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As agencies serving Native people, it is vital to prepare for a COVID-19 outbreak. We encourage you to explore harm reduction strategies to reduce COVID-19 risk for your clients.

What is COVID-19?

COVID-19 (2019 Novel Coronavirus) is a viral respiratory illness caused by a coronavirus that has not been found in people before. It can lead to lower respiratory illnesses like pneumonia and bronchitis.¹

How is COVID-19 spread?

• Through respiratory droplets of infected individuals from coughing, sneezing, etc.
• Close contact with an infected person (within 6 feet)
• Possibly through contact with infected surfaces or objects then touching your mouth, nose, or eyes¹

What are the symptoms of COVID-19?

• Fever, cough, and shortness of breath

Symptoms may appear 2–14 days after exposure.¹

How can our agency prepare for COVID-19?

• Establish communication with your local health department to stay informed about COVID-19.
• Know how and where to report and refer potential cases for testing; identify COVID-19 testing locations.
• Establish, review, and update your emergency plan.
• Collect sanitation supplies as available—masks, alcohol-based sanitizer, cleaning supplies, linens.
• Identify isolation spaces for sick individuals.
• Be aware of school/business closures—they may impact staff, volunteers, and clients.^2,3

How can our agency help prevent cases of COVID-19?

• When possible, high-risk staff should work from home.
• Staff/volunteers with respiratory symptoms should not come to the facility.
• Limit visitors and face-to-face interactions.
• Frequently clean and disinfect all common areas.
• Keep beds/mats at least 3-6 feet apart and sleep head-to-toe.
• Screen clients at entry for respiratory symptoms and fever.
• Provide soap and water and hand sanitizer throughout the facility and encourage frequent hand washing.^2,3

What if a client has symptoms?

• If a client is experiencing fever, cough, and/or shortness of breath, give them a facemask and isolate in a private room if possible.
  • Achieving isolation in a facility may be difficult,
    but decreases the risk to everyone.
• Follow local public health guidance to obtain testing for potential COVID-19 cases.
• If client has severe symptoms (extreme difficulty breathing, bluish lips or face, etc.), call 911 and notify your public health department.
• Limit number of staff entering and exiting the room and document staff who have contact with sick clients.
• Staff should wear facemasks, gloves, gowns, and eye protection when engaging sick clients and wash hands thoroughly before and afterwards.
• Sick clients should be encouraged not to interact with pets. If they do, encourage harm reduction strategies such as, frequent handwashing and not sleeping with pets.^2,3

How can our agency help manage client and staff stress?

Sustained effort during an outbreak can lead to stress and burnout.

• Watch for changes in behavior and substance use, loss of appetite, anxiety, depression, and other changes in mental status among staff and clients.
• Try to get adequate sleep, healthy food, and exercise. Stress can impact the immune response.
• Consider utilizing Indigenous cultural methods such as, prayer, singing, and plant medicines in managing stress and providing holistic care.
• Anticipate the needs of people during and after quarantine or isolation. Both can lead to potential stigma, fear/worry over health status, and sadness or anger.⁴

What do we do after the outbreak is declared over?

• Staff, volunteers, and clients are all likely to be physically, emotionally, mentally, and spiritually exhausted.
• Deaths may have occurred among clients, staff, or volunteers. Allow time for grieving.
• Talk with clients and staff to evaluate your plan of action and determine what was effective and what emerged as problems.
• Continue practicing everyday preventive actions (washing hands, cleaning surfaces, etc.).
• Maintain and expand emergency planning and lines of communication for future outbreaks.^2,3

National Resources

• Centers for Disease Control and Prevention Interim guidance for homeless service providers to plan and respond to coronavirus disease 2019 (COVID-19)
• CDC Mental health and coping during COVID-19
• SAMHSA’s Disaster Distress Helpline 
  Toll-Free: 1-800-985-5990 (English and Español) 
  SMS: Text TalkWithUs to 66746 
  SMS (Español): “Hablanos” al 66746 TTY: 1-800-846-8517
• National Suicide Prevention Lifeline 
  Toll-Free: 1-800-273-TALK (1-800-273-8255) 
  Toll-Free (Español): 1-888-628-9454 
  TTY: 1-800-799-4TTY (1-800-799-4889)

References

1. Centers for Disease Control and Prevention (2020). About COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/about/index.html.
2. 2007/2008 APIC Emergency Preparedness Committee (2008). Infection Prevention and Control for Shelters During Disasters. Association for Professionals in Infection Control & Epidemiology, Inc.
3. CDC (2020). Interim guidance for homeless service providers to plan and respond to coronavirus disease 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/plan-prepare-respond.html
4. CDC (2020). Mental health and coping during COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/about/coping.html