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Characteristics of SARS-CoV-2 and COVID-19 important for infection control and prevention include:

1. Respiratory droplets are the primary mode of COVID-19 transmission.  These do not travel far, thus risk of infection is greatest inside 6 feet, and the risk can be reduced by face coverings on both infected people and their contacts.
2. Transmission also occurs from finer aerosols that can travel greater distance, though this appears less common.  Aerosols may be generated by medical procedures but also by routine activities like singing or coughing.  Dilution by fresh air, and the use of medical grade respirators can reduce airborne infections.
3. Contamination of surfaces (including hands) by droplets or mucous are a third route of infection, although less common.  Virucidal disinfection and good hand washing practices are important control methods.
4. People without symptoms CAN transmit COVID-19.  Limiting contact with sick people is important, but not sufficient to control transmission.
5. Transmission risk increases with the length of time of exposure.
6. Transmission risk increases both with the number of infected people in the population and the number of people encountered at close range in social or work interactions.  Limiting exposure to large numbers of people, either in groups or in individual interactions helps reduce transmission.
7. Little is known about how COVID-19 treatments affect transmission.   COVID-19 vaccines currently appear to lower the risk of transmission, but little is known about the duration of protection.

These offer strong rationale for key ICP concepts while COVID-19 is present in the community:

Administrative measures and surge plans

1. Establish clear emergency command and appropriate span of control for key objectives.
2. Track emergency orders and waivers that affect healthcare operations (from Federal, state and local authorities).
3. Maintain situation awareness of the pandemic in your community (disease trends, response plans, partner activities).
4. Prepare for possible staff loss to illness, isolation or quarantine and for redeploying staff as needed.
5. Prepare for behavioral stress from isolation, fear, and burnout in both staff and patients.

Protect your perimeter to minimize disease entry

1. Reduce the numbers and types of people entering a facility.   This could include visitor limits, work-from-home, telehealth, and triaging care requiring face-to-face contact.
2. Exclude people with COVID-19 symptoms, or provide care under isolation precautions, but assume others are still potentially contagious. 
3. Support staff capability to protect their households from COVID-19 exposures from work or community.  Support immediate testing of household members with symptoms, and support household isolation or quarantine as needed.  
4. Support staff and community vaccination.

Enhance internal infection control and prevention with COVID-19 specific measures

1. Standard precautions are important but need additional COVID-19-specific measures and respiratory protection plan.
2. Minimize the number of those exposed to possible COVID-19 cases, including rapidly identifying and separating possible cases, and limiting exposure to cases.
3. Universal face coverings for both patients and staff to extent possible.
4. Enhance environmental cleaning and air handling. 
5. Provide rapid, accessible testing to symptomatic or exposed staff and patients.
6. Use well-fitted (or powered) respirators for higher risk exposures.  Train and equip staff for correct personal protective equipment use every time. 
7. Rapidly investigate and counsel contacts of COVID-19 cases among any staff or patients in the facility, in collaboration with public health authorities.