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Coronavirus Pandemic - Updated January 19, 2021

Coronavirus Pandemic - Updated January 19, 2021

Created: Tuesday, January 19, 2021 - 08:44

For WaterISAC's Coronavirus Pandemic Member Crowdsourcing webpage (Members Only), click here.

This portal page is being updated regularly and is organized as follows:

  • Situation Updates (updated regularly)
  • CISA/FEMA Broad Stakeholder Call Information
  • Resources
    • COVID-19 Cases (numbers of cases in WaterISAC member countries and worldwide)
    • Return to Work Planning
    • Water and Wastewater Utility COVID-19 Impacts and Responses
    • Personal Protective Equipment (PPE)
    • General Workplace  and Community Safety and Security
    • Cybersecurity
    • Business Continuity 
  • Government Declarations   

Situation Update

January 19, 2021

On Friday, President-elect Joe Biden presented a five-point plan aimed at expediting the COVID-19 vaccination campaign. The five points include:

  • Working with states to clearly identify priority groups for the vaccine, the first of which will be adults 65 and older and “frontline” essential workers (those who regularly interact with and are exposed to the public as part of their duties, such as first responders and grocery store clerks).
  • FEMA establishing 100 federally supported vaccination centers across the country by the end of February. Biden also said he would oversee the creation of thousands of community immunization sites, such as school gyms and community centers, as well as mobile vaccination units that would travel to hard-to-reach communities to deliver the vaccines.
  • “Fully activating” pharmacies to act as vaccination sites, building on the Trump administration’s reliance on commercial pharmacies to distribute the vaccine.
  • Using the full force of the Defense Production Act to make the supplies needed to administer vaccines, including syringes and personal protective equipment.
  • Committing to transparency and introducing a massive public information campaign to combat disinformation.

Read more at the University of Minnesota Center for Infectious Disease Research and Policy and Ars Technica.

The money to pay for some of the points would come from a $1.9 trillion stimulus plan Biden announced the day before, on Thursday. The plan includes a request for $160 billion in funding for a national vaccination program, expanded testing, and other steps. The plan also entails billions in grants and loan programs for small businesses, and $350 billion in emergency funding for state, local, and territorial governments. Read more at the New York Times.

In other COVID-19 updates:

  • Recently three distinct versions of the coronavirus seem to have independently converged on some of the same mutations, despite being thousands of miles apart in the UK, South Africa, and Brazil. All three variants seem to be becoming more common. And all three are potentially more transmissible. What’s been observed with the recent variants demonstrates coronavirus is in a constant arms race against our immune system and should serve as a reminder that it will keep evolving. Although vaccines are believed to still be effective against the current variants, eventually they may need to evolve with new mutations. Read more at the Atlantic.
  • A coronavirus variant first identified in Denmark has been linked to several large outbreaks in California, prompting state and local officials to investigate whether it may be more transmissible. State officials disclosed the rise of the variant Sunday night after genetic monitoring linked it to a fast-growing share of new cases. Experts stress that they need to look more closely at the circumstances of the outbreaks, as well as at the latest variant before declaring it more contagious or more dangerous than the virus already broadly circulating. Read more at the Washington Post.

January 14, 2021

Yesterday the U.S. Centers for Disease Control and Prevention (CDC) announced a new order requiring all air travelers arriving in the U.S. to have tested negative for COVID-19 within three days of their departure. Documentation of the negative test result, or proof of having recovered from COVID-19, is required before passengers are allowed to board the aircraft. This order goes into effect on January 26. The announcement comes as the U.S. continues to experience a critical level of COVID-19 activity, with more than 200,000 new cases reported on Tuesday alone, and given concerns of new variants of the virus, including those that show evidence of being more transmissible, emerging in countries around the world. Much attention has been paid to the variant that originated in the UK and that is known to be circulating in the U.S., but there are now also reports of two more variants of concern linked to Brazil, both which have a mutation or mutations that may affect transmissibility and host immunity. And yesterday researchers based in Ohio said they have spotted a new variant, native to the state, and likely behind rapid spread of the virus in Columbus. Like the strain that originated in the UK, the variant seems to spread more easily than the original virus, but vaccines should still be able to offer protection. Read more in two articles from the University of Minnesota Center for Infectious Disease Research and Policy (article one and article two).

January 12, 2021

Today the U.S. Department of Health and Human Services announced new guidelines that recommend COVID-19 vaccines be given to everyone over 65 in the country. The move is intended to expand eligibility for the vaccine and accelerate a nationwide effort that has fallen short of its initial targets. Decisions for vaccine allocations are ultimately left to state and local governments, but the federal government has been issuing recommendations for priority groups that have been adopted to varying degrees. Currently, the vaccines are largely being distributed to people in the highest-risk categories, including frontline health care workers and older people in nursing homes. HHS will also no longer hold back vaccine doses to ensure that those who receive a first dose will have a second dose in reserve. Instead, all existing doses will be sent to states to provide initial inoculations. Second doses are to be provided by new waves of manufacturing. Both vaccines authorized in the U.S. so far require two doses: 21 days apart for the one developed by Pfizer and BioNTech, and 28 days apart for the one from Moderna. Read more at the New York Times.

In other COVID-19 updates

  • From Rhode Island to California, all regions of the U.S. are seeing an uptick in COVID-19 cases in what is likely the post-holiday surge of the virus that experts feared. California, Arizona, Oklahoma, South Carolina, and Rhode Island are reporting the highest rates of new daily cases per person. Read more at the University of Minnesota Center for Infectious Disease and Research Policy.
  • The new, more transmissible variant of the virus, first found in the UK, continues to spread in the U.S., with Minnesota reporting its first case associated with the strain over the weekend. Read more at the Minneapolis Star Tribune.
  • President-elect Joe Biden said he would be announcing his plan to "get the entire COVID operation up and running," including the necessary costs, on Thursday. Biden said he was confident in his team would be able to administer vaccines to 50 million Americans in his first 100 days. The announcement came as Biden received his second dose of the COVID-19 vaccine, as part of an effort to reassure the country of the safety of the vaccines. Read more at CNN.
  • A podcast from the New York Times offers helpful insights into the latest on the COVID-19 pandemic, providing information on the new variant of the coronavirus (and why it’s more transmissible) and why the vaccine rollout has been taking longer than expected (due in part to holiday staffing and saving doses for nursing homes). Access the podcast at the New York Times.
  • The Cybersecurity and Infrastructure Security Agency (CISA) has published the COVID-19 Vaccine Distribution Physical Security Measures infographic, which highlights resources within the Department of Homeland Security and other agencies to enhance relevant stakeholder knowledge of physical security. This infographic is intended to assist facility owners, operators, and vaccine recipients to increase their understanding of potential physical threats and relevant mitigation measures. While there are elements of cyber vulnerabilities across the distribution process as well, this product focuses on physical protective measures to safely administer the vaccine. These resources and others are intended to help reduce the chance of a successful attack occurring and the impact should one occur. Access the infographic at CISA.

January 7, 2021

In a news conference yesterday, Health and Human Services Secretary Alex Azar encouraged states to focus on administering COVID-19 vaccines to as many people as possible as quickly as possible, and not let "perfection be the enemy of the good" as far as adhering to the federal government’s vaccine priority guidelines. "We need to not be overly prescriptive," Azar explained, adding that if people in top priority groups had been offered the vaccine and doses were left over, states should quickly start offering the vaccine to other groups. As of Wednesday, only 28 percent of vaccine doses distributed to hospitals and 13 percent of those allocated to nursing homes have been delivered into arms, according to U.S. Centers for Disease Control and Prevention data. Azar also announced that a “federally arranged pharmacy partnership” will launch soon. He said it will involve more than 40,000 pharmacy locations across the country, to which states can allocate vaccines for administration, including to those “over a certain age or in certain occupations” and eventually to the general public. Read more at the University of Minnesota Center for Infectious Disease Research and Policy, USA Today, and CNBC Television (via YouTube).

As WaterISAC reported on in its December 22 Security & Resilience Update, a CDC advisory committee recommended that water and wastewater sector workers be included in phase 1c for COVID-19 vaccine allocations as part of the “other essential workers” group. Phase 1c also includes people aged 65 to 74 and 16 to 64 with underlying health conditions. Phase 1a consists of healthcare personnel and long-term care facility comprise phase 1a, and phase 1b is for individuals 75 and older and “frontline” essential workers (those who regularly interact with and are exposed to the public, which include police and firefighters, public transit workers, and grocery store workers, among others). Although the federal government is issuing recommendations for vaccine allocations, ultimately these decisions are left to state and local governments.

January 5, 2021

Public health officials are warning of the likelihood of a post-holiday spike in COVID-19 cases and other activity in the days and weeks ahead. “It’s terrible, it’s unfortunate, but it was predictable,” said Dr. Anthony S. Fauci on Sunday. Although air travel is down markedly from years past, American airports had their busiest day of the pandemic on Saturday, with nearly 1.2 million passengers passing through security checkpoints, according to the Transportation Security Administration. And tens of millions more people were expected to travel by car.

Further complicating the situation, the new, more transmissible variant of the virus, first found in the UK, is now known to be circulating in the U.S. The variant was first detected in Colorado last week, and since then there have also been cases associated with the strain in California, Florida, and New York. Additionally, the nationwide vaccination effort has not rolled out as quickly as anticipated. Operation Warp Speed had said it would inoculate 20 million Americans by the end of 2020, but so far about 4.5 million people have received the first of two injections, according to the Centers for Disease Control and Prevention data. Surgeon General Dr. Jerome Adams explained the vaccine rollout has gone slower than anticipated because healthcare facilities are still dealing with an onslaught of new cases and increased demand for testing. "I want everyone to know that over the next week or two is when we should be paying attention closely and making sure we continue to see this ramp up," he said.

Read more at the New York Times and the University of Minnesota Center for Infectious Disease and Research Policy.

In other COVID-19 updates:

  • The FBI has issued a press release warning of emerging fraud schemes related to COVID-19 vaccines. In one scheme, the perpetrators offer early access to a vaccine upon payment of a fee. The press release describes other variations of this activity and offers tips to avoid vaccine-related fraud. Read the press release at the FBI.
  • The peer-reviewed data on both the Moderna and Pfizer/BioNTech COVID-19 vaccines are in, which note that they demonstrate 94 to 95 percent protection from the disease. When compared with placebos, Moderna's vaccine showed 94.1 percent efficacy and Pfizer's had 95.0 percent efficacy. Both rates are for patients who received the two intended doses. Adverse events were uncommon in both studies. Read more at the University of Minnesota Center for Infectious Disease and Research Policy.
  • The idea is being floated of halving the dose of each shot of the Moderna vaccine to expedite the administration of vaccines to more people. Data from Moderna’s clinical trials demonstrated that people between the ages of 18 and 55 who received two 50-microgram doses showed an “identical immune response” to the standard of two 100-microgram doses said Dr. Moncef Slaoui, an official with the federal government’s Operation Warp Speed. While some experts agreed this could be an approach, some also voiced hesitancy, with one noting “this is not something I would want to see done unless it were absolutely necessary.” Read more at the New York Times.

December 30, 2020

Yesterday public health officials in Colorado confirmed a COVID-19 case attributed to the variant that’s been seen in the United Kingdom, the first such case in the U.S. The case involves a man who has no travel history, meaning the variant is likely spreading in the U.S. after having been brought by travelers from the UK in recent months.

Given this development and possible concerns of its implications for their utilities and communities, WaterISAC is sharing with members recently published or updated resources from the U.S. Centers for Disease Control and Prevention (CDC). These include "New COVID-19 Variants," "Emerging SARS-CoV-2 Variants," and "Implications of the Emerging SARS-CoV-2 Variant VOC 202012/01." Some of the most significant observations from these resources include:

  • Transmissibility: The variant seems to spread more easily and quickly than others.
  • Severity of illness and lethality: There is no evidence the variant causes more severe illness or increased risk of death.
  • Vaccine efficacy: There is no evidence to suggest the variant has any impact on vaccine efficacy.

December 29, 2020

Canada and Australia are now among a growing list of countries to have confirmed their first cases of COVID-19 due to the variant recently observed in the United Kingdom, which is now the dominant strain there. Although the U.S. has yet to confirm any cases due to this variant, many government officials and health experts have indicated it is likely already in the country. Yesterday, Health and Human Services Assistant Secretary Brett Giroir said, "We don't have proof that it's here, but we do suspect that it is likely here, given the global interconnectedness.” Researchers are rushing to understand more about how the UK variant behaves, but preliminary information has suggested its transmissibility may be as high as 70 percent greater than that of other strains. These developments have led to many countries to implement or increase their travel restrictions in an effort to slow the spread. In the U.S., travelers arriving from the U.K. are now required to show proof of a negative COVID-19 test under new rules issued by U.S. Centers for Disease Control and Prevention (CDC). Even without the presence of the new variant, officials and experts are already expecting more spikes in cases due to increased travel and family gatherings during the holidays. "As we get into the next few weeks, it might actually get worse," said Dr. Anthony Fauci. Nearly 1.3 million people traveled through U.S. airports Sunday, setting a pandemic travel record  – despite warnings from the CDC to stay at home to quell coronavirus cases. Read the articles at the University of Minnesota Center for Infectious Disease Research and Policy, The Hill, NPR, and USA Today.

In other COVID-19 updates:

  • Experts are optimistic that the COVID-19 vaccines will still be effective against the variant observed in the UK, as well as other strains. And even if the virus were to mutate further, the vaccines could be rapidly reprogrammed to remain effective against new variants. While a tweaking of vaccines could be done quickly, actually rolling out a recalibrated vaccine would take some time, perhaps a couple of months, due to manufacturing and regulatory requirements. Read more at the Washington Post.
  • Novavax’s COVID-19 vaccine candidate entered final-stage testing in the U.S. yesterday. If testing goes well and the vaccine is eventually approved, it would be added to the U.S.’s vaccination campaign, adding to an effort that is need of more supplies. “If you want to have enough vaccine to vaccinate all the people in the U.S. who you’d like to vaccinate — up to 85 percent or more of the population — you’re going to need more than two companies,” said Dr. Anthony Fauci. Read more at the Associated Press.
  • World Health Organization (WHO) experts have warned that the world will have to learn to live with the COVID-19 and that despite the severity of the current pandemic it is “not necessarily the big one.” The “destiny” of the virus is to become endemic, even as vaccines begin to be rolled out, says Professor David Heymann, the chair of the WHO’s strategic and technical advisory group for infectious hazards. And Dr. Mark Ryan, the head of the WHO emergencies program, warned that the next pandemic may be worse. “This pandemic has been very severe … it has affected every corner of this planet. But this is not necessarily the big one,” he said. “This is a wake-up call. We are learning, now, how to do things better: science, logistics, training and governance, how to communicate better. But the planet is fragile,” he added. Read more at The Guardian.
  • Adding to the knowledge scientists and public health experts have learned about the COVID-19 virus is that all the scrubbing and disinfecting of surfaces previously advocated might not be necessary. Back in January and February, surface contamination was thought to be a problem, with early studies suggesting the virus could live on surfaces for days. Since then scientists have found that even in hospital settings, no infectious virus could be identified on surfaces near COVID-19 patients. What's found is viral RNA, which is like the “corpse of the virus” and is not infectious. In retrospect, extensive actions to disinfect surfaces seem like overkill. Today, the evidence points toward breathing in the virus from the air as being the most important route of transmission, and the one deserving of the most attention for reducing cases. Read more at NPR.

December 22, 2020

Over the weekend, a CDC advisory committee recommended that water and wastewater sector workers be included in phase 1c for COVID-19 vaccine allocations, not in phase 1b as had been anticipated up until recently. Essential workers are included in phase 1b, but only those considered to be “frontline,” meaning those who regularly interact with and are exposed to the public as part of their duties. Examples of frontline essential workers include police and firefighters, public transit workers, and grocery store workers. Phase 1c includes “other essential workers,” which in addition to those in the water and wastewater sector also captures workers in the IT and communications, energy, and finance sectors, among others. Both phases also include seniors, with individuals 75 and older in phase 1b and individuals 65 to 74 in phase 1c. Phase 1c also includes people aged 16 to 64 with underlying health conditions. As WaterISAC has previously noted, although the federal government is issuing recommendations for vaccine allocations, ultimately these decisions are left to state and local governments. WaterISAC reiterates its recommendation (including that from the December 10 Security & Resilience Update), as well as that of the Water Sector Coordinating Council (whose letter on the matter has been posted below as resource #43), that water and wastewater utilities discuss the vaccine prioritization status of their workers with their respective state and local health departments.

In other COVID-19 updates:

  • The CDC advisory committee decided to recommend specific groups for vaccine allocation, to include creating a distinction between “frontline” and “other” essential workers, because of the limited supply of vaccines. Given the limitations, "difficult choices have to be made," said Dr. Kathleen Dooling, a committee member. "Front-line workers in particular are unable to work from home and have a high level of interaction with the public or others in the workplace," she added. Read the article at NBC News.
  • Doses of the Moderna vaccine began being administered across the U.S. yesterday, after having been authorized by the federal government in the preceding days. The authorization of a second vaccine should vastly expand the reach of COVID-19 vaccines. Additionally, the Moderna vaccine should be available in more locations than the previously-authorized Pfizer vaccine because it doesn’t require super-cold freezer storage. Read the article at the University of Minnesota Center for Infectious Disease Research and Policy.
  • In the UK, public health officials are responding to a newly identified variant of the coronavirus that appears to be more contagious than more established variants. The officials say models suggest the variant may be up to 70 percent more transmissible and may be responsible for a rapid increase in COVID-19 cases in parts of the country in recent weeks. There is no strong evidence that the variant causes more severe cases, at least not yet. And experts have said the current COVID-19 vaccines should be effective against the variant. Still, the situation in the UK raised alarm around the world, with many nations barring or imposing restrictions on travelers from the country. Speaking about the development, Dr. Anthony Fauci said the new variant is likely in the U.S. "We have to make that assumption [that it has arrived in the U.S.]" said Fauci. "When you see something that is pretty prevalent in a place like the U.K…I would not be surprised if it's already here. When we start to look for it we're gonna find it," he explained. Read the articles at the University of Minnesota Center for Infectious Disease Research and Policy, the New York Times (articles one and two), and Newsweek.
  • Despite repeated pleas of public health officials for people to stay home over the holidays and avoid travel, Transportation Security Administration data show that more than 2 million people have passed through security checkpoints over the last two days. Travel volume is down 60 percent from last year but is still much higher than in earlier pandemic months. Read the article at NPR.

December 17, 2020

The Cybersecurity and Infrastructure Security Agency (CISA) has written a letter to critical infrastructure partners and colleagues re-promoting its Essential Critical Infrastructure Workforce Guidance as a tool to assist COVID-19 response. CISA notes it is working with states and local officials to help inform their vaccine prioritization decisions, which includes by encouraging them to use the guidance document. WaterISAC previously reported on CISA’s outreach to state and local governments about factoring in essential workers, including those at water and wastewater utilities, in its December 10 Security and Resilience Update. WaterISAC has also consistently referred to CISA’s guidance when recommending members reach out to their state and local health departments about the status of workers for vaccine allocation. The Water Sector Coordinating Council also referred to this guidance when recommending utilities collaborate with their state and local departments, which WaterISAC reported on in a special advisory on Monday. CISA’s full letter has been posted below as resource #44 (scroll to the list of documents near the bottom of this page).

In other COVID-19 updates:

  • Today, independent vaccine advisors for the Food and Drug Administration (FDA) meet to discuss emergency use authorization (EUA) for Moderna's vaccine, which if approved would clear the way for a second vaccine to be distributed. A separate vaccine advisory group for the Centers for Disease Control and Prevention (CDC) will have an emergency meeting on Dec 19 to discuss a recommendation for Moderna's vaccine, plus an emergency session on Dec 20 to discuss on vote on the next groups that should be prioritized the receive the vaccine. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.
  • The New York Times has set up an online vaccine distribution tracker, depicting the amount of doses allocated to states, territories, and other jurisdictions.
  • The Associated Press has created an online “pandemic atlas,” which provides overviews of how COVID-19 has impacted countries around the world. It includes numbers on total deaths and cases, as well as summaries of how the countries have responded and fared from the pandemic.

December 15, 2020

U.S. COVID-19 Vaccination Campaign Begins

Pfizer’s COVID-19 vaccine began being administered across the U.S. yesterday, with the first doses going to a priority group consisting of healthcare personnel and residents of long-term care facilities. The U.S. vaccine distribution network kicked into high gear following the federal government’s final approval of the vaccine for emergency over the weekend, with shipments of the vaccine arriving at 145 distribution centers yesterday, with 425 sites expected to receive their deliveries today and the remaining 66 tomorrow. U.S. Health and Human Services Secretary Alex Azar said he believes 20 million people will be vaccinated by the end of the month, with additional doses of Pfizer's vaccine coming in and 12.5 million doses of Moderna's vaccine, which is awaiting authorization, also ready to be shipped. Pending the Moderna vaccine's authorization, Azar said, "we have enough vaccines already purchased to ensure we can meet our goal of vaccinating every American who wants it by the end of the second quarter of 2021."

In other COVID-19 updates:

  • The Trump Administration is rushing to roll out a $250 million public education campaign to encourage Americans to be vaccinated against COVID-19, according to the New York Times. It said the U.S. Department of Health and Human Services is overseeing the campaign, which will include ads in print, social media, and radio formats.
  • According to a Kaiser Family Foundation survey, about a quarter (27 percent) of the public remains vaccine hesitant about a COVID-19 vaccine, saying they probably or definitely would not get it even if it were available for free and deemed safe by scientists. Among those who are hesitant to get a COVID-19 vaccine, the main reasons are worries about possible side effects (59 percent cite this as a major reason), lack of trust in the government to ensure the vaccines’ safety and effectiveness (55 percent), concerns that the vaccine is too new (53 percent), and concerns over the role of politics in the development process (51 percent). Still, the share of the public willing to get vaccinated has increased, with about 71 percent now saying they would definitely or probably get the vaccine, an improvement from September when that number stood at 63 percent.
  • State leaders quoted in the Wall Street Journal said they are billions short in funding needed to roll out the COVID-19 vaccine to Americans who want to be immunized by June. They said additional funding is needed to hire medical workers, do community outreach, set up vaccination clinics, and ensure proper storage for the vaccines.
  • Have questions about the COVID-19 vaccine and/or getting vaccinated? The U.S. Centers for Disease Control and Prevention has posted and updated numerous webpages to help, including:

December 14, 2020

Today, the Water Sector Coordinating Council (WSCC), a body of water and wastewater utility representatives that advises the federal government on security and resilience issues relevant to the sector, released a statement urging utilities to collaborate with their state and local health departments to ensure their staff members are considered as plans are developed for the distribution of COVID-19 vaccines. The full statement from the WSCC has been posted below as resource #43 (scroll to the list of documents near the bottom of this page).

The WSCC's statement echoes WaterISAC's previous guidance to its members, with an initial recommendation in the September 17 Security & Resilience Update and the latest in the December 10 Security & Resilience Update. In its messaging, WaterISAC has pointed to federal government planning and guidance documents that support the prioritization of the water and wastewater sector for vaccine allocation, including the Centers for Disease Control and Prevention's COVID-19 Vaccination Program Interim Playbook for Jurisdiction Operations and the Cybersecurity and Infrastructure Security Agency's Guidance on the Essential Critical Infrastructure Workforce.

However, final distribution strategies are left to state and local governments, and WaterISAC once again encourages its members to contact their health departments to ensure the water and wastewater sector is included in their plans. The documents referenced above and other materials posted to this webpage can assist utilities in preparing for these conversations.

December 10, 2020

A Food and Drug Administration (FDA) advisory panel is expected to vote today on whether Pfizer’s COVID-19 vaccine candidate should be approved. If it votes in favor of approval, it will likely lead the FDA to authorize the vaccine within days and the first doses to be administered in the U.S. next week. Health care personnel and long-term care facility residents are likely to get these first doses, as was recommended by a U.S. Centers for Disease Control and Prevention (CDC) advisory panel last week. Although the panel has yet to vote on the vaccine prioritizations for other groups, it is likely that it will recommend essential workers (including those at “utilities”) for phase two.

While the federal government can make recommendations about vaccine prioritization, these decisions are ultimately up to the states. And when it comes to workers and who among them are “essential” and should be prioritized for vaccines, there are some differences in interpretation among the states, as some companies and industry groups are reported to have found. The Cybersecurity and Infrastructure Security Agency (CISA), which worked with partner groups across all critical infrastructure sectors to create the Guidance on the Essential Critical Infrastructure Workforce (now in version four), has indicated it is working with states to help inform their vaccine prioritization decisions. To further inform these decisions and help ensure water and wastewater workers are given the appropriate status, WaterISAC encourages it members to contact their state and local health departments on this issue. WaterISAC initially recommended this in its September 17 Security & Resilience Update, when it pointed to CISA’s guidance as a reference for helping to inform these discussions.

  • The National Governors Association (NGA) has published a report to help support an equitable distribution of COVID-19 vaccines, presenting key themes, strategies, and challenges across state and territorial plans. As part of preparing this report, the NGA worked with the Duke-Margolis Center for Health Policy and the COVID Collaborative to conduct a qualitative analysis of all publicly available state and territorial COVID-19 vaccination plans. The analysis aims to support identification of key issues and promote sharing of promising practices across the country.
  • USA Today published an article discussing the federal government’s COVID-19 vaccine distribution process, based on a discussion with the lead of supply, production, and distribution for Operation Warp Speed. Among other details, the vaccine will be shipped to all 50 states and outlying U.S. territories within 24 hours following the FDA’s authorization. Additionally, the federal government plans to only ship half of all vaccine available each week. The other half will be held in storage and be released just before the second dose is due for those vaccinated the first time.
  • President Trump signed an Executive Order (EO) on Tuesday stating that Americans should have priority access to vaccines developed in the U.S. or procured by the U.S. government. The EO goes on to say that once the country’s vaccination needs have been met, the U.S. will facilitate international access to its vaccines. Nations Security Advisor Robert O’Brien issued a statement following the EO providing further explanation and background.
  • A new surge of COVID-19 activity related to Thanksgiving gatherings may be starting to show, with a record 104,600 people in the hospital for COVID-19 infections reported earlier this week. Additionally, more than 200,000 Americans are now testing positive for COVID-19 each day, on average.

December 8, 2020

CDC Recommends Indoor Mask-Wearing When Not at Home, and Other COVID-19 Updates

The U.S. Centers for Disease Control and Prevention (CDC) is now recommending “universal use of face masks,” which for the first time includes in all indoors settings, with the exception of when people are in their homes (excepting when a member of the household is infected or had a recent potential COVID-19 exposure). The CDC had already recommended mask-wearing in outdoors settings and public spaces. The CDC explained it issued the updated guidance given that the U.S. has entered a high-level transmission phase, with the onset of colder weather, more time spent indoors, and the ongoing holiday season. In the same updated guidance, the CDC addressed other measures for reducing COVID-19 transmission, which include postponing travel plans. Despite the recommendation, experts are anticipating a holiday travel rush. The Sunday after Thanksgiving was the busiest day of air travel in 2020, with more than 1.1 million Americans flying. Read more at the University of Minnesota Center for Infectious Disease Research and Policy and the Washington Post.

In other COVID-19 updates:

  • What are employers entitled to know about their employees’ holiday travel plans, and what measures can they legally take to protect the safety of the workplace? According to an article in the Wall Street Journal, employers generally have wide latitude during a pandemic in what they can ask and do, although the situation varies by state. Permissible actions can include asking workers to take a pledge to refrain from any risky behavior – as some companies did right before Thanksgiving – and cautioning employees against any conduct that would violate federal or local health guidelines. Employers can also discipline workers for what they do during off hours. That could include if workers don’t disclose potential exposure to the virus and return to the workplace without quarantining after personal travel or after attending large celebrations. Read more at the Wall Street Journal.
  • The National Institutes of Health (NIH) has released a tool designed to help businesses and other organizations plan COVID-19 testing. The COVID-19 Testing Impact Calculator is free, available online, and can be used within organizations to model the costs and benefits of COVID-19 testing strategies. The tool also shows how other CDC-recommended countermeasures, such as masks, contact tracing, and social distancing, can work in concert with testing to keep people safe. Users enter which of these measures are in place in their organization and the tool integrates this information to produce testing recommendations. NIH developed the tool with other organizations, including a team at the Massachusetts General Hospital in Boston and researchers at the Massachusetts Institute of Technology. Read more and access the tool at NIH.
  • The U.S. Department of Health and Human Services (HHS) has released a Preservation Planning Toolkit, which is intended for any PPE-using organization to plan and implement preservation strategies. With the tool, users enter data on their current or prospective PPE use practices. The tool then assists users with understanding types of preservation strategies and provides estimates of positive impacts of those measures in increasing the duration of PPE supplies. Access the toolkit at HHS.
  • The United Kingdom (U.K.) began delivering the first does of COVID-19 vaccine to its citizens today, using the Pfizer vaccine that was approved for use in the country last week. The U.K. is the first Western country to start a mass vaccination program, with other nations expected to approve vaccines in coming days or weeks, part of a global immunization effort. In the U.S., The Food and Drug Administration will consider Emergency Use Authorizations (EUAs) for Pfizer’s COVID-19 vaccine candidate on Thursday and Moderna’s vaccine candidate on December 17. HHS Secretary Alex Azar expressed optimism Sunday that the vaccine could be authorized “within days.” Read the articles at the Associated Press and Fox Business.
  • Pfizer has told the U.S. government it cannot provide substantial additional doses of its COVID-19 vaccine until late June or July because other countries have rushed to buy up most of its supply, according to media reporting. That means the U.S. government may not be able to ramp up as rapidly as it had expected from the 100 million doses of the Pfizer vaccine that it purchased earlier this year, raising questions about whether it can keep to its aggressive schedule to vaccinate most Americans by late spring or early summer. Government officials denied there would be availability issues in the second quarter, citing other vaccines in the pipeline, such as Moderna’s, also expected to be approved in coming weeks. Both vaccines are two-dose regimens, so the 100 million doses purchased of each would cover 50 million people each. Read more at the Washington Post.

December 3, 2020

As discussed in the Tuesday Security and Resilience Update, that same day the U.S. Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) was meeting to vote on which among a series of priority groups should be the first to receive a COVID-19 vaccine (link to the presentations made during the meeting at CDC). As expected, the group voted that when a COVID-19 vaccine is authorized by the Food and Drug Administration (FDA) and recommended by ACIP, healthcare workers and people in long-term care facilities should be the first to receive vaccinations, as part of phase “1a”. Before the vote, members also discussed those considered in phases “1b” (“essential workers,” which includes those at “Utilities”) and “1c” (adults with high-risk medical conditions and who are 65 and older) but decided to take no action until after an upcoming FDA meeting. During that meeting, scheduled for December 10, the FDA will discuss the emergency use authorization request for Pfizer’s COVID-19 vaccine candidate. For this past Tuesday’s meeting, ACIP also discussed gating criteria for moving to the next phase. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.

In other COVID-19 updates:

  • Vaccination cards will be issued to everyone getting the COVID-19 vaccine, health officials say. Additionally, vaccination clinics will report to their state immunization registries what vaccine was given, so that, for example, an entity could run a query if it didn't know where a patient got a first dose. The card will be provided in a vaccine kit that also includes a needle and syringe, alcohol wipes, and a mask. Read more at CNN.
  • IBM has released a report on cyber actors targeting the COVID-19 vaccine supply chain. According to the report, impersonating a biomedical company, cyber actors are sending phishing and spearphishing emails to executives and global organizations involved in vaccine storage and transport to harvest account credentials. The emails have been posed as requests for quotations for participation in a vaccine program. Read more and access the report via CISA.
  • Yesterday, the CDC said though the 14-day quarantine period after exposure to COVID-19 is still ideal, it now recommends two acceptable periods: 10 days without a test if the person in quarantine has no symptoms and 7 days with a negative test if the individual has no symptoms. In both instances, the CDC urges people to continue to monitor their symptoms for the full 14 days following exposure. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.
  • Also yesterday, the CDC issued updated travel guidance during the COVID-19 pandemic. The CDC begins by emphasizing “travel can increase your chance of spreading and getting COVID-19,” adding “postponing travel and staying home is the best way to protect yourself and others from COVID-19.” If people decide to travel, the CDC recommends they get tested 1 to 3 days before travel, with testing repeated 3 to 5 days after travel. For returning travelers, the CDC recommends they avoid nonessential activities for 7 days after travel for people who were tested, extending the period to 10 days for those who weren't tested.
  • The World Health Organization has released a new resource with tips for staying safe during the winter holidays. The resource consists of a calendar with tips for each day this month, such as a recommendation to stay home if you’re feeling unwell and on ways to celebrate without gathering with family and friends.
  • With predictions of tough months ahead and public health officials encouraging the public to maintain its vigilance, now’s a good time to review COVID-19 symptoms. Fever, cough, and shortness of breath are the highest-frequency symptoms of COVID-19. But other symptoms can include fatigue or muscle aches, headaches, loss or distorted sense of smell or taste, sore throat, congestion, runny nose, and stomach issues. Read more at the Washington Post and CDC.

December 1, 2020

CDC Advisory Committee Holds Meeting on Priority Vaccine Allocation Today, States Continue Efforts to Prepare for Distribution, and Other COVID-19 Updates

Today at 2 pm ET, the U.S. Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) will meet to vote on which among a series of priority groups should be the first to receive the COVID-19 vaccine. During a meeting last week, ACIP members indicated that healthcare workers and people in long-term care facilities (phase 1a) should be the first to be vaccinated, followed by essential workers (phase 1b, which includes those at “utilities”) and adults with high-risk medical conditions and those over 65 (phase 1c). But the committee did not vote on those recommendations. The ACIP expected to recommend that those in phase 1a be first in line, and then to make recommendations at later meetings for priority groups in the next phases. Recommendations from the advisory group are sent to CDC Director Dr. Robert Redfield, who also informs Health and Human Services Secretary Alex Azar. If the recommendations are approved, they will become official CDC recommendations on immunization in the U.S.

The ACIP typically votes on who should get a vaccine after the Food and Drug Administration (FDA) has approved it. The advisory group is meeting today because states want priority group guidance before Friday, when they must submit final details to the federal government on where they want vaccine to be delivered once one is authorized. Ultimately state officials will decide how the doses are distributed, but many have said they plan to follow the federal recommendations.

Read more at the University of Minnesota Center for Infectious Disease Research and Policy and the Washington Post.

In other COVID-19 updates:

  • The initial doses of vaccine will only be enough to cover a fraction of the entire phase 1 population. There are an estimated 21 million healthcare workers, 3 million people in nursing homes, 87 million essential workers, 53 million adults over age 65, and more than 100 million people with high-risk conditions. U.S. officials anticipate that by the end of this year they’ll have 40 million doses of vaccines from Pfizer and Moderna, which have both submitted for emergency use authorizations (EUAs) from the Food and Drug Administration (FDA) for their two-dose vaccine candidates, enough to immunize 20 million people. Read more at the University of Minnesota Center for Infectious Disease Research and Policy and the Washington Post.
  • With the Thanksgiving holiday now in the rearview mirror, a time when air travel was at its highest point since the COVID-19 pandemic began, health officials are bracing for another spike in infections. Dr. Deborah Birx, who coordinates the White House’s COVID-19 task force, said over the weekend that the post-Thanksgiving spike could be worse than what the nation experienced after Memorial Day. She added that people who gathered for Thanksgiving should assume they've been infected and get tested in the next 5 to 10 days. She also urged those who attended gatherings to limit their social contacts, especially with older family members. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.
  • Yesterday the Government Accountability Office (GAO) published the report COVID-19: Urgent Actions Needed to Better Ensure an Effective Federal Response, which examines the federal government’s continued efforts to respond to and recover from the COVID-19 pandemic. It makes 12 new recommendations to federal agencies and for congressional consideration on topics including medical supply shortages, COVID-19 testing, COVID-19 vaccines and therapeutics, assistance to individuals and businesses, and program integrity.

November 24, 2020

The CDC is strongly urging Americans to avoid traveling for the Thanksgiving holiday, observing that postponing travel and staying home is the best way to protect yourself and others this year. Its “Celebrating Thanksgiving” webpage offers a series of questions for those considering travel, recommendations for those who do travel, and general tips for mitigating risks during the holiday. Despite the urging, as well as similar pleas from state and local health officials and others, more than 3 million Americans passed through airport security checkpoints on Friday, Saturday, and Sunday. The daily travel numbers are among the highest recorded at U.S. airports since the pandemic began in March. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci expressed concern that a surge of Thanksgiving travelers could translate to a surge in cases. “The travel, the congregate setting, not wearing masks, the chances are that you will see a surge superimposed upon a surge. What we're doing now is going to be reflected two, three weeks from now," he stated.

In other COVID-19 updates:

  • This dim outlook comes as the U.S. is already experiencing spiking case numbers in most places, which have led to warnings about full hospitals, exhausted health care workers, and expanded lockdowns. Over the past week, there has been an average of 173,165 cases per day in the U.S., an increase of 49 percent from the average two weeks earlier. On one day last week, there were nearly 200,000 new cases of COVID-19.
  • The Food and Drug Administration (FDA) announced it has scheduled a meeting on December 10 to discuss Pfizer’s request for an Emergency Use Authorization (EUA) of its COVID-19 vaccine. The FDA has also published new information about the vaccine development and review process. These include:
  • AstraZeneca announced yesterday that early analysis of some of its late-stage clinical trials, conducted in the United Kingdom and Brazil, showed that its COVID-19 vaccine was about 70 percent effective in preventing cases of COVID-19. The drug maker and the University of Oxford, with whom the company partnered developed the vaccine, said they would submit their data to regulators in Britain, Europe, and Brazil and seek emergency authorization.
  • People are most likely to pass on COVID-19 within the first five days of having symptoms, a British study suggests. The research indicates patients had the highest levels of virus early on in their illness and "live" virus, capable of replicating, was found up to nine days after symptoms began. "People really need to be supported to make sure they isolate as soon as they get symptoms, however mild. By the time some people get the results of swabs, they may be past their most infectious phase,” said Dr Muge Cevik, who was involved in the study.

November 19, 2020

Vaccine Announcements Continue to Inspire Optimism, but Distribution Questions Remain

Yesterday, Pfizer announced that its COVID-19 vaccine has 95 percent efficacy, better than the 90 percent noted in its initial announcement last week, and that it will apply for emergency use authorization (EUA) from the Food and Drug Administration (FDA) in the coming days. It also reported the vaccine demonstrated high efficacy in older adults and helps protect against severe cases, data that had been eagerly awaited by the scientific and public health communities. Commenting on this development, Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (which WaterISAC often looks to for information and analysis of COVID-19 and other public health issues), said he believes Pfizer is likely to receive the EUA. He added that he has complete confidence in the FDA's review and the input of its science advisors and looks forward to guidance on where and how to use the vaccine to come from the Center for Disease Control and Prevention's, following recommendations it received from its Advisory Committee on Immunization Practices. Osterholm observed that the next task will be to actually deliver the vaccine to the public. "The number one challenge is no longer research and development; it's how to convert a vaccine into a vaccination."

In other COVID-19 updates, which are described in further detail on WaterISAC’s COVID-19 general webpage:

  • The U.S. Government Accountability Office (GAO) released a report (posted below as resource #41) saying supply chain issues could interfere with a smooth rollout of a COVID-19 vaccine. The report details the challenges of scaling up mass production of COVID-19 vaccines and drugs, including needing to add new manufacturing capacity—or shift capacity from other products—because most was already in use before the pandemic. Even when large quantities of vaccines and drugs are manufactured, they must be sealed in sterile containers in finish-fill facilities, the current scarcity of which could lead to production backlogs. Supplies of products needed for this process, including glass vials and syringes, are also limited. The report cautions that manufacturing supply chains may struggle to keep up with demand because of coronavirus-related disruptions such as changes in worker availability, fluctuating demands for certain products, and some countries' export restrictions. Read the article at the University of Minnesota’s Center for Infectious Disease Research and Policy.
  • Can employers mandate employees get the vaccine? Yes, according to the legal experts interviewed for one article. Whether they should is a different matter, given that federal protections could allow for some exceptions and the possibility of workers’ compensation claims and public relations problems. Some of the other suggested approaches include allowing workers to get the vaccine on company time, having senior leadership promote that they got the vaccine, and engaging the union (if applicable) to promote the shot. Read the article at CNN.
  • The American Enterprise Institute, a public policy think tank, has published a report (posted below as resource #42) on building a resilient workforce in the post-COVID-19 world. As the report describes, before the pandemic remote work was reserved for just seven percent of the workforce. In a matter of weeks, COVID-19 forced virtually every industry, employer, and worker to transform their approach to work. This report seeks to outline the positive and negative trade-offs of remote work for employers and employees. It also intends to improve the collective understanding of the existing research on remote work and some of the immediate impacts of COVID-19.
  • COVID-19 has led to a movement among architects and building standards professionals over how to promote healthy conditions indoors, where viruses could thrive and threaten occupants. Months into the pandemic, designers are tracking changes in how people interact with buildings and trying to see how they can help make the indoors healthier. Design tweaks could start with a user's entry into a building, through vestibules and queuing areas to facilitate temperature checks or social distancing. Architects are also incorporating one-way doors and hallways, spreading workstations farther apart, deploying touchless technologies, and upgrading air-filtration systems. Read the article at Thomson Reuters Foundation.

November 17, 2020

CDC Clarifies Guidance on Reintegrating Exposed Workers into Operations, and other COVID-19 Updates

Yesterday CDC issued updated guidance stating that reintegrating into onsite operations critical infrastructure workers who had been exposed to COVID-19 but who are not experiencing any symptoms and have not tested positive should be used as a last resort and only in limited circumstances. The CDC added that these cases could include when cessation of operation of a facility may cause serious harm or danger to public health or safety. This guidance as posted to CDC’s updated “COVID-19 Critical Infrastructure Sector Response Planning” webpage, which also notes that all workers should wear a mask in accordance with guidance from CDC, OSHA, and state and local authorities.

In other COVID-19 updates:

  • With significant increases in COVID-19 cases across the nation, many states and cities are reimposing or instituting new measures to slow the spread of the disease. Some states are halting phased reopening plans or imposing new coronavirus-related restrictions. Several are putting limits on social gatherings, adding states to travel quarantine lists, mandating face masks and encouraging residents to stay home, as many did in the spring. Others are restricting business hours of operation and limiting restaurant capacity. Thirty-five states – plus the District of Columbia and Puerto Rico – now require people to wear face coverings in public statewide. Read more at the University of Minnesota Center for Infectious Disease Research and Policy and USA Today.
  • The U.S. added more than 180,000 new COVID-19 cases on Friday, a new record. Over the past week, there has been an average of 155,442 cases per day, an increase of 82 percent from the average two weeks earlier. According to the Johns Hopkins University tracker, as of today there are 11,207,088 confirmed cases of COVID-19 in the U.S. (+785,410 since the Thursday Security and Resilience Update). In WaterISAC’s other member countries, Canada and Australia, there are 305,449 (+24,984) and 27,760 (+85) cases, respectively. Read more at the New York Times and NPR.
  • In more good news from the vaccine front, yesterday Moderna Inc. announced that early data from a phase 3 clinical trial indicate its vaccine candidate showed 94.5 percent efficacy. The news comes a week after Pfizer announced its vaccine demonstrated 90 percent efficacy in a phase 3 trial involving more than 44,000 volunteers. Like the Pfizer-BioNtech vaccine, the Moderna vaccine will also require cold storage, which experts have noted could pose problems for distribution. But while the Pfizer vaccine needs to be stored at –94°F, the Moderna vaccine needs to be stored at –4°F and is stable for 30 days at refrigerator temperatures (36°F to 46°F). Even with the positive news about both vaccine candidates, it's likely to be several months before large segments of the population can get vaccinated. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.

November 12, 2020

CDC Says Masks Protect Wearers, and other COVID-19 Updates

The U.S. Centers for Disease Control and Prevention (CDC) posted updated guidance stating that cloth face masks offer protection from SARS-CoV-2, the virus that causes COVID-19, for both the person wearing them and those around them. In previous guidance, the CDC noted the main benefit of mask wearing was to help prevent infected people from spreading the virus to others. "You protect others, their mask protects you, and your mask also protects you," said National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci, speaking about the new guidance. The CDC cites a number of studies that support the updated guidance and discusses the efficacy of different materials for cloth face masks. It emphasizes that those composed of multiple layers of cloth with higher thread counts demonstrated superior performance.

In other COVID-19 updates:

  • State governments’ COVID-19 vaccine distribution plans show many are not ready to deliver the shots when they’re available, according to a review by ProPublica. As reported on in the Tuesday Security and Resilience Update, Pfizer revealed that its vaccine may be 90 percent effective, making it a leading candidate. However, the Pfizer vaccine is unusually difficult to ship and store. It is administered in two doses given 28 days apart, has to be stored at temperatures of about minus 100 degrees Fahrenheit, and will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses. ProPublica found health officials haven’t figured out how to get the ultracold doses to critical populations living far from cities. And needing to use 1,000 doses within a few days may be fine for large hospital systems or mass vaccination centers. But it could rule out sending the vaccine to providers who don’t treat that many people, even doctors’ offices in cities. Read more at ProPublica.
  • The number of Americans hospitalized for COVID-19 is hitting new highs as coronavirus infections continue to spike across the country. The COVID Tracking Project reports that 61,964 Americans were hospitalized with COVID-19 as of Nov 10. That's the most hospitalizations recorded since the beginning of the pandemic in March. And with hospitalizations lagging a few weeks behind new cases, that number will continue to climb. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.
  • There were more than 142,000 new cases of COVID-19 in the U.S. yesterday, according to the New York Times. According to the Johns Hopkins University tracker, as of today there are 10,421,678 confirmed cases of COVID-19 in the U.S. (+311,126 since the Tuesday Security and Resilience Update). In WaterISAC’s other member countries, Canada and Australia, there are 280,465 (+8,431) and 27,675 (+6) cases, respectively.
  • More than half of people who recover from COVID-19 still report fatigue 10 weeks later, regardless of the seriousness of their initial infection, an observational study found. Sixty-seven of 128 participants (52.3 percent) reported fatigue, a common symptom of acute COVID-19 infection, a median of 10 weeks after recovery, while 54 (42.2 percent) said they had recovered their full health. Additionally, nearly a third of the participants hadn’t returned to work. Before their illness, 105 participants (82 percent) had worked outside the home, but 33 (31 percent) of them still had not returned to employment by the time of study participation. "This is of particular concern, given that it is recommended that post-viral infection return to work should take place after four weeks to prevent deconditioning," the researchers wrote. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.

November 10, 2020

New resources and information:

  • Occupational Safety and Health Administration (OSHA) guidance and an accompanying one-pager (also posted below as items #39 and 40) to help employers understand which standards are most frequently cited during coronavirus-related inspections. OSHA based these documents on data from citations issued, many of which were the result of complaints, referrals, and fatalities in industries. In the guidance document, OSHA also notes that if offers no-cost, on-site consultation services to small and medium-sized businesses. These services are confidential and separate from enforcement, meaning they don’t result in penalties or citations.
  • National Institute of Standards and Technology (NIST) research findings that show masks with exhalation valves do not slow the spread of the disease. NIST conducted the research by taking special videos that depict airflow patterns through masks with and without the valves.

The U.S. has recorded more than 100,000 new daily cases of COVID-19 on numerous days over the past week, rising to higher than 130,000 cases on some days according to some accounts. The U.S. also recently passed over 10 million total COVID-19 cases. Read more at the University of Minnesota Center for Infectious Disease Research and Policy.

According to the Johns Hopkins University tracker, as of today there are 10,110,552 9,309,298 confirmed cases of COVID-19 in the U.S. (+801,254 since last Tuesday’s Security and Resilience Update). In WaterISAC’s other member countries, Canada and Australia, there are 272,034 244,218 (+27,816) and 27,669 27,610 (+59) cases, respectively.

On an optimistic note, yesterday Pfizer said its COVID-19 vaccine may be a remarkable 90 percent effective, based on early and incomplete test results. Read more at the Associated Press.

October 29, 2020

The U.S. Centers for Disease Control and Prevention (CDC) has updated its “COVID-19 Employer Information for Utility Workers” webpage, providing its latest advice on how to protect staff and others. It provides guidance for creating a COVID-19 workplace health and safety plan, recommends actions to take if an employee is suspected or confirmed to have COVID-19, and describes controls utilities can implement to prevent infections among workers. Access the webpage at the CDC.

October 27, 2020

The U.S. Centers for Disease Control and Prevention (CDC) has published a series of webpages discussing the use of wastewater surveillance as a new public health tool to understand COVID-19 spread in communities. As described on the main “Wastewater Surveillance” webpage, the CDC has initiated the National Wastewater Surveillance System (NWSS) in collaboration with the U.S. Department of Health and Human Services and other agencies throughout the federal government. The CDC adds that it is currently developing a portal for state, tribal, local, and territorial health departments to submit wastewater testing data into a national database for use in summarizing and interpreting data for public health action. The webpage also includes a “How do I become engaged in NWSS?” section. Access the webpage at the CDC.

The main webpage also linkes to the following CDC webpages on this topic:

WaterISAC has reported on the use of wastewater to measure the spread of COVID-19 in communities. As discussed in the June 23 Security and Resilience Update, the Water Research Foundation (WRF) published a report on recommendations of global experts on this topic. In the June 9 Security and Resilience Update, it described how some wastewater utilities in the U.S. have been participating in the early stages of efforts to track the levels of coronavirus in their areas. And in the April 16 Security and Resilience Update, it discussed Australia’s use of this technology.

October 22, 2020

Earlier this week, the Brookings Institution, a policy think tank, published an article on the role of water infrastructure in the response and recovery to the ongoing COVD-19 pandemic, noting its “importance to health, hygiene, and safety has never been more obvious.” However, it also describes some of the challenges facing water infrastructure and the communities it serves, and how these have been highlighted because of the pandemic. While emphasizing that state and local leaders mostly understand these challenges, it calls on more action to be taken at the federal level, with water being elevated to core issue as part of driving a lasting recovery. Some of the solutions proposed in the article include increased technial and financial support for customer assistance programs and embracing the digital transition of water systems, such as with advanced metering infrastructure. Read the article at the Brookings Institution.

Yesterday, the U.S. Centers for Disease Control and Prevention issued new guidance that expands the pool of people considered at risk of contracting the COVID-19 by changing the definition of who is a “close contact” of an infected individual. The CDC previously defined a close contact as someone who spent at least 15 consecutive minutes within six feet of a confirmed coronavirus case. It now defines a close contact as someone who was within six feet of an infected individual for a total of 15 minutes or more over a 24-hour period. The change is likely to have its biggest impact in schools, workplaces and other group settings where people are in contact with others for long periods of time. Read an article about the change at the Washington Post.

October 6, 2020

On Friday, the National Academies released the final Framework for Equitable Allocation of COVID-19 Vaccine, presenting its criteria for what it believes should be used to set priorities for equitable distribution among groups of potential vaccine recipients. The Framework identifies a four-phased approach to vaccine allocation, with high-risk health workers, first responders, and individuals who are at heightened risk for COVID-19 in the first phase. Water and wastewater utilities fall in the second phase, which includes “critical workers in high-risk settings – workers who are in industries essential to the functioning of society and at substantially higher risk of exposure.” See the top of page 3-30, which identifies “workers in the utilities sector” and specifically lists the water sector as an example. The intent with the final Framework is that it be provided to the U.S. Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) to assist with the creation and implementation of national and/or local guidelines for COVID-19 vaccine allocation. Access the report at The National Academies.

This is the second in a set of strategies requested or authored by the federal government regarding allocation of a COVID-19 vaccine. As WaterISAC reported on in its September 17 Security and Resilience Update, the U.S. Department of Health and Human Services released two documents outlining the federal government’s strategy for distributing a COVID-19 vaccine. The documents include an interim playbook that indicates critical infrastructure workers should be considered by jurisdictions when making decisions about vaccination priority.

September 17, 2020

Yesterday the U.S. Department of Health and Human Services released two documents outlining the federal government’s strategy for distributing a COVID-19 vaccine. The documents, developed in coordination with the U.S. Department of Defense and the Centers for Disease Control and Prevention (CDC), provide a strategic distribution overview along with an interim playbook for state, tribal, territorial, and local public health programs and their partners on how to plan and operationalize a vaccination response to COVID-19 within their respective jurisdictions.

In “Section 4: Critical Populations,” specifically on page 14, the playbook indicates that critical infrastructure workers should be considered by jurisdictions when making decisions about vaccination priority. It refers to the U.S. Department of Homeland Security Cybersecurity and Infrastructure Security Agency’s (CISA’s) Guidance on the Essential Critical Infrastructure Workforce, which includes workers in the water and wastewater sector. The playbook also references CDC’s Roadmap to Implementing Pandemic Influenza Vaccination of Critical Workforce, which provides additional information and tools for state and local planners on how to operationalize and implement specific plans for targeting critical workforce groups. Although this information is specific to an influenza pandemic, the playbook indicates that it may help to inform the COVID-19 vaccination planning for critical workforces.

Given the release of the strategy, WaterISAC recommends its members contact their appropriate health departments to discuss their COVID-19 vaccine priority status. Both CDC's Roadmap and CISA’s Guidance on the Essential Critical Infrastructure Workforce (also available here) may help to inform these discussions and ensure water and wastewater workers are given the appropriate status.

September 10, 2020

HHS Issues Guidance on COVID-19 Vaccine Access while CDC Announces End of Enhanced Screenings for International Travelers; Studies on COVID-19-related Impacts to Mental and Financial Health

HHS Guidance
Yesterday, the U.S. Department of Health and Human Services (HHS) issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) to expand access to safe and effective COVID-19 vaccines when they are made available. This guidance authorizes state-licensed pharmacists to order and administer COVID-19 vaccinations to persons ages three or older, subject to certain requirements. "Allowing pharmacists to order and administer COVID-19 vaccines will greatly expand convenient access for the American people," said Assistant Secretary for Health Admiral Brett P. Giroir.

Vaccine Update: There are numerous candidate COVID-19 vaccines being developed in the U.S. and around the world. Both the World Health Organization (WHO) and STAT, an online health and medicine journal, are tracking the progress of these candidates. Yesterday STAT published an exclusive report on a recent decision by AstraZeneca to pause the phase three trials of its vaccine following the unexplained illness in a participant. The participant received the vaccine rather than the placebo, and  AstraZeneca said the pause and investigation are standard whenever there is an unexplained illness, which can happen by chance in large clinical trials.

CDC Announcement
Also yesterday, the U.S. Centers for Disease Control and Prevention (CDC) announced that beginning on September 14, the U.S. government will remove requirements for directing all flights carrying airline passengers arriving from, or recently had a presence in, certain countries to land at one of 15 designated airports and halt enhanced entry health screening for these passengers. Currently, enhanced entry health screening is conducted for those arriving from, or with recent presence in, China, Iran, the Schengen region of Europe, the United Kingdom, Ireland, and Brazil. The CDC explained symptom-based screening has limited effectiveness because people with COVID-19 may have no symptoms or fever at the time of screening, or only mild symptoms. It added that resources will instead be dedicated to more effective mitigation efforts that focus on the individual passenger, including, pre-departure, in-flight, and post-arrival health education, among other measures.

COVID-19’s Impacts on Mental and Financial Health
While much of the attention has been on COVID-19’s costs on human life, in terms of cases and deaths, two recently published reports reflect on the disease’s other impacts. A study recently published in the medical journal JAMA indicates that more than a quarter of American adults are experiencing COVID-19-related symptoms of depression. Financial pressures as a result of the pandemic are thought to be the main factor for the rise. And according to the results of a poll conducted by NPR, the Robert Wood Johnson Foundation, and Harvard’s T.H. Chan School of Public Health, at least half of households in four major U.S. cities reported serious financial problems triggered by the pandemic, and more than half report serious problems caring for their children. The results also showed these effects are falling heaviest on households with annual incomes below $100,000 and in Black and Latino families.

September 3, 2020

The U.S. Centers for Disease Control and Prevention (CDC) sent planning documents to public health agencies around the country last week discussing preparations for two COVID-19 vaccines. Although the CDC referred only to a “Vaccine A” and “Vaccine B,” the technical details it provided, including the time between doses and storage temperatures, match well with the two vaccines furthest along in U.S. clinical tests, made by Moderna and Pfizer. Both companies are currently testing their candidates in Phase 3 trials. Normally, vaccine makers would wait for clinical trials to yield definitive results before moving forward with manufacturing. This time, many manufacturers have begun preparing in advance for production, and the CDC told public health agencies last week that limited doses may be available beginning in late October or November. The CDC’s planning documents indicate the extraordinary complexity of distributing vaccines to hundreds of millions of people. In its documents, the CDC said certain groups would have priority, beginning with health care workers, essential workers, “national security populations,” and employees and residents of long-term care facilities. Read more at the New York Times.

Earlier this week, the National Academy of Science released a draft of its framework for vaccine distribution, providing an opportunity for public comments. The framework was commissioned by the National Institutes of Health and the CDC. The Advisory Committee on Immunization Practices (ACIP), an independent panel of the CDC, will take the recommendations developed through the framework into account as it formulate its own recommendations for the CDC. The period for public comment is open until 11:59 p.m. ET on Friday, September 4. The discussion draft and public comment form can be found here.

September 1, 2020

Two scientific studies published late last week provide further evidence for the airborne spread of COVID-19 and the importance of effective ventilation systems. One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak affecting 81 percent of residents and 50 percent of healthcare workers at a Dutch nursing home to inadequate ventilation. For the second, a letter accompanying the research was written in support of a study published on July 6 warning of the hazards of airborne COVID-19 transmission in poorly ventilated environments. Read the article at the University of Minnesota’s Center for Infectious Disease Research and Policy.

As WaterISAC has previously described, both the Occupational Safety and Health Administration (OSHA) and the U.S. Centers for Disease Control and Prevention (CDC) encourage workplaces to implement measures regarding air filtration and circulation to reduce the risk of COVID-19 transmission. WaterISAC has posted these and other resources regarding this topic to this webpage. It has also reported on information provided by other organizations. The design and architecture firm Gensler is among them; it published a building air filtration primer in early May. Members may also be interested in an “HVAC and Reopening Buildings amid COVID-19” article recently published in Facility Executive.

August 20, 2020

The U.S. Department of Homeland Security Cybersecurity and Infrastructure Agency (CISA) has released version 4.0 of its Guidance on the Essential Critical Infrastructure Workforce. For this version, there are no changes to the “Water and Wastewater” section, which identifies the types of workers needed to operate and maintain the sector’s infrastructure. Central to the value of the guidance in the early months of the pandemic was the discrete problem it was intended to support solutions for – enabling essential workers to work during COVID-19-related community restrictions. CISA’s assessment is that, for the most part, essential workers are able to work, and it that what is now most important is that essential workers are able to work in a safe environment. To support this, it offers a series of worker risk mitigation strategies for consideration. These include creating a risk categorization methodology for worker safety and determining the allocation of scarce resources for workers, such as PPE, other protection, access to medical evaluation, testing, and vaccines, among other strategies. This section of the document also includes links to other resources that provide additional guidance on health, workplace, and worker safety issues related to the pandemic. Read the guidance at CISA.

In addition to the hyperlink embedded above, the latest version of the guidance has been posted to this webpage as resource #38.

August 18, 2020

Researchers at the University of Southern California (USC) say they've found the symptoms of COVID-19 tend to appear in a specific order: fever, cough and muscle pain, then nausea and/or vomiting, then diarrhea. Knowing the order of COVID-19’s symptoms may help patients seek care promptly or decide promptly to self-isolate, they researchers say. It also could help doctors rule out other illnesses or plan how to treat patients. The researchers’ findings may prove useful for the upcoming flu season, helping medical professionals differentiate between cases of that illness and COVID-19. “This order is especially important to know when we have overlapping cycles of illnesses like the flu that coincide with infections of COVID-19,” said USC Professor Peter Kuhn. “Doctors can determine what steps to take to care for the patient, and they may prevent the patient’s condition from worsening.” To discover the sequence, the USC researchers examined data from more than 55,000 confirmed cases in China, collected from February 16 to 24. And to compare the order of COVID-19 symptoms to flu, the researchers examined data from 2,470 cases in North America, Europe, and the Southern Hemisphere that were reported to health authorities from 1994 to 1998. Their findings were recently published in the journal Frontiers in Public Health. Read the press release at USC.

August 13, 2020

There were 1,470 confirmed COVID-19 related deaths in the U.S. yesterday, the highest single-day total yet in August.  With the exception of three days this summer, Wednesday’s death total was the country’s highest since late May. The figure was higher on each of those three days because of single states reporting large numbers of backlogged deaths from unspecified days. For the past two weeks, the U.S. has averaged more than 1,000 deaths per day, more than twice as many as in early July. Read more at the New York Times.

With the COVID-19 pandemic continuing to have serious impacts on the U.S., some organizations have recently released reports containing recommendations for new and revised approaches to addressing this unprecedented public health challenge.

  • The first report is from the Johns Hopkins University (also posted below as resource #35), which offers policy actions at the federal, state, and local levels to gain control of the pandemic. The recommended actions in the report pertain to non-pharmaceutical interventions, PPE supply chains, and testing and contact tracing, among other topics. The report’s authors emphasize that leaders and stakeholders at all levels will need to contribute their commitment, technical expertise, insights, and funding to make these proposed actions possible.
  • The Association of American Medical Colleges published the next report (also posted below as resource #36), presents a roadmap for containing the coronavirus and ending the pandemic with measures that include addressing critical shortages, reopening schools safely, and prioritizing the distribution of a vaccine. It also identifies longer-term actions to protect and strengthen public health, reduce health disparities, and improve the overall health of the nation.
  • The third and final report was published by the National Governors’ Association (also posted below as resource #37). It doesn’t offer recommendations for how to end the pandemic, but it does provide insights and considerations for policy makers as they seek to make workforces resilient to the disruptions. The report was actually written before the pandemic began, but the authors observe the new context reinforces their findings and underscores the urgency of the transformations that should be implemented as part of a systemwide, resilient education and workforce development agenda.

In other COVID-19 news, the has updated its guidance on face masks, warning that those with valves or vents do not prevent the wearer from spreading the disease to others.

August 11, 2020

On Thursday, the U.S. Department of State and the Centers for Disease Control and Prevention (CDC) rescinded their global advisories recommending U.S. citizens avoid all international travel because of the COVID-19 pandemic. While the decision removed blanket recommendations to avoid all international travel, the Department of State and CDC still encourage citizens not engage in non-essential travel to much of the world through their respective systems that list threats and recommendations by country. For the U.S. Department of State, it advises all U.S. citizens to read the country-specific Travel Advisories and U.S. Embassy COVID pages for updates on the impact of COVID-19 worldwide. For the CDC, it has published a “COVID-19 Travel Recommendations by Destination” webpage, which depicts COVID-19 risk levels in each country. The webpage complements the CDC’s Travel Health Notices webpage, established to inform travelers about current health issues that impact travelers’ health, like disease outbreaks in specific international destinations. The CDC has also recently updated its “Travel during the COVID-19 Pandemic” webpage, which provides numerous recommendations and considerations when traveling. Here the CDC reminds the public that travel increases chances of getting and spreading COVID-19 and that staying home is the best way to protect oneself and others from COVID-19. It also recommends people avoid travel if they’re sick or if they’ve been around someone with COVID-19 in the past 14 days.

WaterISAC has become aware of the following COVID-19 resources that may be useful to members as they respond to the pandemic:

July 28, 2020

CDC Revises Guidance on Isolation Period for Most COVID-19 Cases
The U.S. Centers for Disease Control and Prevention (CDC) recently issued revised guidance based on its assessment that most people with COVID-19 are no longer infectious 10 days after they begin having symptoms. As a result, the CDC discourages people from getting tested a second time after they recover. “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,” the CDC says. For people who have tested positive but don't have 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.” There are exceptions for the 10-day guidance, including people with compromised immune systems who may be infectious for a longer period of time. Additionally, the recommendation of 10 days is specifically for those who test positive for the coronavirus and have been asked to self-isolate. It doesn’t apply to people who need to quarantine to keep from possibly spreading the virus. The incubation period for the virus is 14 days, health experts say, so anyone who has been exposed to the virus would need to quarantine to see if they become sick. Read the guidance at the CDC and an article about the guidance at NBC News.

Final Stage Testing of First U.S. Vaccine Candidate Begins
Yesterday, final-stage testing of a COVID-19 vaccine began. Also referred to as the phase 3 trial, this stage involves 30,000 volunteers at 89 sites across the country receiving shots of Moderna’s COVID-19 vaccine candidate (half of the volunteers will receive a placebo). After volunteers get two doses a month apart, scientists will closely track which group experiences more infections as they go about their daily routines, especially in areas where the virus is rapidly spreading. The answer probably won’t come until November or December, cautioned the National Institute of Health’s Dr. Anthony Fauci. Don’t expect a vaccine as strong as the measles vaccine, which prevents about 97 percent of measles infections, Dr. Fauci said, who added he would be happy with a COVID-19 vaccine that’s 60 percent effective. If Moderna's candidate is successful, it will mark the fastest vaccine development timeline in history. Modern's vaccine is the first U.S. vaccine to enter phase 3 trials, but at least three more are soon to follow. All are part of the U.S. government's Operation Warp Speed, which has set the goal of producing, manufacturing, and distributing an effective vaccine against the novel coronavirus by 2021. Read the articles at The University of Minnesota’s Center for Infectious Disease Research and Policy and The Associated Press.

For more on this topic, the New York Times is maintaining a Coronavirus Vaccine Tracker.

July 23, 2020

The U.S. Centers for Disease Control and Prevention (CDC) recently posted a webpage discussing COVID-19 in rural communities, which could be a useful resource for water and wastewater utilities in these areas. The webpage includes a section discussing why rural communities may be at higher risk for COVID-19, influenced by factors like the health of populations, the healthcare infrastructure, and the presence of agricultural and food processing industries in such places. On the webpage the CDC also describes the approaches that can be taken by businesses and workplaces and residents, among other groupings, to reduce the risk of COVID-19 transmission. Among its recommendations the CDC encourages the use of face coverings, as well as other COVID-19 prevention behaviors, to limit exposure to the virus. Access the webpage at the CDC.

Given the increasing number of confirmed COVID-19 cases around the country, there have been increasing calls for face coverings to be worn in public places. Some state and local government leaders have issued face covering mandates. And on Tuesday, President Trump encouraged Americans to wear face coverings, saying that “they have an impact,” adding that the COVID-19 situation “will probably unfortunately get worse before it gets better.”

On the topic of face coverings, WaterISAC has found two recent resources that may be helpful to members:

  • Dr. Michael Osterholm, the Director of the University of Minnesota’s Center for Infectious Disease Research and Policy (a site regularly referenced by WaterISAC), published a commentary on face masks yesterday. He emphasized his support for wearing face masks while also advocating for other protective steps, like physical distancing.
  • Additionally, an article from Security Informed addresses how organizations can enforce face covering requirements, such as by their employees and customers, without confrontation or bias. As noted in the article, there have been violent confrontations between individuals charged with enforcing these requirements and others.

WaterISAC has also posted numerous resources regarding face coverings and other protective measures to its COVID-19 general webpage. These include a link to CDC resources and information, including its main face covering webpage.

July 21, 2020

The U.S. Department of Homeland Security Cybersecurity and Infrastructure Security Agency (CISA) has just released the COVID-19 Recovery CISA Tabletop Exercise Package (CTEP), a compilation of instructions and templates to help organizations conduct their own exercise regarding COVID-19 recovery. The CTEP materials include an exercise planner handbook, an exercise brief slide deck, and an after-action report/improvement plan, among others. The intent of the CTEP is to assist critical infrastructure owners and operators in assessing their recovery and business continuity plans and addressing key questions.  The CTEP also provides organizations the opportunity to discuss how ongoing recovery efforts are impacted by a potential “second wave” of COVID-19 infections. Access the CTEP at CISA.

CISA has also advised its partners of another resource that may be helpful in their COVID-19 response and recovery efforts, the Communications Sector Coordinating Council’s Return to Normal: Guidance and Resources for Communications Providers (also posted below as resource #34). Although specifically tailored to the communications sector, the information and advice provided in this resource can be useful to other critical infrastructure, including water and wastewater utilities. It contains sections on key planning questions and considerations, employee testing protocols, workplace social distancing, use of PPE, and distancing and cleaning in common eating and break areas, among others.

This resource is similar to another COVID-19 resource WaterISAC has promoted in its Security and Resilience Updates and on its COVID-19 general webpage, the Electricity Subsector Coordinating Council’s Assessing and Mitigating the Novel Coronavirus (COVID-19) (posted below as resource #10).

CISA/FEMA Broad Stakeholder Call Information

The U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency (CISA) and the Federal Emergency Management Agency (FEMA) are continuing to convene Broad Stakeholder Calls, which are open to critical infrastructure operators and other stakeholders. They are being held every Tuesday 3:00 to 4:15 pm ET until futher notice. Beginning in July, the calls will only be held every-other Tuesdays - the next call is on August 4.

The call-in information is as follows:

Dial: 1-800-593-7177
Enter passcode: 7963614

Resources - COVID-19 Cases

For the latest information on the numbers and locations of cases in WaterISAC member countries (the U.S., Canada, and Australia) and around the world, visit the following websites:

  • For the U.S., visit the U.S. Centers for Disease Control and Prevention (CDC).
  • For Canada, visit the Public Health Agency of Canada (PHAC).
  • For Australia, visit the Australian Department of Health.
  • Johns Hopkins University is managing an online, GIS-based tracker, showing cases around the world.
    • Malicious COVID-19 Website – WaterISAC has learned there is a malicious website that looks very similar to and appears intended to mimic the Johns Hopkins University tracker. The malicious website infects visitors with the AZORult Trojan, an information stealing program that can exfiltrate sensitive data. Read more at Reason Blog.
  • As individuals and organizations try to get a sense of the degree of COVID-19 spread in the communities, a series of new, online tools built by researchers and public health experts, including from the Harvard Global Health Institute, may be of assistance. The tools include a risk-assessment map that allows people to check the state or the county where they live and see a COVID-19 risk rating of green, yellow, orange or red. The risk levels are based upon the number of new daily cases per 100,000 people. There are other important metrics when it comes to tracking the spread and severity of COVID-19. But the group settled on tying the alert level to numbers of new cases per 100,000, noting it's a good indicator to show the current picture of outbreaks and compare them in a consistent way. "It allows you to compare a rural area in upstate New York compared to New York City and have an apples-to-apples comparison for relative impact and relative caseload," says Ellie Graeden of Talus Analytics and the Center for Global Health, Science and Security at Georgetown University, which is part of the group. Read an article about the new tools at NPR.

Resources - Return to Work Planning

  • Planning Considerations for Organizations in Reconstituting Operations during the COVID-19 Pandemic (FEMA) - This resource provides lists of reconstitution planning considerations in general and for state, local, tribal, and territorial governments as well as for the private sector. It also provides a list of additional resources and lists of questions to consider when reconstituting operations, categorized by people, messaging/communications, facilities, and resources / logistics. This document is posted below as resource #27.
  • Guidance on Returning to Work (OSHA) - This resource is intended to assist employers as they reopen businesses and employees return to work. It discusses general strategies businesses should implement during each phase of reopening and provides a series of guiding principles and examples of how to implement them. It also contains sections discussing its standards and required protections in workplaces and answering frequently asked questions. This resource is also posted below as resource #33.
  • Exercise Starter Kit (FEMA) - This resource is intended for organizations to convene their own workshops on reconstitution, or the process of returning to full operations, during COVID-19. The kit includes a sample facilitator guide and conduct slides that present suggested discussion questions focused on four themes: people, facilities, messaging and communications, and resources and logistics. The suggested questions build upon the White House’s guidance for employers in the Guidelines for Opening Up America Again and FEMA’s Planning Considerations for Organizations in Reconstituting Operations during the COVID-19 Pandemic (in addition to the links included for each document, they are also posted below as resources #21 and 27). All of the kit’s materials, including the questions, are designed and intended to be adapted and customized to an organization’s own needs. The intended outcome from the workshop is a roadmap for a reconstitution plan tailored to an organization.
    • FEMA has also launched a series of four new COVID-19 training videos through its Center for Domestic Preparedness. While the content in most of these is tailored to healthcare professionals, some of it can be useful for a general audience and could be used by an organization providing employees with a baseline of information about COVID-19. The first video, for example, offers an overview of the virus and discusses symptoms, diagnosis, treatment, and prevention.
  • All-Hazards Preparedness Exercise Starter Kit (FEMA) - The intent of this tool, as well as with the Exercise Starter Kit discussed above, is to facilitate discussions, validate planning, and identify and address gaps. With the release of this tool, FEMA Administrator Pete Gaynor encouraged his audience to review their plans, to include for emergency operations, continuity, resource management, mutual aid, logistics, public information, and recovery against the ongoing COVID-19 response.
  • CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening American Up Again (CDC) - The U.S. Centers for Disease Control and Prevention (CDC) published a document containing information intended to be helpful for businesses as they consider and make reopening decisions and actions. The document  contains an “Interim Guidance for Employers with Workers at High Risk” section that encourages businesses to keep in mind as they gradually scale up their operations that some workers are at higher risk for severe illness from COVID-19. The CDC lays out a series of three steps that are intended to inform decisions and actions as organizations scale up their operations. It also identifies the actions it recommends organizations take as part of these steps, such as intensifying cleaning, disinfection, and ventilation; having a plan for when employees become sick; and being prepared to scale down operations based on state and local health department notices or if there are COVID-19 cases in the workplace. This resource is available at the CDC here. It has also been posted below as resource #31.
  • Workplaces during the COVID-19 Pandemic (CDC) - This simple decision tree from the U.S. Centers for Disease Control and Prevention is intended to assist employers with walking through the process of making return to work decisions and bringing employees back into the workplace.
  • Reopening Guidelines for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes (CDC) - This webpage provides a general framework for cleaning and disinfection practices. The associated Guidance for Cleaning and Disinfecting contains a decision flowchart.
  • Errands and Going Out (CDC) - While utilities can do much to reduce the spread of COVID-19 at the workplace to promote safety and business continuity, there is also the risk that employees will contract the disease elsewhere in their communities. This is an increasingly important consideration given that reopening is underway across the U.S. and public life in many places is returning to a semblance of normalcy. Information and guidance provided via the CDC’s could be provided to employees to assist them in making risk-informed decisions. This resource links to other webpages that discuss topics like: 
  • Information on Maintaining or Restoring Water Quality in Buildings with Low or No Use (EPA) - EPA has posted two documents regarding recommended actions to be taken by building owners and managers to address building water quality prior to reopening. The first document contains lists of actions for building owners and managers to take; it also includes steps for public water systems. The second document complements the first by providing a simple checklist of actions.
  • Guidance for Building Water Systems (CDC) - The CDC published this guidance to help minimize the risk of Legionnaire’s disease and other diseases associated with water given that water has likely become stagnant in many buildings, such as those that have been vacated by businesses while social distancing measures are in place. The guidance recommends an eight step process before reopening a building, which includes flushing the water system and maintaining the water system (this step asks readers to consider contacting their local water utility to learn about any recent disruptions in the water supply).
  • Safely Re-Opening Buildings: General Guidance for Water Utilities (Canadian Water and Wastewater Association) – Developed to be used by water and wastewater utilities, this resource is intended to provide advice on steps to take to prepare for increased flushing, recommendations for distributing information to building owners, and guidance on communicating with the public and media.
  • Safely Reopening Buildings: A Fact Sheet for Building Owners/Operators (Canadian Water and Wastewater Association) – Developed to be used by building owners and operators, this resource provides general instruction for flushing and cleaning water systems and links to more detailed resources and guidance. CWWA notes the fact sheet can go out as is, but it encourages utilities to customize it before sending to building owners and operators, adding such details as utility name and logo, chlorine residual levels, and local contacts, among others.
  • Coronavirus Building Flushing Guidance (The Environmental Science Policy & Research Institute [ESPRI]) - This guidance helps address the issue of building water quality degradation. As noted in the document, when buildings are shut down or used less frequently, as is happening during the current COVID-19 situation, water quality in the buildings can become a serious issue. In addition to discussing how water quality degrades in buildings in these circumstances, the guidance provides a general roadmap for how to flush contaminants from buildings and get plumbing system water quality back to pre-stagnation conditions. This document is posted below as resource #17.
  • Assessing and Mitigating the Novel Coronavirus (ESCC) - The Electricity Subsector Coordinating Council’s (ESCC's) guide includes a “Responsible Re-entry and Return to the Workplace” section. In this section, the ESCC highlights four strategic priorities for returning to the workplace. Given similarities to the electricity sector, these priorities may also be relevant for water and wastewater utilities. This document is posted below as resource #10.
  • Distribution of Infrared Thermometers (FEMA) - In late May, FEMA announced the federal government is distributing non-contact infrared thermometers (NCITs) to state, local, tribal, and territorial governments to support the reopening of the nation’s workplaces. The NCITs are being provided to these governments for further distribution to local authorities and businesses based on current conditions and their individual reopening plans and priorities. Although FEMA notes that these governments will be responsible for distributing NCITs and will have significant flexibility in making their decisions, it has identified considerations for establishing priority. These considerations include workplaces with essential critical workers (based on the DHS CISA’s Guidance on the Essential Critical Infrastructure Workforce), that are currently operating, and that support the reopening of other businesses. FEMA also emphasizes the thermometers should be used in accordance with CDC guidance for businesses and employers and OSHA guidance for preparing workplaces for identifying potentially ill individuals including employees, customers, vendors or other visitors. As FEMA reminds its partners, temperature checks are one important part of an assessment symptom screening process that includes checking for fever. Fever is one of many symptoms to reduce social exposure to individuals who may be exhibiting elevated temperature.
  • Reopening Business Digital Resources Center (U.S. Chamber of Commerce) - The U.S. Chamber has made available an online portal that presents the latest state guidelines, guidance and advice for businesses, and other tools and resources to help employers and employees return to work safely and successfully. It offers a standardized employee screening questionnaire and a customizable workplace flyer for communicating to employees and customers the steps an organization is taking to keep them safe and prevent the spread of COVID-19. The U.S. Chamber notes it will regularly update the page as new information becomes available.
    • Reopening Guidance for General Office Settings (American Industrial Hygiene Association) - This is one of the resources the site links to, which discusses what employers should do to prepare their facilities for reopening, such as in general office spaces, conference rooms, lobbies and common areas, restrooms, and eating areas.
    • Path Forward Webinar Series - On the site the U.S. Chamber notes it is convening a weekly  webinar (Thursdays at 3:00 pm ET). Moderated by U.S. Chamber President Suzanne Clark, this series explores the complex issues that must be considered as part of a responsible reopening strategy. Each week a panel of experts discusses topics like barriers to reopening, big questions about immunity and liability, and ways employers can use innovative approaches to ensure safety into the workplace.
  • Coronavirus and COVID-19 (Society for Human Resources Management [SHRM]) - SHRM has made available toolkits and tools, such as a coronavirus poster for business entrances, as well as forms and guides, including a return-to-work guide for employees. There are other COVID-19 FAQ pages and news articles that discuss a variety of topics germane to human resources professionals during the COVID-19 pandemic.
  • There are numerous online resources that provide country-wide overviews as well as detailed information by state on the state of reopening, restrictions, and testing. Some include:
    • The National Governors Association is maintaining an online database of actions that have been taken by states, including stay-at-home orders, travel restrictions, and non-essential business closures, among others.
    • The New York Times is operating a tracker showing the status of reopening and COVID-19 restrictions by state.
    • MultiState Associates is maintaining a tracker that has an up-to-date list of executive orders and various travel restrictions.
    • A Kaiser Family Foundation website provides state-level information on social distancing measures, health policy actions, cases/deaths, and more.
    • A Politico website provides an overview of how states are responding to COVID-19 in seven maps, using data from the Kaiser Family Foundation.

Resources - Water and Wastewater Utility COVID-19 Impacts and Responses

  • Food Grade CO2 Suppliers and Producers (EPA) - For water utilities that utilize carbon dioxide (CO2) in their treatment processes, the EPA has provided a document identifying food grade CO2 suppliers and producers in the event that water utilities need to find alternative companies. The CO2 used by water utilities is often produced as a byproduct of the ethanol manufacturing process, and with the demand for ethanol having decreased (largely due to the decrease in vehicle driving) some manufacturers have suspended or reduced their operations. At this time, it seems that the water utilities that learned of potential disruptions to their CO2 shipments from their primary vendors were able to switch to alternate companies. Access the resource document at EPA or below (posted as resource #28).
  • Critical Infrastructure Operations Centers and Control Rooms Guide for Pandemic Response (DHS CISA) - This guide provides considerations and mitigation measures for operations centers and control rooms that are continuing to operate during a pandemic. The considerations and measures in the document are organized into sections for coordination with federal, state, and other authorities; communication and information sharing; protecting personnel; protecting equipment; and workforce planning. This document is posted below as resource #24.
  • The Financial Impact of the COVID-19 Crisis on Drinking Water Utilities (Raftelis for AMWA and AWWA) - The financial impact of the COVID-19 crisis on U.S. water utilities is estimated to exceed $15 billion, according to a new report prepared by Raftelis for the Association of Metropolitan Water Agencies (AMWA) (read the press release at AMWAand the American Water Works Association (AWWA). It estimates drinking water utilities in the U.S. will see revenues from customer payments drop by nearly $14 billion. The impacts result from the elimination of water shutoffs for non-payment, increased late payments due to high unemployment, reductions in non-residential water demands, and fewer new customers. These utilities may also experience additional future revenue losses estimated at approximately $1.6 billion in aggregate as a result of deferrals of planned water rate increases. The drop in revenue will require utilities to scale back projects by as much as $5 billion (annualized) to help manage cash flows due to the crisis. These reductions will have a cascade effect on communities, reducing economic activity by an estimated $32.7 billion and costing 75,000 to 90,000 private sector jobs. The financial impact of the COVID-19 crisis on drinking water and wastewater utilities combined is estimated to exceed $27 billion (the report has also been posted below as resource #20).
  • Water Utility COVID-19 Financial Impact Tool (EPA) - This tool is intended to help drinking water and wastewater utilities assess how the COVID-19 pandemic has affected their financial health. The tool, an Excel spreadsheet that can be downloaded from EPA’s website, walks utilities through a series of questions in the categories of revenues, expenses, and cashflow. The spreadsheet automatically calculates the changes for a utility’s revenues and expenses by looking at current 2020 monthly financials versus the average monthly financials of the utility’s 2019 audited financial statement. Utilities can use the tool each month to keep a running total of their cashflow. EPA emphasizes that use of the tool is voluntary and results are provided for utilities’ information only. Additionally, EPA is not collecting the data entered by utilities or the results.
    • As noted in a news release announcing the tool, many utilities expect to experience revenue losses due to reduced commercial consumption, households that are unable to pay their bills, and deferred or cancelled rate increases. Utilities also anticipate incurring increased costs related to overtime wages, PPE purchases, and increased demand on customer assistance programs. Having an understanding of the extent of financial impacts can help utilities as they plan for ongoing operation and maintenance and capital infrastructure needs, including implementing plans to repair, replace, and modernize aging infrastructure. “It’s important for water utilities to understand – as early as possible – how to carry out their responsibilities and plan reinvestment for their communities as local economies start to recover from COVID-19,” said EPA Administrator Andrew Wheeler. Read the news release at EPA.
  • Coronavirus Disease 2019 (COVID-19) (EPA) - One of the resources linked to on this webpage is "Coronavirus and Drinking Water and Wastewater," guidance that emphasizes the continued safety of tap water amid the COVID-19 pandemic. This guidance echoes previous statements by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC), which are referenced in the next two materials below. It specifically states that consumers can continue to use tap water as usual, to include for drinking and hand washing, and that they do not need to boil their water to protect against COVID-19. Additionally, referencing a statement previously made by the WHO, it notes that “there is no evidence to date that COVID-19 virus has been transmitted via sewerage systems, with or without wastewater treatment.” And it adds that “standard treatment and disinfectant processes at wastewater treatment plants are expected to be effective” against the COVID-19 virus.
  • Water Transmission and COVID-19 (CDC) - This webpage discusses the transmission of the COVID-19 virus in drinking water and wastewater as well as whether wastewater workers should take extra precautions.
  • Incident Action Checklist - Pandemic Incidents (EPA) - This is the latest in EPA’s suite of incident action checklists and follows the same format as the others. It contains a brief discussion of the impacts water and wastewater utilities might experience in these incidents; provides links to resources with more information; has checklists of actions to take when preparing for, responding to, and recovering from a pandemic; and includes a contact list that can be filled out by a utility. In addition to the link above, this document is also posted below as resource #1.
    • Recording of Incident Action Checklist Webinar (EPA) – EPA has posted the recording from its April 7 webinar entitled “COVID-19 Planning and Response: Overview of EPA’s Pandemic Incident Action Checklist for Water Utilities."  The webinar provided an overview of EPA’s Pandemic Incident Action Checklist. It also included a case study from Todd Brown, the Town of Marbleton, Wyoming Public Works Director, who discussed the actions his small system has taken in response to COVID-19, as well as a Q&A session.
  • COVID-19 Critical Infrastructure Sector Response Planning – On this webpage, the CDC encourages critical infrastructure workplaces to develop a COVID-19 response plan; it includes advice and links to resources to assist in this process. The CDC also discusses how to adapt a response plan based on the CDC’s guidance.
  • Water, sanitation, hygiene and waste management for COVID-19 (WHO) - This technical brief from the World Health Organization discusses the persistence of the COVID-19 virus in drinking water and sewage and on surface. It states that “while persistence in drinking-water is possible, there is no current evidence that surrogate human coronaviruses are present in surface or ground water sources or transmitted through contaminated drinking-water.” For wastewater, it says, “While there is no evidence, to date, on the COVID-19 virus survival in water or sewage, the virus is likely to become inactivated significantly faster than non-enveloped human enteric viruses with known waterborne transmission.” In the “Keeping water supplies safe” section, the brief states that “based on current evidence the risk to water supplies is low.” The section also describes measures for keeping water supplies safe and for treating water, adding that “conventional, centralized water treatment methods which utilize filtration and disinfection should inactivate COVID-19 virus.” The “Safely managing wastewater and or/fecal waste” section states “there is no evidence to date that COVID-19 virus has been transmitted via sewerage system, with or without wastewater treatment.” Referencing findings from the 2003 outbreak of SARs, another type of coronavirus, the brief suggests there is low likelihood of wastewater treatment workers contracting COVID-19 in work environments. The brief also contains sections about cleaning practices for keeping surfaces disinfected. The technical brief is posted below as resource #2.
  • Introductions to Coronaviruses (Stantec) - This white paper from Stantec states that utilities can continue using standard treatment measures for both water and wastewater for coronaviruses. The white paper is posted below as resource #3.
  • COVID-19 (OSHA) -  On this webpage, the Occupational Safety and Health Administration indicates exposure risk may be elevated for wastewater management workers, among other types of workers. OSHA notes its existing standards apply to protecting workers from COVID-19, which are described on the webpage.
  • Current Priority: Coronavirus (WEF)  - The Water Environment Federation’s webpage contains The Water Professional’s Guide to COVID-19, the recording from its February 25 “Updates on Novel Coronavirus for Water Professionals” webcast, and other information and resources regarding COVID-19.
  • Coronavirus Disease 2019 (COVID-19): Water and Wastewater Sector Impacts and Needs - WaterISAC conducted a survey of its members asking about impacts and needs regarding COVID-19. Below WaterISAC has captured the two options that received the most responses from the 25 organizations that participated in the survey:
    • Primary Business Concerns – Absenteeism (84 percent) and Supply Chain Impacts (76 percent)
    • Specific Actions Already Being Taken – Reviewing Advisories (84 percent) and Reviewing or Completing Business Continuity Plans (64 percent)
    • Additional Actions that Might Need to Be Taken – Quarantining Essential Employees at Utility (48 percent) and Stockpiling Materials Needed for Operations (48 percent)
    • Priority Information Needs – Potential Supply Chain Impacts (88 percent) and Effectiveness of PPE and Disinfection Measures (84 percent)
  • Pandemic Impacts to Lifeline Critical Infrastructure (DHS) - This Critical Infrastructure Security and Resilience Note examines the impact of a pandemic on the lifeline critical infrastructure, which includes the water and wastewater sector. The Note observes that the greatest risk to the water and wastewater sector comes from the loss of available operators and support staff due to illness and absenteeism, and it cities a previous report from AMWA and WaterISAC that found that the sector deemed roughly 41 percent of workers critical to maintaining systems.
  • Key Considerations for Water and Wastewater Utilities Responding to the Coronavirus (Moonshot Missions) - This guide contains a compendium of best practices being implemented by water and wastewater utilities. Given that utilities are continuing to employ and experiment with new approaches, Moonshot Missions intends to routinely update this document. Moonshot Missions' founder is former DC Water CEO George Hawkins. This document is posted below as resource #15.
  • "Cities are using sewer systems as COVID-19 early warning signs" (The Verge) - Some wastewater utilities in the U.S. have been participating in the early stages of efforts to track the levels of coronavirus in their areas. The utilities provide wastewater samples to research teams, such as one at Yale University, who analyze the contents for indicators of the virus and report their findings to local officials. “We’re expecting cases to pick up again because people are moving forward with their lives, interacting with the community, going to restaurants, and taking public transportation. Inevitably, there’s going to be an increased opportunity for exposure,” said Jordan Peccia, a Yale professor of chemical and environmental engineering working on the project. “This will give us an opportunity to kind of act a little quicker than depending on hospital data.”

    • The practice of testing wastewater to detect COVID-19 spread in communities is also being employed in Australia. As WaterISAC reported on in its April 16 Security and Resilience Update, Australian researchers completed a successful regional pilot in which they were able to detect coronavirus gene fragments in untreated wastewater. The technology used in the pilot is being integrated into an existing system under which crime agencies monitor wastewater, covering about 57 percent of the population, to detect the presence of illicit drugs.

Personal Protective Equipment (PPE)

  • COVID-19 Pandemic: Personal Protective Equipment Preservation Best Practices (FEMA) - This document summarizes government guidance and best practices currently being implemented across the U.S. for COVID-19 response. This document lists actions and considerations that are grouped into the categories of reduce, reduce, and repurpose. This document is posted below as resource # 17.
  • Interim Guidance for Conserving and Extending Filtering Facepiece Supply in Non-Healthcare Sectors (NIOSH) - The National Institute for Occupational Safety and Health (NIOSH) recently issued this document offering strategies to conserve, extend, and respond to shortages of NIOSH-approved filtering facepiece respirators (FFRs).
  • Addressing PPE Needs in Non-Healthcare Setting (FEMA) - FEMA has published two documents providing guidance on how organizations in non-healthcare sectors should consider and manage their PPE needs during the COVID-19 pandemic response while ensuring the protection of workers. They focus on the prioritization of certain kinds of PPE (e.g., N95 face masks) for the healthcare sector, the expected continuation of PPE shortages, the importance of preserving PPE, and the careful consideration of what kinds of PPE workers should use, whether required by law or regulation for routine duties or for mitigating exposure to COVID-19.
    • The first document, a one page advisory (posted below as resource #22), summarizes the guidance and provides information for contacting FEMA about PPE allocations and orders.
    • The second document, a fact sheet (posted below as resource #23), states that if PPE is required by law or regulation for routine duties, organizations should take steps to preserve the PPE for reuse as well as to consider alternative types of PPE that are acceptable and that can support operations. In this section FEMA provides links to numerous resources, such as a CDC “Strategies to Optimize the Supply of PPE and Equipment” webpage and a PPE burn rate calculator. If PPE is not required by law or regulation, FEMA advises organizations not attempt to acquire medical of industrial use PPE given that it is likely unavailable and needs to be prioritized for the healthcare sector. Instead, FEMA recommends organizations and employees follow CDC guidance on simple cloth face coverings and implement exposure reduction measures, such as plexiglass barriers and improved ventilation systems. The fact sheet also provides information on acquiring PPE during shortages, if it’s deemed to be required, and lists a series of key questions to ask before making requests.
  • COVID-19 Frequently Asked Questions (OSHA) - This webpage addresses a series of frequently asked questions regarding the use of masks in the workplace. It outlines the differences between cloth face coverings, surgical masks, and respirators. It further reminds employers not to use surgical masks or cloth face coverings when respirators are needed. In addition, it encourages social distancing measures and recommends also recommends reviewing the CDC’s guidance on cloth face coverings.
  • Joint Advisory: Potential Availability of Cloth Masks for the Water Sector (WaterISAC) - On April 22, WaterISAC sent a joint advisory to members explaining a new program for distributing donated PPE to water and wastewater utilities nationwide (the text of the advisory is posted below as resource #25).
  • (TLP:GREEN) Indicators of Fraudulent 3M Personal Protective Equipment (FBI) - The FBI has published a report providing indicators of fraudulent 3M PPE. The report indicates the signs of fraudulent PPE, which it reinforces with images. Given the TLP:GREEN marking, this report has been posted to WaterISAC’s members only COVID-19 crowdsourcing webpage.
  • CDC calls on Americans to wear masks to prevent COVID-19 spread (CDC) - The CDC published this press release following an editorial by Director Dr. Robert Redfield in the Journal of the American Medical Association (JAMA) in which he called for the universal wearing of face coverings. "We are not defenseless against COVID-19," Redfield said in the press release. "Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities."
  • Use of Cloth Face Coverings to Help Slow the Spread of COVID-19 and Considerations for Wearing Cloth Face Coverings (CDC) - These webpages highlight CDC’s recommendations for cloth face coverings, which include that people wear cloth face coverings in public settings when around people outside of their household and especially when social distancing measures are difficult to maintain. It provides evidence on the effectiveness of cloth face coverings.

Resources - General Workplace and Community Safety and Security

  • Interim Guidance for Businesses and Employers to Plan and Respond to 2019 Novel Coronavirus (CDC) - The U.S. Centers for Disease Control and Prevention has published interim guidance for businesses on how to prevent workplace exposures to acute respiratory illnesses, including the COVID-19. Some of the recommended measures in the guidance include actively encouraging sick employees to stay home, separating sick employees, and performing routine environmental cleaning, among others. The guidance also includes planning considerations if there are more widespread, community outbreaks of COVID-19.
  • COVID-19 Dashboard ("What's New") (CDC) - The CDC continues to update its COVID-19 resources, posting new and revised information and guidelines for specific communities and sectors as well as for the general public. Some of the products that may be of interest to water and wastewater utilities include:
  • COVID-19 One-Stop Shop Toolkits (CDC) - Here you can access and download videos, social media, public service announcements, checklists, FAQs, among other resources, for a variety of venues and settings.
  • Coronavirus Emergency Management Best Practices (FEMA) – FEMA has created a new webpage where it has posted best practices and lessons learned across all levels of government, the private sector, professional associations, and other organizations. The content is organized around five themes: Helping People, which includes best practices on topics such as crisis counseling resources and anticipating and attending to civil rights; Government Operations, best practices such as public information and continuity of operations considerations; Private Sector and Infrastructure, which includes best practices for commercial trucking and food stores; Recovery Planning and Implementation, to include the newly released FEMA Disaster Financial Management Guide (discussed in the General Security and Resilience section below) and economic recovery considerations; and Medical Supplies and Equipment, including best practices for the preservation of personal protective equipment while ensuring workers are protected.
  • Guidance on Preparing Workplaces for COVID-19 (OSHA) – The Occupational Safety and Health Administration (OSHA) has developed a guide to assist workplaces with implementing measures for infection prevention and industrial hygiene during COVID-19 outbreaks. It contains sections discussing steps all employers can take to reduce workers’ risk of exposure as well as for measures to implement to protect workers in low, medium, and high and very high exposure risk settings. The document is posted below as resource #4.
  • List of Disinfectants to Use against COVID-19 (EPA) - The U.S. Environmental Protection Agency released a list of EPA-registered disinfectant products that have qualified for use against SARS-CoV-2, the novel coronavirus that causes COVID-19. Products appearing on EPA’s list registered disinfectant products have qualified for use against COVID-19 through the agency’s Emerging Viral Pathogen program. This program allows product manufacturers to provide EPA with data, even in advance of an outbreak, that shows their products are effective against harder-to-kill viruses than SARS-CoV-2. It also allows additional communications intended to inform the public about the utility of these products against the emerging pathogen in the most expeditious manner.
  • Risk Management for Novel Coronavirus (COVID-19) (DHS CISA) - The U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency has published an Insights document to help organization executives think through physical, supply chain, and cybersecurity issues that may arise from the spread of Coronavirus Disease 2019 (COVID-19). CISA states it is sharing this readiness information to help organizations plan for potential organizational and workforce impacts from COVID-19. That includes taking steps like identifying mission essential functions, updating incident response plans, factoring in workforce changes in a distributed environment, the possibility of malicious cyber actors taking advantage of public concern by conducting phishing attacks and disinformation campaigns. The document is posted below as resource #5.
  • FEMA Administrator April 15, 2020 letter to Emergency Managers (FEMA) - On April 15, FEMA Administrator Peter Gaynor released a letter intended for the nation’s emergency managers that discusses the agency’s lessons learned at this stage in the response and its priorities going forward. Some of the points he addresses are the preservation and prioritization of scarce resources, the use of data-driven decision making, mitigation efforts to flatten the curve, strengthening the supply chain, and the importance of busting myths. In his discussion of the first point, Administrator Gaynor encourages use of the guidance that has been disseminated to maximize supply inventories of PPE. These include the CDC’s Strategies to Optimize the Supply of PPE and Equipment and FEMA’s COVID-19 Pandemic: Personal Protective Equipment Preservation Best Practices (posted to this webpage as resource #19).
  • FEMA Administrator June 1, 2020 letter to Emergency Managers (FEMA) - On June 1, FEMA Administrator Pete Gaynor addressed the nation’s emergency managers in a letter reflecting on the three-month mark of the U.S.’s response to COVID-19 pandemic and addressing what he and his agency perceive to be potential challenges to come. The letter was sent on the official first day of the Atlantic Hurricane season, and Gaynor took the opportunity to emphasize the importance of preparing for these events, noting that forecasters predicted above-normal activity for this year.
  • COVID-19 Pandemic Operational Guidance for the 2020 Hurricane Season (FEMA) - This guide provides information to assist with preparations for response and recovery operations and encouraging personal preparedness. The document describes anticipated challenges to disaster operations posed by COVID-19; outlines how FEMA plans to adapt its response and recovery operations given these challenges; and provides guidance, checklists, and resources to help emergency managers adapt the response and recovery plans. FEMA notes that while the document focuses on hurricane season preparedness, most planning considerations can also be applied to any disaster operation in the COVID-19 environment, including floods and wildfires. This resource is available at FEMA here. This document is posted below as resource #32.
  • Stay-at-home orders and other restrictions significantly limited the spread of the coronavirus, according to two separate research studies published in the journal Nature.
    • The effect of large-scale anti-contagion policies on the COVID-19 pandemic - According to this study, the measures prevented 60 million coronavirus infections in the U.S. (the study also looked at five other countries). “The disease was spreading at a really extraordinary rate that is rare even among very infectious diseases,” said Solomon Hsiang, director of the Global Policy Laboratory at the University of California at Berkeley and the leader of the research team. “Without these policies employed, we would have lived through a very different April and May,” he noted.
    • Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe - This study was conducted by epidemiologists in the United Kingdom, estimated the shutdown measures saved about 3.1 million lives in 11 European countries and dropped infection rates by an average of 82 percent.
  • Hand Sanitizer Quiz (Food and Drug Administration) - The FDA encourages consumers to test their knowledge about the appropriate use of hand sanitizer. The quiz provides questions and answers to some of the most frequently asked questions related to hand sanitizer. This quiz can help consumers learn how to correctly use hand sanitizer.
  • How Exactly Do You Catch Covid-19? There Is a Growing Consensus (The Wall Street Journal) - This article describes what scientists and other experts currently believe about how COVID-19 infections occur. As the article highlights, the virus spreads mainly through close-up, person-to-person interactions for extended periods of time. In these settings the virus doesn’t simply rely on being spread through sneezing and coughing. It can be transmitted through seemingly benign activities like speaking and breathing that produce respiratory bits of varying sizes that can disperse along air currents and potentially infect people nearby. Additionally, some researchers say the coronavirus can also be transmitted through aerosols, or minuscule droplets that float in the air longer than large droplets. Given what is known about how coronavirus spreads, crowded events, poorly ventilated areas, and places where people are talking loudly increase the risk of infections. The article also notes what the CDC recently acknowledged, that it’s not common to contract COVID-19 from a contaminated surface.

Resources - Cybersecurity

  • ICT Supply Chain Risk Management (DHS CISA) -  To assist its partners with managing risks to their Information and Communications (ICT) supply chains, CISA has published several resources, to include a new ICT Supply Chain Essentials guide. Other resources include an ICT Supply Chain Risk Management Fact Sheet, an ICT SCRM Task Force Threat Scenarios Report, and an ICT Response Paper on Executive Order 13873. ICT systems include the hardware, software, and services critical to communicating, which support a broad range of critical infrastructure activities, including in the water and wastewater sector. Access the resources at CISA’s ICT Supply Chain Risk Management webpage.
  • Defending against COVID-19 Cyber Scams (DHS CISA) - The U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency has published an advisory warning individuals to remain vigilant for scams related to COVID-19. In the advisory, CISA notes that cyber actors may send emails with malicious attachments or links to fraudulent websites to trick victims into revealing sensitive information or donating to fraudulent charities or causes. It encourages exercising caution in handling any email with a COVID-19-related subject line, attachment, or hyperlink, and be wary of social media pleas, texts, or calls related to COVID-19.
  • COVID-19 Disinformation Activity (DHS CISA) - The U.S. Department of Homeland Security's Cybersecurity and Infrastructure Security Agency has published this resource discussing some of the false information and conspiracy theories related to COVID-19. As the document notes, some of this disinformation emanates or is being promoted by foreign governments. To counteract disinformation, it provides factual information and provides simple steps anyone can take to fact check information and minimize the risk of spreading false or misleading content. This resource has been posted to below as resource #30.
  • COVID-19 Disinformation Toolkit (DHS CISA) - The U.S. Department of Homeland Security Cybersecurity and Infrastructure Agency has published a COVID-19 Disinformation Toolkit, which is intended to be used by state, local, tribal, and territorial officials to understand and bring awareness to misinformation, disinformation, and conspiracy theories related to COVID-19. To help address the overabundance of false information – what the World Health Organization referred to as an “infodemic” – the Toolkit provides “Core Messaging” and talking points organizations can use in their communications that encourage vigilance on the part of partners and individuals. CISA has also made available graphics and posters, including in Facebook, Instagram, and Twitter formats, that can be used to help spread awareness.
  • COVID-19-Related Phone Scams and Phishing Attacks (CDC) – CDC has published a webpage raising awareness of phone calls that have been made and emails that have been sent purporting to come its personnel. Although they appear to originate from the CDC, they are in fact scams and phishing attempts. The CDC provides some tips for how to spot these and prevent yourself or your organization from falling victim.
  • COVID-19 Consumer Warnings and Safety Tips (Federal Communications Commission [FCC]) - This webpage provides numerous examples of the scam and hoax emails, voicemails, and text messages. The webpage offers a list of tips to protect against scams.
  • Enterprise VPN Security (DHS CISA) - DHS’s CISA has published a webpage encouraging organizations implement an enterprise virtual private network (VPN) as a means of adopting a heightened state of cybersecurity while employees participate in telework. It offers some considerations for implementing VPNs and a list of measures for mitigating cybersecurity concerns in alternate workplace situations.
  • Public Service Announcement (PSA) (FBI IC3) - The FBI warns of an increase in fraud schemes related to COVID-19. The PSA discusses fake CDC emails, phishing emails, and counterfeit treatments and equipment. It offers links to legitimate websites that provide true and accurate information, such as those posted by the CDC and the EPA, and lists measures for good cyber hygiene and security.
  • Web Conferencing Security (Australian Cyber Security Centre [ACSC]) - The ACSC published this document to provide guidance on how to select a web conferencing solution and how to use it securely. As noted in the document, web conferencing is increasingly in use as employees strive to remain connected with supervisors and with each other while working from home. However, these solutions oftentimes have vulnerabilities that, if left unaddressed, can introduce security threats. This document is posted below as resource #18.
  • COVID-19 Phishing Resource Center (Cofense) - Visitors to this website can access a YARA rule consisting of major, actionable indicators for COVID-19 phishing emails and related malware; real examples of COVID-19 phishing emails that evaded security systems; and recommendations from Cofense’s anti-phishing professionals. Cofense is also hosting a webinar tomorrow, on March 26, at 11:00 am ET on the evolving coronavirus threats as well as useful tools and recommendations to combat the escalating volume of email attacks.
  • Coronavirus Rumor Control (FEMA) - This webpage is intended to help the public distinguish between rumors and facts regarding the response to the COVID-19 pandemic. The webpage addresses rumors regarding a national lockdown and quarantine, FEMA's deployment of military assets, the stockpiling of groceriers and supplies, checks being sent to citizens by the government, and immunity to the COVID-19 virus by those below 60 years of age and who are not suffering from health problems. 
    • On about April 14, FEMA updated this webpage to address allegations that it is seizing or re-routing PPE and other medical supplies, both those that are being shipped to the U.S. from overseas and that are being distributed internally within the country. FEMA emphasizes that reports it is seizing or re-routing supplies are false.
  • Criminals Exploiting COVID-19 Outbreak for Financial Gain through Procurement and
    Consumer Fraud
    (FBI’s Office of the Private Sector) -  This advisory discusses how criminals have seized upon the ever-growing demand for Personal Protective Equipment (PPE) to manufacture and sell counterfeit materials, such as N95 masks. The advisory provides a list of measures consumers and procurement personnel can take to help prevent financial loss and the purchase of potentially unsafe equipment. This advisory is posted below as resource #6.
  • Threat Update: COVID-19 Malicious Cyber Activity and a Security Managers Guide: Working at Home (ACSC) - The Threat Update from the Australian Cyber Security Centre (ACSC) takes a look at some of the malicious cyber attacks and scams that seek to exploit the ongoing situation with COVID-19. As shown in one of the case studies, members of the public have received text messages that appeared to come from the government and that purported to offer authoritative information on COVID-19 testing. It concludes with a series of mitigation strategies for this and other COVID-19 malicious cyber activity, some of which focus on employees in remote work situations. This advisory is posted below as resource #7.
  • Security Managers Guide - Working from Home (ASIO) - This guide from the Australian Security Intelligence Organisation (ASIO) describes security measures for remote work. It discusses the policies and procedures organizations should put in place when having employees work from home; provides lists of tips for conducting a risk assessment and maintaining physical security, among others; and includes a series of references for further reading. This advisory is posted below as resource #8.

Resources - Business Continuity

  • Business Continuity Planning in the Event of an Influenza Pandemic: A Reference Guide (WaterISAC and the Association of Metropolitan Water Agencies)
  • Business Continuity Planning for Water Utilities (Water Research Foundation, U.S. EPA, and the American Water Works Association)
  • Business Continuity Planning Suite (FEMA)
  • Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources (DHS) - This guide is intended to serve as a reference for utility operators as they tailor emergency response plans to address the unique challenges of a pandemic event. It contains a list of primary actions to take, which are accompanied by series of supporting actions and questions to consider. The guide is posted below as resource #9.
  • Assessing and Mitigating the Novel Coronavirus (COVID-19) Resource Guide, version 10 – The Electricity Subsector Coordinating Council (ESCC), a liaison body between the federal government and the electric power industry), has published a document that addresses steps to take at different stages of COVID-19 mitigation and response and offers lists of business continuity planning considerations. This guide has evolved significantly from its first version, which WaterISAC reported on in the March 19 Security and Resilience Update. Although this guide is specifically intended for electric utilities, many of the steps and considerations it discusses can be applied by water and wastewater utilities. For example, the “Sequestration Guidelines and Considerations” section is relevant to any utility implementing or considering a shelter-in-place programs. Some of the other areas of potential relevance and interest include the example Q&A sections (such as "Example Q&A for Using a Respirator for COVID-19 Mitigation" on page 13), "Scenario Development,” and "Social Distancing for Control Center Personnel,” to name just a few. The guide is posted below as resource #10.
  • Guidance on the Essential Critical Infrastructure Workforce: Ensuring Community and National Resilience in COVID-19 Response (DHS CISA) - This memorandum is intended to promote a widespread understanding among state and local officials of the critical role workers in these industries play in sustaining and protecting their communities, including during emergencies. Water and wastewater utilities are specifically identified as one of the critical infrastructure sectors, and the memorandum goes on to identify types of workers for the sector (e.g., operational staff at community water systems and wastewater treatment facilities, workers repairing water and wastewater conveyances and performing required sampling or monitoring, staff and technical support for SCADA and digital systems, and chemical disinfectant suppliers for wastewater and personnel protection). As state and local communities consider COVID-19-related restrictions, this memorandum may assist in critical infrastructure workers being granted appropriate status to go about their duties, such as reporting for work or transiting between work locations. The memorandum is meant only as guidance, not as a federal directive, and it acknowledges that ultimately state and local officials are in charge of implementing and executing response activities in their jurisdictions. Additionally, the memorandum puts responsibility on critical infrastructure partners to use their judgement when balancing safety and the continued delivery of their services. In addition to the accessing the memorandum through the link provided above, it's also posted below as resource #14.
    • On May 19, DHS released version 3.1 of the guidance (posted below as resource #11). There are two significant changes for the “Water and Wastewater” section, which identifies the types of workers needed to operate and maintain the sector’s infrastructure.
      • One, “Laboratory staff performing water sampling and analysis” has been added.
      • And two, the bullet that previously read “Chemical equipment and personal protection suppliers to water and wastewater system” has been modified. It now states: “Suppliers and manufacturers of chemicals, equipment, personal protection equipment, and goods and services for water and wastewater systems.”
    • On April 17, DHS released version 3.0 of the guidance (posted below as resource #12). This iteration includes language focused on sustained access and freedom of movement; a reference to the CDC guidance on safety for critical infrastructure workers; and a statement saying sick employees should avoid the workplace and the workforce. In worker categories, all references to “employees” or “contractors” have been changed to “workers.” For the Water and Wastewater section, one small change has been made: "Chemical and equipment suppliers to water and wastewater systems and personnel protection" has been changed to "Chemical equipment and personal protection suppliers to water and wastewater system."

    • On March 28, DHS released version 2.0 of the guidance (posted below as resource #13). This iteration maintains many of the same descriptions of water and wastewater employees and support personnel as the first version, with some modificiations. Specifically:
      • "Workers repairing water and wastewater conveyances and performing required sampling and monitoring" now adds "including field staff."
      • "Chemical disinfectant suppliers for wastewater and personnel protection" has been revised to also include equipment suppliers, as well as suppliers for water systems. It now reads: "Chemical and equipment suppliers to water and wastewater systems and personnel protection."
  • The EPA published a template for water utilities to use to provide documentation to state and local authorities that their workers that are considered essential (posted below as resource #16 and also available at EPA here). This template complements the letter that EPA Administrator Andrew Wheeler sent to governors on March 27 requesting that water and wastewater workers, as well as the manufacturers and suppliers who provide vital services and materials to the water sector, are considered essential workers and businesses by state authorities when enacting restrictions to curb the spread of COVID-19.
  • Guidance on Essential Services and Functions in Canada during the COVID-19 Pandemic (Public Safety Canada) - Public Safety Canada has published its own guidance on critical infrastructure services and functions that are deemed essential to ensure the health, safety, and economic well-being of the population. The water sector is specifically identified in this document, as are types of workers in the sector (e.g., employees and others needed to operate and maintain drinking water and wastewater/drainage infrastructure). This guidance is very similar to the Memorandum on Identification of Essential Critical Infrastructure Workers during COVID-19 Response recently published by the U.S. Department of Homeland Security.
  • Interim guidance for COVID-19 safety practices for critical infrastructure workers (CDC) - To ensure continuity of operations of essential functions, CDC advises that critical infrastructure workers may be permitted to continue work following potential exposure to COVID-19, provided they remain asymptomatic and additional precautions are implemented to protect them and the community. According to the CDC, in cases where workers have had an exposure but remain asymptomatic, they and their employers should engage in pre-screening, regular monitoring, wearing a face mask, social distancing, and workplace disinfecting and cleaning. As noted in its discussion of face masks, the CDC says employers can approve employees’ supplied face coverings in the event of shortages (its “Cloth Face Covers” webpage provides recommendations on how to make your own). The CDC states that an employee who becomes sick during their work shift should be sent home immediately and that the surfaces in their workplaces be cleaned and disinfected and a list of persons who had contact with the ill employee compiled. The CDC advises that this guidance should be implemented in conjunction with its previously published Interim Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019.
  • Commercial Routing Assistance (CRA) tool (DHS CISA) - ​​​The U.S. Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency (CISA) and Idaho National Laboratory provided this tool, which may be useful to utilities whose employees include truckers or commercial drivers. It is intended to help these workers to understand the restrictions they might encounter as they travel across the country. Commercial Routing Assistance (CRA) tool merges coordinated and vetted data streams, plots multiple automated or custom routing options, and visualizes the wide variety of state regulations and actions that a driver would encounter along a route. With this free tool, commercial operators can plan vehicle movements across multiple states quickly, particularly during emergencies (a fact sheet is posted below as resource #29).

Government Declarations

  • On April 16, the White House released its Opening Up American Again Guidelines (posted below as resource #21). The new guidelines are aimed at clearing the way for an easing of restrictions in areas with low transmission of the coronavirus, while keeping them in place in harder-hit places. The ultimate decisions will remain with governors.
    • On April 28, the White House released the Blueprint for Testing Plans and Rapid Response Programs (posted below as resource #26), which includes recommendations for states to further develop and implement their testing plans. Also referred to as “The Blueprint,” its recommendations are intended to support state development and implementation of testing plans and rapid response plans that were called for in the Opening Up America Again Guidelines. As described on the U.S. Centers for Disease Control and Prevention’s “Testing for COVID-19” webpage, there are two kinds of tests available for COVID-19: diagnostic tests and antibody blood tests. Diagnostic tests check samples from your respiratory system (such as swabs of the inside of the nose) to tell you if you currently have an infection with the virus that causes COVID-19. Antibody blood tests check your blood for antibodies that would show if you have had a previous infection.
  • On March 26, EPA announced a new policy to help address uncertainties regarding EPA enforcement amid the ongoing COVID-19 public health crisis. Public water systems are specifically singled out as "hav[ing] a heightened responsibility to protect public health because unsafe drinking water can lead to serious illnesses and access to clean water for drinking and handwashing is critical during the COVID-19 pandemic." Some water and wastewater associations believe that the current policy and how it relates to public water systems is unclear and have reached out to EPA's Office of Water to request further guidance and additional clarification. WaterISAC will keep its members updated as it learns more.
  • On March 16, President Trump released COVID-19 guidelines, which emphasized the need for the public to listen to and follow the directions of state and local authorities in his administration released and highlighted best practices for reducing the spread of infections. The guidelines call for people to avoid gathering in groups of more than ten people and to work from home whenever possible. However, the guidelines notes that for those who work in critical infrastructure industry, which although not specifically stated in the document does include the water and wastewater sector, “you have a special responsibility to maintain your normal work schedule.”
  • On March 26, EPA announced a new policy to help address uncertainties regarding EPA enforcement amid the ongoing COVID-19 public health crisis. Public water systems are specifically singled out as "hav[ing] a heightened responsibility to protect public health because unsafe drinking water can lead to serious illnesses and access to clean water for drinking and handwashing is critical during the COVID-19 pandemic." Some water and wastewater associations believe that the current policy and how it relates to public water systems is unclear and have reached out to EPA's Office of Water to request further guidance and additional clarification. WaterISAC will keep its members updated as it learns more.
  • On March 13, President Trump declared the situation with Coronavirus Disease 2019 (COVID-19) to be a national emergency. This declaration relies on the National Emergency Act — the same law that former president Barack Obama used to bolster his administration’s response to the H1N1 influenza pandemic of 2009. The law grants the president and executive branch sweeping powers to act quickly and decisively to respond to an emergency. Trump said his declaration would free $50 billion in federal resources to combat the spread of the novel coronavirus and the respiratory disease it causes. The declaration also instructs state governments to set up emergency operations centers, directs hospitals nationwide to activate emergency preparedness contingency plans, and allows Department of Health and Human Services Secretary Alex Azar to waive regulations that could hinder health professionals’ response capabilities.

    • Also on March 13, Trump also issued an emergency declaration using the Stafford Act, which allows for the mobilization of the Federal Emergency Management Agency (FEMA) to assist with the response. As a result of the declaration, FEMA is directed to assist state, local, tribal, territorial governments and other eligible entities with the health and safety actions they take on behalf of the American public.

    • For more about the declarations, read this article at Stat.

  • On March 11, President Donald Trump, in a televised address to the nation, announced a 30-day ban on travel from European countries to the U.S., beginning on March 13 at midnight, in a bid "to keep new cases" of COVID-19 "from entering our shores." Trump also announced economic measures that he said would help the country overcome "temporary economic disruptions" caused by the disease. One of the measures includes financial relief to people who need to stay home because they are sick, quarantined, or caring for others.
  • On January 31, President Donald Trump announced via a Presidential proclamation the suspension of entry into the country of foreign nationals who had visited China in the past 14 days. Measures to detect this virus among those who are allowed entry into the U.S. (U.S. citizens, residents, and family) who have been in China within 14 days also are being implemented.
  • On January 31, U.S. Health and Human Services Secretary Alex Azar declared a public health emergency for the ongoing situation with the COVID-19. The declaration provides aid to the nation’s healthcare community in responding to COVID-19.
Attached Files: 
PDF icon #1 - Incident Action Checklist - Pandemic Incidents (EPA) PDF icon #2 - Water, sanitation, hygiene and waste management for COVID-19 (WHO) PDF icon #3 - Introductions to Coronaviruses (Stantec) PDF icon #4 - Guidance on Preparing Workplaces for COVID-19 (OSHA) PDF icon #5 - Risk Management for Novel Coronavirus (COVID-19) (DHS CISA) PDF icon #6 - Criminals Exploiting COVID-19 (FBI) PDF icon #7 - Threat Update COVID-19 Malicious Cyber Activity (ACSC) PDF icon #8 - Security Managers Guide Working from Home (ASIO) PDF icon #9 - Pandemic Influenza Guide (DHS) PDF icon #10 - Assessing and Mitigating COVID-19_v9 PDF icon #11 - Guidance on Essential Critical Infrastructure Workers_v3.1 (DHS) PDF icon #12 - Guidance on Essential Critical Infrastructure Workers_v3 (DHS) PDF icon #13 - Guidance on Essential Critical Infrastructure Workers_v2 (DHS) PDF icon #14 - Guidance on Essential Critical Infrastructure Workers_v1 (DHS) PDF icon #15 - Key Considerations for Water and Wastewater Utilities Responding to the Coronavirus (Moonshot Missions) File #16 - Water Utility Template COVID-19 (EPA) PDF icon #17 - COVID Building Flushing Guidance (ESPRI) PDF icon #18 - Web Conferencing Security (ACSC) PDF icon #19 - COVID-19 PPE Preservation Best Practices (FEMA) PDF icon #20 - COVID-19 Financial Impacts Report (AMWA and AWWA) PDF icon #21 - Guidelines To Reopen (The White House) PDF icon #22 - PPE Needs in Non-Healthcare Setting_Advisory (FEMA) PDF icon #23 - PPE Needs in Non-Healthcare Setting_Fact Sheet (FEMA) PDF icon #24 - CI Ops Center Control Room Guide (DHS CISA) PDF icon #25 - Joint Advisory - Potential Availability of Cloth Masks for the Water Sector (WaterISAC) PDF icon #26 - Testing Blueprint (The White House) PDF icon #27 - Fact Sheet COVID-19 Reconstitution (FEMA) PDF icon #28 - Food Grade CO2 Suppliers and Producers (EPA) PDF icon #29 - Commercial Routing Assistance Tool (DHS) PDF icon #30 - Insights - COVID-19 Disinformation Activity (DHS CISA) PDF icon #31 - Activities and Initiatives for COVID-19 Response (CDC) PDF icon #32 - COVID-19 Pandemic Operational Guidance for 2020 Hurricane Season (FEMA) PDF icon #33 - Guidance on Returning to Work (OSHA) PDF icon #34 - Return to Normal Guidance and Resources for Comms Providers (CSCC) PDF icon #35 - Resetting Our Response (JHU) PDF icon #36 - The Way Forward on COVID-19 (AAMC) PDF icon #37 - Reimagining Workforce Policy in the Age of Disruption PDF icon #38 - Guidance on Essential Critical Infrastructure Workers_v4 (DHS) PDF icon #39 - Common COVID-19 Citations (OSHA) PDF icon #40 - COVID-19 Lessons Learned (OSHA) PDF icon #41 - Federal Efforts to Accelerate Vaccine (GAO) PDF icon #42 - Building a More Resilient Workplace for Post-COVID-19 World (AEI) PDF icon #43 - Vaccination Statement_14DEC2020 (WSCC) PDF icon #44 - CISA Continues to Support Essential Critical Infrastructure Workers During COVID-19 (CISA) PDF icon 2019-nCoV - What the public should do.pdf PDF icon 2019-nCoV - Stop the spread of germs.pdf