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10/29/20 COVID-19 Brief: Holiday Gatherings: If Not Safest, Make Them Safer

Thanksgiving as we’ve known it (and as we hope to know it again) is simply not a responsible option this year. So what are we to do, and how might we guide our employees in their planning?

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Holiday Gatherings: If Not Safest, Make Them Safer

Thanksgiving. In normal times, the word is likely to evoke images of family and friends gathered together, of dinner tables crowded with chairs and overflowing with food, of table talk that is as likely to break out in laughter as debate, of intimate conversations ending in long embraces and touchdown passes producing loud cheers…

But these are not normal times. This is a pandemic year, and a shadow of death looms over gathering scenes like the one above. That’s not hyperbole. Consider:

  • 1. In a recent interview, CDC Director Robert Redfield stated: “But what we're seeing as the increasing threat right now is actually acquisition of infection through small household gatherings.”
  • 2. And household gatherings are risky because – when it comes to how COVID-19 spreads, such gatherings check all the boxes for transmission via both close contact and airborne spread.

Thanksgiving as we’ve known it (and as we hope to know it again) is simply not a responsible option this year. So what are we to do, and how might we guide our employees in their planning?

The Safest Option

The safest option to avoid spreading COVID-19 this Thanksgiving is to gather in person with only those who live in your household and to use technologies such as Facetime or Zoom to connect with friends and family.

Making Family and Friend Gatherings Safer

For a variety of reasons, the safest option may not work for your family. Similar to businesses that have not been able to have all their employees work from home, the aim is to take steps to reduce the risk of transmission among those who attend the gathering. The risk can’t be brought to zero, but it can be greatly reduced.

Make a Plan

Even if you’re hosting the gathering, efforts to make the event safer won’t work unless your guests comply with safety practices, so work with others who will be attending to develop and get buy-in for a safety plan.

  1. Begin by recognizing that this year must be different than years past.
  2. Consider community risk levels. The risk of any gathering is tied to the risk of the community in which it takes place, as well as the communities from which people travel. Tools like this COVID-19 activity tracker can inform your planning process. For instance, the risk of planning an event in much of Wisconsin is very high right now, and anyone traveling from Wisconsin should be asked to consider staying home or taking extra precautions (testing and self-quarantine) before they travel.
  3. Identify aspects of the holiday that are most important to experience and use the key practices below to make those experiences safer. For instance, if it’s important for older family members to spend time with their grandchildren and great grandchildren, consider how that might be accomplished apart from a large gathering.
  4. Pause for a reality check. Once you’ve developed your plan for a safe gathering, step back and ask: “Is it worth it?” If we stick with this plan, will it be a better experience than the safest option where we celebrate with our own households and find a way to connect with technology?
  5. If you decide to proceed, make sure everyone knows what’s expected and agrees to do their part to make the gathering safer.

The planning process may expose significant differences in how different groups perceive the COVID-19 threat. You are unlikely to convince a relative who thinks COVID-19 has been overblown that it does in fact pose a real threat and trying to do so could harm relationships. If you’re not comfortable that reasonable safety measures will be taken seriously, explain that you’re not comfortable with the risk for you and your family, and fall back to the safest option.

Key Practices for Safer Gatherings

  • Prioritize the safety of those most vulnerable: Older adults and those with certain medical conditions are at highest risk for serious illness, hospitalization and death. Inform them (and those who care for vulnerable people) about the risk inherent in the gathering, and if they decide to attend, take extra precautions to protect them.
  • Have a plan for adolescents and young adults: Young people returning from college or whose lives simply bring them into closer and more frequent contact with others are more likely to be asymptomatic carriers of the virus. Consider having them eat in a separate area, and when they interact with older adults, make sure they maintain distance, wear masks and keep contacts brief.
  • Educate/communicate about symptoms: Make sure all attending are aware of the symptoms of COVID-19, and stress the importance of not attending the event if anyone in a family group experiences symptoms.
  • Gather outdoors: If possible, plan an outdoor event. It is the most important step you can take to reduce the risk of your gathering. If you can’t gather outdoors, seriously consider alternatives to a large gathering, because safely gathering indoors will be difficult to do.
  • Improve ventilation: If it is not possible to gather outdoors and people want to gather indoors despite the much higher risk, open windows to improve indoor air ventilation. Let guests know this is the plan so they can dress accordingly.
  • Follow basic prevention measures: Whether outdoors or indoors, social distancing, handwashing and mask-wearing should all be implemented to the extent possible.
  • Use testing and self-isolation: Particularly if people vulnerable to serious illness will be in attendance, consider testing. We recommend a PCR test five days before the event, followed by an antigen test two or three days before the event to confirm the initial test result. In addition, people/families should self-isolate for a week prior to the event.
  • Think through travel and lodging: Travel by car is generally safer than air travel, though there are steps you can take to make air travel safer. Staying in a reputable hotel will reduce transmission risk compared to staying in someone’s home.

Be Ready to Pivot

As part of the planning process, make sure everyone understands and expects that plans could change suddenly. An illness among a member of the host family; a sharp uptick of cases in the community where the gathering will be held; bad weather that would force the gathering indoors where the risk of transmission is much greater – any of these would be a reason to drastically alter or cancel plans.

COVID-19 has taken much from us, and we’re understandably reluctant to let it rob us of the opportunity to gather with family and friends for Thanksgiving (or the upcoming end-of-year holidays). We must balance competing desires for physical safety and in-person connection with loved ones. While we can’t have both, there is much we can do to protect our health while we enjoy the company of those we love.

Do you have questions or holiday gathering tips to share? Let us know. And, also contact us if there are topics you’d like to see us address in upcoming editions of the WorkSTEPS COVID-19 Brief.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.

Medical:


Area Reported Cases Deaths Recovered
Global 44,017,937 1,167,785 32,301,346
United States 9,051,735 232,272 5,885,393

Source
Source

Fall Surge is here: Newly confirmed cases per day are rising in 47 states, and deaths are up in 34 states. New daily cases on Oct. 23-24th reached about 80,000 +  contrasted with a September 23-24th when we were at about 45,000. Average deaths per day across the U.S. rose 10% over the past two weeks from 721 to nearly 794 as of Sunday. Public health experts warn that it’s only a matter of time before deaths trend upward sharply since death is a lagging indicator of increased infections.

Nationally: North and South Dakota have the most cases per capita nationally, followed by Wisconsin and Montana. In parts of the Midwest and West, hospitals are already struggling to make room for patients as ICU capacity dwindles in metro areas and in smaller rural communities. Wisconsin recently reopened a field hospital that was set up in the early days of the pandemic but sat unused until now. Mitigation practices that people and policy makers can take even now like social distancing, universal adherence to wearing masks, handwashing, ventilation, and policies to limit crowd sizes have shown to be effective.

Europe's resurgence: Europe’s confirmed death toll has surpassed 250,000. France is reporting an average of more than 52,000 new daily infections. Nations across Europe have enacted more restrictions. Spain became the first European country to record more than 1m COVID infections and has declared a state of emergency which includes a nationwide overnight curfew. Italy enacted restrictions which include restaurants and cafes to close at 6 p.m. and closure of  cinemas, gyms and other leisure venues.

Nearly 800,000 US children: In the latest state-level data report, the American Academy of Pediatrics shared statistics demonstrating prevalence of coronavirus among children. They now make up 11 percent of cases about 1,053 cases per 100,000 kids. Children made up between 5%-16.9% of total state tests, and between 3.5%-14.5% of children tested were tested positive. Eleven states reported 15% or more of cases were children.

Cognitive Cost: According to a new study people recovering from COVID-19 may suffer significant brain function impacts, with the worst cases of the infection linked to mental decline equivalent to the brain ageing by 10 years. The not yet peer-reviewed study of more than 84,000 people found that in some severe cases, coronavirus infection is linked to substantial cognitive deficits for months.

Damage to the heart’s right ventricle: When a patient is hospitalized with COVID-19, signs of damage to the right side of the heart may indicate a greater risk of death, according to a study from Weil Cornell researchers. The study suggests that echocardiograms may be key to identifying the most at-risk patients.  

Mitigation / Suppression:

7.5 hour summer flight to Ireland led to a SARS-CoV-2 outbreak: Despite safety precautions, one summer flight into Ireland led to a 59-person outbreak in six of the country's eight health regions. The 7.5 hour-long flight had 49 of its 283 seats filled. Testing confirmed that 13 (26.5%) of the original 49 passengers were positive for SARS-CoV-2, with the other 46 infected via contact with infected passengers. Using genome sequencing public health experts revealed a single source as the cause of spread among the passengers. The researchers found that the plausible attack rate was 17.8%, with 8 people contracting COVID-19 during the 7.5-hour flight, 3 incubating or infected after the flight, and 1 a tertiary contact of a flight case.

Swiss Cheese metaphor: The ‘Swiss cheese’ metaphor helps explain how stacking several simple mitigation practices together can help us protect ourselves and others, and reduce the spread of the virus, to coworkers, family, and friends. The model was developed in aviation showing efficacy of multiple small steps integral to accident prevention.

Source

Corporate:

Occupational Risk: As US coronavirus hospitalizations surge, a new CDC study calculated what U.S health workers and particularly nurses have known: they suffered disproportionately early in the pandemic. Across 13 states from March–May, ~6% of people hospitalized with COVID-19 were health workers: 36.3% of them were nurses; more than 67% work in direct patient care; 72% were female; over 50% were Black; 89.9% had an underlying health condition.  Further understanding of exposure risks for SARS-CoV-2 infection among HCP is critical to inform further prevention strategies for these essential workers.

CDC prison study helps redefine SARS-CoV-2 close contact: Last week a paper in the Morbidity and Mortality Weekly Report highlighted  a case study the CDC used to update how it defines close contacts of people infected with SARS-CoV-2.The study, conducted by the CDC, Vermont Department of Health (VDH), and the Vermont Department of Public Corrections, involved a Vermont corrections facility employee who had multiple brief encounters with six incarcerated or detained persons (IDPs) on Jul 28, while their SARS-CoV-2 test results were pending. On Jul 29, all six inmates received positive test results, and on Aug 5, the corrections officer tested positive as well. Initially, the officer was not considered a candidate for contact tracing because he did not fit the CDC guidance definition of a close contact (a person who's been within 6 feet of an infected individual for 15 consecutive minutes). Upon surveillance video review they discovered that while the officer had never spent 15 consecutive minutes within 6 feet of any of the infected inmates, he had numerous brief encounters that cumulatively totaled more than 15 minutes over a period of 24 hours (17 minutes total). CDC Director Redfield, cited the data from the study as one of the reasons the agency updated its definition of a close contact, which is now defined as someone who's been within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period.

The Work From Home WorkSTEPS Medical Team:

Ben Hoffman, MD, MPH
Chief Medical Officer

Tony Nigliazzo, MD
Medical Director

Loraine Kanyare, MSN, MPH, RN
Director of Case Management

Robert L. Levitin, MD
Physician Consultant

Lynda Phillips, LVN
Nurse Case Manager

Codey Church, LVN
Nurse Case Manager

Kerry Womack, LVN
Nurse Case Manager

Chuck Reynolds
Strategic Communications Consultant

This Guidance (“Guidance”) is provided for informational and educational purposes only. It is not intended as Legal Advice or Medical Advice. Adherence to any recommendations included in this Guidance will not ensure successful diagnosis or treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. Similarly, this Guidance is based on current advice, comments, and guidance from the EEOC, CDC and the CMS made publicly available. The ultimate judgement regarding the propriety of any specific employment action must be made by the company and attorney in light of all of the circumstances presented by the company, state and federal rules existing at the time and the then current state of the National Pandemic. This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies or changes in rules, regulations or laws may require revisions to the recommendations in this Guidance to reflect new data. WorkSTEPS does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.

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