The California Department of Public Health (CDPH) has issued All Facilities Letter (AFL) 20-75, which sets thresholds for COVID-19 outbreaks in hospitals. Hospitals are required to report outbreaks and unusual infectious disease occurrences to their local health department and CDPH Licensing and Certification District Office. Under these definitions, acute care hospitals are to report an outbreak when they have:
- In all counties: Two or more cases of confirmed COVID-19 in a patient seven or more days after admission for a non-COVID condition with epi-linkage. Epi-linkage among patients is defined as overlap on the same unit or ward for any duration or having the potential to have been cared for by common health care personnel within a 14-day time period of each other.
- In purple or red tier counties: Two or more cases of confirmed COVID-19 in health care personnel with epi-linkage who do not share a household and are not close contacts outside of the workplace. Epi-linkage among health care personnel is defined as individuals who were potentially within six feet for 15 minutes or longer while working in the facility during the 14 days prior to the onset of symptoms or positive test. For example, the health care personnel worked on the same unit during the same shift.
- In orange or yellow tier counties: Three or more cases of confirmed COVID-19 in health care personnel with epi-linkage who do not share a household and are not close contacts outside of the workplace. The same definition of epi-linkage as in the bullet above applies.
The state’s Blueprint for a Safer Economy updates the color tiers and is searchable by county.
Long-term acute care hospitals and long-term care facilities are to report an outbreak to their local health department and CDPH District Office anytime one or more residents has a confirmed COVID-19 diagnosis 14 days or more after admission for a non-COVID condition, without an exposure during the previous 14 days to another setting where an outbreak was known or suspected to be occurring.
Additional thresholds are provided for when acute care hospitals, long-term acute care hospitals, and long-term care facilities should investigate and report to the local health department.