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Agenda 04/28/2020 Item #11A (COVID-19 Update)04/28/2020 Collier County Board of County Commissioners COVID-19 update/discussion April 28, 2020 1. Public Health System Report a. Collier County Gating Criteria Assessment b. Operational Assessment (test, trace and isolate capacity, COVID 19 & antibody testing availability & protocols, other resource constraints) c. Vulnerable Population Assessment (including elderly care facilities) 2. Community Healthcare System Report a. Hospital Capacity Assessment (current & surge planning) b. Healthcare Workforce Capacity c. Elective Surgery Capacity 3. Emergency Services Report a. Law Enforcement b. Emergency Management 4. Local Business Conditions & Assistance Assessment a. Chamber Business Survey Summary b. Collier Economic Recovery Update 5. County Operations Report a. Service Level Assessment b. Plans for Restoring Full-Service Levels in Public Service Operations (Parks, Beaches, Library, CHS, DAS, Museum) c. Plans for Restoring Public Lobby’s and Meeting Spaces in Additional Departments & Constitutional Offices ATTACHMENT(S) 1. Florida Strike Force Briefing (PDF) 2. Federal Guidelines for Opening Up America Again (PDF) 11.A Packet Pg. 23 01 .1," ; • r 4710000. Collier County Board of County Commissioners COVID-19 update/discussion April 28, 2020 1. Public Health System Report a. Collier County Gating Criteria Assessment b. Operational Assessment (test, trace and isolate capacity, COVID 19 & antibody testing availability & protocols, other resource constraints) c. Vulnerable Population Assessment (including elderly care facilities) 2. Community Healthcare System Report a. Hospital Capacity Assessment (current & surge planning) b. Healthcare Workforce Capacity c. Elective Surgery Capacity 3. Emergency Services Report a. Law Enforcement b. Emergency Management 4. Local Business Conditions & Assistance Assessment a. Chamber Business Survey Summary b. Collier Economic Recovery Update 5. County Operations Report a. Service Level Assessment b. Plans for Restoring Full-Service Levels in Public Service Operations (Parks, Beaches, Library, CHS, DAS, Museum) c. Plans for Restoring Public Lobby's and Meeting Spaces in Additional Departments & Constitutional Offices d. Opportunities for public involvement in community reopening planning 04/28/2020 COLLIER COUNTY Board of County Commissioners Item Number: 11.A Doc ID: 12269 Item Summary: COVID-19 Update/Discussion Meeting Date: 04/28/2020 Prepared by: Title: Operations Analyst – County Manager's Office Name: Geoffrey Willig 04/22/2020 3:09 PM Submitted by: Title: County Manager – County Manager's Office Name: Leo E. Ochs 04/22/2020 3:09 PM Approved By: Review: Office of Management and Budget MaryJo Brock Level 3 OMB Gatekeeper Review Skipped 04/22/2020 1:24 PM County Attorney's Office MaryJo Brock Level 3 County Attorney's Office Review Skipped 04/22/2020 1:24 PM County Manager's Office Leo E. Ochs Level 4 County Manager Review Completed 04/22/2020 3:49 PM Board of County Commissioners MaryJo Brock Meeting Pending 04/28/2020 9:00 AM 11.A Packet Pg. 24 April 20, 2020 Re-open Florida Presented to Governor Ron DeSantis’ Re-open Florida Task Force BY: Mark Wilson, President and CEO, Florida Chamber of Commerce, Dr. Jerry Parrish,Chief Economist,Florida Chamber Foundation 11.A.a Packet Pg. 25 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 22 Florida At A Glance (Pre COVID-19) 3rd most populated State in America and growing 900 people every day 810 are from other states and countries Florida was creating 1 in every 11 NEW U.S. Jobs since 2015 At $1.1 trillion, Florida is world’s 17th largest economy with a Florida 2030 Blueprint goal of 10th by 2030 Adding $1.19 million in income migration per hour (24/7/365) Unemployment at 2.8% (291,000 unemployed), with 340,800 OPEN and UNFILLED jobs (Feb 2020) 20th most diversified economy in U.S. with a Florida 2030 Blueprint goal of Top 12 by 2030 11.A.a Packet Pg. 26 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) Florida Industry Diversification by MSA Diversification Rankings #1 Lakeland-Winter Haven MSA #2 Palm Bay-Melbourne-Titusville MSA #3 Naples-Immokalee-Marco Island MSA #4 Miami-Ft. Lauderdale-West Palm Beach MSA #5 Orlando-Kissimmee-Sanford MSA #6 Cape Coral-Ft. Myers MSA #7 Jacksonville MSA #8 Tampa-St. Petersburg-Clearwater MSA #9 Ocala MSA #10 North Port-Sarasota-Bradenton MSA Data Source: Florida Gulf Coast University, Regional Economic Research Institute. Q3 2019 data www.theFloridaScorecard.org 11.A.a Packet Pg. 27 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 44 Reopening in Florida will need to be more surgical than in other states for at least 4 reasons 20%Share of tax receipts coming from Tourism Share of general revenues coming from Sales and Use Taxes of Florida’s population is aged 65 or older the beginning of the hurricane season in Florida 79% 21% 6/1 11.A.a Packet Pg. 28 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 5 2 12 13 7 12 4 4 7 4 11 8 1 3 4 1 3 0 2 0 0 2019 GDP share of total, %2019 employment share of total, % 17 11 9 7 7 7 6 5 5 4 4 4 3 3 2 2 2 1 1 0 Professional services Government Healthcare Real Estate Retail Construction Wholesale trade Finance & insurance Agriculture Recreation & sports Manufacturing Administrative Accommodation & food (tourism) Information Transportation Other Management Utilities Education Mining GDP and jobs share by sector 11.A.a Packet Pg. 29 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 6 913 736 279 237 Mining 217 Utilities 118 147 Administrative 211 117Real Estate Retail 93 28 88 76 59 Management 47 40 Agriculture 38 17 9 Professional services Wholesale trade Transportation 1 Education 0 89 Information Accommodation & food (tourism) Construction Recreation & sports Healthcare Government Manufacturing Personal & laundry Finance Religious & Labor unions Repair & maintenance Total vulnerable jobs in Florida, thousands Jobs at risk analysis factors the risk of occupations that are performed in close proximity to other employees and to the public Based on the analysis of risk profile of more than 800 occupations 11.A.a Packet Pg. 30 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 7 Sizable impact on small businesses 42% 22% 69% 10% 27% 38% 22% 47% 44% 34% 65% 53% 33% 16% 69% 71% 19% 3% 7% 44% 91% 13% 5% 18% 6% 20% 20% 10% 13% 16% 20% 9% 13% 18% 10% 15% 6% 10% 9% 14% 8% 9% 45% 73% 13% 84% 53% 42% 68% 40% 40% 46% 25% 34% 49% 74% 16% 22% 70% 88% 79% 48% Construction Retail Information Accommodation & food (Tourism) Administrative Healthcare 93 211 Recreation & sports Transportation Government Real Estate Wholesale trade Manufacturing Personal & laundry Professional services Education Finance & insurance Religious & Labor unions 59 Repair & maintenance 88 Management 76 Utilities Mining 9 736 Agriculture 913 279 237 1 217 147 118 117 89 47 40 38 28 17 0 0-99 employees 100-499 employees 500+ employees 52% 12% 36% 500+ 3,412,102 0-99 100-499 100% = Private Industry vulnerable jobs by company size (%, K) Total private sector jobs impacted (%) 11.A.a Packet Pg. 31 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 88 Potential GDP scenarios 100 90 85 110 95 105 Q2Q1 Q3 Q4 Q1 Q2 Q3 Q4 History Pessimistic scenario Optimistic scenario Real GDP Growth –COVID-19 Crisis Indexed, 2019 Q4=100 2019 2020 -2.3% -8.9% 2020 GDP Growth % Change Real GDP, Indexed 2020 Q4 2024 Q2 Time to Return to Pre-Crisis Quarter 11.A.a Packet Pg. 32 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 99 Potential risk by sector Risk Utilities Education Administrative Wholesale trade Manufacturing Mining Information Medium (20-40% jobs at risk)High (40%+ jobs at risk) Accommodation & food (Tourism) Recreation & sports Retail Real Estate Construction2 Transportation Low (<20% jobs at risk) % of Florida jobs1 19.5 38.837.7 % of Florida GDP1 23.3 38.535.5 Healthcare Agriculture Management Government Professional services Finance & insurance 1.Does not include others 2.Approach will be adapted to different subsectors 11.A.a Packet Pg. 33 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 1010 Potential risk by sector and company size Risk Utilities (21%) Education (51%) Administrative (16%) Wholesale trade (60%) Manufacturing (54%) Mining (52%) Information (30%) Medium (20-40% jobs at risk)High (40%+ jobs at risk) Accommodation & food (Tourism) (55%) Recreation & sports (47%) Retail (27%) Real Estate (60%) Construction2 (87%) Transportation (32%) Low (<20% jobs at risk) Healthcare (58%) Agriculture (91%) Management (12%) Government (0%) Professional services (66%) Finance & insurance (26%) Share of jobs at risk in SMEs (<500 employees) in parentheses % of Florida jobs1 19.5 38.837.7 % of Florida GDP11 23.3 38.535.5 Total Employment 1.8M 3.5M3.4M # SME firms 82K 182K141K #jobs in firms with <100 employees 24.7%37.6%24.8% # jobs in firms with 500+ employees 62.9%50.7%64.6% #jobs in firms with 100-499 employees 12.4%11.7%10.6% 1.Does not include others 2.Approach will be adapted to different subsectors 11.A.a Packet Pg. 34 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 1111 18 94890 13 6 88104812166414 12 20 22 24 26 44 2 28 30 5 32 3 86346636 15 18 17 38 68 14 50404246 52 54 9 56 6058 62 10 767072 16 7 78074 80 82 84 92 6 1 4 8 11 Recreation & sports Jobs at risks % Government Accommodation & food (tourism) Administrative Agriculture Construction Education Finance & insurance Retail Healthcare Share of GDP Percent Management Manufacturing Mining Professional services Real Estate Transportation Utilities Wholesale trade Information Sectors mapped based on the size of the sector, share of jobs at risk, and risk profile Size of bubble = # jobs at riskMediumHighLow Risk profile 11.A.a Packet Pg. 35 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 1212 Detailed data by sector High1 Total jobs Jobs at risk Jobs at risk #jobs in firms with <100 employees #jobs in firms with 100-499 employees #jobs in firms with 500+ employees Accommodation & food (Tourism)1,030,395 912,837 88.6%430,734 132,588 467,073 Recreation & sports 250,811 216,832 86.5%66,968 51,106 132,737 Retail 1,119,514 736,145 65.8%242,656 60,815 816,043 Real Estate 194,770 116,505 59.8%90,793 25,157 78,820 Construction 610,052 278,639 45.7%418,461 111,937 79,654 Transportation 292,680 118,149 40.4%63,976 28,508 200,196 Medium1 Total jobs Jobs at risk Jobs at risk #jobs in firms with <100 employees #jobs in firms with 100-499 employees #jobs in firms with 500+ employees Utilities 23,406 8,843 37.8%1,750 3,207 18,449 Education 162,715 58,632 36.0%54,142 28,690 79,883 Administrative 711,316 236,724 33.3%70,897 39,382 601,036 Wholesale trade 349,279 92,971 26.6%152,032 57,622 139,625 Manufacturing 372,781 88,812 23.8%127,137 75,922 169,722 Mining 4,005 952 23.8%1,770 304 1,930 Information 134,549 27,699 20.6%26,200 13,682 94,668 Low1 Total jobs Jobs at risk Jobs at risk #jobs in firms with <100 employees #jobs in firms with 100-499 employees #jobs in firms with 500+ employees Healthcare 1,193,261 211,342 17.7%456,955 232,813 503,492 Agriculture 2,927 500 17.1%2,656 -271 Management 111,031 17,008 15.3%3,293 10,048 97,690 Government 1,102,818 147,329 13.4%--1,102,818 Professional services 605,087 76,148 12.6%318,232 79,183 207,672 Finance & insurance 384,915 46,997 12.2%60,399 39,410 285,105 1.Does not include others 11.A.a Packet Pg. 36 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) Rank Category Annual Avg Receipts 2018-19 $Billion Avg Percent 2018-19 1 Automotive Dealers 4.00 14.4% 2 General Merchandise Stores 3.71 13.3% 3 Restaurants and Catering Services 2.74 9.8% 4 Lease or Rental of Commercial Real Property 1.91 6.8% 5 Hotel/Motel Accommodations 1.72 6.2% 6 Food & Beverage Stores 1.34 4.8% 7 Building Materials Dealers 1.31 4.7% 8 Wholesale Dealers 1.09 3.9% 9 Amusement & Recreation Services 1.05 3.8% 10 Apparel & Accessory Stores 1.01 3.6% 11 Manufacturing 0.75 2.7% 17 Consumer Electronics, Computers, Music Stores 0.63 2.3% 18 Home Furniture, Furnishings & Equipment 0.59 2.1% 19 Utilities, Electric, Gas, Water, Sewer 0.56 2.0% 20 Rental of Tangible Personal Property 0.41 1.5% 21 Automotive Accessories & Parts 0.37 1.3% 22 Automobile Repair & Services 0.35 1.2% Total 23.55 84.4% Tax receipts by industry 11.A.a Packet Pg. 37 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) 1414 For more information contact: Mark Wilson at mwilson@flchamber.com Dr. Jerry Parrish at jparrish@flfoundation.org 11.A.a Packet Pg. 38 Attachment: Florida Strike Force Briefing (12269 : COVID-19 Discussion Agenda) GUIDELINES OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 39 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Downward trajectory of documented cases within a 14-day period Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests) OPENING UP AMERICA AGAIN (Satisfy Before Proceeding to Phased Opening) *State and local officials may need to tailor the application of these criteria to local circumstances (e.g., metropolitan ar eas that have suffered severe COVID outbreaks, rural and suburban areas where outbreaks have not occurred or have been mild). Additionally , where appropriate, Governors should work on a regional basis to satisfy these criteria and to progress through the phases outlined below. Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period Downward trajectory of covid-like syndromic cases reported within a 14-day period SYMPTOMS CASES Treat all patients without crisis care Robust testing program in place for at-risk healthcare workers, including emerging antibody testing HOSPITALS Proposed State or Regional Gating Criteria ORAND AND 11.A.b Packet Pg. 40 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Core State Preparedness Responsibilities Ability to quickly set up safe and efficient screening and testing sites for symptomatic individuals and trace contacts of COVID+ results Ability to test Syndromic/ILI-indicated persons for COVID and trace contacts of COVID+ results Ensure sentinel surveillance sites are screening for asymptomatic cases and contacts for COVID+ results are traced (sites operate at locations that serve older individuals, lower-income Americans, racial minorities, and Native Americans) HEALTHCARE SYSTEM CAPACITY Ability to quickly and independently supply sufficient Personal Protective Equipment and critical medical equipment to handle dramatic surge in need Ability to surge ICU capacity PLANS Protect the health and safety of workers in critical industries Protect the health and safety of those living and working in high-risk facilities (e.g., senior care facilities) Protect employees and users of mass transit Advise citizens regarding protocols for social distancing and face coverings Monitor conditions and immediately take steps to limit and mitigate any rebounds or outbreaks by restarting a phase or returning to an earlier phase, depending on severity TESTING & CONTACT TRACING OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 41 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Proposed Phased Approach MITIGATES RISK OF RESURGENCE PROTECTS THE MOST VULNERABLE BASED ON UP-TO-DATE DATA AND READINESS IMPLEMENTABLE ON STATEWIDE OR COUNTY - BY-COUNTY BASIS AT GOVERNORS’ DISCRETION OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 42 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Guidelines for All Phases: Individuals Wash your hands with soap and water or use hand sanitizer, especially after touching frequently used items or surfaces. Avoid touching your face. Sneeze or cough into a tissue, or the inside of your elbow. Disinfect frequently used items and surfaces as much as possible. Strongly consider using face coverings while in public, and particularly when using mass transit. CONTINUE TO PRACTICE GOOD HYGIENE PEOPLE WHO FEEL SICK SHOULD STAY HOME Do not go to work or school. Contact and follow the advice of your medical provider. Continue to adhere to State and local guidance as well as complementary CDC guidance, particularly with respect to face coverings. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 43 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Guidelines for All Phases: Employers Social distancing and protective equipment Temperature checks Testing, isolating, and contact tracing Sanitation Use and disinfection of common and high-traffic areas Business travel Develop and implement appropriate policies, in accordance with Federal, State, and local regulations and guidance, and informed by industry best practices, regarding: Monitor workforce for indicative symptoms. Do not allow symptomatic people to physically return to work until cleared by a medical provider. Develop and implement policies and procedures for workforce contact tracing following employee COVID+ test. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 44 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Phase One FOR STATES AND REGIONS THAT SATISFY THE GATING CRITERIA OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 45 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) ALL VULNERABLE INDIVIDUALS* should continue to shelter in place. Members of households with vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. Precautions should be taken to isolate from vulnerable residents. All individuals, WHEN IN PUBLIC (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Social settings of more than 10 people, where appropriate distancing may not be practical, should be avoided unless precautionary measures are observed. Avoid SOCIALIZING in groups of more than 10 people in circumstances that do not readily allow for appropriate physical distancing (e.g., receptions, trade shows) MINIMIZE NON-ESSENTIAL TRAVEL and adhere to CDC guidelines regarding isolation following travel. Phase One INDIVIDUALS *See Appendix 1 for Definition of Vulnerable Individuals EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 46 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Continue to ENCOURAGE TELEWORK, whenever possible and feasible with business operations. If possible, RETURN TO WORK IN PHASES. Close COMMON AREAS where personnel are likely to congregate and interact, or enforce strict social distancing protocols. Minimize NON-ESSENTIAL TRAVEL and adhere to CDC guidelines regarding isolation following travel. Strongly consider SPECIAL ACCOMMODATIONS for personnel who are members of a VULNERABLE POPULATION. Phase One EMPLOYERS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 47 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) SCHOOLS AND ORGANIZED YOUTH ACTIVITIES (e.g., daycare, camp) that are currently closed should remain closed. VISITS TO SENIOR LIVING FACILITIES AND HOSPITALS should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene. LARGE VENUES (e.g., sit-down dining, movie theaters, sporting venues, places of worship) can operate under strict physical distancing protocols. ELECTIVE SURGERIES can resume, as clinically appropriate, on an outpatient basis at facilities that adhere to CMS guidelines. GYMS can open if they adhere to strict physical distancing and sanitation protocols. BARS should remain closed. Phase One SPECIFIC TYPES OF EMPLOYERS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 48 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Phase Two FOR STATES AND REGIONS WITH NO EVIDENCE OF A REBOUND AND THAT SATISFY THE GATING CRITERIA A SECOND TIME OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 49 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) ALL VULNERABLE INDIVIDUALS should continue to shelter in place. Members of households with vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. Precautions should be taken to isolate from vulnerable residents. All individuals, WHEN IN PUBLIC (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Social settings of more than 50 people, where appropriate distancing may not be practical, should be avoided unless precautionary measures are observed. NON-ESSENTIAL TRAVEL can resume. Phase Two INDIVIDUALS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 50 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Continue to ENCOURAGE TELEWORK, whenever possible and feasible with business operations. Close COMMON AREAS where personnel are likely to congregate and interact, or enforce moderate social distancing protocols. NON-ESSENTIAL TRAVEL can resume. Strongly consider SPECIAL ACCOMMODATIONS for personnel who are members of a VULNERABLE POPULATION. Phase Two EMPLOYERS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 51 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) SCHOOLS AND ORGANIZED YOUTH ACTIVITIES (e.g., daycare, camp) can reopen. VISITS TO SENIOR CARE FACILITIES AND HOSPITALS should be prohibited. Those who do interact with residents and patients must adhere to strict protocols regarding hygiene. LARGE VENUES (e.g., sit-down dining, movie theaters, sporting venues, places of worship) can operate under moderate physical distancing protocols. ELECTIVE SURGERIES can resume, as clinically appropriate, on an outpatient and in-patient basis at facilities that adhere to CMS guidelines. GYMS can remain open if they adhere to strict physical distancing and sanitation protocols. BARS may operate with diminished standing-room occupancy, where applicable and appropriate. Phase Two SPECIFIC TYPES OF EMPLOYERS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 52 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Phase Three FOR STATES AND REGIONS WITH NO EVIDENCE OF A REBOUND AND THAT SATISFY THE GATING CRITERIA A THIRD TIME OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 53 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) VULNERABLE INDIVIDUALS can resume public interactions, but should practice physical distancing, minimizing exposure to social settings where distancing may not be practical, unless precautionary measures are observed. LOW-RISK POPULATIONS should consider minimizing time spent in crowded environments. Phase Three INDIVIDUALS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. Resume UNRESTRICTED STAFFING of worksites.Phase Three EMPLOYERS OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 54 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) VISITS TO SENIOR CARE FACILITIES AND HOSPITALS can resume. Those who interact with residents and patients must be diligent regarding hygiene. LARGE VENUES (e.g., sit-down dining, movie theaters, sporting venues, places of worship) can operate under limited physical distancing protocols. GYMS can remain open if they adhere to standard sanitation protocols. BARS may operate with increased standing room occupancy, where applicable. Phase Three SPECIFIC TYPES OF EMPLOYERS EACH PHASE OF THIS GUIDANCE ADDRESSES THOSE ASPECTS OF DAILY LIFE FOR WHICH RESTRICTIONS REMAIN APPROPRIATE DUE TO COVID. OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 55 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda) Appendix 1. Elderly individuals. 2. Individuals with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune system is compromised such as by chemotherapy for cancer and other conditions requiring such therapy. Vulnerable Individuals OPENING UP AMERICA AGAIN 11.A.b Packet Pg. 56 Attachment: Federal Guidelines for Opening Up America Again (12269 : COVID-19 Discussion Agenda)