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

Data, Care Capacity, and The Path to a New Normal

While some areas of our country are in the thick of the battle with Covid-19, acting in all urgency and with great heroism to manage patient loads that are at or beyond their breaking point, much of the rest of the country is beginning to think and talk about what happens next. Two key questions frame those discussions:

• When will we be able to loosen restrictions and get our companies and people back to work?
• How will we do that/what will it look like?

We are fielding a lot of these sorts of questions and admit that we don’t yet have clear answers. However, I think there is value in sharing how we’re processing new information with an eye toward what happens next.

The figure below is a high-level framework for thinking about the relationships between: A) the quality of data-driven insights about Covid-19; B) the capacity of our systems to care for those who become critically ill; and C) the status of our public and private discourse and actions meant to lead us to a new normal. Of note:

• Sweet Spot: As insights improve and care capacity increases beyond pre-crisis levels, we are better able to not only protect and manage people, but to plan for and move toward a new normal.
• Too Slow: If we fail to capitalize on clearer insights and fortified care capacities, we are unnecessarily burdening our economy, with implications for personal and societal health and well-being.
• Too Fast: If we move to put companies and people back to work without data-driven strategies or before we have capacity to care for the critically ill, we risk (re)igniting outbreaks and overburdening care systems, resulting in sickness, death and further economic setbacks.

What we will be striving to understand (and share) in the days and weeks ahead is how these relationships play out geographically and demographically, and what the relationships imply for corporate strategy. In the meantime, this edition of our Brief includes several items that demonstrate how better data is leading to clearer ways of thinking about when and how we can move toward a new normal.  

Please share your feedback on the figure above. We hope it’s helpful and we’re eager to improve it.

Dr. Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

Click here for more info on our Coronavirus Medical Hotline for Employers & Employees

Medical:

Doubling time of deaths in the US is approximately 3 days.

Based upon available information to date, those at high-risk for severe illness from COVID-19 include:

• People aged 65 years and older
• People who live in a nursing home or long-term care facility
• Other high-risk conditions could include:
• People with chronic lung disease or moderate to severe asthma
• People who have heart disease with complications
• People who are immunocompromised including cancer treatment
• People of any age with severe obesity (body mass index [(BM]I)≥40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with severe viral illness, however, to date data on COVID-19 has not shown increased risk

The overall case-fatality rate in Italy (7.2%) is substantially higher than in China (2.3%). When data were stratified by age group, the case-fatality rate in Italy and China appear very similar for age groups 0 to 69 years, but rates are higher in Italy among individuals aged 70 years or older, and in particular among those aged 80 years or older.  The distribution of cases is very different in the 2 countries: individuals aged 70 years or older represent 37.6% of cases in Italy and only 11.9% in China.

The difference is found in three factors:

• An increased fatality rate in the older population- larger population of older age group in Italy.
• The definition of COVID-19 death- Italy expanded its definition of death from COVID-19-  this may have resulted in an overestimation of the case-fatality rate.
• A limited testing strategy, no testing of mild disease-  These more mild cases, with low fatality rate, were thus no longer counted in the denominator.
  

Additional investigation by the CDC to determine the reason for the high transmission rate on cruise ships identified the COVID-19 Virus on cabin surfaces, prior to disinfection, for 17 days.  This does not identify the virus as being viable for transmission; further study is warranted. A recently published article in the New England Journal of Medicine concluded viable COVID-19 virus only persist for 8hrs on most surfaces, and 72 hours on stainless steel.

Concerns over transmission through the mail prompted the USPS to release the following:

“The CDC, the World Health Organization, as well as the Surgeon General have indicated that there is currently no evidence that COVID-19 is being spread through the mail.”

The Food and Drug Administration has approved using plasma from Covid-19 survivors to treat some severe cases of COVID-19. Gov. Andrew Cuomo of New York says the state will be the first to test a serum developed from recovered patients.

New York Times: Coronavirus Briefing

Mitigation:

India is coping with the pandemic by locking down the country and its 1.3 billion people, nearly a fifth of humanity, in the largest quarantine to date.

Kinsa, a smart thermometer manufacturer, tracks 'flu-like illness’ in real time data by fever. They then use the data to map the flu season. They have been doing this for years by tracking the use of their thermometers and mobile apps (which mine the data from users). Their data is exceptional, and given COVID-19 has a high rate of fever they have unintentionally tracked the spread of the disease. Their data shows that mitigation measures have changed the trajectory of COVID-19, decreasing the incidence of fever compared to the previous few weeks.

President Trump’s announcement to not extend the restrictions imposed on the American population past Easter have sparked debate on the containment of the COVID-19 pandemic.

The UK Imperial College released a study using predictive models and historical models. They show that the major challenge of suppression is balancing restrictions and will need to be maintained until a vaccine becomes available (potentially 18 months or more) – given that we predict that transmission will quickly rebound if interventions are relaxed.

Providing insight into how restrictions might be implemented over 18 months, a newly released Harvard study suggests social distancing interventions will need to be made multiple times over a period of time, called "intermittent distancing," at intervals that depend upon the state of the health care infrastructure at any moment in time, meaning, how much load it can absorb of critical care cases of the disease.

Corporate:

US lawmakers passed a 2 trillion relief package. The legislation, which is expected to be enacted within days, is the biggest economic relief package in modern American history, dwarfing the $800 billion stimulus bill passed in 2008

The WHO released its new global campaign:  “Pass the message: Five steps to kicking out coronavirus - hands, elbow, face, distance, feel”

• Hands: rigorous hand hygiene
• Elbow: covering cough and sneeze
• Face: avoid touching
• Distance: social distancing
• Feel: if you feel sick, stay home

American Airlines is adapting to the pandemic.  In a news release they have begun limiting food and beverage services and blocking 50% of middle seats on all flights.