GW Nursing Simulation Reopening Plan

THE GEORGE WASHINGTON UNIVERSITY
SCHOOL OF NURSING
SIMULATION AND
INNOVATION
LEARNING CENTER
COVID-19
REOPENING
PLAN

TABLE OF CONTENTS
Introduction ..................................................... 3
1. Purpose ..................................................... 4
2. Scope ........................................................ 6
3. Definitions .................................................. 8
4. Procedures ................................................ 9
5. Process ....................................................12
6. Traffic Flow ...............................................13
7. Americans with Disabilities Act ....................18
Appendix ........................................................19
Appendix A: Cleaning and Disinfection
Guidelines…………………………………..19
References .................................................... 20
All information in this plan is subject to change based
upon changes in Center for Disease (CDC)
Guidelines and public health restrictions.
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INTRODUCTION
The George Washington University School of Nursing (GWU SON) values a high quality
educational experience. During this unprecedented time of the COVID-19 (Coronavirus
outbreak), the creation of a safe learning environment for learners, faculty, and staff of The
George Washington University School of Nursing Simulation and Innovation Learning Center is
the first priority. The Simulation and Innovation Learning Center wants to provide high quality,
high fidelity, nursing simulation and lab activities in an environment conducive to learning that
maintains the standards of best practice for simulation and safety during the COVID-19
restrictions. These Guidelines:
• follow The George Washington University Guidelines, The George Washington University
School of Nursing Guidelines and the Center for Disease Control and Prevention (CDC)
Considerations for Institutes of Higher Education (CDC, 2020b).
• follow applicable federal and state mandates to reduce the risk of exposure to the COVID-
19 Virus.
• provide recommendations for Personal Protective Equipment (PPE) use while in the
Simulation and Innovation Learning Center simulation, lab and OSCE spaces.
This Reopening Plan assumes that all undergraduates enrolled in the baccalaureate-nursing
program will return to the Virginia Science and Technology Campus (VSTC) starting August
31, 2020 (Fall 2020 Semester). This plan also assumes that there will be no graduate oncampus
events at VSTC for the Fall 2020 Semester. It is also assumed that there will be
on campus activities through Labor Day and Fall Break of the Fall 2020 Semester and all
on campus simulation and lab activities will terminate the week of November 22, 2020.
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1. PURPOSE
The Purpose of this plan is to establish standard guidelines for operations of the Simulation
and Innovation Learning (SAIL) Center to include the 301 OSCE suite, 307 Johnson Lab, 206
Student Practice lab, 205 Dawson Lab, 204 Health Assessment Lab, and 203 Paxton Lab.
These guidelines will govern the SAIL Center staff, faculty, learners, standardized patients, and
community members that utilize the space during the COVID-19 restrictions and during the reopening
process. These guidelines ensure the implementation of standards and guidelines
set forth by The George Washington University, GWU SON, CDC considerations for higher
education, Federal Occupational Safety and Health Administration (OSHA), and state, federal
and local government mandates to reduce and/or eliminate exposure to COVID-19 virus.
For the purposes of this document, definitions of phases for (whitehouse.gov, 2020) opening
are:
Safety
1. Phase I – Campus Closed to faculty, staff, learners, and community with the
exception of essential personnel.
2. Phase II – Campus is under restricted operations – teleworking when possible,
adherence to strict hand hygiene, maintain social distancing, limitations of group
sizes, and vulnerable populations should remain off campus
3. Phase III – Campus is under limited operations – vulnerable populations may return
with social distance, low risk populations limit time in crowded environments, limit
group sizes, and continue strict hand hygiene and environmental hygiene
4. Phase IV – Normal Operations with no restrictions
All food and drink are prohibited in the Lab and Simulation space.
Supplies for simulation activities provided by the simulation staff are single use or disinfected
prior to reuse.
During the COVID-19 restrictions, all personal belongings are to be kept out of the simulation
space unless it is a requirement of the activity (i.e., stethoscope, pencil, paper, etc.). All nonlab
related items will be stored outside of the lab area or in the provided cubbies utilizing
disinfection protocols. Belongings left at the end of the day will be discarded.
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Communication
Signage displayed at all entrances to the simulation/lab space indicates directional traffic
flow, requirements for entrance, and required personal protective equipment. Direct
questions, special requests, and concerns to the Director of Simulation and Experiential
Learning at cfarina@gwu.edu or via telephone at 571-553-0115.
The recommended reporting structure of the SAIL Center is to report non-emergent concerns
to faculty or staff, then the director of simulation, senior associate dean, and finally the dean
of the school of nursing. During an emergency, contact emergency services and report
directly to the director of simulation at the above referenced email or telephone.
Workforce
The workforce of the simulation center includes the Director of Simulation and Experiential
Learning, the Assistant Director of Simulation, Simulation Operations Specialists and
Simulation Information Technology Administrator.
Director of Simulation and
Experiential Learning
Assistant Director of
Simulation
Simulation Technology
Administrator
Crystel L. Farina, PhD(c), RN,
CNE, CHSE
Christine Seaton, DNP, RN,
CHSE
Paul Collins
cfarina@gwu.edu
571-553-0115
cdseaton@gwu.edu
571-553-8512
paulcollins@gwu.edu
571-553-0086
Simulation Ops. Spec. Cyndi Kelley cyndikelley@gwu.edu
571-553-0069
Simulation Ops. Spec Rebecca Melson rmelson@gwu.edu
571-553-0058
Simulation Ops. Spec Janice Ouellette jouellette@gwu.edu
571-553-0222
The workforce, the director, and assistant director of the SAIL center will supervise
learners, faculty and staff utilizing the simulation space to ensure adherence to the safety
guidelines put forth in this document to ensure the safety of all users.
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2. SCOPE
These GWU SON SAIL reopening guidelines apply to all staff, faculty, learners, standardized
patients, and community members (VIP learners, Renters, etc.) who will utilize the Simulation
and Innovation Learning Center. All staff, faculty, learners, standardized patients and
community members are required to read, understand and comply with these guidelines.
Class Size
During the Fall 2020 Semester class size will be limited by the space of the simulation/lab
spaces. Assigned workstations are provided to prevent spread of the virus and enhance
tracking. There is a limit of 25 workstations in the simulation/lab space to include 307 Johnson
(10 stations) 205 Dawson (10 work stations) and 203 Paxton (8 work stations). Lab sections
will need to be limited to 18-20 learners. Debriefing rooms in the Dawson area are limited
to 3 learners with an instructor and debriefing in the Paxton area is limited to 4 learners with
an instructor. Learners will not rotate between workstations. Workstations in the 307 Johnson,
205 Dawson, and 203 Paxton labs are approximately 100 sq. ft., exceeding the social
distancing recommendations of 36 sq. ft. recommended by the CDC (CDC, 2020b).
Health Assessment practice will take place in the OSCE center for the Fall 2020 semester.
Learners will be assigned OSCE care rooms in groups of two. Learners will maintain that
dyad during the semester to allow partnerships for procedures, monitoring, and tracking.
The OSCE space is limited to 24 learners in the 12 primary care rooms. Each OSCE room
is approximately 100 sq. ft., making it possible for two learners to be in each room and
ensuring the 36 sq. ft. recommendations by the CDC. In the health assessment course
learners will practice their assessment skills on each other. Learners will be required to
maintain appropriate and proper face covering, maintain hand hygiene, and adhere to strict
guidelines as noted in the Procedures section (page 9).
Groups and Gatherings
As noted previously, groups of learners may not gather in the debriefing spaces. They also
may not gather in the OSCE faculty space or the OSCE classroom as the space is not large
enough to socially distance the class. Instructions to groups larger than 10 learners will need
to be emailed in advance of the class.
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Scheduling
The simulation team, in collaboration with SON administrative team, will complete scheduling
of the lab and simulation space. The purpose of the scheduling as a team is to ensure
guidelines for social distancing and to prioritize the space for undergraduate and graduate
learners.
Scheduling of labs and simulation activities will limit numbers of learners based on space and
social distancing requirements. Learners will be assigned workstations in the lab and
simulation space to provide consistent tracking of student movement. Additionally, time will be
scheduled between simulation sessions to allow for resetting, cleaning, and disinfecting of the
SAIL Center spaces.
This plan is based on the current CDC guidelines (2020b) and the social distancing
requirements of 6 feet between people requiring a 36 sq. ft. area around each student. As
those requirements change the space allocations will be adjusted to meet the requirements.
Responsibilities
It is the responsibility of all faculty, learners, and staff to ensure a physically and
psychologically safe learning environment for all. There will be requirements specific to the
space and the equipment in use related to cleaning, disinfecting, and limitations.
All areas will be cleaned and disinfected between lab/simulation sessions. Learners, faculty,
and staff will be required to participate in the cleaning and disinfection needs as appropriate to
the assigned area. Please see Procedures for details. The simulation staff will be responsible
for ensuring that supplies and directions for cleaning are available in each area of the SAIL
Center areas.
All faculty, staff, and learners will be responsible for self-reporting temperature and symptoms
via Point and Click (PnC). See Procedures, Page 9.
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3. DEFINITIONS
This section of the plan provides definitions to ensure that there is a clear understanding of the
plan and the areas described in the plan.
Social Distancing – “A set of actions taken to stop or slow the spread of a highly contagious
disease. The goal of social distancing is to limit face-to-face contact to decrease the spread of
illness among people in community settings.” The current recommendation from the CDC is to
distance 6 feet from others (2020).
PPE – Personal Protective Equipment (PPE) is special equipment to protect an individual from
contamination by bacterial and viral pathogens. The special equipment may include gowns
(impermeable to moisture), masks, gloves, coveralls, face shields, goggles and more
depending upon the level of potential contamination.
COVID-19 – “A novel coronavirus is a new coronavirus that has not been previously
identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the
coronaviruses that commonly circulate among humans and cause mild illness, like the
common cold. COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses are
a large family of viruses that are common in people and many different species of animals,
including camels, cattle, cats, and bats. (CDC, 2020a)
High-touch areas – “High touch areas can include doorknobs, arms of reception area chairs,
elevator buttons, stair railings, restroom surfaces, coffee pot handles or dispensers, water
cooler handles, chair backs, and automatic payment machines. These are areas that multiple
humans come into contact with or touch in public spaces. (Lyall, 2020)
Simulation/Lab Space – The simulation/Lab space or Simulation and Innovation Learning
Center (SAIL) includes the 3 rd floor 301 OSCE suite, 307 Johnson Lab, 2 nd floor 206 Practice
Lab, 205 Dawson Lab, 204 Health Assessment Lab, and the 203 Paxton lab areas.
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4. PROCEDURES
The following are procedural plans for re-opening of the SAIL Center during the COVID-19
pandemic restrictions.
Preparation to enter the simulation/lab space– If there are any symptoms of illness, or
they have tested positive for the flu or COVID-19, individuals (faculty, staff, learners, and
standardized patients) are asked to remain at home and follow the guidelines of their
healthcare provider to reduce the risk of spread to others in the area. Prior to entering the
simulation/lab space maintain hand hygiene by washing hands with soap and water for 20
seconds or using an alcohol based hand sanitizer when hands are not visibly soiled.
At the entrance of the simulation/lab space, maintain a distance of 6 feet or greater and ensure
that face covering/mask is properly in place.
Screening – All individuals (faculty, staff, learners, and standardized patients) will complete
COVID-19 screening prior to entering the SAIL Center spaces. The screening process will
consist of Point and Click (PnC) symptom screening will self-disclose information. The
process will require completion of a questionnaire. All symptom answers to the questionnaire
must be negative to enter the simulation/lab space. Individuals with a cough or shortness of
breath will not be permitted to enter the space and will be provided an alternative assignment.
Individuals with at least TWO of the following symptoms: chills, muscle pain, sore throat,
vomiting, diarrhea, headache, and loss of smell/taste will be restricted from entering the
simulation space and provided with an alternative assignment. (Bryant, 2020).Upon entering
the simulation space, display the green PnC badge to enter. Maintain a distance of 6 feet or
greater to social distance and protect privacy of those still completing the screening process.
Learners that have identified themselves as providing care to a positive COVID-19 patient or
have been exposed to COVID-19 will be monitored for symptoms, but will be permitted to
participate in simulation and laboratory activities. Additional PPE may be required.
Cleaning and Disinfection – The Simulation and Innovation Learning Center has been
cleaned and disinfected by the simulation staff prior to reopening. This includes all
equipment in the acute care rooms, primary care rooms, exam rooms, simulators, beds, and
linens. All equipment and simulators have been disinfected using Super Sani-wipes, left
to air dry, and not touched after cleaning during the shutdown of the simulation lab/ spaces.
All linens have been washed at high temperatures, folded and reapplied to beds or placed
in storage.
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All simulators, equipment and beds will be cleaned again, prior to learners re-entering
the simulation/lab spaces.
Each work station will be provided with a sanitizing cleaner. Learners, faculty, and staff are to
ensure that each work station is cleaned with sanitizing cleaner to all areas that were touched
prior to leaving the work station.
Gloves/Masks - Learners, faculty, and staff are expected to wear gloves when appropriate at
the work station. If gloves would not be worn for something in the acute care setting, they
should not be worn at the work station. Gloves are to be worn when touching the simulator.
Face coverings/masks are expected to be worn in the simulation/lab spaces at all times. If a
learning opportunity requires a mask, it should be placed over the primary mask during the
procedure and then removed after the procedure. For example, when learning how to apply
PPE, every student should already have a mask/face covering to be in the building.
To apply the PPE, add an additional mask to the face covering for the lesson and remove
only the secondary mask when the assignment is completed.
It is the responsibility of all faculty, staff, and learners to hold each other accountable for
properly wearing their masks. If someone has let the mask drop below their nose, please
speak up and ask them to adjust the mask for a proper fit. All masks must cover the nose and
mouth to be effective. Once the mask is correctly in place, individuals should refrain from
touching it or adjusting it if possible. If an adjustment is needed, hand hygiene is
recommended after the adjustment.
Movement in the SAIL Center – The SAIL Center is following the healthy environments
guidelines for the simulation/lab space (CDC, 2020b). Individuals are asked to remain in their
assigned space. If there is a need to leave the workstation, individuals are asked to raise their
hand and let the instructor know so that they can ensure it is safe to move through the space.
For example, if there is a need to use the restroom, the instructor will ensure that individuals
will not cross paths with others to move to the restroom. To reduce traffic flow and exposure
not all learners will be able to take a restroom break at the same time.
Prior to leaving the workstation – Prior to leaving the workstation, ensure that all supplies
and equipment have been disposed of or returned to original working order. Dispose of
supplies properly – sharps in sharps containers, trash in the trashcans. Remove gloves that
were used during the learning session. Don clean gloves. Wipe down all areas that were
touched during the learning activity to include equipment, simulators, beds, etc. Dispose of
disinfecting wipes in large white “pickle jar” containers. Remove gloves and dispose of in the
trash. Wait until signaled to leave the simulation/lab space.
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Simulation Staff – After individuals have left the simulation/lab space, simulation staff will
check each work station for supplies, restocking needs, etc., and spray bedlinens, workstation,
etc., with a disinfecting spray.
Products - During the COVID-19 pandemic there has been a shortage of name brand
disinfection wipes, such as Clorox Clean-ups and Lysol wipes. The SAIL Center has made
every effort to use Super Sani-Wipes or equivalent to disinfect the simulation/lab workstations.
Other disinfectants may be used by following the recommended instructions on the packaging
to maintain the anti-bacterial/anti-infective effects of the product. The SAIL Center is
considered a laboratory space and therefore is under the guidelines of GW Safety which
requires the appropriate disposal of chemicals that are used as disinfectants. The SAIL
Center will abide by the regulations and guidelines of GW laboratory safety.
Home supplies – As changes occur with COVID-19, course work may revert to an online
format. If that is to happen, individuals will be sent supplies and equipment to their homes to
ensure the continuity of learning. If this happens, it will be the individual’s responsibility to
maintain the safety and security of supplies and equipment. The Food and Drug
Administration offers resources for the collection and disposal of sharps. Learners will be
required to sign a memorandum of understanding when taking possession of the kits. Details
will be provided to learners as needed to cover safe handling, proper disposal, and cleaning
instructions.
Health Assessment Course – The Health Assessment course is a unique course where
learners will practice what they learn on each other. To maintain the safety of all learners,
additional PPE will be required during the course to include a face shield, in addition to a face
covering.
The OSCE center will be used for the Health Assessment Course for the Fall 2020 semester.
The floor plan for this space provides a sink in every private room. All learners are expected to
perform hand hygiene with soap and water for 20 seconds as the preferred method of hand
cleaning. Additional care and requirements may be needed as healthcare policies change.
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5. PROCESS
The process for entering the SAIL Center is outlined as follows:
• Prior to entering simulation/lab space perform hand hygiene
• Follow the traffic flow pattern of the building and space.
• Ensure that mask is covering nose and mouth
• Proceed to assigned work station
• Faculty and staff will provide additional learning support and supplies as needed
After Learning Activity:
• Remove gloves if needed and apply clean gloves for disinfection process
• Dispose of supplies in the appropriate receptacle (sharps in red sharps container, trash
and gloves in trash can)
• Wipe all areas of the workstation to include IV pumps, bed, bed rails, mattress,
simulator, bed side dresser, over bed table, documentation devices, oxygen flow meter,
oxygen tubing, and all other areas touched during the learning activity
• Remove gloves
• Exit work station when signaled that it is safe
• Follow directional traffic flow as indicated (see Traffic Flow)
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6. TRAFFIC FLOW
To ensure safety of all individuals in the SAIL Center, traffic patterns have been established
to minimize exposure of by crossing traffic paths in the simulation/lab spaces. From the first
floor of Innovation hall, designated stairwells for up and down have been established as well
as limits to the occupancy of elevators to maintain social distancing and safety.
First Floor
Stairs to the right of security near the student lounge are designated as an up stairwell.
to the left of security are designated as a down stairwell.
Stairs
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Second Floor
Arrival onto the second floor from the UP stairwell, turn right to move down the hall. Entrance
to the Dawson simulation lab area (205) and the health assessment classroom (204) will be
through the glass doors off the second floor elevator (205/204 Suite) only.
Exit of the Dawson simulation lab area will be through the utility exit door near the up stairwell.
Exit from the health assessment classroom will be limited to the 203-suite door.
Entrance to the 203 Paxton simulation lab will be limited to the door at the end of the second
floor hallway near the down stairwell. Exit to the 203 Paxton lab will be through the 203 door
(same as health assessment exit).
Individuals will maintain social distancing while entering and exiting all simulation lab areas.
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Third Floor
Arrival onto the third floor will be through the up stairwell or elevators. The hallway will flow to
the left off the elevators. Entrance to the Johnson Lab (307) will be through the large wooden
double doors. Entrance to the OSCE area (301) will be through the large wooden door at the
end of the hallway. Entrance to the OSCE classrooms (308) will be through the main OSCE
entrance and then turn right to enter the OSCE lobby from inside the OSCE suite. Traffic
inside the OSCE suite will move in one direction toward the parking lot and around the outside
of the rooms.
Exit to the Johnson Lab (307) will be limited to the glass doors near the elevators. Exit to the
OSCE center area (301) will be through the Standardized patient exit. Exit to the OSCE
classrooms will be through the OSCE suite lobby. The standardized patient suite and the
debriefing room in the OSCE center will be closed during the COVID restrictions due to the
small size of the rooms and the inability to social distance in those areas.
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There is an area between the Johnson lab 307, the OSCE Center 301, and the up stairwell,
where there will potentially be two-way traffic. The plan is to stagger admission and dismissal
times to and from those areas to eliminate two-way traffic at those times.
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7. AMERICANS WITH DISABILITIES ACT
CONSIDERATIONS
“The University is making accommodations for high-risk individuals to teach and attend classes
and, where feasible, work remotely. As outlined by the D.C. Department of Health and the
CDC, these include but are not limited to individuals with chronic lung disease, moderate to
severe asthma, serious health conditions, immunocompromised conditions, severe obesity,
diabetes, chronic kidney disease, and liver disease and those who are over the age of 65.
GW is giving all students the option to attend virtually; we expect many international students
and at-risk students to do so. The university is also increasing our offerings of classes that are
fully on-line.” (GWU, 2020).
The Simulation and Innovation Learning Center will make every effort to support learners that
need to remain remote. Supplies for learners that need to remain remote are available
through the Director of Simulation and Experiential Learning. Faculty will provide instructions
for remote learning sessions.
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APPENDIX A: CLEANING AND
DISINFECTION GUIDELINES
“Cleaning is defined as wiping surfaces to remove dirt, grime, and germs from the focused
areas. However, germs can also be moved from one surface to another if the same cleaning
tool is used. Unlike cleaning, disinfecting uses chemicals to eliminate germs from focused
surfaces. Disinfection is defined as using chemicals, for example, EPA-registered
disinfectants, to kill germs on surfaces. This process does not necessarily clean dirty surfaces
or remove germs but kills germs on a surface after cleaning and can further lower the risk of
spreading infection.” (Bryant, 2020 pg. 4.)
All equipment and high-touch surfaces to include: task trainers, simulators, IV pumps,
laptops, mobile workstations, over bed tables, bedside dressers, counter tops, telephones,
Pyxis, bed rails, headboards, wheel chairs, bedside commodes, stretchers, door handles,
oxygen devices, and all touched surfaces will be cleaned with a disinfecting wipe prior to the
start of each class session. All simulators and task trainers will be cleaned with soap and
water on a weekly basis.
Linens will be sprayed between class sessions with a disinfecting spray and will be removed
for professional laundering on an as needed basis.
GWU environmental services will provide daily cleaning of floors, sinks, countertops and
doorknobs, light switches, and additional hard surfaces under their oversite.
During cleaning and disinfection, individuals should wear gloves, follow the manufacture's
recommendations for the disinfectant, dispose of gloves after cleaning, and wash hands with
soap and water for 20 seconds upon completion.
Individuals should refrain from shaking dirty laundry, sharing personal items, and using
disinfecting wipes on skin, and mixing cleaning agents. Never mix bleach with another
cleaning agent.
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References
Bryant, K., (May 11, 2020). Policy: Safety guideline for reopening of simulation for Columbia
University School of Nursing Helene Fuld Health Trust Simulation Center. Columbia School
of Nursing Helene Fuld Health Trust Simulation Center Policy Manual.
Centers for Disease Control (CDC), (2020a). Coronavirus (COVID-19).
https://www.cdc.gov/coronavirus/2019-ncov/index.html
Centers for Disease Control (CDC), (May 30, 2020b). Considerations for institutes of higher
Education. Centers for Disease Control and Prevention.
https://www.cdc.gov/coronavirus/2019-ncov/community/collegesuniversities/considerations.html
George Washington University (GWU) (June 15, 2020). The George Washington University
Plan for Fall 2020: Prepared for the District of Columbia Office of Planning and Department
of Health.
Lyall, A. (2020). The high-touch areas you should be cleaning more at home. The Block.
https://9now.nine.com.au/the-block/coronavirus-how-to-clean-high-touch-areas/ae4eeb29-
24a5-44a2-b529-313745d0ae16
United States Department of Labor (n.d.). COVID-19 – Standards.
https://www.osha.gov/SLTC/covid-19/standards.html
The White House (n.d.) Guidelines: Opening up America again. President Trump’s Guidelines
for opening up America again. https://www.whitehouse.gov/openingamerica/
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