The federal government is committed to ensuring that residents and staff in long-term care (LTC) settings, such as nursing homes, assisted living, residential care communities, group homes and senior housing, have access to COVID-19 vaccines to receive primary series and booster shots. For additional examples of LTC settings, see COVID-19 Vaccine Access in Long-Term Care Settingsexternal icon.
The goal is to continue to protect those who are disproportionately affected by COVID-19—especially residents of LTC settings. All LTC settings that request assistance accessing COVID-19 vaccines for their residents and staff will receive the support they need.
Many LTC providers have already identified strategies and partnerships to obtain and administer COVID-19 vaccines for residents and staff. These include:
Coordinating with state and local health departments
Long-term care providers are encouraged to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, either in the local community or on-site. Additional details on these options are available on the pages linked below.https://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships/administrators-managers.htmlhttps://www.cdc.gov/vaccines/covid-19/long-term-care/pharmacy-partnerships/jurisdictions.html
Additional Information COVID-19 Vaccination Recommendations
COVID-19 vaccination is recommended for all people ages 5 years and older in the United States for the prevention of COVID-19. COVID-19 vaccines currently approved or authorized by FDA are highly effective in preventing serious outcomes of COVID-19, including severe disease, hospitalization, and death. Efforts to maximize the proportion of people in the United States who are fully vaccinated against COVID-19 remain critical to ending the COVID-19 pandemic. At present, people with moderately to severely compromised immune systems should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses.
In addition, COVID-19 vaccines may now be administered along with other vaccines. This includes simultaneous administration of the COVID-19 vaccine and other vaccines such as the flu vaccine on the same day, as well as coadministration within 14 days. For more information, see Interim Clinical Considerations for Use of COVID-19 Vaccines.
Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as post-COVID conditions (PCC) or long COVID.
People call post-COVID conditions by many names, including: long COVID, long-haul COVID, post-acute COVID-19, post-acute sequelae of SARS CoV-2 infection (PASC), long-term effects of COVID, and chronic COVID.
WHAT YOU NEED TO KNOW
Post-COVID conditions can include a wide range of ongoing health problems; these conditions can last weeks, months, or years.
Post-COVID conditions are found more often in people who had severe COVID-19 illness, but anyone who has been infected with the virus that causes COVID-19 can experience post-COVID conditions, even people who had mild illness or no symptoms from COVID-19.
People who are not vaccinated against COVID-19 and become infected may also be at higher risk of developing post-COVID conditions compared to people who were vaccinated and had breakthrough infections.
There is no single test for post-COVID conditions. While most people with post-COVID conditions have evidence of infection or COVID-19 illness, in some cases, a person with post-COVID conditions may not have tested positive for the virus or known they were infected.
CDC and partners are working to understand more about who experiences post-COVID conditions and why, including whether groups disproportionately impacted by COVID-19 are at higher risk.
ABOUT LONG COVID OR POST-COVID CONDITIONS
Post-COVID conditions are a wide range of new, returning, or ongoing health problems that people experience after first being infected with the virus that causes COVID-19. Most people with COVID-19 get better within a few days to a few weeks after infection, so at least four weeks after infection is the start of when post-COVID conditions could first be identified. Anyone who was infected can experience post-COVID conditions. Most people with post-COVID conditions experienced symptoms days after their SARS CoV-2 infection when they knew they had COVID-19, but some people with post-COVID conditions did not notice when they first had an infection.
There is no test to diagnose post-COVID conditions, and people may have a wide variety of symptoms that could come from other health problems. This can make it difficult for healthcare providers to recognize post-COVID conditions. Your healthcare provider considers a diagnosis of post-COVID conditions based on your health history, including if you had a diagnosis of COVID-19 either by a positive test or by symptoms or exposure, as well as doing a health examination.
SYMPTOMS
People with post-COVID conditions can have a wide range of symptoms that can last more than four weeks or even months after infection. Sometimes the symptoms can even go away or come back again.
Post-COVID conditions may not affect everyone the same way. People with post-COVID conditions may experience health problems from different types and combinations of symptoms happening over different lengths of time. Most patients’ symptoms slowly improve with time. However, for some people, post-COVID conditions may last months, and potentially years, after COVID-19 illness and may sometimes result in disability.
People who experience post-COVID conditions most commonly report:
GENERAL SYMPTOMS
Tiredness or fatigue that interferes with daily life
Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
Fever
RESPIRATORY AND HEART SYMPTOMS
Difficulty breathing or shortness of breath
Cough
Chest pain
Fast-beating or pounding heart (also known as heart palpitations)
NEUROLOGICAL SYMPTOMS
Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
Headache
Sleep problems
Dizziness when you stand up (lightheadedness)
Pins-and-needles feelings
Change in smell or taste
Depression or anxiety
DIGESTIVE SYMPTOMS
Diarrhea
Stomach pain
OTHER SYMPTOMS
Joint or muscle pain
Rash
Changes in menstrual cycles
SYMPTOMS THAT ARE HARD TO EXPLAIN AND MANAGE
People with post-COVID conditions may develop or continue to have symptoms that are hard to explain and manage. Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other infections. People with these unexplained symptoms may be misunderstood by their healthcare providers, which can result in a long time for them to get a diagnosis and receive appropriate care or treatment. Review these tips to help prepare for a healthcare provider appointment for post-COVID conditions.
HEALTH CONDITIONS
Some people, especially those who had severe COVID-19, experience multiorgan effects or autoimmune conditions with symptoms lasting weeks or months after COVID-19 illness. Multiorgan effects can involve many body systems, including the heart, lung, kidney, skin, and brain. As a result of these effects, people who have had COVID-19 may be more likely to develop new health conditions such as diabetes, heart conditions, or neurological conditions compared with people who have not had COVID-19.
PEOPLE EXPERIENCING ANY SEVERE ILLNESS MAY DEVELOP HEALTH PROBLEMS
PICS refers to the health effects that may begin when a person is in an intensive care unit (ICU), and which may persist after a person returns home. These effects can include muscle weakness, problems with thinking and judgment, and symptoms of post-traumatic stress disorder (PTSD). PTSDexternal icon involves long-term reactions to a very stressful event. For people who experience PICS following a COVID-19 diagnosis, it is difficult to determine whether these health problems are caused by a severe illness, the virus itself, or a combination of both.
PEOPLE MORE LIKELY TO DEVELOP LONG COVID
Researchers are working to understand which people or groups of people are more likely to have post-COVID conditions, and why. Studies have shown that some groups of people may be affected more by post-COVID conditions. These are examples and not a comprehensive list of people or groups who might be more at risk than other groups for developing post-COVID conditions:
People who have experienced more severe COVID-19 illness, especially those who were hospitalized or needed intensive care.
People who had underlying health conditions prior to COVID-19.
Some people affected by health inequities including people from racial or ethnic minority groups and people with disabilities.
HEALTH INEQUITIES MAY AFFECT POPULATIONS AT RISK FOR LONG COVID
Some people are at increased risk of getting sick from COVID-19 because of where they live or work, or because they can’t get health care. Health inequities may put some people from racial or ethnic minority groups and some people with disabilities at greater risk for developing post-COVID conditions. Scientists are researching some of those factors that may place these communities at higher risk of both getting infected or developing post-COVID conditions.
PREVENTING LONG COVID
Research suggests that people who are vaccinated but experience a breakthrough infection are less likely to report post-COVID conditions, compared to people who are unvaccinated.
However, people experiencing post-COVID conditions can seek care from a healthcare provider to come up with a personal medical management plan that can help improve their symptoms and quality of life. Review these tips to help prepare for a healthcare provider appointment for post-COVID conditions. In addition, there are many support groups being organized that can help patients and their caregivers.
Although post-COVID conditions appear to be less common in children and adolescents than in adults, long-term effects after COVID-19 do occur in children and adolescents.
CDC is working to:
Better identify the most frequent symptoms and diagnoses experienced by patients with post-COVID conditions.
Better understand how many people are affected by post-COVID conditions, and how often people who are infected with COVID-19 develop post-COVID conditions afterwards.
Better understand risk factors, including which groups might be more at risk, and if different groups experience different symptoms.
Help understand how post-COVID conditions limit or restrict people’s daily activity.
Help identify groups that have been more affected by post-COVID conditions, lack access to care and treatment for post-COVID conditions, or experience stigma.
Better understand the role vaccination plays in preventing post-COVID conditions.
Collaborate with professional medical groups to develop and offer clinical guidance and other educational materials for healthcare providers, patients, and the public.
For people who are more likely to get very sick from COVID-19 infection, medications are available that can reduce your chances of severe illness and death. Other medications can help reduce symptoms and help you manage your illness.
Here’s what you need to know.
Treating COVID-19
If you test positive and are more likely to get very sick from COVID-19, treatments are availableexternal iconexternal icon that can reduce your chances of being hospitalized or dying from the disease. Medications to treat COVID-19 must be prescribed by a healthcare provider and started as soon as possible after diagnosis to be effective. Contact a healthcare provider right away to determine if you are eligible for treatment, even if your symptoms are mild right now.
Don’t delay: Treatment must be started within days after you first develop symptoms to be effective.
People who are more likely to get very sick include older adults (ages 50 years or more, with risk increasing with older age), people who are unvaccinated, and people with certain medical conditions, such as a weakened immune system. Being vaccinated makes you much less likely to get very sick. Still, some vaccinated people, especially those ages 65 years or older or who have other risk factors for severe disease, may benefit from treatment if they get COVID-19. A healthcare provider will help decide which treatment, if any, is right for you.
The FDA has issued emergency use authorizations (EUA) for certain antiviral medications and monoclonal antibodies to treat mild to moderate COVID-19 in people who are more likely to get very sick.
Antiviral treatmentsexternal icontarget specific parts of the virus to stop it from multiplying in the body, helping to prevent severe illness and death.
Monoclonal antibodiesexternal icon help the immune system recognize and respond more effectively to the virus. They may be more or less effective against different variants of the virus that causes COVID-19.
The National Institutes of Health (NIH) provides COVID-19 Treatment Guidelinesexternal icon for healthcare providers to help them work with their patients and determine the best treatment options for them. Several options are available for treating COVID-19 at home or in an outpatient setting. They include:
Nirmatrelvir with ritonavir (Paxlovid)external icon is an investigational antiviral treatment used in adults and children ages 12 years and older. It is taken at home by mouth (orally). It should be started as soon as possible and must begin within 5 days of when your symptoms start.
Remdesivir (Veklury)external icon is an antiviral treatment used in adults and children. Treatment requires intravenous (IV) infusions at a healthcare facility for 3 consecutive days. It should be started as soon as possible and must begin within 7 days of when your symptoms start.
Bebtelovimabexternal icon is an investigational monoclonal antibody treatment used in adults and children ages 12 years and older. A healthcare provider gives bebtelovimab as a single IV injection. It should be started as soon as possible and must begin within 7 days of when your symptoms start.
Molnupiravir (Lagevrio)external icon is an investigational antiviral treatment used in adults ages 18 years and older. It is taken at home by mouth (orally). It should be started as soon as possible and must begin within 5 days of when your symptoms start.
Some treatments might have side effects or interact with other medications you are taking. To find out if medications to treat COVID-19 are right for you, you have options:
Contact your local community health center or health department
If you are hospitalized, your healthcare provider might use other types of treatments, depending on how sick you are. These could include medications to treat the virus, reduce an overactive immune response, or treat COVID-19 complications.
Managing COVID-19 Symptoms
Most people with COVID-19 have mild illness and can recover at home. If you are worried about your symptoms, the Coronavirus Self-Checker can assist in the decision to seek care. You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better. Learn more about what to do if you are sick.
Preventing COVID-19
COVID-19 vaccines available in the United States effectively protect people from getting seriously ill, being hospitalized, and even dying—especially people who are boosted. As with vaccines for other diseases, you are protected best when you stay up to date. CDC recommends that everyone who is eligible stay up to date on their COVID-19 vaccines, including people with weakened immune systems.
Preventive Medications
The FDA has issued an EUA for tixagevimab plus cilgavimab (Evusheld)external icon, an investigational medicine used in adults and children ages 12 years and older. Evusheld consists of 2 monoclonal antibodies provided together to help prevent infection with the virus that causes COVID-19. A healthcare provider gives Evusheld as 2 separate consecutive intramuscular (IM) injections at a doctor’s office or healthcare facility. If you are moderately or severely immunocompromised or severely allergic to COVID-19 vaccines, you may be eligible for Evusheld. Talk to a healthcare provider to determine if this option is right for you.
The right medications for COVID-19 can help. People have been seriously harmed and even died after taking products not approved for use to treat or prevent COVID-19, even products approved or prescribed for other uses. Talk to a healthcare provider about taking medications to treat COVID-19.
CDC uses Travel Health Notices (THNs) to alert travelers and other audiences to health threats around the world and advise on how to protect themselves.
On April 18, 2022, CDC updated its COVID-19 THN system. Level 4 will no longer be based on COVID-19 incidence or case count alone. It will be reserved for special circumstances, such as rapidly escalating case trajectory or extremely high case counts, emergence of a new variant of concern, and healthcare infrastructure collapse. Levels 3, 2, and 1 will still be primarily determined by 28-day incidence or case counts as outlined below.
COVID-19 Travel Recommendations can be found in two places:
The 4-level system categorizes international destinations into the following levels:
Level 4: Special Circumstances / Do Not Travel
Do not travel to this destination.
If you must travel, make sure you are up to date with your COVID-19 vaccines before your trip.
Level 3: High Level Of COVID-19
Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
If you are not up to date with your vaccines, avoid travel to this destination.
If you have a weakened immune system or are more likely to get very sick from COVID-19, even if you are up to date with your COVID-19 vaccines, talk with your clinician about your risk and consider delaying travel to this destination.
Level 2: Moderate Level Of COVID-19
Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
If you have a weakened immune system or are more likely to get very sick from COVID-19, even if you are up to date with your COVID-19 vaccines, talk to your clinician about what additional precautions may be needed before, during, and after travel to this destination.
Level 1: Low Level of COVID-19
Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
Level Unknown: Unknown Level of COVID-19
Make sure you are up to date with your COVID-19 vaccines before traveling to this destination.
If you are not up to date with your vaccines, avoid travel to this destination.
If you have a weakened immune system or are more likely to get very sick from COVID-19, even if you are up to date with your COVID-19 vaccines, talk with your clinician about your risk, and consider delaying travel to this destination.
Level 4 will be reserved for special circumstances, such as rapidly escalating case trajectory or extremely high case counts, emergence of a new variant of concern, and healthcare infrastructure collapse. Other factors that may be considered include information such as vaccination rate and hospitalization rate. CDC works with country authorities through CDC country or regional offices to gather additional data as appropriate.
Level 1-3 Travel Health Notices are determined as follows:
Primary criteria for destinations with populations over 100,000
Incidence rate (cumulative new cases over the past 28 days per 100,000 population)
New case trajectory (Have daily new cases increased, decreased, or remained stable over the past 28 days?)
Primary criteria for destinations with populations of 100,000 or less
COVID-19 case counts* (cumulative new cases over past 28 days)
New case trajectory (Have daily new cases increased, decreased, or remained stable over the past 28 days?)
*CDC does not count identified imported cases (i.e., cases in travelers who were exposed in another country) against a destination’s total.
Secondary Criteria for Determining Travel Health Notice Levels
Reported case counts and incidence rates depend on testing capacity. CDC assesses testing capacity using two secondary criteria metrics: population testing rate and test-to-case ratio. The population testing rate is the number of tests conducted per 100,000 people over 28 days. The test-to-case ratio is the number of tests conducted for each case reported during the same 28-day period. Testing data are obtained from multiple sources, including Our World in Dataexternal icon, Foundation for Innovative Diagnosticsexternal icon, and country ministries of health.
Travel Health Notice levels 1 through 3 for destinations with a population more than 100,000 people. Levels are based on combined 1) incidence rate (primary criteria) and 2) testing data (secondary criteria)
*Incidence rate is the primary criteria for destinations with a population more than 100,000 people. Testing data are the secondary criteria and that data includes both the testing rate (column 1) and test-to-case ratio (column 2). The resulting THN levels are shown in rows 3–11 of columns 3–5.
Travel Health Notice levels 1 through 3 for destinations with a population of 100,000 people or fewer. Levels are based on combined 1) case count (primary criteria) and 2) testing data (secondary criteria) *
*Case count is the primary criteria for destinations with a population fewer than or equal to 100,000 people. Testing data are the secondary criteria and that data includes both the testing rate (column 1) and test-to-case ratio (column 2). The resulting THN levels are shown in rows 3–11 of columns 3–5.
Population testing rates of more than 1,500 tests per 100,000 people over 28 days are considered sufficient to provide an accurate representation of COVID-19 in the destination. Rates less than or equal to 1,500 tests per 100,000 people over 28 days may signify concerns that testing is insufficient and may not provide an accurate representation of the incidence rate in the destination. The cutoffs for evaluating population testing ratesexternal icon have been adapted from the WHO guidelines.
The WHO determined a test-to-case ratio greater than or equal to 10 as the minimum indicator of sufficient surveillance capacity. A test-to-case ratio of less than 10 tests per case might indicate restrictive testing, or that only symptomatic people are being tested and undercounting the incidence rate (primary criteria). The preferred level is a test-to-case ratio of more than 30. The cutoffs for evaluating test-to-case ratios pdf icon[PDF – 18 pages]external icon have been adapted from the WHO guidelines.
When both the population testing rates and test-to-case ratios are high, CDC has confidence in a destination’s reported incidence. If either the population testing rate or test-to-case ratio is low, CDC has less confidence that the reported incidence accurately depicts the COVID-19 situation in the destination. In this situation, CDC adjusts a destination’s THN level as shown in the tables above. Countries with low incidence and testing rates are classified as unknown as well as countries that report data infrequently.
Level Unknown Travel Health Notices are determined as follows:
If a destination has insufficient data to make a THN level determination, its THN level is designated as “unknown”. Insufficient data means that the destination does not provide data or that the provided data are non-representative of the COVID-19 situation in the destination, making an accurate THN level determination difficult. This situation includes destinations with low COVID-19 incidence and low reported COVID-19 testing levels.
Raising a Travel Health Notice
CDC raises a destination’s THN level when the incidence rate (or case count) and testing metrics meet the THN threshold for a higher level and remain at that level for 14 consecutive days. The THN level may be raised before 14 days if there is a large increase in COVID-19 cases reported.
Lowering a Travel Health Notice
CDC lowers a destination’s THN level when the incidence rate (or case count) and testing metrics meet the THN threshold for a lower level and remain at that level for 28 consecutive days. Vaccination coverage rates and case trajectory will be considered when determining if the THN level can be lowered before 28 days.
Diagnostic testing is intended to identify current infection in individuals and should be performed on anyone that has signs and symptoms consistent with COVID-19 and/or following recent known or suspected exposure to SARS-CoV-2.
Examples of diagnostic testing include:
Testing anyone with symptoms consistent with COVID-19
Testing vaccinated and unvaccinated people who were exposed to someone with a confirmed or suspected case of COVID-19
Screening Testing
Screening tests are intended to identify people with COVID-19 who are asymptomatic and do not have known, suspected, or reported exposure to SARS-CoV-2. Screening helps to identify unknown cases so that measures can be taken to prevent further transmission.
Examples of screening include testing:
Employees in a workplace setting
Students, faculty, and staff in a school setting
A person before or after travel
Someone at home who does not have symptoms associated with COVID-19 and no known exposures to someone with COVID-19
Public Health Surveillance Testing
Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice. See CDC’s Introduction to Public Health Surveillance.
Public health surveillance testing is intended to monitor community- or population-level outbreaks of disease, or to characterize the incidence and prevalence of disease. Surveillance testing is performed on de-identified specimens, and thus, results are not linked to individual people. Public health surveillance testing results cannot be used for individual decision-making.
Public health surveillance testing may sample a certain percentage of a specific population to monitor for increasing or decreasing prevalence, or to determine the population effect from community interventions such as social distancing. An example of public health surveillance testing is when a state public health department develops a plan to randomly select and sample a percentage of all people in a city on a rolling basis to assess local infection rates and trends.
Regulatory Requirements for Diagnostic, Screening, and Public Health Surveillance Testing
Any laboratory or testing site that performs diagnostic or screening testing must have a Clinical Laboratory Improvement Amendments (CLIA) certificate and meet all applicable CLIA requirements. For more information, see the Centers for Medicare & Medicaid Services CLIA websiteexternal icon. Tests used for SARS-CoV-2 diagnostic or screening testing must have received an Emergency Use Authorization from the U.S. Food and Drug Administration (FDA) or be offered under the policies in FDA’s Policy for COVID-19 Testsexternal icon.
Tests used for SARS-CoV-2 public health surveillance on de-identified human specimens do not need to meet FDA and CLIA requirements for diagnostic and screening testing.
Reporting Diagnostic, Screening, and Public Health Surveillance Testing Results
Both diagnostic and screening testing results should be reported to the people whose specimens were tested and/or to their healthcare providers.
In addition, laboratories that perform diagnostic and screening testing must report positive diagnostic and screening test results to the local, state, tribal, or territory health department in accordance with Public Law 116-136, § 18115(a), the Coronavirus Aid, Relief, and Economic Security (CARES) Act. As of April 4, 2022, laboratories are no longer required to report negative results for non-NAAT tests (rapid or antigen test results). The Department of Health and Human Services published guidance on COVID-19 Pandemic Response, Laboratory Data Reporting: CARES Act Section 18115pdf iconexternal icon that specifies what data, in addition to test results, laboratories and testing sites should collect and electronically report.
Public health surveillance testing results cannot be reported directly to the people whose specimens have been tested and are not reported to their healthcare providers. Public health surveillance testing results (test results that are de-identified) can be reported in aggregate to local, state, tribal, or territory health departments upon request. Results from testing that is performed outside of a CLIA-certified facility or without an FDA-authorized test can only be reported to a health department if those results are used strictly for public health surveillance purposes, and not used for individual decision making.
Summary of Testing for COVID-19
Diagnostic
Screening
Public Health Surveillance
Symptomatic
Yes
No
N/A
Unvaccinated or vaccinated with known or suspected exposure
Yes
No
N/A
Unvaccinated and Asymptomatic without Known or Reported Suspected Exposure
No
Yes
N/A
Characterize Incidence and Prevalence in the Community
N/A
N/A
Yes
Testing of Personally Identifiable Specimens
Yes
Yes
No
Results may be Returned to Individuals
Yes
Yes
No
Results Returned in Aggregate to Requesting Institution
No
No
Yes
Results Reported to State Public Health Departments
Yes
Yes
If requested
Testing can be Performed in CLIA-Certified Laboratory
Yes
Yes
Yes
Testing can be Performed in a Non-CLIA-Certified Laboratory
No
No
Yes
Test System Must be FDA Authorized or be Offered under the Policies in FDA’s Guidance
To help prevent the spread of COVID-19 and help our country cope during the pandemic, CDC has occasionally issued legally binding orders and regulations.
People must wear face masks in indoor areas of public transportation traveling into, within, or out of the United States and indoors at U.S. transportation hubs, including airports.
Air passengers, 2 years or older, traveling to the United States from another country must present a negative COVID-19 test result or documentation of recovery from COVID-19 before boarding their flights. Regardless of vaccination status, passengers ages 2 or older are required to present a negative COVID-19 viral test result from a sample taken no more than 1 day before travel. Alternatively, passengers may present documentation showing that they tested positive for COVID-19 on a sample taken within the past 90 days and have been cleared to travel (documentation of recovery).
CDC issued an Order to implement the President’s direction on safe resumption of global travel during the COVID-19 pandemic and provided guidance to airlines, other aircraft operators, and passengers in Technical Instructions and Frequently Asked Questions.
All non-U.S.-citizen, non-immigrants, with limited exceptions, traveling to the United States by air must be fully vaccinated and show proof of vaccination.
CDC issued an Order on October 25, 2021 requiring airlines and other aircraft operators to collect contact information for passengers before they board a flight to the United States from a foreign country. The purpose of collecting this information is to identify and locate passengers who may have been exposed to a person with a communicable disease for public health follow-up. Airlines will retain the information for 30 days and transmit the information to CDC upon request for contact tracing and public health follow-up to keep people safe.
Following a public health determination, the CDC Director is terminating the Order under 42 U.S.C. §§ 265, 268 and 42 C.F.R. § 71.40 suspending the right to introduce certain persons into the United States. The implementation of the termination of the Order will be on May 23, 2022.
CDC considered multiple factors in its public health assessment and finds that, at this time, the available COVID-19 mitigation tools, as well as the fact that 97% of the U.S. population lives in a county identified as having “low” COVID-19 Community Level, will sufficiently mitigate the COVID-19 risk for U.S. communities and make an order under 42 U.S.C. §§ 265, 268 and 42 C.F.R. § 71.40 no longer necessary. This Termination will be implemented on May 23, 2022, to enable the Department of Homeland Security (DHS) to implement appropriate COVID-19 mitigation protocols, such as scaling up a program to provide COVID-19 vaccinations to migrants, and prepare for full resumption of regular migration processing under Title 8 authorities.
During the COVID-19 pandemic, CDC issued an order suspending the right to introduce certain noncitizens attempting to enter the U.S. from Canada or Mexico (regardless of country of origin) at or between ports of entry. CDC has terminated the Order with respect to unaccompanied noncitizen children.
On October 21, 2021, CDC Director Rochelle P. Walensky, M.D., M.P.H., endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for a booster shot of COVID-19 vaccine in certain populations. The FDA’s authorization and CDC’s recommendation for use are important steps forward as we work to stay ahead of the virus and keep Americans safe.
For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at 6 months or more after their initial series:
65 years and older
Age 18+ who live in long-term care settings
Age 18+ who have underlying medical conditions
Age 18+ who work or live in high-risk settings
For the nearly 15 million people who got the Johnson & Johnson COVID-19 vaccine, booster shots are also recommended for those who are 18 and older and who were vaccinated two or more months ago.
There are now booster recommendations for all three available COVID-19 vaccines in the United States. Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.
Millions of people are newly eligible to receive a booster shot and will benefit from additional protection. However, today’s action should not distract from the critical work of ensuring that unvaccinated people take the first step and get an initial COVID-19 vaccine. More than 65 million American remain unvaccinated, leaving themselves- and their children, families, loved ones, and communities- vulnerable.
Available data right now show that all three of the COVID-19 vaccines approved or authorized in the United States continue to be highly effective in reducing risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant. Vaccination remains the best way to protect yourself and reduce the spread of the virus and help prevent new variants from emerging.
The following is attributable to Dr. Walensky:
“These recommendations are another example of our fundamental commitment to protect as many people as possible from COVID-19. The evidence shows that all three COVID-19 vaccines authorized in the United States are safe- as demonstrated by the over 400 million vaccine doses already given. An, they are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant.”
Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions. These conditions can present as different types and combinations of health problems for different lengths of time.
These post-COVID conditions may also be known as long COVID, long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID. CDC and experts around the world are working to learn more about short- and long-term health effects associated with COVID-19, who gets them, and why.
Types of Post-COVID Conditions
New or Ongoing Symptoms
Some people experience a range of new or ongoing symptoms that can last weeks or months after first being infected with the virus that causes COVID-19. Unlike some of the other types of post-COVID conditions that tend only to occur in people who have had severe illness, these symptoms can happen to anyone who has had COVID-19, even if the illness was mild, or if they had no initial symptoms. People commonly report experiencing different combinations of the following symptoms:
Difficulty breathing or shortness of breath
Tiredness or fatigue
Symptoms that get worse after physical or mental activities (also known as post-exertional malaise)
Difficulty thinking or concentrating (sometimes referred to as “brain fog”
Cough
Chest or stomach pain
Headache
Fast-beating or pound heart (also known as heart palpitations)
Joint or muscle pain
Pins-and-needles feeling
Diarrhea
Sleep problems
Fever
Dizziness on standing (lightheadedness)
Rash
Mood changes
Change in smell or taste
Changes in menstrual period cycles
Multiorgan Effects of COVID-19
Some people who had severe illness with COVID-19 experience multiorgan effects or autoimmune conditions over a longer time with symptoms lasting weeks or months after COVID-19 illness. Multiorgan effects can affect many, if not all, body systems, including heart, lung, kidney, skin, and brain functions. Autoimmune conditions happen when you immune system attacks healthy cells in your body by mistake, causing inflammation (swelling) or tissue damage in the affected parts of the body.
While it is very rare, some people, mostly children, experience multisystem inflammatory syndrome (MIS) during or immediately after a COVID-19 infection. MIS is a condition where different body parts can become inflamed. MIS can lead to post-COVID conditions if a person continues to experience multiorgan effects or other symptoms.
Effects of COVID-19 Illness or Hospitalization
Hospitalizations and severe illness for lung-related diseases, including COVID-19, can cause health effects like severe weakness and exhaustion during the recovery period.
Effects of hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that begin when a person is in intensive care unit (ICU) and can remain after a person returns home. These effects can include severe weakness, problems with thinking and judgement, and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.
Some symptoms that can occur after hospitalization are similar to some of the symptoms that people with initially mild or no symptoms may experience many weeks after COVID-19. It can be difficult to know whether they are caused by the effects of hospitalization, the long-term effects of the virus, or a combination of both. These conditions might also be complicated by other effects related to the COVID-19 pandemic, including mental health effects from isolation, negative economic situations, and lack of access to healthcare for managing underlying conditions. These factors have affected both people who have experienced COVID-19 and those who have not.
Prevention
The best way to prevent post-COVID conditions is to prevent COVID-19 illness. For people who are eligible, getting vaccinated against COVID-19 as soon as you can is the best way to prevent getting COVID-19 and can also help protect those around you.
Stopping a pandemic takes all the tools in our toolbox:
Get vaccinated and stay up to date on your COVID-19 vaccines.
Know when to wear a well-fitted mask to help protect yourself and others.
Avoid crowds and poorly ventilated indoor spaces.
Test to prevent spread to others.
Stay 6 feet apart from others who don’t live with you.
Wash you hands often with soap and water. Use hand sanitizer if soap and water aren’t available.
If you are NOT yet fully vaccinated, prevent long-term complications by protecting yourself and others from COVID-19.
Although media articles have reported that some people with post-COVID conditions say their symptoms improved after being vaccinated, studies are needed to determine the effects of vaccination on post-COVID symptoms.
What CDC is Doing
CDC continues to work to identify how common post-COVID conditions are, who is most likely to get them, and why some symptoms eventually improve for some people and may last longer for other people. Rapid and multi-year studies are underway to further investigate post-COVID conditions in more detail. These studies will help us better understand post-COVID conditions and how to treat patients with these longer-term effects.
A resource for Providers Participating in the CDC COVID-19 Vaccination Program, Long-term Care Residents & Their Families
In response to inquiries about medical consent surrounding the administration of a booster shot of Pfizer-BioNTech COVID-19 vaccine to residents in long-term care (LTC) settings at least five months after their Pfizer-BioNTech primary series, the Centers for Disease Control and Prevention (CDC) has developed the following responses to frequently asked questions (FAQs).
These FAQs are intended to clarify that medical consent is not required by federal law for COVID-19 vaccination in the United States.
Providers enrolled in the CDC COVID-19 Vaccination Program, including those administering vaccines to residents in LTC settings, are required by the CDC Provider Agreement to follow applicable state and territorial laws on medical consent. Providers should consult their legal counsel on such requirements.
Frequently Asked Questions
Is medical consent required for LTC residents to receive a booster shot of the Pfizer-BioNTech COVID-19 vaccine?
Medical consent is not required by federal law for COVID-19 vaccination in the United States.
COVID-19 vaccine providers should consult with their own legal counsel for state or territorial requirements related to consent; compliance with all applicable state and territorial laws is required under the CDC Provider Agreement.
The COVID-19 Provider Agreement contains the following requirements:
Before administering a COVID-19 vaccine with Emergency Use Authorization (EUA), the provider must provide the approved EUA fact sheet (or Vaccine Information Sheet, as applicable) to each vaccine recipient, the adult caregiver accompanying the recipient (as applicable), or other legal representative (as applicable). The fact sheet/information sheet explains risks and benefits of the particular COVID-19 vaccine and what to expect but is not a consent document.
Is consent required for the booster shot if consent was previously given for the Pfizer-BioNTech primary series?
Explaining the risks and benefits of any treatment to a patient – in a way that they understand – is the standard of care.
Providers should consult with their legal counsel to determine whether previous medical consent obtained from a resident or their representative is legally sufficient under the applicable laws of the state or territory for purposes of administration of a booster dose of Pfizer-BioNTech COVID-19 vaccine.
Is consent for a booster shot of the Pfizer-BioNTech COVID-19 vaccine required if the vaccine is being administered by a different provider?
Providers should consult with their legal counsel to determine whether consent for the Pfizer-BioNTech primary series previously obtained from an LTC resident or their guardian by a different provider is sufficient, or if consent should be obtained prior to administration of the booster shot of Pfizer-BioNTech vaccine, in accordance with any applicable laws of the state or territory.
Does CDC have a consent form that should be used to receive a COVID-19 vaccine?
No. Since applicable medical consent laws are a matter of state, tribal, or territorial law, providers are advised to consult with their legal counsel to assure compliance with the scope of those consent laws.
A written form is not needed if state law allows for oral consent and the organization/provider does not otherwise require it.
