UNCLASSIFIED// IMMEDIATE O 201856Z MAY 20 MID510001192418U FM CNO WASHINGTON DC TO NAVADMIN INFO SECNAV WASHINGTON DC CNO WASHINGTON DC BT UNCLAS NAVADMIN 147/20 MSGID/NAVADMIN/CNO WASHINGTON DC/CNO/MAY// SUBJ/GUIDANCE TO COMMANDERS ON ADJUSTING HEALTH PROTECTION CONDITIONS AND BASE SERVICES// REF/A/MEMO/OSD/19MAY2020// REF/B/INST/OPNAV/19NOV2018// REF/C/DIRECTIVE/OSD/28MAR2019// REF/D/MEM/OSD/25FEB2020// NARR/ REF A IS SECRETARY OF DEFENSE GUIDANCE FOR COMMANDERS ON RISK-BASED CHANGING OF HEALTH PROTECTION CONDITION (HPCON) LEVELS DURING THE COVID-19 PANDEMIC. REF B IS NAVY PANDEMIC INFLUENZA AND INFECTIOUS DISEASE POLICY. REF C IS DOD DIRECTIVE 6200.03 PUBLIC HEALTH EMERGENCY MANAGEMENT WITHIN THE DOD. REF D IS OUSD PR FORCE HEALTH PROTECTION GUIDANCE (SUPPLEMENT 2).// RMKS/1. THIS NAVADMIN: (1) SUPPLEMENTS GUIDANCE IN REFERENCE (A) AND (B); (2) PROVIDES ADDITIONAL GUIDANCE FOR COMMANDERS WHEN MAKING LOCAL DECISIONS TO ADJUST HPCON SERVICES ON INSTALLATIONS; AND (3) PROVIDES REPORTING REQUIREMENTS FOR HPCON AND INSTALLATION SERVICES STATUS. THE NAVY WILL ADJUST HPCON/RESTRICTIONS ON INSTALLATIONS BY TAKING INTO ACCOUNT LOCAL ASSESSMENTS AND CONDITIONS BASED ON PUBLIC HEALTH SURVEILLANCE DATA, GUIDANCE FROM CENTERS FOR DISEASE CONTROL AND PREVENTION, COLLABORATION WITH STATE, TERRITORIAL AND LOCAL AUTHORITIES, AND ADVICE FROM THE COMMAND PUBLIC HEALTH EMERGENCY OFFICER (PHEO) AND LOCAL MILITARY TREATMENT FACILITY (MTF). THESE DECISIONS AND ASSESSMENTS SHOULD BE COORDINATED WITH OTHER DOD INSTALLATIONS AND FACILITIES WITHIN THE SAME GEOGRAPHIC AREA TO ENABLE CONSISTENT DOD HPCON STATUS ACROSS SERVICES. NAVAL COMPONENT AND REGION COMMANDERS MAY BE MORE OR LESS STRINGENT THAN SURROUNDING COMMUNITY REQUIREMENTS BASED ON MISSION AND RISK CONSIDERATIONS. 2. MISSION. NAVAL COMPONENT COMMANDERS (NCC) WILL COORDINATE HPCON CHANGES WITH COMBATANT COMMANDERS AND/OR SUBUNIFIED COMMANDERS AS APPROPRIATE. COMMANDER, NAVAL INSTALLATIONS COMMAND (CNIC), REGIONAL COMMANDERS (REGCOM), AND LOCAL HEALTH OFFICIALS WILL INFORM THE RESPECTIVE NCC USING A METRICS- BASED, RISK-INFORMED APPROACH TO ADJUSTING INSTALLATION SERVICES AND LOCAL FORCE HEALTH PROTECTION CONDITIONS. THE GOAL IS TO METHODICALLY ENSURE SERVICES ARE RESTORED ON NAVY INSTALLATIONS IN A SAFE AND RESPONSIBLE MANNER WHEN CONDITIONS PERMIT, AND TO MONITOR HEALTH TRENDS SHOULD SERVICES OR HPCON WARRANT RECONSIDERATION. 3. DEFINITIONS. REF (A) TABLE 1 PROVIDES CONSIDERATIONS FOR CHANGING HPCON LEVELS. WHEN CHANGING HPCON LEVELS, NCC WILL USE THE FOLLOWING DEFINITIONS: 3.A WIDESPREAD TRANSMISSION: PERSISTENT ELEVATED CASES WITH EVIDENCE OF ONGOING DISEASE TRANSMISSION AFFECTING THE MAJORITY OF THE REGION. IF NO LONGER WIDESPREAD TRANSMISSION, CONSIDER CHANGING FROM HPCON DELTA TO CHARLIE. 3.B SUSTAINED TRANSMISSION: MULTIPLE CASES (GENERALLY >50 PER 100K PER WEEK) STILL PRESENT AMONG LOCAL RESIDENTS WITH NO EPIDEMIOLOGICAL LINK. IF NO LONGER SUSTAINED TRANSMISSION, CONSIDER CHANGING FROM HPCON CHARLIE TO BRAVO. 4. EXECUTION. 4.A CONCEPT OF OPERATION. THE TRANSITIONS OUTLINED IN THIS NAVADMIN PROVIDES A FRAMEWORK TO ASSESS NAVY INSTALLATIONS AND/OR FACILITIES USING LOCAL COMMUNITY HEALTH CONDITIONS AND CRITERIA TO INCLUDE: (1) DOWNWARD TRAJECTORY OF REPORTED CASES OF INFLUENZA LIKE ILLNESSES (ILI) AND COVID-LIKE ILLNESS (CLI) CASES REPORTED OVER THE PRECEDING 14 DAYS; (2) DOWNWARD TRAJECTORY OF DOCUMENTED COVID-19 CASES OR OF POSITIVE TESTS AS A PERCENT OF TOTAL TESTS OVER THE PRECEDING 14 DAYS; (3) AND MTF AND/OR LOCAL HOSPITALS HAVE THE CAPACITY TO TREAT ALL PATIENTS WITHOUT SITUATIONAL STANDARDS OF CARE AS DEFINED IN REF (C) AND HAVE AN ESTABLISHED COVID-19 TESTING PROGRAM IN PLACE FOR AT-RISK HEALTHCARE WORKERS AND THOSE EXHIBITING ILI AND CLI SYMPTOMS. AN ASSESSMENT OF THESE CONDITIONS AND CRITERIA WILL PROVIDE A LOCALLY DERIVED COMMON OPERATING PICTURE OF RISK TO FORCE. INTEGRATED DATA ANALYSIS IS AVAILABLE VIA THE ADVANA COVID-19 MODELING PLATFORM. FLEET AND INSTALLATIONS COMMANDERS CAN USE THIS PLATFORM TO ACCURATELY DEVELOP COVID-19 COMMON OPERATIONAL PICTURE TO BETTER ENABLE DATA INFORMED DECISION MAKING. THE ADVANA SYSTEM INCLUDES LIVE DATA UPDATES ON CASES, TESTING CAPACITY, BEDS, PERSONNEL, SUPPLY AND LOGISTICS GIVING COMMANDERS REAL-TIME SITUATIONAL AWARENESS WHILE PROJECTING IMPACTS TO READINESS. NCC WILL USE THIS TRANSITION FRAMEWORK TO INFORM DECISIONS WHICH BALANCE OPERATIONAL READINESS, MAINTENANCE, TRAINING, EDUCATION AND THE NEEDS OF INSTALLATION BENEFICIARY POPULATIONS. 4.B CRITERIA. EACH INSTALLATION COMMANDER WILL USE THE FOLLOWING CRITERIA TO FACILITATE RISK-INFORMED DISCUSSIONS WITH REGCOM AND CNIC TO ENABLE NCC DECISIONS. 4.B.1 SYMPTOM TRAJECTORY. DOWNWARD TRAJECTORY OF ILI AND CLI CASES REPORTED OVER THE PRECEDING 14 DAYS. ASSESSMENTS MUST INCLUDE BOTH THE INSTALLATION AND SURROUNDING COMMUNITY TO INCLUDE LOCALITIES SHARING ADJOINING BOUNDARIES, AND LOCALITIES WHERE THE MAJORITY OF THE INSTALLATIONS POPULATION RESIDES. PHEOS IN CONCERT WITH MTF COMMANDERS AND INSTALLATION COMMANDERS WILL DETERMINE THE BEST LOCAL SOURCE OF DATA PER REF (C). E.G., USE THE FEMA EARLY INDICATOR DAILY REPORT OR ADVANA. DEPENDING ON THE TRAJECTORY OF THE SYMPTOMS, INSTALLATION COMMANDERS WILL REPORT THE INSTALLATION AS GREEN (SUSTAINED REDUCTION FOR 14 OR MORE DAYS OR STABLE AT VERY LOW LEVELS), YELLOW (SUSTAINED REDUCTION FOR 7-13 DAYS OR SHIFT UPWARD OF 1 TO 4 CONSECUTIVE DAYS) OR RED (SUSTAINED REDUCTION FOR 0-6 DAYS OR IF THE TRAJECTORY SHIFTS UPWARD FOR 5 CONSECUTIVE DAYS). 4.B.2. COVID-19 CASE AND TESTING TRAJECTORY. DOWNWARD TRAJECTORY OF DOCUMENTED COVID-19 CASES OR POSITIVE TESTS AS A PERCENT OF TOTAL TESTS OVER THE PRECEDING 14-DAY PERIOD. ASSESSMENTS MUST INCLUDE BOTH THE INSTALLATION AND SURROUNDING COMMUNITY TO INCLUDE LOCALITIES SHARING ADJOINING BOUNDARIES, AND LOCALITIES WHERE THE MAJORITY OF THE INSTALLATIONS POPULATION RESIDES. MTF COMMANDERS AND INSTALLATION COMMANDERS WILL DETERMINE THE BEST LOCAL SOURCE OF DATA PER REF (C). E.G., USE FEMAS EARLY INDICATOR DAILY REPORT OR ADVANA. DEPENDING ON THE TRAJECTORY OF THE CASE AND TESTING RATES, INSTALLATION COMMANDERS WILL REPORT THE INSTALLATION AS GREEN (SUSTAINED REDUCTION FOR 14 OR MORE DAYS OR STABLE AT VERY LOW LEVELS), YELLOW (SUSTAINED REDUCTION FOR 7-13 DAYS OR SHIFT UPWARD OF 1 TO 4 CONSECUTIVE DAYS) OR RED (SUSTAINED REDUCTION FOR 0-6 DAYS OR IF THE TRAJECTORY SHIFTS UPWARD FOR 5 CONSECUTIVE DAYS). 4.B.3. CAPACITY TO TREAT AND HEALTHCARE WORKER TESTING PROGRAM. MTF AND/OR LOCAL HOSPITALS CAPACITY TO TREAT ALL PATIENTS WITHOUT SITUATIONAL STANDARDS OF CARE AND HAVE A COVID-19 TESTING PROGRAM IN PLACE FOR AT-RISK HEALTHCARE WORKERS AND THOSE EXHIBITING ILI AND CLI SYMPTOMS. DURING NORMAL OPERATIONS, MTFS AND HEALTHCARE NETWORKS ARE RESOURCED TO PROVIDE CARE TO ALL BENEFICIARIES. MTF COMMANDERS WILL ASSESS THEIR COVID-19 TESTING PROGRAM FOR AT-RISK HEALTHCARE WORKERS AND CAPACITY TO TREAT THEIR POPULATION WITHOUT SITUATIONAL STANDARDS OF CARE, BASED ON ICU BEDS AND VENTILATORS, ASSOCIATED STAFF AND PPE AVAILABLE PER 10K BENEFICIARIES. DEPENDING ON TREATMENT CAPACITY, COMMANDERS WILL REPORT THE INSTALLATION AS GREEN (COVID-19 TESTING PROGRAM FOR AT-RISK HEALTHCARE WORKERS IN PLACE AND ABILITY TO EXPAND TO 6 OR MORE ICU BEDS PER 10K OF THE BENEFICIARY POPULATION), YELLOW (COVID-19 TESTING PROGRAM FOR HEALTHCARE WORKERS IN PLACE AND ABILITY TO EXPAND TO 3-5 ICU BEDS PER 10K OF THE BENEFICIARY POPULATION), OR RED (2 OR LESS ICU BEDS PER 10K OF THE BENEFICIARY POPULATION OR NO COVID-19 TESTING PROGRAM FOR AT-RISK HEALTHCARE WORKERS). 4.C. ADDITIONAL TRANSITION REQUIREMENTS. 4.C.1. HIGH-RISK INDIVIDUALS. ALL COMMANDERS WILL IDENTIFY THOSE WITHIN THEIR COMMAND WHO ARE VULNERABLE AND AT INCREASED RISK OF AN ADVERSE OUTCOME SHOULD THEY BECOME INFECTED COVID-19. IT IS EXPECTED THAT THOSE INDIVIDUALS WILL BE GIVEN WIDE LATITUDE TO TELEWORK AND ONLY RETURN TO WORK WHEN CONDITIONS PERMIT. 4.C.2. MINIMUM PUBLIC HEALTH MITIGATION MEASURES TO PRACTICE WHILE PHASING IN HEALTH PROTECTION CONDITIONS OR OPENING RESTRICTED SERVICES: - WHEN DECIDING TO OPEN COMMON AREAS WHERE PERSONNEL ARE LIKELY TO CONGREGATE (E.G., FITNESS CENTERS OR BARBER SHOPS), ENFORCE STRICT PHYSICAL DISTANCING, SANITATION PROTOCOLS AND LIMIT PATRONAGE. REFER TO THE NAVY AND MARINE CORPS PUBLIC HEALTH CENTER COVID-19 WEB PORTAL FOR GUIDANCE AT: HTTPS://WWW.MED.NAVY.MIL/SITES/NMCPHC/PROGRAM-AND-POLICY- SUPPORT/PAGES/NOVEL -CORONAVIRUS.ASPX#T2 - CONTINUE TO PRACTICE PHYSICAL DISTANCING AND USE PRECAUTIONARY MEASURES (CLOTH FACE COVERINGS) WHEN WITHIN 6 FEET OF OTHER INDIVIDUALS. - LIMIT SIZE AND FREQUENCY OF ALL GATHERINGS. - CONTINUE TO ENCOURAGE TELEWORK AND CONSIDER SPLIT SHIFTS WHEN FEASIBLE. - CONDUCT FREQUENT HAND-WASHING. - CONDUCT ROUTINE INTENSIVE WORKPLACE CLEANING. - IF ILL, STAY AT HOME UNTIL CLEARED BY A MEDICAL PROVIDER.. 4.C.3. TESTING AND RESTRICTION OF MOVEMENT PLANS. CONCURRENT WITH ANY HPCON CHANGE, COMMANDERS SHOULD HAVE ESTABLISHED PLANS AND READY CAPACITY TO CONDUCT COVID-19 TESTING, CONTACT TRACING, RESTRICTION OF MOVEMENT OF THOSE INDIVIDUALS RETURNING FROM HIGH-EXPOSURE LOCATIONS, EXHIBITING SYMPTOMS, OR THOSE EXPOSED TO POSITIVE COVID-19 CASES. 4.C.4. SENTINEL SURVEILLANCE TESTING AND MONITORING PROGRAMS. IN CONSULTATION WITH PHEOS AND LOCAL MTFS, INSTALLATION COMMANDERS WILL ENSURE SENTINEL SURVEILLANCE TESTING AND MONITORING PROGRAMS ARE IN PLACE TO HELP INFORM HPCON LEVEL CHANGES. AS LAB TESTING CAPACITY INCREASES AND ALLOWS, THESE SURVEILLANCE PROGRAMS SHOULD INCLUDE MONITORING FOR ILI AND CLI IN DODS ELECTRONIC SURVEILLANCE SYSTEM FOR EARLY NOTIFICATION OF COMMUNITY-BASED EPIDEMICS (ESSENCE). 4.C.5. RESURGENCE IN COVID-19 CASES. AS WITH MANY PANDEMICS, THERE IS A POSSIBILITY OF A COVID RESURGENCE OR SECOND WAVE. IF COVID-19 ILLNESS TRAJECTORY INCREASES OR MEDICAL FACILITIES BECOME SIGNIFICANTLY BURDENED BY THE TREATMENT OF COVID-19 ILLNESS IN A PARTICULAR GEOGRAPHIC AREA, COMMANDERS SHOULD CONSIDER INCREASING HPCON LEVEL AND CLOSING SERVICES. IT IS IMPORTANT TO LOOK AT THE TREND NOT JUST A SINGLE DAY CHANGE. REF (D) PROVIDES ACTIONS FOR COMMANDERS TO CONSIDER WHEN ELEVATING THE HPCON LEVEL. 5. REPORTING REQUIREMENTS. NCC WILL USE THE CRITERIA IDENTIFIED IN PARA 4.B. TO DEVELOP A VISUAL REPORTING DASHBOARD/SUMMARY IN COORDINATION WITH REGION COMMANDERS/CNIC TO ALLOW EACH NCC TO MONITOR THE STATUS OF EACH INSTALLATION. NCC WILL CONSOLIDATE THESE REPORTS AND PROVIDE THEM BY REGION TO THE CNO BATTLE WATCH ON A WEEKLY BASIS (EACH WEDNESDAY BY 1000EST BEGINNING 27 MAY 20). THE FOLLOWING SERVICES WILL BE INCLUDED IN EACH REPORT: FITNESS CENTERS, GALLEYS, CHILD DEVELOPMENT CENTERS, FLEET AND FAMILY SUPPORT CENTERS, NGIS AND NAVY LODGES, MWR FACILITIES/SAILOR CENTERS, BARBERSHOPS/BEAUTY SALONS, CHAPELS, HOUSING SERVICES, AND COMMISSARY/EXCHANGE FACILITIES. NCC SHOULD ALSO INCLUDE SIMILAR SERVICES, UNIQUE TO THEIR INSTALLATIONS (E.G., CHILD YOUTH PROGRAMS, DODEA SCHOOLS, RESTAURANTS AND FOOD COURTS, ETC.) AS THE NCC DEEMS APPROPRIATE. USE THE FOLLOWING LEGENDS: GREEN-FULLY OPEN; YELLOW-OPEN WITH MITIGATION MEASURES; BLUE-VIRTUAL SERVICES ONLY; RED-CLOSED. 6. THERE WILL BE A NATURAL YET HEALTHY TENSION BETWEEN KEEPING SERVICES SECURED TO PROTECT OUR WORK FORCE AND ENSURING WE PROVIDE SERVICES TO OUR WORK FORCE DURING THIS ENDURING PANDEMIC. COMMANDERS ARE EXPECTED TO TAKE A MEASURED RISK-INFORMED APPROACH, AND ALL HANDS ARE EXPECTED TO FOLLOW PUBLIC HEALTH MEASURES TO FACILITATE THE BALANCE OF RISK TO MISSION AND RISK TO FORCE. THESE CONCEPTS ARE NOT MUTUALLY EXCLUSIVE. WE HAVE LEARNED HOW TO PRACTICE PUBLIC HEALTH MEASURES AND BUILD THEM INTO OUR DAILY ROUTINE. LOCAL COMMANDERS MAINTAIN THE INHERENT RIGHT TO SHUT DOWN SERVICES WHEN GUIDANCE IS NOT BEING FOLLOWED. THROUGH AN ALL HANDS EFFORT, WE CAN RETURN BASIC SERVICES TO OUR WORK FORCE AS WE OPEN UP OUR NAVY AND OPERATE IN THIS NEW NORMAL. 7. RELEASED BY ADM R. P. BURKE, VICE CHIEF OF NAVAL OPERATIONS.// BT #0001 NNNN UNCLASSIFIED//