines were developed by ACHA’s COVID-19 Generous support provided by the American College Task Force. A special thanks to the task force members: Health Foundation. Jean Chin, MD, MBA, FACP, FACHA (Task Force Chair); Deborah Beck, MPA, EdD; Michael Deichen, MD, MPH; Catherine Ebelke, PA-C; Mike Huey, MD, FACHA; Cheryl Hug-English, MD, MPH; Jim Jacobs, MD, PhD; Giang Nguyen, MD, MPH, MSCE, FAAFP; Craig Roberts, MS, PA-C; and Sarah Van Orman, MD, MMM.

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