COVID-19 Precaution Plan

Appendix N8: Supplemental Synthetic Turf Study COVID-19 Precaution Plan

Introduction

Supplemental Measurements for Exploratory Research regarding Exposure during Activities Conducted on Synthetic Turf Fields with Tire Crumb Rubber Infill (OMB Control No. 0923-0062, Exp. 10/31/2021), and associated activities, including recruitment, and biological sample collection, are critical public health activities that should continue if there is evidence of minimal community transmission of SARS-CoV-2, the virus that causes COVID-19, sufficient capacity to investigate cases, and open capacity at hospitals and urgent care centers. Minimal community transmission will be defined by using the Tracking Our COVID-19 Response webpage where the departure state and arrival state are both in the green “trending better” status. When possible, we propose modified strategies for completing essential activities to minimize potential for transmission of SARS-CoV-2.

Initiating field work in the Spring of 2021 will require that precautions be put in place to ensure that staff, contractors, and potential study participants are protected from COVID-19. This plan is based on interim CDC guidance for non-COVID-19 public health activities that require face-to-face interaction during the COVID-19 pandemic and will be used to outline practices for conducting Supplemental Synthetic Turf Study activities.

Changes in the initially developed Supplemental Synthetic Turf Study procedures are proposed to reduce or eliminate close contact (within 6 feet) between CDC/ATSDR staff and study participants to prevent the spread of SARS-CoV-2 during study activities. The precautions and personal protective equipment (PPE) recommended in this plan will be reevaluated at least monthly and more often as needed to ensure they are still in line with CDC and state COVID-19 guidance and may be revised to add or remove precautions as needed. Precautions may vary from site to site based on SARS-CoV-2 infection rates when study activities are conducted.

Plan Objectives

• Minimize risk of exposure, illness, and spread of disease among staff conducting the Synthetic Turf Study activities

• Minimize risk of exposure, illness, and spread of disease among members of the public as a result of the Supplemental Synthetic Turf Study activities

• Preserve essential functions of the Supplemental Synthetic Turf Study

Schedule

Schedules for field work activities will be determined on a site-by-site basis. Decisions about when to restart activities will be made in consultation with ATSDR regional staff as well as state and local public health officials. Scheduling activities will take into account:

• the level of local COVID-19 transmission (number of new cases, emergency department visits, and percent positive for testing in each community as available)

• state and local guidance/mandates

• other site-specific factors as described later in this document

Modifications to Synthetic Turf Study Procedures

Staffing:

Staff travel for Supplemental Synthetic Turf activities will be voluntary. Staff will be briefed on their potential role as well as risks prior to travel and will be given the opportunity to opt out of any travel. Staff will be provided with clear information about new procedures and PPE requirements (as shown in the table at the end of this document). All PPE will be provided to staff prior to initiation of activities. Staff will have an opportunity to ask questions about the precautions and PPE requirements prior to travel. Staff at higher risk for severe illness from COVID-19, including age (older adults) and underlying medical conditions, and/or those who have household members at higher risk for severe illness will be encouraged to discuss any concerns with their supervisors, and supervisors will stress that any travel for this field work is voluntary. Staff are also encouraged to consult with their primary care physician if there are any questions or concerns about health risks.

Cloth face coverings are required for the protection of others. Masks help reduce inhalation of droplets by the wearer (“filtration for personal protection”). The community benefit of masking for SARS-CoV-2 control is due to the combination of these effects; individual prevention benefit increases with increasing numbers of people using masks consistently and correctly. Cloth face coverings should not be placed on anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance or those under the age of two. Staff will be provided with surgical masks. In cases where participants arrive to an appointment without a cloth face covering, they will be provided with a disposable surgical mask. If participants are unable to wear a cloth face covering or surgical mask due to medical conditions, they should not participate in activities.

Field Recruitment:

Staff engaged in field recruitment will follow current guidance for personal protective measures and PPE as directed by the Office of Safety, Security, and Asset Management (OSSAM) and specified in the table at the end of this document. Short additional content will be added to recruiter training on briefly and sensitively acknowledging COVID-19 infection control measures taken to protect participants (e.g., “We are wearing surgical masks and standing back here to keep some social distance so we are all safer from COVID-19.”). The procedure for field recruitment will be that staff will approach field users while maintaining a minimum of six feet from them. If a field user or parent exhibits symptoms, staff will encourage them to seek medical advice. Specifically, staff will suggest that the field user or parent contact their primary care provider by phone or an urgent care center by phone prior to going to an appointment.

Biological Sample Collection (Urine):

All staff will be screened daily for COVID-19 symptoms prior to entry to the field and sample collection location using a symptom questionnaire and temperature check. Staff will follow current guidance for PPE as outlined in the table at the end of this document. Staff will also be instructed to stay home (or at their hotel) if they are experiencing any COVID-19 symptoms and will be screened twice daily and enrolled in Text Illness Monitoring (TIM). If symptoms develop, staff will be instructed to contact the Occupational Health Clinic Deployment Assessment and Monitoring Team (OHC DAM Team) for guidance on appropriate actions to take.

Supplemental Synthetic Turf Study participants will be instructed not to come for their appointment if they are experiencing COVID-19 symptoms (as defined in the list below). All participants will be informed of screening procedures and asked to wear a cloth face covering to their appointment when appointments are scheduled. If field users are found to have symptoms during screening, they will be denied entry to the sample collection area and will be encouraged to consult with their primary care provider. If a participant exhibits symptoms after entering the facility they will be asked to leave and the facility will be cleaned and disinfected, with a disinfectant listed on EPA List N, following CDC guidance, before reopening. If there is a potential exposure, CDC/ATSDR staff will contact the Occupational Health Clinic for guidance on appropriate actions. Staff will share information about the interaction that led to a suspected exposure and will follow guidance from the clinic on appropriate actions. All staff in the field will be monitored for symptoms during their travel and for 14 days after returning regardless of any potential exposure.

Additional actions that will be used to reduce the potential for SARS-CoV-2 transmission include:

• Select outdoor areas for use in sample collection that are large enough to physically distance

• Schedule appointments such that never more than nine individuals (staff and participants, based on the size and configuration of the space) are in the indoor sample collection area at the same time

• Increase physical space between employees and participants

• Use signs, tape marks, or other visual cues such as decals or colored tape on the floor, placed 6 feet apart, to indicate where to stand when physical barriers are not possible

• Require use of surgical masks for staff and cloth face coverings or surgical masks for participants

• Provide hand sanitizer with at least 60% alcohol and surgical masks for participants who do not bring their own cloth face covering upon entry into the sampling area for a physical appointment

• Provide signage showing reasons for precautions and proper wear of cloth face coverings

At the sampling location, each participant will provide urine samples and will complete a questionnaire. Social distancing measures will be implemented. The urine samples will be placed on the table for staff to pick up and avoid hand to hand and close contact. Staff will wear gloves when picking up specimens and gloves will be changed between each participant.

Administrative controls, including staff education on COVID-19, instruction on appropriate PPE for given tasks and how to don and doff PPE, hand hygiene instruction, how to briefly and sensitively acknowledge precautions with participants and note COVID-19 infection control measures taken to protect participants, and instructions for staff to remain home if experiencing any symptoms will be instituted.

Travel

During travel, staff will be directed to the considerations for travel in the United States. Staff will also be provided with the guidance below.

Protect yourself and others during your trip:

• Clean your hands often.

  • Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.

  • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub your hands together until they feel dry.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Avoid close contact with others.

  • Keep at least 6 feet apart from others.

  • Avoiding close contact is especially important if you are at higher risk of getting very sick from COVID-19.

• Wear a cloth face covering in public to protect others.

• Cover coughs and sneezes.

• Considerations for visiting a restaurant while traveling.

When staying in a hotel:

• Take the same steps you would in other public places—for example, avoid close contact with others, wash your hands often with soap and water, and wear a cloth face covering.

• When you get to your room, clean and disinfect all high-touch surfaces. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, remote controls, toilets, and sink faucets.

  • Bring an EPA-registered disinfectant and other personal cleaning supplies, including cloths and disposable gloves.

• Considerations for visiting a restaurant while traveling.

Screening of Personnel

All personnel (CDC/ATSDR staff and contractors) will be screened for symptoms prior to travel and twice daily while in the field by the team lead/safety officer. CDC/ATSDR staff will be enrolled in CDC’s Text Illness Monitoring (TIM) and contractors will report any symptoms to their management daily. Screening will include a temperature check as well as questions about the presence of any signs or symptoms associated with COVID-19. Questions on symptoms will include presence of any of the following:

• Fever or chills

• Cough

• Shortness of breath

• Fatigue

• Muscle or body aches

• Headache

• New loss of taste or smell

• Sore throat

• Congestion or runny nose

• Nausea or vomiting

• Diarrhea

If any employee develops symptoms they will be instructed not to come to work, to inform the site lead, and to contact the Occupational Health Clinic (OHC) DAM Team and the ATSDR site lead. The personnel will text “SYM” to TIMS text (877-232-7671) (Contractor staff should inform their supervisor). Site-specific health and safety plans will be developed to include instructions for seeking medical care should any staff develop symptoms while working in the field. If a staff member develops symptoms consistent with COVID-19, we will pause all activities. If the staff member subsequently tests negative, we will consult with CDC and local/state public health before resuming activities. If the staff member tests positive, we will notify all staff and participants who have been in contact with the positive individual and consult with OSSAM and local/state public health to determine additional actions.

CDC/ATSDR employees will continue to self-report symptoms in TIM for 14 days after returning from the field and will follow instructions from the OHC should any symptoms develop.

Protective Measures

Specific Supplemental Synthetic Turf activities are shown in the table below with recommended PPE, and additional precautions. All PPE for CDC/ATSDR staff will be provided by CDC/ATSDR.

Activity	Description	PPE	Additional Precautions
Travel	Time spent in ride share/public transportation, in airport, on airplane, time spent in public venues while traveling	None	Frequent handwashing Cloth face coverings General travel precautions Ride sharing and public transportation
Field recruitment	Having conversations outside, distributing printed materials	Disposable surgical mask, disposable gloves	Frequent handwashing Stay at least six feet apart from community members
Biological sample collection screener	Greet participants near the sample collection area, take temperature, ask symptom screening questions	Disposable surgical mask, disposable gloves	Confirm participants are symptom- and fever-free before allowing entry to the sample collection area or table Ensure occupancy limit in the area
Biological sample collection paperwork	Perform verbal informed consent, administer questionnaire	Disposable surgical mask, disposable gloves	Frequent handwashing Layout of area to promote social distancing Cleaning and disinfection of surfaces between participants/groups
Field user questionnaire	Administer questionnaire	Disposable surgical mask, disposable gloves	Frequent handwashing Layout of area to promote social distancing Cleaning and disinfection of surfaces between participants/groups
Urine sample processing	Take urine samples from participants, process samples and place in storage	Disposable surgical mask, disposable gloves	Frequent handwashing Layout of area to promote social distancing Cleaning and disinfection of surfaces between participants/groups

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