Entry vaccination requirements TCI

From 1^st September 2021, all visitors to the TCI will need to meet the following entry requirements;

• have no signs or symptoms of COVID-19
• have been fully vaccinated with an accepted COVID-19 vaccine: received the complete series or a combination of accepted mRNA or Adenovirus vector vaccines as outlined below AND;
• have received your last dose at least 14 days prior to the day you enter TCI
• Example: if your last dose was anytime on Thursday July 1st, then Friday July 16th would be the first day that you meet the 14-day condition
• upload your proof of vaccination to the TCI Assured Portal TCI || Dashboard (turksandcaicostourism.com)
• meet all other entry requirements (for example, pre-entry test)

Accepted COVID-19 vaccines in TCI

• Pfizer-BioNTech (Comirnaty, tozinameran, BNT162b2)
• Moderna (mRNA-1273, Spikevax)
• AstraZeneca/COVISHIELD (ChAdOx1-S, Vaxzevria, AZD1222)
• Janssen/Johnson & Johnson (Ad26.COV2.S)
• The list of vaccines accepted for entry to the TCI now includes WHO approved vaccines. At the time of publishing, this expanded list includes; Sinopharm (BBIP-CorV (Vero Cells)) and Sinovac (CoronaVac).

Accepted mixed COVID-19 vaccines

Mixing of accepted vaccines (in a two-dose series) is accepted for entry into TCI; once fourteen (14) days have passed since receiving the second dose.

Recovered from COVID-19 with one dose

If you have recovered from COVID-19, you still need a full series of an accepted COVID-19 vaccine or combination of accepted vaccines. If you’ve only had one dose of an accepted vaccine other than Janssen (Johnson & Johnson), you don’t qualify for the fully vaccinated traveler entry requirement for visitors.

No exceptions for partially-vaccinated travelers

At this time, there are no exemptions for visitors who haven't received the full series of a vaccine or a combination of vaccines accepted by the TCI unless a medical exemption is provided by a licensed physician.

Dependents

Unvaccinated children under the age of 16 years who are accompanied by travelers who are fully vaccinated:

• must follow all testing requirements (unless under the age of 10 years)

This applies to unvaccinated children under 16 years of age, who are accompanying a parent, step-parent, guardian or tutor who is a fully vaccinated traveler.

All unvaccinated children under the age of 16 years should be included as travelers in the submission to TCI Assured.

Traveling with unvaccinated dependent adults

Unvaccinated dependents age 18 or over, must follow all testing requirements and have proof of a medical exemption from a physician as specified, even when they are accompanied by parents or guardians who are fully vaccinated travelers.

Accepted medical exemptions from vaccination for visitors

Some persons may be exempted from vaccination against COVID-19 on medical grounds. This must be in the form of a signed and stamped certificate including the following information:

• full name, gender and date of birth of the individual
• registration number and contact details of a licensed healthcare professional in that jurisdiction
• reason for medical exemption must be clearly stated/explained

Please note the Turks and Caicos Islands Government through the TCI Assured Portal reserves the right to accept or refuse medical exemptions and therefore can deny entry to the Turks and Caicos Islands on this basis.

Pre-entry test result requirements

All travelers 10 years of age or older, regardless of citizenship, must provide proof of a COVID-19 test result to enter TCI.

All travelers must provide one of the accepted types of tests including those who are fully vaccinated.

At this time, proof of having a vaccine will not replace a negative test result.

Travelers should keep proof of their test results for 14 days after their arrival into TCI.

Providing proof of your vaccination in TCI Assured Portal

In TCI Assured Portal, up to 72 hours before your travel, you must provide:

• e-certificate/digital certificates
• certification by Doctor or Government Entity
• vaccination cards/certificates accepted by national authorities: e.g. EU, US, UK (i.e. CDC, NHS) a vaccination letter signed by a medical professional (physician or registered nurse) on official letterhead with contact details or Authorized Government Entity or printed record from an electronic vaccination database

• the details of the first dose (date, country and vaccine you received)
• the details of the second dose if one was required (i.e., for Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, and AstraZeneca/COVISHIELD vaccines)
• a photo or PDF file of the record of each dose of the vaccination, such as receipts, cards, or confirmations:
• if you received two doses and they are both recorded on a single card or PDF, upload that same image or file for dose 1 and again for dose 2
• file formats accepted: PDF, PNG, JPEG or JPG
• maximum file size for upload: each image upload has a 2 MB size limit
• preferred file format: if you received a PDF file of your vaccination record, upload the PDF rather than an image, since the PDF is clearer and easier to read
• these must be in English or a certified translation into English

Bring your original proof of vaccination with you while you travel for inspection.

Returning residents

Fully Vaccinated in the Turks and Caicos Islands:

Upload TCI COVID-19 Vaccine E-Certificate when applying to the TCI Assured Portal. Pre-arrival test or quarantine on arrival are not required at this time.

Partially Vaccinated/Unvaccinated Resident:

All unvaccinated and partially vaccinated residents returning to the Turks and Caicos Islands must upload a negative COVID-19 Test to the TCI Assured Portal within 3 days of travel. On arrival, they will be required to quarantine themselves and their household for a period of seven days and undergo a mandatory test (that must be negative) prior to being released. Fully vaccinated residents are exempt from taking a COVID-19 test prior to reentering the country.

All returning residents, regardless of vaccination status are strongly advised to get tested for COVID-19 after arrival in the TCI.

Penalties for the submission of falsified test results or proof of vaccination;

Offence

1. Any person who—
• gives false information when completing the Travel Authorisation Form under regulation 4; or
• otherwise contravenes the provisions of these Regulations (Turks And Caicos Islands Public And Environmental Health(Control Measures)(Covid-19)(Arriving Passengers Health Clearance) Regulations as amended

commits an offence and is liable on summary conviction to a fine of five thousand dollars or to a term of imprisonment for three months, or to both.

 

Entry vaccepted COVID-19 vaccines in TCI

From 1^st September 2021, all visitors to the TCI will need to meet the following entry requirements;

• have no signs or symptoms of COVID-19
• have been fully vaccinated with an accepted COVID-19 vaccine: received the complete series or a combination of accepted mRNA or Adenovirus vector vaccines as outlined below AND;
• have received your last dose at least 14 days prior to the day you enter TCI
• Example: if your last dose was anytime on Thursday July 1st, then Friday July 16th would be the first day that you meet the 14-day condition
• upload your proof of vaccination to the TCI Assured Portal TCI || Dashboard (turksandcaicostourism.com)
• meet all other entry requirements (for example, pre-entry test)

Accepted COVID-19 vaccines in TCI

• Pfizer-BioNTech (Comirnaty, tozinameran, BNT162b2)
• Moderna (mRNA-1273, Spikevax)
• AstraZeneca/COVISHIELD (ChAdOx1-S, Vaxzevria, AZD1222)
• Janssen/Johnson & Johnson (Ad26.COV2.S)

The list of vaccines accepted for entry to the TCI now includes WHO approved vaccines. At the time of publishing, this expanded list includes; Sinopharm (BBIP-CorV (Vero Cells)) and Sinovac (CoronaVac).

Accepted mixed COVID-19 vaccines

Mixing of accepted vaccines (in a two-dose series) is accepted for entry into TCI; once fourteen (14) days have passed since receiving the second dose.

Recovered from COVID-19 with one dose

If you have recovered from COVID-19, you still need a full series of an accepted COVID-19 vaccine or combination of accepted vaccines. If you’ve only had one dose of an accepted vaccine other than Janssen (Johnson & Johnson), you don’t qualify for the fully vaccinated traveler entry requirement for visitors.

No exceptions for partially-vaccinated travelers

At this time, there are no exemptions for visitors who haven't received the full series of a vaccine or a combination of vaccines accepted by the TCI unless a medical exemption is provided by a licensed physician.

Dependents

Unvaccinated children under the age of 16 years who are accompanied by travelers who are fully vaccinated:

• must follow all testing requirements (unless under the age of 10 years)

This applies to unvaccinated children under 16 years of age, who are accompanying a parent, step-parent, guardian or tutor who is a fully vaccinated traveler.

All unvaccinated children under the age of 16 years should be included as travelers in the submission to TCI Assured.

Traveling with unvaccinated dependent adults

Unvaccinated dependents age 18 or over, must follow all testing requirements and have proof of a medical exemption from a physician as specified, even when they are accompanied by parents or guardians who are fully vaccinated travelers.

Accepted medical exemptions from vaccination for visitors

Some persons may be exempted from vaccination against COVID-19 on medical grounds. This must be in the form of a signed and stamped certificate including the following information:

• full name, gender and date of birth of the individual
• registration number and contact details of a licensed healthcare professional in that jurisdiction
• reason for medical exemption must be clearly stated/explained

Please note the Turks and Caicos Islands Government through the TCI Assured Portal reserves the right to accept or refuse medical exemptions and therefore can deny entry to the Turks and Caicos Islands on this basis.

Pre-entry test result requirements

All travelers 10 years of age or older, regardless of citizenship, must provide proof of a COVID-19 test result to enter TCI.

All travelers must provide one of the accepted types of tests including those who are fully vaccinated.

At this time, proof of having a vaccine will not replace a negative test result.

Travelers should keep proof of their test results for 14 days after their arrival into TCI.

Providing proof of your vaccination in TCI Assured Portal

In TCI Assured Portal, up to 72 hours before your travel, you must provide:

• e-certificate/digital certificates
• certification by Doctor or Government Entity
• vaccination cards/certificates accepted by national authorities: e.g. EU, US, UK (i.e. CDC, NHS) a vaccination letter signed by a medical professional (physician or registered nurse) on official letterhead with contact details or Authorized Government Entity or printed record from an electronic vaccination database
• the details of the first dose (date, country and vaccine you received)
• the details of the second dose if one was required (i.e., for Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, and AstraZeneca/COVISHIELD vaccines)
• a photo or PDF file of the record of each dose of the vaccination, such as receipts, cards, or confirmations:

• if you received two doses and they are both recorded on a single card or PDF, upload that same image or file for dose 1 and again for dose 2
• file formats accepted: PDF, PNG, JPEG or JPG
• maximum file size for upload: each image upload has a 2 MB size limit
• preferred file format: if you received a PDF file of your vaccination record, upload the PDF rather than an image, since the PDF is clearer and easier to read
• these must be in English or a certified translation into English

Bring your original proof of vaccination with you while you travel for inspection.

RETURNING RESIDENTS

Fully Vaccinated in the Turks and Caicos Islands:

Upload TCI COVID-19 Vaccine E-Certificate when applying to the TCI Assured Portal. Pre-arrival test or quarantine on arrival are not required at this time.

Partially Vaccinated/Unvaccinated Resident:

All unvaccinated and partially vaccinated residents returning to the Turks and Caicos Islands must upload a negative COVID-19 Test to the TCI Assured Portal within 3 days of travel. On arrival, they will be required to quarantine themselves and their household for a period of seven days and undergo a mandatory test (that must be negative) prior to being released. Fully vaccinated residents are exempt from taking a COVID-19 test prior to reentering the country.

All returning residents, regardless of vaccination status are strongly advised to get tested for COVID-19 after arrival in the TCI.

Penalties for the submission of falsified test results or proof of vaccination;

Offence

1. Any person who—
• gives false information when completing the Travel Authorisation Form under regulation 4; or
• otherwise contravenes the provisions of these Regulations (Turks And Caicos Islands Public And Environmental Health(Control Measures)(Covid-19)(Arriving Passengers Health Clearance) Regulations as amended commits an offence and is liable on summary conviction to a fine of five thousand dollars or to a term of imprisonment for three months, or to both.

Introduction

As the COVID-19 pandemic continues to evolve, World Health Organization Member States need to implement a comprehensive set of public health measures that are adapted to the local context and epidemiology of the disease. The overarching goal is to control COVID-19 by reducing transmission of the virus and preventing associated illness and death.

Several core public health measures that break the chains of transmission are central to this comprehensive strategy, including:

• Identification, isolation, testing, and clinical care for all cases,
• Tracing and quarantine of contacts, and
• Encouraging physical distancing of at least 2 metres (6 feet) combined with frequent hand hygiene and respiratory etiquette.

Scope:

This document provides updated guidance for the implementation of quarantine. The guidance is based on evidence on controlling the spread of SARS-CoV-2, the virus that causes COVID-19, and scientific knowledge of the virus. The document also addresses the requirements for release from quarantine based on updated technical guidance.

Transmission:

Epidemiology and virology studies suggest that transmission occurs from both symptomatic and asymptomatic persons, to others by close contact through respiratory droplets, direct physical contact, or through contact with contaminated objects and surfaces. Shedding of SARS-CoV-2 is highest in the upper respiratory tract (URT) (nose and throat) early in the course of the disease up to 2-3 days prior the onset of symptoms, and during the first 5-7 days of symptoms.

Incubation Period for COVID-19

The incubation period for COVID-19, (the time between exposure to the virus and symptom onset), is, on average, 5–6 days, but can be up to 14 days. During this period, also known as the “pre-symptomatic” period, some infected persons can be contagious, from 1–3 days before symptom onset. It is important to recognize that pre-symptomatic transmission still requires the virus to be spread via infectious droplets or by direct or indirect contact with bodily fluids from an infected person. An asymptomatic case is a person infected with SARS-CoV-2 who does not develop symptoms.

Definition of Quarantine

Quarantine means “the restriction of activities and/or separation from others of suspect persons, who are not ill in such a manner as to prevent the possible spread of infection or contamination.” Today, many countries have the legal authority to impose quarantine, which, in accordance with Article 3 of the International Health Regulations (2005), must be fully respectful of the dignity, human rights and fundamental freedoms of persons. The Turks and Caicos Islands Public and Environmental Health Regulations speaks to the local legal authority to impose quarantine.

Considerations for the quarantine of contacts of COVID-19 cases

The purpose of quarantine is to have persons who are suspected to have, or who have been exposed to COVID-19 to reduce further spread. Quarantine is different from isolation, which is the separation of infected persons (confirmed to have COVID-19) from others to prevent the spread of the virus.

The following should be taken in consideration:

• Persons who are quarantined need access to health care as well as to financial, social and psychosocial support; protection; as well as to support to meet their basic needs, including food, water, hygiene, communication and other essentials for themselves and for household members and children who they are supporting or caring for. The needs of vulnerable populations should be prioritized.
• Cultural, geographic and economic factors affect the effectiveness of quarantine. Rapid assessment of the local context should evaluate both the drivers of success and the potential barriers to quarantine, and they should be used to inform plans for the most appropriate and culturally accepted measures.

Who should be quarantined?

• In the context of the current COVID-19 outbreak, WHO recommends the rapid identification of COVID-19 cases and their isolation and management either in a medical facility or an alternative setting, such as the home. COVID-19 cases should be quarantined with their entire household as these individuals by virtue of their living situation are considered exposed.
• WHO recommends that all contacts of individuals with confirmed or probable COVID-19 be quarantined in a designated facility or at home with their household. Duration of quarantine/isolation is discussed below.
• A contact is a person in any of the following situations from 2 days before and up to 14 days after the onset of symptoms OR 2 days before and up to 14 days after an asymptomatic tests positive in the confirmed or probable case of COVID-19:
  • Face-to-face contact with a probable or confirmed case of COVID-19 within 2 meters and for more than 15 minutes without wearing face mask/covering;
  • Direct physical contact with a probable or confirmed case of COVID-19.
  • Direct care for an individual with probable or confirmed COVID-19 without using proper personal protective equipment or other situations, as indicated by local risk assessments.

Home quarantine should include the following provision:

• Quarantined person should occupy a well ventilated single room, or if a single room is not available, maintain a distance of at least 2 metres from other household members. The use of shared spaces, crockery and cutlery should be minimized, and shared spaces (such as the kitchen and bathroom) should be well ventilated.

Quarantine arrangements in designated facilities should include the following measures:

Those who are in quarantine should be placed in adequately ventilated rooms.

There are three basic criteria for ventilation:

1. Ventilation rate: the amount and quality of outdoor air provided into the space;
2. Airflow direction: the direction of airflow should be from clean to less-clean zones; and
3. Air distribution or airflow pattern: the supply of air to each part of the space to improve dilution and removal of pollutants from the space.
4. For quarantine at home, consider using natural ventilation, opening windows if feasible and safe to do so.

If a child is a contact:

• Children should ideally be quarantined at home, in the care of a parent or other caregiver.
• When this is not possible, children should be quarantined in a household in the care of an adult family member or other caregiver who is at low risk of severe COVID-19. Known risk factors for severe disease include individuals aged >60 years and individuals with underlying medical conditions.

Infection prevention and control measures

• Any person in quarantine who develops febrile illness or respiratory symptoms at any point during the quarantine period should be treated and managed as a suspected COVID-19 case and immediately isolated.
• Standard precautions apply to all persons who are quarantined and to quarantine personnel.
  • Perform hand hygiene frequently, particularly after contact with respiratory secretions, before eating, and after using the toilet. Hand hygiene includes either cleaning hands with soap and water or with a >70% alcohol-based hand rub.
  • Ensure that all persons in quarantine are practicing respiratory hygiene and are aware of the importance of covering their nose and mouth with a bent elbow or paper tissue when coughing or sneezing, and then immediately disposing of the tissue in a wastebasket with a lid and then performing hand hygiene.
  • Refrain from touching the eyes, nose and mouth.
  • Physical distance of at least 2 metres should be maintained between all persons who are quarantined.

Requirements for monitoring the health of quarantined persons

• Follow up of persons who are quarantined should be conducted within the facility or home for the duration of the quarantine period in accordance with WHO and/or national surveillance protocols and case definitions.
• Groups of persons at higher risk of severe disease (individuals aged >60 years and individuals with underlying medical conditions) may require additional surveillance or specific medical treatments.
• Any individual with severe symptoms: shortness of breath, difficulty breathing or severe chest pain should contact 911 for medical treatment at the nearest hospital.

Laboratory testing during quarantine

• Any person in quarantine who develops symptoms consistent with COVID-19 at any point during the quarantine period should be treated and managed as a suspected case of COVID-19. Testing should be offered to any symptomatic individual in quarantine.
• For household contacts who do not develop symptoms, testing may be offered at any time during quarantine. For contacts outside the household, testing may be offered at least 7 days after the last exposure.WHO no longer considers laboratory testing a requirement for leaving quarantine after 14 days.

Duration of isolation/quarantine and precautions

For most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms, however isolation precautions are being recommended for 14 days.

A limited number of persons with severe illness, or underlying medical conditions may produce replication competent virus beyond 10 days that may warrant extending the duration of isolation; this will be evaluated on a case by case basis.

For persons who never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive RT-PCR test for SARS-CoV-2 RNA however 14 days is being recommended.

Special Considerations for COVID-19 Vaccinated Individuals:

Individuals are considered fully vaccinated for COVID-19 ≥2 weeks after they have received the second dose in a 2-dose series (e.g. Pfizer-BioNTech, Astra Zeneca, Moderna) or ≥2 weeks after receiving single dose series (Johnson & Johnson). Evidence of vaccination must be available for review by the Public Health Team in order to qualify for the quarantine periods outlined below:

• Fully vaccinated individuals with a history of exposure to a suspect or confirmed case of COVID-19 who are asymptomatic

These individuals may have a reduced quarantine period after known exposure to COVID-19 (i.e. close contact) from 14 days to 7 days. Individuals in this situation should monitor for signs and symptoms of COVID-19 and notify the Public Health Team if these develop; in such a case these individuals may require testing and an extension of the quarantine period.

• A fully vaccinated individual that tests positive for COVID-19:
  • If all vaccine-eligible* members of the household are fully vaccinated, a quarantine period of 10 days is recommended.
  • If all vaccine-eligible* members of the household are notfully vaccinated, a quarantine period of no less than 14 days is recommended.

• Fully vaccinated people with COVID-19 symptoms

Although the risk that fully vaccinated people could become infected with COVID-19 is low, any fully vaccinated person who experiences symptoms consistent with COVID-19 should isolate themselves from others, contact the MOH hotlines and be tested for SARS-CoV-2 if indicated. The symptomatic fully vaccinated person should inform their healthcare provider of their vaccination status at the time of presentation to care.

• Household members who have received one or more doses of COVID-19 vaccine

While COVID-19 vaccines have been shown to reduce the likelihood of severe illness for those who have received them, the risk of transmission (a vaccinated person spreading COVID-19 to others) is not yet fully known. Therefore, even if a person has been vaccinated, there is still a risk they could catch COVID-19 and spread it to other people.

If someone in the household has symptoms of COVID-19 or has received a positive test result, the household members must be quarantined even if they have received one or more doses of COVID-19 vaccine. The information in this guideline will reduce the risk of spreading infection and help to protect the wider community.

If an individual has symptoms of COVID-19 or has received a positive test result, they are still required to quarantine even if they have received one or more doses of a COVID-19 vaccine. This will reduce the risk of spreading infection and help protect other people.

*Vaccine-eligible: individuals who are able to receive the vaccine based on local and international recommendations/guidelines.

Role of PCR testing to discontinue isolation or precautions

• A test-based strategy is no longer recommended except to discontinue isolation or precautions earlier than would occur normally; under special circumstances.

References

1. Considerations for quarantine of contacts of COVID-19 cases 19^thAugust 2020
2. https://www.who.int/publications/i/item/clinical-management-of-covid-19
3. Home Care or patients with suspected for confirmed COVID-19 and management of their contacts 12^thAugust 2020 https://apps.who.int/iris/bitstream/handle/10665/333782/WHO-2019-nCoVIPCHomeCare-2020.4-eng.pdf?sequence=5&isAllowed=y
4. https://www.cdc.gov/coronavirus/2019ncov/hcp/duratiohtml#:~:text=For%20most%20persons%20with%20COVID,wi th%20improvement%20of%20other%20symptoms.
5. https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stayathome-guidance-for-households-with-possible-coronavirus-covid-19-infection
6. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html
7. Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection - GOV.UK (www.gov.uk)

As the COVID-19 situation continues to develop, the Ministry of Health will update these guidelines based on the best available evidence.

All facilities, organizers, staff, coaches, athletes, and spectators associated with youth or adult noncontact sports should implement these guidelines to assist with safely resuming sporting events and activities due to COVID-19. These guidelines are subject to change. Venue operators should evaluate the profile of the relevant activities at such venue to make appropriate adaptations as necessary, even if not specifically described below. Additional protocols from a sport’s governing association may be applicable, and additional measures may be applicable depending on the circumstances.

Event Organizers, Facility Managers/Staff, Vendor, and Volunteer Protection

• Screen all staff and volunteers reporting to work/event for COVID-19 symptoms with the following questions:
• Have you been in close contact with a confirmed case of COVID-19 in the past 14 days? (Note: This does not apply to medical personnel, first responders, or other individuals who encounter COVID-19 as part of their professional or caregiving duties while wearing appropriate PPE.)
• Are you experiencing a cough, shortness of breath or sore throat?
• Have you had a fever in the last 48 hours?
• Have you had new loss of taste or smell?
• Have you had vomiting or diarrhea in the last 24 hours?
• Temperature screening staff and volunteers:
• Best practice: employers or organizer to take temperatures onsite with a no-touch thermometer each day upon arrival at work/event
• Minimum: temperatures can be taken before arriving. Normal temperature should not exceed 100.4 degrees Fahrenheit.
• Direct any staff who exhibits COVID-19 symptoms (i.e., answers “yes” to any of the screening questions or who is running a fever) to leave the premises immediately and seek medical care and/or COVID-19 testing, per Ministry of Health guidelines. Employers should maintain the confidentiality of employee health information.
• All staff should stay home if feeling ill, report any symptoms of illness to supervisor and require notification of COVID-19 positive case in employee’s household. Staff who are particularly vulnerable to COVID-19 (e.g., due to age or severe underlying medical conditions) are encouraged to refrain from participating.
• Staff should wear face masks or face coverings (not N-95 or medical masks, which should be reserved for healthcare workers) and other personal protection items as recommended by the CDC/WHO.
• Provide training for staff on personal protective equipment based on CDC guidelines.

• Practice recommended social distancing of 2 metres or 6 ft. apart to the greatest extent possible.

• Stagger shifts, breaks and meals, in compliance with wage and hour laws and regulations, to maintain social distancing.
• Prohibit congregating in break rooms or common areas and limit capacity of such areas to allow for safe social distancing minimum of 6 feet whenever possible.
• Staff should increase hygiene practices—wash hands more frequently, avoid touching face, practice good respiratory etiquette when coughing or sneezing.
• Plan for potential COVID-19 cases, and work with the MoH public health team when needed (e.g., monitor and trace COVID-19 cases, deep clean facilities).
• Prepare for absence of critical staff by developing a roster of qualified individuals who can fill in if staff members are absent due to illness or family circumstances.
• Post extensive signage on preventive measures, including information, to help educate on COVID-19 best practices:
• To stop the spread of the virus.
• COVID-19 symptoms

 Coach, Athlete, Official, and Spectator Protection

• Screen coaches, athletes, officials, and spectators for illness upon arrival to facility each day with the following questions:
• Have you been in close contact with a confirmed case of COVID-19 in the past 14 days? (Note: This does not apply to medical personnel, first responders, or other individuals who encounter COVID-19 as part of their professional or caregiving duties while wearing appropriate PPE.)
• Are you experiencing a cough, shortness of breath, or sore throat?
• Have you had a fever in the last 48 hours?
• Have you had new loss of taste or smell?
• Have you had vomiting or diarrhea in the last 24 hours?
• Temperature checks are a best practice. Those with temperatures above 100.4 degrees Fahrenheit should not be permitted on premises
• Direct coaches, athletes, officials, and spectators who exhibits COVID-19 symptoms (i.e., answers “yes” to any of the screening questions or who is running a fever) to leave the premises immediately and seek medical care and/or COVID-19 testing, per MoH guidelines. Maintain the confidentiality of health information
• All coaches, athletes, officials, and spectators should stay home if feeling ill, report any symptoms of illness to supervisor and require notification of COVID-19 positive case in employee’s household. Staff who are particularly vulnerable to COVID-19 (e.g., due to age or severe underlying medical conditions) are encouraged to refrain from participating
• Practice recommended social distancing to the greatest extent possible
• Limit group sizes and mixing. Keep groups small and, to the extent possible, avoid mixing between groups
• Athletes/Coaches:

• Should maintain at least 6 feet of separation from others when not on the field of play or otherwise engaged in play/activity, where feasible
• Consider physical markings in the benches, or other shared or athlete staging areas to help remind athletes and coaches of appropriate social distancing. Consider alternate seating locations or larger staging areas for athletes or staff to increase social distancing
• Athletes and coaches should refrain from high fives, handshake lines, and other physical contact with teammates, opposing teams, coaches, umpires, and fans. Coaches should regularly review social distancing ruleswith athletes

• Spectators should maintain at least 6 feet of separation from others not from the same household, including in seating areas or bleachers, and refrain from entering athlete areas
• Umpires and Officials should maintain 6 feet of separation from others and when interacting with athletes, coaches, and spectators off the field of play. Avoid exchanging documents or equipment with athletes, coaches, or spectators as much as possible
• Encourage those who can to wear cloth face coverings. Wearing a cloth face covering may not be possible while actively participating in an athletic activity, but an effort should be made to wear a face covering between games, when in dug outs, and when not actively engaged in physical activity
• Coaches, umpires, and officials should wear face coverings if in close proximity to others and if using a projected voice within 15 feet of others
• Athletes should wear face coverings when not actively participating
• Spectators should wear cloth face coverings when maintaining appropriate distance from other spectators.
• Locker rooms should not be utilized for the time being due to it being a confined area; athletes and coaches should dress in uniforms at home.
• Require that all athletes, coaches, and officials wash or sanitize their hands upon arriving and leaving each day, and encourage spectators to do the same. Athletes and coaches should regularly wash their hands or use hand sanitizer between activity while on-site
• Coaches and athletes should increase hygiene practices—wash hands more frequently, avoid touching face, practice good respiratory etiquette when coughing or sneezing. Limit spitting
• Recommend that persons more vulnerable or at-risk for COVID-19 (e.g. due to age or severe underlying medical conditions) take extra precaution or refrain from attending or participating for the time being. Where possible, it is recommended that athletes travel to the venue alone or with a member of their immediate household.
• Drinks and snacks provided from home:
• Athletes, managers/coaches, and umpires/officials should bring their own personal beverages to all athletic activities. Drinks should be labeled with the person’s name. If a parent or coach provides beverages for the team, utilize single-person containers and label for each athlete
• If the organizer provides hydration stations or coolers (e.g., water table for team or group run participants), limit prep areas to persons other than essential staff. Provide cups for pick up by athletes at separate areas/tables in a manner that does not encourage congregation, or separate coolers by at least six feet.
• Individuals should take their drink containers home each day for cleaning or use single-use bottles
• Avoid shared or team beverages
• Athletes should bring individual, pre-packaged food, if needed. Avoid unpackaged shared team food
• Avoid eating and spitting seeds, gum, other similar products

 Facility- or Administrative-Related Process Adaptations

• Arrange any seating areas, tables, chairs, etc. (indoors and out) at least 6 feet from each other. If safe distances are not achievable, barricade or remove seating areas. Install barriers and protective shields where needed to safely distance staff and visitors.
• Post signs encouraging social distancing (visible to athletes and spectators). Use signs or ground markings to indicate proper social distancing at ticket booths, concession areas, bathrooms, or anywhere else a line is anticipated to form. If necessary for the venue, consider establishing a “guest flow” plan, including managing queues and making walkways or stairways one-way or clearly divided for bi-directional travel, with appropriate directional signs/markers. Address high-traffic pedestrian intersections to maximize physical distance between persons.
• Staff or volunteers should conduct regular disinfecting of high-touch surfaces, equipment and common areas of the facility using disinfectant cleaning supplies according to Environmental Health established guidelines. An increased number of volunteers or staff may be necessary
• Hand sanitizer and/or hand washing stations with soap and running water should be readily accessible.
• Limit the number of people present in bathroom facilities at any one time to reduce potential exposure within those confined spaces, and ensure that sanitization is occurring at increased intervals.
• Temporarily close water fountains and encourage athletes and spectators to bring their own water.
• Individuals should not congregate in common areas following the event or practice and should depart the premises as soon as is reasonably possible.
• Communicate expectations and new protocols to participants and families in advance of the sporting event.
• Positive COVID-19 case management: Organizer should maintain a complete list of coaches, athletes, and staff present at each event and be prepared to cooperate with the MoH public health team in the event of a confirmed case of COVID-19 by a participant. An effort should be made to maintain a log of spectators, to the extent possible.
• Limit the number of people in restroom facilities at any one time to reduce potential exposure within those confined spaces, and ensure that sanitization is occurring at increased intervals.  Properly sanitize and distance porta-potties, if used. Provide hand sanitizer or hand washing stations with running water and soap for each porta-potty. Space out porta-potty clusters to create greater social distancing within lines; consider decreasing the ratio of the number of persons per porta-potty. Work with vendor or volunteers to maintain hygiene supplies and to regularly sanitize porta-potties (wearing appropriate PPE) throughout event
• Continue to offer virtual participation options, particularly for persons who are vulnerable or uncomfortable in larger groups. 
• Limit awards ceremonies or post-event celebrations to reduce potential for larger crowds.
• Use areas, venues, or facilities that allow for greater physical separation of athletes (e.g., spread out team practice across extra field space, use wider starting line for cycling, triathlon or running events).

 References

https://www.tn.gov/governor/covid-19/economic-recovery/noncontact-sports.html

CDC Considerations for Youth Sports: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/youth-sports.html

Little League® Best Practice: https://www.littleleague.org/player-safety/coronavirus-update/season-resumption-guide/best-practices/organizing-playing-watching-games/

 

Note that as the COVID-19 situation continues to develop, the Ministry of Health will provide

updates if any additional precautions are recommended.

The use of masks is part of a comprehensive package for Infection prevention and control measures, to reduce the spread of certain respiratory viral diseases, including COVID-19. Masks can be used either for the protection of healthy persons (worn to protect oneself when in contact with an infected individual) or for source control (worn by an infected individual to prevent onward transmission).

Face mask and face coverings do not replace hand hygiene, social distancing and other infection prevention and control (IPC) measures. Therefore, it is important to note that the use of a face mask or face covering alone is insufficient to provide an adequate level of protection or source control, and other personal and community level measures should also be adopted to suppress transmission of respiratory viruses. Whether or not face masks or face coverings are used, compliance with hand hygiene, physical distancing and other infection prevention and control (IPC) measures are critical to prevent human-to-human transmission of COVID-19.

Aim

This guidance provides information and guidance on the use of Non-medical masks and face coverings for the general public to help prevent potential exposure risk of the Coronavirus disease 2019 (COVID-19).

Use of non-medical cloth/ disposable masks or face coverings in community settings

COVID-19 is spread through contact with the respiratory droplets produced by infected individuals when they cough, sneeze, or even when they laugh or speak, including by individuals who have not yet or who may never develop symptoms.

Strategies to re-open sectors and societal activities need to take into account the role of both symptomatic and asymptomatic individuals in spreading COVID-19. This challenges us to consider additional strategies to reduce transmission by whatever means available.

Use of non-medical cloth/ disposable masks or face coverings in workplace settings

There may be some non-healthcare work settings for which medical masks may be more appropriate than non-medical masks. Masks may not be suitable for all types of occupations. Employers should consult with the local public health team before introducing mask-wearing policies to the workplace.

When establishing policies regarding use of non-medical masks or cloth face covering in the workplace, employers should consider carefully the occupational requirements of their workers and their specific workplace configuration to ensure mitigation against any possible physical injuries that might inadvertently be caused by wearing a face covering (e.g., interfering with the ability to see or speak clearly, or becoming accidentally lodged in equipment the wearer is operating).

The potential psychological impacts of the non-medical mask or cloth face covering on other employees or clients should also be considered (e.g. design/construction of the mask, messaging, etc.). Non-medical masks or cloth face coverings are not considered personal protective equipment (PPE).

Although all efforts should be made to preserve the supply of medical masks for healthcare settings, there may be some non-healthcare workplaces in which a medical mask may be a more appropriate choice for the protection of the worker. An f example of this would, providing services to a client who cannot wear a non-medical mask or face covering when the two-metre physical distance cannot be maintained, and measures such as plexiglass/transparent barriers are not possible or available.

Masks may not be suitable for all types of occupation. Employers should consult with their Occupational Health and Safety team and local public health personnel, before introducing mask-wearing policies to the workplace

How to protect others

The best thing you can do to prevent spreading COVID-19 is to wash your hands frequently with warm water and soap for at least 20 seconds. If none is available, use hand sanitizer with a minimum of 60 % ethanol or 70% isopropyl, regularly cleaning and disinfecting your surfaces and objects.

To protect others, you should also:

• Stay at home and away from others if ill.
• Protect those most at risk from the virus
• Maintain a 2-metre (6 feet) physical distance from others.
• When physical distancing cannot be maintained, consider wearing a non-medical mask or homemade face covering.
• Avoid touching your face, mouth, nose or eyes.

Wearing a homemade facial covering/non-medical mask or disposable non-medical mask in the community has not been proven to protect the person wearing it and is not a substitute for physical distancing and hand washing. However, it can be an additional measure taken to protect others around you, even if you have no symptoms.

Wearing a homemade non-medical mask/facial covering in the community is recommended for periods of time when it is not possible to consistently maintain a 2-metre physical distance from others, particularly in crowded public settings such as:

• stores
• shopping areas
• public transportation

Appropriate use of non-medical mask or face covering

When worn properly, a person wearing a non-medical mask or face covering can reduce the spread of his or her own infectious respiratory droplets.

Non-medical face masks or face coverings should:

• Allow for easy breathing.
• Fit securely to the head with ties or ear loops.
• Maintain their shape after washing and drying.
• Be changed as soon as possible if damp or dirty.
• Be comfortable and not require frequent adjustment.
• Be made of at least 2 layers of tightly woven material fabric (such as cotton or linen).
• Be large enough to completely and comfortably cover the nose and mouth without gaping.

Some masks also include a pocket to accommodate a paper towel or disposable coffee filter, for increased benefit.

Non-medical masks or face coverings should NOT

• Be shared with others.
• Impair vision or interfere with tasks.
• Be placed on children under the age of 2 years.
• Be made of plastic or other non-breathable materials.
• Be secured with tape or other inappropriate materials.
• Be made exclusively of materials that easily fall apart, such as tissues.
• Be placed on anyone unable to remove them without assistance or anyone who has trouble breathing.

• Be worn by persons who are unconscious or incapacitated.

Limitations

Homemade masks are not medical devices and are not regulated like medical masks and respirators. Their use poses a number of limitations:

• They have not been tested to recognized standards.
• The fabrics are not the same as used in surgical masks or respirators.
• The edges are not designed to form a seal around the nose and mouth.
• They may not provide complete protection against virus-sized particles.
• They can be difficult to breathe through and can prevent you from getting the required amount of oxygen needed by your body.

These types of masks may not be effective in blocking virus particles that may be transmitted by

coughing, sneezing or certain medical procedures. They do not provide complete protection from virus particles because of a potential loose fit and the materials used (see table 1).

Medical masks, including surgical, medical procedure face masks and respirators (like N95 masks), must be kept for health care workers and others providing direct care to COVID-19 patients.

Alternatives to non-medical masks for the general public

In the context of non-medical mask shortage, face shields may be considered as an alternative noting that they are inferior to mask with respect to prevention of droplet transmission. If face shields are to be used, ensure proper design to cover the sides of the face and below the chin. In addition, they may be easier to wear for individuals with limited compliance with medical masks (such as those with mental health disorders, developmental disabilities, deaf and hard of hearing community and children).

Table 1: Summary guidance and practical considerations for non-medical mask production and management

Guidance and practical considerations

Fabric selection:

Choose materials that capture particles and droplets but remain easy to breathe through.

Avoid stretchy material for making masks as they provide lower filtration efficiency during use and are sensitive to washing at high temperatures.

Fabrics that can support high temperatures (60° or more) are preferable.

Construction:

A minimum of three layers is required, depending on the fabric used: an inner layer touching the mouth and an outer layer that is exposed to the environment.

Choose water-absorbing (hydrophilic) materials or fabrics for the internal layers, to readily absorb droplets, combined with an external synthetic material that does not easily absorb liquid (hydrophobic).

Mask management:

Masks should only be used by one person and not shared with others

All masks should be changed if soiled or wet; a soiled or wet mask should not be worn for an extended period of time.

Non-medical masks should be washed frequently and handled carefully, so as not to contaminate other items.

Clothing fabrics used to make masks should be checked for the highest permitted washing temperature, which is indicated on the clothing label.

Non-woven polypropylene (PP) spunbond may be washed at high temperature, up to 140°C.

The combination of non-woven PP spunbond and cotton can tolerate high temperatures; masks made of these combinations may be steamed or boiled.

Where hot water is not available, wash mask with soap/detergent at room temperature water, followed by either i) boiling mask for one minute OR ii) soak mask in 0.1% chlorine for one minute then thoroughly rinse mask with room temperature water, to avoid any toxic residual of chlorine.

References:

Advice on the use of masks in the context of COVID-19, Interim Guidance 5 June 2020, WHO

https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak

http://www.phn-rsp.ca/sac-covid-ccs/wearing-masks-community-eng.php

Note that as the COVID-19 situation continues to develop, the Ministry of Health will provide updates if any additional precautions are recommended.