What are the guidelines for city workers through 2020 (including police, medical first responders, pressurized and open sewer workers, and undertakers)?
The CDC recommends wastewater and sanitation workers use standard practices associated with wastewater treatment plant operations to protect against COVID-19 transmission and does not recommend any additional COVID-19–specific protections at this time. While persistence in water is possible, there is no evidence that the COVID-19 virus has been transmitted via sewerage systems with or without wastewater treatment. Further, there is no evidence that sewage or wastewater treatment workers contracted the severe acute respiratory syndrome (SARS) in 2003. Workers at sanitation treatment facilities should wear appropriate PPE, perform hand hygiene frequently, and avoid touching eyes, nose, and mouth with unwashed hands.
Medical first responders should follow all general OSHA-recommended steps to avoid acquiring COVID-19, including isolating suspected cases, conducting routine cleaning and disinfection, training workers, identifying workers with increased susceptibility, and using and optimizing PPE. All EMS units should implement robust infection control procedures, including protocols for safely using PPE. When COVID-19 is suspected in a patient needing emergency transport, first responders should notify healthcare facilities in advance that they may be caring for, transporting, or receiving a patient with suspected COVID-19 infection.
EMS clinicians should exercise appropriate precautions when responding to any patient with signs or symptoms of a respiratory infection, including beginning assessments from a distance of 6 feet if possible and minimizing patient contact until patients are equipped with a face mask. If COVID-19 is suspected, all PPE as described below should be used. If COVID-19 is not suspected, EMS clinicians should follow standard procedures and use appropriate PPE for evaluating a patient with a potential respiratory infection. During transport, EMS clinicians should limit the number providers in the patient compartment to essential personnel only.
Law enforcement officials should maintain a distance of 6 feet if possible when interacting with the public and ensure only trained EMS workers assess and transport anyone with suspected COVID-19 infection. If contact with individuals with suspected COVID-19 infection is required, law enforcement should follow CDC’s Interim Guidance for EMS, including the use of all recommended PPE. If close contact occurs during apprehension, officials should properly clean and disinfect gear prior to reuse using a household cleaning spray, follow standard operating procedures for disposing used PPE, and follow standard procedures for laundering clothes.
Standard precautions and routine infection control procedures are currently recommended for undertakers and funeral home workers handling the body of a deceased COVID-19 patient. Specifically, the Minnesota Department of Health recommends morticians use standard PPE, including protection of eyes, nose, and mouth, when preparing the body or embalming. CDC guidance state that embalming, burial, and cremation are permitted, though workers should check for additional state and local requirements that may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.
The CDC confirms there is no known risk associated with being in the same room at a funeral with the body of a deceased COVID-19 patient. However, funeral home workers should advise individuals to avoid touching the body and follow CDC guidance, including social distancing and hand hygiene.
The risk of COVID-19 transmission via untreated wastewater remains unclear. While the virus that causes COVID-19 has been found in the feces of some patients, scientists expect the risk of such spread is low.
Authors: Emily Plumley, MPH, Yale School of Public Health
Completed on: May 6, 2020
Last revised on: May 6, 2020
Reviewed by: Marsha-Gail Davis MD
Reviewed on: May 14, 2020
This summary was written as part of the CoRESPOND Earth 2.0 COVID-19 Rapid Response at UC San Diego. For more information about the project, please visit http://earth2-covid.ucsd.edu