Isolation & Quarantine Facilities Assessment & Recommendations

Assessment Process Literature Review  CD I&Q Definitions  WA Administrative Code (WAC) Individual I&Q Conditions and Principles  Potential Disease Agent Characteristics – CDC  CDC Infection Control and I&Q Guidance Interviews  Preparedness, CHS, CD-EPI, CBPH, Contracts, Risk Communications Staffs Research and Review Facility Options Analyze Facility Pros and Cons Develop Recommendations

I&Q Facilities Parameters Preliminary Objective: Find 300 rooms  100 in each King County Emergency Coordination Zone Plan for Individual Level I&Q  NOT Community Level Disease Agents Considered:  Executive Order Quarantinable Diseases AND  CDC Category A Bioterrorism Threats OR  Diseases with Potential for Pandemic Spread

I&Q Facility Planning Priorities CDC Category A Bioterrorist Agent (BT-A) OR Potential for Pandemic Named in Exec Order Indv. I&Q Planning Priority Anthrax (BT-A)NO Botulism (BT-A)NO Plague (BT-A)YESX Smallpox (BT-A)YESX Tularemia (BT-A)NO Viral Hemorrhagic Fevers (BT-A)YESX SARSYESX Pandemic InfluenzaNO

Distinguishing I&Q Factors PlagueSmallpoxVHFSARS Isolation Period 3 days3 weeksLate stage10 days Quarantine Period 3 days12 daysn/a Tiered; 10 days max. Infection Control Precautions Standard N-95 mask N-95 mask; Body fluids PPE Standard Preferred Placement HomeFACILITYHospitalHome

I&Q Facilities Considerations Separate rooms/wings ideal; wards OK in large events Adherence to standard and airborne precautions Adequate water, electricity, heating, cooling, ventilation Maintain a clean and quality facility Easy to coordinate and deliver services (accessibility) Attend to physical, emotional, mental, spiritual needs  communications, comfort, entertainment, acceptability I&Q periods could be as long as 3 weeks  comfortable, functional, securable Compatible with Community Level Quarantine measures  e.g. limit the movement of people; social isolation

A Note on Effectiveness Quarantine need not be 100% complete to be effective Voluntary Quarantine is our desired outcome  Involuntary Quarantine is resource intensive Maximum utilization of scarce CD-EPI and/or IQRC resources Law Enforcement and Court System Involvement Requires a More Secure Facility Recommendations are biased in favor of “publicly acceptable” facilities  Motels or similar familiar and comfortable home-like environments  In large events, clean temporary structures vs. deteriorated structures

I&Q Facility Options Considered Public Facilities “Mothballed” Public Facilities Existing Structures:  Community health centers, nursing homes, treatment centers, apartments, schools, dormitories, hotels Temporary Structures:  Trailers, modular units, barracks, tents, bubble systems, field hospitals, RVs, youth camps, fire fighter shelters Emergency Declaration of Dedicated Facility:  Hospital, separate hospital building, hotel

Motel Option Certain motels best address CDC guidance  Separate rooms and restrooms  Independent air circulation Allows for client privacy and self- sufficiency  Significant factor in long-term periods Currently used for TB isolation PRO: High chance for acceptability CON: Post-event stigma of site

HHS – Contingency Stations Placed inside existing structure Modular: 50 bed units, up to 250 per station Includes beds and supplies Available through SNS  4 hours for quarantine (plane)  12 hours for mass care PRO: Eliminates need for local supply stocking/storage CON: Potential for Post-Event Stigmatization of host facility

Alaska Structures Tents Medical Shelter is 650 square feet Erected in 30 minutes or less Soft wall, aluminum frame Modular, expandable Positive pressure ventilation Able to isolate between shelters and hallways PRO: Could accommodate HHS-CS option CON: water, electrical hook-up needed; may require pre-purchase of tent

Sprung Tents Quickly assembled 30 ft to 300 ft long 30 year guarantee Large, open space Can be placed on any flat surface PRO: Could accommodate HHS-CS CON: water, electrical hook-up needed; may require pre-purchase of tent

Mobile Field Hospital Option Large scale solution May be able to secure one from military State of Connecticut Model  Serves as alternate hospital facility PRO: Could accommodate HHS-CS option CON: purchase, storage, site, water, electrical hook-up are all needed

Pros for Each Option Motel:  High chance for public acceptance  Best meets CDC criteria HHS – CS:  Large scale, flexible  Eliminates need for local purchase and storage of supplies Field Hospital:  Large scale, flexible  Acute care is possible

Cons for Each Option Motel:  Public stigmatization after event major concern HHS – CS:  Public stigmatization of host facility  Common ventilation system, no privacy Field Hospital:  Stocking and staffing - expensive  Common ventilation system, no privacy

I&Q Facility Continuum IsolationQuarantine Non-Acute Mass Care Acute Mass Care Field HospitalXXX HHS - CS in a Host Structure XX Motel RoomsXX

I&Q Facility Recommendations Develop a Continuum of Options: Partner with Motels (TB Model) Accommodate HHS – Contingency Stations  Temporary Tents Emergency Declaration of “Designated Facility”  Hospital Wing  Hotel

Action Steps Secure motel agreements (1 underway) Secure HHS-CS accommodation facility agreements Prepare a list of potential “Designated Facility” options Develop an Operational Plans  Site specific as secured  Generic to be used at any site designated in the event