CS 315926-A 03/12/2020

For more information: www.cdc.gov/COVID19

Implementation of Mitigation Strategies for Communities 

with Local COVID-19 Transmission 

Background

When a novel virus with pandemic potential emerges, 

nonpharmaceutical interventions, which will be called 

community mitigation strategies in this document, often 

are the most readily available interventions to help slow 

transmission of the virus in communities. Community 

mitigation is a set of actions that persons and communities 

can take to help slow the spread of respiratory virus 

infections. Community mitigation is especially important 

before a vaccine or drug becomes widely available.

The following is a framework for actions which local and 

state health departments can recommend in their 

community to both prepare for and mitigate community 

transmission of COVID-19 in the United States. Selection and 

implementation of these actions should be guided by the 

local characteristics of disease transmission, demographics, 

and public health and healthcare system capacity. 

Goals

The goals for using mitigation strategies in communities 

with local COVID-19 transmission are to slow the 

transmission of disease and in particular to protect:

• Individuals at increased risk for severe illness, including

older adults and persons of any age with underlying

health conditions (See Appendix A)

• The healthcare and critical infrastructure workforces

These approaches are used to minimize morbidity and 

mortality and the social and economic impacts of COVID-19. 

Individuals, communities, businesses, and healthcare 

organizations are all part of a community mitigation strategy. 

These strategies should be implemented to prepare for and 

when there is evidence of community transmission. Signals of 

ongoing community transmission may include detection of 

confirmed cases of COVID-19 with no epidemiologic link to 

travelers or known cases, or more than three generations of 

transmission. 

Implementation is based on:

• Emphasizing individual responsibility for implementing

recommended personal-level actions

• Empowering businesses, schools, and community

organizations to implement recommended actions,

particularly in ways that protect persons at increased risk of

severe illness

• Focusing on settings that provide critical infrastructure or

services to individuals at increased risk of severe illness

• Minimizing disruptions to daily life to the extent possible

Guiding principles

• Each community is unique, and appropriate mitigation

strategies will vary based on the level of community

transmission, characteristics of the community and their

populations, and the local capacity to implement strategies

(Table 1).

• Consider all aspects of a community that might be

impacted, including populations most vulnerable to severe

illness and those that may be more impacted socially or

economically, and select appropriate actions.

• Mitigation strategies can be scaled up or down depending

on the evolving local situation.

• When developing mitigation plans, communities should

identify ways to ensure the safety and social well-being of

groups that may be especially impacted by mitigation

strategies, including individuals at increased risk for

severe illness.

• Activation of community emergency plans is critical for

the implementation of mitigation strategies. These plans

may provide additional authorities and coordination

needed for interventions to be implemented (Table 2).

• Activities in Table 2 may be implemented at any time

regardless of the level of community transmission based

on guidance on from local and state health officials.

• The level of activities implemented may vary across the

settings described in Table 2 (e.g., they may be at a minimal/

moderate level for one setting and at a substantial level for

another setting in order to meet community response needs).

• Depending on the level of community spread, local and state

public health departments may need to implement

mitigation strategies for public health functions to identify

cases and conduct contact tracing (Table 3). When applied,

community mitigation efforts may help facilitate public

health activities like contact tracing
2

Table 1. Local Factors to Consider for Determining Mitigation Strategies

Factor Characteristics

Epidemiology • Level of community transmission (see Table 3)

• Number and type of outbreaks (e.g., nursing homes, schools, etc.)

• Impact of the outbreaks on delivery of healthcare or other critical infrastructure or services

• Epidemiology in surrounding jurisdictions

Community 

Characteristics

• Size of community and population density

• Level of community engagement/support

• Size and characteristics of vulnerable populations

• Access to healthcare

• Transportation (e.g., public, walking)

• Planned large events

• Relationship of community to other communities (e.g., transportation hub, tourist destination, etc.)

Healthcare capacity • Healthcare workforce

• Number of healthcare facilities (including ancillary healthcare facilities)

• Testing capacity

• Intensive care capacity

• Availability of personal protective equipment (PPE)

Public health capacity • Public health workforce and availability of resources to implement strategies

• Available support from other state/local government agencies and partner organizations
Table 2. Community mitigation strategies by setting and by level of community transmission or impact of COVID-19

Potential mitigation activities according to level of community transmission or impact of COVID-19 by setting

Factor None to Minimal Minimal to moderate Substantial

Individuals and 

Families at Home 

“What you can do to 

prepare, if you or a 

family member gets 

ill, or if your 

community

experiences spread of

COVID-19”

• Know where to find local information on

COVID-19 and local trends of COVID-19 cases.

• Know the signs and symptoms of COVID-19

and what to do if symptomatic:

» Stay home when you are sick

» Call your health care provider’s office in

 advance of a visit

» Limit movement in the community

» Limit visitors

• Know what additional measures those at highrisk and who are vulnerable should take.

• Implement personal protective measures (e.g.,

stay home when sick, handwashing, respiratory 

etiquette, clean frequently touched surfaces

daily).

• Create a household plan of action in case of

illness in the household or disruption of daily 

activities due to COVID-19 in the community.

» Consider 2-week supply of prescription 

and over the counter medications,

food and other essentials. Know how 

to get food delivered if possible.

» Establish ways to communicate with others

(e.g., family, friends, co-workers).

» Establish plans to telework, what to do 

about childcare needs, how to adapt

to cancellation of events.

• Know about emergency operations plans for

schools/workplaces of household members.

• Continue to monitor local information about

COVID-19 in your community.

• Continue to practice personal protective

measures.

• Continue to put household plan into action.

• Individuals at increased risk of severe illness

should consider staying at home and avoiding

gatherings or other situations of potential

exposures, including travel.

• Continue to monitor local information.

• Continue to practice personal protective

measures.

• Continue to put household plan into place.

• All individuals should limit community 

movement and adapt to disruptions in routine

activities (e.g., school and/or work closures)

according to guidance from local officials.
4

Factor Potential mitigation activities according to level of community transmission or impact 

Schools/childcare “What childcare facilities, K-12 schools, and colleges and universities can do to prepare for COVID-19, if the school or facility has cases of COVID-19, or if the community is experiencing spread of COVID-19)”

• Know where to find local information on 

COVID-19 and local trends of COVID-19 cases.

• Know the signs and symptoms of COVID-19 

and what to do if students or staff become symptomatic at school/childcare site.

• Review and update emergency operations plan 

(including implementation of social distancing measures, distance learning if feasible) or develop plan if one is not available.

• Evaluate whether there are students or staff 

who are at increased risk of severe illness and develop plans for them to continue to work or receive educational services if there is moderate levels of COVID-19 transmission or impact.» Parents of children at increased risk for severe illness should discuss with their health care provider whether those students should stay home in case of school or community spread. 

» Staff at increased risk for severe illness should have a plan to stay home if there are school-based cases or community spread. 

• Encourage staff and students to stay home 

when sick and notify school administrators of illness (schools should provide non-punitive sick leave options to allow staff to stay home when ill).

• Encourage personal protective measures 

among staff/students (e.g., stay home when sick, handwashing, respiratory etiquette).

• Clean and disinfect frequently touched 

surfaces daily.

• Ensure hand hygiene supplies are readily 

available in buildings.

•

» Alter schedules to reduce mixing (e.g., 

stagger recess, entry/dismissal times) 

» Limit inter-school interactions» Consider distance or e-learning in some  settings 

• Consider regular health checks (e.g., 

temperature and respiratory symptom screening) of students, staff, and visitors (if feasible).

• Short-term dismissals for school and 

extracurricular activities as needed (e.g., if cases in staff/students) for cleaning and contact tracing.

• Students at increased risk of severe illness 

should consider implementing individual plans for distance learning, e-learning.

• Broader and

either as a pstaff and/or 

• Cancellation 

congregatioparticipation 

• Implement d

Implement social distancing measures:

» Reduce the frequency of large gatherings

(e.g., assemblies), and limit the number ofattendees per gathering.

None to Minimal Minimal to moderate 
5

Assisted living facilities, senior living facilities and adult day programs “What facilities can do to prepare for COVID-19, if the facility has cases of COVID-19, or if the community is experiencing spread of COVID-19)”

• Know where to find local information on

COVID-19.

• Know the signs and symptoms of COVID-19

and what to do if clients/residents or staffbecome symptomatic.

• Review and update emergency operations

plan (including implementation of socialdistancing measures) or develop a plan if oneis not available.

• Encourage personal protective measures among 

staff, residents and clients who live elsewhere (e.g., stay home or in residences when sick, handwashing, respiratory etiquette).

• Clean frequently touched surfaces daily.• Ensure hand hygiene supplies are readily

available in all buildings.

• Implement social distancing measures:

» Reduce large gatherings (e.g., group socialevents)» Alter schedules to reduce mixing (e.g.,  stagger meal, activity, arrival/departure  times) » Limit programs with external staff» Consider having residents stay in facility and limit exposure to the general community » Limit visitors, implement screening

• Temperature and respiratory symptom

screening of attendees, staff, and visitors.

• Short-term closures as needed (e.g., if cases in

staff, residents or clients who live elsewhere)for cleaning and contact tracing.

• Longer-term • Restrict or li

of 1 per day)

Factor

Potential mitigation activities according to level of community transmission or impact of 

None to Minimal Minimal to moderate 
6

Workplace “What workplaces can do to prepare for COVID-19, if the workplace has cases of COVID-19, or if the community is experiencing spread of COVID-19)”

• Know where to find local information on 

COVID-19 and local trends of COVID-19 cases.

• Know the signs and symptoms of COVID-19 and 

what to do if staff become symptomatic at the worksite.

• Review, update, or develop workplace plans to 

include:» Liberal leave and telework policies» Consider 7-day leave policies for people with COVID-19 symptoms» Consider alternate team approaches for  work schedules.

• Encourage employees to stay home and 

notify workplace administrators when sick (workplaces should provide non-punitive sick leave options to allow staff to stay home when ill).

• Encourage personal protective measures 

among staff (e.g., stay home when sick, handwashing, respiratory etiquette).

• Clean and disinfect frequently touched 

surfaces daily.

• Ensure hand hygiene supplies are readily 

available in building.

• Encourage staff to telework (when feasible), 

particularly individuals at increased risk of severe illness.

• Implement social distancing measures:

» Increasing physical space between workers at the worksite » Staggering work schedules» Decreasing social contacts in the workplace  (e.g., limit in-person meetings, meeting for lunch in a break room, etc.)

• Limit large work-related gatherings (e.g., staff 

meetings, after-work functions).

• Limit non-essential work travel.• Consider regular health checks (e.g., 

temperature and respiratory symptom screening) of staff and visitors entering buildings (if feasible).

• Implement e

(when feasib

• Ensure flexi

need to stay dismissals.

• Cancel non-• Cancel work

tradeshows, 

Factor

Potential mitigation activities according to level of community transmission or impact o

None to Minimal Minimal to moderate 
7

Community and faith-based organizations“What organizations can do to prepare for COVID-19, if the organizations has cases of COVID-19, or if the community is experiencing spread of COVID-19)”

• Know where to find local information on 

COVID-19 and local trends of COVID-19 cases.

• Know the signs and symptoms of COVID-19 

and what to do if organization members/staff become symptomatic.

• Identify safe ways to serve those that are at high 

risk or vulnerable (outreach, assistance, etc.).

• Review, update, or develop emergency plans 

for the organization, especially consideration for individuals at increased risk of severe illness.

• Encourage staff and members to stay home 

and notify organization administrators of illness when sick.

• Encourage personal protective measures 

among organization/members and staff (e.g., stay home when sick, handwashing, respiratory etiquette).

• Clean frequently touched surfaces at 

organization gathering points daily.

• Ensure hand hygiene supplies are readily 

available in building.

• Implement social distancing measures:

» Reduce activities (e.g., group congregation, religious services), especially for organizations with individuals at increased risk of severe illness. 

» Consider offering video/audio of events.

• Determine ways to continue providing support 

services to individuals at increased risk of severe disease (services, meals, checking in) while limiting group settings and exposures.

• Cancel large gatherings (e.g., >250 people, 

though threshold is at the discretion of the community) or move to smaller groupings.

• For organizations that serve high-risk 

populations, cancel gatherings of more than 10 people.

• Cancel comm

of any size.

Factor

Potential mitigation activities according to level of community transmission or impact of 

None to Minimal Minimal to moderate 
8

Healthcare settings and healthcare provider (includes outpatient, nursing homes/longterm care facilities, inpatient, telehealth) “What healthcare settings including nursing homes/longterm care facilities, can do to prepare for COVID-19, if the facilities has cases of COVID-19, or if the community is experiencing spread of COVID-19)”

• Provide healthcare personnel ([HCP], including 

staff at nursing homes and long-term care facilities) and systems with tools and guidance needed to support their decisions to care for patients at home (or in nursing homes/longterm care facilities).

• Develop systems for phone triage and 

telemedicine to reduce unnecessary healthcare visits.

• Assess facility infection control programs; 

assess personal protective equipment (PPE) supplies and optimize PPE use.

• Assess plans for monitoring of HCP and plans 

for increasing numbers of HCP if needed.

• Assess visitor policies.• Assess HCP sick leave policies (healthcare 

facilities should provide non-punitive sick leave options to allow HCP to stay home when ill). 

• Encourage HCP to stay home and notify 

healthcare facility administrators when sick.

• In conjunction with local health department, 

identify exposed HCP, and implement recommended monitoring and work restrictions.

• Implement triage prior to entering facilities 

to rapidly identify and isolate patients with respiratory illness (e.g., phone triage before patient arrival, triage upon arrival).

• Implement changes to visitor policies to 

further limit exposures to HCP, residents, and patients. Changes could include temperature/symptom checks for visitors, limiting visitor movement in the facility, etc.

• Implement triage before entering facilities 

(e.g., parking lot triage, front door), phone triage, and telemedicine to limit unnecessary healthcare visits.

• Actively monitor absenteeism and respiratory 

illness among HCP and patients.

• Actively monitor PPE supplies.• Establish processes to evaluate and test large 

numbers of patients and HCP with respiratory symptoms (e.g., designated clinic, surge tent).

• Consider allowing asymptomatic exposed HCP 

to work while wearing a facemask.

• Begin to cross train HCP for working in other 

units in anticipation of staffing shortages.

• Restrict or li

day) to redu

• Identify area

subject to alimplement nmildly sympwearing a fa

• Cancel elect• Establish co

numbers of 

• Consider req

when in the 

Factor

Potential mitigation activities according to level of community transmission or impact of 

None to Minimal Minimal to moderate 
9

Table 3. Potential mitigation strategies for public health functions

Public health control activities by level of COVID-19 community transmission

None to Minimal Minimal to Moderate Substantial

Evidence of isolated cases or limited 

community transmission, case 

investigations underway, no evidence of 

exposure in large communal setting,e.g., 

healthcare facility, school, mass 

gathering.

Widespread and/or sustained 

transmission with high likelihood or 

confirmed exposure within communal 

settings with potential for rapid increase 

in suspected cases.

Large scale community transmission, 

healthcare staffing significantly 

impacted, multiple cases within 

communal settings like healthcare 

facilities, schools, mass gatherings etc.

• Continue contact tracing, monitor

and observe contacts as advised in

guidance to maximize containment

around cases.

• Isolation of confirmed COVID-19 cases

until no longer considered infectious

according to guidance.

• For asymptomatic close contacts

exposed to a confirmed COVID-19

case, consideration of movement

restrictions based on risk level, social

distancing.

• Monitoring close contacts should be

done by jurisdictions to the extent

feasible based on local priorities and

resources.

• Encourage HCP to develop phone

triage and telemedicine practices.

• Test individuals with signs and

symptoms compatible with COVID-19.

• Determine methods to streamline

contact tracing through simplified

data collection and surge if needed

(resources including staffing through

colleges and other first responders,

technology etc.).

• May reduce contact tracing if

resources dictate, prioritizing to those

in high-risk settings (e.g., healthcare

professionals or high-risk settings

based on vulnerable populations or

critical infrastructure).

• Encourage HCP to more strictly

implement phone triage and

telemedicine practices.

• Continue COVID-19 testing of

symptomatic persons; however, if

testing capacity limited, prioritize

testing of high-risk individuals.

• May reduce contact tracing if

resources dictate, prioritizing to those

in high-risk settings (e.g., healthcare

professionals or high-risk settings

based on vulnerable populations or

critical infrastructure).

• Encourage HCP to more strictly

implement phone triage and

telemedicine practices.

• Continue COVID-19 testing of

symptomatic persons; however, if

testing capacity limited, prioritize

testing of high-risk individuals.
10

Appendix A: Underlying medical conditions that may increase the risk of 

serious COVID-19 for individuals of any age.

• Blood disorders (e.g., sickle cell disease or on blood thinners)

• Chronic kidney disease as defined by your doctor. Patient has been told to avoid or reduce the dose of medications because 

kidney disease, or is under treatment for kidney disease, including receiving dialysis

• Chronic liver disease as defined by your doctor. (e.g., cirrhosis, chronic hepatitis) Patient has been told to avoid or reduce 

the dose of medications because liver disease or is under treatment for liver disease.

• Compromised immune system (immunosuppression) (e.g., seeing a doctor for cancer and treatment such as 

chemotherapy or radiation, received an organ or bone marrow transplant, taking high doses of corticosteroids or other 

immunosuppressant medications, HIV or AIDS)

• Current or recent pregnancy in the last two weeks

• Endocrine disorders (e.g., diabetes mellitus)

• Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)

• Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)

• Lung disease including asthma or chronic obstructive pulmonary disease (chronic bronchitis or emphysema) or other chronic 

conditions associated with impaired lung function or that require home oxygen

• Neurological and neurologic and neurodevelopment conditions [including disorders of the brain, spinal cord, peripheral 

nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability, moderate to severe 

developmental delay, muscular dystrophy, or spinal cord injury].