• Health care professionals: HCPs who had a higher-risk exposure but remain asymptomatic do not require work restrictions if they have received all COVID-19 vaccine doses, including a booster dose; do not develop symptoms and test negative on day 2; and have a second negative test between days 5-7. A testing strategy is suggested for those who are COVID positive. 
• Shelter residents and staff: Due to the high risk of secondary transmission for residents and staff of shelters, the CDC recommends continuing a 10-day quarantine (for those who have had an exposure) and a 10-day isolation (for those who are sick and are presumed or confirmed COVID positive). During periods of critical staff shortages, the guidance allows for a shorter isolation time period in consultation with your public health authority, taking into consideration the characteristics of the facility.
  

CURRENT/EMERGING ISSUES & STRATEGIES FOR SUCCESS

1. Skyrocketing demand for isolation beds has left few resources for those needing to quarantine, leaving few options except a return to shelter or street.
2. Scrambling to find adequate staffing to provide medical care to new isolation and quarantine facilities that are opening in response to the surge.
3. Decreasing ability to offer surveillance testing due to low staff and no place to put asymptomatic positives. 
4. Managing clinical and shelter staffing shortages as more staff test positive.
5. Because of shortages in testing, growing unknown number of positive cases that are asymptomatic remaining in shelters and causing virus spread.
6. Increasing referrals from hospitals to I&Q facilities as people are not sick enough to remain in the hospital, but are still symptomatic and needing to isolate.
7. Limiting the number of days clients can spend at I&Q facilities can expand overall capacity, but clients may prefer these facilities to general shelters, which may be closing due to staff shortages or still operating at lower volume.
8. Restricting access to shelters when clients test positive and not offering isolation and quarantine placements leaves people isolating on the streets, often in winter/hazardous conditions.
9. Shifting to prioritize testing and treatment over vaccinations because the current surge requires a response mode instead of a preventive one.
10. Treating frostbite and other weather-related injuries/conditions due to lack of shelter space leaves clients in potentially dire situations, and clinicians without many options. 
    

1. Provide pulse oximeters and virtual visits to individuals in isolation and quarantine when staff are not able to deliver care in-person.
2. Increase telehealth visits and decrease number of in-person appointments while also reassigning staff to isolation and quarantine facilities.
3. Prioritize high-risk positive clients for isolation at facilities that have on-site medical care.
4. Help shelters safely cohort groups of exposed and/or positive-but-asymptomatic clients when isolation and quarantine facilities are not available.
5. Consider how shelters might collectively allocate their spaces to allow for better cohorting of clients across programs (e.g., one facility for those needing quarantine, another for asymptomatic positives, etc.), providing hazard pay to staff in higher risk settings.
6. Double up COVID-positive patients at isolation hotels to increase capacity.
7. Don’t “overmedicalize” isolation and quarantine for people who are mildly symptomatic but able to recover on their own without medical oversight conserving staff for clients needing more medical attention.
8. Collaborate with local/state emergency management/disaster response to help staff new I&Q facilities that may not need as many medical providers.
   

POLICY DEVELOPMENTS

• Vaccine mandates go before the Supreme Court: On January 7, the Supreme Court heard oral arguments in the cases against the OSHA and CMS vaccine mandates. A decision is expected in the coming days.
• Increased access to at-home tests: The Biden Administration announced in late December that it will make 500 million at-home COVID tests available to anyone who requests one. The website to request at-home test kits will be available this month. Starting January 15, individuals covered by a health insurance plan they purchased or from their employer can purchase up to eight FDA-approved tests kits (online or in person) per month and have the cost covered by their insurance. Medicare recipients will be eligible for the free test kits purchased by the government and Medicaid recipients are eligible for free test kits through their state Medicaid program. Read the guidance from CMS for more information.
  
• Updated booster guidance: The FDA authorized and the CDC endorsed eligibility for a booster dose of the Pfizer-BioNTech COVID vaccine for youth ages 12 to 15. This group is now eligible to receive a booster dose five months after the last dose of their initial series. The CDC now states that all individuals who received the Pfizer-BioNTech primary series can receive their booster dose at five months. No changes have been made to the booster dose recommendations for the Johnson & Johnson (2 months) or Moderna (6 months) vaccines. In addition, the CDC recommends that immunocompromised children ages 5 to 11 should receive an additional primary dose of vaccine 28 days after their second shot.
• Testing supplies for health centers: HRSA-supported health centers and Medicare-certified rural health clinics are invited to join the HRSA COVID-19 Testing Supply Program. This program allows health centers to order at-home testing supplies at no cost to them or their patients. These tests are also available to health centers to use with their staff.
• First COVID pill authorized: The FDA authorized the Pfizer oral antiviral pill for the treatment of mild to moderate COVID-19 in individuals 12 years and older. This pill is encouraged for individuals who are at risk or likely to experience severe COVID infection.
  
• Operation Expanded Testing: Through funding provided by HHS and DoD, regional contractors will provide testing materials and supplies, staff, and results reporting at no cost to recipients. Congregate settings, including homeless shelters, are eligible to submit requests. Regions are divided as: Midwest, South and Northeast, and West.

NEW RESOURCES

• Supporting COVID-19 Positive and/or Symptomatic Guests within Congregate Shelters: A Guide from Public Health – Seattle & King County
• The Rockefeller Foundation: Early Insight from the Equity-First Vaccination Initiative
• CDC: Interactive Ventilation Tool
• CDC: Omicron Variant: What You Need to Know
• CDC: Stay Up to Date with Your Vaccines
• CDC MMWR: Receipt of COVID-19 Vaccine During Pregnancy and Preterm of Small-for-Gestational-Age at Birth – Eight Integrated Health Care Organizations, United States, December 15, 2020-July 22, 2021
• CDC MMWR: Risk Factors for Severe COVID-19 Outcomes Among Persons Aged ≥18 Years Who Completed a Primary COVID-19 Vaccination Series – 465 Health Care Facilities, United States, December 2020-October 2021
  

RESEARCH

• The Commonwealth Fund: The U.S. COVID-19 Vaccination Program at One Year: How Many Deaths and Hospitalizations Were Averted?
• AJPH: Using Point-In-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015-2019
• CIDRAP: Lack of High School Education Predicts Vaccine Hesitancy
• JAMA Network: Lottery-Based Incentives and COVID-19 Vaccination Rates in the US
  

WHAT WE'RE READING

• KHN: Deep Roots Help This Chicago Pharmacist Avoid Creating Another Drugstore Desert
• Press Herald: Commentary: Grief for Our Unhoused Neighbors Will Fuel My Fight to End Homelessness
  
  (Have something you've published related to COVID-19? Let us know!)

• Politico: ‘It Is Embarrassing’: CDC Struggles to Track COVID Cases As Omicron Looms
• AP: CDC Posts Rationale for Shorter Isolation, Quarantine
• Reuters: COVID Science: Virus Leaves Antibodies That May Attack Healthy Tissues
• STAT: Study Raises Doubts About Rapid COVID Tests’ Reliability in Early Days After Infection
• STAT: 10 Lessons I’ve Learned from the COVID-19 Pandemic
• The Hill: White House: No Plans to Change Definition of ‘Fully Vaccinated’