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12/17/20 COVID-19 Brief: The Home Stretch Will Be Long – Resilience Needed Now More Than Ever

We are rounding the corner into the home stretch, but it’s going to be a looonnnggg one, and it’s going to require a different set of leadership skills than was needed to navigate earlier phases of the pandemic.

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

The Home Stretch Will Be Long – Resilience Needed Now More Than Ever

Take-Aways

  • We appear to be rounding the corner on Covid-19, but the home stretch will be long.
  • The leadership skills needed now are different than early on. Then, it was about reacting to a new and unexpected threat; now, it’s about stamina.
  • Leading in the next phase will challenge us to: 1) Distinguish between what is urgent and what is important; 2) Balance compassion for our people with the need/opportunity to inspire high performance; and 3) Energize everyone every day.
  • We can apply the above recommendations to leadership of our corporate Covid-19 strategies. Critical will be reframing the pandemic away from day-to-day urgencies and toward the critical goal of returning our businesses, jobs lives and communities to normal by achieving high rates of vaccination.
  • Leaders should take the opportunity to strengthen their resilience in and through the next phase of this crisis.

By every measure, 2020 has been rough. Even if your business has prospered during the pandemic, you and your employees have been subject to uncertainty, fear, loss, change, and isolation. I doubt you need convincing of this, but if you’d like a nice (depressing) summary, this recent WSJ article will give you the numbers behind the pain.

The Home Stretch

At the threshold of a new year, it feels like we’re rounding the corner and heading into the home stretch of this troubled journey. Even as our minds struggle with headlines about record-setting numbers of new infections and deaths, we’re processing really good news about vaccines. We sit with sadness and frustration, but also with hope and anticipation that 2021 will be different.

And, if vaccine approvals, production, distribution and vaccination all goes well, 2021 will be different. But even in the best-case scenarios, we won’t be returning to anything that feels like “normal” until well into the third quarter, and fourth quarter is probably more likely.

We are rounding the corner into the home stretch, but it’s going to be a looonnnggg one, and it’s going to require a different set of leadership skills than was needed to navigate earlier phases of the pandemic.

Leading Through This Next Phase

The best thing I’ve read about the leadership challenge we now face and the mindset with which we need to face it landed in my inbox this week. The title, How to Lead When Your Team is Exhausted - and You Are Too, spoke to me, so I read it immediately and with great interest. I expect the title will grab you as well and that you’ll be enticed as I was to read it in full. As such, I’m just going to simply summarize the author’s key points, and then add my thoughts about the specific challenge of leading a corporate Covid-19 strategy.

Key points

  • Home stretch leadership will be different than the leadership needed in the initial phases of the pandemic. The first wave required leaders to quickly assess the threat and to mount a response. It was an adrenaline-filled response to a sudden and unexpected threat…a fight for survival. In this next phase, we need psychological stamina to fight through the randomness, gloom and persistent burden of the pandemic.
  • Cultivating resilience for what comes next will require that we reframe the challenges we’re facing and use that new framing to tap the psychological stamina we and our teams need to succeed.
  • First, as the article’s author Merete Wedell-Wedellsborg notes, we need to distinguish between urgent and important. Rather than continue to react to the circumstances of the pandemic, leaders should focus proactively on what comes next for the business, identify that as what matters most, and keep everyone’s sights set on creating that desired future. The pandemic has shaken economies, industries, businesses, and functions within businesses. The shake-up presents an unprecedented opportunity to think critically and strategically about how the company will emerge better and stronger from this crisis.
  • Second, we need to balance compassion and containment. We need to share with vulnerability, listen with empathy and respond with compassion because – to one degree or another – everyone’s life has been turned upside-down and we shouldn’t pretend otherwise. Having said that, the objective isn’t for leaders to throw a pity party. Rather, it is to acknowledge common fears and frustrations so that colleagues can function as a team in pursuit of new aims; to – as the author puts it – give the team a second wind for the race ahead.
  • Third, we need to energize everyone every day. This work is enabled by the prior tasks. Our job is to remind ourselves and our teams about the important work we’re doing and the shared commitment we’ve made to doing it. It’s also about keeping score so that we don’t forget to celebrate successes and hold each other accountable to do better.
  • The article concludes by recognizing the importance of personal resilience, particularly for leaders. Wedell-Wedellsborg notes: “Managing your own mind and deciding to take charge of your destiny (and helping others do the same) is where you find mental strength for the last mile.”

Advice Applied to Covid-19 Strategy Leadership

As I read again and summarize the points above, the following thoughts occur to me relative to the challenges we face in leading corporate Covid-19 strategy:

  • Urgent vs. important: We will not be able to escape the urgencies that await us in the months ahead – urgencies related to continue implementation of basic prevention policies, managing outbreaks, and planning/executing employee vaccinations. As leaders, we should strive to frame all of that urgent activity within the context of what matters most – enabling the company to safely return to normal operations (and people return to normal lives) as quickly as possible. Help people to vividly picture that future, hold it up in front of them, and use it to inspire all the work that will need to be done.
  • Compassion and Containment: Remember the “We’re all in this together!” sentiment that was wonderfully common in the early days of the pandemic? It was trampled by political division and is hard to find now. But, it seems to me, we have an opportunity to bring it back. Despite a vocal anti-vaccine movement, the vast majority of people are again united in the hope that they can get their lives back. If we take time to acknowledge the suffering that we’ve all endured and vividly picture the future we want, we can rally people around vaccination to achieve our goals.
  • Energize Everyone, Every Day: As we plan for workforce vaccination, we should set our goals, share the progress we’re making, and keep employees informed about where things are and how they can help. If we’re in this together again, then make it clear that we’re in it together.

And finally, regarding personal resilience: A crisis will both test our resilience and help us strengthen our resilience skills. Space won’t allow a lot of words on this. I will only say that if you’ve not explicitly looked at your own resilience, do so. There is a lot written on resilience, you can find apps that will help you build your resilience, and you may want to consider coaching to improve your resilience. It will serve you through this crisis and well beyond.  

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 74,942,739 1,662,660 52,644,710
United States 17,456,957 315,727 10,179,873

National: On Tuesday, the CDC reported 16.11 million total cases and 298,266 deaths. The US reported a new single-day record for daily incidence on December 11, with more than 244,000 new cases.  The US is averaging 2,430 deaths per day, 34 states; Washington, DC; and Puerto Rico are reporting increasing COVID-19 incidence over the past 2 weeks. Daily incidence has more than doubled in 3 states over that period—California, Maine, and South Carolina—and another 12 are reporting increases of 50% or more.

Global: On Tuesday, the WHO COVID-19 Dashboard reported 71.35 million cases and 1.61 million deaths. The global cumulative incidence surpassed 70 million cases on December 13. From the first reported COVID-19 case, it took 90 days for the global total to reach 1 million cases. The WHO reported weekly incidence was 3.4% higher than the previous week, the second consecutive week-to-week increase. Mortality increased for the eighth consecutive week, although only a moderate 0.8% increase over the previous week. London closed pubs and restaurants this week. The Netherlands has shut gyms, cinemas, schools and nonessential shops until Jan. 19. Germany, a country that loves its Christmas rituals - is locking down for Christmas.

The coronavirus at 1yr: A year into the pandemic, what scientists know about how it spreads, infects, and sickens: A year into the pandemic, STAT is outlining a portrait of SARS-CoV-2 based on what scientists learned as the virus raced around the world, crippling some economies, societies, and health systems in its wake. How the virus cracks open cells and wards off the body’s first-line attack. How it can spread before people start feeling sick. How it’s changed since the dawn of the pandemic, and what, if anything, that means. How the omnivorousness of the disease it causes, called Covid-19, reaches not just the lungs but into the heart, brain, gut, and beyond.  

Household Transmission of SARS-CoV-2 A Systematic Review and Meta-analysis (JAMA Network): In this meta-analysis of 54 studies with 77,758 participants, the estimated overall household secondary attack rate was 16.6%, higher than observed secondary attack rates for SARS-CoV and Middle East respiratory syndrome coronavirus. Controlling for differences across studies, secondary attack rates were higher in households from symptomatic index cases than asymptomatic index cases, to adult contacts than to child contacts, to spouses than to other family contacts, and in households with 1 contact than households with 3 or more contacts.

Study Finds No Link Between COVID-19, Guillain-Barré Syndrome: Researchers in the UK published findings from a study on Guillain-Barré syndrome (GBS) and COVID-19. The GBS study, published in Brain, found no causative association between GBS and COVID-19. The researchers compared GBS data during the UK’s first COVID-19 wave (March-May 2020) against GBS data from 2016-19. Like many other health conditions, reports of GBS decreased during the first wave, falling from 113-132 cases in March-May in 2016-19 to 56-93 cases in 2020. This could be a result of individuals delaying medical care during the UK’s “lockdown” or a reduction in transmission of other infections that could lead to GBS. The researchers also included seroprevalence data for SARS-CoV-2 infection among blood donors, and they estimate the risk of GBS to be approximately 0.016 cases of GBS per 1,000 cases of COVID-19. The researchers also evaluated patient-level data from 47 GBS cases reported in the UK, including 13 confirmed and 12 probable COVID-19 cases and 22 non-COVID-19 patients. They identified an increase in the use of intubation among GBS patients with COVID-19, which the researchers believe is “likely” due to the pulmonary effects of COVID-19 rather than increased severity of GBS presentation.

Baricitinib Plus Remdesivir Shows Promise for Treating COVID-19: The combination of baricitinib, an anti-inflammatory drug, and remdesivir, an antiviral, reduced time to recovery for people hospitalized with COVID-19, according to clinical trial results published in the New England Journal of Medicine. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. (NIH, 12/11/2020)

Mitigation / Suppression:

FDA permits first fully at-home Covid-19 test: On Tuesday, the FDA issued an emergency use authorization for the first at-home Covid-19 test – it’s called ‘The Ellume COVID-19 Home Test’. The public can purchase it at a drugstore for home use. The test entails swabbing your own (or household members) nose and finding out the answer via your smartphone in 20 minutes. The Ellume home test is a rapid antigen test that runs a liquid sample along a surface with reactive molecules, detecting fragments of SARS-CoV-2 proteins. The test requires the user to download an app which the test’s analyzer connects to and guides the user through the test and how interpret results. In the past, the FDA had authorized at-home tests that required a prescription or lab for results. Caveat: The new test is less specific and less sensitive than molecular lab tests.

FDA authorizes the first at home self-administered molecular test: The Lucira COVID-19 All-In-One Test Kit test has been authorized for home use with self-collected nasal swab samples in individuals age 14 and older who are suspected of COVID-19 by their health care provider. It is also authorized for use in point-of-care (POC) settings (e.g., doctor’s offices, hospitals, urgent care centers and emergency rooms) for all ages but samples must be collected by a healthcare provider when the test is used at the POC to test individuals younger than 14 years old. The test is currently authorized for prescription use only.

The test works by swirling the self-collected sample swab in a vial that is then placed in the test unit. In 30 minutes or less, the results can be read directly from the test unit’s light-up display that shows whether a person is positive or negative for the SARS-CoV-2 virus. Positive results indicate the presence of SARS-CoV-2. Individuals with positive results should self-isolate and seek additional care from their health care provider. Individuals who test negative and experience COVID-like symptoms should follow up with their health care provider as negative results do not preclude an individual from SARS-CoV-2 infection.

FDA-authorized Pfizer Vaccine administration began this week: Last Friday, the FDA issued an EUA for the Pfizer/BioNTech vaccine. This allows Pfizer to distribution the vaccine nationwide. Eligibility will start with priority populations such as high-risk individuals and essential workers. The first shipments of the Pfizer/BioNTech vaccine have already been distributed and vaccination efforts began across the country.  

Vaccine Combinations: As initial doses of first generation SARS-CoV-2 vaccines are being distributed in some countries, discussions are already underway to optimize second generation vaccine formulations and dosing schedules. Last week, AstraZeneca announced that it is collaborating with the developers of Russia’s Sputnik V vaccine to determine whether administering a combination of the two vaccines could improve efficacy. Reportedly, the initial clinical trials of the combination vaccine would be held in Russia and will begin in Russian adults. According to the press release issued by AstraZeneca, the UK government has already announced upcoming clinical trials to evaluate combinations of adenovirus-based vaccines, like those produced by AstraZeneca/Oxford University and Russia’s Gamaleya Research Institute, and mRNA vaccines, like those from Pfizer/BioNTech and Moderna; however, the AstraZeneca and Gamaleya Institute collaboration will evaluate a combination of two adenovirus-based vaccines.

Utilizing a combination of different vaccines for the same pathogen is called “heterologous boosting,” and it aims to improve both efficacy and accessibility. AstraZeneca indicated that the heterologous boosting approach could speed the process of completing the 2-dose regimen, particularly if the availability of some vaccines is limited; however, UK government health officials stated that the focus is on improving the immune response and not a response to limited supply.

U.S. Buys Another 100 Million Doses of Moderna COVID-19 Vaccine as Emergency Use Authorizations Roll Out (Homeland Preparedness News): With the distribution of Pfizer’s COVID-19 vaccine underway in the United States and an emergency use authorization (EUA) expected to follow for Moderna’s vaccine this week, the federal government is preparing through massive logistics and additional purchases.

Corporate

Impact of Coronavirus on businesses and economies: This time last year, concepts such as “lockdowns,” “mask mandates” and “social distancing” were unknown to most of us. Today they are part of our everyday language as the COVID-19 pandemic continues to impact all aspects of our lives.

A guide to who can safely get the Pfizer/BioNTech Covid-19 vaccine

A Covid-19 vaccine rollout is underway across the U.S., but there are still questions about who ought to — and can — get the vaccine. Here's what we know:

  • Pregnant and lactating people: Although none of the trials used to approve the Pfizer/BioNTech vaccine included this group, the CDC said that pregnant and lactating women should be given the option to take the vaccine if they choose to.
  • People with allergic reactions: Those with allergies to certain foods, insects, latex and other common allergens can be vaccinated, the CDC said. Those with a history of anaphylaxis to injectables or other vaccines can be vaccinated with caution and a risk assessment from their provider. Those who are allergic to any of the Pfizer/BioNTech vaccine ingredients, however, should refrain from getting the shots.
  • Those younger than 16: The CDC isn't recommending the vaccine for this age group yet since the vaccine has only been approved for those aged 16 years and older. And while studies for those ages 12-15 are ongoing, studies in those younger than 11 haven't begun.

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

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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Newsletter written by WorkSTEPS CMO Dr. Ben Hoffman and WorkSTEPS’ expert medical team.

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