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Thursday, September 24, 2020
Greetings Long-Term Care and Residential Care Facilities of San Diego County,
Please find information below regarding the latest guidance and resources from county, state, and
federal organizations, including new updates:
- All Facilities Letter (AFL) reminds licensed health facilities of requirements to report outbreaks
and unusual infectious disease occurrences to the County Epidemiology Unit and Licensing
and Certification District Office and provides investigation and reporting thresholds for
reporting for COVID-19 (AFL 20-75)
- AFL provides recommendations for Personal Protective Equipment, resident
placement/movement, and staffing based on the residents' COVID-19 status (AFL 20-74)
- AFL provides guidance for confirming resident treatment wishes during the COVID-19
pandemic through proactive advance care planning (AFL 20-73)
- AFL notifies home health agencies of a temporary waiver of specified regulatory requirements
due to the state of emergency related to COVID-19 (AFL 20-72)
- Notes from the California Department of Public Health conference call for Skilled Nursing
Facilities to provide updates on COVID-19 (9-17-20)
- PowerPoint slides from the Community Care Licensing Division’s Regional Informational
“Town Hall” webinar (9-21-20)
- Influenza (flu) vaccination information and resources
- Reminder: Long-Term Care and Residential Care Facilities telebriefing tomorrow, Friday,
9/25/20, 4:00 – 5:00 pm with special guest the County of San Diego Registrar of Voters
As a reminder, if you have a positive COVID-19 case at your facility, please report it by calling the
County Epidemiology Unit phone line at (619) 692-8499 or (858) 565-5255 for after-hours or on the
weekend. The County as well as your State licensing departments are here to support you.
If you missed any recent email updates from this sector, review them here. For additional information
and resources, please see our website www.coronavirus-sd.com/LTC.
Thank you for your continued efforts and partnership with the County of San Diego!
California Department of Public Health CDPH publishes news and All Facilities Letters (AFLs)
regularly. If you would like to receive email notifications
of AFLs, please submit your request to
[email protected]. See the newly released
advisories below:
NEW! Letter to All Facilities: AFL 20-75 – September 22, 2020
This AFL reminds licensed health facilities of requirements to report outbreaks and unusual
infectious disease occurrences to their local health department (LHD) and Licensing and
Certification District Office and provides investigation and reporting thresholds for reporting for
COVID-19. The national Council of State and Territorial Epidemiologists (CSTE) recently
posted Proposed Investigation/Reporting Thresholds and Outbreak Definition for COVID-19 in
Acute Care Hospitals, Critical Access Hospitals, Long-Term Care Facilities (LTCFs) and
Long-Term Care Acute Hospitals (PDF). These thresholds are intended to expedite facilities'
investigation of COVID-19 cases and reporting to public health authorities, to help ensure
early detection of possible outbreaks and timely intervention to prevent the virus' spread.
Click here to read AFL 20-75
NEW! Letter to Skilled Nursing Facilities: AFL 20-74 – September 17, 2020
This AFL provides recommendations for PPE, resident placement/movement, and staffing
based on the residents' COVID-19 status. The AFL provides guidance for facilities to ensure
confirmed COVID-19 positive residents are placed on the dedicated COVID-19 positive unit
("red" area) and then evaluate exposure status of other residents in the facility. CDPH
recommends facilities group residents into three separate cohorts.
Click here to read AFL 20-74
NEW! Letter to Skilled Nursing Facilities: AFL 20-73 – September 22, 2020
This AFL provides guidance for confirming resident treatment wishes during the COVID-19
pandemic through proactive advance care planning.
Click here to read AFL 20-73
NEW! Letter to All Facilities: AFL 20-72 – September 17, 2020
This AFL notifies home health agencies of a temporary waiver of specified regulatory
requirements due to the state of emergency related to the Coronavirus Disease 2019
(COVID-19) outbreak. Pursuant to Governor Newsom's Executive Order N-75-20, and
consistent with federal guidance issued by the Centers for Medicare and Medicaid Services
(CMS), the Director of the California Department of Public Health (CDPH) may waive any of
the licensing and staffing requirements of Chapter 8 of Division 2 of the Health and Safety
Code (HSC) and the accompanying regulations with respect to home health agencies.
Click here to read AFL 20-72
NEW! Notes from the California Department of Public Health conference call for Skilled Nursing
Facilities to provide updates on COVID-19 on 9-17-20. Please see attached PDF titled, “AFC-SNF+IP+Call+Notes+9.17.20”.
Letter to All Facilities: AFL 20-71 – September 14, 2020
The California Department of Public Health announces a recall of the Advoque Safeguard
N95 Particulate Filtering Respirator, the Respirator MODEL ADV001, effective September
10, 2020. Advoque masks containing the specific National Institute for Occupational Safety
and Health approval number TC-84-A-PH02, including masks distributed prior to September
10, 2020, may no longer be distributed and used as an N95 Respirator. Please immediately cease use of this product. If you have this model of N95 and will experience a shortage as
a result of this recall, please feel free to reach out to [email protected]
for an alternate respirator.
Click here to read AFL 20-71
Letter to Skilled Nursing Facilities: AFL 20-70 – September 14, 2020
This AFL provides recommendations to skilled nursing facilities for non-emergency
transportation during the COVID-19 pandemic. Click here to read AFL 20-70
Letter to Skilled Nursing Facilities: AFL 20-53.3 – September 12, 2020
This AFL supersedes 20-53.2 and provides recommendations for SNFs developing COVID-
19 Mitigation Plans. This includes recommendations for baseline, screening, and response-
driven testing of SNF residents and health care personnel to prevent spread of infection in
the facility. This revision updates and clarifies testing guidelines to align with the Centers for
Medicare and Medicaid Services interim final rule on facility and resident COVID-19 testing
and terminology from new CDC testing guidance, and includes the use of point of care
antigen test instruments.
Click here to read AFL 20-53
Letter to All Facilities: AFL 20-69 – September 11, 2020 This AFL describes the surveys that CDPH will conduct during the COVID-19 pandemic.
Click here to read AFL 20-69
Guidance on the Use of Antigen Tests for Diagnosis of Acute COVID-19. CDPH provides antigen
guidance statement for all Californians. The guidance explains Antigen testing, results,
testing facility, and appropriate use.
Click here to read the guidance.
Guidance for the Prevention of COVID-19 Transmission for Gatherings. This guidance provides an
updated plan for Californians to gather outside their household and replaces the March 16,
2020 gatherings guidance. It applies to public and private gatherings and other gatherings
not covered by existing sector guidance.
Click here to read the guidance.
Click here to see a full list of recent AFLs
California Department of Social Services The Community Care Licensing Division (CCLD) of the California
Department of Social Services (CDSS) publishes Provider
Information Notices (PINs) to communicate important license related
information to CCLD-licensed providers. The local CDSS San Diego
Adult and Senior Care office can be reached at (619) 767-2300 or
NEW! PowerPoint presentation slides from CCLD’s Regional Town Hall call held on 9-21-20 that
provided guidance and resources to Adult and Senior Care licensees in San Diego. Please see attached PDF titled, “CCLD Town Hall Webinar Slides 9_21_20”.
Letter to All Community Care Providers – August 31, 2020
The Governor’s Proclamation of a State of Emergency Due to Extreme Weather and Fires PIN 20-21-CCLD provides notification of the Governor's proclamation of a State of
Emergency regarding Community Care Licensing Division facilities and homes impacted by
the extreme weather and fires in California, and the opportunity for waivers of certain
licensing requirements.
Click here to read PIN 20-21-CCLD
Click here to browse the full list of recent PINs.
COVID-19 Considerations for Long-Term Care Facilities Toolkit – September 2020
“This toolkit is a compilation of considerations for LTC facilities based on lessons learned
during the early months of the pandemic accompanied by resources to inform planning and
response efforts.” Click here for the full Toolkit.
Flu and Vaccine Information Getting Vaccinated Against the Flu More Important Than Ever
NEW! In an effort to prevent a "twindemic" of COVID-19 and seasonal influenza, California
Department of Public Health (CDPH) is urging Californians to get vaccinated against the flu
now to protect themselves and their loved ones. Caregivers and residents in long-term care
facilities are at higher risk of getting severe flu disease.
For more information about the flu, visit CDPH's website. For the flu vaccine location nearest
you, visit www.flu.gov.
To read the full CDPH article, click here.
For additional Flu Season 2020-2021 information, please see resources below:
Click here for the County of San Diego Immunization Program influenza webpage
Click here for the Centers for Disease Control and Prevention (CDC) ways to protect your
health this season and more:
• The Difference between Flu and COVID-19
• Information for Health Care Professionals 2020-2021 Flu Season
• Frequently Asked Influenza (flu) Questions: 2020-2021 Season
San Diego County Emergency Site As parts of the county continue to battle wildfires, it is a
sobering reminder that disasters can happen at any time and
that everyone should be prepared for emergencies. Here are
some helpful resources that are available for the public to stay
informed about and prepare for fires and other disasters in San
Diego County:
• For fire, disaster information updates, and the County of San Diego Emergency Map, visit
www.sdcountyemergency.com
• To prepare for, plan for, and stay informed on disasters in San Diego County, visit
www.ReadySanDiego.org
• Download the SDEmergencyApp, a no-cost mobile application available to download for
iOS and Android devices. To learn more, click here
• Register here with AlertSanDiego to get emergency notifications, like evacuation orders
and warnings, on your cell phone during a disaster in your area. (Listed and unlisted
landlines are already included in this system and do not need to be registered)
Friday, September 25 at 4:00pm
Telebriefing for Long-Term Care and Residential Care Facilities with a Special Guest from the County of San Diego Registrar of Voters
WHEN: Friday, September 25, 2020, at 4:00 p.m.
Please pre-submit your questions in advance here. Participants
will have the opportunity to ask questions during the call
through the online chat feature on the Zoom platform.
Join the telebriefing at the specified time and date using one of the options below:
• Option 1 | Computer (preferred):
o Click on the following link
https://zoom.us/j/218631109
o Meeting ID: 218 631 109
o If you have any difficulties accessing the
participant link, please use option 2.
• Option 2 | Phone:
o Dial-In Number: 1 (669) 900-6833 or 1 (346) 248-
7799
o Meeting ID: 218 631 109.
Visit the Long-Term Care and Residential Care Facilities Sector Support webpage to learn more.
Friday, October 16 at 4:00pm
Telebriefing for Older Adult and Disability Service Providers
WHEN: Friday, October 16, 2020, at 4:00 p.m.
Please pre-submit your questions at least 24 hours before the
telebriefing, so that they can be answered on the call.
Participants will have the opportunity to ask questions during
the call through the online chat feature on the Zoom platform.
Please click here for more information, including access link
and call-in option.
County of San Diego COVID-19 Dashboard and Weekly “COVID-19 Watch” Report The County of San Diego publishes a weekly surveillance report
on the coronavirus-sd.com website called “COVID-19 Watch”.
Click here to review the report.
Additionally, visualize and track data real time on the interactive
web-based dashboard developed by the County of San Diego
Epidemiology and Immunization Services Branch.
See the dashboard here.
Latest San Diego County Public Health Order The latest updates to the local Public Health Order included
additional key items for reopening businesses (September 10,
2020). Read the latest order.
Recent Email Updates and Resources from the Long-Term Care and Residential Care Sector
• September 17, 2020 Update
• September 10, 2020 Update
• September 3, 2020 Update
Click here to browse all past email updates.
211 San Diego For health or testing related questions, contact your healthcare
provider. For general questions about COVID-19, information
about community resources, or if you are uninsured, call 2-1-1 San Diego. Click here for free COVID-19 testing information.
COVID-19 Downloadable Resources and Materials for Your Facility Find FAQs, posters, videos, and other materials.
Guidance from the Centers for Disease Control and Prevention
• COVID-19 in Nursing Homes and Long-Term Care
Facilities
• Considerations for Use of SARS-CoV-2 Antigen Testing in
Nursing Homes
• Printable Algorithm for considerations for testing
asymptomatic and symptomatic residents or HCP.
• Guidelines on Masks, How to Select, Wear, and Clean
Your Mask
• Guidelines for Group Homes for Individuals with
Disabilities
• Guidelines for Direct Service Providers of Individuals with
Disabilities
• Considerations When Preparing for COVID-19 in Assisted
Living Facilities
• Considerations for Memory Care Units in Long-term Care
Facilities
For general information about COVID-19 from the CDC, please visit www.cdc.gov/coronavirus.
General COVID-19 Information from Federal and State Organizations
• Centers for Disease Control and Prevention – COVID-19
• California Department of Public Health, Immunization
Branch – COVID-19
• California Department of Social Services – COVID 19
For questions related to long-term care and residential care facilities, please email: [email protected].
Get the latest information about what's happening across the county with COVID-19.
Text COSD COVID-19 to 468-311 to get text alert updates from the County of San Diego.
California Department of Public Health
Center for Health Care Quality AFC Skilled Nursing Facilities Infection Prevention Calls
September 16 & 17, 2020
Review of September 12th AFL 20-53.3: COVID-19 Mitigation Plan Recommendations for Testing of HCP and Residents at SNFs https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-53.aspx The September 16th webinar recording and handouts can be found at the links below. Flow charts presented are below.
• https://www.hsag.com/cdph-ip-webinars
• Access the recording | HSAG Slides | CDPH Slides: Testing
Important Updates:
• COVID-19 Data Reports: Per AFL 20-68, HSAG creates COVID-19 trend reports every Monday for all nursing homes in the state using data from NHSN. To access your report, please complete the HSAG QIIP Administrator Form. To ensure your facility's data report is updated, confer rights to HSAG by following these instructions.
• Correcting Inaccurate NHSN Data: If your nursing home’s data is incorrect on the HSAG COVID-19 trend reports, you need to access NHSN to correct your data. If your facility no longer has a user that can access NHSN, please complete the NHSN Facility Administrator Change Request Form or contact [email protected]
• CMS Targeted COVID-19 Training for Frontline Nursing Home Staff and Management: Access the scenario based trainings for your staff at the CMS Quality, Safety and Education Portal (QSEP): https://qsep.cms.gov. To get a certificate of completion, staff need to complete the pre- and post-test, training and the evaluation.
o Frontline Nursing Home Staff Modules ▪ Module 1: Hand Hygiene and PPE ▪ Module 2: Screening and Surveillance ▪ Module 3: Cleaning the Nursing Home ▪ Module 4: Cohorting ▪ Module 5: Caring for Residents with Dementia in a Pandemic
o Management Modules ▪ Module 1-5: Same subjects as frontline staff trainings ▪ Module 6: Basic Infection Control ▪ Module 7: Emergency Preparedness and Surge Capacity ▪ Module 8: Addressing Emotional Health of Residents and Staff ▪ Module 9: Telehealth for Nursing Homes ▪ Module 10: Getting Your Vaccine Delivery System Ready
• CMS Update: On September 16, 2020, the Centers for Medicare & Medicaid Services (CMS) received the final report from the independent Coronavirus Commission for Safety and Quality in Nursing Homes:
o Coronavirus Commission on Safety and Quality in Nursing Homes Full Report o Administration Response to Commission Findings o COVID-19 Guidance and Updates for Nursing Homes during COVID-19
Questions & Answers: Q: How do I know what my county positivity rate is? A: Visit https://healthdata.gov/dataset/covid-19-nursing-home-data-test-positivity-rates to identify the CMS test positivity rates for all counties in the nation. Other websites with county data include: https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/ and https://data.cms.gov/stories/s/q5r5-gjyu. Data on county positivity will be release weekly by CMS. Counties are classified as either green, yellow or red based on their positivity rate. Facilities can use the CMS data to determine their test positivity rate or they can use data from the state or local health department if that data is more recent.
Q: Testing costs are getting expensive for facilities – sometimes even as high as $12,000 a week. How are the costs of the weekly tests being covered? Residents are receiving messages from their insurance companies related to testing and being charged; thus they don’t want to be tested to avoid those charges. What should they do? A: Insurance companies should be covering this expense. We have regulations in California that mandate insurance companies cover these costs. We strongly encourage facilities experiencing coverage barriers for people with HMOs to reach out to the Department of Managed Care (DMC) that regulates HMOs. Point insurance companies to DMC website showing they are mandated to cover the costs. For residents and staff that have non-HMO coverage, it is recommended to reach out to the Department of Insurance. Q: Based on the county's positivity rate, what are the testing expectations for ombudsman, surveyors, laboratories, diagnostic testing companies, EMS, psychologist, dentist, podiatrist, ophthalmologist, optometrist, and other outside consultants coming into the facility? Should NHs ask for proof of recent test results? Is verbal attestation of a negative test result sufficient? Is the NH responsible for testing them? A: We currently do not have specific guidance on testing of individuals coming into the facility, aside from residents and staff. We are not expecting facilities to cover the costs of these tests in whole. We encourage facilities to determine the best practice for this considering their own unique circumstances. Q: If a facility uses an antigen test for a contract worker who comes to the building and it comes back positive, do they need to report this and start outbreak testing if the contractor has never been in the building? A: If the facility conducted the antigen test, then they would need to report that result. Regarding response testing, if the individual has not been in the building and just tested positive, this would not require response testing. Q: Would you count a positive test from a patient that had tested positive previously over 90 days ago as a new positive or ongoing? Would this trigger response testing? A: Because it is a new case for the facility, this would need to trigger response testing and be reported as a new case. Q: Question related to point of care testing instruments. How can facilities get them if they haven’t received them already? A: The point of care antigen tests are being distributed by the federal government and not CDPH. Distribution of the tests have been scheduled for delivery in two waves:
• Wave 1: Devices scheduled for delivery between July 20th and August 14 (~2,400 nursing homes) to hot spot nursing homes.
• Wave 2: Devices scheduled for delivery between August 17 through September 30 (~11,800 nursing homes)
Nursing homes must have a Clinical Laboratory Improvement Amendment (CLIA) Certificate of Waiver to receive a testing device. Visit https://data.cms.gov/Special-Programs-Initiatives-COVID-19-Nursing-Home/Nursing-Home-Data-Point-of-Care-Device-Allocation/jbvf-tb74 to identify which nursing homes have received or will be receiving the test kit.
THE DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE L ICENSING DIVISION
ADULT AND SENIOR CARE PROGRAM
Emergency Disaster and
Preparedness 1
PIN 20-28-ASC2
PIN 20-28-ASC cont.
PIN 20-28: EMERGENCY RESIDENT TRANSFERS DURING THE
CORONAVIRUS DISEASE (COVID-19) PANDEMIC
• Provides guidance to adult and senior care program licensees for
evacuating and transferring residents in emergency situations during
the COVID-19 pandemic and includes the following addendums:
Addendum A: Checklist. List of what to consider when evacuating residents
during infectious disease outbreaks.
Addendum B: Decision Tree. Receiving emergency transfer placements
decision tree based on COVID-19 screening and/or testing.
3
Emergency Plan
A current Emergency Plan is required per Title 22 and applicable statutes
in the Health/Safety Code:
• Adult Residential Facility (ARF), Community Crisis Home (CCH),
Enhanced Behavioral Supports Home (EBSH), Adult Residential
Facility for Persons with Special Health Care Needs (ARFPSHN):
Section 80023
• Residential Care Facility for the Elderly(RCFE): Section 87212, and
HSC Section 1569.695
• Residential Care Facility for Chronically Ill (RCFCI): Section 87823
• Social Rehabilitation Facilities (SRF): Section 81023
Licensees must be prepared for natural disasters and emergencies such
as wildfires, floods, earthquakes, and widespread serious illnesses.
• Licensees required to review and modify emergency plan, as
needed.
4
5
Emergency Disaster Plan
(LIC610E)
6
Emergency Disaster Plan
(LIC610D)
What To Do: Evacuation
In preparation for emergency situations during the COVID-19 pandemic,
CCLD recommends facilities:
• Be aware and engage in regional planning efforts to transfer
residents with COVID-19.
• Network with facilities that may receive emergency transfer of
residents and develop transfer agreements with other facilities.
• Review, plan, modify existing emergency plan to include infection
control measures for COVID-19 and ensure all contact information is
current.
• Ensure staff are trained, knowledgeable of emergency preparedness
and procedures.
• Prepare client medication and Personal Protective Equipment (PPE)
to be transferred with client.
• Refer to Addendum-A for infectious disease evacuation checklist.
7
Continue Infection Control8
Universal•
1. Use Barrier Protection: Cover up any openwounds or sores before proceeding.
2. Wear Gloves when handling bodily fluids or
contaminated materials and other waste.
3. Wear a Face Mask/Gown
4. Use Caution when handling sharp objects, needles,
and waste.
5. Discard Contaminated Materials. Follow biohazard
procedures for disposal.
6. Clean Area thoroughly with disinfectant.
7. Wash Hands Thoroughly with soap and water for at
least 20 seconds.
8. Wash Clothing in hot water.
StandardHand Hygiene: wash hands after contact with blood or body fluids and after taking off gloves.
Mask, eye protection, face shield: worn to protect eyes, nose and mouth.
Care equipment: soiled care equipment should be handled to prevent contamination and exposure to skin and mucous membranes.
Sharps: DO NOT recap, bend or break needles. Place in sharps container.
Gown/plastic apron: wear to protect skin and prevent soiling of clothing during procedures.
Gloves: should be worn for touching blood, body fluids, mucous membranes and contaminated items.
Environment: clean toilets with alcohol wipes and blood spills immediately.
•
•
•
•
•
•
Precautions!
Developing a Plan9
1. Monitor your state and local health departments for additional information and recommendations.
2. Prepare your employees. Staff needs to be informed and prepared. Your review should include: • Infection control policies including hand hygiene, cough etiquette • Personal protective equipment • Staying home when sick • Focus on facts from verified resources, such as the CDC and the WHO
3. Gather supplies – You will want to have supplies on hand in the event your community is directly impacted by the outbreak.
4. Review infection control protocols, with a focus on hand hygiene and personal protective equipment.
5. Develop a communication plan – Give clear and direct communication to your staff, residents, and families. Be prepared to communicate with the media should you be approached. Focus on letting everyone know you are following CDC and health department guidelines.
Addendum-A10
Due to the challenges of evacuating a community care facility duringCOVID-19, or other infectious disease outbreak CCLD recommends achecklist (Addendum-A) as a new layer to emergency preparednessplans for emergency transfers.
The following are some important things to consider:
✓ Is it necessary to evacuate? If yes, when? How early?
✓ How to maintain the separation of between Covid-19 (+) and (-) residents?
✓ How to assist residents with physical distancing, hand hygiene, face covering, etc. while evacuating.
✓ What can staff do to help minimize their risk of Covid-19 exposure?
✓ How to implement isolation and quarantine if necessary?
✓ Consider when to initiate communication with family members and intent to take family members home during potential emergency evacuation.
✓ Anticipate the need for extra supply of PPEs and hand hygiene products.
✓ Is there adequate transportation ready and available?
What To Do: Evacuees
For facilities receiving emergency transfer of evacuated resident(s), CCLD
recommends the following:
• Communicate with the transferring facility regarding space, staffing,
transportation, medical records, transfer information, etc.
• Ensure adequate supply of PPEs (e.g. face covering, etc.) available
for transferred residents and staff.
• Ensure all residents’ medical records, medications, etc. are transferred
with the resident.
• Designate an area to receive evacuated resident(s).
• Note, in the event that there are no licensees with the space and/or
staff to accept emergency transfer of residents, the transferring facility
should contact local and/or state authorities, including the Community
Care Licensing Division Regional Office.
11
12
The following COVID-19 precautions are recommended when evacuating or transferring residents:
Screen residents for symptoms of COVID-19.
Test residents experiencing Covid-19 symptoms prior to or upon transfer to new facility or shelter, if possible.➢ Residents experiencing symptoms should be isolated in the facility receiving
emergency transfers.
➢ Facilities do not have to wait for test results before accepting emergency transfer residents.
• Organize residents by their Covid-19 status, if possible.
• Evacuated residents with same Covid-19 status should be transportedin the same vehicle.
• Residents should remain wearing appropriate PPEs (e.g. facemask, etc.) through the entire evacuation/transfer process.
• Refer to Addendum-B for receiving emergency transfer placement decision tree based on Covid-19 screening and/or testing.
Evacuation: Covid-19 Precautions
Addendum-B13
The
Decision Tree
Additional Resources
CA Dept of Social Services (CDSS) Home Page:
➢ Current information on COVID-19
➢ Current Adult and Senior Care Provider Informational Notices (PINs)
➢ To sign-up, visit ccld.ca.gov and click on “receive important updates.”
https://www.cdss.ca.gov/inforesources/community-care-licensing
Everbridge Mass Notification System:
➢ PIN 20-22-ASC
CA Dept of Public Health (CDPH):https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/nCOV2019.a
spx
Center for Disease Control (CDC):https://www.cdc.gov/
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