County Community Disease Containment
Standard Operating Guide
AUTHORITIES
Primary Agency
Supporting Agencies
 X County Health Department
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Emergency Medical Services (EMS)
Local hospital(s)
X County Emergency Management
Behavioral/Mental Health Agency
Local Funeral Directors
County/District Coroner
X County Sheriff
Local Elected Officials
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I. MISSION
The Community Disease Containment Standard Operating Guide (CC SOG) provides X
County with step-by-step instructions for reducing or minimizing person-to-person spread
of disease by separating individuals with disease or at an increased risk for developing
disease from individuals at lower risk.
I.a. PURPOSE
The CC SOG is used during infectious or contagious disease outbreaks to assist decision
makers in implementing community containment measures, which require individuals to
be separated from the general population. This SOG and the core attachment the
“Kansas Community Containment Isolation/Quarantine Tool Box” (Attachment 1) contains
information and tools needed to implement a range of measures necessary in the case of
an outbreak of infectious or contagious disease. The tools include flow charts, statutes,
regulations, sample forms, and protocols for performing the tasks associated with
community disease containment. This SOG is interdependent with other SOG’s. The
related SOG’s are referenced in this SOG and must be referred to when dealing with
community disease containment issues. The Kansas Isolation and Quarantine statute
K.S.A. 65-129 (Attachment 1, Section V.) provides the template for control efforts in the
case of large-scale outbreaks of naturally occurring diseases like pandemic influenza or
SARS or artificially introduced biological agents in connection with bioterrorism.
There are many other alternatives that will be utilized beyond individual isolation and
quarantine. These alternatives are addressed within this SOG. The effectiveness of
these measures will rely upon the understanding, comprehension and active cooperation
of the public, business and clinical care infrastructures within communities. These
measures are discussed in Attachment 1/Section II.
I.b. SCOPE
The X County Health Department will maintain and update this SOG and will provide all
involved community partners with a copy. A copy of this guide will be maintained at the X
County Health Department as well as X County Emergency Management. A copy or
appropriate excerpts/sections will be provided to local legal and or law enforcement
authorities in the event of their involvement. The following is a link to the online version of
the Tool Box (Attachment 1) that can be used or be sent to partners in a community
containment activity (state link will be provided when developed or local link can be
created).
In accordance with CDC and KDHE requirements, this guide will be reviewed quarterly to
ensure accurate and updated information. Changes will be posted on the “Record of
Review and Update” found at the front of the SOG.
II. SUMMARY
X County has formed a HEALTH AND MEDICAL TASK FORCE as a part of the county
Biological Incident Annex that will ensure a multi-disciplinary approach to planning for and
response to incidents requiring a major medical or public health response including
Community Containment measures, in accordance with state law, regulations and
pertinent CDC guidance. The Health and Medical Task Force will meet program
requirements as set forth in the preparedness checklist for community containment
measures in (Attachment 1/Section II [preparedness checklist]).
A HEALTH AND MEDICAL TASK FORCE may be expanded (depending upon scope and
magnitude of the situation) to include:
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State Health Officer
State Epidemiologist
State legal counsel
State program (pertinent to diseases associated with event) staff
Local County or District Attorney
Local and/or County Law Enforcement
Local and State Emergency Management
Regional or surrounding jurisdiction local health officers
These positions and their back-up point-of-contact information can be found in the X
County Mass Dispensing SOG.
The following provides guidance on the range of approaches that will be used in relation
to various levels of threat represented by different infectious and contagious diseases. In
addition, specific guidance documents and templates are provided for use by local health
departments in conjunction with Kansas’s statutes associated with Isolation, Quarantine
and other community containment measures (Attachment 1/Section II).
Command and Control (Decision Making):
Implementation of community disease containment measures will require cooperation
between local, state, and possibly federal authorities. K.S.A. 65-129 provides the local
county health officer or the state health officer with the authority to declare necessary
containment measures (Attachment 1/section V). X County is required to use the county
specific Incident Command System (ICS) in accordance with National Incident
Management System (NIMS) requirements.
A copy of the incident command structure for community disease containment in X
County can be found in the attachment 2. The emergency call-down roster for
community disease containment in X County is located in Attachment 3.
These positions and their back-up point-of-contact information can be found in
Attachment 4. Job action sheets for the command staff are found in Attachment 5.
At any given time during the containment process, X County will activate the required level
or levels of community containment measures based upon the scope of the threat
represented by a particular infectious or contagious disease agent, its mode of
transmission and control, and its anticipated impact on the community. Guidance and
recommendations for these measures can be found in Attachment 1/Section I (flow charts)
and Section II (Guidelines and Recommendations). If X County Health Officer is unable to
function in their legally designated capacity or determines that the magnitude and scope
of the event extends beyond their jurisdiction or available resources, the State Health
officer and/or designee(s) shall serve in X County health officers place in accordance with
(K.S.A. 65-129).
III. LEVELS OF ACTIVATION
X County Local Health Officer or health department designee(s) in conjunction with the
Health and Medical Task Force will assess the impact of a particular infectious and
contagious disease and determine the scope and magnitude of the community
containment measures in conjunction with the local or state epidemiologist and pertinent
program staff. The X County Local Health Officer in conjunction with the Health and
Medical Task Force will determine the levels of activation needed based upon the
guidance provided in the X County Biological Incident Annex and will direct their actions
through the use of the tools provided in The Kansas Community Containment
Isolation/Quarantine Toolbox found in Attachment 1 (toolbox) and involve other members
of the HEALTH AND MEDICAL TASK FORCE as indicated.
X County Local Health Officer and/or designees in conjunction with the HEALTH AND
MEDICAL TASK FORCE will assess the need to involve community partners at levels
indicated by the determinations of the HEALTH AND MEDICAL TASK FORCE and draft
orders for the enforcement of various community containment measures as warranted by
events (Attachment 1/Section III [sample orders]). During a response requiring activation
of this SOG, X County Health Officer and/or health department designees will coordinate
with community partners to:
(A)
General (refer to X County Biological Incident Annex)
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X County Health Department Administrator/Designee will activate the HEALTH
AND MEDICAL TASK FORCE and establish an incident command structure in
accordance with the Local Emergency Operation Plan.
Activate established legal preparedness plan (refer to Attachment I/Section III).
Notify community partners, such as law enforcement, first responders, healthcare
facilities, mental health professionals, local businesses, and the legal community
using the X County emergency personnel call-down roster (Attachment 3).
Monitor and assess factors that will determine the types and levels of response,
including the epidemiologic profile of the outbreak, available local resources, and
level of public acceptance and participation.
Activate the Crisis Risk Communications SOG for the X County Public Health
department
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(B)
Temporary emergency facilities for patient isolation, quarantine, and
assessment of patients (Attachment 1/Section IV [appendix 3])
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Activate appropriate community-based facilities for isolation of patients who have
no substantial healthcare requirements.
Activate facilities that will be used for individuals who do not have access to an
appropriate home setting (e.g. travelers and homeless populations) when home
isolation is indicated
Activate quarantine facilities and plans for staffing and equipping them.
Utilizing the MASS DISPENSING SOG activate clinic sites and plans for staffing
and equipping them, including the ability to dispense antiviral drugs to identified
cases in the priority groups.
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(C)
Community containment measures (Att. 1/Section I/Section II/Section IV)
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Activate procedures and legal authorities to restrict movement within the
community as necessary.
Activate procedures for medical evaluation and isolation of quarantined persons
who exhibit signs of illness.
Provide Just in time training for volunteers, first responders and healthcare
workers, as necessary, in the use of personal protective equipment
Provide appropriate prophylaxis or vaccination for law enforcement, first
responders or those individuals or groups having at-risk contact with individuals in
isolation or quarantine based on the priority prophylaxis list (Attachment 6).
Activate the local health department Crisis Risk Communications SOG and the
local Mental Health Plan (in development) in order to prevent stigmatization and
provide mental health services to persons in isolation or quarantine.
Utilizing community partners as supporting agencies, implement movement
restrictions (including quarantine, and the provision of essential services and
supplies). Examples of supporting agencies are as follows:
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Law enforcement
Emergency Medical Services
Local Elected Officials
First responders
Other government service workers
Utilities
Transportation industry
Local businesses
Schools and school boards
Clergy and other NGO’s
(D)
Utilizing tools provided in the X County Biological Incident Annex and
Attachment 1/Section IV, coordinate delivering medical care, food, and
services to persons in isolation or quarantine. Examples of services that will
require the help of non-traditional partners include:
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Coordinate with the county Emergency Operations Center to activate the
infrastructure to deliver essential goods and services to persons in isolation and
quarantine. Plans or delivering essential goods and services can be found in the X
County LEOP:
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Food, water, electricity, garbage collection, heating or air conditioning
Medications, medical supplies, and medical consultation
Mental health services
Faith based services
Other supportive services (day care, laundry, banking, essential shopping,
etc.)
Social diversion (television, radio, internet access, reading material)
Transportation for medical evaluation and/or treatment
Communication resources (phone, internet, etc)
IV. LEVELS OF CONTAINMENT(Attachment 1/Section II)
No single strategy for limiting the spread of contagious disease is possible or appropriate
for all types of disease outbreaks. Because each outbreak will be situational, specific
strategies need to be flexible, adaptable and developed for a “case-by-case” basis. The
five primary tools of infection control, isolation, quarantine, community restrictions and
sheltering can be used separately or in combination to limit the spread of disease.
Decision makers will employ the least restrictive means necessary to limit exposure and/or
disrupt transmission of the disease. See Attachment 1 Section I (Community Containment
Flowchart) and Section II for levels of containment. The “Key Considerations” noted in
Section II must be met for implementation of the more extreme measures.
V. OPERATIONAL IMPLEMENTATION
X County Health Officer and/or health department designees working with the HEALTH
AND MEDICAL TASK FORCE shall implement the various Community Containment
measures as indicated by the nature of the infectious or contagious disease agent and the
scope and magnitude of the anticipated impact on the community as determined by the
following:
(a) Protocol for Rapid Response and Containment (Adapted from the WHO
Pandemic Influenza Protocol for Rapid Response and Containment):
http://www.who.int/csr/disease/avian_influenza/guidelines/pandemicfluprotocol_17.
03a.pdf.
Recognize the event: The X County health department infectious disease
nurse/administrator/designee will receive a report of a confirmed, probable or suspect
case of an infectious or contagious disease from the Kansas Department of Health and
Environment’s Health Alert Network or their local hospital laboratory. X County health
officer and/or their designee will activate the HEALTH AND MEDICAL TASK FORCE.
The HEALTH AND MEDICAL TASK FORCE will ascertain the nature of the threat
according to the flow charts and decision trees found in Attachment 1/Section I utilizing
the X County Biological Incidence Annex for guidance.
Responsibilities of the HEALTH AND MEDICAL TASK FORCE:
Verify the event: During an outbreak situation, after the causative agent has been
identified, laboratory confirmation of cases may not be required for a jurisdiction to
initiate community containment measures. However, when X County receives
notification of case/cases (see BIA or,
http://www.kdheks.gov/labs/downloads/Lab_table_revised_K_8_3_05_draft_revise
d.xls) with a disease condition that is considered a threat to the community, X
County Health Officer and/or designated health department staff and the HEALTH
AND MEDICAL TASK FORCE will carry out an initial risk assessment to determine
the control measures warranted by the nature of the infectious or contagious
disease agent.
Individual Containment Measures: In certain circumstances individuals who are
infected or exposed to contagious disease agents will be separated from persons
who are well.
Isolation is used when a person who is believed to be ill as a result of infection
with a communicable disease agent or who is believed to be shedding the
infectious or contagious disease agent is kept separated from healthy persons to
prevent the spread of the disease. A decision tree for individual isolation can be
found in Attachment 1/Section I.
Quarantine is used when a healthy individual is believed to have been exposed to
a communicable disease agent and are kept apart from other healthy persons to
prevent spread of the disease. A decision tree for individual quarantine can be
found in Attachment 1/Section I
Community Disease Containment Measures are used if disease transmission is
significant and sustained, local public health authorities will consider implementing
community-based containment measures (Attachment 1/Section I [Community
Containment Decision Tree]).
Public education and communication will be a critical element of any plan,
particularly when oversight is logistically difficult or impossible. Posting of signs in
public places and community gathering spots (e.g., billboards, on major thoroughfares, in newspapers, in grocery stores, in offices buildings, community centers,
places of worship, and throughout public transportation systems) can reinforce
public messages. The media will be enlisted to help provide information in this
effort. The X County Health Department Risk Communications SOG shall be
initiated in accordance with various levels of activation.
Community-wide infection control measures: Members of the Health and
Medical Taskforce will encourage all persons with signs and symptoms of a
disease to utilize measures to protect themselves and others. The range of
measures can be found in Attachment 1 Section II.
Snow days and self-shielding: Members of the Health and Medical Taskforce
will encourage the community to stay home and avoid public places and public
gatherings. The length of the snow day period may encompass the incubation
period of a disease. Compliance with the snow day is encouraged and may be
enhanced by self-shielding activities. Information about snow days and selfshielding can be found in Attachment 1 Section II.
Closure of public buildings: Members of the Health and Medical Taskforce will
encourage closure of public buildings when warranted. This option will have a
large impact on business and community infrastructure. Information about closure
of public buildings can be found in Attachment 1 Section II.
Widespread community quarantine: in extreme circumstances the HEALTH
AND MEDICAL TASK FORCE will consider the use of widespread or community
wide quarantine. Information on widespread community quarantine can be found
in Attachment 1 Section II Page 6. Key considerations for large-scale
community disease containment can be found in the Kansas Community
Containment Flow Chart (Attachment 1 Section I [community containment
flow chart] and Section II [Key Considerations]).
X County Health officer and the HEALTH AND MEDICAL TASK FORCE will determine
that due to the nature of an infectious or contagious disease agent that one of the above
containment measures or variations (Attachment 1/Section II) is warranted. If the
HEALTH AND MEDICAL TASK FORCE determines that individuals or group of individuals
will agree to voluntarily isolate and/or quarantine themselves, X County Health Officer or
designee will deliver a request/order (Attachment 1/Section III, sample orders – Section
I/flow charts). If X County Health officer and HEALTH AND MEDICAL TASK FORCE
determine that an individual or group of individuals will not agree to voluntarily submit to
isolation and/or quarantine, X County Health Officer will expand the HEALTH AND
MEDICAL TASK FORCE as circumstances warrant in this SOG to include legal and/or law
enforcement authorities (Attachment 1 Section I and Section II). X County Health Officer
or designee will deliver orders appropriate to the circumstances (Attachment 1/Section III
[Law Enforcement Communication]).
HEALTH AND MEDICAL TASK FORCE assesses and determines the need to identify
contacts that may be at risk for contracting the indicated infectious or contagious
disease.
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1. Management of contacts
Community-based containment measures (Attachment 1./Section I/flow chart for
community containment)
1. Measures that affect groups of exposed or at-risk persons
o Quarantine of groups of exposed persons
o Containment measures that apply to use of specific sites or buildings
2. Measures that affect communities
o Promotion of community-wide infection control measures (e.g., respiratory
hygiene/cough etiquette)
o Snow days and self shielding
o Closure of office buildings, shopping malls, schools, and public
transportation
o Widespread community quarantine (A full discussion of the range of
measures and associated activities can be found in Attachment 1/Section II)
3. Compliance
Voluntary Compliance
o Risk Communication/Education
o Basic needs
o Business Continuity/Financial Relief
o Promoting peace of mind
o Rewards and Incentives
Enforced Compliance
o Law enforcement
o Perimeters and active monitoring (Attachment 1/Section II/IV [appendices 1
& 2])
o Punishing Noncompliance
VI. ESSENTIAL GOODS AND SERVICES
Addressing essential needs is important to induce compliance and requisite to enforce
compliance, particularly in the case of large-scale outbreaks that may require expansive or
prolonged disease exposure control measures. Authorities must be capable of meeting
the needs of those who cannot do so independently. Information regarding this can be
obtained in the X County BIA and (Attachment 1, Section IV).
Essential Goods are goods that are required to maintain life, health, and general well
being and are usually categorized into three tiers: 1) basic life requirements; 2) general
health and sanitation needs; and 3) compliance-enhancing goods and services.
Essential services are those that meet daily needs and must be maintained during a
crisis—including communications, utilities/heating, and sanitation.
The X County Health Department Administrator/designee will activate the LHD COOP
SOG to ensure health department essential services are available to the public.
VII. SPECIAL POPULATIONS’ NEEDS
The X CHD Administrator/Designee will coordinate with the Health and Medical Task
Force, local EM, and representatives of the community partners dealing with special
needs populations to ensure that individuals with special needs have access to essential
goods and services during an public health emergency requiring the implementation of
community disease containment measures. The X County Health Department Crisis Risk
Communication SOG will be utilized to create messaging that enables all special needs
individuals to understand how to protect themselves and measures that will be taken if
they have been isolated or quarantined within their facility.
VIII. HUMAN CONSIDERATIONS
Families.
• Separation from family will be a major stressor to those in quarantine.
• Separated family members shall be provided with reasonable options for reunification. A
special case arises when either a parent or a child—but not both—must be quarantined or
isolated. Even in cases where home quarantine is an option, exposed parents shall, when
feasible, be permitted to choose facility quarantine in order to minimize the risk to their
children.
Parents of exposed children (who may normally be placed in facility quarantine/isolation)
may wish to care for their children at home and will be allowed to do so if they can provide
adequate medical care.
In some cases, officials will consider requests from family members to enter a quarantined
facility or area in order to be with family members. In extreme circumstances such as
imminent death of a person in isolation, family members will be permitted into isolation,
provided that they use appropriate protective equipment and enter quarantine following
the visit.
• Multiple methods of communication will be made available to family members.
Communication via telephones, walkie-talkies, two-way radios, blackberries, e-mail, webbased chats, or videoconferencing.
• Hospitals will identify individuals in quarantine or isolation to KDHE and X County Health
Department.
Special Needs Groups
Groups that require additional resources (e.g. problems with physical mobility or language
skills) maybe unable to comply with disease containment measure unless their special
needs are met.
• Homeless populations that may have been exposed will be identified and transported to
a pre-identified facility (Attachment 7) for isolation or quarantine.• Transportation will be
arranged for the elderly, disabled, and/or immobile. These groups may need specially
equipped vehicles or the assistance of response personnel for transport to pre-identified
quarantine or isolation facilities (Attachment 7).
• Blind and deaf populations shall have access to alternative forms of information
communication. Among other assistance, the blind will need Braille informational
materials, and the deaf may require sign-language translation.
• Measures will be taken to reduce the risk of spreading infection among prison
populations. The correctional facility will cancel outside visits, require protective gear
among prisoners and employees, adjust sentences, shift prisoner locations, and develop
protocols for prisoner transportation.
Foreign Groups
• X County Health Department and the HEALTH AND MEDICAL TASK FORCE shall use
the X County Crisis Risk Communications SOG to construct informational materials,
signage, and in-person interactions that will be made available in multiple languages.
Health monitoring and counseling services, will be provided by multilingual workers, and
quarantine orders and other legal documentation shall be prepared in multiple languages
prior to an outbreak by X County Health Department. Additional translation services will
be provided using the Language Line translation service (Attachment 8) by X County
Health Department.
• X County Health Department and the HEALTH AND MEDICAL TASK FORCE shall use
the X County Crisis Risk Communications SOG to ensure efforts are made to
accommodate the needs of various ethnic groups. Special care will be taken to ensure
that control measures do not reflect any prejudice or bias against ethnic groups. Effort
shall be made to accommodate special diet and cultural practices when delivering food
and supplies. Counseling will be provided, when possible, from those of the same ethnic
and linguistic backgrounds.
IX. MENTAL HEALTH NEEDS
a) Family Communication
Communication will be provided using telephone, videoconference, and/or internet/email
access. Those observing disease exposure controls will be provided with a means of
contacting their families and friends.
b) Counseling
Professional counselors, clergy, or members of the community with proper mental health
training will provide counseling. Counselors will use Internet chat rooms to talk to those
observing disease exposure controls.
XI. DETERMINING END OF ISOLATION AND QUARANTINE PERIOD
a) Discharge from Isolation (Attachment 1/Section III and IV)
Recovered patients may continue to be infectious (e.g., for influenza, shed virus from the
respiratory tract or from feces) after overt clinical symptoms have stopped. The X County
Health Department Administrator/Health Officer/Designee will adhere to quarantine and
isolation timeframe requirements set forth in KAR 28-1-6
(http://www.kslegislature.org/legsrv-kars) and guidance issued by KDHE pertaining to
diseases not addressed within K.A.R. 28-1-6. To avoid transmission after release from
isolation/ hospital, patients shall remain in quarantine (home or other appropriate facility)
for the length of the incubation period of the disease. Recovered patients may or may not
have developed immunity and may or may not still be infectious and thus must be
educated by X County Health Department Administrator/Designee/Health Officer about
their health risks, the risks they present to their community, and the possibility that they
may become re-infected if further exposed to the infectious agent. Educational material
for contagious disease outbreaks are included in the X County Crisis Risk
Communication SOG. See Attachment #1 Section IV for Sample Release Order.
b) Discharge from Quarantine (Attachment 1/Section III and IV)
Individuals shall be quarantined for a sufficient period of time—typically at least the length
of the pathogen’s incubation period—to ensure they did not contract the disease. The
incubation period is the time interval between infection (i.e., introduction of the infectious
agent into the susceptible host) and the onset of the first symptom of illness known to be
caused by the infectious agent. If a person does not develop symptoms during this
period, he or she can be assumed uninfected and return to normal activities.
In some cases, the pathology of the infectious agent may be unknown. In those instances,
the X County Health Department Administrator/Designee/Health Officer shall implement
longer quarantines at first, and then reduce the time for quarantine when the causal agent
has been identified and its pathology is known. The initial quarantine period shall be
governed by clinical diagnosis, symptomology, timeframe for presumptive laboratory and
confirmatory laboratory results, disease duration, course of treatment, and requirements
set forth in K.A.R. 28-1-6. The decision to discharge an individual being held in isolation
or quarantine will be made by the X County Health Officer/Designee after evaluation of the
individual for disease symptoms following timeframe guidance set forth in K.A.R. 28-1-6.
The X County Health Officer/Designee will issue a release order (hand delivered or by
phone) to the individual in quarantine or isolation of release when all provisions of K.A.R.
28-1-6 have been met, see Attachment 1 Section IV For Sample Release Order.