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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

  • Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be
  • 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.

  • If surfaces are dirty, they should be cleaned using a detergent or soap and water
  • prior to disinfection.

  • For disinfection, diluted household bleach solutions, alcohol solutions with at least
  • 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.

  • Prepare a bleach solution by mixing:
  • 5 tablespoons (113ri cup) bleach per gallon of water or
  • 4 teaspoons bleach per quart of water
  • 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.).

  • For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible
  • 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

  • Wear disposable gloves when handling dirty laundry from an ill person and then
  • 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.

  • Stay home: People who are mildly ill with COVID-19 are able to recover at home.
  • Do not leave, except to get medical care. Do not visit public areas.

  • Stay in touch with your doctor. Call before you get medical care. Be sure to get care
  • if you feel worse or you think it is an emergency.

  • A void public transportation: A void using public transportation, ride-sharing, or
  • taxis.

    Separate yourself from other people in your home, this is known as home isolation

  • Stay away from others: As much as possible, you should stay in a specific "sick
  • room" and away from other people in your home. Use a separate bathroom, if

    available.

  • Limit contact with pets & animals: You should restrict contact with pets and other
  • 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

  • Call ahead: If you have a medical appointment, call your doctor's office or
  • 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

  • If you are sick: You should wear a facemask when you are around other people and
  • before you enter a healthcare provider's office.

  • If you are caring for others: If the person who is sick is not able to wear a facemask
  • (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

  • Cover: Cover your mouth and nose with a tissue when you cough or sneeze.
  • Dispose: Throw used tissues in a lined trash can.
  • Wash hands: Immediately wash your hands with soap and water for at least 20
  • 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

  • Wash hands: Wash your hands often with soap and water for at least 20 seconds.
  • This is especially important after blowing your nose, coughing, or sneezing; going

    to the bathroom; and before eating or preparing food.

  • Hand sanitizer: If soap and water are not available, use an alcohol-based hand
  • sanitizer with at least 60% alcohol, covering all surfaces of your hands and rubbing

    them together until they feel dry.

  • Soap and water: Soap and water are the best option, especially if hands are visibly
  • dirty.

  • A void touching: A void touching your eyes, nose, and mouth with unwashed hands.
  • A void sharing personal household items

  • Do not share: Do not share dishes, drinking glasses, cups, eating utensils, towels,
  • or bedding with other people in your home.

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  • Wash thoroughly after use: After using these items, wash them thoroughly with
  • 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.