Elkhart County Health Department
Covid-19 Best Prevention Practices
October 20, 2020

This document is intended to serve the public as a guide to the best practices they can take, or look for others to take, in the prevention of the spread of the SARS-CoV-2 virus and the disease it causes, Covid-19. Currently, the State of Indiana has identified Elkhart County as orange based upon its number of weekly Covid-19 positive cases per 100,000 residents and the 7-day positivity rate for all tests completed. At level Orange, the state health commissioner works with the local health officer to consider additional actions necessary to protect the community. At this time, the Elkhart County Health Department has selected to issue this Covid-19 best prevention practices to help the community independently make the appropriate choice and prevent the need for future restrictions. If Elkhart County residents and visitors do not follow these best prevention practices, Elkhart County may move to level red, which provides that the State health commissioner may independently take action to restrict activities in Elkhart County. These restrictions may further reduce social gathering sizes, restrict large events, restrict business capacities, limit visitations, limit elective hospital procedures, restrict school programs and events, and require remote learning. The Elkhart County Health Department implores you to follow these best prevention practices to help avoid the need for additional restrictions.

1. Long-term Care Facilities
Be extra careful when visiting long-term care facilities. The residents of these facilities are primarily comprised of a known vulnerable population. The Indiana State Department of Health issued updated visitation guidelines for long-term care facilities. Since Elkhart County currently shows an all tests positivity rate of 10.1% on the Indiana COVID-19 Data Report, the State Department of Health advises all long-term care facilities to stop indoor visitation. All long-term care facilities should consistently and regularly monitor their circumstances against the current visitation guidelines issued by the State Department of Health to determine when indoor or outdoor visitation is advisable.

2. Avoid Crowds
Avoid all crowds and crowded areas. Schedule social activities with as few people as possible, and use outdoor venues as much as possible. The greater the number of people at an event, the greater the risk someone, or more than one person, has an asymptomatic case of Covid-19, and is transmitting the virus to those around him. The more crowded the area, the higher the chance you will come into close contact with that person, and get infected. When events occur outdoors, there is typically more space to distance yourself, and there is better air circulation to keep the virus particles in the air from concentrating and reaching high levels, as they would in a room indoors with poor circulation. And remember that crowds don’t just happen at events with high numbers of people, like sporting events and concerts. They are also common at small gatherings, clubs, weddings, funerals, fund-raisers, church, and even stores. Check out each event, and make sure there is good air circulation, and lots of space between people. Confirm that all meetings and gatherings and special events meet the requirements of Public Health Order 03-2020.

2.1 Meetings and Gatherings
Public Health Order 03-2020 prevents all public and private meetings or gatherings (outside a single household or living unit or religious service) whether familial, social, governmental, philanthropic, or otherwise from having 250 or more people in attendance. Any meeting or gathering of less than 250 people may only occur if social distancing requirements can be achieved and maintained, sanitation measures are implemented at the site, and compliance with the face covering mandate can be achieved and maintained.

2.2 Special or Seasonal Events
A special or seasonal event is distinct from a meeting or gathering because the main purpose is not necessarily for individuals to interact with others outside of one’s household, but instead to attend a single event and or events of limited duration. A special or seasonal event of less than 250 attendees is only permitted if social distancing requirements can be achieved and maintained, sanitation measures are implemented at the site, and compliance with the face covering mandate can be achieved and maintained. A special or seasonal event anticipating 250 or more attendees must submit a Plan Review Request and obtain approval of its Special or Seasonal Event – Covid-19 Plan from the Elkhart County Health Department before the event begins

3. Hand Sanitation
Frequently wash your hands for 20 seconds with soap and water. If soap and water are not available, use a hand sanitizer with at least 60% alcohol. Be especially certain to wash your hands after coughing, sneezing, or blowing your nose. Everyone should wash their hands after being in a public place, whether it was a grocery store, big box store, library, church, restaurant, or any other location where you are exposed to people who don’t live in your household. Although this seems like a simple thing to do, it’s actually one of the most important things to do to prevent the spread of any respiratory virus.

4. Six Foot Distancing
Maintain a six-foot distance from anyone not living in your household. If this is impossible, limit the close contact to less than 15 minutes, and wear a face covering. Infected people expel the coronavirus on tiny airborne droplets of mucous when coughing, sneezing, laughing, singing, speaking, or vocalizing at all. Most of these droplets will fall to the ground before reaching a 6-foot distance. Anyone who remains 6 feet away from others greatly reduces their chance of being infected with this coronavirus. We now know that about 80% of people with Covid-19 are asymptomatic or have only mild symptoms, but can spread the virus to others without knowing it. We also now know that people can spread the virus up to 48 hours before they become symptomatic (pre-symptomatic spread), so just because someone feels well today doesn’t mean he can’t spread the virus to you today. Because anyone can have the virus and not know it, a 6-foot distance should be maintained from anyone not living in your household.

5. Face Coverings
Wear a cloth face covering when in public areas, even when outdoors if unable to maintain 6 feet distance from others not in your household. The most common way for the virus to spread is by small airborne droplets expelled when a person vocalizes, coughs, or sneezes. A properly worn cloth face covering will prevent their spread to other uninfected persons. A cloth face covering should be worn in all public buildings, all businesses, and any indoor space open to the public (museums, libraries, churches, etc.). They should also be worn in outdoor public spaces when 6 feet distance cannot be maintained. Cloth face coverings MUST cover the nose and mouth. Respiratory droplets carrying coronavirus are expelled from the nose as well as the mouth, so both areas must be covered. Cloth face coverings should be made from multiple layers of fabric, and fit snugly against the side of the face. Cloth face coverings should be washed and dried every day. Disposable facemasks may be used instead of a cloth face covering. A new disposable facemask should be used each day, and the old one placed in the trash. Alternative options should be identified for individuals who are unable to or should not wear a face covering (e.g. children under the age of 2, anyone with a disability that makes it hard to wear or remove a face covering, anyone who is deaf and uses their mouth and face to communicate, anyone who has been advised by their doctor to not wear a face covering, if a person is unconscious or has trouble breathing). Children between the ages of 2-12 should be supervised when wearing a mask. Face shields, which are made of clear plastic, do not offer the same level of protection as a cloth face covering. A face shield MUST cover the nose and mouth completely, and extend back over the cheeks to the level of the ears to be effective. Face shields should be cleaned and dried every day. For additional information on face coverings see Executive Order 20-43, Public Health Order No. 01-2020, and Elkhart County Health Department FAQ’s.

6. Stay Home if Sick
Stay home if you have Covid-19 symptoms or otherwise feel ill, and isolate yourself from others in your household. The virus that causes Covid-19 can be transmitted to others while you are feeling ill, so stay away from others as much as possible. If possible, limit yourself to a single room and single bathroom that is exclusively for your use. If you must interact with others in your household, keep your interactions as brief as possible, maintain six feet distance between you and others as much as possible, and wear a face covering even in your own home.

7. Get Tested
Get tested for Covid-19 if you feel even mild Covid-19 symptoms, or if you have been exposed to someone who has tested positive for Covid-19. Some people with Covid-19 have only very mild symptoms, or no symptoms at all, but they still transmit the virus to others. By getting tested, you can discover if your symptoms are due to Covid-19, or if there is another cause for your discomfort. And by getting tested after an exposure, you can discover whether you have been infected and are transmitting the virus to other vulnerable people unknowingly. When discovered early, steps can be taken to prevent or minimize the transmission to others.

8. Avoid Facial Contact
Avoid touching your face, eyes, nose, or mouth. The SARS-CoV-2 virus that causes the disease Covid-19 can remain infectious on surfaces for some time, depending on the surface and how often it is cleaned. All humans have a tendency to touch our face often, and it is common to touch a surface, maybe a doorknob, or a computer keyboard, countertop, or phone, and then shortly after touch our face. We may just scratch a bit, pluck an eyelash, place a bite of something in our mouths, but whatever we do, we risk picking the virus up from a surface and transferring it to our face. Once on the face, it is easy for the virus to get to the mucous membranes of our eyes, nose and mouth, and then be able to multiply and cause disease.

9. Cover your Mouth and Nose
Cover coughs and sneezes with a tissue, or the inside of your elbow. Throw used tissues away in the trash. Coughing and sneezing release large quantities of respiratory droplets, and spreads them great distances. These droplets are the bits of mucous the virus rides on to find another victim to infect. We need to capture these droplets by sneezing and coughing into tissues, and then disposing of the tissue. If no tissue is handy, use the crook or inside of your elbow. Any mucous droplets deposited there are unlikely to find their way to a surface such as a doorknob or countertop that someone else would touch. Avoid coughing or sneezing into your hand, and then touching a commonly used surface before washing or sanitizing your hands. If you are wearing a face covering and you need to cough or sneeze, you should still cough or sneeze into your elbow while keeping the face covering on.

10. Sanitize Surfaces and Devices
Clean and disinfect frequently touched surfaces daily. This should include doorknobs, light switches, countertops, hard surfaces, and electronics. Although transmission of the virus by touching surfaces with infectious virus on them is uncommon, it does happen. Cleaning is a good way to lower the risk of Covid-19 spread. Using your usual household cleaners is all that is needed. Check with your electronics maker to see what cleaning methods to use on these items.

11. Be Vigilant
Treat everyone with love and kindness, but continuously exercise the ten preventative measures outlined above remembering that either you or the person near you may be an asymptomatic transmitter of Covid-19. We are all responsible for our own actions and we must work together to keep everyone safe.
Signed and issued October 20, 2020, in Elkhart County, Indiana.

Dr. Lydia Mertz, Elkhart County
Local Health Officer