Monitor community levels of COVID-19 to guide COVID-19 prevention efforts. People can use information about the current level of impact of COVID-19 on their community to decide which prevention behaviors to use and when (at all times or at specific times), based on their own risk of serious illness and that of the members of their household, their risk tolerance and the factors specific to the environment. The CDC’s COVID-19 Community Levels reflect the current effect of COVID-19 on communities and identify geographic areas that may experience an increase in severe COVID-19-related outcomes, based on hospitalization rates, hospital bed occupancy and the incidence of COVID-19 in the previous period. period*** (1). Prevention recommendations based on COVID-19 community levels have the explicit goals of reducing medically important illness and limiting the strain on the healthcare system. At all COVID-19 community levels (low, medium and high), recommendations emphasize staying up to date with vaccinations, improving ventilation, testing symptomatic people and those who have been exposed, and to isolate infected persons. At the average COVID-19 community level, recommended strategies include adding protections for those at high risk of severe illness (e.g., using masks or respirators that provide a higher level of protection). At the high community level of COVID-19, additional recommendations focus on all people wearing masks indoors in public and further strengthen protection for high-risk populations.††† As SARS-CoV-2 continues to circulate, changes in community levels of COVID-19 for a jurisdiction help indicate when the use of certain prevention strategies should be discontinued or increased, depending on the level of risk of serious illness of a person or that of his household or social contacts. The COVID-19 Community Levels provide a general framework that public health officials and jurisdictions can use and adapt as needed based on the local context by combining local information to assess the need for public health interventions.
Non-pharmaceutical interventions. Implementing multiple prevention strategies helps protect individuals and communities from exposure to SARS-CoV-2 and reduces the risk of medically significant illness and death by reducing the risk of infection (Table). Implementing multiple non-pharmaceutical preventative interventions can complement the use of vaccines and therapies, especially as community levels of COVID-19 increase and in people at high risk of severe disease. The CDC’s COVID-19 prevention recommendations no longer differentiate based on a person’s vaccination status, as breakthrough infections do occur, although they are usually mild (16), and people who have had COVID-19 but are not vaccinated have some degree of protection against serious illness from their previous infection (17). In addition to the strategies recommended at all COVID-19 community levels, education and messaging to help people understand their risk of medically significant illness complement recommendations for risk-based prevention strategies.
Infection test in progress. Diagnostic tests can identify infections at an early stage so that infected people can take steps to reduce their risk of transmitting the virus and receive treatment, if clinically indicated, to reduce their risk of serious illness and death. All people should get tested for an active infection when they are symptomatic or have known or suspected exposure to someone with COVID-19. When considering implementing testing for asymptomatic people with no known exposure, and where, public health officials might consider prioritizing high-risk congregate settings, such as long-term care facilities. duration, homeless shelters and correctional facilities, and work environments that include congregate settings. housing with limited access to medical care.§§§ In these types of high-risk gathering places, screening tests could complement diagnostic testing of symptomatic people by identifying asymptomatic infected people (18,19). When implemented, testing strategies should include all people, regardless of their vaccination status. Testing may not be cost-effective in general community settings, especially if the prevalence of COVID-19 is low (20,21).
Insulation. Symptomatic or infected persons should self-isolate promptly, and infected persons should remain isolated for ≥ 5 days and wear a well-fitting, high-quality mask or respirator if they must be around other people. Infected persons may end isolation after 5 days, only when they have been fever-free for ≥ 24 hours without the use of medication and all other symptoms have improved, and they should continue to wear a mask or a respirator around others at home and in public per day 10¶¶¶ (Figure) (22,23). People who have access to antigen testing and choose to use testing to determine when they can stop masking should wait to take the first test until at least day 6 and are fever-free for ≥ 24 hours without the use of anti-fever medication and all other symptoms improved. Using two antigen tests with ≥ 48 hours between tests provides more reliable information due to improved test sensitivity (24). Two consecutive test results must be negative for people to stop masking. If one of the test results is positive, people should continue to wear a mask around others and continue testing every 48 hours until they have two consecutive negative results. ****
Management of SARS-CoV-2 exposures. The CDC now recommends case investigation and contact tracing only in health care settings and certain high-risk congregational settings.†††† In all other circumstances, public health efforts can focus on case notification and providing information and resources to those at risk regarding access to testing. People who have had recent confirmed or suspected exposure to an infected person should wear a mask for 10 days around others when indoors in public and should be tested ≥ 5 days after exposure (or more early, if symptomatic), regardless of their vaccination status .§§§§ Given the high levels of anti-SARS-CoV-2 seroprevalence in the population (seven,16), and to limit the social and economic impacts, quarantine of exposed people is no longer recommended, regardless of vaccination status.