UNCLASSIFIED// ROUTINE R 042056Z NOV 20 MID200000323834U FM CNO WASHINGTON DC TO NAVADMIN INFO SECNAV WASHINGTON DC CNO WASHINGTON DC BT UNCLAS NAVADMIN 298/20 MSGID/NAVADMIN/CNO WASHINGTON DC/CNO/NOV// SUBJ/US NAVY COVID-19 STANDARDIZED OPERATIONAL GUIDANCE VERSION 3.1// REF/A/NAVADMIN/OPNAV/301424ZSEP20// REF/B/NAVADMIN/OPNAV/171541ZAPR20// REF/C/NAVADMIN/OPNAV/021507ZJUL20// REF/D/MEMO/OSD/13APR2020// REF/E/MEMO/OSD/11JUN2020// REF/F/INST/OSD/24AUG2020// REF/G/MEMO/NMCPHC/24JUL2020// REF/H/GUIDE/BUMED/17JUL2020// REF/I/MEMO/NMCPHC/13APR2020// REF/J/MEMO/BUMED/07AUG2020// REF/K/NAVADMIN/OPNAV/241512ZAUG20// REF/L/NAVADMIN/OPNAV/212043ZOCT20// REF/M/NAVADMIN/OPNAV/082145ZJUL20// NARR/REF A IS NAVADMIN 266/20, U.S. NAVY COVID-19 STANDARDIZED OPERATIONAL GUIDANCE VERSION 3.0. REF B IS NAVADMIN 113/20 RESTRICTION OF MOVEMENT (ROM) GUIDANCE UPDATE. REF C IS NAVADMIN 189/20, NAVY MITIGATION MEASURES IN RESPONSE TO CORONAVIRUS OUTBREAK UPDATE 6. REF D IS USD P&R FHP SUPPLEMENT 8 - DOD GUIDANCE FOR PROTECTING PERSONNEL IN WORKPLACES DURING THE RESPONSE TO THE COVID-19 PANDEMIC. REF E IS USD P&R FORCE HEALTH PROTECTION (FHP) SUPPLEMENT 13 - DOD GUIDANCE FOR COVID-19 CLINICAL LABORATORY DIAGNOSTIC TESTING SERVICES. REF F IS DODI 6490.03, DEPLOYMENT HEALTH, 19JUN19. REF G IS NAVY AND MARINE CORPS PUBLIC HEALTH CENTER MEMO EVALUATING CDC 20 JULY 2020 UPDATE ON RETURN TO WORK GUIDANCE AT CDC WEBSITE WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/HCP/DURATION-ISOLATION.HTML. REF H IS CORONAVIRUS DISEASE READINESS GUIDE VERSION 1.1, 17JUL20. AT WEBSITE ESPORTAL.MED.NAVY.MIL/BUMED/RH/M3/M34/CRG/DEFAULT.ASPX. REF I IS NAVY AND MARINE CORPS PUBLIC HEALTH CENTER MEMO 2019 NOVEL CORONAVIRUS (COVID-19) CASE AND CONTACT INVESTIGATION GUIDE AT WEBSITE ESPORTAL.MED.NAVY.MIL/SITES/NMCPHC/PPS/WPPC19/COVID19_CONTACT _INVESTIGATION _CONTACT_TRACING_GUIDE.ASPX. REF J IS BUMED MEMO FLEET CONTACT TRACING RING APPROACH AT WEBSITE HTTPS://COMMUNITY.MAX.GOV/PAGES/VIEWPAGE.ACTIONPAGEID=2157064930&ATTACHMENTID =2159706846. REF K IS NAVADMIN 236/20, UPDATED PROCEDURES FOR FOREIGN VISIT REQUESTS TO U.S. NAVY COMMANDS DURING COVID-19 PANDEMIC. REF L IS NAVADMIN 283/20 NAVY MITIGATION MEASURES IN RESPONSE TO CORONAVIRUS OUTBREAK UPDATE 6 MODIFICATION 1. REF M IS NAVADMIN 194/20 FACE COVERINGS IN UNIFORM.// POC/RADM KARL THOMAS/OPNAV N3N5B/703-692-9291/KARL.O.THOMAS1(AT)NAVY.MIL// RMKS/1. THIS MESSAGE UPDATES THE U.S. NAVY COVID-19 STANDARDIZED OPERATIONAL GUIDANCE VERSION 3.0 ISSUED IN REF (A). REF (A) IS CANCELLED. THIS UPDATE REVISES THE DEFINITION OF CLOSE CONTACT AS UPDATED BY THE CDC, REVISES THE GUIDANCE ON FACE COVERINGS, ADDS ADDITIONAL DISCUSSION ON SUPER-SPREADING AND ADDRESSES FLU/COVID SYMPTOM RETURN TO WORK POLICY. NCC, FLEET, TYCOM, AND OPERATIONAL COMMANDERS MAY ISSUE ADDITIONAL GUIDANCE TO SUBORDINATE UNITS. 1.A. TO INCREASE PROBABILITY OF A COVID-FREE MISSION READY CREW, UNITS WILL ADHERE TO THE FOLLOWING STANDARDIZED OPERATIONAL GUIDANCE. THESE DATA DRIVEN RISK MITIGATION MEASURES PROVIDE COMMANDERS THE TOOLS TO PREVENT, AND WHEN NECESSARY CONTAIN, COVID-19 IMPACT TO FORCE, MISSION AND MISSION ASSURANCE TO SAFELY AND CONFIDENTLY REMAIN ON MISSION. THIS GUIDANCE BUILDS ON REFS (B) AND (C) WHILE INCORPORATING GUIDANCE FROM REFS (D) THROUGH (J). IT WILL GUIDE INDIVIDUAL AND UNIT HEALTH PROTECTION, PRESERVE OPERATIONAL READINESS, AND PROTECT SHIPMATES, INSTALLATIONS, AND COMMUNITIES FROM COVID-19 TRANSMISSION. ALTHOUGH BIASED TOWARD THE SHIPBOARD ENVIRONMENT, THIS GUIDANCE APPLIES TO ALL PERSONNEL AND UNITS DEPLOYING TO AND FROM HOMEPORT (ORIGINATING UNIT LOCATION FOR RESERVE PERSONNEL) AS WELL AS ALL SHORE-BASED COMMANDS. IT DOES NOT APPLY TO ROUTINE TRAVEL (E.G. PCS, TDY, TAD) UNLESS THE TRAVELER IS A DEPLOYING INDIVIDUAL OR IS ASSIGNED TO OR WILL BE WORKING ABOARD AN OPERATIONAL UNIT. 1.B. ADHERENCE TO THIS GUIDANCE INCLUDES ACCOUNTING FOR SPECIFIC CIRCUMSTANCES INVOLVING CIVILIAN EMPLOYEES OR CONTRACTORS PER PARAGRAPH 10. 1.C. COMMANDERS. THERE IS NO SUBSTITUTE FOR COMMAND ENGAGEMENT TO SUCCESSFULLY PREVENT AND MITIGATE COVID-19 WITHIN YOUR UNIT. YOU SET THE TONE AND MUST CONVEY THE IMPORTANCE OF EACH SAILOR ACTIONS AND PERSONAL RESPONSIBILITY TO FOLLOW PUBLISHED HEALTH PROTECTION PROCEDURES BOTH ON AND OFF DUTY, PROPERLY EXECUTE ROM-SEQUESTER IF REQUIRED, AND HOLD THEMSELVES AND THEIR SHIPMATES ACCOUNTABLE FOR PERSONNEL AND MISSION READINESS. COMMAND ENGAGEMENT, CREW OWNERSHIP, INDIVIDUAL ACCOUNTABILITY AND DISCIPLINED COMPLIANCE WITH EFFECTIVE HEALTH PROTECTION MEASURES SUCH AS CLOTH FACE COVERING USE, SOCIAL DISTANCING, SELF-MONITORING FOR ILLNESS AND AGGRESSIVE SPACE CLEANING ARE THE GREATEST INFLUENCERS TO PREVENTING COVID-19 OUTBREAKS. SOME GENERAL OBSERVATIONS AND DISCUSSION POINTS FOR YOUR LEADERSHIP TEAMS FOLLOW: 1.C.1. WE HAVE DEPLOYED MISSION READY CARRIER STRIKE GROUPS, DEFENSE SUPPORT OF CIVIL AUTHORITIES READY FORCES, STRATEGIC ASSETS AND INDEPENDENT UNITS WITHIN THE COVID-19 ENVIRONMENT. THE KEY ENABLER IS A DETAILED ROM-SEQUESTER PLAN EXECUTED WITH RIGOROUS DISCIPLINE, COMPLIANCE, AND LEADERSHIP OVERSIGHT. THE GOLD STANDARD OF SINGLE OCCUPANCY BARRACKS OR HOTEL ROOMS IS NOT ALWAYS ACHIEVABLE. WHEN A CREW IS REQUIRED TO ROM-SEQUESTER AT HOME, A DETAILED SUPPORT PLAN TO ELIMINATE THE NEED TO INTERACT WITH THE PUBLIC IS ESSENTIAL. ROM-SEQUESTER IN HOMES OR MULTIPLE OCCUPANCY BARRACKS HAS BEEN SUCCESSFUL, BUT ONLY WITH STRICT COMPLIANCE TO DETAILED HEALTH PROTECTION MITIGATION MEASURES. 1.C.2. TESTING CAN SUPPORT ROM-SEQUESTER RISK DECISIONS BUT TESTING RESOURCES ARE CONSTANTLY STRAINED AND MAY BECOME MORE STRAINED DURING INFLUENZA SEASON. DEVELOP A DETAILED PLAN EARLY AND COMMUNICATE CLEARLY AND REGULARLY UP ECHELON TO COORDINATE YOUR PLAN AND ENSURE YOU RECEIVE PROPER TESTING SUPPORT AT THE APPROPRIATE TIME. PLAN FOR DELAYED TEST RESULTS. DO NOT SECURE ROM-SEQUESTER IF TEST RESULTS ARE DELAYED. LEAVING ROM-SEQUESTER WITHOUT WAITING FOR DELAYED RESULTS IS A THREAT VECTOR DIRECTLY ATTRIBUTED TO COVID OUTBREAKS. BE READY TO DEVELOP AND EXECUTE A NEW PLAN. 1.C.3. TO DATE MORE THAN 200 SHIPS HAVE HAD AT LEAST ONE CASE ONBOARD. IN THE MAJORITY OF THOSE CASES, AGGRESSIVE EARLY ACTION TO ISOLATE, QUARANTINE, CONTACT TRACE, AND CONTINUE STRICT HEALTH PROTECTION MITIGATION MEASURES HAS CONTAINED THE INCIDENCE RATE ONBOARD TO WELL LESS THAN FIVE PERCENT, ALLOWING THOSE SHIPS TO FIGHT THROUGH AND REMAIN ON MISSION. THE KEY ENABLERS ARE STRICT COMPLIANCE WITH PERSONAL PROTECTIVE EQUIPMENT (PPE), AGGRESSIVE SANITATION/CLEANING, MINIMIZING CREW INTERACTIONS THROUGH SOCIAL DISTANCING, AND REDUCING USE OF CONFINED SPACES (E.G., GYMS, SMOKE PITS). 1.C.4. NUMEROUS STUDIES HAVE IDENTIFIED THE SPREADING AND CONTAGIOUS NATURE OF COVID-19 IS OVER-DISPERSED OR NOT SPREAD EVENLY. SAID ANOTHER WAY, A FEW INDIVIDUALS ACCOUNT FOR A LARGE PORTION OF SPREADING. SINCE IT IS NOT POSSIBLE TO IDENTIFY THESE HIGHLY CONTAGIOUS INDIVIDUALS (WHO MAY BE ASYMPTOMATIC), THE BEST WAY TO AVOID OR PREVENT SUPER-SPREADING CLUSTERS OF COVID-19 IS TO STAY AWAY FROM VENUES WITH PROLONGED CONTACT, POOR VENTILATION, AND CROWDING. THE MAJORITY OF THESE EVENTS OCCUR IN POORLY VENTILATED, CROWDED INDOOR ENVIRONMENTS WHERE MANY PEOPLE CONGREGATE OVER TIME. COMMANDERS SHOULD BE AWARE OF THESE FACTORS AND HOW THEY APPLY TO INDIVIDUAL UNITS WHILE OPERATING AND MAINTAINING THEIR SHIPS AND AIRCRAFT IN A COVID-19 ENVIRONMENT, BUT NOT AT THE EXPENSE OF SAFE AND EFFECTIVE OPERATIONS. STRICT ADHERENCE TO TYCOM STANDARD OPERATING PROCEDURES, USE OF PPE, AND PERSONAL RESPONSIBILITY MEASURES SUCH AS SOCIAL DISTANCING, MINIMIZING IN PERSON EVENTS, AND LIMITING TIME OF GROUP INTERACTIONS HELP TO PREVENT SUPER-SPREADING. 1.C.5. SAILOR RATES OF INFECTION ARE GENERALLY THE SAME AS THE RATES OF INFECTION IN THE LOCAL AREA. ROM-SEQUESTER CONOPS, LEAVE AND ALL TDY TRAVEL APPROVALS MUST ACCOUNT FOR LOCAL COMMUNITY TRANSMISSION RATES AS DIRECTED IN REF (C) AND MODIFIED BY REF (L). 1.C.6. WITHIN THE UNIFORMED NAVY POPULATION, ROUGHLY 35 PERCENT OF INFECTED SAILORS EXHIBIT FEW TO NO SYMPTOMS. THIS SHOULD BUILD CONFIDENCE IN THE SHIP ABILITY TO FIGHT THROUGH OUTBREAKS, BUT IT SHOULD ALSO STRESS THE NEED FOR STRICT ADHERENCE TO ROM-SEQUESTER PLANS AND TESTING. TESTING IS THE BEST WAY TO UNCOVER ASYMPTOMATIC SERVICE MEMBERS. 1.C.7. ASSUME COVID-19 IS ONBOARD. THIS SHOULD BE THE NUMBER ONE PLANNING FACTOR! AVOID FALSE CONFIDENCE, COMPLACENCY, AND COVID FATIGUE WHICH CAN RESULT FROM ROM-SEQUESTER AND OVER CONFIDENCE IN NEGATIVE COVID-19 TESTING. EVEN AFTER THE RIGOROUS EXECUTION OF A 14-DAY ROM-SEQUESTER, CONTINUED EXECUTION OF FULL HEALTH PROTECTION MITIGATION MEASURES TO THE MAXIMUM EXTENT POSSIBLE IS REQUIRED TO ENSURE ASYMPTOMATIC CARRIERS DO NOT LEAD TO UNCONTROLLABLE OUTBREAKS. THIS INCLUDES CLOTH FACIAL COVERING USE, MANAGING THE CREW IN COHORTS, MINIMIZING THE TIME SPENT WITHIN 6 FEET OF OTHERS, MAXIMIZING DISTANCING WHENEVER AND WHEREVER POSSIBLE, AND AVOIDING UNNECESSARY CLOSE CONTACT WITH OTHERS. 1.C.8. MAXIMIZE SEPARATION BETWEEN CARETAKER CREW (DUTY CREW DURING ROM-SEQUESTER PERIOD) AND OFF-SHIP ROM-SEQUESTER CREW TO PROTECT BOTH GROUPS. WE HAVE EXPERIENCED CASES WHERE SHIFTING TO ROM-SEQUESTER ONBOARD PRIOR TO RECEIVING THE 14-DAY PERIOD ROM TEST RESULTS CONTRIBUTED TO OUTBREAKS THAT IMPACTED PLANNED OPERATIONS. CONVERSELY, WHEN THE CREW REMAINED SEQUESTERED FOR THE FULL 14 DAYS AND WERE NOT MIXED TOGETHER UNTIL NEGATIVE TEST RESULTS WERE CONFIRMED, WE HAVE ACHIEVED 100 PERCENT SUCCESS IN DEPLOYING COVID-19 FREE. 1.C.9. BERTHING. SAILORS SHOULD ALTERNATE HEAD/FOOT WHERE BERTHING CONFIGURATION ALLOWS TO MINIMIZE CLOSE CONTACT. WHERE POSSIBLE, SPREAD OUT SLEEPING ARRANGEMENTS. IN CONGESTED BERTHINGS, ENSURE SAILORS USE PERSONAL PILLOWS AND LINENS ARE REGULARLY LAUNDERED. 1.C.10. COMMANDERS MUST UNDERSTAND THE CURRENT HPCON LEVEL. THREE UNITS WERE ABLE TO TRACE AN OUTBREAK THAT IMPACTED SHIP OPERATIONS TO COMMAND DINNERS AT A PUBLIC RESTAURANT. AS THE COUNTRY CONTINUES TO RE-OPEN, INDIVIDUAL SAILORS AND COMMANDS MUST SHOW RESOLVE IN PRACTICING PROPER HEALTH PROTECTION MEASURES AND AVOID UNNECESSARY RISK. ADDITIONALLY, LIBERTY AND ALL TEMPORARY DUTY TRAVEL APPROVAL PRIOR TO ROM-SEQUESTER MUST BE WEIGHED AGAINST RISK OF CONTRACTING COVID. THIS IS ESPECIALLY TRUE IF COVID-FREE WITH A PORT CALL BETWEEN AT-SEA PERIODS. REF (C) AS MODIFIED BY REF (L) PROVIDES DETAILED TRAVEL APPROVAL GUIDANCE. 1.C.11. FACE COVERINGS WITH AN EXHAUST VALVE AND BANDANNAS ARE PROHIBITED. THESE TYPE OF FACE COVERINGS DO NOT ENTRAIN MOISTURE IN EXHALED BREATH, FAILING TO REDUCE THE SPREAD OF THE COVID-19 VIRUS AND FAILING TO PROTECT OTHER PERSONNEL. 1.C.12. COMMANDS MAY ISSUE LOCAL GUIDANCE AUTHORIZING USE OF MULTI-LAYER NECK GAITERS MEETING REF (M) AND ALL SAFETY REQUIREMENTS WHERE A SEPARATE EAR STRAP OR NECK STRAP FACE COVERING IS NOT SUITABLE FOR THE OPERATIONAL ENVIRONMENT. 1.D. THE ECHELON TWO AND NAVAL COMPONENT COMMANDERS (NCC) ARE THE WAIVER AUTHORITY TO DEVIATE FROM THIS GUIDANCE. 1.E. CONTENTS. PARAGRAPH 2 DEFINITIONS. PARAGRAPH 3 MINIMUM ACTION REQUIRED PRIOR TO DEPLOYED OPERATIONS. 3.A. MEDICAL SCREENING. 3.B. ROM-SEQUESTER PRIOR TO DEPLOYMENT. 3.C. DEPLOYING UNITS. 3.D. SHIP RIDERS PRIOR TO BUBBLE ESTABLISHMENT. 3.E. SHIP RIDERS PENETRATING SHIP BUBBLE. PARAGRAPH 4 MINIMUM REQUIRED ACTION FOR MAINTENANCE, BASIC, ADVANCED/INTEGRATED, AND SUSTAINMENT PHASES. 4.A. MAINTENANCE PHASE. 4.B. BASIC/ADVANCED PHASE. 4.C. INTEGRATED PHASE. 4.D. SUSTAINMENT PHASE. PARAGRAPH 5 GUIDANCE FOR FORWARD DEPLOYED NAVAL FORCES. PARAGRAPH 6 EXEMPTIONS FOR AIRCREW AND AIRCRAFT MAINTAINERS. PARAGRAPH 7 REQUIRED ACTION WHEN MEMBER EXHIBITS SYMPTOMS OF COVID-19. 7.A. ISOLATE AND DESIGNATE AS A PERSON UNDER INVESTIGATION (PUI). 7.B. IDENTIFY, QUARANTINE CLOSE CONTACTS. 7.C. PUI PROTOCOL. 7.D. RETURN TO WORK (RTW) GUIDANCE. PARAGRAPH 8 UNDERWAY TESTING. PARAGRAPH 9 POST-DEPLOYMENT/REDEPLOYMENT. PARAGRAPH 10 OUTBREAK INVESTIGATION AND CONTACT TRACING WORKFORCE TRAINING. PARAGRAPH 11 ADDITIONAL ROM AND MEDICAL SCREENING CONSIDERATIONS. 2. DEFINITIONS. 2.A. COVID-19 CASE: A MEMBER DESIGNATED BY A MEDICAL PROVIDER BY ONE OF TWO METHODS: 1) A POSITIVE COVID-19 LABORATORY TEST (CONFIRMED CASE), OR 2) ASSESSED AS PRESUMED POSITIVE PER THE COUNCIL OF STATE AND TERRITORIAL EPIDEMIOLOGIST (CSTE) CRITERIA FOR A PROBABLE CASE. 2.B. PATIENT (OR PERSON) UNDER INVESTIGATION (PUI): AN INDIVIDUAL WITH SIGNS OR SYMPTOMS OF COVID-19 WHO HAS A TEST RESULT PENDING OR WOULD HAVE BEEN TESTED HAD A TEST BEEN AVAILABLE. ASYMPTOMATIC INDIVIDUALS QUARANTINED DUE TO CLOSE CONTACT WITH A COVID-19 POSITIVE MEMBER ARE NOT CLASSIFIED AS PUIS. ASYMPTOMATIC INDIVIDUALS BEING TESTED FOR COVID-19 ARE NOT CONSIDERED PUIS WHILE AWAITING TEST RESULTS. 2.B.1. PUIS WHO RECEIVE A POSITIVE COVID-19 LAB TEST RESULT ARE CONSIDERED A CONFIRMED COVID-19 CASE AND APPROPRIATE REPORTING SHOULD TAKE PLACE. 2.B.2. MEMBERS ARE NO LONGER CONSIDERED PUIS WHEN THEY RECEIVE A NEGATIVE COVID-19 LAB TEST RESULT OR HAVE MET ALL CRITERIA FOR RETURN TO WORK OUTLINED IN PARAGRAPH 7.D. 2.C. HIGH-RISK PERSONNEL: THOSE INDIVIDUALS, DESIGNATED BY A MEDICAL PROVIDER, THAT MEET THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) CRITERIA FOR INCREASED RISK OF SEVERE ILLNESS FROM COVID-19 AVAILABLE AT: HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/NEED-EXTRA-PRECAUTIONS/PEOPLE-AT -HIGHER-RISK.HTML. THIS LIST EVOLVES AS KNOWLEDGE OF COVID-19 GROWS AND SHOULD BE CHECKED FREQUENTLY. 2.C.1. OPERATIONALLY AT-RISK PERSONNEL: THOSE INDIVIDUALS, DESIGNATED BY OPERATIONAL COMMANDERS, WHOSE DUTIES PLACE THEM AT A HIGHER RISK OF EXPOSURE TO THE VIRUS, THEREBY INCREASING THE LIKELIHOOD OF INTRODUCING COVID-19 INTO A BUBBLE. EXPOSURE CAN OCCUR WHEN PARTICIPATING IN OPERATIONS, ACTIVITIES, AND PORT CALLS IN COUNTRIES WITH ACTIVE COVID-19 CASES, ENGAGING WITH PERSONNEL FROM COUNTRIES WITH ACTIVE COVID-19 CASES, AND OPERATIONS THAT MAY RESULT IN ENVIRONMENTAL AND PERSON-TO-PERSON TRANSMISSION, SUCH AS REPLENISHMENT AT SEA AND FOOD SERVICE. 2.D. CLOSE CONTACT: INDIVIDUALS IDENTIFIED AS BEING WITHIN APPROXIMATELY 6 FEET (2 METERS) OF A COVID-19 CASE FOR A PROLONGED PERIOD OF TIME. CDC GUIDANCE DEFINES PROLONGED PERIOD OF TIME AS A CUMULATIVE FIFTEEN MINUTES IN THE PAST TWENTY-FOUR HOURS. CLOSE CONTACT CAN OCCUR WHILE CARING FOR, LIVING WITH, VISITING, WORKING WITH, OR SHARING A DENSELY POPULATED SPACE WITH A COVID-19 CASE. CLOSE CONTACT CAN ALSO BE ESTABLISHED VIA DIRECT CONTACT (E.G. BEING COUGHED OR SNEEZED UPON BY A COVID-19 CASE). DETERMINATION OF CLOSE CONTACT PRESUMES THE INTERACTION TRANSPIRED DURING THE POTENTIALLY INFECTIOUS PERIOD OF THE COVID-19 CASE, DEFINED AS 48 HOURS PRIOR TO SYMPTOM ONSET, OR FIRST POSITIVE TEST IF ASYMPTOMATIC, TO THE TIME THE COVID-19 CASE IS PLACED IN ISOLATION. UNDER THESE CIRCUMSTANCES, AN INDIVIDUAL IS CONSIDERED A CLOSE CONTACT EVEN IF THEY WERE WEARING A CLOTH FACE COVERING. SOME EXAMPLES SPECIFIC TO THE SHIPBOARD ENVIRONMENT INCLUDE: A) INDIVIDUALS WITHIN THE COVID-19 CASE BERTHING AREA ASSIGNED AN ADJACENT RACK INCLUDING DIRECTLY ACROSS A NARROW AISLE; B) PROLONGED INTERACTION WITHIN RELATIVELY CONFINED SPACES INTERNAL TO THE SHIP (E.G. WORK SPACE, GALLEY, GYM, SMOKING DECK, CHAPEL, ETC). 2.E. MEDICAL SCREENING: COVID-19 MEDICAL SCREENING SHOULD INCLUDE EVALUATION FOR THE FOLLOWING SYMPTOMS: FEVER OR CHILLS, COUGH, SHORTNESS OF BREATH OR DIFFICULTY BREATHING, FATIGUE, MUSCLE OR BODY ACHES, HEADACHE, NEW LOSS OF TASTE OR SMELL, SORE THROAT, CONGESTION OR RUNNY NOSE, NAUSEA OR VOMITING, AND DIARRHEA. A COMPLETE LIST OF COVID-19 SYMPTOMS CAN BE FOUND AT: HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/SYMPTOMS- TESTING/SYMPTOMS.HTML. THE FLU VACCINE CAN BE ASSOCIATED WITH MILD SIDE EFFECTS SUCH AS SORENESS, REDNESS OR SWELLING AT THE INJECTION SITE, LOW GRADE FEVER AND BODY ACHES. THESE SYMPTOMS COULDBE CONFUSED WITH COVID LIKE SYMPTOMS SO HISTORY OF FLU SHOT SHOULD BE CONSIDERED WHEN EVALUATING COVID LIKE SYMPTOMS. 2.F. SELF-MONITORING: PER THE CDC, SELF-MONITORING INCLUDES ASSESSING FOR COVID-19 SYMPTOMS PER PARAGRAPH 2.E. INDIVIDUALS THAT DEVELOP COVID-19 SYMPTOMS SHOULD IMMEDIATELY SELF-ISOLATE, AVOID CONTACT WITH OTHERS, AND SEEK ADVICE FROM A HEALTHCARE PROVIDER TO DETERMINE IF FURTHER MEDICAL EVALUATION IS REQUIRED. 2.G. RESTRICTION OF MOVEMENT (ROM). GENERAL DOD TERM FOR LIMITING PERSONAL INTERACTION TO REDUCE RISK TO THE HEALTH, SAFETY AND WELFARE OF A BROADER COHORT. ROM IS USED TO MINIMIZE RISK OF INDIVIDUALS ENCOUNTERING COVID-19 CONTAGIOUS INDIVIDUALS, AND TO PREVENT PERSONNEL WHO HAVE BEEN IN A HIGHER RISK AREA FROM POTENTIALLY INFECTING OTHERS. ROM INCLUDES ISOLATION, QUARANTINE AND ROM-SEQUESTER. PERSONNEL EXECUTING A ROM ARE CONSIDERED TO BE IN A DUTY STATUS AND ROM PERIODS WILL NOT BE COUNTED AS ANNUAL LEAVE. 2.G.1. ISOLATION: MEDICAL TERM FOR THE STRICT SEPARATION OF PERSONNEL FROM OTHERS DUE TO THE DEVELOPMENT OF POTENTIAL OR PROVEN COVID-19 SYMPTOMS OR A POSITIVE COVID-19 TEST. 2.G.2. QUARANTINE: MEDICAL TERM FOR SEPARATING ASYMPTOMATIC PERSONNEL FROM THOSE PEOPLE REASONABLY BELIEVED TO HAVE BEEN EXPOSED TO A COMMUNICABLE DISEASE, TO PREVENT THE POSSIBLE SPREAD OF THE COMMUNICABLE DISEASE. FOR THE COVID-19 PANDEMIC, PERSONNEL WITH NO COVID-19 SYMPTOMS WHO HAVE RECENTLY RETURNED FROM A HIGHER RISK LOCATION OR HAD CLOSE CONTACT WITH A KNOWN COVID-19 POSITIVE PATIENT SHOULD BE QUARANTINED. THE QUARANTINE PERIOD IS 14-DAYS. PERSONNEL WHO HAVE TESTED POSITIVE FOR COVID-19 DO NOT NEED TO QUARANTINE OR GET TESTED AGAIN FOR UP TO 3 MONTHS AS LONG AS THEY DO NOT DEVELOP SYMPTOMS AGAIN. THIS EXCEPTION IS DUE TO THE PRESENCE OF DEAD VIRAL FRAGMENTS THAT ARE NO LONGER CONTAGIOUS BUT WILL LIKELY YIELD A POSITIVE TEST RESULT. 2.G.3. ROM-SEQUESTER: U.S. NAVY TERM FOR PREEMPTIVE SEPARATION OF FORCES TO REDUCE RISK OF INFECTION WHILE ATTEMPTING TO ESTABLISH A COVID-FREE BUBBLE. ROM-SEQUESTER CAN BE CONDUCTED ONBOARD SHIP, IN CONTRACTED FACILITIES, OR IN PERSONAL RESIDENCE DEPENDENT ON UNIT-SPECIFIC SCENARIOS. DURING ROM- SEQUESTER, INTERACTION WITH INDIVIDUALS MUST BE MINIMIZED, BY NECESSITY ONLY WITH ALL HEALTH PROTECTION MEASURESIMPLEMENTED. ASSUME EVERYONE HAS COVID. INTERACTION WITHIN ROM-SEQUESTER LOCATION IS RESTRICTED TO NECESSITIES SUCH AS FOOD DELIVERY, HEALTH AND WELFARE CHECKS, ETC. 2.H. BUBBLE: TERM FOR INDIVIDUALS, UNITS OR INSTALLATIONS THAT HAVE ESTABLISHED LOW PROBABILITY OF COVID-19 INFECTION. A CREW THAT HAS BEEN UNDERWAY, OR ROM-SEQUESTERED, FOR GREATER THAN 14 DAYS WITHOUT COVID-19 POSITIVE PERSONNEL AND NO COVID-19 SYMPTOMS IS CONSIDERED TO BE WITHIN A BUBBLE. 2.I. BUBBLE TO BUBBLE TRANSFER (B2BT): TERM FOR MOVEMENT OF UNITS OR PERSONNEL FROM ONE BUBBLE TO ANOTHER VIA CONTROLLED MEANS. A WIDE VARIETY OF MODES OR MEANS OF TRANSPORTATION CAN BE USED FOR B2BT. THE KEY FACTOR IS THAT THE EVOLUTION IS CLOSELY CONTROLLED TO MINIMIZE RISK OF COVID-19 EXPOSURE TO BOTH INDIVIDUALS AND UNITS WHO HAVE NOT COMPLETED A ROM-SEQUESTER DURING TRANSFER. 2.J. TESTING: GENERAL TERM FOR THE INTENDED USE OF REAGENTS, SUPPLIES, AND EQUIPMENT TO DETECT THE PRESENCE OF SARS-COV-2, THE VIRUS THAT CAUSES COVID- 19, IN SAMPLES COLLECTED FROM INDIVIDUALS. 2.J.1. DIAGNOSTIC TESTING: USE OF AN APPROVED TEST BY CERTIFIED LABORATORIES, TO INCLUDE SHIPBOARD CERTIFIED LABS, TO DIAGNOSE COVID-19 INFECTION IN AN INDIVIDUAL SUSPECTED OF BEING INFECTED. INDIVIDUALS SUSPECTED OF BEING INFECTED INCLUDE SYMPTOMATIC INDIVIDUALS WHO PRESENT TO A HEALTHCARE PROVIDER, AND INDIVIDUALS IDENTIFIED THROUGH CONTACT TRACING. 2.J.2. SCREENING TESTING: TESTING OF A POPULATION TO ENSURE THE ENTIRE POPULATION OR AN AT RISK SUB-POPULATION IS CLEAR OF INFECTION. TYPICALLY DONE IN CONJUNCTION WITH A RESTRICTION OF MOVEMENT TO ENSURE THE POPULATION DID NOT HAVE AN OPPORTUNITY TO BECOME INFECTED OR THE INFECTION HAD RUN ITS COURSE PRIOR TO BRINGING A GROUP TOGETHER. MAY ALSO BE USED TO TEST CRITICAL WATCHSTANDERS UNDERWAY WEN AN INFECTION IS SUSPECTED OR IDENTIFIED. 2.J.3. SURVEILLANCE TESTING: TESTING OF RANDOM PORTIONS OF A POPULATION TO SEARCH FOR AND IDENTIFY POTENTIAL SPREAD OF ASYMPTOMATIC COVID-19 INFECTIONS. 2.K. INFLUENZA LIKE ILLNESS (ILI): PER CDC, ILI IS DEFINED AS FEVER (TEMPERATURE OF 100.4 DEGREES F [37.8 DEGREES C] OR GREATER) AND A COUGH AND/OR A SORE THROAT WITHOUT A KNOWN CAUSE. A PERSON MAY BE CONTAGIOUS FOR UP TO 7 DAYS WITH THE FLU. THERE ARE NO DEFINITIVE SYMPTOMS THAT CAN BE USED AS DISCRIMINATORS TO DIAGNOSE AN INFECTION AS FLU ONLY AND NOT COVID OR RULE OUT CO-INFECTION. INFECTION WITH FLU DOES NOT PRECLUDE OR REDUCE THE GENERAL PROBABILITY THAT COVID INFECTION IS PRESENT. THERE IS EVIDENCE THAT CO-INFECTION CAN OCCUR AND THAT IT IS POSSIBLE FOR ONE INFECTION TO BE SYMPTOMATIC WHILE THE OTHER IS NOT. IT MAY NOT BE POSSIBLE TO DISCRIMINATE BETWEEN THE FLU AND COVID-19. 2.L. POOLED TESTING: TESTING APPROACH COMBINING INDIVIDUAL SAMPLES TO TEST PRESENCE OF INFECTION IN THE COMBINED POOL. USED IN A SCREENING OR SURVEILLANCE STRATEGY TO EXPAND A LABORATORY CAPACITY TO PERFORM SARS-COV-2 TESTING. POOLED TESTING FACILITATES DETERMINATION OF POPULATION HEALTH WHILE CONSERVING TESTING RESOURCES. 3. MINIMUM ACTION REQUIRED PRIOR TO DEPLOYED/DSCA READY FORCE OPERATIONS. 3.A. MANDATORY MEDICAL SCREENING BY A MEDICAL PROVIDER. 3.A.1. PRE-DEPLOYMENT SCREENING FOR ALL PERSONNEL WILL CONSIST OF AN ASSESSMENT OF COVID-19 EXPOSURE HISTORY, A TEMPERATURE CHECK, A CHECK FOR COVID-19 SIGNS AND SYMPTOMS LISTED IN PARA 2.E. FOR MILITARY MEMBERS, IT WILL ALSO INCLUDE A REVIEW OF ANY PAST COVID-19 TESTING AND A THOROUGH EVALUATION OF THE MEMBERS RISK FACTORS FOR SEVERE ILLNESS FROM COVID-19. 3.A.2. DEPLOYMENT OF HIGH-RISK INDIVIDUALS SHOULD BE UNCOMMON AND GUIDED BY MEDICAL RECOMMENDATIONS FOUND IN REF (H). THE DECISION TO DEPLOY THE INDIVIDUAL MUST BE MADE, AT A MINIMUM, BY THE ISIC. MILITARY SEALIFT COMMAND (MSC) WILL MEDICALLY SCREEN CIVIL SERVICE AND CONTRACT PERSONNEL FOR DEPLOYMENT ON MSC VESSELS IN ACCORDANCE WITH EXISTING MSC INSTRUCTIONS AND CONTRACTS. 3.B. CONDUCT A MINIMUM 14-DAY ROM-SEQUESTER PRIOR TO DEPLOYMENT. DEPENDING ON SCHEDULED AND PLANNED OPERATIONS, THE NCC WILL DETERMINE IF ROM-SEQUESTER IS REQUIRED PRIOR TO INTEGRATED PHASE. 3.B.1. CONDUCT ENHANCED DAILY PERSONNEL MEDICAL SCREENING (QUESTIONNAIRE AND TEMPERATURE CHECKS). 3.B.2. ALL PERSONNEL DEPLOYING OUTSIDE THE UNITED STATES WILL UNDERGO A 14- DAY ROM-SEQUESTER PRIOR TO DEPLOYMENT UNLESS COMBATANT COMMAND MANDATES IN- COUNTRY ROM. IF TRAVELING OCONUS AND THE HOST NATION REQUIRES 14-DAY IN- COUNTRY ROM, CONUS PRE-DEPLOYMENT ROM-SEQUESTER IS NOT REQUIRED UNLESS THE HOST NATION OR COMBATANT COMMAND EXPLICITLY MANDATES BOTH. CONSULT FOREIGN CLEARANCE GUIDANCE FOR MOST CURRENT REQUIREMENTS, AVAILABLE AT HTTPS://WWW.FCG.PENTAGON.MIL. 3.B.3. ACCEPTABLE ROM-SEQUESTER FACILITIES ARE: SHIP BERTHING, LIVING BARGE, INDIVIDUAL BARRACKS/HOTEL ROOMS, OR PERSONAL RESIDENCE (LIMITED CONTACT WITH OTHER RESIDENTS). EACH HAS PROS AND CONS THAT MUST BE WEIGHED AGAINST UNIT-SPECIFIC CIRCUMSTANCES AND RISK. MINIMIZING CONTACT WITH OTHERS AND FOLLOWING HEALTH PROTECTION MITIGATION MEASURES IS CRITICAL TO SUCCESSFUL ROM-SEQUESTER. 3.B.4. PRACTICE SOCIAL DISTANCING AND SANITIZE MORE FREQUENTLY WHILE MANNING ESSENTIAL WATCH STATIONS, COMPLETING REQUIRED MAINTENANCE, AND CONDUCTING REQUIRED UNDERWAY PREPARATION (LOGISTICS, TRAINING, ETC.). 3.B.5. DEVELOP OPERATIONAL BENCH FOR REDLINE PERSONNEL TO MAINTAIN MISSION ESSENTIAL OPERATIONS (NUCLEAR POWER PLANT, BRIDGE, COMBAT INFORMATION CENTER, CWC WATCHES, MEDICAL PROVIDERS, ETC). 3.C. ROM-SEQUESTER PER FLEET APPROVED COMMUNITY CONOPS. ALL ROM-SEQUESTERS WILL BE A MINIMUM OF 14 DAYS IN LENGTH AND REQUIRE TWO TESTS. PERSONNEL SHOULD RECEIVE A NEGATIVE TEST RESULT PRIOR TO EMBARKING A SHIP OR ANY OTHER CONGREGATE ROM ENVIRONMENT. ROM SEQUESTER IN NON-CONGREGATE FACILITIES MAY COMMENCE PRIOR TO RECEIVING A NEGATIVE TEST RESULT. 3.C.1. ROM-SEQUESTER CONDUCTED ASHORE: REQUIRES ISOLATION PER CDC GUIDANCE (I.E., SEPARATE ROOM, NO SHARED BATHROOM). A SECOND TEST SHALL BE CONDUCTED ON OR AFTER DAY 14. A NEGATIVE COVID TEST RESULT IS REQUIRED TO EMBARK. 3.C.2. ROM-SEQUESTERS CONDUCTED ONBOARD A VESSEL OR IN A GROUP SETTING ASHORE (I.E., NOT ISOLATED PER CDC GUIDANCE): THE NCC WILL DIRECT EXACT TIMING OF THE SECOND TEST, BUT THE SECOND TEST SHALL BE NO EARLIER THAN DAY SEVEN. SERVICE MEMBERS TESTING POSITIVE WILL BE IMMEDIATELY ISOLATED TO MITIGATE COVID-19 VIRUS SPREAD. 3.C.3. THE NCC (COMMANDER MSC FOR CIVIL SERVICE AND CONTRACT MARINERS) MAY APPROVE DEVIATIONS TO ROM-SEQUESTER PLANS DUE TO EMERGENT TASKING OR TESTING LIMITS. THE NCC CAN ALSO ELECT TO BE MORE RESTRICTIVE IN THEIR TESTING PROTOCOLS PROVIDED TESTING CAPACITY SUPPORTS. 3.C.4. TESTING IS THE BEST WAY TO IDENTIFY ASYMPTOMATIC COVID-19 POSITIVE INDIVIDUALS. HOWEVER, TESTING DOES NOT GUARANTEE A COVID-FREE UNIT DUE TO THE POTENTIAL FOR FALSE NEGATIVE TESTS. COMMANDERS SHALL ASSUME COVID IS ON THEIR SHIPS AND SUBMARINES AND ENSURE STRICT COMPLIANCE TO HEALTH PROTECTION MEASURES UNTIL SUFFICIENT COVID-FREE UNDERWAY TIME HAS ELAPSED AND BUBBLE INTEGRITY HAS BEEN MAINTAINED. 3.C.5. USE OPERATIONAL UNIT RETURN TO WORK (RTW) GUIDANCE, PARA. 7.D.1 TO CLEAR COVID POSITIVE INDIVIDUALS. 3.D. SHIP RIDERS (E.G. CONTRACTORS, TECH REPS, INSPECTION TEAMS, ETC.), DIRECT SUPPORT PERSONNEL, AND ALL OTHERS ASSISTING COMMANDS PRIOR TO BUBBLE ESTABLISHMENT WILL ADHERE TO LOCAL FORCE HEALTH PROTECTION REQUIREMENTS (DAILY COVID-19 SCREENING QUESTIONNAIRE, TEMPERATURE CHECKS, SOCIAL DISTANCING, PPE USAGE, RESTRICTED SHIPBOARD MOVEMENT, SANITIZATION, ETC.). WHEN INVOLVED IN MOVEMENT TO SEQUENTIAL COMMANDS, IT MAY BE ADVISABLE TO ROM-SEQUESTER COHORTS, USE B2BT, AND/OR TEST PERIODICALLY. 3.E. SHIP RIDERS (E.G. CONTRACTORS, TECH REPS, INSPECTION TEAMS, ETC.), DIRECT SUPPORT PERSONNEL, AND ALL OTHERS PENETRATING AN ESTABLISHED BUBBLE WILL COMPLETE A 14-DAY ROM-SEQUESTER WITH A NEGATIVE TEST PRIOR TO EMBARKING. A NEGATIVE TEST POST ROM IS NOT REQUIRED FOR PERSONNEL WHO RECOVERED FROM COVID-19 WITHIN THE PAST 90 DAYS (DUE TO PERSISTENT POSITIVE RESULTS). USE OPERATIONAL UNIT RTW GUIDANCE TO CLEAR COVID POSITIVE PERSONNEL, PARA. 7.D.1. MITIGATION PLANS TO PENETRATE AN ESTABLISHED BUBBLE WITHOUT A 14 DAY ROM-SEQUESTER AND/OR TEST DUE TO EMERGENT OPERATIONAL REQUIREMENTS MUST BE APPROVED BY THE NCC OR NCC-DESIGNATED APPROVAL AUTHORITIES. 4. MINIMUM REQUIRED ACTION FOR MAINTENANCE, BASIC, ADVANCED/INTEGRATED, AND SUSTAINMENT PHASES. 4.A. MAINTENANCE PHASE. AGGRESSIVE AWARENESS, SELF-MONITORING, TIMELY DIAGNOSIS AND THOROUGH CONTACT TRACING ARE ALL CRITICAL TO COMBATTING COVID- 19. FAILURE TO CONNECT THE DOTS ON SYMPTOMATIC SAILORS MAY LEAD TO UNCONTROLLABLE OUTBREAKS. COMMANDERS MUST REMAIN ALERT TO SIGNS OF COVID SPREAD BY ASYMPTOMATIC SAILORS. SIGNS MAY BE SAILORS FROM DIFFERENT DEPARTMENTS WITHOUT KNOWN COVID POSITIVE SAILORS SUDDENLY EXHIBITING SYMPTOMS. THE FOLLOWING MINIMUM MEASURES APPLY: 4.A.1. COMPLY WITH LOCAL HPCON REQUIREMENTS, HEALTH PROTECTION MEASURES AND BE AWARE OF LOCAL COMMUNITY TRANSMISSION RATES. EMPHASIZE PERSONAL RESPONSIBILITY (FREQUENT HAND WASHING, CLOTH FACE COVERINGS, SOCIAL DISTANCING, AVOIDING LOCAL AREAS WITH HIGH POPULATION DENSITY, SELF-MONITOR, ETC.) EVEN IN THE ABSENCE OF A KNOWN OUTBREAK OR IN AN ESTABLISHED BUBBLE. REPORT AND ISOLATE PERSONNEL WITH COVID-19 SYMPTOMS. SCREEN ALL INDIVIDUALS DAILY PRIOR TO ENTERING THE WORK CENTER IN ACCORDANCE WITH CDC GUIDANCE, AVAILABLE AT HTTPS://WWW.CDC.GOV/SCREENING/INDEX.HTML. CLEAN AND DISINFECT SPACES DAILY IAW NAVSEA CLEANING GUIDANCE. CONSIDER ADDITIONAL COVID-19 OPERATIONAL RISK MANAGEMENT (ORM) MEASURES FOR MAJOR EVENTS (E.G. SHIPBOARD DRILLS). 4.A.2. SUPPORT ORGANIZATION COMMANDERS (E.G. SHIPYARD PERSONNEL, CONTRACT SUPPORT, TRAINING TEAMS) CONSIDER FACTORS SUCH AS THE CURRENT HPCON, CDC THREAT LEVEL, METHOD/MODE OF TRAVEL, ETC. WHEN ASSESSING RISK AND DETERMINING WHETHER ROM-SEQUESTER IS WARRANTED. FOR EXAMPLE, A TEAM OF SHIPYARD WORKERS MOVING FROM AN AREA WITH LOW COVID CASES TO AN AREA OF LOW, MEDIUM OR HIGH COVID CASES MIGHT NOT WARRANT ROM-SEQUESTER UNLESS COMPELLED BY OTHER CIRCUMSTANCES SUCH AS TRAVEL THROUGH A HIGH RISK AIRPORT. REGARDLESS, VISITORS SHOULD FOLLOW THE SAME DAILY SCREENING PROCEDURES, SELF-MONITORING, TEMPERATURE CHECKS, SOCIAL DISTANCING, PPE USAGE, AND PERSONAL RESPONSIBILITY PROTOCOLS AS SHIP FORCE. 4.A.3. AIRCRAFT SQUADRON COMMANDERS SHOULD CONSIDER THE CURRENT RISK LEVEL PER PARAGRAPH 4.A.2 TO DETERMINE IF ROM-SEQUESTER IS REQUIRED FOR TRAINING DETACHMENTS. FOR EXAMPLE, A SAILOR MAY USE A PERSONAL VEHICLE TO DRIVE FROM MILITARY BASE TO MILITARY BASE WITH INFREQUENT GAS OR FOOD STOPS TO MAINTAIN A MODIFIED BUBBLE. REGARDLESS, TRAVELERS SHOULD FOLLOW THE SAME DAILY SCREENING PROCEDURES, SELF-MONITORING, TEMPERATURE CHECKS, SOCIAL DISTANCING, PPE, AND PERSONAL RESPONSIBILITY PROTOCOLS DICTATED BY LOCAL HPCON CONDITIONS. 4.B. BASIC AND ADVANCED PHASES. INCLUDES SAME MEASURES AS THE MAINTENANCE PHASE, PLUS: 4.B.1. UNDERWAY OPERATIONS WITH MEDICAL TREATMENT FACILITY (MTF) SUPPORT WITHIN 72 HOURS: SCREEN HIGH RISK SAILORS AND ENSURE PPE LOADOUT MEETS FLEET GUIDANCE. CONDUCT DAILY SCREENING PROCEDURES FOR COVID-19 SYMPTOMS. FOLLOW PLATFORM SPECIFIC COVID-19 CONOPS AND STANDARD OPERATING PROCEDURES (SOPS). 4.B.2. UNDERWAY OPERATIONS WHEN MTF SUPPORT WILL NOT BE AVAILABLE WITHIN 72 HOURS: SAME MEASURES AS LOCAL OPERATIONS, PLUS, IAW FLEET COMMANDER GUIDANCE, CONSIDER MEDICAL TEAM AUGMENT, MEDEVAC AUGMENT/HELO CAPABILITY, AND/OR SHIPBOARD TESTING CAPABILITY. 4.C. INTEGRATED PHASE: SAME MEASURES AS MAINTENANCE AND BASIC AND ADVANCED PHASES, PLUS: 4.C.1. IF DEPLOYING IMMEDIATELY AFTER INTEGRATED PHASE (E.G., COMPTUEX(C2X), ARGMEUEX)OR PRE-OVERSEAS MOVEMENT EVALUATION (POMEVAL), FOLLOW THE GUIDANCE IN PARAGRAPH 3. 4.D. SUSTAINMENT PHASE. 4.D.1. UNDERWAY: MAINTAIN BUBBLE PER PARAGRAPH 3.E. 4.D.2. PIER-SIDE: FOLLOWING DEPLOYMENT, FOLLOW BASIC PHASE GUIDANCE. OPERATIONAL COMMANDERS MAY ELECT TO SHIFT TO PARAGRAPH 3 GUIDANCE DEPENDING ON LIKELIHOOD OF CONTINGENCY OPERATIONS. 4.E. FOR SHORE BASED COMMANDS SENDING PERSONNEL TO AFLOAT UNITS, FOLLOW THE GUIDANCE THAT APPLIES TO THE PHASE OF THE RECEIVING UNIT. FOR ALL OPERATIONAL UNIT PERSONNEL TRAVELING TO SHORE COMMANDS (E.G. SCHOOLS, TDY), FOLLOW MAINTENANCE PHASE CRITERIA OF PARA 4.A. AND REQUIREMENTS OF REF (C) AS MODIFIED BY REF (L). 4.F. FOR ALL PHASES, DISCIPLINED INDIVIDUAL AND ORGANIZATIONAL PUBLIC HEALTH PROTECTION MEASURES ARE THE BEDROCK OF RISK REDUCTION AND RISK MITIGATION. COVID MITIGATION PROTOCOL, WHERE APPROPRIATE, SHOULD CONSIDER ADDITIONAL SUPPORT FOR HIGH RISK PERSONNEL. COMMANDERS ARE RESPONSIBLE FOR DEVELOPING, MANAGING, OVERSEEING AND IMPLEMENTING PROTOCOLS FOR THEIR UNITS. INDIVIDUALS ARE RESPONSIBLE FOR EXECUTING THOSE PROTOCOLS. 5. DUE TO THE UNIQUE NATURE OF FORWARD DEPLOYED NAVAL FORCES (FDNF) AND THEIR HOST NATION RELATIONSHIP, THE NCC WILL DEFINE OPERATIONAL REQUIREMENTS FOR FDNF UNITS BASED ON PARAGRAPHS 3 AND 4. 6. COMMANDERS MAY NEED TO EXEMPT AIRCREW AND AIRCRAFT MAINTAINERS FROM THIS GUIDANCE TO MEET EMERGENT OPERATIONAL OR NATOPS CURRENCY EQUIREMENTS. ROBUST RISK MITIGATION IS REQUIRED TO MINIMIZE COVID THREATS TO EXISTING BUBBLES. MITIGATION PLANS MUST BE APPROVED BY THE NCC. FOR AVIATION UNITS EMBARKED ON SURFACE UNITS, MITIGATION PLANS WILL BE INCLUDED AND APPROVED AS PART OF THE OVERALL SHIP MITIGATION PLAN. 7. REQUIRED ACTION WHEN ANY MILITARY, CIVILIAN, OR CONTRACTOR EXHIBITS SIGNS OR SYMPTOMS OF COVID-19 INFECTION. 7.A. ISOLATE, MEDICALLY SCREEN AND DESIGNATE AS A PUI OR PROBABLE COVID-19 CASE. RESTRICT CONTACT AND PROTECT THE OPERATIONAL BENCH IF APPLICABLE. 7.A.1. IF ISOLATED ABOARD SHIP, USE SMALL BERTHING AREAS (E.G. STATEROOMS, PREFERABLY WITH HEADS) FOR SEPARATION. WHEN ADEQUATE SHIPBOARD ISOLATION CAPACITY IS EXHAUSTED, CONSIDER TRANSFERRING PUIS TO UNITS WITH REMAINING CAPACITY OR ASHORE IAW FLEET COMMANDER GUIDANCE, IF FEASIBLE AND MISSION ALLOWS. 7.A.2. IF ISOLATED ASHORE, PROVIDE NECESSARY MEDICAL TREATMENT UNTIL CLINICALLY IMPROVED. 7.B. IDENTIFY, QUARANTINE, AND MEDICALLY SCREEN CLOSE CONTACTS OF COVID-19 CASES. ISOLATE SYMPTOMATIC PUIS AS DEFINED IN PARAGRAPHS 2.A AND 2.B AS SOON AS POSSIBLE. MINIMUM SCREENING SHOULD INCLUDE USE OF CDC COVID-19 QUESTIONNAIRE, CDC FACILITIES COVID-19 SCREENING, AVAILABLE AT HTTPS://WWW.CDC.GOV/SCREENING/PAPER-VERSION.PDF TO ASSESS RISK. WHEN LOCAL TESTING CAPACITY AND SUPPLIES ALLOW, TESTING IS RECOMMENDED FOR ALL CLOSE CONTACTS OF CONFIRMED OR PROBABLE COVID-19 PATIENTS. PEOPLE WHO HAVE TESTED POSITIVE FOR COVID-19 DO NOT NEED TO QUARANTINE OR GET TESTED AGAIN FOR 3 MONTHS, BUT MUST CONTINUE SOCIAL DISTANCING AND CLOTH FACE COVERING USE. WHEN ADEQUATE SHIPBOARD QUARANTINE CAPACITY IS EXHAUSTED, CONSIDER TRANSFERRING CLOSE CONTACTS TO UNITS WITH REMAINING CAPACITY OR ASHORE, IF FEASIBLE AND MISSION ALLOWS. 7.B.1. CLOSE CONTACTS WHO SUBSEQUENTLY TEST POSITIVE WILL BE ISOLATED AND TREATED UNDER COVID-19 CASE PROTOCOLS. CLOSE CONTACTS MUST REMAIN IN QUARANTINE FOR 14 DAYS EVEN IF THEY TEST NEGATIVE. SOME INDIVIDUALS MAY TEST NEGATIVE FOR SEVERAL DAYS AFTER EXPOSURE AND TAKE UP TO 14 DAYS TO EXHIBIT SYMPTOMS. 7.B.2. ASYMPTOMATIC INDIVIDUALS QUARANTINED DUE TO CLOSE CONTACT ARE NOT CONSIDERED PUI, PER PARAGRAPH 2.B. 7.B.3. IF A CLOSE CONTACT BECOMES SYMPTOMATIC - FOLLOW PUI PROTOCOL. 7.B.4. SPECIFIC TO NAVAL SPECIAL WARFARE INITIAL ACCESSIONS TRAINING ONLY, INCLUSIVE OF THE SEAL/SWCC PIPELINES. BOAT TEAMS WHO ARE CLOSE CONTACTS OF A COVID-19 CASE MAY CONTINUE TO EXECUTE TRAINING AS A COHORT, PHYSICALLY DISTANCED FROM OTHER BOAT CREWS IAW A TRAINING CONOP APPROVED BY NAVSPECWARCOM. 7.C. PROTOCOL FOR PUI. 7.C.1 ISOLATE ALL PUIS. TEST PUI IF POSSIBLE. 7.C.2. IF TEST RESULT IS POSITIVE - CONTINUE ISOLATION AND FOLLOW PARAGRAPH 7.D. CONDUCT COVID-19 CONTACT TRACING PER PARAGRAPH 9.D. 7.C.3 IF TEST RESULT IS NEGATIVE - CONTINUE TO ISOLATE AND FOLLOW PARAGRAPH 7.D. PROVIDE MEDICAL TREATMENT UNTIL CLINICALLY IMPROVED. IF A KNOWN COVID- 19 OUTBREAK IS OCCURRING, CONTINUE TO ISOLATE AND FOLLOW PARAGRAPH 9.D. 7.C.4 IF TEST RESULT IS NEGATIVE AND PUI DOES NOT IMPROVE - CONTINUE TO ISOLATE AND FOLLOW PARAGRAPH 7.D. IF A KNOWN COVID-19 OUTBREAK IS OCCURRING, CONDUCT COVID-19 CONTACT TRACING PER PARAGRAPH 9.D. 7.C.5 IF NO TEST IS PERFORMED - CONTINUE TO ISOLATE. MEDICALLY SCREEN TWICE A DAY AT A MINIMUM AND, IF SYMPTOMS WORSEN, CONSULT MEDICAL ISIC AND FLEET/TYCOM SURGEON REGARDING TRANSFER TO MEDICAL TREATMENT FACILITY. AT SEA, TRANSFER ASHORE IAW FLEET COMMANDERS GUIDANCE. FOLLOW PARAGRAPH 7.D. IF A KNOWN OR SUSPECTED COVID-19 OUTBREAK IS OCCURRING, CONDUCT COVID-19 CONTACT TRACING PER PARAGRAPH 9.D. 7.D. RETURN TO WORK (RTW) GUIDANCE FOR COVID-19 CASES AND PUIS. 7.D.1. OPERATIONAL UNITS. COVID-19 CASES MUST MEET ALL OF THE FOLLOWING CRITERIA TO RTW: (1) AT LEAST 24 HOURS HAVE PASSED SINCE RESOLUTION OF FEVER WITHOUT THE USE OF FEVER REDUCING MEDICATION; (2) PROGRESSIVE IMPROVEMENT IN OTHER COVID-19 SYMPTOMS AS DETERMINED BY A MEDICAL PROVIDER; AND (3) AT LEAST 14 DAYS HAVE ELAPSED SINCE THE SYMPTOMS FIRST APPEARED OR SINCE THE DATE OF THE FIRST POSITIVE RT-PCR TEST IF ASYMPTOMATIC. 7.D.2. ALL OTHER UNITS AND STAFFS. COVID-19 CASES AND PUIS MUST MEET ALL OF THE FOLLOWING CRITERIA TO RTW: (1) AT LEAST 24 HOURS HAVE PASSED SINCE RESOLUTION OF FEVER WITHOUT THE USE OF FEVER REDUCING MEDICATION; (2) IMPROVEMENT IN OTHER COVID-19 SYMPTOMS; AND (3) AT LEAST 10 DAYS HAVE ELAPSED SINCE THE SYMPTOMS FIRST APPEARED OR RT-PCR TEST DATE IF ASYMPTOMATIC. 7.D.3. FOR SEVERE CASES WHERE INDIVIDUALS REQUIRED HOSPITALIZATION, EXTEND THE DURATION OF ISOLATION SUCH THAT RTW IS NO EARLIER THAN DAY 21 (20 DAYS SINCE SYMPTOM ONSET) AS SOME PERSONS WITH SEVERE COVID-19 ILLNESS MAY REMAIN INFECTIOUS FOR SLIGHTLY LONGER PERIODS OF TIME. 7.D.4. RETURN TO PHYSICAL EXERCISE. THE RTW GUIDANCE IN 7.D.1 THROUGH 7.D.3 IS BASED ON RESOLUTION OF INFECTIVITY. BASED ON SEVERITY OF ILLNESS, SOME PERSONNEL MAY REQUIRE TIME TO GRADUALLY RETURN TO INTENSE EXERCISE. REF (H) CONTAINS RETURN TO EXERCISE RECOMMENDATIONS. 7.D.5. NCC MAY ELECT TO TREAT CRITICAL OPERATIONAL ENABLERS, SUCH AS INSPECTION AND CERTIFICATION TEAMS, AS OPERATIONAL UNITS PER PARA. 7.D.1. 7.D.6. A TEST-BASED STRATEGY IS NO LONGER RECOMMENDED TO DETERMINE RTW BECAUSE IN THE MAJORITY OF CASES IT RESULTS IN IDENTIFYING THOSE WHO CONTINUE TO SHED DETECTABLE SARS-COV-2 RNA BUT ARE NO LONGER INFECTIOUS. A COMBINATION OF BOTH SYMPTOM RESOLUTION AND TESTING CRITERIA IS NOT RECOMMENDED AS IT WILL LIKELY EXTEND RTW WITH NO CORRESPONDING DECREASE OF INFECTION TRANSMISSION. 7.D.7. COVID LIKE ILLNESS (CLI)/INFLUENZA LIKE ILLNESS (ILI). 7.D.7.A. A PATIENT WITH SUSPECTED CLI/ILI WHO HAS TESTED NEGATIVE FOR COVID-19 MAY RETURN TO WORK AFTER THE FOLLOWING CRITERIA HAVE BEEN MET: (1) AT LEAST 24 HOURS AFTER THE RESOLUTION OF FEVER WITHOUT THE USE OF FEVER REDUCING MEDICATION; (2) IMPROVEMENT IN SYMPTOMS AND (3) AT LEAST 10 DAYS SINCE THE ONSET OF SYMPTOMS. 7.D.7.B. THE SYMPTOMS OF ILI (THE FLU) ARE SIMILAR TO CLI SYMPTOMS, AND THE ABSENCE OF COVID-SPECIFIC SYMPTOMS, OR TESTING POSITIVE FOR ANOTHER ILLNESS SUCH AS INFLUENZA, DOES NOT ELIMINATE THE POSSIBILITY OF COVID INFECTION. THE RISK OF COVID AND ILI CO-INFECTION EXISTS AND THE CDC RECOMMENDS EXECUTING THE FULL COVID ISOLATION PERIOD FOR ALL SYMPTOMATIC INDIVIDUALS, EVEN WHEN TESTING NEGATIVE FOR COVID-19. THEREFORE, RETURN TO WORK CRITERIA FOR ILI AND CLI ARE THE SAME. A NCC WITH MEDICAL CONCURRENCE MAY, WHEN REQUIRED BY OPERATIONAL DEMANDS, REDUCE THE RETURN TO WORK DURATION OF SUSPECTED FLU WITH A NEGATIVE COVID TEST TO 24 HOURS AFTER RESOLUTION OF FEVER WITHOUT THE USE OF FEVER REDUCING MEDICATION, IMPROVEMENT IN SYMPTOMS AND 7 DAYS(VICE 10) SINCE ONSET OF SYMPTOMS. THIS IS A NCC RISK DECISION THAT SHOULD BE MADE ONLY UNDER OPERATIONAL NECESSITY. 7.E. COVID-19 CASES MAY CONTINUE TO TEST POSITIVE FOR UP TO THREE MONTHS DUE TO THE PRESENCE OF PERSISTENT NON-INFECTIOUS VIRAL FRAGMENTS. THEREFORE, COVID-19 CASES ARE EXEMPT FROM ANY REQUIRED TESTING PROTOCOL FOR THREE MONTHS FOLLOWING ANY POSITIVE TEST. INDIVIDUALS THAT EXHIBIT NEW OR PERSISTENT SYMPTOMS DURING THAT THREE MONTH PERIOD SHOULD BE EVALUATED BY A MEDICAL PROVIDER. STUDIES HAVE NOT FOUND EVIDENCE THAT CLINICALLY RECOVERED PERSONS WITH PERSISTENCE OF VIRAL RNA HAVE TRANSMITTED COVID-19 TO OTHERS. 7.E.1. RECOVERED PERSONS MUST CONTINUE TO WEAR CLOTH FACE COVERINGS AND SOCIAL DISTANCE INFECTION PRECAUTIONS MUST CONTINUE TO BE TAKEN AFTER RTW IS APPROVED. 7.F. ANTIBODY TESTING AND VIRAL CULTURE. ANTIBODY TESTING OR VIRAL CULTURE SHOULD NOT BE USED AS A PRIMARY OR STAND-ALONE RETURN TO WORK CRITERION. HOWEVER, IF EITHER HAVE BEEN OBTAINED DURING A COVID CASE CLINICAL EVALUATION, RESULTS MAY BE USED AS SUPPLEMENTAL CRITERIA FOR PARTICULARLY CHALLENGING CASES OR FOR PUBLIC HEALTH OUTBREAK MANAGEMENT PURPOSES. 7.G. COMMAND AND MEMBER NOTIFICATION. THE INDIVIDUAL SICK SLIP (DD FORM 689) MUST BE USED TO NOTIFY BOTH THE MEMBER AND THE CHAIN OF COMMAND OF ANY TEST-CONFIRMED OR PRESUMPTIVE COVID ILLNESS, WHETHER SYMPTOMATIC OR NOT. SECTION 11 (DISPOSITION) AND SECTION 12 (REMARKS) MUST CLEARLY INDICATE THE MEDICALLY-RECOMMENDED DISPOSITION, FOLLOW UP, AND QUARANTINE/ISOLATION REQUIREMENTS IN ACCORDANCE WITH THIS GUIDANCE. THE SICK SLIP MUST ALSO BE USED TO NOTIFY ASYMPTOMATIC MEMBERS AND THE CHAIN OF COMMAND OF ANY PUI OR CLOSE CONTACT, QUARANTINE, OR ISOLATION REQUIREMENTS IN ACCORDANCE WITH THIS GUIDANCE. BEGINNING AND ENDING DATES OF THE QUARANTINE/ISOLATION PERIOD, SYMPTOM-FREE REQUIREMENTS, AND MEDICAL FOLLOW UP MUST BE CLEARLY INDICATED IN SECTION 12 (REMARKS). 8. UNDERWAY TESTING. 8.A. UNDERWAY OPERATIONS SHOULD CONTINUOUSLY ASSESS THE INTEGRITY OF A BUBBLE THROUGH CLI/ILI SCREENING. FOR PLATFORMS WITH EXPANDED TESTING CAPABILITY, TESTING STRATEGIES MAY BE EMPLOYED AS PART OF THE MITIGATION MEASURES IN 1.C.1 THROUGH 10, TO INCLUDE SYMPTOMATIC TESTING (DIAGNOSTIC) AND TARGETED OR WHOLE CREW TESTING (SCREENING). 8.B. OPERATIONS, ACTIVITIES, AND ENGAGEMENTS DURING DEPLOYMENT MAY NOT ALLOW FOR PERSONNEL TO COMPLETE A 14-DAY ROM/SEQUESTRATION PRIOR TO EMBARKING/ RE-EMBARKING A SHIP. COVID-19 SCREENING TESTING OF OPERATIONALLY AT-RISK PERSONNEL AND MISSION CRITICAL POPULATIONS MAY DETECT COVID-19 INFECTIONS EARLY AND PRESERVE MISSION EFFECTIVENESS. 8.B.1. OPERATIONALLY AT-RISK PERSONNEL, SUCH AS AIR CREW AND INDIVIDUALS ASHORE IN A COUNTRY WITH ACTIVE COVID-19 INFECTIONS, ARE AT THE GREATEST RISK OF EXPOSURE TO THE VIRUS. QUARANTINE THESE GROUPS FROM THE REMAINING CREW WHEN RE-ENTERING THE BUBBLE, INCREASE MEDICAL SCREENING AND SELF-MONITORING EFFORTS AND WHEN AVAILABLE, TEST THESE INDIVIDUALS INTO AND OUT OF THE 14-DAY QUARANTINE, EFFECTIVELY CONDUCTING ROM-SEQUESTER AND SCREENING TESTING ONBOARD. 8.B.2. COVID-19 INFECTION IN PERSONNEL WHO ARE CONSIDERED MISSION CRITICAL, SUCH AS CRITICAL CARETAKER CREW, AIR OPERATIONS CREW, AND REACTOR PERSONNEL, MAY DEGRADE OPERATIONS AND IMPACT THE MISSION. WHEN THERE IS A RISK OF INFECTION ONBOARD, PRIORITIZE MISSION CRITICAL CREW MEMBERS IN AN AFLOAT TESTING STRATEGY. 8.B.3. THERE IS NO SUBSTITUTE FOR AN EFFECTIVE TEST-ROM SEQUESTER-TEST STRATEGY PROCESS TO ESTABLISH AND MAINTAIN THE BUBBLE. DURING UNDERWAY OPERATIONS, BRIEF STOPS FOR PERSONNEL (BSP) OR EMBARKING PERSONNEL FROM FOREIGN PORTS MAY PRECLUDE THE ABILITY TO COMPLETE A 14-DAY ROM-SEQUESTER. QUARANTINE THESE PERSONNEL FROM THE REMAINING CREW MEMBERS FOR AT LEAST 14 DAYS, INCREASE MEDICAL SCREENING AND SELF-MONITORING EFFORTS, AND, WHEN AVAILABLE, TEST THESE INDIVIDUALS INTO AND OUT OF THE 14-DAY QUARANTINE. 8.C. POOLED TESTING UNDERWAY. POOLED TESTING UNDERWAY WILL ONLY BE CONDUCTED IN DIRECT COORDINATION WITH NAVAL HEALTH RESEARCH CENTER AND REQUIRES NOTIFICATION OF BUMED SURGEON GENERAL OR DEPUTY SURGEON GENERALS OFFICE BY THE FLEET SURGEON. 8.D. FLU VACCINE. 8.D.1. RECEIVING A FLU VACCINE MAY CAUSE SOME SYMPTOMS SIMILAR TO COVID-19. 8.D.1.A. POSSIBLE FLU VACCINE SYMPTOMS MAY INCLUDE MYALGIA, MILD FEVER, CHILLS AND INJECTION SITE SORENESS. 8.D.1.B. IF INDIVIDUAL RECEIVES THE FLU VACCINE AND EXPERIENCES SYMPTOMS BEYOND 72 HOURS OR SYMPTOMS NOT CONSISTENT WITH THE FLU VACCINE (SUCH AS LOSS OF TASTE OR SMELL, SORE THROAT, CHEST PAIN, TEMPERATURE GREATER THAN 101, OR COUGH), THEY SHOULD BE EVALUATED BY A HEALTHCARE PROVIDER. 9. POST-DEPLOYMENT AND REDEPLOYMENT. 9.A. MILITARY MEMBERS RETURNING TO CONUS FROM DEPLOYMENT WILL COMPLETE A 14-DAY ROM AT HOME STATION. MEMBERS RETURNING VIA SHIP OR MILAIR WITH NO ACTIVE COVID-19 CASES WITHIN THEIR UNIT IN THE LAST 14 DAYS, MAY COUNT TRANSIT TIME (BEGINNING ON THE DAY OF DEPARTURE FROM THE LAST PORT OR AIRFIELD) TOWARD THE ROM REQUIREMENT. SERVICE MEMBERS ON POST-DEPLOYMENT ROM ARE RESTRICTED TO THEIR PERSONAL RESIDENCE OR OTHER APPROPRIATE DOMICILE AND MUST LIMIT CLOSE CONTACTS. 9.B. REDEPLOYING INDIVIDUALS MUST BE SCREENED AT THE ASSIGNED PLACE OF DUTY OR POINT OF EMBARKATION. AT A MINIMUM, SCREENING WILL CONSIST OF COVID-19 QUESTIONNAIRE, ASSESSMENT OF EXPOSURE HISTORY, TEMPERATURE CHECK, CHECK FOR COVID-19 SIGNS AND SYMPTOMS LISTED IN PARAGRAPH 2.E., AND REVIEW OF ANY PAST COVID-19 TESTING. 9.C. AT THE COMPLETION OF DEPLOYMENT, ALL PERSONNEL WILL COMPLETE A POST-DEPLOYMENT HEALTH ASSESSMENT (DD FORM 2796) AND POST-DEPLOYMENT HEALTH REASSESSMENT (DD FORM 2900) IN ACCORDANCE WITH REF (F). 9.D. ALL COVID-19 DIAGNOSTIC TESTS MUST BE ENTERED IN THE MEDICAL RECORD. SCREENING AND SURVEILLANCE TESTS THAT ARE INDIVIDUALLY IDENTIFIABLE MUST BE ENTERED INTO THE MEDICAL RECORD. 10. OUTBREAK INVESTIGATION AND CONTACT TRACING WORKFORCE TRAINING. 10.A. RAPID AND THOROUGH CONTACT TRACING MINIMIZES OUTBREAKS AND IS CRITICAL TO MISSION SUCCESS. BELOW IS A TOOLKIT TO ASSIST WITH THE INVESTIGATION OF CASES OR AN OUTBREAK OF COVID-19 AND CONTAINS LINKS TO CONTACT TRACING TRAINING. THIS INFORMATION CAN BE USED BY MEDICAL AND NON-MEDICAL PERSONNEL TO WORK TOGETHER TO STOP THE SPREAD OF COVID-19. 10.B. ALL UNITS WILL TRAIN A MINIMUM OF TWO PERSONNEL FOR EVERY 100 PERSONNEL AT THEIR COMMAND. COMMANDS OF MORE THAN 500 PERSONNEL MUST TRAIN AT LEAST 10 PEOPLE. SMALL UNITS MUST TRAIN A MINIMUM OF TWO INDIVIDUALS. MSC TRAIN CONTACT TRACERS FOR MSC VESSELS IN ACCORDANCE WITH EXISTING MSC INSTRUCTIONS AND CONTRACTS. 10.C. THE FOLLOWING COMPRISES THE CONTACT TRACING TRAINING: 10.C.1. NAVY VIDEO ON CONTACT TRACING AT: HTTPS://WWW.MILSUITE.MIL AND SEARCH FOR VIDEO 29421. 10.C.2. JOINT KNOWLEDGE ONLINE (JKO) COURSE HIPAA AND PRIVACY ACT TRAINING COURSE NUMBER DHA-US001 HIPAA AND PRIVACY ACT TRAINING ON JKO AT HTTPS://JKO.JTEN.MIL/ (1.5 HOURS). THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) WAS INSTITUTED TO PROTECT THE PRIVACY AND SECURITY OF CERTAIN HEALTH INFORMATION. 10.C.3. ONLINE COVID-19 CONTACT TRACING BY JOHNS HOPKINS UNIVERSITY AT HTTPS://WWW.COURSERA.ORG/LEARN/COVID-19-CONTACT-TRACING(6.0 HOURS). FOLLOW THE INSTRUCTIONS ONLINE FOR FREE ENROLLMENT AND CERTIFICATE. 10.C.4. IF UNDERWAY OR DO NOT HAVE INTERNET BANDWIDTH TO COMPLETE ONLINE TRAINING, A POWERPOINT VERSION OF CONTACT TRACING TRAINING CAN BE ACCESSED AT: HTTPS://ESPORTAL.MED.NAVY.MIL/SITES/NMCPHC/PPS/WPPC19/COVID- 19_CONTACT_TRACING_TRAINING.ASPX. 10.C.5. AFTER FINISHING THE TRAINING, THE TRAINED MEMBER WILL CONTACT THE PUBLIC HEALTH OFFICER AT THE NEAREST NAVY MEDICINE READINESS AND TRAINING COMMAND (NAVMEDREADTRNCMD), OR THE COMMAND LOCAL MEDICAL PERSONNEL IF ASSOCIATED WITH A NAVMEDREADTRNCMD/OPERATIONAL UNIT, TO IDENTIFY A MENTOR FOR QUESTIONS, GUIDE ACTIVITIES RELATED TO CONTACT TRACING, AND ENSURE COMPLIANCE WITH RELEVANT MEDICAL AUTHORITY (E.G., COMUSFLTFORCOM SURGEON, COMPACFLT SURGEON, OR COMNAVSPECWARCOM SURGEON) GUIDANCE AND PROCEDURES WITH RESPECT TO CONTACT TRACING. THE RELEVANT MEDICAL AUTHORITY AND FACILITY MAY HAVE SPECIFIC FORMS OR PROCEDURES THAT ARE UNIQUE TO THEIR ENVIRONMENT. IT IS IMPORTANT THAT CONTACT TRACING BE A COORDINATED EFFORT BETWEEN THE TRAINED MEMBER AND THE LOCAL NAVMEDREADTRNCMD PUBLIC HEALTH OFFICE WHEN IN GARRISON OR THE COGNIZANT TYCOM FOR OPERATIONAL UNITS. ADDITIONALLY, TIMELY ENGAGEMENT OF THE ASSOCIATED NAVY AND ENVIRONMENTAL AND PREVENTIVE MEDICINE UNIT (NEPMU) IS RECOMMENDED FOR AN EFFECTIVE RESPONSE TO A LARGE OUTBREAK. 10.D. THE FOLLOWING IS THE COVID-19 CASE INVESTIGATION CHECKLIST (APPLIES TO ALL CLINICALLY SUSPECTED OR CONFIRMED CASES). 10.D.1. IMMEDIATE STEPS: (1) IMPLEMENT APPROPRIATE CONTROL MEASURES. (2) SEPARATE THE CASE FROM OTHER PERSONNEL. (3) PLACE THE CASE IN ISOLATION (AS SOON AS POSSIBLE). (4) FOR SHIPS THAT ARE PIER-SIDE, ONCE MEDICAL EVALUATION AND DISPOSITION HAS OCCURRED, ISOLATE CASES OFF OF THE SHIP WHENEVER POSSIBLE. (5) FOR SHIPS THAT ARE UNDERWAY, ISOLATE CASES IN DESIGNATED SPACES, CONSISTENT WITH TYCOM/FLEET/COMMAND DIRECTION AND FLEET COMMANDER PUBLISHED COVID UNDERWAY GUIDANCE SOP. 10.D.2. WEAR APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT (PPE) AS DIRECTED BY YOUR LOCAL MEDICAL AUTHORITY DURING ALL FACE-TO-FACE INTERACTION WITH THE CASE. COVID-19 SPECIFIC PPE INCLUDES (WHEN AVAILABLE) GOWN, GLOVES, NIOSH-CERTIFIED DISPOSABLE N95 RESPIRATOR, AND EYE PROTECTION. CFCS CAN BE USED IF MAINTAINING APPROPRIATE SOCIAL DISTANCING RECOMMENDATIONS. 10.D.3. NOTIFY CHAIN OF COMMAND. 10.D.4. NOTIFY SENIOR MEDICAL DEPARTMENT REPRESENTATIVE, DEPARTMENT OF DEFENSE (DOD) PREVENTIVE MEDICINE AUTHORITY, AND LOCAL CIVILIAN HEALTH DEPARTMENT (IF APPLICABLE) OF ANY CONFIRMED COVID-19 CASE. 10.D.5. IF THE CASE(S) HAS BEEN ONBOARD THE SHIP DURING THE INFECTIOUS PERIOD (48 HOURS BEFORE SYMPTOM ONSET OR POSITIVE LAB UP TO THE TIME OF ISOLATION), ALL AREAS VISITED (WORKSPACE, HEADS, BERTHING, GYMS, ETC.) SHOULD BE CLOSED OFF IN ORDER TO MINIMIZE POTENTIAL EXPOSURE TO AEROSOLIZED VIRUS. WAIT 24 HOURS (OR AS LONG AS PRACTICAL) FROM THE TIME THE CASE WAS LAST PRESENT IN SPACES BEFORE REENTERING THOSE AREAS TO CLEAN AND DISINFECT. 10.D.6. BEGIN A CASE INVESTIGATION AS SOON AS A PERSON PRESENTS WITH COVID-19 LIKE ILLNESS (PUI). INTERVIEW THE CASE(S) OR PUI(S) AND REVIEW MEDICAL RECORDS (IF APPLICABLE) TO ASSESS VALIDITY OF THE DIAGNOSIS AND DETERMINE FOLLOW-UP RESPONSE MEASURES. (1) IF DETERMINED NOT TO BE VALID, RESPONSE STOPS. CLOSED-OFF AREAS MAY BE RE-OPENED. (2) IF DETERMINED TO BE A VALID CLINICALLY-SUSPECTED OR CONFIRMED CASE, PROCEED. 10.D.7. CONDUCT A DETAILED CASE INTERVIEW. AS SOON AS POSSIBLE (IDEALLY WHEN CASE PRESENTS TO MEDICAL OR WITHIN 24 HOURS), COMPLETE THE CASE INTERVIEW AND CONTACT TRACING FORM AND CONTACT LIST FOR EACH CASE. KEY ASPECTS OF THE CASE INTERVIEW INCLUDE: (1) ANY KNOWN HIGH-RISK EXPOSURE THAT THE CASE HAD (E.G. TRAVEL, CONTACT WITH A CONFIRMED COVID-19 CASE), AND TIMELINE OF EXPOSURE. (2) SYMPTOM HISTORY (INCLUDING EXACT DATE OF ONSET OF ANY SYMPTOMS AND LIST OF SYMPTOMS). (3) LIST OF ALL POSSIBLE CLOSE CONTACTS (PER DEFINITION ABOVE) WHO WERE EXPOSED TO THE CASE BETWEEN 48 HOURS PRIOR TO ONSET OF SYMPTOMS AND THE TIME HE/SHE WAS ISOLATED, OR 48 HOURS PRIOR TO A POSITIVE TEST IF THE CASE IS ASYMPTOMATIC. CONTACTS OF CONTACTS ARE NOT CONSIDERED EXPOSED TO COVID-19. THERE IS NO REQUIREMENT TO MONITOR OR QUARANTINE CONTACTS OF CONTACTS, UNLESS THE INITIAL CONTACT LATER DEVELOPS SYMPTOMS AND BECOMES A CASE. (4) DATE OF ISOLATION. ENSURE NO CONTINUED EXPOSURES ARE OCCURRING, ESPECIALLY WITH HOUSEHOLD CONTACTS. 10.D.8. QUARANTINE ALL CLOSE CONTACTS AS SOON AS POSSIBLE AFTER EXPOSURE TO THE CASE HAS BEEN VERIFIED. PEOPLE WHO HAVE PREVIOUSLY TESTED POSITIVE FOR COVID-19 DO NOT NEED TO QUARANTINE FOR UP TO 3 MONTHS AS LONG AS THEY DO NOT DEVELOP SYMPTOMS AGAIN. 10.D.9. IF INDICATED, COLLECT AND SHIP LABORATORY SPECIMENS TO THE APPROPRIATE DOD, COMMERCIAL, OR PUBLIC HEALTH LABORATORY CERTIFIED TO PERFORM COVID-19 TESTING (CHOSEN LAB AND SHIPPING PROCEDURES WILL BE DETERMINED BY LOCAL PROTOCOLS). DOCUMENT TEST RESULTS FOR ANY OTHER RESPIRATORY PATHOGENS (E.G. RAPID FLU, RESPIRATORY PANEL). (1) FOR SHORE-BASED UNITS OR SHIPS THAT ARE PIER-SIDE IN HOMEPORT, FOLLOW SUPPORTING MILITARY TREATMENT FACILITY (MTF) OR LOCAL CIVILIAN PROCEDURES FOR COVID-19 TESTING. (2) FOR SHIPS THAT ARE UNDERWAY, SHIP CAPABILITIES AND FLEET POLICIES WILL DETERMINE TESTING PRACTICES. EVERY EFFORT SHOULD BE MADE TO TEST AND CONFIRM THE PATHOGEN IF AN OUTBREAK IS SUSPECTED. 11. ADDITIONAL ROM AND MEDICAL SCREENING CONSIDERATIONS. 11.A. CIVILIAN EMPLOYEES. COMMANDERS MUST ENSURE ROM AND MEDICAL SCREENING GUIDANCE GIVEN TO DOD CIVILIAN EMPLOYEES CAN BE APPLIED CONSISTENT WITH APPLICABLE CIVILIAN PERSONNEL LAW, REGULATION, AND POLICY. COMMANDERS SHOULD CONSIDER TELEWORKAND SAFETY LEAVE AS OPTIONS TO FACILITATE DOD CIVILIAN COMPLETION OF ROM. COMMANDERS ARE ENCOURAGED TO CONSULT THEIR SERVICING OGC COUNSEL, STAFF JUDGE ADVOCATES, AND/OR HUMAN RESOURCE OFFICE FOR CASE- SPECIFIC GUIDANCE. 11.B. CONTRACTOR PERSONNEL. THIS GUIDANCE DOES NOT ALTER, MODIFY, OR CHANGE THE TERMS AND CONDITIONS OF ANY DOD CONTRACT. COMMANDERS MUST ENSURE ROM AND MEDICAL SCREENING GUIDANCE GIVEN TO DOD CONTRACTOR PERSONNEL CAN BE APPLIED CONSISTENT WITH THE PERTINENT CONTRACT AND APPLICABLE PROCUREMENT LAW, REGULATION, AND POLICY. COMMANDERS ARE ENCOURAGED TO CONSULT THEIR SERVICING OGC COUNSEL, STAFF JUDGE ADVOCATES, AND/OR CONTRACTING PERSONNEL FOR CASE-SPECIFIC GUIDANCE. ONLY WARRANTED CONTRACTING OFFICERS CAN ALTER TERMS AND CONDITIONS OF A DOD CONTRACT, INCLUDING PROVISIONS FOR PAYMENT OF COSTS ASSOCIATED WITH DOD CONTRACTOR ROM. 12. RELEASED BY VADM P. G. SAWYER, DEPUTY CHIEF OF NAVAL OPERATIONS FOR OPERATIONS, PLANS AND STRATEGY, OPNAV N3/N5.// BT #0001 NNNN UNCLASSIFIED//