Repurposing facilities for quarantine or isolation and management of mild COVID-19 cases

1 Interim Guidance on Repurposing Non-health-care Facilities for Isolation and Management of Mild Cases of COVID-1 9 1. Introduction 1.1 Background The World Health Organization (WHO) has issued guidance for self-isolation of patients with mild symptoms at home [1]. However, in cases where safe and appropriate home care is not available, vulnerable people1 are present at home, or asymptomatic patients or patients with mild symptoms have risk factors2 for severe disease, the contact person should be quarantined or isolated and managed elsewhere to prevent further community transmission. Quarantine also applies to persons entering points of entry into countries. For these purposes, countries have effectively transformed public facilities and other accommodations into temporary quarantine and isolation facilities. This interim guidance updates the guidance published on 1 June 2020 entitled “Repurposing facilities for isolation and management of mild COVID-19 cases” on recommended minimum standards of repurposing existing premises into isolation facilities. In addition to updating Infection Prevention and Control (IPC) and other management recommendations based on new evidence and best practices, this guidance expands to repurposing facilities for quarantine and includes protection and provision of care for 1 Such as people with disabilities, mental health concerns, people living in unsafe conditions such as domestic violence. Vulnerable populations also include persons with 1) risk factors such as advanced age or co-morbidities; 2) frequent exposure such as health workers; 3) poor access to health care. 2 Older age, smoking, and underlying noncommunicable diseases, such as diabetes, hypertension, cardiac disease, chronic lung disease, cerebrovascular disease, dementia, mental disorders, chronic kidney disease, immunosuppression, obesity and cancer [2] 3 The tool is applicable for IPC quality measurement in both quarantine and isolation non-health isolation facilities. It is recommended that Members States adapt the tool to local context. children, prevention and management of health care workers (HCW) infections and a monitoring and evaluation framework for quality improvement (Annex 1)3. Key definitions: Quarantine is “the restriction of activities for the separation of persons who are not ill but who may be exposed to an infectious agent or disease, with the objective of monitoring their symptoms and ensuring the early detection of cases”. Isolation is “the separation of ill or infected persons from others to prevent the spread of infection or contamination.” In this document, “non-health isolation facility” refers to facilities designated for suspected or confirmed cases of COVID-19 that do not require in-patient medical treatment. 1.2 Target audience National, subnational, provincial and district health managers involved in responding to the COVID-19 outbreak and coordinating local health systems, especially in low-resource settings. Repurposing facilities for quarantine or isolation and management of mild COVID-19 cases Revised and republished as of 1 April 2022 (Originally published on 1 June 2020) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 2 Recommendations 1.3 Eligible groups for quarantine and non-health isolation facilities Quarantine: • for contacts of individuals with confirmed or probable SARS-CoV-2 infection (WHO continues to recommend quarantine in a designated facility or in a separate room in the household). [3] Isolation: • confirmed COVID-19 patients with mild symptoms who are evaluated as low risk, with no impending need for hospitalization but needing basic health care and monitoring. • confirmed COVID-19 patients with no or mild symptoms who are evaluated as low risk but not fit for home isolation and meeting one or more of the following criteria: 1. Household contains high-risk family members (elderly, infants and young children, pregnant women, and immunosuppressed patients). 2. Household lacks basic isolation facilities and means to support livelihood needs, such as a single- person bedroom, individual toilet, isolation measures, and food, access to safe drinking water, hand washing facilities or other necessities. 3. Household is in a remote area with limited access to health facilities. 4. Patients are experiencing homelessness and cannot be discharged to a congregate setting. 5. Hospitalized COVID-19 patients who have recovered, with no or minimal symptoms, but who do not fulfill the discharge criteria. [ 4] 1.4 Demand estimation and capacity review • Review the epidemiological projections of COVID-19 transmission inside the country, region and municipalities. • Calculate the expected number of mild cases over the course of the outbreak at national and subnational levels. Consider cross- jurisdiction collaboration to alleviate the burden on the health system. • Obtain the number and spaces of existing facilities possible for repurposing. In doing so, collaborate with relevant public and private sectors including social services, civil affairs, tourism, commerce and municipal/ provincial/regional governments. 1.5 Identification, selection and requisition of facilities Non-health-care facilities could be repurposed into quarantine or isolation facilities if the minimum requirements are met: • Large space with leveled floors to enable a rapid construction, roof and installation of essential accommodation facilities such as temporary beds, mattresses, and essential medical and livelihood supplies including water, toilets, electricity and adequate ventilation. • Able to cope with a surge in patient inflow and outflow on a massive scale, ranging from hundreds to thousands. • Able to isolate patients in either single rooms or with a spatial distance of at least 1 metre (if possible, 2 metres) to facilitate access and movement of health-care workers. [5] • Able to house distinct clean zones, semi- clean zones and contaminated zones. • Located in areas with road connection, security, and telecommunications signal coverage. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 3 Examples of facilities Example 1: Stadiums, exhibition centres, museums and other premises that have an open layout to accommodate a surge in the number of patients and that allow limited numbers of health-care personnel to monitor and manage patients needing care, including referrals. Recommended characteristics include: • large space; • flat and level floor(s); • water, sanitation and hygiene (WASH) facilities; • easy to move patients on trolleys; • parking space available for patient referral and logistic arrangements; • appropriate ventilation, preferably natural. Example 2: Hotels, hostels, inns, schools, student dormitories and other facilities with existing accommodation conditions and WASH facilities. These facilities should be allocated to patients who can take care of themselves without extensive assistance due to limited monitoring or access by medical staff. In addition to IPC, isolation facilities should be equipped with staff capable to perform basic health-care functions, including: 1. monitoring vital signs – temperature, pulse rate, respiratory rate, blood pressure and oxygen saturation using pulse oximeter; 2. detecting deteriorating patients early and conducting timely communication; 3. referral to higher-level health facilities; 4. providing symptom-relieving aids – antipyretics, cooling packs, and nutrition and fluid intake advice. 1.6 General principles of repurposing facilities Operational plans should be developed with dedicated budget and identified funding source. It should include the minimum requirements for ensuring patient/users safety and IPC, as follows. 1.6.1 Space allocation and infrastructure • Clearly define and distance respective entrances for patients and staff. • Allocate zones by functions and degrees of contamination. For example, have a “contaminated zone” for patients, a “clean zone” for receiving supplies and a “semi- clean zone” for health-care workers and support staff to put on, take off and dispose of personal protective equipment (PPE). [5][6] • Separate staff toilets and amenities from those designated for patients to prevent cross-contamination. • Designate separate passages or corridors by functions: 1. patient entry, referral and exit 2. movement of health workers 3. escape passages for emergencies. • In multistoried accommodation facilities such as hotels and dormitories, clearly distinguish stairways and elevators for patients and staff. • Install fire extinguishers in abundance per local requirements. • Ensure privacy considerations. For example, partitions that separate bed units into spaces resembling hospital rooms and wards are recommended to provide basic privacy between patients. Accommodate people by gender identify, families, and unaccompanied children in separate areas on the same floor, or on separate floors, including separate toilets and amenities for personal hygiene. • Develop a system for reporting any abuse or violence and ensure safety plans are in place for protection. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 4 1.6.2 Essential supplies and equipment • Bed linens adapted to local preference and availability. • On top of a clean work uniform, essential PPE for health-care workers, including [7]: 1. disposable gowns 2. medical masks, or respirators if supply is sufficient 3. eye protection 4. gloves • Essential PPE for non-health- care staff, including: 1. medical masks 2. gloves 3. disposable gowns, 4. closed shoes 5. if doing procedures that generate splashes (e.g. while washing surfaces), additional protection such as face shields and impermeable aprons. • Safe and clean water for drinking and personal hygiene with appropriate drainage should be easily accessible at all times. If piped water is not available, water trucks, buckets and other means can be utilized; however, these must meet IPC standards. • Basic and essential medical supplies and equipment, such as pulse oximeters, thermometers, blood pressure monitors, stethoscopes, emergency kits4 and antipyretics. • Provisions for safely dispensing personal medication such as insulin for diabetics etc. • Stress-relieving aids adapted to local context, such as books, television sets and toys for children. IPC precautions should be observed when exchanging and sharing such objects. • Mosquito nets and insect repellent in areas affected by malaria and dengue diseases. (see Annex 1 – checklist 3 for Review of essential equipment and supplies). 4 Oxygen supply, masks, Ambu bag, intubation kit, epinephrine, automated external defibrillator (AED), syringe, normal saline, gloves, etc. • Essential personal hygiene products (including menstrual, baby products). 1.6.3 Human resources • Develop standard operating procedures, team compositions and work rosters for continuous operation (see Annex 1). • Record staff presence and work logs at the beginning and end of each shift. • Screen, monitor and record staff temperature and symptoms daily [8]. • Ensure health-care workers are present who can monitor the conditions of patients on a regular basis. • Provide sufficient information and training about COVID-19 to non-health-care workers so that they can carry out assigned tasks with minimum risks and prevent the possible spread of COVID-19 within the establishment. These include concierge staff, receptionists, dormitory managers, cleaners, drivers, cooks and security guards. • Leverage existing networks and groups in the community to staff ancillary positions such as faith-based organizations and local women’s or youth unions and networks. 1.6.4 Infection prevention and control Managers of quarantine or isolation facilities should provide to the staff the latest IPC updates for IPC measures toward COVID-19. [7] • Ensure all staff are trained and strictly apply IPC precautions as per local guidance. This includes: appropriate selection and use of PPE, hand hygiene, respiratory hygiene, environmental cleaning, managing medical devices and equipment, laundry, food service utensils, and medical waste in accordance with safe routine procedures. [8] • Restrict staff from entering patient rooms when not providing care, environmental cleaning or other essential functions. Encourage patients to perform personal hygiene and ensure environmental hygiene within their own rooms/spaces. Staff can provide additional assistance, if required. • Restrict visitors. Telecommunication with close connections is recommended. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 5 • Place soiled linens in clearly labeled leak- proof bags or containers after carefully removing solid excrement. • Allocate waste zones, including cleaning and disinfection points, temporary waste storage, organic pits and sharp pits. All wastes from isolated patients are infectious waste and must be managed accordingly. Ensure three categories of medical waste containers (household, infectious and sharps) at point of care. • Routinely clean and disinfect frequently touched surfaces, such as switches, door handle, and furnishings (e.g. alcohol 70%, 0.1% sodium hypochlorite solution) • Mop floor with detergent, followed by disinfectants routinely (e.g. 0.1% (1000 ppm) hypochlorite solution. As for blood and body fluids large spills (i.e. more than about 10mL), a concentration of 0.5% (5000 ppm) of sodium hypochlorite is recommended. [7] 1.6.5 Information, communication and social engagement • Governments are advised to engage in two- way communication with the public to inform about quarantine and isolation facilities with detailed explanations of the purpose and function and to alleviate community concerns. This will help elicit public awareness and support. • Each facility should keep a clear and complete logbook on user/patient registration, medical records and discharge records. • Local coordination bodies and quarantine or isolation facilities should communicate on a timely basis to exchange information. This could include the number of newly admitted, discharged and referred users/patients in each quarantine, isolation facility, the number of beds occupied, the number of vacant beds, the operational status, and adverse events, if applicable. • Social engagement and support are vital to patients recovering and alleviating their anxiety during quarantine or isolation. Health workers, non- health-care workers and patients can provide emotional support to each other: • providing access to mental health and psychosocial support services (on-site, telephone-based and other remote options); • ensure client safety procedure is in place for emergencies and other crises. 1.6.6 Prevention, identification and management of COVID-19 among health workers • The interim technical guidance for the Prevention, identification and management of health worker infection in the context of COVID- 19 recommends active or passive syndromic surveillance and testing in HCWs, depending on the local transmission scenario. • Administrators should encourage HCW to continue following recommended IPC and public health and social measures, in communities, homes and workplaces. They should be supported and monitored for any long-lasting post-SARS-CoV-2 infection effects and any potential psychological implications. [8] 1.6.7 Strengthen IPC quality improvement through robust monitoring and evaluation • A checklist is developed for local adaption. This is aiming at identifying IPC lapses in facility environment in three high risk areas: check-in, medical assessment, and specimen collection. • The assessor conducts a walk-through observation in each of the three areas using the checklist (Annex 1). Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 6 2. Protection and provision of care for children When implementing quarantine and isolation, authorities should avoid family separation and weigh in the welfare of the child against the potential risk of SARS-CoV-2 transmission within the family. [6] A child under 18 should be under the care of a legal guardian. • In settings where children are isolated without caregivers, sufficiently trained care staff must be provided to support children with a safe, caring and stimulating environment that also meets their needs for psychosocial support and education (e.g. online access to learning). • Each quarantine or isolation facility that receives children should assign one staff member as a focal point for child protection issues. The child protection focal point will need to be familiarized with risks of violence, exploitation, abuse or neglect. • A strict child safeguarding policy must be in place. Staff who monitor the health of quarantined children should be trained to recognize the symptoms of COVID-19 in children, as well as signs that they need immediate medical assistance. Referral pathways should be established in advance. 3. Guidance development 3.1 Acknowledgements This document was developed by a guideline development group composed of staff and consultants from the Division of Health Systems and Services of the WHO Regional Office for the Western Pacific. It serves as an integrated section of a series of health systems preparedness and response guidance issued by the Regional Office. 3.2 Guidance development methods This document was developed based on a review of relevant literature and WHO guidelines. The guideline development group reached consensus on the recommendations through group discussion. 3.3 Declaration of interests Interests have been declared in line with WHO policy, and no conflicts of interest were identified from any of the contributors. References 1. Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms and management of their contacts [interim guidance]. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/331133). 2. COVID-19 Clinical management: living guidance. 25 January 2021. Geneva: World Health Organization; 2020 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1) 3. Considerations for quarantine of contacts of COVID-19 cases, 25 June 2021 [Interim guidance]. Geneva: World Health Organization; 2021. (https://www.who.int/publications/i/item/WHO-2019-nCoV-IHR-Quarantine-2021.1) 4. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected [interim guidance]. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/331446). 5. Severe acute respiratory infections treatment centre: practical manual to set up and manage a SARI treatment centre and a SARI screening facility in health care facilities. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/331603). 6. Considerations for quarantine of contacts of COVID-19 cases: interim guidance, 25 June 2021. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/342004). 7. Infection prevention and control during health care when coronavirus disease (COVID- 19) is suspected or confirmed: interim guidance, 12 July 2021. Geneva: World Health Organization; 2021 (https://apps.who.int/iris/handle/10665/342620). 8. Prevention, identification and management of health worker infection in the context of covid-19: Interim guidance, 30 October 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/336265). 9. Protocol and tools for assessment and improvement support of quarantine center and isolation facility for COVID-19. Lao Ministry of Health. September 2020 10. Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages: interim guidance, 23 December 2020. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/338033) 11. Roadmap to Improve and Ensure Good Indoor Ventilation in the context of COVID-19. 1 March 2021. Geneva: World Health Organization; 2021 (https://www.who.int/publications/i/item/9789240021280) 12. PPE Burn Rate Calculator (Version 1) excel icon. CDC. 24 March 2021. (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html) WPR/DSE/2020/006 © World Health Organization 2020 Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 1 Annex 1 - Making Quarantine and Non-Health Isolation Facilities Safe from COVID-19: A Quality Assessment Tool Table of Contents 1. Introduction ........................................................................................................................................ 2 2. Approach used to improve quarantine and non-health isolation facilities ....................................... 3 Planning: Evaluation of a single quarantine or non-health isolation facility ..................................... 3 SECTION 1. Facility Assessment ......................................................................................................... 4 1. Observations of facility environments ....................................................................................... 5 2. Interviews with users ............................................................................................................... 29 3. Review of essential equipment and supplies ........................................................................... 35 4. Review of policies, guidelines and standard operating procedures: isolation, quarantine and IPC 39 5. Review Staff training status: quarantine and non-health isolation facilities ........................... 42 6. Interview for staff and volunteers ........................................................................................... 44 SECTION 2. Identify individual facility priority actions to improve isolation or quarantine services.. 46 SECTION 3: Synthesize findings from a review of several facilities ................................................. 50 Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 2 1. Scope and purpose of the assessment tool This toolkit aims to support external assessors, managers and staff to assess and improve safe facility operations of 1) Quarantine facilities; 2) Non-health Isolation facilities. When used on multiple facilities, the results can be synthesized to support identifying national or subnational actions to address common problems found. 2. Approach used to improve quarantine and non-health isolation facilities This guide provides checklists to assess the quality of environments, practices, supplies and policies. From these checklists and interviews, areas needing improvement and relevant actions are identified for the individual quarantine and non-health isolation facility (Table A-1 – Sections 1 and 2). Table A-1: Key steps of quarantine and non-health isolation facility review Tool Method Section 1: Assess quarantine environments and practices Checklist 1 Observations of facility environments: 1.1 Reception and specimen collection 1.2 User residential rooms 1.3 Accommodation and WASH of residential area 1.4 Staff area Checklist 2 User interviews Checklist 3 Review of essential equipment and supplies Checklist 4 Review of policies: support of quarantine and isolation practices Checklist 5 Review of staff training summary: quarantine and non-health isolation facilities Checklist 6 Interview questions for staff and volunteers Section 2: Develop a facility action plan Table 2 Facility staff use data to determine priority actions for immediate improvements Section 3: Synthesize findings from a review of multiple facilities Table 3 Synthesize facility review findings across several quarantine and non-health isolation facilities Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 3 Planning: Evaluation of a single quarantine or non-health isolation facility Participants: A facility team is formed including persons responsible for quality assurance, facility management, clinical management, local governance and development partners. Facility staff pair with a trained external facilitator to assess quarantine facility environments and practices and to develop their quality improvement plan and subsequently support monitoring. Please ensure the team includes persons suitable to interview typical residents of the facilities regarding gender, language, and other communication barriers to ensure the user feels safe and respected. Timing: 1 or 2 days for each facility review, immediate improvements and identification of priority short-term actions. If multiple facilities are done, then a day needs to be added at the end to identify common concerns that need to be addressed sub-nationally or nationally. Preparations: 1. Identify key stakeholders responsible for quarantine/non-health isolation facilities. This is often not the Ministry of Health and may involve multiple ministries and local officials. Identify who is the focal point to communicate with. It is best of some staff will join. 2. Obtain clearance for external assessors to visit selected facilities from the responsible ministry focal point, facility managers, national, sub-national and local authorities. 3. Identify budget to support field visits. 4. Orient external staff on the methodology and organize roles. If multiple facilities are to be assessed, develop the plan who will go to which facility, when and timing and venue to meet after all facilities completed to summarize common concerns. 5. External staff support facility staff to organize the review, learn the approach and coordinate implementation of the facility assessment (for example, send the checklists to the facility staff with the explanation of the purpose of the assessment) 6. Ensure safety of the assessors: a. Ensure an adequate supply of Personal Protective Equipment (PPE) for the assessors, (masks, eye protection, gown and gloves) and alcohol-based hand rub (ABHR) b. Provide the assessors with PPE and ABHR and train them how to use them, according to the National standards c. Advise them to avoid the 3Cs (crowded places, close contact settings, confined and enclosed spaces) as possible d. Follow national standard and advise them for room observations e. Avoid touching other persons or any items in the room (e.g. request users to turn on taps to check water is functioning, instead of assessors doing this) f. After finishing assessment of all five occupied user rooms, the assessors should remove all PPEs following standard procedures including hand hygiene, before entering other physical spaces. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 4 SECTION 1. Facility Assessment Facility Name: Province: District: Facility function (tick the appropriate option)  Quarantine center  Non-health isolation facility Name and contacts of the manager / persons in charge of the facility • Name: Phone no: • Name: Phone no: Date(s) of Visit/Assessment (DD/MM/YY): Review conducted by: Informants interviewed to complete data collection tools: Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 5 Observations of facility environments Instructions 1. IPC for assessors observing rooms: a. Provide the assessors with PPE and ABHR and observe them to ensure they do use correctly. b. Remind them to avoid the 3Cs (crowded places, close contact settings, confined and enclosed spaces) as possible. c. Remind them for room observations that assessors should: i. use ABHR before putting on, changing and removing PPE; ii. stand at least 1 meter away from others; iii. follow national standards and advise them for room observations. iv. avoid touching other persons or any items in the room (e.g. request users to turn on taps to check water is functioning, instead of assessors doing this); v. after finishing assessment of all five occupied user rooms, the assessors should remove all PPEs following standard procedures including hand hygiene, before entering other physical spaces. 2. Observation of facility areas and rooms: a. Walk through the facility and observe the check-in, screening, medical assessment, specimen collection areas, user rooms5 and shared bathrooms areas. b. For residential facilities: If less than 10 total user rooms, assess all. If more than 10 user rooms, randomly select five occupied and five non-occupied rooms. For large facilities, consider using systematic sampling6. c. For accommodation in large repurposed isolation facilities (e.g. stadium, warehouse): Select 10 beds and 10 shared bathrooms, assess them. If more than 10 beds and 10 bathrooms, select them randomly. d. For each room observe hand washing resources, toilets, bathrooms, sinks and other aspects of the environment and IPC measures. e. For staff area, observe the area where staff perform administrative work, eat (e.g. canteen), rest, and dormitory if available, as well as any outdoor areas where staff do non-clinical activities. f. Complete Checklists 1.1 for screening and medical treatment area regardless of type of facility, 1.2 for residential facilities, 1.3 for accommodation and WASH of residential area, and 1.4 for staff areas of repurposed facilities. Enter response with Yes (Y), No (N), Not Applicable (NA) or enter a number where appropriate. 5 User rooms in the checklist 1.2 does not include assessment of Q&I facility set up in repurposed facilities (e.g. school, warehouse, stadium, barracks). 6 Systematic random sampling for occupied rooms: Divide the total number of occupied rooms in the facility (N) by 5 to obtain the interval (I=N/5). Then, randomly select a number between 1 and I which is the first room (n). Add the interval again and so forth until the 5th room is selected. For example, if N=50, I =10; and the randomly selected first room was 3 and then next 13 (3+10). Thus, the selected room numbers will be: 3, 13, 23, 33, 43. For non-occupied rooms, apply the same method for the total number of non-occupied rooms. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 6 g. For each environmental resource assessed, record the total number of observations (N) and of these, how many meet the criteria asked (n). To perform calculations: n= number of yes (how many meet the criteria asked) N= total number of observations %= n/N x 100 h. Calculate and assess if the number of toilets is adequate per facility, by i. recording the number of female and male users, ii. recording number of toilets for female and for male users, iii. calculate the female toilet ratio, iv. calculate the male toilet ratio, v. complete the table below, vi. compare the facility results with the standards (SPHERE) and assess the potential gaps. i. Give feedback to staff at the end of the review on areas for improvement and support making immediate improvements. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 7 Checklist 1.1 Observations of facility environments: check-in, medical assessment and specimen collection areas  Quarantine center  Non-health isolation facility Review rooms/areas used for check-in/arrival, screening/medical assessment and specimen collection (by observing the facility’ environment, staff performing the procedure and asking staff if not obvious). Complete 1 column for each room/area available. Question Answer with Y or N or NA or enter a Number Rooms/areas Comments Check-in area Screening / Medical assessment area Specimen collection area 1 2 1 2 1. Is there an up-to-date registration book or electronic system in place that records the entries and exits? 2. Are there clearly marked zones for users who are: a. Under quarantine b. COVID-19 suspected c. COVID-19 confirmed 3. Is natural ventilation used? a. Set up in an open-air area? b. Are there concerns about the ventilation? E.g. windows open adequately, adequate number/area of windows to allow airflow, adequate airflow? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 8 Question Answer with Y or N or NA or enter a Number Rooms/areas Comments Check-in area Screening / Medical assessment area Specimen collection area 1 2 1 2 4. Is mechanical ventilation used?1 (one or more of extraction fan, air condition, heat pump) a. Are there concerns about the ventilation? E.g. adequate airflow, number of vents/units available. condition and functionality of units used 5. Is this area: a. Clean (no visible stains, free of clutter) b. Semi-clean (minor clutter and visible stains) c. Dirty (cluttered environment, mold, blood, sputum, rubbish on floor)? 6. Is an up-to-date logbook/form for recording regular room cleaning/ disinfection available? a. How many times was the area cleaned in the previous 24 hr? 7. When cleaning is done: a. Is disinfectant applied to cloths or paper towels to wipe surfaces? b. Are pproved disinfectants used? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 9 Question Answer with Y or N or NA or enter a Number Rooms/areas Comments Check-in area Screening / Medical assessment area Specimen collection area 1 2 1 2 c. Are all high-use areas cleaned including work-surfaces? 8. How many reusable equipment were used during medical assessment/ specimen collection? a. How many of them were cleaned and disinfected between users? 9. How many total seats are in the area? 10. How many seats are occupied? Of these, how many are a. At least 1 meter apart? b. Persons are wearing a face- mask? 11. Are there visual marks (e.g. on the floor) to respect physical distancing, of at least 1 meter, by the users? 12. Are there provisions for people who require support such as ramps and handrails? 13. Information and Visual aids Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 10 Question Answer with Y or N or NA or enter a Number Rooms/areas Comments Check-in area Screening / Medical assessment area Specimen collection area 1 2 1 2 a. Are there clear signs for user flow directions? b. Are there clear signs for sitting area? c. Are there posters on respiratory etiquette? d. Are there posters on hand hygiene? e. Is a registration/occupancy form provided to the users of the facility? f. Is there an accessible information pack provided to the users upon registration7? support etc) 14. How many staff are working in this area? 15. How many staff are in close contact8 (1m or less) from users in the area now? 16. How many are wearing 7 Information pack should include at least: services that are available, how long they will need to stay and what will happen if they become sick, contact information for their local embassy or consular, code of internet access if available or the mode of communication with family/friends; explanation of user’ rights. Communication aids are in a language that users can understand. Specific information for specific needs of women, children, and of vulnerable populations should also be available. 8For specific IPC measures to apply for COVID-19, refer to the WHO “Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed: interim guidance, 29 June 2020.” Available at: https://apps.who.int/iris/handle/10665/332879 Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 11 Question Answer with Y or N or NA or enter a Number Rooms/areas Comments Check-in area Screening / Medical assessment area Specimen collection area 1 2 1 2 a. Gloves? b. Medical masks? c. Gowns? d. Eye protection? 17. How many sinks are there? Of these, how many: a. Look clean? b. Have free flowing water that is clear? (ie when the water tap/faucet is on, the water flows and is not sputtering) c. Have soap available? d. Have single-use towels or hand dryers available? 18. How many ABHR2 stations are available in the area? a. How many ABHR bottles are expired? b. How many ABHR bottles are at least half full? c. How many dispense hand-rub when used? d. Are any located within 1 meter of the entrance to area Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 12 Question Answer with Y or N or NA or enter a Number Rooms/areas Comments Check-in area Screening / Medical assessment area Specimen collection area 1 2 1 2 19. How many functional dedicated waste containers are Medical/infectious waste? Of these how many a. Have a lid on? b. Are less than ¾ filled? c. Number with foot pedal? 1 Perform a detailed assessment of indoor ventilation in collaboration with facility engineers or facility managers. See “Roadmap to Improve and Ensure Good Indoor Ventilation in the context of COVID-19”. WHO 2021. (https://www.who.int/publications/i/item/9789240021280. For ventilation assessments consider: 1. ventilation rate: the amount and quality of outdoor air provided into the space – determine whether the room feels stuffy with evidence of limited or inadequate airflow. A ventilation rate of 60 liters/second per person (L/s/person) is adequate for naturally ventilated areas or 6 air changes per hour for mechanically ventilated areas (See: https://apps.who.int/iris/rest/bitstreams/1296389/retrieve); 2. airflow direction: the direction of airflow should be from clean to less-clean zones; 3 correct management of exhausted air – review whether fences or barriers are used to avoid passage of people close to openings (windows, doors, AC outlets); and people or animals are kept at a distance at least of 4 m. No action is needed if the air is exhausted from the roof or 2 m higher than people (i.e. due to stack effect, whirlybirds); 4. No use of non-ducted convectors with indoor air circulation – determine whether split or fan coil units are used. 2 Alcohol-based Hand Rub (ABHR) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 13 Checklist 1.2 Observations of facility environments: user residential rooms9 Question Answer with yes (Y) or No (N) or enter a Number Non-occupied residential room Occupied residential room Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 1. Is this room for: a. Confirmed cases? b. Suspected cases? c. Quarantine? 2. Is natural ventilation used?1 a. Are there concerns about the ventilation? E.g. windows open adequately, adequate number/area of windows to allow airflow, adequate airflow? 3. Is mechanical ventilation used?1 (one or more of extraction fan, air condition, heat pump) a. Are there concerns about the ventilation? E.g. adequate airflow, number of vents/units available. condition and functionality of units used 4. Is this room: a. Clean (no visible stains, free of clutter) n/N b. Semi-clean (minor clutter and visible stains) n/N c. Dirty (cluttered environment, mold, blood, sputum, rubbish on the floor) n/N 9 User residential rooms does not include assessment of Q&I facility set up in repurposed facilities (e.g. school, warehouse, stadium, barracks). Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 14 Question Answer with yes (Y) or No (N) or enter a Number Non-occupied residential room Occupied residential room Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 5. Are equipment and detergent/ disinfectant solutions available for self- cleaning the room? n/N 6. Are masks available for user use? n/N a. If not, why? _____________________ Summarize answers 7. Are dedicated thermometers available for users to self-monitor their temperature? n/N 8. For isolation facility only, are oximeter available for users to self-monitor? 9. If oximeters are shared between people, are they disinfected between users? (e.g using 70% alcohol) 10. Are the following available: a. Explanation of how meals will be provided safely? n/N b. Explanation of how to safely use the bathroom/shower? (rooms without bathroom) n/N c. Guidelines/schedule of routine health checks/screening? n/N d. Guidelines on symptoms and when to contact health staff? n/N e. Guidelines on what to do when leaving the room (e.g. physical distancing and mask use) n/N Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 15 Question Answer with yes (Y) or No (N) or enter a Number Non-occupied residential room Occupied residential room Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 f. Guidelines on hand washing/hygiene? n/N g. Contact numbers/ details for staff? n/N h. A working communication tool (e.g., cell-phone with network connection or internet connection) n/N 11. Are different families living in the same room? 12. Are any different families sharing the same bed? 13. How many functional/ usable beds in the room? Of these, how many are N a. At least 1 meter apart? n/N b. Have a mosquito net10? n/N 14. Is the nearest sink inside the room? 15. Does the nearest sink: N a. Inside the room?11 b. Look clean? c. Have free flowing water that is clear? (ie when the water tap/faucet is on, the water flows and is not sputtering) 10 For facilities in tropical climates 11 When assessing the same common external sink, the assessor mentions it in the “comments” column. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 16 Question Answer with yes (Y) or No (N) or enter a Number Non-occupied residential room Occupied residential room Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 d. Have soap available? a. Have single-use towels or hand dryers available? 16. Is there alcohol-based hand rub inside the room? a. Is it at least half full? 17. Is the nearest toilet: a. Inside the room? b. Functioning (including not blocked and not locked)?12 n/N c. Clean? e.g., no water on the floor, no dirt / feces or urine on the toilet, wall, floor n/N 18. Is the nearest shower: N a. Inside the room?13 b. Functioning (including not blocked and not locked)? n/N c. Clean? n/N 19. How many functional dedicated waste containers are available in the room? Of these, how many N a. Have a bag labelled for infectious waste? 12 When assessing the same common external toilet, the assessor mentions it in the “comments” column. 13 When assessing the same common external shower, the assessor mentions it in the “comments” column. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 17 Question Answer with yes (Y) or No (N) or enter a Number Non-occupied residential room Occupied residential room Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 b. Are less than ¾ filled? c. Have a lid on? 1 To perform a detailed assessment of indoor ventilation see “Roadmap to Improve and Ensure Good Indoor Ventilation in the context of COVID-19”. WHO 2021. (https://www.who.int/publications/i/item/9789240021280 in collaboration with facility engineers or facility managers. For ventilation assessments consider: 1. ventilation rate: the amount and quality of outdoor air provided into the space – determine whether the room feels stuffy with evidence of limited or inadequate airflow. A ventilation rate of 60 liters/second per person (L/s/person) is adequate for naturally ventilated areas or 6 air changes per hour for mechanically ventilated areas (See: https://apps.who.int/iris/rest/bitstreams/1296389/retrieve); 2. airflow direction: the direction of airflow should be from clean to less-clean zones; 3 correct management of exhausted air – review whether fences or barriers are used to avoid passage of people close to openings (windows, doors, AC outlets); and people or animals are kept at a distance at least of 4 m. No action is needed if the air is exhausted from the roof or 2 m higher than people (i.e. due to stack effect, whirlybirds); 4. No use of non-ducted convectors with indoor air circulation – determine whether split or fan coil units are used. 2 Alcohol-based Hand Rub (ABHR) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 18 Checklist 1.3 Observations of re-purposed non-health isolation facility environment: accommodation and WASH Assessed accommodation such as re-purposed stadium, warehouse or other large non-health facilities. Note: For Question 1 to 4, please insert the answer under column “Comments”. Question Answer with yes (Y) or No (N) or enter a Number Bed accommodation and shared bathrooms (if more than 10, please randomly select 10) Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 1. How many people in total, are being accommodated in the facility right now? Total Number:_______ a. Total men Total Number:_______ b. Total women Total Number:_______ c. d. Total families with young children Total Number:_______ e. Total of unaccompanied youth Total Number:_______ 2. Is natural ventilation used? 1 a. Are there concerns about the ventilation? 3. Is mechanical ventilation used? 1 (one or more of extraction fan, air condition, heat pump) a. Are there concerns about the ventilation? 4. Are there bathrooms dedicated for staff use only? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 19 Question Answer with yes (Y) or No (N) or enter a Number Bed accommodation and shared bathrooms (if more than 10, please randomly select 10) Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 Beds in shared accommodation (if more than 10, please randomly select 10) 5. Is this accommodation area: 1 2 3 4 5 6 7 8 9 10 a. Clean (no visible stains, free of clutter) Semi-clean (minor clutter and visible stains) n/N b. Semi-clean (minor clutter and visible stains) n/N c. Dirty (cluttered environment, mold, blood, sputum, rubbish on the floor) n/N 6. How many beds in total in this area? a. How many beds less than 1 m apart? n/N b. How many different families are sharing the same bed? n/N 7. Is there at least one bottle with ABHR per bed? n/N 8. Is there one mosquito’s net per bed14? n/N 9. Is there at least one rubbish bin available per bed? If yes, how many are n/N 14 For facilities in tropical climates. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 20 Question Answer with yes (Y) or No (N) or enter a Number Bed accommodation and shared bathrooms (if more than 10, please randomly select 10) Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 a. Less than ¾ filled? n/N b. Have a lid on? n/N 10. Does the user of each bed wear facemask? n/N 11. Is a thermometer available per bed? (for users to self-monitor their temperature) n/N 12. Is communication pack available per bed or per family? n/N 13. Does the user of each bed have a working communication device (e.g., cell-phone with network connection or internet connection) If not, please explain why in the comment column n/N Shared bathrooms 11. Are there clearly marked pathways for users and staff to walk? 12. Is there a timetable visible/system to book shared bathrooms (showers/sinks)? If yes, a. Is there an option for different languages so it is easily understood and accessible to all? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 21 Question Answer with yes (Y) or No (N) or enter a Number Bed accommodation and shared bathrooms (if more than 10, please randomly select 10) Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 13. Is there an up-to-date logbook /record for cleaning/disinfection? n/N a. How many times a day was cleaning/disinfection reported in the last 24 hours? Mean Median 14. How many toilets are there? N Of these, how many are a. For men? n/N b. For women? n/N c. Not specified d. Functioning (including not blocked and not locked)? n/N e. Clean? e.g., no water on the floor, no dirt / feces or urine on the toilet, wall, floor n/N f. Meet the needs of people with reduced mobility/are wheelchair accessible? n/N 15. How many sinks are there? N How many sinks: a. Look clean? n/N b. Have free flowing water that is clear? (ie when the water tap/faucet is on, the water flows and is not sputtering) c. n/N Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 22 Question Answer with yes (Y) or No (N) or enter a Number Bed accommodation and shared bathrooms (if more than 10, please randomly select 10) Total n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 d. Have soap available? n/N e. Have single-use towels or hand dryers available? n/N 16. How many showers are there? N Of these, how many are: a. Functioning (including not blocked and not locked)? n/N b. Clean? n/N c. Designated for use by women? n/N d. Meet the needs of people with reduced mobility/are wheelchair accessible? n/N 17. How many functional dedicated waste containers are available in the room? Of these, how many a. Have a bag labelled for infectious waste? b. Are less than ¾ filled? c. Have a lid on? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 23 WASH Formula and Standard 15 WASH measure Calculation Standard Facility Results Toilets per population Total functional toilets ÷ total facility population 1 shared toilet/20 people 1 To perform a detailed assessment of indoor ventilation see “Roadmap to Improve and Ensure Good Indoor Ventilation in the context of COVID-19”. WHO 2021. (https://www.who.int/publications/i/item/9789240021280 in collaboration with facility engineers or facility managers. For ventilation assessments consider: 1. ventilation rate: the amount and quality of outdoor air provided into the space – determine whether the room feels stuffy with evidence of limited or inadequate airflow. A ventilation rate of 60 liters/second per person (L/s/person) is adequate for naturally ventilated areas or 6 air changes per hour for mechanically ventilated areas (See: https://apps.who.int/iris/rest/bitstreams/1296389/retrieve); 2. airflow direction: the direction of airflow should be from clean to less-clean zones; 3 correct management of exhausted air – review whether fences or barriers are used to avoid passage of people close to openings (windows, doors, AC outlets); and people or animals are kept at a distance at least of 4 m. No action is needed if the air is exhausted from the roof or 2 m higher than people (i.e. due to stack effect, whirlybirds); 4. No use of non-ducted convectors with indoor air circulation – determine whether split or fan coil units are used. 15 Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, fourth edition, Geneva, Switzerland, 2018. Available at: https://handbook.spherestandards.org/en/sphere/#ch001 Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 24 Checklist 1.4 Observations of facility environments: staff area Review staff' in-door and out-door areas by observing the area’ environment and staff. In-door area, could be area used for administrative work, canteen, or resting. The assessors note the purpose of the area in column 1,2 and/ or 3. Column 4 is to assess staff' dormitory, and column 5 to assess staff out-door area where available. Question Answer with yes (Y) or No (N) or Not Applicable (NA) or enter a Number Staff area Total n/N (%) Comments In-door Out-door 1 2 3 4 Dormitory 5 Rest 1. Is the staff area/space separated from users’ area (e.g. for administrative work, breaks, meal, sleeping) 2. Is there an up-to-date registration book or electronic system in place that records the staff entries per shift? 3. Is there information/signs/ poster to notify the staff of: a. Removing all PPE used in users area b. Wearing a facemask (where universal masking is required) c. Maintaining physical distancing of at least 1 meter between staff, at all time d. Frequently perform hand hygiene e. Not sharing personal items between staff f. Not bringing items used in residential user rooms into the staff area (e.g. mobile phones, electronic devices, stationary) 4. Is there a designated area for PPE? If yes: a. The area to take off PPE is set up before entering the staff area? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 25 Question Answer with yes (Y) or No (N) or Not Applicable (NA) or enter a Number Staff area Total n/N (%) Comments In-door Out-door 1 2 3 4 Dormitory 5 Rest b. An appropriate waste disposal area for used PPE is available? c. Hand hygiene facilities (either a functional sink with soap or ABHR) d. With clear separation, marking between put on and take off area? e. Supply of clean PPE at area where it is put on? i. Face-masks? ii. Eye protections? iii. Gowns? iv. Gloves? 5. How many staff are in the area? Of those, how many a. Maintain a safe distance of at least 1 meter with other? b. Are separated by a physical barrier? c. Wear a facemask, except when eating/ drinking? (where universal masking policy) 6. How many usable beds in the room? Of these, how many are N Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 26 Question Answer with yes (Y) or No (N) or Not Applicable (NA) or enter a Number Staff area Total n/N (%) Comments In-door Out-door 1 2 3 4 Dormitory 5 Rest a. At least 1 meter apart? n/N 7. How many sinks inside the staff’ area? Of these, how many are N a. Look clean? n/N b. Have free flowing water that is clear? (ie when the water tap/faucet is on, the water flows) c. Have soap available? d. Have single-use towels available? 8. How many alcohol-based hand rub bottles are inside the area? Of those how many are a. At least half full? b. Operational 9. Is natural ventilation used?1 a. Are there concerns about the ventilation? E.g. windows open adequately, adequate number/area of windows to allow airflow, adequate airflow? 10. Is mechanical ventilation used?1 (one or more of extraction fan, air condition, heat pump) a. Are there concerns about the ventilation? E.g. adequate airflow, number of vents/units available. condition and functionality of units used 11. Is the staff area Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 27 Question Answer with yes (Y) or No (N) or Not Applicable (NA) or enter a Number Staff area Total n/N (%) Comments In-door Out-door 1 2 3 4 Dormitory 5 Rest a. Clean (no visible stains, free of clutter) b. Semi-clean (minor clutter and visible stains) c. Dirty (cluttered environment, mold, blood, sputum, rubbish on the floor) 12. Is there a log book to record cleaning available? If yes, a. Cleaning and disinfection of staff area, at least daily? b. Cleaning and disinfection of frequently touched surface (e.g. door handle, switches, tables surface, computer keyboard, mouse, desk phone) prior to each shift, and daily? 13. Are frequent-touch surfaces smooth, not porous, easy to clean and disinfect (e.g. plastic, no fabric, no wooden material)? 14. How many dedicated toilets for staff are available? Of these, how many are a. Inside the staff area/ separated from the users’ area? b. Functioning (including not blocked and not locked)? c. Clean? e.g., no water on the floor, no dirt / feces or urine on the toilet, wall, floor 15. How many dedicated showers for staff are available? Of these, how many are a. Inside the staff area/separated from the users’area? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 28 Question Answer with yes (Y) or No (N) or Not Applicable (NA) or enter a Number Staff area Total n/N (%) Comments In-door Out-door 1 2 3 4 Dormitory 5 Rest b. Functioning (including not blocked and not locked)? c. Clean (e.g., no dirt, rubbish on the floor)? 1 To perform a detailed assessment of indoor ventilation see “Roadmap to Improve and Ensure Good Indoor Ventilation in the context of COVID-19”. WHO 2021. (https://www.who.int/publications/i/item/9789240021280 in collaboration with facility engineers or facility managers. For ventilation assessments consider: 1. ventilation rate: the amount and quality of outdoor air provided into the space – determine whether the room feels stuffy with evidence of limited or inadequate airflow. A ventilation rate of 60 liters/second per person (L/s/person) is adequate for naturally ventilated areas or 6 air changes per hour for mechanically ventilated areas (See: https://apps.who.int/iris/rest/bitstreams/1296389/retrieve); 2. airflow direction: the direction of airflow should be from clean to less-clean zones; 3 correct management of exhausted air – review whether fences or barriers are used to avoid passage of people close to openings (windows, doors, AC outlets); and people or animals are kept at a distance at least of 4 m. No action is needed if the air is exhausted from the roof or 2 m higher than people (i.e. due to stack effect, whirlybirds); 4. No use of non-ducted convectors with indoor air circulation – determine whether split or fan coil units are used. 2 Alcohol-based Hand Rub (ABHR) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 29 Interviews with users Users who are staying in the facility are interviewed to understand, the effectiveness of the non- health isolation or quarantine services provided and the satisfaction of the users. Instructions 1. Select 10 users randomly from the user register or electronic record. Make sure to obtain representativeness in the sample (e.g. consider balance of men and women, elderly, people from marginalized populations, families with young children). If phone numbers are available, a phone interview is possible. If phone interviews are not possible, arrange to conduct an in-person interview in a place where appropriate distancing and IPC measures can be taken (e.g. appropriate PPE, in open air area). 2. Select the interviewer respecting gender, language, and other communication needs of user to ensure the user feels safe and respected. 3. Obtain verbal informed consent. State, “This interview aims to understand how we can help improve isolation/quarantine care all users. Everything you say here will be kept confidential, meaning no one will know what you said. Anytime you want to stop, you may. Your care will remain the same. The interview will take about 15 minutes. Do you agree to do this interview?” Record informed consent given. 4. Record findings in Checklist 2 indicating Y (yes), N (no), DK (don’t know) or NA (not applicable). If you find additional important information on any question, then make notes under comments. 5. How to perform calculations: n= number of yes N= total number of interviewees %= n/N x 100 Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 30 Question Answer the questions with Y (yes), N (no), DK (don’t know) or NA (not applicable) User number Summary n/N (%) Comments 1 2 3 4 5 6 7 8 9 10 1. Was verbal informed consent obtained? 2. gender of the users a. Women b. Man c. Other 3. Why were you admitted? a. Isolation? b. Quarantine? 4. How many days have you completed here? 5. How many days do you have remaining? 6. Before transfer to the facility: a. Did the staff check your temperature and ask you if you had any symptoms? 7. Did the staff request that you sanitize your hands with ABHR? 8. During transfer to the facility: a. Did you wear a facemask the entire time? b. Did you stay at least 1 meter apart from others?16 c. Did the staff and/or others in the vehicle wear a facemask the entire time? 9. When were you given a COVID-19 test? a. Before arriving at the facility? b. When you arrived at the facility? c. During your stay in the facility? (if yes, how many times? ) d. You were not given a COVID-19 test. 10. When you arrived at the facility: Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 31 16 Except family members. 17 Information pack should include at least: services that are available, how long they will need to stay and what will happen if they become sick, contact information for their local embassy or consular, code of internet access if available or the mode of communication with family/friends; explanation of user’ rights. Communication aids are in a language that users can understand . Specific information for specific needs of women, children, and of vulnerable populations should also be available. a. Did you wait for less than 15 mins in a closed area? Mean/Median b. Were you separated by at least 1 meter from other users waiting? c. Did you wear a mask? d. Were you asked to wash your hands or to use hand sanitizer (ABHR) before entering the facility? e. Was your temperature checked? f. Were you asked if you had any symptoms (e.g., cough, difficulty breathing)? g. Were you asked about your contacts? h. Were you asked about previous tests and results? i. Were you asked about travel/areas visited? j. Were you given an information pack when you were admitted containing information about the facility, how to communicate, support17 etc? 11. During your stay, was your temperature checked at least once a day? 12. During your stay did you have any symptoms? a. did you report your symptoms to the authorities? 13. Where are health checks conducted if users are feeling unwell? a. In the user’s room? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 32 b. In a separate examination room/clinic in the facility? c. In a separate examination room/clinic outside of the facility 14. Did staff who came into close contact with you (within 1 metre) wear (including anyone coming into your room, giving you food directly, examining or collecting specimens who): a. Gloves? b. Medical masks? c. Gowns? d. Eye protection? 15. Are there any important supplies in your room that were not provided (for e.g. soap, drinking water)? If yes, please list. 16. Is electricity available 24 hours a day? 17. Do you clean your own room? If yes a. Do you have necessary equipment and solution to clean your room? 18. How many times a day is food delivered? 19. Did you receive adequate and proper prescribed medications? 20. During your time here, have you been hungry because not enough food was provided? 21. During your time here, have you been thirsty because not enough water was provided? 22. Were your dietary needs met? (e.g. allergies, diabetic, Halal etc) 23. Do you have access to food for any dependants (e.g. toddlers)? 24. How is food delivered? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 33 a. Left outside the door (no contact) b. Handed directly (contact) 25. Do you have a way to communicate with your family or others when necessary? (e.g. phone) 26. Do you have a way to communicate with staff if needed? 27. Did you experience facility staff unable to access and provide you support for any reason? If yes, please provide the reason (in comments). 28. How can you prevent infection with COVID-19 and protect others? (tick all that apply, but don’t read to user) a. Wear a mask? b. Keep a distance of at least 1 meter between yourself and others? c. Do not share food and utensils? d. Wash hands with soap and water or use ABHR? e. Ensure that indoor spaces are kept well ventilated? 29. Do you have a private secure area to store your valuables? 30. Have you felt unsafe at any time during your stay? If Yes, please specify: 31. Do you have someone in the facility that you can talk to if you have concerns, issues or any requests? If Yes, specify: Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 34 Checklist 2 Interviews with users Additional comments: 32. If you have children, do you have someone in the facility to contact with regards to child protection and support? Please note additional comments if we can help. 33. Do you have any concerns or difficulties living here? Please note additional comments below if we can help. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 35 Review of essential equipment and supplies Instructions 1. Review the list of essential equipment and supplies, asking the staff who work in stock areas (e.g. logistic staff) or the manager of facility, using the stock card or similar recording system (check list: 3.1, 3.2, 3.3). 2. For items that are not recorded, and are in the user’ room (e.g. beds, mattresses), ask the logistic staff or manager, the number of items and condition (check list 3.1, 3.2). 3. For checklist 3.1: When assessing the unoccupied users’ room, review availability of equipment and supplies and condition (to validate the manager, logistic staff’ feedback on equipment’ good condition). 4. For checklist 3.3: a. write the total number of supplies available on the day of the review, based on the stock card; b. estimate supply needs for the next 3 months, referring to existing tool used by the facility or recommended by the national guidelines. International tools to forecast need of Personal Protective Equipment (PPE) can also support the estimation18; c. calculate if there is a gap. If the total number of supplies available on the day is “0” or superior of what is needed, there is no gap (C=B-A, if C ≤0, there is no gap); d. observe if the stock available is in good condition, there is no expired supplies. For this, observe 2 or 3 samples of each item; e. answer the last column “All criteria met?” by responding Y (Yes) only if C ≤0 and D=Yes. 18 “PPE Burn Rate Calculator (Version 1) excel icon”. CDC. Available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn- calculator.html Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 36 Checklist 3. Review of availability of key equipment and supplies How many users is the facility equipped to house?_________ (N) How many are actually present? ________ n (% of capacity) 3.1 Non-consumable supplies and equipment19 for users Item Total number available on the day of the review, n (% of user capacity) How many of the first 5 items are in good condition? Equipment for accommodation 1. Beds 2. Mosquito net 3. Mattresses 4. Sheets 5. Blankets 6. Towels 7. Bucket 8. Rubbish bin with lid and pedal 9. Walking-aids for elderly or people with limited mobility 10. Secure storage places (e.g. baggage, other possessions) 11. Oximeter (for isolation facility) 12. First AID kit per facility 3.2 Equipment and admin supplies Item Available on the day of the review (Y/N) Is the condition good? Equipment functional? Electricity generation 13. Back-up generator Admin 14. Registration forms 15. Communication material for the users 16. Printed procedures for staff 17. Communication tools (e.g. phone/ Internet/ Wifi) 19 The WHO definition of “Normal storage conditions” is: “Storage in dry, well-ventilated premises at temperatures of 15-25 °C or, depending on climatic conditions, up to 30 °C”. When storage is set up in a hot and humid climate without having air conditioning, storage should be installed in a well-ventilated premise protected from direct, intense light. When storage is set up in a cold climate, the storage premises should not be installed in a room less than 2°C (WHO. Technical Report Series, No. 908, 2003. Appendix: Storage and labelling conditions). Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 37 3.3 Consumables Consumable item Total number of supplies available on the day of the review?20 (n) Estimated supply needs for the next 3 months Gap C=B-A Stock condition good? No expired supplies? All criteria met? Answer Yes only if: C≤0 and D=Yes A B C D User items 18. Thermometers 19. Soap 20. Alcohol-based hand rub 21. Toilet paper 22. Laundry detergent 23. Menstrual hygiene products 24. Dental hygiene products PPE 25. Disposable gloves 26. Medical mask 27. Disposable face shield 28. Disposable gown 29. Disposable waterproof apron Environmental cleaning and waste management 30. Detergent 31. Appropriate disinfectant21 32. Alcohol disinfectant (70%) 33. Plastic bag for household waste 34. Plastic bag for infectious waste Other 35. Fuel for back-up generator 3.4 Non-disposable item Non-disposable item Total number of supplies available on the day of the review?22 (n) Estimated supply needs for the next 3 months Gap C=B-A Stock condition good? No expired supplies? All criteria met? Answer Yes only if: C≤0 and D=Yes A B C D PPE (staff) 36. Rubber gloves 37. Goggles 38. Non-disposable face shield 39. Non-disposable gown 20 Refer to stock card 21 For instance, sodium hypochlorite (solution of 0.1% (1000ppm) for routine disinfection, 0.5% (5000ppm) for spills of blood or body fluids; hydrogen peroxide ≥0.5%. 22 Refer to stock card Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 38 40. Non-disposable waterproof apron 41. Closed rubber boots Environmental cleaning and waste management 42. Cleaning cloths 43. Mop Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 39 Review of policies, guidelines and standard operating procedures: isolation, quarantine and IPC Instructions 1. Get copies of facility policies, guidelines and standard operating procedures (SOPs) for isolation, quarantine and IPC listed in Checklist 4. Note national policies are not included unless they are explicitly adopted. 2. Record policies seen in Checklist 4. 3. Identify policies currently not available. 4. Verify whether written policies currently available are being practiced based on interviews and observations. 5. Calculate current availability of WASH amenities using estimates of numbers of toilets available for males and females from Checklist 1.3. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 40 Checklist 4 Review of policies, guidelines and standard operating procedures for isolation, quarantine and IPC/ WASH Policies/guidelines and SOPs Are the national policy, guidelines or SOPs available at the time of the visit? Have the national policy, guidelines, SOPs, locally made material such as poster? Have the staff been oriented? 1. Overall facility operation including 1. Picking up users from port of entry (transfer to Q&I facility) 2. Monitoring the health of quarantined/ isolated persons, recognition of symptoms and management of user with symptoms 3. Monitoring the health of staff 4. Management of older persons and those with disabilities, co-morbid conditions or impairments that require special attention 5. Referral of users and staff needing clinical management beyond the capability for the facility 6. Logbook of patient referral and transfer records, including adverse event registration 7. Governmental discharge clearance (and certificate) 8. Ventilation minimum requirements in place for reviewing and correcting it 9. Information and communication pack for users23 10. Procedure or mechanism to ensure persons in quarantine/isolation remain for the expected duration 11. Procedure for when facility reaches maximum capacity 12. IPC procedures in staff area (e.g. administrative work, rest, dormitory, canteen), to prevent transmission of COVID- 19 13. Policy for staff vaccination 2. Screening at arrival of quarantine 14. Updated COVID-19 case definition 3. IPC/WASH procedures 15. Primary source and availability of safe drinking water 23 Information pack should include at least: services that are available, how long they will need to stay and what will happen if they become sick, contact information for their local embassy or consular, code of internet access if available or the mode of communication with family/friends; explanation of user’ rights. Communication aids are in a language that users can understand. Specific information for specif ic needs of women, children, and of vulnerable populations should also be available. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 41 Policies/guidelines and SOPs Are the national policy, guidelines or SOPs available at the time of the visit? Have the national policy, guidelines, SOPs, locally made material such as poster? Have the staff been oriented? 16. Hand hygiene 17. Personal Protective Equipment (PPE) 18. Environmental cleaning and disinfection, including frequency of cleaning/ disinfecting of public spaces, public and private bathrooms and public sinks and ABHR points 19. Cleaning disinfecting of reusable user care equipment 20. Management of soiled linens 21. Solid waste management 22. Wastewater management 4. Specimen collection 23. Testing policy 24. Storage and transport of collected specimens 25. Safe disposal of wastes generated during specimen collection 5. Standards for 26. Toilets per facility population 27. Toilets for women/men 28. Litres of water per person/day Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 42 Review Staff training status: quarantine and non-health isolation facilities Instructions Ask the manager of the facility to obtain the information below: 1. the types of staff at the facility involved with screening, cleaning, food delivery, transport/ referral’ staff (e.g. driver), specimen collector and medical assessments on Checklist 5–training summary; 2. identify the total number for each type listed; 3. the total number of staff trained on each topic. Ensure new and trainee staff are included and that staff who have departed are not counted. If any staff members have been trained more than once, count them only once. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 43 Checklist 5 Staff Training Summary: quarantine and isolation facilities Training or skills received in the previous 6 months Type of staff Total (N) Training topic (n/N) Clinical assessment/ screening Cleaning/ disinfection 24 Hand washing practice Use of PPE Specimen collection procedures Overall facility operation25 Other (e.g. standards for WASH) Total trained (%) 24 Environmental controls: cleaning and disinfection of environment, equipment, linen 25 Ensure at least one staff is trained on minimum requirements of the ventilation system Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 44 Interview for staff and volunteers Staff and volunteers who are working in the facility are interviewed individually to understand their experiences and concerns. Instructions 1. Select 5 staff and volunteers total. Make sure to obtain the representativeness in the sample (e.g. consider sex, age, professional cadre, types of tasks, and level of seniority). If conditions permit, arrange to conduct an in-person interview in a place where appropriate distancing and IPC measures can be taken (e.g. appropriate PPE, in open air area). If not, a phone interview is possible. 2. Select the interviewer respecting gender, language, education levels, and other communication needs to ensure the staff or volunteer feels safe and respected. 3. Obtain verbal informed consent. State, “This interview aims to understand how we can help improve isolation/quarantine care all staff and volunteers. Everything you say here will be kept confidential, meaning no one will know what you said. Anytime you want to stop, you may. Your care will remain the same. The interview will take about 15 minutes. Do you agree to do this interview?” Record informed consent given. 4. Listen, probe and synthesize responses to each question below. 5. All responses are confidential and when collated, responses should be deidentified. Staff/ volunteer 1 2 3 4 5 Job title Gender (woman/man/gender diverse) Age # of Weeks working here 1. How do you feel working at this facility? Please outline your experience. [Note to the assessor: please summarize overall experience, positive and negative] 2. Have you received any training before or during working in the facility? If you have, what were the subject and type of training? [Note to the assessor: to ask only if there is no manager or someone to provide overall training information, and checklist 5 could not be completed] 3. Have you felt stressed, worried, frightened, or unsafe at any time while working here? If you have, can you let me know what were these, with examples? Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 45 [Note to the assessor: use probing questions to find out details behind a concern, to generate a full picture of the issue. For example: if a female employee said she is scared to work on night shift, ask questions around whom she works with on the same shift (male or female), transportation, lightening and electricity, etc., as underlying causes will be guiding actions to address these.] 4. Have you experienced any crime (e.g., stealing), violence or serious disputes? If yes, please describe. 5. Have you had any cases who needed referral but was delayed? If yes, please describe. 6. Have you had any in-facility transmission of COVID-19? If yes, please describe. 7. Have you reported your worries and concerns to management? If yes, could you describe if any actions were done to address these? 8. Do you have any other suggestions on how to improve working conditions for you and your colleagues, or care for the users? Your comments will be reflected towards facility management, and your information will be well protected. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 46 SECTION 2. Identify individual facility priority actions to improve isolation or quarantine services Instructions 1. Write Checklists 1-5 and staff and volunteer interview findings on flipcharts. 2. Review each checklist and identify strengths and areas for improvement, including those identified from interviews. 3. After dialog, agree all issues that need to be addressed and, on their prioritization to be addressed onsite today, and those in the next three months. Enter these onto Table 2–Priority Facility Actions 4. For each underlying issue, identify actions that can be taken to address the issue, who is responsible and timing. 5. For the actions taken onsite during the visit, indicate under “status” today’s date. 6. Debrief with the facility director and available staff to discuss and eventually agree on the findings and the plan. i. Leave a copy of the Facility Priority Actions with facility staff and decide when the plan will be reviewed and who will be responsible for conducting the review. If the assessment is part of an annual implementation review, keep Checklists 1–5, interviews and Table 2 for review with the larger review team. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 47 Table 2 Priority actions to improve individual isolation or quarantine services Facility Name: _________________________ Facility function: _______________________ (tick the appropriate option)  Quarantine center  Non-health isolation facility Priority Areas for Improvement Priority Actions Person- responsible Timing Status/ Date26 Observations of facility environments (Checklists 1.1 – 1.4) Observations of re-purposed facility environment: accommodation and WASH (Checklist 1.3) 26 If completed on the day of the onsite visit, note as such. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 48 User feedback: summary of the dialogue with the users regarding their comfort, their concern, safety issues, stress (Checklist 2) Essential equipment and supplies (Checklists 3.1, 3.2, 3.3) Policies, SOPs, Guidelines (Checklist 4) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 49 Staff training (Checklist 5) Staff and volunteers feedback: summary of interview with the staff and volunteers (Checklist 6) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 50 SECTION 3 Synthesize findings from a review of several facilities Conducted by evaluation teams that have reviewed several isolation or quarantine facilities. Instructions 1. Review the Table 2 findings from each facility. Tally the common strengths, actions taken onsite, priority actions for the next 3 months in Table 3. 2. Discuss which gaps need national or subnational support and mark accordingly. 3. Discuss what national or subnational priority actions need to be taken. Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 51 Table 3 Synthesis of review findings: national or subnational sample of facilities Programme area Strengths Priority areas for improvement Actions taken onsite Prioritized additional actions National or subnational support needed Environmental hygiene, space, organization and promotional materials (Checklist 1.1 – 1.4) User feedback (Checklist 2) Essential equipment and supplies (Checklist 3) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 52 Programme area Strengths Priority areas for improvement Actions taken onsite Prioritized additional actions National or subnational support needed Policies, guidelines, coordination, and resources to support implementation (Checklist 4) Staff training (Checklist 5) Staff and volunteers feedback (Checklist 6) Repurposing Facilities for Quarantine or Isolation and Management of Mild COVID-19 Cases 53