4.1 Mass Care Considerations for Shelter-In-Place or Restricted Movement Scenarios

4.1.1 Sheltering-In-Place, Non-Congregate Sheltering, Mobility Restrictions, and Widespread Venue Closures

A natural, accidental, or intentional outbreak of a highly contagious disease could result in a community being asked to shelter-in-place⁷⁶ (e.g., “stay at home”) based on a public health order. A large, outdoor attack could result in individuals in the affected area being advised to shelter-in-place at a specific location or within their homes for a short period of time to prevent them from being exposed to the biological agent and to protect them from a potential secondary attack. (Refer to KPF 3: Control the Spread of Disease, for additional information on these protective actions.)

An epidemic or pandemic caused by a highly transmissible agent may result in the closure of schools, businesses, and other public venues. Additional NPIs may also be advised, and sheltering-in-place could be necessary for an extended length of time. Shelter-in-place plans should include the whole community, with specialized considerations for vulnerable populations and those requiring access to essential medical services (i.e., dialysis, methadone, etc.) and/or medical supplies and other life-sustaining care. Existing all-hazards plans for sheltering-in-place may not be sufficient during a biological incident due to the potential need for specific infection control measures (e.g., PrEP, hand hygiene, wearing PPE, social distancing, disinfecting surfaces and spaces, etc.) to minimize the risk of pathogen transmission between responders and sheltered populations during the provision of mass care services. Biological incident plans also must account for the possibility of workforce shortages (e.g., significant numbers of staff and volunteers ill or quarantined and unable to participate in provision of mass care services) and traditional community mass care services being stretched to capacity. Planners should work with public health authorities, HCCs, and other appropriate partners to adapt mass care plans to meet the needs of sheltered populations, including routine feeding, prescription refills, coordination of transportation to medical appointments, access to veterinary services, etc. based on the biological incident environment.

In addition to sheltering-in-place, non-congregate sheltering (e.g., the use of hotels, public venues, private property, etc.) of certain populations may be necessary during a biological incident to protect public health and save lives. Examples of potential targeted populations include those who test positive and do not require hospitalization but should be isolated (including those exiting from hospitals); those who have been exposed but do not require hospitalization; and asymptomatic high-risk individuals subject to social distancing protocols as a precautionary measure.

Plans for sheltering-in-place and non-congregate sheltering should incorporate considerations for meeting the basic needs of the community affected, such as ensuring access to adequate food and water supplies for all, again including vulnerable populations and pets and service animals. All these needs will become more acute the longer sheltering-in-place, non-congregate sheltering, and/or venue closures extend; additional challenges will arise if business closures lead to loss of income for individuals or households.