UNCLASSIFIED// ROUTINE R 021344Z JUN 21 MID200000905152U FM CNO WASHINGTON DC TO NAVADMIN INFO SECNAV WASHINGTON DC CNO WASHINGTON DC BT UNCLAS NAVADMIN 110/21 MSGID/NAVADMIN/CNO WASHINGTON DC/CNO/JUN// SUBJ/U.S. NAVY COVID-19 STANDING GUIDANCE UPDATE 1// REF/A/NAVADMIN/OPNAV/241900ZMAY21// REF/B/MEMO/OSD/12APR2021// REF/C/NAVADMIN/OPNAV/042044ZMAY21// REF/D/MEMO/OSD/04MAY2021// REF/E/DOC/NMCPHC/14MAY2021// REF/F/DOC/NMCPHC/19MAR2021// REF/G/NAVADMIN/OPNAV/251655ZJUN20// REF/H/MEMO/OSD/11JUN2020// REF/I/DHA-IPM 20-004/6MAY2021// REF/J/NAVADMIN/OPNAV/301952ZAPR21// REF/K/NAVADMIN/OPNAV/051532ZAPR21// REF/L/MEMO/OSD/06JUL2020// REF/M/NAVADMIN/OPNAV/071719ZJUL16// NARR/REF A IS NAVADMIN 099/21, U.S. NAVY COVID-19 STANDING GUIDANCE. REF B IS USD P&R FORCE HEALTH PROTECTION (FHP) SUPPLEMENT 20 - DOD GUIDANCE FOR PERSONNEL TRAVELING DURING THE CORONAVIRUS DISEASE 2019 PANDEMIC AVAILABLE AT https://www.defense.gov/Explore/Spotlight/Coronavirus/Latest- DOD-Guidance/. REF C IS NAVADMIN 088/21, SARS-COV-2 VACCINATION AND REPORTING POLICY. REF D IS USD P&R FORCE HEALTH PROTECTION (FHP) SUPPLEMENT 16 REVISION 1 DOD GUIDANCE FOR DEPLOYMENT AND REDEPLOYMENT OF INDIVIDUALS AND UNITS DURING CORONAVIRUS DISEASE 2019 PANDEMIC AVAILABLE AT https://www.defense.gov/Explore/Spotlight/Coronavirus/Latest-DOD-Guidance/. REF E IS NAVY AND MARINE CORPS PUBLIC HEALTH CENTER U.S. NAVY FORCE HEALTH PROTECTION WITH CONSIDERATIONS FOR VACCINE EFFICACY. REF F IS NAVY AND MARINE CORPS PUBLIC HEALTH CENTER DOCUMENT ASSESSING REAL COVID-19 RISK. REF G IS NAVADMIN 178/20, COVID-19 TESTING. REF H IS USD P&R FHP SUPPLEMENT 11 GUIDANCE FOR CORONAVIRUS DISEASE 2019 SURVEILLANCE AND SCREENING WITH TESTING. REF I IS THE DEFENSE HEALTH AGENCY-INTERIM PROCEDURES MEMORANDUM ON THE DEPARTMENT OF DEFENSE CORONAVIRUS DISEASE 2019 VACCINATION PROGRAM IMPLEMENTATION. REF J IS NAVADMIN 086/21, UPDATED GUIDANCE TO COMMANDERS ON ADJUSTING HEALTH PROTECTION CONDITIONS AND BASE SERVICES DURING COVID-19 PANDEMIC (CORRECTED COPY). REF K IS NAVADMIN 073/21, NAVY MITIGATION MEASURES IN RESPONSE TO CORONAVIRUS OUTBREAK UPDATE 7 (CONDITIONS-BASED APPROACH TO COVID-19 PERSONNEL MOVEMENT AND TRAVEL RESTRICTIONS). REF L IS OSD MEMO ON ASSURING ALLIES AND PARTNERS REGARDING US FORCE DEPLOYMENTS IN A CORONAVIRUS DISEASE 2019 ENVIRONMENT. REF M IS NAVADMIN 158/16, SOVEREIGN IMMUNITY POLICY.// POC/COVID-19 CRISIS ACTION TEAM /(703) 681-1125/EMAIL: USN.NCR.BUMEDFCHVA.MBX.BUMED-2019-NCOV-RESPONSE-CELL(AT)MAIL.MIL. RMKS/1. THIS MESSAGE UPDATES PARAGRAPH (7) IN U.S. NAVY COVID-19 STANDING GUIDANCE. REF (A) IS CANCELLED. WITH MORE THAN A YEAR OPERATING IN THE COVID-19 ENVIRONMENT, OUR SAILORS, CIVILIANS AND CONTRACTOR PERSONNEL HAVE ASSUMED PERSONAL RESPONSIBILITY AND GAINED SIGNIFICANT EXPERTISE IN MITIGATING AND PREVENTING THE SPREAD OF THE DISEASE AS DEMONSTRATED BY ACHIEVING THE LOWEST SERVICE COVID-19 CASE COUNT AND HIGHEST VACCINATION RATES. WE MUST CONTINUE TO PURSUE FULL VACCINATION AND APPLY BEST HEALTH PROTECTION MEASURES BOTH AT HOME AND AT WORK TO SUSTAIN AND IMPROVE UPON THIS PERFORMANCE. COMMANDING OFFICERS ARE ULTIMATELY RESPONSIBLE FOR THE HEALTH PROTECTION OF THEIR CREWS AND SHOULD APPLY THE GUIDANCE PROVIDED BELOW TO BEST FIT THEIR SPECIFIC OPERATIONAL SITUATION SUPPORTED BY THE MEDICAL COMMUNITY AND GUIDED BY THEIR CHAIN OF COMMAND. IN THE ABSENCE OF OPNAV OR DEPARTMENT OF DEFENSE (DOD) GUIDANCE, FOLLOW THE CENTERS FOR DISEASE CONTROL (CDC) GUIDANCE. WIDESPREAD IMMUNIZATION, COMMAND ENGAGEMENT, CREW OWNERSHIP, AND INDIVIDUAL ACCOUNTABILITY ARE THE CORNERSTONES TO OUR SUCCESS TO DATE. HEALTH PROTECTION MEASURES SUCH AS VACCINATION, THE CREATION OF A BUBBLE, FACE COVERINGS, PHYSICAL DISTANCING, STAYING OUT OF THE WORKSPACE WHEN FEELING ILL AND AGGRESSIVE SPACE CLEANING ARE THE GREATEST INFLUENCERS TO PREVENT AND ISOLATE COVID-19. THE COVID-19 VACCINES AUTHORIZED BY THE U.S. FOOD AND DRUG ADMINISTRATION ARE SAFE, EFFECTIVE AND IN PARTICULAR, ARE VITAL TO PROTECTING RECIPIENTS FROM HOSPITALIZATION AND DEATH. COMMANDING OFFICERS SHOULD MAKE EVERY EFFORT TO EDUCATE THEIR CREWS ON THE IMPORTANCE OF VACCINATION AND FACILITATE OPEN DISCUSSIONS WITH MEDICAL PERSONNEL IF THERE ARE QUESTIONS. DOCUMENTED COVID-19 CASES AMONG IMMUNIZED PERSONNEL ARE VERY INFREQUENT AND ALL CASES HAVE BEEN MILD TO MODERATE. CONSISTENT WITH REF (F), TO DATE NONE OF THE MORE THAN 230,000 FULLY IMMUNIZED NAVY AND MARINE CORPS MEMBERS HAVE BEEN HOSPITALIZED. 2. DEFINITIONS. COVID-19 CASE, CLOSE CONTACT, INFLUENZA LIKE ILLNESS (ILI), ISOLATION, QUARANTINE, TESTING (DIAGNOSTIC, SCREENING, AND SURVEILLANCE), AND OTHER DEFINITIONS ARE AVAILABLE ON THE CDC WEBSITE. THE FOLLOWING NAVY DEFINITIONS ARE PROVIDED: 2.A. PATIENT (OR PERSON) UNDER INVESTIGATION (PUI): AN INDIVIDUAL WITH 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. HIGH-RISK PERSONNEL: THOSE INDIVIDUALS, DESIGNATED BY A MEDICAL PROVIDER, WHO MEET THE CDC CRITERIA FOR INCREASED RISK OF SEVERE ILLNESS HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/NEED-EXTRA-PRECAUTIONS/ PEOPLE-AT-HIGHER-RISK.HTML. 2.C. RESTRICTION OF MOVEMENT (ROM): GENERAL DOD TERM FOR LIMITING PERSONAL INTERACTION TO REDUCE RISK TO THE HEALTH, SAFETY AND WELFARE OF A BROADER COHORT. PERSONNEL EXECUTING A ROM ARE CONSIDERED TO BE IN A DUTY STATUS AND ROM PERIODS WILL NOT BE COUNTED AS LEAVE. 2.C.1. ROM-SEQUESTER: U.S. NAVY TERM FOR PREEMPTIVE SEPARATION OF FORCES TO REDUCE RISK OF INFECTION WHILE ATTEMPTING TO ESTABLISH A COVID-FREE BUBBLE. 2.D. BUBBLE: TERM FOR INDIVIDUALS, UNITS OR INSTALLATIONS THAT HAVE ESTABLISHED LOW PROBABILITY OF COVID-19 INFECTION DUE TO CREW IMMUNIZATION LEVEL AND/OR COMPLETION OF 14 DAY ROM-SEQUESTER FOR NON-IMMUNIZED INDIVIDUALS. 2.E. VACCINATED: AN INDIVIDUAL WHO HAS RECEIVED THE FIRST SHOT IN A SERIES OF TWO SHOTS OF COVID-19 VACCINE. WHILE NOT USED IN THE TRADITIONAL MEDICAL CONTEXT, THE TERMS VACCINATED AND IMMUNIZED WILL BE USED TO DIFFERENTIATE THOSE WHO HAVE RECEIVED PARTIAL OR FULL DOSES, RESPECTIVELY. 2.F. IMMUNIZED / FULLY VACCINATED: INTERCHANGEABLE TERMS FOR AN INDIVIDUAL WHO COMPLETED THE VACCINE SERIES AND IS CONSIDERED IMMUNE TWO WEEKS AFTER THE VACCINE SEQUENCE IS COMPLETE. IMMUNITY DURATION WILL BE GUIDED BY CDC, BUT IS NO LESS THAN SEVEN MONTHS FOR THIS STANDING GUIDANCE. 2.G. DEFERRED: AN INDIVIDUAL WHO WAS OFFERED AN AUTHORIZED VACCINE, BUT DECLINED OR WAS UNABLE TO RECEIVE IT FOR ANY REASON. THESE INDIVIDUALS ARE ENCOURAGED AND ALLOWED TO CHOOSE, AT ANY TIME, TO RECEIVE THE VACCINE UNLESS MEDICALLY CONTRAINDICATED. AFTER RECEIVING A VACCINE DOSE, AN INDIVIDUAL WILL NO LONGER BE LISTED AS DEFERRED. 2.H. 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.I. HEALTH PROTECTION MEASURES (HPM): TERM FOR MEASURES TAKEN TO DECREASE RISK OF COVID-19 IN AN OPERATIONAL SETTING. THIS INCLUDES PHYSICAL DISTANCING, WEARING OF FACEMASKS, AND ENHANCED ENVIRONMENTAL CLEANING. FULLY IMMUNIZED INDIVIDUALS ARE NOT REQUIRED TO WEAR FACEMASKS OR PHYSICALLY DISTANCE FROM OTHERS. EXCEPTIONS ARE THAT FACEMASKS ARE STILL REQUIRED FOR ALL MEDICAL AND DENTAL PERSONNEL WHEN PROVIDING HEALTH CARE AND FOR ALL INDIVIDUALS UNDERGOING TRAVEL ABOARD PUBLIC TRANSPORTATION TO JOIN A CREW ALREADY UNDERWAY, REGARDLESS OF IMMUNIZATION STATUS. 3. CLOSE CONTACTS AND SYMPTOMATIC PERSONNEL. 3.A. CLOSE CONTACTS WHO HAVE BEEN FULLY VACCINATED AND INDIVIDUALS WHO HAVE TESTED POSITIVE IN THE PAST THREE MONTHS DO NOT NEED TO QUARANTINE. ASYMPTOMATIC PERSONNEL WHO ARE NOT IMMUNIZED AND ARE SUSPECTED OF EXPOSURE SHALL QUARANTINE IN ACCORDANCE WITH (IAW) CDC AND LOCAL MEDICAL GUIDANCE. 3.B. SYMPTOMATIC PERSONNEL REGARDLESS OF IMMUNIZATION STATUS SHALL FOLLOW LOCAL MEDICAL AND CDC GUIDANCE ON WHAT TO DO WHEN YOU ARE SICK. 3.C. A NON-IMMUNIZED PATIENT WITH SUSPECTED COVID-LIKE ILLNESS (CLI) OR ILI WHO HAS TESTED NEGATIVE FOR COVID-19 MAY RETURN TO WORK AFTER: (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. IMMUNIZED PATIENTS WITH SUSPECTED CLI/ILI SHOULD CONSULT THEIR MEDICAL PROVIDER BEFORE RETURNING TO WORK. 3.D. COVID-19 CASES MAY CONTINUE TO TEST POSITIVE FOR UP TO THREE MONTHS DUE TO THE PRESENCE OF PERSISTENT NON-INFECTIOUS VIRAL FRAGMENTS AND THEREFORE EXEMPT FROM TESTING PROTOCOL FOR THREE MONTHS FROM THE EARLIER OF SYMPTOM ONSET OR FIRST POSITIVE TEST. INDIVIDUALS WHO EXHIBIT NEW OR PERSISTENT SYMPTOMS DURING THAT THREE MONTH PERIOD SHOULD BE EVALUATED BY A MEDICAL PROVIDER. 3.E. OUTBREAK INVESTIGATION AND CONTACT TRACING WORKFORCE TRAINING. EACH COMMAND WILL MAINTAIN THE ABILITY TO EXECUTE CONTACT TRACING FOR ASSIGNED PERSONNEL BY HAVING AN APPROPRIATE NUMBER OF PERSONNEL TRAINED (NO LESS THAN TWO) BASED ON UNIT IMMUNIZATION LEVEL. NAVY E-LEARNING: CONTACT TRACING TRAINING FOR SAILORS AND MARINES CFHP-NMFSC-CTSM-01 OR TEST-OUT ASSESSMENT FOR CONTACT TRACING TRAINING FOR SAILORS AND MARINES CFHP-NMFSC-CTSMTA-01. 4. DEPLOYED OPERATIONS 4.A. PRE-DEPLOYMENT SCREENING. SCREENING FOR ALL PERSONNEL WILL CONSIST OF AN ASSESSMENT OF EXPOSURE HISTORY, A REVIEW OF ANY PAST TESTING AND A THOROUGH EVALUATION OF THE MEMBERS RISK FACTORS FOR SEVERE ILLNESS FROM COVID-19. THE DECISION TO DEPLOY A HIGH RISK INDIVIDUAL MUST BE MADE, AT A MINIMUM, BY THE COMMANDING OFFICER IN CONSULTATION WITH MEDICAL PROVIDERS. MILITARY SEALIFT COMMAND (MSC) WILL MEDICALLY SCREEN CIVIL SERVICE AND CONTRACT PERSONNEL FOR DEPLOYMENT ON MSC VESSELS IAW EXISTING MSC INSTRUCTIONS AND CONTRACTS. IMMUNIZATION STATUS SHOULD BE PART OF THE DECISION TO DEPLOY HIGH RISK PERSONNEL ALONG WITH THE PERCENT OF THE UNIT IMMUNIZED, THE PROXIMITY TO AN MILITARY TREATMENT FACILITY (MTF) OR AFLOAT MEDICAL FACILITY WITH COVID THERAPEUTICS AND ICU CAPABILITIES, AND MEDICAL PROVIDER CONSULTATION. 4.B. PRE-DEPLOYMENT ROM-SEQUESTER. ROM-SEQUESTER IS NOT REQUIRED FOR IMMUNIZED INDIVIDUALS ATTACHED TO SHIPS OR SUBMARINES, NOR FOR IMMUNIZED INDIVIDUALS TRAVELING BY AIRCRAFT UNLESS OTHERWISE REQUIRED BY GCC AS MEANS OF RESPECTING HN LAW OR BY A MORE RESTRICTIVE DOD POLICY. FOR NON-IMMUNIZED INDIVIDUALS ONLY, 14-DAY ROM-SEQUESTER WITH TEST-IN AND TEST-OUT IS REQUIRED PRIOR TO DEPLOYMENT.DURING ROM-SEQUESTER, CONDUCT ENHANCED DAILY PERSONNEL MEDICAL SCREENING. 4.B.1. IAW REF (D), NON-IMMUNIZED PERSONNEL DEPLOYING OUTSIDE THE UNITED STATES NOT USING MILITARY/CHARTERED TRANSPORTATION WILL CONDUCT A 14-DAY ROM PRIOR TO DEPLOYMENT UNLESS COMBATANT COMMAND MANDATES IN-COUNTRY ROM. IAW REF (B), NCC MAY DELEGATE TO FIRST FLAG OFFICER/SES IN CHAIN OF COMMAND THE AUTHORIZATION TO REDUCE THIS ROM TIMELINE TO AS FEW AS SEVEN DAYS IF OPERATIONALLY NECESSARY WITH A NEGATIVE PCR TEST ADMINISTERED ONE TO THREE DAYS PRIOR TO EMBARKATION. INDIVIDUALS WHO HAVE HAD COVID-19 IN THE PAST THREE MONTHS ARE EXEMPT FROM ROM. IF TRAVELING OCONUS AND THE HOST NATION REQUIRES IN-COUNTRY ROM, CONUS PRE-DEPLOYMENT ROM-SEQUESTER IS NOT REQUIRED UNLESS THE HOST NATION OR COMBATANT COMMAND EXPLICITLY MANDATES BOTH. IMMUNIZED AND NON-IMMUNIZED PERSONNEL MUST CONSULT FOREIGN CLEARANCE GUIDANCE FOR MOST CURRENT REQUIREMENTS APPLICABLE TO ALL TRAVELERS, AVAILABLE AT HTTPS://WWW.FCG.PENTAGON.MIL. 4.B.2. ROM-SEQUESTER CONDUCTED ASHORE REQUIRES ISOLATION PER CDC GUIDANCE (IDEALLY SEPARATE ROOM, NO SHARED BATHROOM). A SECOND TEST SHALL BE CONDUCTED ON OR AFTER DAY 14 FOR NON-IMMUNIZED PERSONNEL. A NEGATIVE COVID TEST RESULT IS REQUIRED TO EMBARK AN OPERATIONAL UNIT IF NON-IMMUNIZED, OR IAW WITH NCC APPROVED COMMUNITY CONOPS (E.G., SSN/SSBN). 4.C. UNDERWAY HEALTH PROTECTION MEASURES (HPM). BASED ON A YEAR OF EXPERIENCE AND EXTENSIVE MODELING BY NAVY AND MARINE CORPS PUBLIC HEALTH CENTER INCORPORATING BASELINE NATURAL IMMUNITY, COVID PREVALENCE AND VACCINE EFFECTIVENESS WHICH IS CONTAINED IN REFS (E) AND (F), RECOMMEND UNDERWAY HPM IMPLEMENTATION AS FOLLOWS: -- LARGE DECKS WITH MEDICAL CAPABILITY (LPD/LHD/LHA/CVNS) AFTER NON-IMMUNIZED INDIVIDUALS COMPLETE QUALITY 14 DAY PRE-DEPLOYMENT ROM AND HAVE A NEGATIVE PCR TEST PRIOR TO EMBARKING: NCCS MAY RELAX HPM FOR ALL CREWMEMBERS ONCE UNDERWAY PROVIDED IMMUNIZATION RATE OF COMBINED CREW IS GREATER THAN 70%. IF IMMUNIZATION RATE IS LESS THAN 70%, NON-IMMUNIZED CREWMEMBERS MUST PRACTICE HPM FOR AT LEAST 14 DAYS UNDERWAY. IF NO CASES FOR AT LEAST 14 DAYS, THEN NCCS MAY RELAX HPM. -- SMALLER SHIPS OR THOSE WITH LESS ON-BOARD MEDICAL CAPABILITY (LHD/LHA/LPDS WITHOUT FLEET SURGICAL TEAM OR BOARD CERTIFIED MEDICAL OFFICER EMBARKED), AFTER NON-IMMUNIZED INDIVIDUALS COMPLETE QUALITY 14 DAY PRE-DEPLOYMENT ROM AND HAVE A NEGATIVE PCR TEST PRIOR TO EMBARK: NCCS MAY RELAX UNDERWAY HPM FOR ALL CREWMEMBERS ONCE UNDERWAY IF CREW IMMUNIZATION RATE IS GREATER THAN 80% (DUE TO LESS ONBOARD MEDICAL CAPABILITY). IF IMMUNIZATION RATE IS LESS THAN 80%, NON-IMMUNIZED CREWMEMBERS MUST PRACTICE HPM FOR AT LEAST 14 DAYS UNDERWAY. IF NO CASES FOR AT LEAST 14 DAYS, THEN NCCS MAY RELAX HPM. -- FOR ALL UNITS REGARDLESS OF TYPE WHEN NON-IMMUNIZED INDIVIDUALS HAVE NOT COMPLETED PRE-DEPLOYMENT ROM (E.G., LOCAL OPS, GROUP SAIL OR C2X): NCCS MAY RELAX UNDERWAY HPM FOR ALL CREWMEMBERS PROVIDED COMBINED IMMUNIZATION RATE IS AT LEAST 90%. IF IMMUNIZATION RATE IS LESS THAN 90%, NON-IMMUNIZED CREWMEMBERS MUST PRACTICE HPM FOR AT LEAST 14 DAYS UNDERWAY. IF NO CASES FOR AT LEAST 14 DAYS, THEN NCCS MAY RELAX HPM. -- HPM MEASURES MAY BE TEMPORARILY RELAXED WHERE OPERATIONALLY NECESSARY. -- IT IS ALWAYS GOOD PRACTICE FOR ALL CREWMEMBERS TO PRACTICE HPM WHENEVER PRACTICAL REGARDLESS OF VACCINATION STATUS TO HELP PREVENT A WIDE VARIETY OF SHIPBORNE DISEASES. 4.C.1. DISEASE SEVERITY AND VACCINES. GIVEN FDA AUTHORIZED VACCINES PROTECT AGAINST DISEASE SEVERITY, EVEN IN THE VERY SMALL PERCENT OF PEOPLE WHO MAY POTENTIALLY STILL GET COVID-19 INFECTION, THE RISK OF HAVING TO MEDEVAC AN IMMUNIZED COVID-19 INFECTED INDIVIDUAL IS EXTREMELY LOW. REDUCING THE LIKELIHOOD OF SEVERE ILLNESS IS A KEY OUTCOME MEASURE THAT SPEAKS TO THE ABILITY TO MAINTAIN OPERATIONS AT SEA WITHIN EXISTING MEDICAL CAPABILITIES. 4.D. PENETRATING A BUBBLE. 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 MEASURES. WHEN INVOLVED IN MOVEMENT TO SEQUENTIAL COMMANDS, IT MAY BE ADVISABLE TO ROM-SEQUESTER NON-IMMUNIZED COHORTS, USE BUBBLE TO BUBBLE TRANSPORTATION, AND/OR TEST NON-IMMUNIZED INDIVIDUALS PERIODICALLY. IMMUNIZED INDIVIDUALS ARE NOT REQUIRED TO ROM-SEQUESTER. NCCS MAY REQUIRE NON-IMMUNIZED SHIP RIDERS PENETRATING AN ESTABLISHED BUBBLE TO COMPLETE A 14- DAY ROM-SEQUESTER WITH TEST-IN AND TEST-OUT PRIOR TO EMBARKING DEPENDENT ON CREW IMMUNIZATION LEVEL. A TEST IS NOT REQUIRED FOR PERSONNEL WHO HAVE RECOVERED FROM COVID-19 WITHIN THE PAST 90 DAYS (DUE TO THE POSSIBILITY OF PERSISTENT POSITIVE RESULTS IN NON-INFECTIOUS PERSONS). IMMUNIZED PCS AND SHIP RIDERS WHO ARE ASYMPTOMATIC DO NOT NEED TO CONDUCT ROM PRIOR TO EMBARKING A SHIP. MITIGATION PLANS FOR NON-IMMUNIZED INDIVIDUALS TO PENETRATE AN ESTABLISHED BUBBLE WITHOUT A 14 DAY ROM-SEQUESTER AND/OR TEST DUE TO EMERGENT OPERATIONAL REQUIREMENTS MUST BE APPROVED BY THE COMMANDING OFFICER. 4.E. PORT VISITS. COMMANDING OFFICERS MAY ALLOW IMMUNIZED INDIVIDUALS ON UNITS MAKING PORT CALLS IN OVERSEAS SAFE HAVEN PORTS WHERE THERE IS U.S. PRESENCE AND BASE FACILITIES (E.G., GUAM, BAHRAIN, YOKOSUKA, ROTA, SASEBO) TO TAKE ADVANTAGE OF BASE SERVICES. GEOGRAPHIC NCCS (DELEGABLE TO NUMBERED FLEET COMMANDERS) WILL CONTROL FOREIGN PORT VISIT OFF-BASE LIBERTY FOR ALL INDIVIDUALS IN COORDINATION WITH COUNTRY TEAMS AND LOCAL AUTHORITIES TAKING INTO ACCOUNT INDIVIDUAL AND CREW IMMUNIZATION STATUS, COUNTRY COVID PREVALENCE AND MISSION REQUIREMENTS. 4.F. AIRCRAFT OPERATIONS. COMMANDERS MAY NEED TO EXEMPT AIRCREW AND AIRCRAFT MAINTAINERS FROM THIS GUIDANCE TO MEET EMERGENT OPERATIONAL OR NATOPS CURRENCY REQUIREMENTS. MITIGATION PLANS MUST BE APPROVED BY THE COMMANDING OFFICER. FOR AVIATION UNITS EMBARKED ON SURFACE UNITS, MITIGATION PLANS WILL BE INCLUDED AND APPROVED AS PART OF THE OVERALL SHIP HEALTH PROTECTION PLAN. 4.G. TESTING. TESTING IS THE ONLY METHOD TO DETECT ASYMPTOMATIC TRANSMISSION WITHIN THE NON-IMMUNIZED FORCE. CONSIDER SCREENING TESTS FOR NON-IMMUNIZED INDIVIDUALS DURING OFRP CYCLE TO IDENTIFY COVID-19 EARLY AND TO BREAK THE TRANSMISSION CYCLE. CONTINUOUSLY ASSESS THE INTEGRITY OF A BUBBLE THROUGH CLI/ILI SCREENING OF NON-IMMUNIZED PERSONNEL. PLATFORMS WITH TESTING CAPABILITY SHOULD EMPLOY SYMPTOMATIC TESTING (DIAGNOSTIC) FOR EVERYONE AND TARGETED CREW TESTING (SCREENING) FOR NON- IMMUNIZED SAILORS. 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. DIAGNOSTIC POOLED TESTING UNDERWAY IS ALLOWED FOR MODERATE COMPLEXITY LABS USING BIOFIRE AND CEPHEID AND 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. 4.H. POST-DEPLOYMENT. IAW CDC GUIDANCE, NON-IMMUNIZED PERSONNEL RETURNING TO CONUS FROM DEPLOYMENT ARE REQUIRED TO HAVE A NEGATIVE VIRAL TEST RESULT NO MORE THAN THREE DAYS BEFORE TRAVEL INTO THE U.S.; BE TESTED 3-5 DAYS AFTER ARRIVAL AND STAY HOME AND SELF-QUARANTINE FOR SEVEN FULL DAYS, EVEN IF THE TEST IS NEGATIVE. POST DEPLOYMENT ROM AND TESTING IS NOT REQUIRED FOR PERSONNEL WHO HAVE RECOVERED FROM COVID-19 WITHIN THE PAST 90 DAYS (DUE TO THE POSSIBILITY OF PERSISTENT POSITIVE RESULTS IN NON-INFECTIOUS PERSONS), AND DOES NOT APPLY TO SHIPS, THEIR EMBARKED AIRCRAFT OR SUBMARINES RETURNING TO PORT PROVIDED THERE HAVE BEEN NO ACTIVE COVID-19 CASES OR POTENTIAL CONTACT WITH INFECTED PERSONNEL DURING THE LAST 14 DAYS OF DEPLOYMENT.NON- IMMUNIZED INDIVIDUALS WHO DO NOT GET TESTED MUST STAY HOME AND SELF- QUARANTINE FOR 10 DAYS AFTER TRAVEL. NON-IMMUNIZED SERVICE MEMBERS REDEPLOYING FROM, ORTHROUGH, A FOREIGN COUNTRY, UPON ARRIVAL AT THE DESTINATION DOMICILE WILL ROM AT THEIR PERSONAL RESIDENCE (OR APPROPRIATE DOMICILE) FOR AT LEAST 10 DAYS WITHOUT TESTING OR AFTER AN APPROPRIATE RISK ASSESSMENT BY THE FIRST FLAG OFFICER IN THE CHAIN OF COMMAND FOR SEVEN DAYS WITH A NEGATIVE COVID-19 TEST WITHIN 48 HOURS PRIOR TO THE END OF THE SEVEN DAY ROM. SERVICE MEMBERS REQUIRED TO ROM ARE RESTRICTED TO THEIR RESIDENCE AND MUST LIMIT CLOSE \CONTACTS FOR THE DURATION OF ROM. 4.H.1. IMMUNIZED PERSONNEL HAVE NO ROM OR TESTING REQUIREMENTS POST- DEPLOYMENT. 4.H.2. AT THE COMPLETION OF DEPLOYMENT, MILITARY PERSONNEL WILL COMPLETE A POST-DEPLOYMENT HEALTH ASSESSMENT (DD FORM 2796) AND POST-DEPLOYMENT HEALTH REASSESSMENT (DD FORM 2900) IAW REF (D). 5. ALL UNITS, STAFFS AND SHORE COMMANDS. 5.A. HPM. FOLLOW LATEST DOD FORCE HEALTH PROTECTION, CDC AND STATE/LOCAL AREA GUIDANCE TO ENSURE THE HEALTH OF THE FORCE. 5.B. SEE REF (J) NAVADMIN FOR LATEST GUIDANCE ON ADJUSTING HEALTH PROTECTION CONDITIONS AND BASE SERVICES. 5.C. SEE REF (K) NAVADMIN UPDATES FOR LATEST GUIDANCE ON CONDITIONS BASED APPROACHES TO PERSONNEL MOVEMENT AND TRAVEL RESTRICTIONS. 6. 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. 6.A. 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. 7. PROVISION OF CREW HEALTH INFORMATION, TESTING AND QUARANTINE. NCCS WILL MAKE EVERY EFFORT TO COMPLY WITH THE POLICY GUIDANCE IN REF (L) REGARDING HOST NATION COVID-19 QUARANTINE AND TESTING REQUIREMENTS FOR ARRIVING U.S. FORCES AND CIVILIAN PERSONNEL. 7.A. SOVEREIGN IMMUNITY. SOME COUNTRIES MAY REQUEST DETAILED INFORMATION ABOUT THE HEALTH OF THE CREW ONBOARD, INCLUDING TEST RESULTS, PROOF OF VACCINATION, ETC., AS A CONDITION OF ENTRY. IT IS DOD AND DEPARTMENT OF THE NAVY POLICY TO PRESERVE THE SOVEREIGN IMMUNITY OF WARSHIPS, NAVAL AUXILIARIES, AND SOVEREIGN IMMUNE AIRCRAFT, INCLUDING PROTECTING CREW INFORMATION, TO THE MAXIMUM EXTENT POSSIBLE. THE NAVY DECLARATION OF HEALTH (NAVMED 6210/3) IS THE ONLY AUTHORIZED MEANS FOR PROVIDING HEALTH INFORMATION OF THE CREW TO FOREIGN OFFICIALS. PROVIDING ANY INFORMATION BEYOND THE NAVMED 6210/3 AS A CONDITION OF ENTRY EXCEEDS THE U.S. REQUIREMENTS UNDER INTERNATIONAL LAW AND CONTRARY TO THE EXECUTIVE BRANCH POSITION. SHOULD A HOST NATION REQUIRE INFORMATION BEYOND THE NAVMED 6210/3 AS A CONDITION OF ENTRY, CONSULT WITH THE APPLICABLE GEOGRAPHIC NAVAL COMPONENT COMMAND (GNCC). SEE REF (M) FOR ADDITIONAL GUIDANCE. 7.A.1. COMMANDING OFFICERS, MASTERS, AND AIRCRAFT COMMANDERS SHALL COMPLY WITH ALL DOMESTIC AND FOREIGN QUARANTINE REGULATIONS FOR PORT ENTRY, AND MAY DOCUMENT SUCH COMPLIANCE ON THE NAVMED 6210/3. COMMANDING OFFICERS, MASTERS, AND AIRCRAFT COMMANDERS SHALL NOT PROVIDE ANY INDIVIDUAL OR COLLECTIVE MEDICAL DATA OR COPIES OF HEALTH RECORDS, NOR ANY SUPPLEMENTARY OR LOCALLY DEMANDED HEALTH FORMS, AND SHALL NOT GRANT ACCESS TO SHIP OR CREW HEALTH RECORDS OR ALLOW THE SAME TO BE SEARCHED OR INSPECTED BY HOST NATIONS. 7.A.2. SERVICE MEMBERS AND THE CREWS OF NAVAL AUXILIARIES WILL NOT SUBMIT TO HOST NATION COVID-19 TESTING AS A REQUIREMENT OF PORT ENTRY. NOR SHALL HOST NATION OFFICIALS BE PERMITTED TO REQUIRE PRODUCTION OF, OR TAKE A PHOTOCOPY OF, SERVICE MEMBERS PROOF OF VACCINATION AS A CONDITION OF PORT ENTRY. 7.A.3. ANY ACTION THAT MAY CONSTITUTE A WAIVER OR POTENTIAL WAIVER OF SOVEREIGN IMMUNITY MUST BE COORDINATED WITH OPNAV N3N5 PRIOR TO ACTION BEING TAKEN. IAW REFS (L) AND (M), AND NAVY POLICY, GNCCS SHALL PROVIDE AS LITTLE INFORMATION AS POSSIBLE IN ORDER TO MEET MISSION ESSENTIAL OPERATIONAL REQUIREMENTS AND SHOULD NOT SUBMIT TO ANY REQUIREMENT THAT THE U.S. WOULD NOT REQUIRE OF SIMILAR VISITORS (E.G., THE U.S. DOES NOT REQUIRE HN TESTING OR PROOF OF VACCINATION FOR THE CREWS OF VISITING WARSHIPS OR NAVAL AUXILIARIES). GNCCS WILL DETERMINE IN ADVANCE WHICH HOST NATIONS WILL REQUIRE SUCH INFORMATION AND SHIPS MAY BE DIVERTED AS NECESSARY, TO AVOID PROVIDING INFORMATION CONTRARY TO THESE REQUIREMENTS. 7.B. OPNAV STRONGLY DISFAVORS PERMITTING HOST NATION TESTING OF PERSONNEL. HOST NATION TESTING MAY NOT MEET U.S. HEALTH AND SAFETY PROTOCOLS, MAY UNNECESSARILY EXPOSE OUR PERSONNEL TO FOREIGN DATA COLLECTION, MAY PROVIDE UNVERIFIABLE AND/OR INACCURATE RESULTS, AND ESTABLISHES POOR PRECEDENT FOR FUTURE HEALTH EMERGENCIES.WHEN GNCCS DETERMINE THAT ACQUIESCING TO HN TESTING IS NECESSARY FOR MISSION ACCOMPLISHMENT, GNCCS WILL CONSULT WITH BUMED OR FORCE SURGEON TO ENSURE THAT SUCH HN TESTING MEETS ESTABLISHED INTERNATIONAL STANDARDS OF CARE. ADDITIONALLY, ACQUIESCING TO HOST NATION TESTING IS CONTRARY TO U.S. PRACTICE FOR SIMILAR VISITORS. 7.C. PERSONNEL EXITING THE PIER/AIRPORT FACILITY. IF REQUIRED TO EXIT THE PIER/AIRPORT FACILITY AND ENTER THE HOST NATION, THE GNCCS, IN CONJUNCTION WITH THE COUNTRY TEAM, MAY ASSERT THAT ONLY VACCINATED INDIVIDUALS WILL BE ALLOWED WITHIN THEHOST NATION, BUT MAY NOT PROVIDE THE PERCENTAGE OR TOTAL NUMBER OF THE CREW THAT HAS BEEN VACCINATED. OTHER ALLOWABLE MEASURES INCLUDE SUBMITTING TO A TEMPERATURE SCAN UPON ENTERING/EXITING THE PIER OR THE AIRPORT. THESE ASSERTIONS AND MEASURES SHOULD NOT BE ALLOWED FOR PERSONNEL SOLELY USING PIER/AIRPORT FACILITIES IN SUPPORT OF PORT VISITS (E.G., INSIDE AN ECP OR SAFE-HAVEN ARRANGEMENT) AND NOT ENTERING THE HOST NATION. 7.C.1. AIRCRAFT COMMANDERS SHALL COMPLY WITH FOREIGN CLEARANCE GUIDE REQUIREMENTS FOR ENTRY INTO THE HOST NATION (E.G., MOVING OUTSIDE OF AN ECP OR SAFE-HAVEN ARRANGEMENT). 7.C.2. U.S. WARSHIPS AND NAVAL AUXILIARIES. HOST NATION TESTING OF INDIVIDUALS FORENTRY INTO THE HOST NATION FOR MISSION ESSENTIAL OPERATIONAL REQUIREMENTS, BUT NOT LIBERTY, CAN BE APPROVED BY THE GNCC. SHIPS ENTERING A HOST NATION UNDER SUCH CONDITIONS SHOULD LIMIT THEIR SHORE PARTY TO MISSION ESSENTIAL PERSONNEL. GNCCS SHOULD MAKE EVERY ATTEMPT TO GAIN HOST NATION PERMISSION TO HAVE THE NAVY CONDUCT ONBOARD TESTING USING NAVY EQUIPMENT PRIOR TO ENTRY TO AVOID SUBJECTING U.S. PERSONNEL TO LOCAL HEALTH TESTING. GNCCS ACQUIESCING TO HN TESTING FOR MISSION ESSENTIAL OPERATIONAL REQUIREMENTS SHOULD NOTIFY OPNAV N3N5. NOTIFICATION SHOULD INCLUDE DESCRIPTION OF HN REQUIREMENTS. OPNAV N3N5 APPROVAL IS REQUIRED PRIOR TO HOST NATION TESTING FOR QUALITY OF LIFE (LIBERTY) PORT VISITS. UNITS REQUESTING LIBERTY IN PORTS REQUIRING HOST NATION TESTING MUST ROUTE A REQUEST VIA THE CHAIN OFCOMMAND TO OPNAV N3N5. REQUESTS SHALL CONTAIN JUSTIFICATION FOR SELECTING A PORT REQUIRING HOST NATION TESTING, TESTING REQUIREMENTS OF THE HOST NATION, WHY AN ALTERNATE PORT IS NOT FEASIBLE, AND IMPACT TO MISSION IF THE REQUEST IS DENIED. REQUESTS SHOULD ALSO INCLUDE AN ASSESSMENT OF THE MEDICAL RISK, LEGAL RISK, COLLECTION AND PRIVACY RISK, ANTITERRORISM/FORCE PROTECTION RISK, MISSION RISK, AND COUNTRY TEAM COORDINATION. NOTIFICATIONS AND REQUESTS SHOULD BE SENT VIA RECORD MESSAGE TRAFFIC. 7.D. GNCCS WILL ENSURE APPROPRIATE TRAINING ON THE PROTECTION OF HEALTH INFORMATION AS PART OF OPSEC/PERSONAL SECURITY AND ON THE IMPORTANCE OF VIGOROUSLY DEFENDING THE ABSOLUTE SOVEREIGN IMMUNITY OF WARSHIPS AND THE SOVEREIGN IMMUNITY OF OTHER STATE VESSELS AND AIRCRAFT. 8. TESTING. REF (G) IS CANCELLED AND REPLACED WITH THE FOLLOWING GUIDANCE. 8.A. ASYMPTOMATIC TESTING REQUESTS AND COORDINATION. COMMANDS WILL COORDINATE TESTING NEEDS WITH THEIR SUPPORTING MTF 60 DAYS IN ADVANCE FOR PLANNED SHIP / SQUADRON / UNIT MOVEMENTS. ADVANCED PLANNING IS REQUIRED TO ENSURE TESTING CAPACITY IS AVAILABLE TO SUPPORT OPERATIONAL DEMANDS. 8.A.1. ISIC AND TYPE COMMANDERS WILL ENSURE TESTING IS PLANNED AND COORDINATED IN ADVANCE. 8.A.2. ISIC AND TYPE COMMANDERS WILL COORDINATE WITH THE APPROPRIATE NAVY MEDICAL REGION TO SUPPORT SHORT NOTICE (LESS THAN TWO WEEKS ADVANCED PLANNING) TESTING. 8.B. SENTINEL SURVEILLANCE TESTING (SST) IS REQUIRED PER REF (H). SST IS DESIGNED TO DETECT AND PREVENT ASYMPTOMATIC SPREAD OF COVID-19. COMMANDS WITH GREATER THAN 75% FULLY IMMUNIZED PERSONNEL WILL TEST THE DESIGNATED PERCENTAGES IN PARAGRAPH 8.B.1 AND 8.B.2 MONTHLY VICE EVERY 14 DAYS DUE TO HIGHER VACCINATION RATES. COMMANDS WITH GREATER THAN 85% IMMUNIZATION DO NOT REQUIRE SST. COMMANDS WHO ARE TESTING THEIR INSTALLATION/UNIT POPULATION TO MEET TRAVEL/HOST NATION/FHP 16 TRAVEL REQUIREMENTS CAN INCLUDE THOSE TESTS IN THEIR SST CALCULATIONS. 8.B.1. COMMANDS WILL TEST 1% OF NON-IMMUNIZED CREW/STAFF EVERY 14 DAYS.COMMANDS WITHOUT ORGANIC TESTING CAPABILITY WILL COORDINATE WITH THEIR SERVICING MTF. 8.B.2. MEDICAL COMMANDS UNDER THE AUTHORITY, DIRECTION AND CONTROL OF THE NAVY WILL TEST TEN PERCENT OF NON-IMMUNIZED PERSONNEL EVERY 14 DAYS. 9. VACCINE ORDERING AND ADMINISTRATION. AMPLIFYING GUIDANCE TO REF (C). 9.A. NEW COVID VACCINATION SITES MUST COMPLETE TRAINING, LOGISTICS, AND PREPAREDNESS FOR VACCINE ADVERSE REACTIONS IAW REF (I), COMPLETE A READY TO RECEIVE CHECKLIST AND SUBMIT TO TYCOM FOR REVIEW. 9.A.1. COMMANDING OFFICERS OF NEW VACCINATION SITES WILL ENSURE VACCINATION PERSONNEL COMPLETE TRAINING REQUIRED BY REF (I) AS PART OF THE READY TO RECEIVE CHECKLIST. 9.A.2. COMMANDING OFFICERS OF NEW VACCINATION SITES WILL ENSURE APPROPRIATE COLD STORAGE CONDITIONS ARE AVAILABLE, TEMPERATURE CONDITIONS ARE SPECIFIC TO EACH VACCINE AND AVAILABLE FROM THE US FDA FOR AUTHORIZED AND LICENSED VACCINES. 9.B. ONLY SHIPS WITH ROLE TWO CAPABILITIES EMBARKED ARE AUTHORIZED TO ADMINISTER VACCINE WHILE AT SEA. ALL FLEET PLATFORMS WHO HAVE COMPLETED REQUIREMENTS IAW REF (I) ARE AUTHORIZED TO ORDER AND ADMINISTER VACCINE PIER- SIDE WHEN ACCESS TO ROLE TWO OR EMERGENCY MANAGEMENT SERVICES SUPPORT IS READILY AVAILABLE. 10. EXTERNAL NAVY VACCINE REPORTING. ACTIVE DUTY AND RESERVE PERSONNEL VACCINATED AT A COMMERCIAL OR GOVERNMENT VACCINATION SITE OUTSIDE THE DEFENSE HEALTH AGENCY NETWORK WILL PROVIDE VACCINATION DOCUMENTATION TO THEIR UNIT MEDICAL REPRESENTATIVE FOR INCLUSION IN ELECTRONIC HEALTH RECORDS. UNITS WITHOUT ORGANIC MEDICAL PERSONNEL WILL PROVIDE VACCINATION DOCUMENTATION TO THE LOCAL MILITARY TREATMENT FACILITY OR CLINIC WHERE THEIR PRIMARY CARE IS PROVIDED. RESERVE UNITS WILL ACTIVELY VERIFY VACCINATION STATUS AT EACH VIRTUAL OR IN PERSON DRILL WEEKEND AND RESERVISTS WILL TURN IN THEIR VACCINE DOCUMENTATION AT THEIR NEXT WORKDAY/DRILL DAY FOR INCLUSION IN THEIR HEALTH RECORD. 11. RELEASED BY RADM K. O. THOMAS, ASSISTANT DEPUTY CHIEF OF NAVAL OPERATIONS FOR OPERATIONS, PLANS AND STRATEGY, OPNAV N3/N5B.// BT #0001 NNNN UNCLASSIFIED//