PRINCIPAL’S BULLETIN
NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES
Directed Health Measure Order 2020-008
Pursuant to Neb. Rev. Stat. §§ 71-502 and 81-601 and Title 173 Neb. Admin. Code Ch. 6
the Nebraska Department of Health and Human Services ("Department") may exercise its
authority to order Directed Health Measures necessary to prevent the spread of
communicable disease, illness, or poisoning. The objectives of this order are to reduce
morbidity and mortality; minimize disease transmission; protect health care personnel and
preserve health care system functioning.
Having reviewed information from the United States Department of Health and Human
Services Centers for Disease Control and Prevention ("CDC"), local public health
departments, treating health care providers and health care facilities, and other public
health, security, and law enforcement authorities; having consulted with medical and
communicable disease control personnel of the Department; and having considered
directives and guidelines issued by the CDC and other public health authorities, the Director
finds as follows:
That a member or members of the public have been exposed to a communicable
disease, illness or poisoning, COVID-19; there are now confirmed cases of
"community spread" or "community transmission" of COVID-19 in the areas
subject to this Directed Health Measure.
That multiple areas of the United States are experiencing "community spread" of
the virus that causes COVID-19. Community spread, defined as the transmission of
an illness for which the source is unknown, means that isolation of persons traveling
from known areas of infection is no longer enough to control spread.
That exposure presents a risk of death or serious long-term disabilities to any person;
the exposure is wide-spread and poses a significant risk of harm to people in the
general population; there is a particular subset of the population that is more
vulnerable to the threat and thus at increased risk; and the threat is from a novel
infectious disease.
That the immediate implementation of the following Directed Health Measures is
necessary as members of the public continue to gather in large numbers, in close
proximity to each other, and in enclosed spaces, thereby endangering the health of
themselves and the public.
That one of the goals of the following Directed Health Measures is to minimize inperson
interaction, which is the main means of transmission of COVID-19.
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Gatherings, restaurants, and bars increase and encourage talking, touching, and
other social interaction in environments with a multitude of hard surfaces.
That requiring individuals who test positive for COVID-19 or who have the following
symptoms: fever of 100.4 F. or above, or a sudden onset of a cough or sudden onset of
shortness of breath; and individuals who reside or have resided with individuals who
have tested positive for COVID-19 or with individuals who have the above symptoms
to home-quarantine, unless quarantined in a health care facility, for a period of no less
than 14 days from the date of the positive test or onset of symptoms per attached
Quarantine Directions is the least restrictive practical means of quarantining those
individuals that effectively protects unexposed and susceptible individuals. If a HomeQuarantined
is residing with other household members, the household members'
Home-Quarantine may be discontinued 7 days after the original person has been
released from home-quarantine. However, the household member(s) must continue to
self-monitor for the above listed symptoms for an additional 7 days. Home-Quarantine
shall be per the attached Quarantine Directions. Individuals with the above-listed
symptoms who have tested positive for influenza or an alternative diagnosis
including seasonal allergies or other chronic condition and individuals who reside
or have resided with individuals who have tested positive for influenza or an
alternative diagnosis including seasonal allergies or other chronic condition are not
subject to quarantine under this Order.
That a home-quarantine will allow the most freedom of movement and
communication with family members and other contacts without allowing the
transmission of COVID-19 to others and allow the appropriate level of medical care
needed for the quarantined individuals unless it is necessary to admit the quarantined
individuals to a health care facility.
That hospital capacity and health care resources including health care personnel
hours and/or medical supplies, such as personal protective equipment, are being
depleted by elective surgeries and elective procedures and that a shortage of hospital
capacity or health care resources will hinder efforts of health care personnel and
health care facilities to treat persons who test positive for COVID-19.
That a delay in the imposition of an effective Directed Health Measure would
significantly jeopardize the ability to prevent or limit the transmission of COVID-
19 or pose unacceptable risks to any person or persons.
That the following Directed Health Measures have been identified as effective
against public health threats by the CDC and other similar public health authorities
to effectively prevent, limit, or slow the spread of COVID-19.
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I. The following Directed Health Measures are hereby ordered for: Cass, Douglas, and
Sarpy counties, effective immediately and continuing until April 30, 2020, in
addition the following Directed Health Measures are also hereby ordered for
Lancaster, Dodge, Saunders and Washington counties, effective immediately and
continuing until May 6, 2020 and in addition the following Directed Health
Measures are also hereby ordered for Hall, Hamilton, York, Seward, Butler, Polk
and Merrick counties, effective immediately and continuing until May 6, 2020, and
in addition the following Directed Health Measures are also hereby ordered for
Madison, Stanton, Cuming, and Burt counties effective immediately and continuing
until May 6, 2020 and in addition the following Directed Health Measures are also
hereby ordered for Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte,
Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties effective
immediately and continuing until May 11, 2020 and in addition the following
Directed Health Measures are also hereby ordered for Adams, Clay, Webster and
Nuckolls counties effective immediately and continuing until May 11, 2020 and in
addition the following Directed Health Measures are also hereby ordered for
Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties
effectively immediately and continuing until May 11, 2020 and in addition the
following Directed Health Measures are also hereby ordered for Antelope, Boyd,
Brown, Cherry, Holt, Keya Paha, Knox, Pierce, and Rock Counties effectively
immediately and continuing until May 11, 2020 and in addition the following
Directed Health Measures are also hereby ordered for Hooker, Arthur, McPherson,
Logan, Thomas and Lincoln counties effective immediately and continuing until
May 11, 2020 unless renewed, extended, or terminated by subsequent order, all
persons in all the aforementioned counties are ordered to comply:
1. Gatherings are hereby prohibited;
A gathering is defined as any event or convening that brings together more
than ten (10) patrons, customers or other invitees, excluding staff, in a single
room or single space at the same time, including but not limited to, preschools,
daycare facility (including in-home facilities), gymnasium, salon,
fitness center, auditorium, stadium, arena, large event conference room,
meeting hall, theater, library, or any other confined indoor or outdoor space.
This also includes weddings and funerals, as well as parades, fairs, festivals,
concerts and other indoor and outdoor events.
For the purpose of clarity, a gathering does not include normal operations
at airports, bus and train stations, health care facilities and services ( as
defined in the Health Care Facility Licensure Act NEB. REV. STAT. §§
71-401 to 71-475), other mental health and /or substance use treatment
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day programs which are not required to be licensed (such as Day
Rehabilitation or Day Treatment), shopping malls and centers, or other
spaces where ten or more persons may be in transit. It also does not include
typical office environments, factories, or retail or grocery stores where
large numbers of people are present but it is typically unusual for them to
be within six feet of one another. It also does not include events at which
members of the media may need to be present, courts of law, public
utilities, state, county, and city operations, election offices and polling
places on election day, logistics/distribution centers, or family residences
housing ten or more people. However these settings are directed to use
heightened, diligent and effective disinfection of exposed surfaces
meeting the directions of the Nebraska Department of Health and Human
Services, Centers for Disease Control and Prevention and the
Environmental Protection Agency.
Liquor, beer, and wine sales are restricted to carry-out sales and delivery
only, to the extent permitted by law. No onsite consumption is permitted.
This includes bars, taverns, and private clubs, regardless of name or
characterization.
Food and beverage sales at restaurants, bars, taverns, private clubs, and
any dine-in establishments are restricted to carry-out, drive-through, and
delivery only. This does not apply to and/or exempts food service in health
care facilities.
Lines for carry-out and drive-through in the above-referenced
establishments must have an environment where patrons and staff
maintain social distancing ( a distance of six feet away from other persons)
whenever possible.
2. Elective medical and dental surgeries and elective medical and dental
procedures are hereby prohibited. For the purposes of this Order, this
means a surgery or procedure that is scheduled in advance because it does
not involve a medical or dental emergency. Surgeries or procedures that
must be done to preserve the patient's life or physical health, but do not
need to be performed immediately, are allowed by a case-by-case
determination of the medical or dental provider.
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3. Individuals who test positive for COVID-19 or who have the following
symptoms: fever of 100.4 F. or above, or a sudden onset of a cough or sudden
onset of shortness of breath; and individuals who reside or resided with
individuals who have tested positive for COVID-19 or with individuals who
have the above symptoms shall home-quarantine, unless quarantined in a
health care facility, for a period of no less than 14 days, from the date of the
positive test or onset of symptoms, per attached Quarantine Directions. If a
Home-Quarantined is residing with other household members, the household
members' Home-Quarantine may be discontinued 7 days after the original
person has been released from home-quarantine. However, the household
member(s) must continue to self-monitor for the above listed symptoms for an
additional 7 days. Home-Quarantine shall be per the attached Quarantine
Directions. Individuals with the above-listed symptoms who have tested
positive for influenza or an alternative diagnosis including seasonal allergies or
other chronic condition and individuals who reside or have resided with
individuals who have tested positive for influenza or an alternative diagnosis
including seasonal allergies or other chronic condition are not subject to
quarantine under this Order. Please see the attached, and hereby incorporated
in full, Quarantine directions, per 173 NAC 6-006.03B. Individuals with the
above-listed symptoms who have tested positive for influenza or an
alternative diagnosis including seasonal allergies or other chronic condition
and individuals who reside or have resided with individuals who have tested
positive for influenza or an alternative diagnosis including seasonal allergies
or other chronic condition are not subject to quarantine under this Order.
II. The following Directed Health Measures are hereby ordered for ALL counties
statewide effectively immediately and continuing until May 31, 2020 unless
renewed, extended, or terminated by subsequent order, all persons in all the
aforementioned counties are ordered to comply:
1. All schools; public, private and parochial: are hereby ordered to cease all inperson
instruction, and all extra-curricular activities except for: remote
learning, child care services, meal distribution, distribution of educational
materials and supplies, general building or physical plant operations and
maintenance, and residential services may be continued as needed or
necessary
2. Schools are defined as public, private, and parochial elementary and
secondary schools.
This order supersedes previous Directed Health Measure Orders 2020-001, 2020-002,
2020-003, 2020-004, 2020-005, 2020-006 and 2020-007 for the aforementioned counties,
provided, this Order does not supersede the provisions of any Directed Health Measure(s)
issued by Local Health Departments, except that the Directed Health Measures contained
in this order are binding and enforceable regardless of any Directed Health Measure(s)
issued by Local Health Departments.
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This Order will remain in effect no longer than necessary to ensure that individuals or
groups affected by COVID-19 no longer pose a public health threat.
Failure to comply with this Order will result in legal action for enforcement by civil and/or
criminal remedies.
In the event of noncompliance with the terms of this Order, law enforcement and other
Municipal and Local Public Health Department personnel will be required to aid the
Department in enforcement of the Order, pursuant to 173 NAC 6 and NEB. REV. STAT.§
71-502.
Any person subject to this Order may request a contested case hearing to contest the validity
of the Order. A request can be made to the DHHS Hearing Office by fax at 402-742-2376
or requested by phone at 402-4 71-723 7.
Upon request, the Department will schedule a hearing to be held as soon as reasonably
possible under the circumstances. Unless requested otherwise, the hearing will be scheduled
no sooner than three days after the request is received by the Department. The hearing will
be conducted in accord with the Department's rules of practice and procedure adopted
pursuant to the Administrative Procedure Act.
The parties to the hearing will be limited to the Department and requesting party unless one
or more additional persons have requested contested case hearings on substantially identical
issues; the interests of administrative economy require that the matters be consolidated; and
no party would be prejudiced by consolidation, in which case notice of the consolidation
will issue.
A party may be represented by counsel at the party's own expense, or may appear pro se if
a natural person.
Reasonable prior notice of the time and place for hearing will be given. The hearing may
be conducted in whole or in part by telephone.
The purpose of the hearing is to determine if the factual bases for the Order exist and the
reasonableness of the ordered measures. The Director may affirm, reverse or modify the
Order by a written Findings of Fact, Conclusions of Law, and Order to be issued as soon as
reasonably possible after the hearing.
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For the Nebraska Department of Health and Human Services:
~ ~ , h11)
Gary ktho~MD I
Chief Medical Officer/Director of Public Health
'(-I - 1-0
Date
Pursuant to Title 173 Neb. Admin. Code. Ch. 6, 007.02, this Order has been provided to
and shall be disseminated through mass media.
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Quarantine Directions
Symptoms of the subject disease and course of treatment:
These symptoms may appear 2-14 days after exposure: fever of 100.4 degrees Fahrenheit
or above, cough, and shortness of breath. Follow your medical provider's directions for
course of treatment. Emergency warning signs for COVID-19 require medical attention
immediately. Emergency warning signs include: trouble breathing, persistent pain or
pressure in the chest, new confusion or inability to arouse and bluish lips or face. Consult
your medical provider for any other symptoms that are severe or concerning.
Instructions on the disinfecting or disposal of any personal property;
Surfaces
discarded after each cleaning. If reusable gloves are used, those gloves should be
dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be
used for other purposes. Consult the manufacturer's instructions for cleaning and
disinfection products used. Clean hands immediately after gloves are removed.
prior to disinfection.
70% alcohol, and most common EPA-registered household disinfectants should be
effective.
o Diluted household bleach solutions can be used if appropriate for the surface.
Follow manufacturer's instructions for application and proper ventilation.
Check to ensure the product is not past its expiration date. Never mix
household bleach with ammonia or any other cleanser. Unexpired household
bleach will be effective against coronaviruses when properly diluted.
o Products with BPS-approved emerging viral pathogen claims
https://www.epa. go Ids i te s/pro du c tion/fi le s/2020-03/documents/s arscov-
2 - list 03-03-2020.pdf are expected to be effective against COVID-19
based on data for harder to kill viruses. Follow the manufacturer's instructions
for all cleaning and disinfection products (e.g., concentration, application
method and contact time, etc.).
contamination if present and clean with appropriate cleaners indicated for use on
these surfaces. After cleaning:
o Launder items as appropriate in accordance with the manufacturer's
instructions . If possible, launder items using the warmest appropriate water
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setting for the items and dry items completely, or Use products with
the BP A-approved emerging viral pa tho gens claims ( examples at
bttps >span>://www .americanchemistty.corn /Novel -CoronavirusFigbting-
Products -List.pdf that are suitable for porous surfaces.
Clothing, towels, linens and other items that go in the laundry
discard after each use. If using reusable gloves, those gloves should be dedicated for
cleaning and disinfection of surfaces for COVID-19 and should not be used for other
household purposes. Clean hands immediately after gloves are removed.
o If no gloves are used when handling dirty laundry, be sure to wash hands
afterwards.
o If possible, do not shake dirty laundry. This will minimize the possibility of
dispersing virus through the air.
o Launder items as appropriate in accordance with the manufacturer's
instructions. If possible, launder items using the warmest appropriate water
setting for the items and dry items completely. Dirty laundry from an ill
person can be washed with other people's items.
o Clean and disinfect clothes hampers according to guidance above for
surfaces. If possible, consider placing a bag liner that is either disposable
(can be thrown away) or can be laundered.
Precautions to prevent the spread of the subject disease;
Stay home except to get medical care.
Do not leave, except to get medical care. Do not visit public areas.
if you feel worse or you think it is an emergency.
taxis.
Separate yourself from other people in your home, this is known as home isolation
room" and away from other people in your home. Use a separate bathroom, if
available.
animals, just like you would around other people.
o Although there have not been reports of pets or other animals becoming sick
with COVID-19, it is still recommended that people with the virus limit
contact with animals until more information is known.
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o When possible, have another member of your household care for your animals
while you are sick with COVID-19. If you must care for your pet or be
around animals while you are sick, wash your hands before and after you
interact with them.
Call ahead before visiting your doctor
emergency depatiment, and tell them you have or may have COVID-19. This will
help the office protect themselves and other patients.
Wear a facemask if you are sick
before you enter a healthcare provider's office.
(for example, because it causes trouble breathing), then people who live in the home
should stay in a different room. When caregivers enter the room of the sick person,
they should wear a facemask. Visitors, other than caregivers, are not recommended.
Cover your coughs and sneezes
seconds. If soap and water are not available, clean your hands with an alcohol-based
hand sanitizer that contains at least 60% alcohol.
Clean your hands often
This is especially important after blowing your nose, coughing, or sneezing; going
to the bathroom; and before eating or preparing food.
sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing
them together until they feel dry.
dirty.
A void sharing personal household items
or bedding with other people in your home.
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soap and water or put in the dishwasher.
Clean all "high-touch" surfaces everyday
You have a right to an independent medical exam at your own expense.
Provisions to ensure and monitor compliance;
Self-monitor twice daily for fever and other symptoms listed above for fourteen days.
Coordinate with your health care provider and local public health department.
Individuals who tested positive for COVID-19 may be released from quarantine if at least
seven (7) days have passed since onset of symptoms and symptoms have improved and the
individual has been fever-free for at least 72 hours without the use of fever-reducing
medication.