CC 2020-05-05_06a Supplement No 1TO:
FROM:
MEMORANDUM
CITY COUNCIL
WHITNEY McDONALD, DEPUTY ACTING CITY MANAGER
SUBJECT: SUPPLEMENTAL INFORMATION
AGENDA ITEM 6a. – MAY 5, 2020 CITY COUNCIL SPECIAL MEETING
UPDATE REGARDING COUNTYWIDE COVID-19 EFFORTS
D ATE: MAY 4, 2020
Attached is the San Luis Obispo County Steps to Adapt and Reopen Together (START)
Plan which will be discussed as part of the above referenced agenda item.
cc: City Attorney
City Clerk
Directors
City website
County of San Luis Obispo Public Health Department
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San Luis Obispo County
Steps to Adapt and Reopen Together:
The SLO County START Guide
County of San Luis Obispo Public Health Department
ReadySLO.org | RecoverCentralCoast.org
Last updated: May 1, 2020 2
Project Collaboration
Expert Panel
The following are medical and public health experts who authored the START Guide :
Aydin Nazmi, PhD (Chair)
Kevin Ferguson, MD, FASCP
J. Trees Ritter, DO, FIDSA
Ann McDowell, MPH
Kathy Eppright, Esq.
Project Team
The following individuals supported and integrated with the expert panel, engaged stakeholders,
developed a communications plan and synthesized inputs into attached guidelines:
Guy Savage, County of SLO
Melissa James, REACH
Carolyn Berg, County of SLO
Derek Johnson, City of SLO
Andrew Hackleman, REACH
Whitney Szentesi, County of SLO
Morgan Torell, County of SLO
Liz Pozzebon, County of SLO
Elected Panel
The following individuals steered the overall START Guide effort:
Bruce Gibson, District 2 Supervisor
Lynn Compton, District 4 Supervisor
Heather Moreno, Mayor of Atascadero
Caren Ray Russom, Mayor of Arroyo Grande
Business, Education, Faith, Community and other organization Stakeholder Leaders
The following stakeholder leaders convened nearly 250 representatives from local communities,
businesses, faith organizations, education institutions and more; generating insights, inputs and
ideas critical to how businesses and society can safely operate in the phases of reopening:
City of Paso Robles - Mayor Steve Martin, Tom
Frutchey
City of Atascadero - Mayor Moreno, Rachelle Rickard
City of Morro Bay - Mayor Headding, Scott Collins
City of San Luis Obispo - Mayor Harmon, Derek
Johnson
City of Pismo Beach - Mayor Waage, Jim Lewis
City of Arroyo Grande - Mayor Ray Russom, Jim
Bergman
City of Grover Beach - Mayor Lee, Matt Bronson
City of Santa Maria - Mayor Patino, Jason Stilwell
Special Districts/Community Services Districts - Will
Clemens
Transportation - Pete Rodgers, Kevin Bumen
Business/General/Chambers of Commerce - Jim
Dantona, Erica Crawford, Gina Fitzpatrick, Jocelyn
Brenann, Glenn Morris, Emily Reneau
Downtowns/Main Street - Bettina Swigger, Pat Arnold
Education/Childcare - Courtney Kienow, Jeff
Armstrong, James Brescia, Jill Stearns, Kevin Walthers
Faith Institutions/Organizations - Tim Theule, Dan Dow
Agribusiness - Brent Burchett, Cara Crye
Building & Development - Loreli Cappel, Lenny Grant,
Brad Brechwald
Beverage Industry - Joel Peterson, Adam Firestone
Restaurants - Shanny Covey, Derek Kirk
Lodging - Chuck Davison, Clint Pearce
Knowledge & Innovation/Technology - John Townsend,
Rick Stollmeyer, Cory Hy Karpin
Advanced Manufacturing - Ty Safreno
Events, Venues, Attractions - Chuck Davison, Paul
Letherman
REACH – Ermina Karim, Matthew Woods
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Executive Summary
Purpose: To create a science-based framework for SLO County residents, businesses, and
organizations by which to reopen in a phased manner while prioritizing public health and protecting
our most vulnerable populations.
The SLO County START Guide outlines the steps for reopening that can be safely taken in our
community, balanced with the importance of resuming individual and economic activities as the
COVID-19 epidemic evolves. Implementation measures will be developed based on this Guide by
stakeholder groups representing public agencies, community groups, and business sectors.
The SLO County START Guide
Describes the conditions under which the County may begin to reopen institutions and
businesses safely while prioritizing public health
Provides guidelines to limit the spread of COVID-19 and establishes tools and approaches to
minimize future outbreaks once restrictions are loosened or lifted
Offers measurable decision points to identify how phased transitions can occur and which
public health criteria might inform decisions to loosen or tighten restrictions in SLO County
In the absence of a COVID-19 vaccine or specific therapeutics to combat infected individuals,
preventive strategies, such as the restrictions being implemented worldwide, are the most effective
path to contain and mitigate the infection.
The SLO County START Guide draws on three main sources for its framework:
1. The Federal Government (Guidelines: Opening Up America Again);
2. The State of California (Roadmap to Modify the Stay-at-Home Order and Update on the
Pandemic Roadmap); and
3. Resolve to Save Lives (RSL), a global health initiative that describes the “adaptive response”
to the COVID-19 pandemic. Several points of consensus are evident from the sources
reviewed. The summaries below take into account these commonalities, bridge their
discrepancies, and provide the foundations for the SLO County START Guide.
It is challenging to predict when COVID-19 may reoccur in SLO County after the first epidemic wave.
However, it is recommended that the County tighten restrictions or recommend preventive
measures at the individual and institutional levels if infection rates or risk substantially increase.
Data from other counties can also be used to assess risk and inform strategy.
The START Guide is supplemented by two accompanying documents:
1. Standards and Guidelines for organizations and businesses
2. Status Report on SLO County Readiness to Meet California’s Six Indicators to Modify
Stay-at-Home Order
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Three unique factors warrant concern for SLO County as the epidemic evolves:
1. The popularity of SLO County as a tourist destination. It is likely that tourism, especially from
other California regions, including some epidemic hot spots, will increase as people tire of
stay-at-home orders and the weather warms.
2. The influx of a significant number of college students who have spent time outside of the
area and potentially returning with COVID-19 with or without symptoms. Cal Poly, with a
student population of 22,000, could increase risk at the community level, as could, to a lesser
extent, Cuesta College.
3. A lack of immunity among the majority of residents given a relatively low prevalence of
COVID-19 during the first wave as compared to other areas of California.
An influx of visitors and students, increased public congregation, and lack of immunity could
significantly increase risk for COVID-19 in the county. As such, a second epidemic wave of the COVID -
19 outbreak could be larger, infecting more people than the first.
When to reopen and the importance of data. The figure below portrays the spectrum of
reopening, from the Stay-at-Home Order through the three phases of reopening. Indicators and
metrics for moving forward or backward are outlined in Tables 3 and 4. Loosening of restrictions will
be phased in gradually and based on local data. Subsequently, data will be continually monitored for
signs of a substantial spike in new infections or a new epidemic curve, in which case restrictions may
be reinstated.
Both patient outcomes (i.e. new infections, admissions, deaths) and system capacity (i.e. facilities,
personnel, ability to trace contacts) will be drivers of county guidelines to loosen or tighten
restrictions. To protect public health, it is critical that loosening of preventive measures be
retightened when local or regional data suggest worsening of key parameters.
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These guidelines are intended to be instructive, not prescriptive, and no criteria by itself should be
an automatic trigger for action. Rather, the set of factors described below may be utilized and
interpreted based on patterns evident in the community. It should be noted that any reopening may
be associated with an unpredictable amount of risk. However, given existing scientific evidence and
analysis of SLO County’s risk profile, these guidelines are proportionate, and should be utilized in
the context of the adaptive response in the event of worsening criteria.
It is critical that all members of our community commit to implement ing the phased preventative
strategies outlined in this plan and be prepared to adapt to retightening of these preventative
measures if necessary. A successful reopening will depend on everyone in our community doing
their part.
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Move to Phase One when Stay-at-Home Order is lifted or
modified, and criteria have been met for 14 days
Move to Phases Two and Three when guidelines are
met for a least 30 days (Table 3)
Move to the previous Phase when one or more criteria
substantially worsen (Table 4)
Epidemiology: Criteria related to number of cases and deaths
Healthcare: Criteria related to capacity to screen patients, staff and stock hospitals, and accept patients
Public Health: Criteria related to quick testing, contact tracing, and other critical infrastructure
All Phases Phase One
Day 1 (if threshold criteria met)
Phase Two
Day 30 (if threshold criteria met)
Phase Three
Day 60 (if threshold criteria met)
Individuals
Continue to practice
good personal
hygiene
Stay home when sick
Protect vulnerable
populations
Vulnerable populations continue to stay at home
Physical distancing
Masks recommended in public when physical distancing is
difficult
Monitor symptoms
Gatherings of no more than 10 people
Minimize non-essential travel
Vulnerable populations continue to stay at home
Physical distancing
Masks recommended in public when physical distancing is
difficult
Gatherings of no more than 50 people
Minimize non-essential travel
Vulnerable populations can resume public
interactions, but should practice physical distancing
and minimizing exposure
Physical distancing eased
Gatherings with restrictions on numbers of people
TBD
Low-risk populations should consider minimizing
time spent in crowded environments
All
institutions
&
businesses*
Adhere to START
Standards and
Guidelines for:
Physical distancing,
protective equipment,
sanitation,
disinfection, and
business travel
Do not allow
symptomatic people
to return to work
Partial/phased/modified reopening under strict operating
standards for distancing, sanitation, hygiene
Continue to support telework
Ensure enough hand sanitizer and/or hand washing stations
at strategic locations
Close common or congregation areas at workplaces and/or
enforce strict operating standards
Strongly consider special accommodations for personnel
who are vulnerable
Minimize non-essential travel
Remain open under modified operating standards for
distancing, sanitation, hygiene
Continue to support telework
Ensure enough hand sanitizer and/or hand washing stations
at strategic locations
Close common or congregation areas at workplaces and/or
enforce modified operating standards
Strongly consider special accommodations for personnel
who are vulnerable
Minimize non-essential travel
Resume unrestricted staffing and operations
Most institutions and businesses fully reopen
Specific
types of
institutions
&
businesses*
General businesses (e.g. retail, manufacturing, personal
care, body art) phased/partial reopening
Specific sectors: (e.g. food facilities, movie theaters,
museums, places of worship) phased/partial reopening
K-12 schools partial reopening
Parks, playgrounds, and campgrounds modified reopening
Fitness (e.g. gyms, pools) modified reopening
Beaches, outdoor activities remain open with modifications
Health-care – non-urgent surgeries and office visits can
resume, when healthcare facilities and hospitals ready
K-12 schools, child care centers and summer camps
modified reopening
Massage, spa services modified reopening
Post-secondary institutions TBD
Post-secondary institutions modified reopening
Clubs, lodges, and meeting halls fully open
Large entertainment and sporting venues modified
reopening
Visits to senior facilities and hospitals can resume
with strict physical distancing protocols
*Refer to The START Standards and Guidelines
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Table of Contents
Contents Page
Executive Summary ............................................................................................................................................ 2
Table of Contents ............................................................................................................................................... 7
Glossary ............................................................................................................................................................... 8
SECTION 1. Introduction to the SLO County START Guide ........................................................................... 9
SECTION 2. Summary of Frameworks ........................................................................................................... 11
SECTION 3. Integrated Summary ................................................................................................................... 13
SECTION 4. State and County Considerations .............................................................................................. 15
SECTION 5. Recommendations ...................................................................................................................... 18
Phase One ..................................................................................................................................................... 20
Phase Two...................................................................................................................................................... 21
Phase Three ................................................................................................................................................... 22
References ......................................................................................................................................................... 25
Appendices ........................................................................................................................................................ 26
SUPPLEMENTAL DOCUMENTS........................................................................................................................ 34
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Glossary
Adaptive response The process by which key indicators may be used to inform change in
strategy, such as moving forward or backward along phases
COVID-19 Abbreviated name for the disease caused by SARS-CoV-19
Epidemic A widespread occurrence of a disease in a community at a particular time
Epidemic curve A visual display of the frequency of new cases over time based on the
date of onset of a disease
Epidemiology The study of epidemics, or the distribution and determinants of diseases
Framework A system of rules, ideas, or beliefs that is used to plan or decide
something
Indicators Variables that can be measured and compared against a standard
Mitigation The act of reducing the severity or seriousness of something
Pandemic A disease that is spread over the world
Public health The health of the population or community as a whole, especially as the
subject of government regulation or support
Quarantine A state or period of isolation in which people who may have been
exposed to a virus are placed
SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 of the
genus Betacoronavirus, the causative agent of COVID-19, the novel
coronavirus
Stay-at-Home Order The order from the State of California to remain at home whenever
possible in order to prevent spread of COVID-19; also referred to as
“shelter-at-home” or “shelter-in-place,” although they are not strictly the
same
Vulnerable Individuals who are at increased risk or especially susceptible to infection
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SECTION 1. Introduction to the SLO County START Guide
Purpose
To create a science-based framework for SLO County residents, businesses, and organizations by
which to reopen in a phased manner while prioritizing public health and protecting our most
vulnerable populations.
Background
Due to the SARS-CoV-2 (COVID-19) pandemic, California Governor Gavin Newsom issued Executive
Order N-33-20 (“Stay-at-Home” Order) on March 19, 2020, mandating that, until further notice, all
Californians “stay home or at their place of residence” except for some limited activities with
exceptions for “essential critical infrastructure workers.”
A plan for reopening our community is important for policy makers, health workers, employers, and
other sectors of society to provide clarity and a framework for safely lifting or modifying public
health orders. The SLO County START Guide outlines the steps for reopening that can be safely
taken in our community, balanced with the importance of resuming individual and economic
activities as the COVID-19 epidemic evolves (Table 1). Implementation measures will be
developed based on this Guide by stakeholder groups representing public agencies, community
groups, and business sectors. The SLO County START Guide is intended to be a living document
that remains dynamic with the evolution of the epidemic and emergence of new data .
TABLE 1. FUNCTIONS OF THE SLO COUNTY START GUIDE .
The SLO County START Guide
Describes the conditions under which the County may begin to reopen institutions and
businesses safely while prioritizing public health
Provides strategies to limit the spread of COVID-19 and establishes tools and approaches to
minimize future outbreaks once restrictions are loosened or lifted
Offers measurable decision points to identify how phased transitions can occur and which public
health criteria might inform decisions to loosen or tighten restrictions in SLO County
The START Guide: Integrating Frameworks
The Guide draws from and integrates three main sources (Table 2). While these sources contain
many points of agreement, some variation is evident. The expert panel conducted a thorough
analysis of these sources and the relevant scientific literature to produce a customized framework
for SLO County based on baseline COVID-19 data, anticipated and emerging risk factors, and
the region’s unique characteristics.
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The sections of the Guide are described below:
• Section 2, Summary of Frameworks, describes the key elements from each of the three
frameworks in their original iteration, without alterations or adaptations.
• Section 3, Integrated Summary, shows guidelines and their potential application to SLO
County in light of county characteristics and current data.
• Section 4, State and County Considerations, highlights factors that are relevant to SLO
County based on state data, local issues, and projections for the pandemic.
• Section 5, Recommendations, makes specific recommendations for the county, its entities,
and stakeholders, based on an integrated adaptation of the available evidence and
frameworks. The recommendations take into account their commonalities, bridge
discrepancies, and provide the foundations for implementation and policy approaches.
TABLE 2. M AIN SOURCES CONTRIBUTING TO THE SLO C OUNTY START GUIDE FRAMEWORK . SEE ALSO APPENDICES.
Entity Document/s Release Date
(2020)
U.S. Federal Government
Guidelines: Opening Up America Again April 16
State of California
California’s Roadmap to Modify the Stay-
at-Home Order & Update on the
Pandemic Roadmap
April 14 & 28
Resolve to Save Lives (RSL), an
Initiative of Vital Strategies
When and How to Reopen After COVID-19 April 1
Most of the recommendations and benchmarks from these sources are applicable at the county
level and many of the criteria and guidelines are similar. This START Guide adapts and integrates
their content in the context of demographic, geographic, and other characteristics of SLO County in
light of the evidence to date.
It should be noted that California State orders supersede County guidelines and as such, the
recommendations of this Guide are contingent on the State reopening, or at least initiating a
sequence for modifying orders. If and when local or county discretion are permitted, it is anticipated
that this Guide may help inform strategy and policy.
“Decisions to reopen should not be about a date but about the data.”
-Dr. Tom Frieden, CEO of Resolve to Save Lives and former Director of the CDC
In the absence of a COVID-19 vaccine or specific therapeutics to combat infected individuals,
preventive strategies, such as the restrictions being implemented worldwide, are the most effective
path to contain and mitigate the infection.
The standard preventive measures form the basis of our current approach to the pandemic and will
continue, but gradually loosen, as we reopen society to its “normal” functioning. It is important to
note that decisions regarding loosening restrictions must be made in light of local data and should
be viewed as temporary during times of decreased risk and remain fluid in response to changing
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public health and healthcare variables, as it is difficult to predict secondary waves of outbreaks or
localized resurgences. Preventive measures should be retightened when local data suggest that
disease spread has significantly increased, may do so, or that disease severity is worsening. As such,
it is fundamental to continually reevaluate benchmarks, maximize local capacity to collect and share
data related to the outbreak, and remain open and nimble to adjusting local guidelines and
restrictions.
SECTION 2. Summary of Frameworks
The key elements, in their original iteration, from each of the three sources used to develop the SLO
County START Guide appear below.
I. Federal guidelines for phased reopening were released, but the administration made it clear
that Governors would have discretion to determine reopening criteria and timelines in their own
states. The guidelines emphasize a phased reopening based on data at the state and county levels ,
so-called “gating” criteria (Appendix 1). Guidelines in each Phase for individuals, employers, and
specific types of employers appear in Appendix 2. Federal guidelines also call for all Phases to
include continuation of good personal hygiene practices and staying at home when sick for
individuals. For employers, all Phases also include implementing appropriate policies in accordance
with authorities and best practices related to physical distancing, protective equipment, sanitation,
disinfection, business travel, and not allowing symptomatic people to return to work.
II. The State of California has released two main documents outlining the general strategy for
reopening but has not indicated a timeline for lifting or modifying the Stay-at-Home Order. First, the
State outlined six criteria to be used as a framework (Appendix 3) for decision making related
to reopening:
1) The ability to monitor and protect communities through testing, contact tracing, isolating
and supporting those who are positive or exposed
2) The ability to prevent infection in people who are at risk for more severe COVID-19
3) The ability of the hospital and health systems to handle surges
4) The ability to develop therapeutics to meet the demand
5) The ability for businesses, schools, and childcare facilities to support physical distancing
6) The ability to determine when to reinstitute certain measures, such as the stay-at-home
orders, if necessary
San Luis Obispo County has issued a statement to the State entitled, “SLO County’s Readiness to
Meet California’s Six Indicators for Modifying the Stay-at-Home Order,” which outlines steps it
has taken to align with the criteria above in the context of the START Guide (Supplement 2).
The State also released an Update on the Pandemic Roadmap (Appendix 5) that describes
“Resilience Roadmap Stages” whereby lower and higher risk workplaces are reopened
sequentially:
Stage 1- Safety and Preparedness (current stage, as of April 30, 2020)
Stage 2- Creating opportunities for lower risk sectors to adapt and reopen
Stage 3- Creating opportunities for higher risk sectors to adapt and reopen
Stage 4- End of Stay-at-Home Order
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III. Resolve to Save Lives (RSL), an Initiative of Vital Strategies describes the “adaptive response” to
the COVID-19 pandemic, represented in Figure 1.
The RSL report contains detailed criteria by which to loosen and tighten restrictions. Namely, it
emphasizes three sub-categories of criteria, all of which have measurable benchmarks:
1. Epidemiology (five variables)
2. Healthcare (seven variables)
3. Public health (six variables)
FIGURE 1. THE ADAPTIVE RESPONSE T O COVID-19. (REPRODUCED FROM RESOLVE TO SAVE LIVES)
The RSL report indicates that COVID-19 physical distancing measures can be loosened when all of 18
criteria are met (Appendix 6). Once these criteria are met, loosening restrictions can happen over
time to reopen (Appendix 7). Strict mitigation measures are needed when one or more criteria in at
least two of three columns are met (Appendix 8). If the criteria are met, tightening of restrictions
should occur (Appendix 9). The report underscores that retightening restrictions should remain an
option for the foreseeable future.
It is important to note that the availability and fidelity of local data would be fundamental to
objective assessment against the criteria.
The RSL guidelines are the most detailed of the three sources. In conjunction with federal and state
frameworks, the report provides an instructive model for which to develop customized criteria and
guidelines for SLO County.
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“If we lift too early, the pandemic can take hold again. And that itself is very bad
for the economy.” -Emil Verner, MIT Economist, co-author of “Pandemics Depress the
Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu.”
SECTION 3. Integrated Summary
Several points of consensus are evident from the sources reviewed. The summaries below take into
account these commonalities, bridge their discrepancies, and provide the foundations for the
Recommendations section.
When to reopen and the importance of data. It is clear that loosening of any restrictions
should be phased in gradually and based on local data. Subsequently, data must be
continually monitored for signs of regression or a new epidemic curve, in which case restrictions
may be reinstated (Figure 2).
Timing. Before easing any restrictions, there must be:
• Capacity to test 100% of symptomatic individuals unless definable as “probable case” per
CDC definition
• At least 90% of contacts traced and tested if symptomatic
• No significant increase in disease prevalence for at least 14 or up to 30 days
• A continued decline or no significant increase in COVID-19 deaths for at least 14 or up to 30
days
• Decreasing healthcare worker infections such that they are rare
• Sufficient capacity in the healthcare system (ability to staff, screen, test, sufficient PPE for
workers) and ability to surge by at least 30% quickly
FIGURE 2. THE SPECTRUM OF REOPENING , FROM THE STAY-AT-HOME ORDER THROUGH THE THREE PHASES OF REOPENING .
INDICATORS AND METRICS FOR MOVING FORWARD OR BACKWARD ARE OUTLINED IN TABLES 3 AND 4.
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The federal guidelines outlined 14-day periods before moving to the next Phases of reopening
whereas the RSL report indicated 30 days. The SLO County START Guide uses the former to enter
Phase One and the latter to enter Phases Two and Three. The reason for this is to develop a period
of relative constancy for one month (in Phase One) after partial reopening to allow the consequent
risk profile of the county to stabilize.
Loosening of restrictions. It should be made clear to the public that loosening of restrictions
should be viewed as temporary. That is, even after restrictions are loosened, they could be
retightened to varying degrees if the situation warrants. It should also be understood that
loosening of restrictions will be phased in gradually, as not to give the impression that
everything will return to “normal” immediately. State of California orders and guidelines, and those
from other entities such as the California State University Chancellor’s Office, may also impact the
dynamics of loosening and tightening restrictions in SLO County.
Phases. A phased reopening framework for the SLO START Guide is described below in general
terms. Detailed criteria appear in Section 5, Recommendations.
• Phase One of reopenings should take place in venues and environments that are subject to
manageable protocols for physical distancing and other preventive measures.
• Phase Two can begin 30 days after initiation of Phase One if the criteria to ease restrictions
have not worsened or if they have improved. Further loosening of restrictions may include
partial or phased reopenings not covered in Phase One, and further easing of restrictions on
institutions covered in Phase One.
• Phase Three can begin 30 days after initiation of Phase Two if the criteria to ease
restrictions have not worsened or if they have improved, or alternatively, if a vaccine
becomes available and widely administered locally. In this Phase, all institutions and
businesses reopen, and most types of gatherings may recommence. Physical distancing in
Phase Three may also be eased.
Until such time that a vaccine is developed and widely available, the adaptive response (Figure 1) is
recommended as a way to prevent infections and protect the public’s health.
Preventive strategies. It should be noted that some preventive actions should continue
indefinitely. For example:
• Personal hygiene (washing hands frequently, covering coughs, staying at home when ill,
using face masks in public when ill)
• Vulnerable individuals such as the elderly and those with pre-existing conditions should stay
at home, self-isolate, or be cared for whenever possible. For infected patients who cannot be
safely cared for at home (or if unhoused), designated facilities should be provided.
• Isolation of cases and quarantine of case contacts
• Quarantine of travelers from high-infection areas
Using data to inform strategy. Both patient outcomes (i.e. new infections, admissions, deaths) and
system capacity (i.e. facilities, personnel, ability to trace contacts) may be drivers of County
guidelines to loosen or tighten restrictions. It is critical to retighten restrictions when local or
regional data show an increase in new infections or worsening of other key parameters.
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It is challenging to predict when COVID-19 may reoccur in SLO County after the first epidemic wave.
However, it is recommended that the County tighten restrictions or recommend preventive
measures at the individual and institutional levels if infection rates or risk substantially increase.
Data from other counties can also be used to assess risk and inform strategy.
SECTION 4. State and County Considerations
To date, the State of California has fared relatively well in the COVID -19 pandemic due to early and
aggressive preventive measures.
Notwithstanding, as of April 28, the state has about 45,000 confirmed COVID-19 cases (out of a total
of nearly 580,000 lab tests conducted) and an overall death rate of 4.0% (Figure 3) among tested
persons.
Within the state, counties with relatively low population density and those geographically isolated
from large urban centers have mostly been spared high infection rates.
FIGURE 3. COVID-19 CASES IN C ALIFORNIA , REFLECTING 45,031 CONFIRMED CASES AND 1,809 DEATHS . STATE OF
C ALIFORNIA PUBLIC DATASET . D ATA FROM APRIL 28, 2020.
In line with this, SLO County has experienced a relatively low infection rate and as of April 30, 2020,
the total number of infections stands at 184 with only one death and minimal hospitalizations
(Figure 4). The number of new infections in the county is currently low, approximately 3 per day.
However, the county’s proximity to Los Angeles County, the current state epicenter of the outbreak
with more than 20,000 confirmed cases, is concerning, especially as SLO County is on a well-traveled
thoroughfare to and from Southern California.
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FIGURE 4. COVID-19 CASES IN SAN LUIS OBISPO COUNTY (184 CONFIRMED CASES AND 1 DEATH.)
C OUNTY OF SAN L UIS OBISPO PUBLIC DATASET . DATA FROM APRIL 30, 2020.
Epidemics of communicable diseases tend to occur in waves , whereby a second or even third
outbreak causes a spike in infection rates severa l months following the first wave (Figure 1).
Three main points of concern associated with the anticipated multiple waves of COVID -19
warrant attention:
• It is possible that the second epidemic wave of the COVID -19 outbreak could occur between
summer and fall 2020. That outbreak could be larger, infecting more people than the
first. This is especially possible when preventive measures are loosened following the first
epidemic curve and Cal Poly resumes on-campus instruction and activities.
• It is estimated that by June 2020, the grand majority of Americans will still be susceptible
to the virus. It is not expected that a COVID-19 vaccine will be in circulation in the near
future. This suggests that infection rates in subsequent waves will not necessarily be lower
than in the first wave, as often assumed, nor will individual-level risk of infection.
• COVID-19 antibody (or immunity) tests to identify individuals who were infected and
recovered are not yet widely available nor is it known when they will be. It is also unknown
whether those infected with SARS-CoV-2 can be reinfected or how long immunity will last. As
such, it will not be possible to identify which persons may be considered immune over
an extended period of time.
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FIGURE 5. COVID-19 CASES AND DEATHS IN CALIFORNIA COUNTIES , SHOWING SLO COUNTY RELATIVE TO NEIGHBORING
COUNTIES. DATA FROM A PRIL 27, 2020.
Additional unique factors warranting consideration for SLO County include the following:
1. The popularity of SLO County as a tourist destination. It is likely that tourism will
increase, albeit not likely to previous years’ levels, as people tire of stay-at-home orders and
the weather warms. It is also possible that visitors may perceive SLO County to be a low-risk
travel destination (i.e. due to low population density and low infection rate), potentially
making it a more attractive destination than the more urban regions of Northern or
Southern California. (Figure 5)
2. The influx of a significant number of college students spending time outside of the area
and potentially returning with COVID-19 with or without symptoms. With student
populations of 11,500 and 22,000, respectively, Cuesta College and Cal Poly could
significantly increase risk for the county population for three reasons: a) The sheer number
of students coming into the city and county, b) The range of locations that students would be
coming from include a number of state and national infection hot spots, and c) Likelihood of
congregation in restaurants, bars, gyms, beaches, and on campus.
3. A lack of immunity among a majority of residents given a relatively low prevalence of
COVID-19 during the first wave as compared to other areas of California. Although SARS-
CoV-2 antibody (or immunity) tests may soon be available which will assist in identi fying
individuals who have been infected, recovered and potentially have at least short-term
immunity, the performance characteristics of these tests and the durability of any conferred
immunity has yet to be determined.
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SECTION 5. Recommendations
The SLO County START Guide characterizes the timing and features of a phased reopening drawn
from a combination of the federal guidelines, the State of California framework and Pandemic
Roadmap, and criteria from RSL. Contextual factors specific to SLO County, including COVID-19 and
health system data, were taken into consideration when producing the recommendations.
Businesses that have remained open through the epidemic per State and County guidelines are not
affected by these guidelines. These guidelines are intended to be instructive, not prescriptive,
and no criteria by itself should be an automatic trigger for action. Rather, the set of factors
described below may be utilized and interpreted based on patterns evident in the community. It
should be noted that any reopening may be associated with an unpredictable amount of risk.
However, given existing scientific evidence and analysis of SLO County’s risk profile, these guidelines
are proportionate but should be utilized in the context of the adaptive response in the event of
worsening criteria.
The START Standards and Guidelines (Supplement 1) provides best practices that should be
followed by all institutions and businesses in all Phases of reopening. Certification and
acknowledgement of operating standards by institutions and businesses may be required.
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TABLE 3. ADAPTED GUIDE LINES FOR LOOSENING RESTRICTIONS , BY CATEGORY.
Epidemiology Healthcare Public health
✓ No significant
increase in disease
prevalence for at
least 14 days
✓ Decreasing
proportion of cases
not linked to a source
case
✓ No significant
increase in deaths
✓ Health care worker
infections rare
✓ Ability – including staffing
– to increase up to 30%
number of patients
treated in intensive care
units from current census
✓ Ability – including staffing
– to screen large numbers
of symptomatic patients
safely (e.g., outdoor tents,
drive through)
✓ Sufficient PPE for all
health care workers even
if cases increase by 30%
✓ Sufficient face masks to
provide to all patients
seeking care even if cases
increase by 30%
✓ Ensure at least baseline
capacity in general health
services, including
through expansion of
telemedicine for COVID-19
and usual care
✓ Health care facilities
enforce policies and
redesign to minimize
possibility of exposure at
triage and all other
locations
✓ All cases interviewed
for contact elicitation
✓ Contacts elicited for at
least 90% of cases
✓ 100% of symptomatic
contacts and others
with symptoms
undergo testing within
24 hours of
identification of
symptoms, unless
definable as “probable
case” per CDC
✓ Enough hand sanitizer
to place at entry and
strategically placed in
buildings including
workplaces
✓ Designated facilities for
non-hospitalized
COVID-19-infected
people who can’t be
safely cared for at
home (e.g., because of
space constraints,
homelessness,
medically vulnerable
household members,
or otherwise)
✓ Demonstrated ability to
convey physical
distancing
recommendations that
change behavior in
most residents
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Phase One
In Phase One, many businesses and institutions may reopen partially or in a modified manner,
subject to compliance with County orders. This may commence following the lifting or modification
of the California Stay-at-Home Order if the guidelines in Table 3 have been met for the preceding 14
days.
1) Continue for individuals, institutions, and businesses
a. Physical distancing measures at all venues and all times
b. Personal preventive hygiene and quarantine/isolation measures
c. Use of face coverings and masks in public especially when physical distancing is
difficult or not possible
d. Monitoring of symptoms
e. Protection for vulnerable populations such as the elderly
2) Individuals
a. Gatherings should be limited to 10 people, physical distancing maintained as
much as possible
b. Minimize non-essential travel
3) All institutions and businesses
a. The START Standards and Guidelines best practices should be followed by
all institutions and businesses in all Phases of reopening
i. Required certification and acknowledgement of operating standards
b. Must adhere to strict operating standards for personal hygiene, sanitation of
facilities and equipment, and physical distancing
c. Continue to support telework
d. Ensure enough hand sanitizer or hand washing stations at strategic locations
e. Close common or congregation areas at workplaces, and/or enforce strict
physical distancing measures
f. Strongly consider special accommodations for personnel who are vulnerable
g. Minimize non-essential travel
4) Specific types of institutions and businesses
a. Phased or partial reopening: General businesses, such as retail stores,
offices, manufacturing, personal care services and body art facilities
i. May reopen only when physical distancing measures may be strictly
enforced, masks or face coverings are worn when distancing not
possible, limiting the number of clients in the establishment such as by
instating an appointments-only policy or other modifications
b. Phased or partial reopening: Sector specific businesses and institutions,
such as food facilities, movie theaters, museums, and places of worship)
can operate under strict operating standards
i. May reopen only when operating standards for physical distancing,
personal hygiene, and sanitation of facilities and equipment can be
enforced. Includes rearranging seating, limiting the number of people in
the establishment, masks or face coverings for staff who come into close
contact with others, and other procedures
c. Partial reopening: K-12 schools for summer school and extended school
year for special education, with strict operating standards for personal
hygiene, sanitation of facilities and equipment, and other preventive measures
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d. Modified reopening: Fitness, such as gyms, exercise facilities or studios, and
public pools and public /spa pools, with strict operating standards for personal
hygiene, sanitation of facilities and equipment, and physical distancing
e. Modified reopening: Parks and playgrounds, with operating standards for
personal hygiene, and sanitation of facilities and equipment
f. Remain open: Beaches, hiking and biking trails, and other outdoor
activities with operating standards for personal hygiene, and sanitation of
facilities and equipment
g. Modified reopening: Campgrounds, with strict operating standards for
personal hygiene, sanitation of facilities and equipment, physical distancing, and
other preventive measures
h. Resume: Health Care including non-urgent surgeries when health care facilities
and hospitals ready with sufficient staffing and PPE
i. Still closed: Body massage, steam or sauna facilities, events, venues and
attractions that gather more than 10 non-household members, post-
secondary institutions, and visits to senior facilities and hospitals
Phase Two
If guidelines in Table 3 continue to be met for a minimum of an additi onal 30 days at the county
level, some further restrictions may be loosened, and loosened restrictions from Phase One may be
slightly eased, subject to compliance with County orders.
1) Continue for individuals, institutions, and businesses
a. Physical distancing measures at all venues and all times
b. Personal preventive hygiene and quarantine/isolation measures
c. Use of face coverings and masks in public especially when physical distancing is
difficult or not possible
d. Monitoring of symptoms
e. Protection for vulnerable populations such as the elderly
2) Individuals
a. Gatherings should be limited to 50 people, physical distancing maintained as
much as possible
b. Minimize non-essential travel
3) All institutions and businesses
a. The START Standards and Guidelines best practices should be followed by
all institutions and businesses in all Phases of reopening
i. Required certification and acknowledgement of operating standards
b. Must adhere to modified operating standards for personal hygiene, sanitation
of facilities and equipment, and physical distancing standards
c. Continue to support telework
d. Ensure enough hand sanitizer or hand washing stations at strategic locations
e. Modified reopening of common or congregation areas at workplaces, with
operating standards for use by staff
f. Strongly consider special accommodations for personnel who are vulnerable
g. Minimize non-essential travel
4) Specific types of institutions and businesses
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a. Remain open: General businesses, such as retail stores, offices, manufacturing,
personal care, and body art facilities.
i. Modified operating standards for personal hygiene, and sanitation of
facilities and equipment. Limiting number of people inside establishment
may be eased under certain circumstances.
b. Remain open: Sector specific businesses and institutions, such as food facilities,
movie theaters, museums and places of worship
i. Modified operating standards for personal hygiene, and sanitation of
facilities and equipment. Limiting number of people inside establishment
may be eased under certain circumstances.
c. Modified reopening: K-12 schools, child care centers, and summer camps with
operating standards for personal hygiene, sanitation of facilities and equipment, and
other preventive measures
d. Remain open: Fitness, such as gyms, exercise facilities or studios, and public pools
and public /spa pools, with modified operating standards for personal hygiene and
sanitation of facilities and equipment.
e. Modified reopening: Body massage and steam or sauna facilities with operating
standards for personal hygiene, sanitation of facilities and equipment, and other
preventive measures
f. Remain open: Parks, playgrounds, beaches, hiking and biking trails,
campgrounds, and other outdoor activities, with modified operating standards
for personal hygiene, sanitation of facilities and equipment
g. TBD: Post-secondary institutions
h. Still Closed: Events, venues and attractions that gather more than 50
individuals; and visits to senior facilities and hospitals
Phase Three
If guidelines in Table 2 continue to be met for a minimum of an additional 30 days at the county
level, some further restrictions may be loosened, and loosened restrictions from Phase Two may be
further eased, subject to compliance with County orders.
1) Continue for individuals, institutions, and businesses
a. Personal preventive hygiene and quarantine/isolation measures
b. Monitoring of symptoms
c. Protection for vulnerable populations
2) Individuals
a. Vulnerable populations can resume public interactions but should continue
physical distancing and minimizing exposure
b. Ease physical distancing
c. Gatherings, with restrictions on number of people: TBD
d. Low-risk populations should consider minimizing time spent in crowded
environments
3) All institutions and businesses
a. The START Standards and Guidelines best practices should be followed by
all institutions and businesses in all Phases of reopening
i. Required certification and acknowledgement of operating standards
b. Resume unrestricted staffing and operations (most institutions and businesses)
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c. Adhere to standard sanitation and operating standards
4) Specific types of institutions and businesses
a. Fully reopen: General businesses
b. Fully reopen: Sector specific businesses and institutions
c. Fully reopen: K-12 schools, child care centers and summer camps
d. Fully reopen: Fitness, such as gyms and exercise facilities or studios, and public
pools and public /spa pools
e. Fully reopen: Parks, playgrounds, beaches, hiking and biking trails, and
campgrounds and other outdoor activities
f. Fully reopen: Clubs, lodges, meeting halls
g. Modified reopening: Post-secondary institutions, with operating standards
for personal hygiene, sanitation of facilities and equipment, and other preventive
measures
h. Modified reopening: Large entertainment and sporting venues, with
operating standards for personal hygiene, sanitation of facilities and equipment,
and other preventive measures
i. Resume with strict physical distancing protocols : Visits to senior facilities
and hospitals (to be eased after an additional 14 days if loosening criteria
continue to be met)
Through the phased reopening. The START Guide follows an adaptive response to individual- and
institutional-level restrictions for retightening restrictions.
If COVID-19 related parameters worsen and the criteria are met for retightening restrictions ,
the County would move to the previous Phase of operation (see Figure 2). If moving back to Phase
One or Two is required, the loosening criteria (Table 3) must then be met for 30 days prior to moving
forward again.
The guidelines for retightening restrictions are when one or more crite ria in at least two of
three columns in Table 4 are met.
Some preventive actions should continue indefinitely . Personal hygiene (washing hands
frequently, covering coughs, using face masks if ill), vulnerable individuals such as the elderly and
those with pre-existing conditions should be protected, stay at home, or self-isolate whenever
possible, isolation of cases and quarantine of case contacts, and quarantine of travelers from
high-infection areas.
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TABLE 4. ADAPTED MITIGATION MEASURES NEEDED WHE N ONE OR MORE CRITERIA IN AT LEAST 2 OF 3 COLUMNS ARE MET .
Epidemiology Healthcare Public health
✓ Increasing new case
counts of at least 10%
for 5 consecutive days
above a stable baseline
in the context of no
substantial increase in
testing
✓ Doubling time of cases
less than 5 days (from
a stable baseline)
✓ More than 3 unlinked
chains (clusters) of
transmission in a 14-
day period
✓ High likelihood of
exposure at mass
gathering or
congregation of people
or delayed detection of
a case (>5 days from a
mass gathering or
long-term care facility)
✓ Increasing number of
new health care
worker infections
averaged over a 7-day
period
✓ Inability to scale up to
30% the number of ICU
patients from current
census (including
staffing)
✓ Can no longer screen
large numbers of
symptomatic patients
safely, including
staffing (e.g., outdoor
tents, drive through)
✓ Less than 4 weeks
supply of PPE for 30%
increase in current
case load
✓ Insufficient PPE for all
health care workers
✓ Insufficient face masks
to provide to all
patients seeking care
✓ Do not have baseline
capacity in general
health services,
including through
expansion of
telemedicine for
COVID-19 and usual
care
✓ Health care facilities
can no longer be
structured to reduce
possibility of exposure
at triage and all other
locations
✓ Cannot elicit contacts
for 20% or more of
cases
✓ 10% or more of non-
household
symptomatic contacts
fail to get tested or get
tested in more than 24
hours of symptom
onset
✓ Insufficient hand
sanitizer to place at
entry of buildings
including workplaces
✓ No designated facilities
for non-hospitalized
COVID-19 infected
people who can’t be
safely cared for at
home (e.g., because of
space constraints,
medically vulnerable
household members,
or otherwise)
✓ No longer have the
ability to convey
physical distancing
recommendations
which change behavior
in residents
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References
“California’s Roadmap to Modify the Stay-at-Home Order.” Office of Governor Gavin Newsom. April 14, 2020.
“COVID-19: A Prescription to Get the US Back to Work.” Morgan Stanley Research. (2020).
Executive Order N-33-20. Executive Department, State of California.
Florida R and Pedigo S. “How our cities can reopen after the COVID-19 pandemic.” The Brookings Institution.
(2020).
Gavin K. “With the COVID-19 Curve Flattening, It’s Time to Prevent a Second Peak.” University of Michigan Health
Lab, April 15, 2020.
Gottlieb S, Rivers C, McClellan MB, Silvis L, Watson C. National Coronavirus Response: A Road Map to
Reopening. American Enterprise Institute. (2020).
Guidance of Preparing Workplaces for COVID-19. US Department of Labor, OSHA. Document 3990-03 2020.
(2020).
“Guidelines: Opening Up American Again.”www.whitehouse.gov. April 16, 2020
Kristof N. “Brace Yourself for Waves of Coronavirus Infections.” The New York Times. April 4, 2020.
Lazo A, Mai-Duc C. “How California Has Avoided a Coronavirus Outbreak as Bad as New York’s…So Far.” The
Wall Street Journal, April 8, 2020.
Prem K, Liu Y, Russell TW, Kucharski AJ, Eggo RM, Davies N et al. “The effect of control strategies to reduce social
mixing on outcomes of the COVID-19 epidemic in Wuhan, China: A modelling study.” The Lancet Public Health.
https://doi.org/10.1016/S2468-2667(20)30073-6.
Resolve to Save Lives, an Initiative of Vital Strategies. “When and How to Reopen After COVID-19.” (2020).
www.preventepidemics.org.
Turner K, Davidson SL, Park S, Collins J, Pedati CS. “Standardized surveillance case definition and national
modification for 2019 novel coronavirus disease (COVID-19).” Council of State and Territorial Epidemiologists.
Committee on Infectious Disease. Interim-20-ID-01. 2020.
“Update on California’s Pandemic Roadmap.” Office of Governor Gavin Newsom. April 28, 2020.
“What’s ahead on COVID-19? Expert offers forecast for summer, fall.” American Medical Association Public
Health. April 6, 2020.
Xu S and Li Y. “Beware of the second wave of COVID-19.” The Lancet. April 8, 2020.
County of San Luis Obispo Public Health Department
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Last updated: May 1, 2020 26
Appendices
A PPENDIX 1. FEDERAL GUIDELINES FOR “GATING CRITERIA ” TO MOVE FROM RESTRICTIONS INTO ANY P HASE .
Symptoms Cases Hospitals
Downward trajectory of
influenza-like illness (ILI) within
a 14-day period
AND
Downward trajectory of
COVID-19-like syndromic cases
within a 14-day period
Downward trajectory of
documented cases within a 14-
day period
OR
Downward trajectory of
positive tests as a percent of
total tests within a 14-day
period (flat or increasing
volume of tests)
Treat all patients without crisis
care
AND
Robust testing program in
place for at-risk healthcare
workers, including emerging
antibody testing
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A PPENDIX 2. SUMMARY OF FEDERAL GUIDELINES FOR INDIVIDUALS , EMPLOYERS, AND SPECIFIC TYPES OF EMPLOYERS IN EACH
OF THREE PHASES .
Phase One Phase Two Phase Three
Individuals
All vulnerable people
continue to shelter in place
Physical distancing
Gatherings of no more than
10 people
Minimize non-essential travel
All vulnerable people
continue to shelter in place
Physical distancing
Gatherings of no more than
50 people
Non-essential travel can
resume
Vulnerable people can
resume public interactions,
but should practice physical
distancing and minimizing
exposure
Low-risk populations should
consider minimizing time
spent in crowded
environments
Employers
Continue to encourage
telework
Return to work in phases
Minimize non-essential travel
Close common or
congregation areas or
enforce strict physical
distancing measures
Strongly consider special
accommodations for
personnel who are
vulnerable
Continue to encourage
telework
Close common or
congregation areas or
enforce moderate physical
distancing measures
Strongly consider special
accommodations for
personnel who are
vulnerable
Resume unrestricted staffing
Specific
Types of
Employers
Schools and organized youth
activities remain closed
Visits to senior facilities and
hospitals remain prohibited
Large venues (restaurants,
theaters, sporting venues,
places of worship) can
operate under strict physical
distancing protocols
Elective surgeries can resume
(out-patient only)
Gyms can reopen if operating
under strict physical
distancing and sanitation
protocols
Bars remain closed
Schools and organized youth
activities can open
Visits to senior facilities and
hospitals remain prohibited
Large venues can operate
under moderate physical
distancing protocols
Elective surgeries can resume
(in- and out-patient)
Gyms can remain open under
strict physical distancing and
sanitation protocols
Bars may open with physical
distancing protocols
Visits to senior facilities and
hospitals remain can resume
Large venues can operate
under limited physical
distancing protocols
Gyms can remain open if
they adhere to standard
sanitation protocols
Bars may open with
increased occupancy
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A PPENDIX 3. CALIFORNIA STATE ’S S IX INDICATORS FOR M ODIFYING THE STAY-AT-HOME O RDER.
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A PPENDIX 4. CALIFORNIA STATE ’S R ESILIENCE R OADMAP STAGES 1-4.
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A PPENDIX 5. C RITERIA FOR LOOSENING PREVENTIVE MEASURES . (REPRODUCED FROM RESOLVE TO SAVE LIVES).
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APPENDIX 6. A CTIONS THAT CAN HAPPEN OVER TIME FOLLOWING LOOSENING OF RESTRICTIONS . (REPRODUCED FROM
RESOLVE TO SAVE LIVES ).
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A PPENDIX 7. C RITERIA FOR TIGHTENING PREVENTIVE MEASURES , NOT ADAPTED TO SLO COUNTY. (REPRODUCED FROM
R ESOLVE TO SAVE LIVES ).
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A PPENDIX 8. ACTIONS TO TIGHTEN RESTRICTIONS IN THE EVENT OF REGRESSION . (REPRODUCED FROM RESOLVE TO SAVE
LIVES ).
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SUPPLEMENTAL DOCUMENTS
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SUPPLEMENTAL DOCUMENT TO THE TO THE
STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
DRAFT STANDARDS AND GUIDELINES
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
DRAFT STANDARDS AND GUIDELINES
Introduction
The County developed the following draft supplemental document to convey initial
recommendations for best practices and guidance for businesses in the first phase of reopening.
These are initial standards and guidelines describing how businesses can operationalize and reopen
in Phase 1 of the START Guide. Employers should read the pages applicable to their industry or
business and consider what it would take for them to comply with the best practices specified,
knowing that direction closely aligned with these best practices will come as part of the modified,
replaced or lifted County Shelter At Home Order.
Structurally, employers/businesses should use this document as follows: Section 1 includes draft
recommended guidelines and best practices that all employers/businesses should follow.
Subsequent Sections provide additional measures identified for specific industry sectors and specific
business types, as listed on the table of contents below. Those specific industries should reference
both Section 1 in conjunction with the section(s) applicable to its business. For example, a hotel with
an on-site restaurant would reference Section 1, Section 3 and Section 4 collectively.
The County will continue to monitor State and Federal guidance materials to determine
modifications needed, if any, to create alignment. The County will further monitor public comments
on the START Guide and this supplemental document, and consider modific ations needed, if any,
before finalizing a set of Phase 1 guidelines and issuing new or modified Orders. The County will
also continue to work with specific industries and business types to seek input on the feasibility of
implementing such initial recommended measures.
All Businesses Guidelines
with additional Guidelines for specific industries or business types Beverage Industry Facility Retail Food Facility Lodging Retail Stores Manufacturing Certified Farmers Market Agriculture Building/Dvlpmt/Construction Faith-Based/Community Orgs Public Pools/Hot Tubs/Spas Pools Body Art Events/Venues/Attractions Hair & Nail Salons/Barbers Gyms Other industries identified
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Table of Contents
Section 1. All Employers Page 38
Section 2. Beverage Industry Facility Page 42
Section 3. Restaurants (Retail Food) Page 43
Section 4. Lodging Page 45
Section 5. Retail Stores Page 47
Section 6. Manufacturing Page 48
Section 7. Certified Farmers’ Markets Page 49
Section 8. Agriculture Page 51
Section 9. Building, Development and Construction Page 52
Section 10. Faith-Based and Community Organizations Page 53
Section 11. Public Swimming Pools, Public Spa Pools Page 54
Section 11. Public Swimming Pools, Hot Tubs/Spa Pools Page 54
Section 12. Body Art (Tattoo, Permanent Cosmetics, and Body Piercing Facilities) Page 55
Section 13. Hair Salons, Barbers and Nail Salons Page 57
Section 14. Fitness Centers/Gyms Page 59
Section 15. Events, Venues and Attractions Page 60
Other Sectors and Employers (coming soon) Page 61
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 1. ALL EMPLOYERS
Section 1 includes draft recommended guidelines and best practices that all employers should
follow. The best practices are written to describe what the current understanding of actions that can
be taken to limit or mitigate the spread of COVID-19 in the workplace. It is recognized that not all the
best practices can be implemented in all workplaces.
In addition to these measures, additional best practices and guidelines have been identified for
specific industry sectors and specific business types, as listed on the table of contents. Those specific
industries should reference both Section 1 in conjunction with the section(s) applicable to its
business.
A. Training:
i. Train employees on all measures and protocols applicable to their function or role prior to
returning to work at place of business.
B. Signage:
Template signage to be used can be found on the County’s website at: www.ReadySLO.org.
i. Provide signage at each entrance of the facility to inform employees and customers of
common COVID-19 symptoms and that they must not enter the facility if they are sick with
or suspect they may be experiencing COVID 19 symptoms.
ii. Provide signage regarding the social / physical distancing protocol at the facility; persons
to maintain a minimum six-foot distance from non-household members as much as
practicable and not engage in any unnecessary physical contact.
iii. Provide signage regarding proper hand washing technique should be poste d at all hand-
wash sinks.
iv. Provide signage encouraging regular hand washing in breakrooms and other locations
where employee information is provided.
C. Measures to Protect Employee Health:
i. Direct all employees to stay home if sick.
ii. Instruct employees to notify a supervisor if they are experiencing symptoms of COVID-19,
such as fever, cough, gastrointestinal symptoms.
iii. Direct sick employees with symptoms associated with COVID -19 to be evaluated for testing
by their doctor or urgent care.
iv. Direct all employees to self-monitor for symptoms of COVID-19.
v. Direct all employees to maintain at least six feet distance from customers and from each
other, as much as practicable.
vi. Provide face coverings to employees and encourage employees to use face covering when
physical distancing is not feasible.
vii. Encourage customers to utilize face coverings when entering the facility.
viii. Separate workstations by at least six feet.
ix. Do not share office supplies, tools, etc.
x. Provide separate seating in common areas such as break ro oms and conference rooms.
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xi. Utilize and encourage virtual meetings where possible.
xii. Encourage telecommuting where possible.
xiii. Discourage congregation of employees during breaks and lunches, unless physical
distancing can be maintained.
xiv. Instruct cleaning staff to wear applicable Personal Protective Equipment (PPE) such as
disposable gloves and eye protection for all tasks in the cleaning process, including
handling trash. Direct staff to wash their hands immediately after removing disposable
gloves.
xv. Disinfect high contact surfaces in break rooms, restrooms, and other common areas (i.e.
door handles, lobbies, etc.) frequently. Those areas receiving more traffic should be
disinfected more often. As a best practice, all businesses should disinfect on the following
schedule and maintain a log capturing actions, at a minimum:
1. Public Restrooms: Twice daily
2. Employee Breakrooms: Daily
3. Employee Restrooms: Daily
4. Other employee shared areas: Daily
5. High contact surfaces (door handles, light switches, etc.): At least daily and more
frequently if needed
xvi. Sanitize incoming packages, products or materials as part of the receiving process.
xvii. Direct employees to regularly clean their workstations daily, or at the start and end of their
shift for shared workstations and areas.
xviii. Make sanitizer / disinfectant and related cleaning supplies available to all employees at
specified locations.
xix. Ensure employees frequently wash hands using soap, water and single-use paper towels.
In situations where hand washing facilities are not available, provide hand sanitizer that
contains at least 60% alcohol.
xx. Provide hand sanitizer containing at least 60% alcohol to all employees and customers at
common points of ingress/egress and in common areas such as conference rooms,
breakrooms, or other locations used by multiple employees.
xxi. Provide hand sanitizer to employees at their workstation when their role requires regular
interaction with customers.
xxii. Post copies of measures and protocols being taken related to COVID -19 in a conspicuous
place and provide to all employees.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Limit the number of customers in the facility at any one time to the maximum number
which allows for customers (or groups of household members) and employees to easily
maintain at least six-foot distance from one another, at all practicable times.
ii. At retail counters or in other locations where queueing is possible, placing tape or other
markings at least six feet apart in customer areas inside the facility and on sidewalks at
public entrances with signs directing customers to use the markings to maintain distance.
If groups of household members often wait together, increase distances between
markings so that separation of household groups of at least six feet is ma intained.
iii. Where long lines can form, assign an employee to monitor lines in order to ensure that the
maximum number of customers in the facility is not exceeded.
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iv. Limit use of lobbies / waiting rooms. Develop a system(s) that allows customers to wait in
cars or other locations.
v. Offer service by appointment-only.
vi. Offer and encourage on-line product ordering with curbside pickup or delivery.
vii. Create one-way shopping aisles in higher traffic areas.
viii. Separate order areas from pickup and delivery areas to preve nt customers from gathering.
ix. Implement protections for cashiers, pharmacy workers, and other workers who normally
have regular, close interaction with the public with engineering controls such as Plexiglas
screens or other physical barriers, or spatial distance of at least six feet.
x. Develop restroom occupancy plans that will help ensure 6 foot physical distancing can be
accomplished, limit restrooms to single user if necessary.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitation / Disinfection:
i. Provide contactless payment systems or, if not feasible, sanitize payment systems
frequently, depending on volume of use.
ii. Provide hand sanitizers at check-out stands/stations.
iii. Provide disinfecting wipes containing an EPA-registered disinfectant or other disinfection
measure(s) for employee or customer use where appropriate.
iv. Eliminate or restrict use of self-service sampling unless provided from a single use
container (personal care products, foods, etc.).
v. Assign employee(s) to disinfect high-contact surfaces frequently (point of sale terminals,
counters, common tables, restroom surfaces, doorknobs, phones, keyboards, light
switches, etc.).
F. Additional Measures to Protect Health:
i. Discourage customers from bringing their own bags, mugs, or other reusable items from
home.
ii. Clean visibly dirty surfaces with soap and water prior to disinfecting.
iii. Use EPA-approved disinfectant against COVID-19 and read the label to make sure it meets
your needs and application. A list of approved disinfectants can be found at:
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
iv. Only allow service animals into your facilities.
G. Other Considerations for Employers:
i. Review and follow guidelines by the Center for Disease Control (CDC) to develop,
implement, maintain, and revise your cleaning and disinfecting plan as new information
becomes available.
ii. Read instructions and wear gloves and other Personal Protective Equipment (PPE) as
specified by the manufacturer for the cleaning and disinfecting products you are using.
iii. Consider what items can be moved or removed completely to reduce frequent handling or
contact from multiple people. Soft and porous materials, such as area rugs and seating,
may be removed or stored to reduce the challenges with cleaning and disinfecting them.
You can find additional reopening guidance for cleaning and disinfecting in the CDC’s
Reopening Decision Tool.
iv. Implement flexible sick leave and supportive policies and practices.
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v. Consider how your facilities will operate if absenteeism spikes from increases in sick
employees, those who stay home to care for sick family members, and those who must
stay home to watch their children.
vi. Prepare to perform cleaning and disinfection if persons suspected or confirmed to have
COVID-19 have been in your facilities.
Note: Throughout these Standards and Guidelines, face coverings shall refer to material that fully covers a
person’s nose and mouth.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 2. BEVERAGE INDUSTRY FACILITY
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health: No additional measures. See Section 1.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Assign an employee to monitor that the maximum number of customers in the facility is
not exceeded and physical distancing is being maintained.
ii. Control physical distancing of people consuming food and beverage by limiting bar service,
separating dining tables and restricting table use to keep household parties separated
from others by a minimum of 6 feet.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection
(beyond requirements in California Retail Food Code):
i. Do not allow customers to sit or stand within 6 feet of food, glassware, consumables, or
other materials that will be provided to other customers. In bar situations, if 6 feet of
separation from such materials is not possible, install Plexiglas or other smooth and easily
cleanable shielding materials to prevent contamination.
ii. Discontinue self-serve operations, such as salad bars, buffets, food sampling, and
beverage service stations that require customers to use common utensils or dispensers.
iii. Offer single use disposable utensils or containers and provide packets of condiments, not
bulk dispensed items.
iv. Provide cups, lids, stir sticks etc. upon request and do not provide them via self-service
v. Use online ordering, menu boards, single use disposable menus, or use menus which can
be sanitized between use (i.e. laminated).
vi. Evaluate the use of physical barriers for employees that normally have close interaction
with customers such as at check-out counters, wine tasting staff, servers, bartenders, etc.
vii. Assign employee(s) to disinfect high-contact surfaces frequently (e.g. point of sale
terminals, counters, tables, restroom surfaces, etc.).
F. Additional Measures to Protect Health:
i. Provide handwashing stations and hand sanitizer (at least 60% alcohol) for public use.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 3. RESTAURANTS (RETAIL FOOD)
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this industry
should implement the following additional measures:
A. Training: See Section 1. No additional measures. See Section 1.
B. Signage: See Section 1. No additional measures. See Section 1.
C. Measures to Protect Employee Health:
i. High contact surfaces in break rooms, restrooms, and other common areas should be
disinfected on the following schedule:
Public Restrooms: Hourly
ii. Ensure employees more frequently wash hands using soap, warm water and single use
paper towels at hand wash sinks.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
iii. Designate an employee who will monitor that the maximum number of customers in the
facility is not exceeded and physical distancing is maintained.
iv. Provide seating by reservation.
v. Encourage to-go service, where applicable.
vi. Control physical distancing of people consuming food and beverage by limiting at-bar
service, separating dining tables and restricting table use to keep household parties
separated from others by a minimum of 6 feet.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection
(beyond requirements in California Retail Food Code):
vii. Do not allow customers to sit or stand within 6 feet of food, glassware, consumables, or
other materials that will be provided to other customers. In bar situations, if 6 feet of
separation from such materials is not possible, install Plexiglas or other smooth and easily
cleanable shielding materials to prevent contamination.
viii. Discontinue self-serve operations, such as salad bars, buffets, food sampling, and
beverage service stations that require customers to use common utensils or dispensers.
Consider single use disposable utensils or containers and provide pac kets of condiments,
not bulk dispensed items.
ix. Provide cups, lids, stir sticks etc. upon request and do not provide them via self-service.
x. Utilize online ordering, menu boards, single use disposable menus, or utilize menus which
can be sanitized between use (i.e. laminated).
xi. Consider physical barriers for employees that normally have close interaction with
customers such as at cashier stands or check-out counters.
xii. Assign employee(s) to disinfect high-contact surfaces frequently (point of sale terminals,
counters, tables, restroom surfaces, etc.).
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xiii. Make disinfecting wipes containing an EPA-registered disinfectant or other disinfection
measure(s) available near shopping carts and shopping baskets.
xiv. Assign employee(s) to disinfect high-contact surfaces frequently (point of sale terminals,
counters, restroom surfaces, etc.).
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Last updated: May 1, 2020 45
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 4. LODGING
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health: No additional measures. See Section 1.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Eliminate buffet style breakfasts where self-service is required.
ii. Discourage use of lounge and other common areas where 6 foot physical distancing
cannot be maintained between parties.
iii. Encourage to-go service, where applicable.
iv. Control physical distancing of people consuming food and beverage by limiting at-bar
service, separating dining tables and restricting table use to keep household parties
separated from others by a minimum of 6 feet.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
i. Do not allow customers to sit or stand within 6 feet of food, glassware, consumables, or
other materials that will be provided to other customers. In bar situations, if 6 feet of
separation from such materials is not possible, install Plexiglas or other smooth and easily
cleanable shielding materials to prevent contamination.
ii. Continue to rotate rooms such that the longest possible period of time between occupants
is provided.
iii. Remove items that are strictly for convenience of guests (e.g. hair dryers, coffee makers,
etc.), particularly in hotel rooms, if those will not be disinfected after each guest’s stay
ends.
iv. High touch items such as TV remote controls, alarm clocks, and other convenience items
that cannot be removed should be disinfected:
1. Daily, if stayover service is provided.
2. Between guests for all other situations.
Note: Normal cleaning may be appropriate, as opposed to disinfecting, if the room or lodging
has been vacant (empty) for more than 7 days.
v. Provide in-room sanitizer and hand wipes to all guests.
F. Additional Measures to Protect Health:
i. Launder items (where possible) according to the manufacturer's instructions, using the
warmest appropriate water setting and dry items completely. Or, disinfect items with an
EPA-registered household disinfectant.
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ii. Do not shake dirty laundry as it may increase the possibility of dispersing the virus through
the air.
iii. Clean and disinfect hampers or other carts used for transporting laundry.
iv. Ask guests how they are feeling when they check out. If they are complaining of COVID -19
symptoms, follow your detailed plans for cleaning and disinfecting the room they used.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 5. RETAIL STORES
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health: No additional measures. See Section 1.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Assign an employee to monitor that the maximum number of customers in the facility is
not exceeded.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
<<To be determined, e.g. best practices related to on trying on clothes, clothing returns, is still
pending>>
F. Additional Measures to Protect Health:
i. Offer special hours or appointments for immuno-compromised and other vulnerable
populations.
ii. Clean and sanitize dressing rooms daily, or at least twice per day if there is high use.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 6. MANUFACTURING
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Indus try
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health:
i. In addition to normal PPE that is worn by employees, offer face coverings for all employees
where air flow is limited, physical distancing is difficult, or risk of transmission is increased
due to materials being used. Before requiring face coverings, ensure they meet applicable
safety guidelines.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing: No
additional measures. See Section 1.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection: No
additional measures. See Section 1.
F. Additional Measures to Protect Health:
i. Offer special services for immune-compromised and other vulnerable populations.
ii. Evaluate the use of smooth and easily cleanable barriers if employees work side by side
without at least a six-foot separation in assembly line type manufacturing operations.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 7. CERTIFIED FARMERS’ MARKETS
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
i. Post signage at each public entrance of the Certified Farmers Market to inform vendors,
employees, and customers that they must not enter the market/event if they are sick with
COVID 19 symptoms.
ii. Post signage regarding the Social Distancing Protocol at the market/event, instru ct persons
to maintain a minimum six-foot distance from non-household members as much as
practicable and to not engage in any unnecessary physical contact.
C. Measures to Protect Employee Health:
i. Ensure vendors and employees more frequently wash hands using soap, water and single
use paper towels at each booth/vendor station. Provide hand sanitizer containing at least
60% alcohol at each booth/vendor station.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Implement foot traffic directional patterns (one-way) to limit customer interactions.
ii. Consider designating a foot traffic control monitor to ensure social distancing
requirements are maintained.
iii. Designate, with signage and/or physical barriers (ropes, warning tape), a separate order
and delivery/pickup areas to prevent customers from gathering at one location.
iv. Eliminate or reduce food and beverage consumption areas. If provided, separate dining
tables and restrict table use to keep household parties separated from others by a
minimum of 6 feet.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection: No
additional measures. See Section 1.
F. Additional Measures to Protect Health:
i. Provide stocked handwashing stations and hand sanitizer (at least 60% alcohol) for public
use.
ii. Use gloves to avoid direct bare hand contact with ready-to-eat foods.
iii. Separate booth(s) and mobile food facilities by at least six feet.
iv. Make face coverings available for vendors and employees for voluntary use. Ask vendors
and employees to use face covering when physical distancing of six feet is not feasible,
including at booths or tables .
v. Vendors should regularly sanitize/disinfect customer contact and touch points such as
tables and surfaces, on the following schedule:
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1. Counter and tables: Every 30 minutes
2. Sneeze guards: Where utilized, before each market and if they become dirty or soiled
vi. Designated employees should accept payment and handle produce/restock tables. If this
cannot be accomplished, then handwashing or use of a hand sanitizer should take place
between each transaction.
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Last updated: May 1, 2020 51
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 8. AGRICULTURE
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health:
i. Ensure that portable toilets are cleaned at least once daily.
ii. Provide agricultural workers with materials needed to regularly wash their hands (soap,
water, single use towels).
iii. Provide agricultural workers with face coverings when physical distancing cannot be
maintained.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing: No
additional measures. See Section 1.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
i. Sanitize shared equipment, tools and other materials after use, to ensure the next user is
protected.
F. Additional Measures to Protect Health: No additional measures. See Section 1.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 9. BUILDING, DEVELOPMENT & CONSTRUCTION
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health:
i. In addition to normal PPE that is worn by employees, evaluate the use of face coverings for
all employees where air flow is limited, physical distancing is difficult, or risk of
transmission is increased due to materials being used. Before requiring face coverings,
ensure they applicable safety guidelines.
ii. Limit use of office trailers on job sites by multiple trades or teams (e.g., restrict to
construction management team).
iii. Provide workers with materials needed to regularly wash their hands (soap, water, single-
use towels).
iv. Provide single serve bottles of drinking water / discontinue use of bulk water dispensers.
v. Sanitize portable restrooms at least once daily.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Coordinate on-site scheduled work so that trades/teams can maintain physical distance.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
i. Sanitize shared equipment, tools and other materials after use, to ensure next user is
protected.
F. Additional Measures to Protect Health:
i. Consider special services for immune-compromised and other vulnerable populations.
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Last updated: May 1, 2020 53
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 10. FAITH-BASED AND COMMUNITY
ORGANIZATIONS
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health: See Section 1. No additional measures. See Section 1.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Evaluate whether you can offer on-line or video gatherings.
ii. Ensure, through empty rows and seats, 6 feet of separation between family groups.
iii. Implement one-way foot traffic directional patterns to limit attendee interactions.
iv. Designate a foot traffic control monitor to ensure social distancing requirements are
maintained.
v. Control ingress/egress to eliminate crowding or bunching of attendees. Implement phased
entrance and release, as opposed to everyone moving at once. Use ushers to provide
seating assignments.
vi. Consider adding additional services to minimize number of attendees
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection: No
additional measures. See Section 1.
F. Additional Measures to Protect Health:
i. Offer special services for immune-compromised and other vulnerable populations.
ii. Funeral ceremonies are allowed to continue but should follow all physical distancing and
other protocols to limit the spread of COVID-19.
1. Provide disposable tissues to all attendees and provide trash receptacles.
2. Provide portable hand sanitizing stations, preferably touchless.
iii. Eucharist/Communion: Use no-interaction approaches such as placing a wafer/host in a
small plastic cup or small paper candy/muffin type cup/tin and passing to the recipient via
a tray on a pole or basket with a pole.
iv. Collection of Donations/Money: Use no-interaction approaches such as having
parishioners place gifts/tithes/donations in a basket with a pole through a vehicle and/or
drop in a basket upon leaving the service. For example, have a basket/box on a table that
worshippers can leave money as they leave the service. Any person that is responsible for
retrieving the donations should immediately wash their hands after handling.
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Last updated: May 1, 2020 54
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 11. PUBLIC SWIMMING POOLS, PUBLIC /SPA
POOLS
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health:
i. Disinfect high contact surfaces in break rooms, restrooms, and other common areas on
the following schedule:
1. Check-in Counters: At least twice daily while in operations
2. Restrooms: At least twice daily for high use restrooms
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Limit the number of users in the pool facility at any one time to the maximum number
which allows for customers (or groups of household members) and employees to easily
maintain at least six-foot distance from one another, at all practicable times. Physical
distancing shall be maintained both in the water and out.
ii. Assign an employee to monitor that the maximum number of users in the facility is not
exceeded and that social distancing is maintained.
iii. Place tape or other markings at least 6 feet apart in user line areas or any other area in the
pool where users congregate.
iv. Public swimming pools, therapy and lap swimming pools that do not have employees,
lifeguards, or coaches on deck to monitor social/physical distancing shall remain closed
until the Shelter-at-Home Order is modified, replaced, or lifted.
v. Keep spa pools (those with jets) closed until the Shelter-at-Home Order is modified,
replaced, or lifted. If the pool and spa pool share the same enclosure, indicate how the spa
pool will be closed (caution tape, signage, barriers, etc.).
vi. Separate seating for users and other onlookers to assure minimum six feet distancing.
vii. Instruct all employees to maintain at least six feet distance from users and from each
other, as much as practicable.
E. Measures to Prevent Unnecessary Hand Contact/Increase Sanitization/Disinfection:
i. Assign employee(s) to disinfect high-contact surfaces often (point of sale terminals,
counters, restroom surfaces, handrails, pool gates if not hands free, etc.).
F. Additional Measures to Protect Health:
i. Offer special services for immune-compromised and other vulnerable populations.
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Last updated: May 1, 2020 55
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 12. BODY ART (Tattoo, Permanent Cosmetics,
and Body Piercing Facilities)
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage:
i. Use signage to warn customers that face coverings or masks must be worn becau se
social/physical distancing is not possible.
C. Measures to Protect Employee Health:
i. Ensure practitioners wash hands more frequently and customers wash hands prior to
procedure.
ii. Ensure practitioners don disposable gloves after washing hands and prior to each
procedure.
iii. Instruct customers to wear face coverings or masks.
iv. Provide sanitizers or EPA-registered disinfectants and related cleaning supplies to all
employees.
v. Evaluate the use of face shields to provide additional protection to employees and
customers.
vi. Keep the facility as well ventilated as possible for increased exchange of outside air.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Limit the number of customers so there is at least a 6-foot physical separation between
workstations during each procedure. Perform procedures by appointment only, with no
walk-in customers.
ii. Develop systems that allow clients to wait in their cars until their practitioner is ready to
perform the procedure, rather than waiting inside the facility.
iii. Limit people inside the facility to employees/practitioners and clients only.
iv. Leverage technology to conduct consultations remotely rather than in-person.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
i. Provide practitioners with hand sanitizer and medical-grade surgical (face) masks that
completely cover the nose and mouth to use during a procedure.
ii. Use only medical-grade surgical masks and gloves that are changed with each procedure.
iii. Do not use cell phones while procedures are being conducted.
iv. Require sanitization/disinfection of workstations, equipment, tables, chairs, and other
surfaces touched by clients between each procedure and maintain documentation logs.
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F. Additional Measures to Protect Health:
i. Prohibit procedures that include tattooing or piercing genitals, or other respiratory
anatomy such as the lips and the nose until the Shelter-at-Home Order is modified,
replaced, or lifted.
ii. Evaluate establishing a customer self-certification checklist that certifies they are free of
COVID-19 related symptoms before having a procedure performed.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 13. HAIR SALONS, BARBERS, AND NAIL SALONS
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage:
i. Post signage that warns customers that masks are needed because social/physical
distancing is not possible.
ii. Post signage that non-clients are prohibited from entering the facility.
C. Measures to Protect Employee Health:
i. Require face coverings for both practitioners and clients.
ii. Require that practitioners wash hands before starting a new client, immediately after
working on a client, and after cleaning up post-client.
iii. Require that practitioners wash hands (using soap, water and single use paper towels)
before donning gloves and after removing them .
iv. Provide sanitizers or EPA-registered disinfectants and related cleaning supplies to all
practitioners and employees.
v. Evaluate the use of face shields to provide additional protection to employees and
customers.
vi. Keep the facility as well ventilated as possible for increased exchange of outside air.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Dis tancing:
i. Limit the number of customers so there is at least a 6-foot physical separation between
workstations during service delivery.
ii. Limit procedures to be conducted by appointment only, with no walk-in customers.
iii. Encourage clients to wait in their cars until their practitioner is ready, rather than waiting
inside the facility.
iv. Limit people inside the facility to employees and clients only.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
i. Provide practitioners with hand sanitizer and surgical (case) masks that completely cover
the nose and mouth to use during a procedure.
ii. Use only medical-grade surgical masks and gloves that are changed with each procedure.
iii. Do not use cellphones while services are being delivered.
iv. Require sanitization/disinfection of workstations, equipment, tables, chairs, and other
surfaces touched by clients between each procedure and maintain documentation logs
F. Additional Measures to Protect Health:
i. Install Plexiglas or other smooth and easily cleanable shielding materials if services can be
delivered from a fixed position.
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SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 14. FITNESS CENTERS/GYMS
In addition to the measures listed in Section 1 All Businesses, additional measures have been
identified for specific industry sectors and specific business types. Employers within this Industry
should implement the following additional measures:
A. Training: No additional measures. See Section 1.
B. Signage: No additional measures. See Section 1.
C. Measures to Protect Employee Health:
i. Disinfect high contact surfaces in break rooms, restrooms, and other common areas on
the following schedule:
1. Public Bathrooms: Twice daily
2. Employee Breakrooms: Daily
3. Employee Restrooms: Daily
4. Other employee shared areas: Daily
5. High contact surfaces (door handles, light switches, etc.): Daily or more frequently if
needed
6. Gym equipment: After each user.
D. Measures to Prevent Crowds from Gathering / Encourage Physical Distancing:
i. Evaluate only allowing access via appointment.
ii. Assign an employee to monitor that the maximum number of customers in the facility is
not exceeded.
iii. Use an “every other machine” approach to ensure 6 foot distancing.
iv. In the early stages of reopening, only open cardio and strength equipment areas; do not
conduct classes such as spin, aerobics, Zumba, Pilates, martial arts, etc.
v. Common equipment touch points on all equipment need to be disinfected between each
user.
vi. Develop systems for those waiting to use a piece of equipment.
E. Measures to Prevent Unnecessary Hand Contact / Increase Sanitization / Disinfection:
i. Stop use of water fountains, shared water bottles, and water stations - provide or
encourage customers to use individual water bottles.
ii. Provide disinfecting wipes containing an EPA-registered disinfectant or other disinfection
measure for customers to wipe down equipment after each use.
F. Additional Measures to Protect Health:
i. Offer special hours or appointments for immuno-compromised and other vulnerable
populations.
ii. Implement mid-day halts, where gym members are stopped from entering the facility and
a full, secondary cleaning can be completed.
County of San Luis Obispo Public Health Department
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Last updated: May 1, 2020 59
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SECTION 15. EVENTS, VENUES, AND ATTRACTIONS
Events, venues, and attractions that gather more than 10 non-household members together,
indoors or outdoors, are currently prohibited under the County Executive Order. This includes
amphitheaters, concert halls, performing arts centers, amusement parks, arcades, sporting venues
and arenas, banquet halls, casinos, cardrooms, clubs, lodges (e.g., Elk Lodge), meeting halls, country
clubs, social clubs, dance halls, water parks, and other similar venues, whether public or privately
owned.
Further guidance on events, venues, and attractions will be provided at a later date.
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Last updated: May 1, 2020 60
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
TBD: OTHER SECTORS
Note: Other sectors are under consideration but require further effort and discussion . These
include areas such as Healthcare, Education Institutions/Facilities, Child Care,
Transit/Transportation, Tourism, and more. As such they are not included in this draft Standards
and Guidelines document.
County of San Luis Obispo Public Health Department
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Last updated: May 1, 2020 61
SUPPLEMENTAL DOCUMENT TO THE TO THE
STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SLO County’s Readiness to Meet
California’s Six Indicators for Modifying
The Stay-at-Home Order
County of San Luis Obispo Public Health Department
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Last updated: May 1, 2020 62
SUPPLEMENTAL DOCUMENT TO THE TO THE STEPS TO ADAPT AND REOPEN TOGETHER (START) GUIDE
SLO County’s Readiness to Meet California’s Six Indicators for
Modifying the Stay-at-Home Order
This supplement to the County of San Luis Obispo’s Steps to Adapt and Reopen Together
(“START”) Guide is written to provide feedback and signal to State officials and the public the
state of readiness with respect to the six indicators for modifying the California Stay-at-Home
Order and the County’s Shelter At Home Order.
For each indicator listed below, situational status is provided in an effort to share evidence of
the County’s alignment with each specification.
1. The ability to monitor and protect our communities through testing, contact tracing,
isolating, and support for those who are positive or exposed
✓ Testing – there are an estimated1 4,100 SLO County residents who have been
tested to date since PCR testing for the SARS-CoV-2 (COVID-19) virus came
online. Over the past two weeks, an average 600 residents have been tested per
week across the County Public Health Laboratory, hospital-based laboratories
and commercial laboratories.
Beginning the first week of May, capacity for testing an additional 1,320 residents
per week will be added through the California contract with Optum.
Shortly thereafter, through a County contract with U.S. Health Fairs and a
surveillance study conducted in partnership with the Infectious Diseases Branch
of the California Department of Public Health, an additional 200-250 tests per
week will commence.
All told, these efforts will yield testing capability of over 300 residents daily.
While the exact level of adequate testing is unknown, this number puts the
county within reasonable reach of the Harvard University recommendation of
152/100,000 population2 (pop. = 280,000; 2.8 x 152 = 425).
✓ Contact tracing – the County Public Health Department has sufficient resources
to continue its consistent pattern of 100% case investigation and complete
contact tracing. If necessary, additional contact tracing resources are available
through the County’s Disaster Service Worker (DSW) program.
✓ Isolation – every person with a positive COVID-19 test result is issued a Health
Officer’s Order for isolation. Contacts are issued quarantine orders to
themselves and employers when indicated.
✓ Support for those who are positive or exposed – each individual who tests
positive for COVID-19 receives a daily telephone call from a Public Health Nurse
(PHN) to determine their health status, wraparound needs and to answer any
questions the person may have. When Centers for Disease Control and
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Prevention (CDC) criteria are met, the person is provided a clearance letter from
Public Health. High-risk exposed persons also receive daily check-in from a PHN
to ascertain symptoms if any and need for testing or health care.
2. The ability to prevent infection in people who are at risk for more severe COVID-19
✓ Persons who work or live in high-risk settings are eligible for priority, quick (< 24
hr.) turnaround testing at the Public Health Lab to allow rapid isolation from
high-risk peers, residents and co-workers.
✓ Extensive testing of staff and persons living in congregate setting such as skilled-
nursing facilities or corrections institutions is performed within one day of new
case identification and includes testing of asymptomatic people.
✓ The County maintains contracts with four geographically distributed motels in
order to house COVID-19-positive persons who either are homeless or cannot
safely isolate at home.
✓ SLO County maintains a food and medication distribution program to homes of
older and medically vulnerable persons so that they need not leave their homes
for these items. To date, 4,788 packages of food and 82 medication deliveries
have been home-delivered.
3. The ability of the hospital and health systems to handle surges
✓ To date, 12.7% of all cases of COVID-19 have spent one or more days in an acute
care hospital; 3.4% have needed ICU care.
✓ Daily hospital bed counts are monitored and the lowest single day percent of
licensed beds available has been 12% (when influenza was still widespread); the
average percent available general beds for the past three weeks stands at 31.8%.
✓ Across the local hospital system, there is surge capacity for an additional 562
beds or 140% of routinely staffed beds.
✓ Hospital ICU bed occupancy has averaged 22.5%.
✓ One hospital system added 11 ventilators to its inventory early in the local
outbreak for an increase of 18% over baseline; the County has procured an
additional 55 ventilators for use across the four community hospitals.
✓ In partnership with the California Polytechnic (Cal Poly) State University, the
County has stood up a 629-bed Alternate Care Site, with the opportunity to add
300 additional beds in an adjoining gymnasium. The ACS has the ability to
provide acute and sub-acute care, including oxygen support and intravenous
hydration, should hospital surge capacity be exceeded.
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4. The ability to develop therapeutics to meet the demand
✓ The local blood bank, Vitalent, in partnership with the hospitals, a local
immunologist and the Public Health Department have a program to procure and
utilize convalescent plasma in critically-ill COVID-19 patients.
✓ All community hospitals have a supply of hydrochloroquine for use in selected
cases.
✓ Patient proning (placing patient face down) is used as a treatment modality as
indicated.
5. The ability for businesses, schools, and childcare facilities to support physical distancing
✓ A detailed plan, known as the START Guide, has been completed. With
development from a panel of epidemiologists, physicians, and an attorney, and
in conjunctions with teams of 22 business and organizational sector
representatives (~250 participants), the START Guide provides criteria and timing
for moving through three-phases of reopening over a minimum period of ten
weeks. Specific guidance for maintenance of non-pharmaceutical interventions,
social distancing and use of infection control measures is included in the
document. Phasing of reopening actions is based upon the nature and risk
profile of the business or organization including schools, childcare, higher
education and faith-based institutions.
✓ Monitoring out of town travel is conducted on a weekly basis through obtaining
occupancy rates of hotels, motels and vacation rentals from Visit SLOCAL.
6. The ability to determine when to reinstitute certain measures, such as the stay-at-home
orders, if necessary
✓ The SLO County START Guide has specific measures delineated, based in large
measure upon the Results to Save Lives3 framework, that will inform the County
and the County Health Officer as to when new protective measures or full or
partial reversion to a “stay-at-home” order may be necessary.
Notes:
1 – actual number of tests performed to date is not possible as private lab reporting of negative
results was not available for a major local lab until April 3, 2020.
2 – Ashish Jha, Harvard Global Health Institute, Harvard T.H. Chan School of Public Health
3 – Resolve to Save Lives is an initiative of the global public health organization Vital Strategies
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