Isolation facilities (ISOFACs) will need to be established in accordance with best practice and other applicable guidance while taking into consideration the following issues:

- While both COVID-19 positive and PUIs require isolation, it is important not to mix them to prevent the spread of COVID-19 to a non-infected PUI.
- 24/7 communication between COVID-19 Isolation berthing and the medical personnel is mandatory as patients may develop worsening symptoms.
- Design ISOFAC policies and areas to allow maximum autonomy and self-management by the ISOFAC occupants and their units, including cleaning, food delivery, and transport.
- A designated “dead drop” area allows unit representatives to deliver food and supplies while avoiding inadvertent interactions with COVID positive patients.
- Identify a camp mayor for each isolation facility. Camp mayors should become familiar with base policies and instructions for requested services, repairs, and maintenance.
- Isolation facilities must include plans for medical or security evacuations including a designated shelter area.

ISOFACs are designed to allow outpatient recovery similar to a COVID positive patient recovering at home in CONUS. Unfortunately, most forward-deployed locations berth individuals in group berthing, this arrangement makes isolation difficult to achieve. While individual berthing with separated bathrooms is optimal, patient isolation cohorts may be the only option available. Isolation berthing should be designed to allow adequate comfort for multiple patients of varying symptom severity. Isolation areas should be well demarcated (e.g., “Isolation Area - No Unauthorized Access!”) and include posted guides on proper PPE procedures. Additionally, consider any medical evacuation routes in the event of worsening COVID-19 disease.

If possible, ISOFACs should include an entry anteroom that separates the outside from the isolation rooms and may include a designated “clean area” and “dirty area.” The clean area should be stocked with PPE and visual donning instructions. The “dirty area” should include a biohazard disposal bin and hand sanitizing station for doffing PPE.

A designated bunker should be pre-identified for the ISOFAC occupants in the event of an indirect fire. To mitigate transmission to non-isolated individuals, consider taping PPE bags to each door for patients to grab on their way to the bunker or other quick access methods.

Some ISOFACs may allow for individual/paired isolation (e.g. Containerized Housing Unit [CHU]), whereas others may require cohort isolation (e.g. tent). Subsequently, individual/paired isolation areas should be considered the preferred isolation site for females and individual cases. For unit outbreaks, cohort isolation may result in improved unit morale and accountability. Cohort isolation of confirmed cases can join pre-existing cohorts, whereas presumed positives (i.e. PUIs) should be isolated individually.

Medical personnel should conduct a daily sick call and should wear full PPE during encounters. Common symptoms may be immediately treated with over-the-counter medications; any individual with specific concerns should be evaluated. For worsening symptoms, consider obtaining vital signs and a NEWS score. Refer to Screening and Triage: Early Recognition of Patients with COVID-19 in the DoD Practice Management Guideline for current best practices.

Quarantine Facilities

Many sites have established a centralized base quarantine facility. However, it is important to realize that during a significant outbreak, the number of close contacts can quickly overwhelm any centralized facility. Therefore, units should have pre-established plans to quarantine close contacts within their living spaces. Quarantine is a command function, although medical issues that arise during quarantine should be referred to the appropriate medical unit.

Consider the following issues when establishing a comprehensive quarantine plan:

- Quarantine is a unit responsibility, though medical experts have much to offer in advisement and assistance for quarantine planning, tracking, and execution.
- Establishing a base quarantine camp requires strong partnerships between medical experts, Base Operating Support Integrator (BOS-I), Base Defense Operation Center (BDOC), and base leadership.
- Designating one or two days per week to initiate travel quarantine cohorts helps reduce limited quarantine resources and streamlines throughput.
- Base quarantine camps require daily walkthroughs from a Camp Mayor to mitigate current or future concerns. Daily vital sign checks for quarantined personnel increases the risk of close contact exposure with little benefit.

At a minimum, quarantine plans must include designated berthing areas, latrines, and showers for close contacts that are separated from the general populace. Meals should be delivered to quarantined individuals. Examples of unit quarantine plans include: 1) quarantining close contacts in their CHU rooms with a designated quarantine latrine, 2) moving close contacts into a designated quarantine tent that includes adjoining chemical latrines and portable shower units, and 3) deploying temporary fencing around an affected tent to designate it as a quarantined tent. Medical teams may provide guidance as units establish their quarantine plans and facilities.

Bases that serve as theater gateways experience a high volume of travel quarantine requirements. Quarantine cohorts must start and end their quarantine period as a group. However, it may prove infeasible to establish travel quarantine cohorts for each day’s arrivals. A base may choose to designate a fixed day(s) of the week for travel quarantines to begin. As an example, a base may begin a 14-day travel quarantine cohort every Tuesday. Incoming personnel who arrive Wednesday through Monday are placed into the upcoming quarantine cohort upon arrival; however, the 14-day quarantine period does not start until Tuesday. The entire cohort is then released to their respective units two weeks later. Individuals who do not abide by the quarantine order restart their 14-day quarantine along with all others in their cohort. This model requires three quarantine areas that rotate between the “fill” cohort, a cohort in their first quarantine week, and a cohort in their second quarantine week. Privacy dividers (e.g., central tent dividers) can allow males and females from the same cohort to share a cohort area.