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UPDATED: APRIL 1, 2020 @ 8:04 P.M.

North Central District Health Department, in communication with state officials, have signed the NCDHD counties, including Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce and Rock, into the Directed Health Measures, effective April 1, at 10 p.m., through May 11, unless the order is extended.

Please read the Directed Health Measures in full carefully, they can be found on the Department of Health and Human Services website at http://dhhs.ne.gov/Pages/Coronavirus.aspx or on the NCDHD website at: https://ncdhd.ne.gov

I. Gatherings are hereby prohibited;

A gathering is defined as any event or convening that brings together more than ten (10) patrons, customers or other invitees, excluding staff, in a single room or single space at the same time, including but not limited to, pre­ schools, daycare facility (including in-home facilities), gymnasium, salon, fitness center, auditorium, stadium, arena, large event conference room, meeting hall, theater, library, or any other confined indoor or outdoor space. This also includes weddings and funerals, as well as parades, fairs, festivals, concerts and other indoor and outdoor events.

For the purpose of clarity, a gathering does not include normal operations at airports, bus and train stations, health care facilities and services (as defined in the Health Care Facility Licensure Act NEB. REV. STAT. §§ 71-401 to 71-475), other mental health and /or substance use treatment

day programs which are not required to be licensed (such as Day Rehabilitation or Day Treatment), shopping malls and centers, or other spaces where ten or more persons may be in transit. It also does not include typical office environments, factories, or retail or grocery stores where large numbers of people are present but it is typically unusual for them to be within six feet of one another. It also does not include events at which members of the media may need to be present, courts of law, public utilities, state, county, and city operations, election offices and polling places on Election Day, logistics/distribution centers, or family residences housing ten or more people. However these settings are directed to use heightened, diligent and effective disinfection of exposed surfaces meeting the directions of the Nebraska Department of Health and Human Services, Centers for Disease Control and Prevention and the Environmental Protection Agency.

Liquor, beer, and wine sales are restricted to carry-out sales and delivery only, to the extent permitted by law. No onsite consumption is permitted. This includes bars, taverns, and private clubs, regardless of name or characterization.

Food and beverage sales at restaurants, bars, taverns, private clubs, and any dine-in establishments are restricted to carry-out, drive-through, and delivery only. This does not apply to and/or exempts food service in health care facilities.

Lines for carry-out and drive-through in the above-referenced establishments must have an environment where patrons and staff maintain social distancing (a distance of six feet away from other persons) whenever possible.

1. Elective medical and dental surgeries and elective medical and dental procedures are hereby prohibited. For the purposes of this Order, this means a surgery or procedure that is scheduled in advance because it does not involve a medical or dental emergency. Surgeries or procedures that must be done to preserve the patient's life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical or dental provider.

2. Individuals who test positive for COVID-19 or who have the following symptoms: fever of 100.4 F. or above, or a sudden onset of a cough or sudden onset of shortness of breath; and individuals who reside or resided with individuals who have tested positive for COVID-19 or with individuals who have the above symptoms shall home-quarantine, unless quarantined in a health care facility, for a period of no less than 14 days, from the date of the positive test or onset of symptoms, per attached Quarantine Directions. If a Home-Quarantined is residing with other household members, the household members' Home-Quarantine may be discontinued 7 days after the original person has been released from home-quarantine. However, the household member(s) must continue to self-monitor for the above listed symptoms for an additional 7 days. Home-Quarantine shall be per the attached Quarantine Directions. Individuals with the above-listed symptoms who have tested positive for influenza or an alternative diagnosis including seasonal allergies or other chronic condition and individuals who reside or have resided with individuals who have tested positive for influenza or an alternative diagnosis including seasonal allergies or other chronic condition are not subject to quarantine under this Order. Please see the attached, and hereby incorporated in full, Quarantine directions, per 173 NAC 6-006.03B. Individuals with the above-listed symptoms who have tested positive for influenza or an alternative diagnosis including seasonal allergies or other chronic condition and individuals who reside or have resided with individuals who have tested positive for influenza or an alternative diagnosis including seasonal allergies or other chronic condition are not subject to quarantine under this Order.

II. The following Directed Health Measures are hereby ordered for ALL counties statewide effectively immediately and continuing until May 31, 2020 unless renewed, extended, or terminated by subsequent order, all persons in all the aforementioned counties are ordered to comply:

1. All schools; public, private and parochial: are hereby ordered to cease all in­ person instruction, and all extra-curricular activities except for: remote learning, child care services, meal distribution, distribution of educational materials and supplies, general building or physical plant operations and maintenance, and residential services may be continued as needed or necessary

2. Schools are defined as public, private, and parochial elementary and secondary schools.

This order supersedes previous Directed Health Measure Orders 2020-001, 2020-002, 2020-003, 2020-004, 2020-005, 2020-006 and 2020-007 for the aforementioned counties, provided, this Order does not supersede the provisions of any Directed Health Measure(s) issued by Local Health Departments, except that the Directed Health Measures contained in this order are binding and enforceable regardless of any Directed Health Measure(s) issued by Local Health Departments.

These Directed Health Measures are enforceable by law enforcement. Persons in violation of these Directed Health Measures may be charged with a Class V Misdemeanor.

Wednesday afternoon, the North Central District Health Department announced eight counties it serves will be included in a directed health measure.

Antelope and Holt counties will be included in the directive.

DHMs are enforceable by law enforcement. Individuals in violation of a DHM may be charged with a Class V misdemeanor.

A news release, sent by NCDHD, said, "On April 1, 2020, at 2 p.m., it was announced that a DHM will be coming later today, which will include the North Central District Health Department district counties of Antelope, Boyd, Brown, Holt, Keya Paha, Knox, Pierce and Rock."

Governor Pete Ricketts issued the first DHM, March 18. It applies to Cass, Douglas and Sarpy countines and is in effect through at least April 30.

A second DHM, announced March 25, applies to Dodge, Lancaster, Saunders and Washington counties and continues through May 6.

Butler, Hall Hamilton, Merrick, Polk, Seward and York counties were included in a third DHM. It is effective until May 6, unless renewed.

A fourth DHM, effective March 29, includes Burt, Cuming Madison and Stanton counties and will be in effect until May 6, unless renewed.

Monday, Ricketts issued a DHM for Banner, Box Butte, Cheyenne, Dawes, Deuel, Garden, Grant, Kimball, Morril, Scotts Bluff, Sheridan and Sioux counties, which will be in effect until May 11.

DHMs impose enforceable limits on public gatherings. It also requires restaurants and bars to close dining areas immediately and move to takeout service, delivery and/or curbside service only until further notice.

The Summerland Advocate-Messenger will post the DHM when it is released.

This is a developing story. We will post updates as news is released.