Dr. Kara Jacobs-Slifka from CDC joined the April 29, 2021 LeadingAge Coronavirus Update call. She responded to questions from Ruth Katz and from callers.

Q: We are paying attention to the new guidance from the CDC. What can you tell us about that?

A: These are updates of guidance we posted several weeks ago. We will continue to update guidance as we continue to learn more post-vaccination.

Q: Is it accurate to interpret the new CDC/CMS guidance to say that if ANYONE who is unvaccinated or of unknown status enters a room or activity, that this means mask on? At least one state’s survey agency is saying that the guidance only specifies residents and so the vaccination status of the staff doesn’t factor in.

A: If everyone in a room is vaccinated then people don’t need to wear a mask or social distance. If someone (resident or staff members) who is not vaccinated comes into the room, then yes – we’d recommend everyone mask up and social distance.

Q: Does the guidance differentiate between staff and residents?

A: No, it applies to both. We are trying to figure out and would appreciate suggestions from your members regarding how to differentiate between vaccinated and unvaccinated individuals in various settings without invading the privacy of people. In a setting where you don’t know the vaccination status of individuals, approach the situation as if people are not vaccinated.

Q: States started changing guidance right away when the new CDC guidance came out. Do you know how many are changing? In the state I live in, Maryland, the governor has gone to no masks outside, vaccinated or not. They “encourage” mask use if you are not vaccinated; as of Saturday they are lifting all outdoor dining restrictions like social distancing and masking. What’s your thinking about this?

A: I don’t know exactly which states have changed their approaches, but we do know that changes are occurring. My hope is that the changes are based on what we know for sure and keeping science in mind. We are interested in lessons learned so that we can make changes to the guidance in an ongoing way. We do understand that continually changing guidance can be frustrating, but it is important to incorporate new learning since this is a novel virus.

Q: We started with a poll question today, asking if our callers (mostly providers of aging services across the continuum of care) think the new CDC/CMS guidance will help or hinder their efforts to address vaccine reluctance or refusal in the last 25-30% of people, mostly staff. In looking at the results about half say the guidance will not affect vaccine uptake, but about half believe it will help increase uptake. What are your thoughts?

A: It may well be that as people see the increased flexibility that vaccination allows, they will become more willing to be vaccinated. Let’s hope so.

Q: We have some questions about children under 12, who don’t have the option to be vaccinated. I’m thinking here of grandkids coming to visit in a long term care setting; or staff going out into the community, maybe to a restaurant, with their kids. How do we square up the new guidance with this large fully unvaccinated sector – the population under age 12?

A: This guidance still allows children to join in visitation, but because they are unvaccinated we would recommend that source control continue to be used during visits. We recommend continued use of masks and social distance also for other visitors who are unvaccinated or whose status is unknown. Indoor settings are more problematic than outdoor settings. It will be helpful to take a look at the CDC infographics about what to do in various settings.

Q; Can outdoor visitation occur during outbreaks? CDC says all visitation is suspended during outbreak testing – does that mean indoor and outdoor?

A: The guidance is focused on indoor visitation. State guidance also plays a role here and should be observed as some states suspend both indoor and outdoor visitation.

Q: Should nursing home staff be wearing eye protection at all times or just when providing care?

A: Look toward our infection prevention guidance. It is based on whether you know individual has, or is suspected to have COVID-19, or is in quarantine – then use full PPE. If you have moderate to substantial community transmission (more than 5% positivity rates in the surrounding county) use N95 masks or similar throughout. Eye protection is used during resident care encounters.

Q: Can vaccinated staff drop the mask or do they need to keep wearing masks?

A: Source control is still recommended while at work, but if staff are in a meeting and everyone is vaccinated, they can choose to take off their masks. At this time, however, this guidance relates only to staff-only situations, such as staff meetings or in staff break rooms. At all other times, healthcare personnel should continue to wear source control while at work.

Q: How would the guidance apply to an outdoor concert at an assisted living community?

A: You need to take into account that you may have a mix of vaccinated and unvaccinated people. Look at both the healthcare and community guidance as well as state and local guidance. It may also depend on how close together will people be.