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5/12/20 COVID-19 Brief: How Bad Will It Get?

The WorkSTEPS team continues to carefully track what is happening with the COVID-19 pandemic.

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

How Bad Will It Get? It Depends In Part on Personal Responsibility and Business Leadership

It has been about 100 days since we saw our first case of COVID-19 in the US. How are we doing?

According to this summary published in WebMD, not very well. The curve is flattening overall, but progress is uneven because of state-level differences in safe-at-home orders and wide variability in testing, contact tracing, and treatment capacities. And yet, even as many states struggle, the economic and societal consequences of shut-downs have become increasingly real, creating political pressure for states to reopen their businesses, return their people to work and get their economies moving again.

No state has taken the guardrails of social interaction and business operation completely down, but experts worry that any loosening of restrictions before trends bend down and mitigation capacities are built up is a big risk.

So, the big question is: Will lifting at-home orders and re-opening businesses necessarily mean outbreaks that will overwhelm health care resources, kill more citizens and force another round of shut-downs?

Well, it depends. It depends on some things most of us can’t control, but also on some things we can.

Things We Can’t Control

There are some critical goals that must be met if we are going to avoid the worst outcomes of this pandemic. We need the capacity to test and contact trace so we can quickly identify and contain potential outbreaks. We need to build up our ability to care for those who get sick. We need to continue finding more effective ways to treat patients so we can decrease the incidence of serious illness and death. And of course, we need the ultimate game-changer – an effective vaccine.

This is all important stuff, but it’s stuff most of us can do little to control.

Things We Can Control

There is a link in the WebMD article mentioned above to another article titled Where The Latest COVID-19 Models Think We're Headed — And Why They Disagree. As the article notes, the projected COVID-19 death toll in the US by May 30th may be below 90,000 or over 150,000.

What accounts for the variation? As the article states:

“Each model makes different assumptions about properties of the novel coronavirus, such as how infectious it is and the rate at which people die once infected. They also use different types of math behind the scenes to make their projections. And perhaps most importantly, they make different assumptions about the amount of contact we should expect between people in the near future.” (emphasis mine)

The amount of contact we should expect between people… Certainly, this is a function of laws restricting social activities and business operations, but there is more to it than that. The amount of disease-spreading contact people have with each other will also be a function of personal responsibility and business leadership.

Regarding Personal Responsibility, let’s begin by acknowledging that there will be a small percentage of our fellow citizens (perhaps as many as 20% if we apply Pareto Principal thinking) who will not comply with behaviors to protect themselves and others no matter what the laws are. This is nothing new. In other situations, we have to protect ourselves from the troubling minority who…drive under the influence, use their hands instead of tongs at the salad bar, and seem to think it’s OK to trim their toenails on an airplane.

The point is, in just about every endeavor of life, we learn to cope with the knuckleheads who appear unconcerned about the health and happiness of others. COVID-19 prevention is just another area of life where we need to take responsibility for ourselves while we guard against the irresponsible behaviors of others.

Regarding the Leadership of Businesses, it is important to begin by recognizing the influence companies have over their employees and, by extension, their families. It matters that your company establishes a comprehensive COVID-19 mitigation strategy, that you communicate policies effectively to employees, and that you hold leaders, supervisors and employees accountable for compliance.

It’s also important to recognize the influence your company has over your customers. By requiring customers to adhere to the standards you set for your own employees, you drive home the seriousness of the COVID-19 threat and the importance of preventive measures. For decades we’ve required customers to wear the same PPE as our employees when entering hazardous areas. This is no different.

Finally, companies need to understand the leadership role they play in the community. Beyond setting an example, company leaders have an opportunity to visibly support efforts to build essential capacities for testing, contact tracing and treatment. In doing so, they can demonstrate that they not only care for the health of the community, but that they support actions that can make re-opening and economic growth sustainable.

Will We Rise to the Occasion?

I wish I had a clear and positive sense of how we will respond as fellow citizens with our fates so clearly bound together. On the bright side, when I was out and about in Houston over the weekend, it seemed like people were doing pretty well – the 80% were doing mostly the right things. But then I read that Mark Cuban hired a firm to observe businesses’ and customers’ compliance with rules and recommendations as businesses reopened. The results weren’t promising.

I’m hoping Cuban’s first report reflects sample bias – a snapshot of eager businesses and consumers who are less risk-averse. I’m hoping that responsible citizens and visibly responsible business leaders will show the way to reopen safely, sustainably and prosperously for all.

Be well and stay safe.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

Medical:


Area Reported Cases Deaths Recovered
Global 4,219,351 284,799 1,507,763
United States 1,370,850 80,869 256,910

A new decontamination system developed by Battelle is now operating in multiple cities across the United States. The decontamination system utilizes vaporized hydrogen peroxide to kill viruses, including COVID-19 in N95 respirators. The process can be performed as many as 20 times per respirator. Battelle has contracted with the federal government to enable hospital systems to use the service free of charge. Each unit can decontaminate 80,000 respirators per day. The federal contract will fund as many as 60 sites, which if all deployed could provide a capacity of 5 million respirators per day.  

On late Friday, the FDA has issued an emergency use authorization for the first diagnostic test that works by detecting SARS-CoV-2 antigens from nasal cavity using swabs. The tests quickly detect fragments of proteins found on or within the virus by testing samples. The emergency use authorization (EUA) was issued to Quidel Corporation for the Sofia 2 SARS Antigen FIA. This test is authorized for use in labs certified by CLIA (Clinical Laboratory Improvement Amendments) and for facilities like clinics operating under a CLIA Certificate of Waiver. Testing is one of the pillars of the national response, and antigen testing is a needed addition to currently available PCR and serologic tests. The main advantage of the antigen test is the speed of the test, results can be obtained in minutes.

On Saturday, the US Department of Health and Human Services announced the allocation plan for the drug remdesivir donated by Gilead Sciences, Inc. The donated treatment will be used to treat hospitalized COVID-19 patients in areas hardest hit by the pandemic. State health departments will distribute the doses to hospitals with the greatest needs in their states. Candidates for the donated doses will the patients with severe cases of COVID-19. The donation to the United States is part of 1.5 million vials of remdesivir the company is donating worldwide.

The CDC announced a new program to collect and analyze genomic data during the pandemic. The project called labeled SPHERES: SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance will leverage private and public labs, academic institutions, and private sector nationwide to research the genetic evolution of the virus over the course of the pandemic, support disease surveillance and contact tracing, and inform diagnostic, therapeutic, and vaccine development. Other countries have initiated similar programs. Coordinating national genetic sequencing can help researchers make better use of the data.

A novel clinical presentation in children involving symptoms seen with Kawasaki disease and toxic shock syndrome may be linked to COVID-19. This is according to reports from American Academy of Pediatrics, The Lancet, and the New York State Department of Health. A child presenting with persistent fever, rash, eye irritation, upset stomach, swollen lymph nodes or even cardiac involvement. Early recognition by pediatricians and prompt referral to the ER, or critical care, is essential. Public health officials are distributing notices to local health systems to inform pediatricians of the potential correlation.

Researchers in Massachusetts are testing a unique coronavirus vaccine candidate that uses an established type of gene therapy to trigger an immune response that could kill off the virus.

The AAVCOVID vaccine program is the only gene-based vaccine approach for the coronavirus that uses adeno-associated virus, which is a little piece of harmless virus that triggers an immune response.  

Mitigation and Suppression:

Experts from the Infectious Diseases Society of America (IDSA), issued guidelines last Wednesday about who should be tested, how they should be tested, when they should be tested, and what to make of the results.

Who: IDSA guidelines state that all patients who have clinical signs or symptoms that could be consistent with COVID-19, as defined by the CDC, should be tested.

Asymptomatic patients: If there aren’t enough tests, symptomatic patients should get them, but there are exceptions that necessitate asymptomatic testing: patients in hospital for any reason, areas with wide community spread, compromised immunity.

What test is best: IDSA recommend a nasal swab or a nasopharyngeal swab based on a review of current medical literature. However, more information is needed about the various tests.

Repeat testing: Tests can have up to a 30% false negative rate. The IDSA recommends if you have a high clinical suspicion, you should retest.

Antibody testing: Look for signs that a person was recently infected, as shown by antibodies their immune system produced to fight the coronavirus. With other diseases, the presence of antibodies often means you have acquired immunity against re-infection, for at least some period of time, but how long isn’t fully known yet for COVID-19.

How much is enough testing: In general more is better; restrictions will be current resources and increasing testing to parts of the country that have not achieved sustained access to testing.

Corporate:

A combination of strategies will be the new normal as states and businesses re-open. The first step to stopping the spread of SARS-CoV-2 has been behavioral changes – social distancing, handwashing, cough hygiene, masks etc. For this pandemic, masks and gloves, hand hygiene, and “shelter in place” mandates have demonstrated benefits. Evidence suggests that transmission is greatest very early in infection prior to development of symptoms. As such, biomedical prevention strategies that provide reliable protection will be essential. Preliminary results from a large randomized controlled trial show that the antiviral drug remdesivir substantially reduced the duration of hospitalization for COVID-19. Ultimately, a safe and effective vaccine is crucial for preventing COVID-19. Numerous early-phase vaccine studies are underway. Proof of vaccine efficacy will require large trials in each study. No one can predict when or the efficacy of a vaccine, but most trials are designed to demonstrate 60 or 70% prevention efficacy, not 100% protection. HIV has taught us that multiple simultaneous preventive strategies are essential. Behavioral changes to reduce COVID-19 spread must be accepted as the “new normal.” Ongoing research in each prevention domain must be sustained. We cannot depend on a single “magic bullet”, but a multitude of ongoing strategies are the way to re-opening.

Before COVID-19, less than 4% of Americans worked from home. Amid COVID-19 that figure has rapidly increased to more than 50%. Work may be fundamentally changed in sectors that can handle remote working. Work-anywhere culture could give introverts the upper hand over social butterflies. Axios suggests open-plan offices could be a thing the past, and cubicles—partitioned by plexiglass “sneeze guards” could be the new normal.

From screening and antibody testing of your employees to guidance on return-to-work to medical consulting and policy development, WorkSTEPS partners with your organization to support your response to the threat of COVID-19 in the workplace. Click here to learn more about our COVID-19 Services.

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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