A Message on COVID-19 from WorkSTEPS Medical Director, Dr. Ben Hoffman:

Masks Are In – Implications for Company Policies and Communications

Late last week the CDC issued a recommendation regarding the use of cloth face coverings (aka, face masks). While some have criticized the CDC for not acting sooner, we recognize that the delay was caused by an important debate about whether mask-wearing by the general public would be sufficiently effective to offset related risks. At the end of the day, it’s been determined that the benefits of mask-wearing (particularly the prevention of transmission by asymptomatic and pre-symptomatic people carrying the disease) outweigh two important risks:

• The risk that the general public will increase the scarcity of medical-grade masks (N-95 and surgical masks), making it even more difficult and expensive to provide proper protection to health care workers most at risk; and
• The risk that people wearing masks will gain a false sense of security, reducing their vigilance in practicing key behaviors – most notably social distancing.

Through well-informed policies and clear communications, companies can make the most of disease-preventing benefits of mask-wearing while reducing the risks identified above.

The mask-wearing recommendation is new to the public, but it’s something we’ve been thinking about/advising on for a number of weeks. Following is a high-level summary of our guidance for policies and communications regarding masks. At the end, we’ve provided links to resources that can help you hone your policy and communications plan.

Policy Guidance

Company policies regarding the wearing of face masks for the prevention of Covid-19 should be guided by the following:

• Masks offer additive protection: A policy regarding the use of face masks recognizes that masks are not a substitute for other policies and nor do masks reduce the importance of other policies. Policies related to the daily screening of workers (questionnaire and temperature checks), social distancing or use of physical barriers, surface disinfection, personal hygiene, contact tracing/quarantine and safe return to work are all critical to establish and maintain, with mask policies offering simply another layer of protection.
• Required use of masks: The primary function of face masks is to prevent the spreading of the coronavirus by asymptomatic or pre-symptomatic employees. Therefore, to protect all workers, companies should consider requiring masks in circumstances where an employee’s work prohibits maintaining at least a 6-foot separation from others and where it is not possible to establish physical barriers to reduce exposure.
• Voluntary use of masks: Employees not required to wear masks should be allowed to wear masks if they choose.
• Medical vs. non-medical cloth masks: Due to a shortage of PPE for medical professionals, the CDC recommends against use of N-95 respirators or surgical masks for the general public in most instances. However, where an employee is required to wear a mask, it is ideal if a company assures that the mask they’re wearing consistently offers sufficient protection and that it is disposable (i.e., surgical masks).

Therefore – at least for the near-term – organizations should consider policies that conserve surgical masks by providing them only to employees who are required to wear them, and to allow other employees to voluntarily wear cloth masks (see links below).

Communication Guidance

There is a lot of buzz about the wearing of masks in traditional and social media channels right now and that makes for a challenging internal communication environment. Therefore, it is imperative that internal communications be strong. We recommend at two-tier strategy:

1. Policy Education: Under normal circumstances, a policy about wearing PPE is pretty straightforward; but this is no ordinary time. People are frightened, the shortage of PPE requires conservation, and as noted above, there’s a lot of “talk” about masks right now. So in communicating about your mask policy, be sure to address:

• Why masks, and why now
• Why some positions require masks and others do not
• For those required to use masks, the essentials of how to acquire, use, remove, etc.
• For those not required, make clear that people are welcome to wear cloth masks, and consider guidance regarding mask quality and appropriate parameters aligned with company dress codes (e.g., no political messaging)

2. General Education: Your organization has an opportunity to educate employees (and by extension their families and friends in the community) about the appropriate use of face masks for the prevention of Covid-19. Perhaps the most important message is that masks offer an added level of protection and that all need to continue to be vigilant about social distancing, personal hygiene, etc. Additional educational resources in links below.

Current thinking about how best to use masks to stunt the growth of Covid-19 is, like so much else, evolving. We will be monitoring research and looking for innovative practices to share with you in the weeks ahead. In the meantime, following are some resources that can help your organization develop a sound policy and communication strategy around the use of masks.

• CDC Recommendation on Cloth Face Covers: Background and rationale for the new recommendation.
• CDC Information on How to Make and Use Cloth Face Covers: Includes link to FAQs and information about how to make basic face coverings.
• How Masks Might Help Prevent Covid-19: Compelling graphics vividly illustrate how coronavirus is spread and how wearing a mask may help.
• Is A Homemade Mask Effective? And What's The Best Way To Wear One? Practical advice in FAQ format.

Be well and stay safe,

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

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

Medical:

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Coronavirus has a global burden of over 1 million, with almost a quarter of the cases in the U.S.. The virus has been detected in at least 209 countries. Italy, Spain, and the United States make up over half of the deaths worldwide. Last week, the number of recorded deaths in the United States topped 1,000 in a single day for the for the first time.

On Saturday, Pres. Trump warned the nation to brace ourselves in coming weeks citing some parts of the nation as climbing toward their peaks of coronavirus infections. More than 8,000 people have died from the virus so far in the U.S., but projections showed that number could grow to at least 100,000.  

New York continues to be the epicenter in the U.S. The state reported its highest number of deaths in a single day on Friday, with a loss of 562 people.  Governor Cuomo stated he would sign an executive order giving the state the power to reallocate medical equipment from hospitals in counties with lower needs and the private sector. Governor Cuomo this week also instituted an unprecedented plan for all New York hospitals, to work as a single network.

New York Times: Coronavirus News Updates

On Saturday, the British government reported 708 deaths, which was a record spike for a 24-hour period. The number of confirmed cases this Sunday was at 47,806, with total fatality of 4,934 people.

The U.S. Department of Health and Human Services received 30 million doses of hydroxychloroquine sulfate in March from a division of Swiss based pharmaceutical Novartis, for use in clinical trials and potentially treating coronavirus patients. Large randomized double blinded studies remain scant, but are needed to definitively assess efficacy of the malaria drug as effective treatment for coronavirus.

Germany has remained an anomaly with significantly lower fatal cases than most neighboring countries. By Saturday, more than 92,000 people were confirmed positive, and 1,295 deaths. That fatality rate is at 1.4 percent, compared with 12 percent in Italy, approximately 10 percent in Spain, 4 percent in China and 2.5 percent in the United States. Strategies Germany is using include an extremely large number of lab diagnoses. With 350,000 tests administered a week, they’re testing more than any European country. A high number of tests has allowed for early isolation of infected people. In mid-January, Charité hospital in Berlin had developed a test and posted the formula online for other labs to build a stock of test kits. Plans are underway to begin antibody testing by April, to gauge communities where immunity is occurring. This will be useful in relaxing social distancing guidelines. Germany is also testing all contacts including those without symptoms. Germany had a high intensive care capacity prior to the outbreak, which they ramped up in preparation for infection in the country.

Mitigation / Suppression:

Dr. Deborah Birx, the coordinator of the virus response, pleaded with to Americans on Thursday to follow social distancing  guidelines “to a tee.” Dr. Birx added other countries are beginning to bend their infection trajectories. On Saturday, Dr. Birx reinforced the administration’s message that the next two weeks of social distancing will be extraordinarily important to slow the outbreak, and hot spots in New York, Detroit and Louisiana will likely reach a peak within six to seven days.

Currently, 311 million people in 41 states, D.C and Puerto Rico have been urged to stay home. However, some states including Arkansas, Iowa, Nebraska, North Dakota, and South Dakota had not instituted state-wide orders on Friday.

On Friday, the CDC reported recent studies revealed there is significant impact of people who are asymptomatic (people without symptoms), and presymptomatic (prior to exhibiting symptoms) transmitting the virus. The virus can spread between people in close proximity by speaking, coughing, sneezing—even if those people are not exhibiting symptoms. In light of new evidence, CDC updated mask guidelines, to recommend wearing cloth face coverings or masks in public settings like the grocery stores and pharmacies especially in areas of significant community-based transmission. Medical grade N95 and surgical masks continue be reserved for healthcare workers and first responders.

Surgeon General, Dr. Jerome Adams demonstrated how to create a cloth face mask at home.

A 2013 study on different types of homemade masks suggested that homemade masks should only be considered as a last resort to prevent droplet transmission. Common household items were tested with bacterial and viral aerosols to assess filtration efficiency. 100% Cotton t-shirts had a mean filtration rate between 50-69%, tea towels between 72-83%, Cotton mix between 70-74%, vacuum cleaner bag between 85-94%, silk between 54-58%.

Strategies for releasing Covid-19’s grip on daily life hinge on identifying cases and tracing their contacts so they can be quarantined before they show symptoms. Manual tracing has proved to be an insurmountable hurdle in the U.S as there are thousands of new cases daily and not enough public health workers. Digital tools, like, using cellphone location data and apps for self-reporting positive tests, could make contact tracing possible. This is a strategy that has helped countries such as South Korea, Taiwan, and Singapore deal with the pandemic, though sometimes the measures infringe on privacy.

Google published COVID-19 Community Mobility Reports using cell phone data around the globe to show how communities globally are doing in terms of social distancing compliance. These Community Mobility Reports aim to provide insights into what has changed in response to policies aimed at combating COVID-19. The reports chart movement trends over time by geography, across different categories of places such as retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential.

Corporate:

3M stated it planned to increase its N95 mask production by 30% over the next year. 3M has plants in the U.S. and abroad. Concerns emerged as to whether majority of their current production in plants around the world ends up for sale in the U.S. where it is urgently needed to meet limited supply for healthcare workers. 3M issued a statement saying different plants around the world meet needs for different markets, but they would be diverting 10 million N95 masks from their 3M Chinese plant to the U.S.

As the coronavirus pandemic continues around the world, uncertainty is growing. Employee opinion may shift rapidly with the spread of verified and unverified news. Governments and companies have taken precautionary measures to combat community spread; travel restrictions are in place, remote working where feasible, and the activation of Business Continuity Plans. What companies need to continue focusing on now is keeping employees safe, well-informed, and positive. In a bid to strengthen connectedness, companies can encourage employees to maintain regular check ins with their remote teams, stick to a regular schedule, exercise, socialize (with family in same home, phone/video calls), and relax. Your company leadership can distribute and encourage news from reliable sources. The above are important for sustaining emotional well-being during this time. There is a growing library of mental resilience resources for companies and the public. Please find a few curated resources on mental resilience:  

• WHO: Mental health and COVID-19
• WHO: Mental health and psychosocial considerations during the COVID-19 outbreak
• MARSH Insights: COVID-19 Employee Mental Resilience
• Resilience.Org: Coronavirus – facts and what to do
• Forbes Magazine: The Leader’s Guide To Managing COVID-19 Panic