As day-to-day urgencies with COVID-19 subside even a little, our customers are recognizing the need to address a number of health issues that have been left untended and have often gotten worse during the pandemic. At the top of the list – mental health. For answers to some of the questions we’ve been getting, Dr. Hoffman interviews Noah Wayne, PhD, VP of Clinical Programs for NexJ Health, a partner of WorkSTEPS.
A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman
1. The pandemic has been a global traumatic event that has tripled rates of depression and other mental illnesses.
2. While we’ve made progress on mental health stigmatization, people still tend to hide their struggles. Employers should assume employees are struggling and take action to address mental health.
3. At a high level, organizations need to message against the stigma and make sure employees are aware of available resources.
4. At the individual level, it is ideal for employers to promote the use of screening services, coupled with the availability of counseling services to help people better understand their mental state and access help as needed.
5. As we move away from the constant crisis mode of the pandemic, we need to return to a holistic, person-centric approach to employee wellbeing that emphasizes physical and mental aspects.
As day-to-day urgencies with COVID-19 subside even a little, our customers are recognizing the need to address a number of health issues that have been left untended and have often gotten worse during the pandemic. At the top of the list – mental health.
For answers to some of the questions we’ve been getting, I turned to Noah Wayne, PhD, VP of Clinical Programs for NexJ Health, a partner of WorkSTEPS. Edited for length, below is the record of my recent Q&A conversation with Noah.
Dr. Ben Hoffman: We hear a lot about COVID-19 and how it has been such a struggle for many in terms of mental health. What does the data tell us about who is being impacted and what specifically they're struggling with in terms of mental health issues?
Dr. Noah Wayne: COVID-19 is very much being experienced like a global traumatic event that has changed our way of life. It has instilled fear, created significant economic challenges, and has killed our loved ones. So, fundamentally, people are experiencing higher than normal rates of mental health issues, such as depression and anxiety, post-traumatic stress disorder, substance abuse, and in some cases, general feelings of hopelessness.
The pandemic has sparked a lot of research in the mental health area. A paper in JAMA last year compared depression rates amongst a snapshot of the American population with another snapshot taken pre-COVID-19. The results indicated a threefold increase in depression rates at all levels - mild, moderate, and severe. Those findings are consistent in Canada, in the UK and around the world. And the people that have been affected the most are those who are most vulnerable. So those in lower socioeconomic strata communities with fewer economic resources and greater exposure to stressors report greater levels of depression and trauma.
Ben: Do you think that HR leaders or company executives understand the magnitude of the mental health challenge that some of their employees are under at this point in time?
Noah: The thing to remember about mental health issues is that they're typically not visible to employers and colleagues until they reach the point of burnout, leading to significant decreases in work output. Or issues are hidden until there are visible signs of anxiety and distress.
What is really important for an HR executive to know is that – statistically – the people working in their company are experiencing higher than normal levels of stress, anxiety, and depression. It's gone up across the board and includes people who have been able to keep their jobs and maybe had to pivot to work remotely. Working remotely is stressful, especially if people are raising a family and have all the other sides of their life now coalesced in one living unit. Are employees underplaying the stress? They may be, and that should give leaders even more reason to be aware of what the research is showing as far as what the increased burden is during COVID-19 on mental health.
Ben: Right now, the news is pretty good on the COVID-19 front in terms of vaccine efficacy and case rates. Assuming things continue to improve, do you expect the mental health picture to improve in a sort of straight line, or will there be a lag? How can we expect a return to some level of normalcy to be reflected in mental health improvement?
Noah: There is reason to believe that mental health will improve. Research done over the summer and the fall showed that the lockdowns and other measures we've had to take as a society to help curb the spread of COVID-19 had a significant negative impact on people's mental health and wellness. And you can see that as those lockdowns eased, people's depression went down; and when lockdowns ramped back up, we’ve seen a ramping up again of depression symptoms.
These trends would indicate that once people are vaccinated and once the infection rates go down enough so that the economy opens up, people can see their loved ones and can get out of their houses and start to interact in a more normal way, there will be some corresponding improvements in mental health. Having said that, there will be some people who have been more specifically affected by the lockdown or by the pandemic – say, by a personal illness or the death of a loved one – who may suffer some lingering mental health impacts.
Ben: Different people have been undergoing different types of stresses and experiencing different types of mental health issues. For instance, the experience of somebody working from home is different than a factory worker who has been reporting to work every day, which is different from somebody working a cash register… What should employers be doing at a high level to help people better cope with the varied stresses that they encounter? And then, what should employers be doing to make sure that each individual employee feels that they have the support that they need?
Noah: When it comes to mental health, it's great that we've taken these inroads to start talking about things like stress, depression, and anxiety because traditionally, they haven’t been talked about. With that said, there is still a lot of stigma for employees around talking about their mental health. There is concern about: “How will my employer react if I talk about my mental health issues?” So first of all, it’s important to make sure employees know that they have a nonjudgmental and open work environment where they can talk about mental health issues if they are struggling. It’s about creating a culture that promotes and is centered around the health and wellness of employees.
The CDC actually does a really great job outlining a framework for what companies can do to create an atmosphere of openness around mental health (Mental Health in the Workplace - CDC). Among their recommendations is to be transparent and clear in communications to employees, such as emailing policies around support for mental health and access to resources. Such communication should be standard across the organization.
At the individual level, one of the first things is to make mental health assessments available to employees, and to educate employees about what they are, what they measure, and how to access them. So, if an employee is feeling down and not sure if it may be depression, they can complete an assessment and receive a report that gives them a better understanding of how their feelings represent their actual mental state, as well as information about accessing available resources.
Layered on the assessment, the next thing is providing free and subsidized health coaching, counseling, and self-management programs that help employees address their mental health issues. Finally, especially in this remote working environment, managers and supervisors should be having regular check-ins with their direct reports.
Ben: Throughout this pandemic, we've seen some front-line employees who've had to navigate challenging workplace environments – whether it’s a customer who won't heed a policy or different attitudes among employees about the need for masks or social distancing. What are the psychological impacts of these conflicts, and what should employers be doing to help mitigate the impacts of these conflicts?
Noah: Those conflicts can be traumatizing. When an employee is simply trying to uphold the policy that their bosses tell them to uphold, it can feel very lonely. It can feel dangerous when someone doesn't comply with the risk of exposure, but also at another level, it gets terrifying when somebody becomes aggressive and potentially violent.
It really is up to employers to not only enact policies around preventative measures, but also to provide proper training to prepare employees for situations that could get escalated. The employee's first experience dealing with an aggressive patron or an aggressive coworker should not be their first time confronting the situation. Their training should prepare them to know the right ways of de-escalation, but also the right time to just walk away.
Ben: In a recent article, we talked about how employers should use employee input to create a shared vision of what life will be like “someday” when things get back to normal. We can make “someday” come sooner if we keep doing the things that we need to do from a prevention and vaccination standpoint. Any thoughts on this sort of tactic of shared visioning?
Noah: Absolutely. It’s important that plans are open to adjustment but planning out what the next year could look like is important. So, you can say that by summer if the CDC recommends we can open up, then this is what that might look like in terms of capacity and the measures that we would take to be able to ensure a safe to return to work. Then, as we head into fall, this is what it could look like.
Being able to rely on authoritative sources and articulate a plan in a dialogue with your employees not only gives employees a bit of a heads-up in knowing what they can expect, but what they can do now to help encourage that vision. These things help reduce uncertainty (though – as I said – it needs to be clear that plans can change) and provides some sense of control over how things will turn out.
Ben: Any other final advice?
Noah: Before COVID-19, we talked about diabetes and cardiovascular disease, and then when COVID-19 came – and rightfully so – the conversation shifted. As we are able to turn away from the urgencies of the pandemic, it will be important to emphasize again these person-centered programs, seeing each employee as a whole person who may have a family, that has a physical health profile as well as a mental health profile. We can't forget all of those elements. So, providing a form of support and intervention that can cross the digital landscape and address mental health, physical health, and concerns around COVID-19 in a very empathetic and compassionate approach will be important.
Ben: Finally, if our readers are interested in learning more about mental health resources offered by NexJ Health, what should they do?
Noah: Companies interested in learning more about mental health resources available through NexJ can send an email and we will follow up.
What are you thinking about as you look toward a return to more normal operations? What employee health, safety and work readiness issues are tapping at your brain, begging for a bit of attention?
In the weeks ahead, this article will be focusing more on the challenges of returning to full capacity and full speed work. If there are topics you’d like us to cover, click here to let me know.
Hospitalizations rates fall to pre-holiday levels: Despite the enormous death toll, decrease in new daily cases, hospitalization rates, and deaths are a sign the pandemic is loosening its grip in the US. On Tuesday, the US reported 67,879 new COVID-19 cases yesterday, and 2,196 deaths. And there are 55,058 COVID-19 patients in US hospitals. That's the lowest reported number of hospitalized patients since November. Vaccination efforts are expected to ramp up nation-wide this week after severe winter weather delays last week. Currently, 82,114,370 doses of vaccine have been delivered to states, with 65,032,083 doses administered. Close to 20 million Americans have received the full 2-dose series, and more than 44 million have had at least one dose.
500,000 milestone: In one year, more than half a million Americans have died from COVID-19. At least 28,903,679 million have been infected. The first American death from COVID-19 was reported on Feb 29, 2020. By May 28, 100,000 had died. It took only 1 month, from Jan 19 to today, for the nation's death count to grow from 400,000 to 500,000. For context, more Americans have died from COVID-19 than American soldiers in both World Wars and Vietnam combined. The US has the most reported deaths in the world, followed by Brazil (246,605), Mexico (180,107), and India (156,385).
FDA Issues Policies to Guide Medical Product Developers Addressing Virus Variants: On Tuesday, the FDA announced it would not require additional large clinical trials for vaccine booster shots aimed to target variant strains of COVID-19. According to the latest update from the CDC, there are 1,881 reported cases of B117 in 45 states, 46 cases of B1351 in 14 states, and five cases of P1 in four states. A senior FDA official stated: “The FDA is committed to identifying efficient ways to modify medical products that either are in the pipeline or have been authorized for emergency use to address emerging variants.” The updated guidance outlines the FDA’s scientific recommendations for modifications to authorized vaccines.
Global health platform: A new platform launched Wednesday will enable open access to 10 million anonymized COVID-19 records from 160 countries. Backed by Google, epidemiologists launched the platform to collect and openly share granular data on individual COVID-19 cases around the world. Each record can contain dozens of data points about the case, including demographics, travel history, testing dates, and outcomes. The vision of the scientists that this would be the kind of rapid response data system that could be deployed in real time after an event like the onset of COVID-19 pandemic in Hubei China. Scientists would be able to quickly share cases and track the movement of infections in real time.
Pharmaceutical company chief executives address lawmakers: This week chief executives from Pfizer, Moderna, Johnson & Johnson (J&J), AstraZeneca, and Novovax spoke with lawmakers addressing vaccine production and when Americans can expect more doses. According to Johnson & Johnson, the company will be able to immediately ship 100 million doses during the first half of the year upon receiving FDA emergency use authorization (EUA). An FDA advisory board meets on February 26th to consider granting an EUA to Johnson & Johnson. J&J vaccine would also be the first adenovirus vaccine, and also the first single dose vaccine, requiring only traditional refrigeration. Pfizer chief executive stated the company would be increasing weekly doses of available vaccines and that all 300 million contracted doses to the US should be delivered by the end of July.
Super spreaders: Super-spreader events have long been recognized as a major contributor on spread of the pandemic. Lengthy indoor gatherings, poor ventilation, and activities like singing and aerobic exercise help these events along. One of the mysteries has been how much individual behavior or biology play into these events. Using data from an observational study of 194 healthy people researchers found that exhaled aerosol particles vary greatly between subjects. Those who were older with higher body mass indexes (BMI) and an increasing degree of COVID-19 infection had three times the number of exhaled respiratory droplets as others in the study groups. Researchers found that 18% of the human subjects accounted for 80% of the exhaled particles of the group, reflecting a distribution of exhaled aerosol particles that follows the 20/80 rule seen in other infectious disease epidemics - meaning 20% of infected individuals are responsible for 80% of transmissions.
Public areas that played role in transmission: Using anonymized mobile phone location data of 100 million Americans over 2 months, a Stanford team published a nature study showing that restaurants, cafes, and gyms can play an outsized role in transmission.
The Work From Home WorkSTEPS Medical Team:
Tony Nigliazzo, MD
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
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.