5/19/20 COVID-19 Brief: To Protect Workers and Customers, Try a Four-Part Cocktail

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:

To Protect Workers and Customers, Try a Four-Part Cocktail with a Twist

Much is being written now about what businesses and communities need to do to open up and return people to work and to life. Among the more compelling articles I’ve read in the past week was this article by physician and author Dr. Atul Gwande.

Three things make the article a stand-out:

1) It’s based on real-world experience of a large organization that has succeeded at keeping COVID-19 infection rates low among its employees; 2) The organization is Mass General Brigham, a 75,000-employee health care system in COVID-19 hot-spot that treats people seriously ill with COVID-19 and sees another 1000 patients suspected of infection every day; and 3) Gwande credits their success to what he calls a “cocktail” of four prevention measures, none of which are perfect, but all of which work together to produce the intended result of keeping COVID-19 from spreading among employees and to patients.

The Four-Part Cocktail

The mitigation measures Mass General has used are familiar: Screening, social distancing, mask-wearing and hygiene (which includes both handwashing and surface disinfection). In his article, Gwande describes each measure, why it works, how it is limited in its effectiveness, and how those limitations are made up for by other measures.

In the figure below, I’ve tried to capture the main points which demonstrate what the article describes. In summary:

  • Screening is necessary, but imperfect because some people are unaware they’re sick and others will fail to accurately assess their own symptoms, so…
  • Social distancing is needed to help stop the airborne spread of the SARs-CoV-2 virus when people talk, cough or sneeze, but virus particles may hang in the air for a while, and coughs & sneezes can send particles farther than 6 feet, so…
  • Mask wearing is helpful to block the majority of stuff that comes out of people’s mouths when they talk, cough or sneeze, but masks aren’t perfect and sick people will do things like cough into their hands and wipe their noses before touching things, so…
  • Hygiene is needed to kill the virus on surfaces and hands before people rub the virus into their nose, mouth or eyes.

None of the measures are perfect but working together they can help any organization contain the spread of COVID-19 among employees and to customers.

The Twist

Gwande dedicates the final part of the article to culture, which is not a separate part but a sort of secret ingredient that makes sure all the other parts work together. He writes about how people tend to focus on two desires – safety (keep me safe) and freedom (leave me alone). But, to make the cocktail of protection measures to work, we need people to embrace another desire – a selfless desire to “keep you safe.”

I agree with the article when it says that the culture piece is the most difficult. However, I would argue that many employers can apply what they’ve learned in creating a culture of safety to developing a culture of prevention around COVID-19. Any company that has even a moderately strong safety culture has moved beyond merely selfish interests in safety to a desire and commitment on the part of employees to protect each other, the environment and even expensive equipment.

An Urgent Need to Fortify Culture

As restrictions ease, people are going to want to return to old patterns and ways of living at home and in their communities, and your employees will carry their new attitudes toward COVID-19 and disease risk into work.

You likely saw pictures of mask-less patrons crowding bars in Wisconsin within minutes of a state supreme court ruling that overturned the states Safer at Home order last week. Do you honestly think the guy with a beer in one hand while he high-fived his buddies with the other in Milwaukee last Wednesday night reported to work the next day with the same mindset around COVID-19 prevention?

Of course not; and that’s why a systematic implementation of all four parts of the COVID-19 prevention cocktail, supported by a strong “keep you safe” culture is so urgent.

So, if you have not yet done so, I urge you to dive deeply into your safety culture and find ways to link or imbed your COVID-19 efforts within it.

We wish you well in your efforts. If you’re having success with a culture of safety around COVID-19 prevention, let me know. We’re interested in the challenges companies are confronting and the strategies you’re using to overcome them.

Be well and stay safe.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.


Area Reported Cases Deaths Recovered
Global 4,848,110 317,792 1,880,111
United States 1,532,861 91,093 347,225

The drug maker Moderna said Monday that the first coronavirus vaccine to be tested in people appears to be safe and able to stimulate an immune response against the virus.

The findings, which quickly prompted a rally on Wall Street, are based on results from the first eight people who each received two doses of the experimental vaccine, starting in March.

Those people, healthy volunteers, made antibodies that were then tested in human cells in the lab, and were able to stop the virus from replicating — the key requirement for an effective vaccine. The levels of those so-called neutralizing antibodies matched the levels found in patients who had recovered after contracting the virus in the community. FDA cleared the drug maker to begin phase 2 trials. Moderna predicts the vaccine to be available for widespread use by late 2020 or early 2021.

Article found in NY Times briefing here

The Food and Drug Administration states that the Abbott ID Now rapid test for COVID-19 — touted by the White House and widely used nationally — may return false negative results, meaning it can incorrectly indicate that patients who are infected with the novel coronavirus are not. Stengel said that while the test can still be used and correctly identify positive test results in minutes, negative results may need to be confirmed with another test.

Read the full STAT article

The speedy Abbott test, which is supposed to determine in five to 13 minutes whether a person has the virus, missed a third of the positive samples found by the diagnostic company Cepheid when both tests used nasopharyngeal swabs, said the study done by a group from New York University. It missed more than 48 percent when both firms’ tests used dry nasal swabs.

Washington Post article

UN states urgent need to address a growing mental health crisis as a result of COVID-19:

Psychological distress in populations is widespread. Many people are distressed due to the immediate health impacts of the virus and the consequences of physical isolation.  Many are afraid of infection, dying, and losing family members. Individuals have been physically distanced from loved ones and peers. Millions of people are facing economic turmoil having lost or being at risk of losing their income and livelihoods. Frequent misinformation and rumors about the virus and deep uncertainty about the future are common sources of distress. A long-term upsurge in the number and severity of mental health problems is likely.

Access the Policy Brief here

On a day when COVID-19 cases soared, healthcare supplies were scarce and an anguished doctor warned he was being sent to war without bullets, a cargo plane landed at the Los Angeles International Airport, supposedly loaded with the ammo doctors and nurses were begging for: some of the first N95 medical masks to reach the U.S. in almost six weeks.

But the shipment arriving that night in late March wasn’t going to solve the problem. An Associated Press investigation has found those masks were counterfeits — as are millions of medical masks, gloves, gowns and other supplies being used in hospitals across the country, putting lives at risk.

AP News Article

Last week, a study showed that droplets from speech in a confined space can be enough for person to person spread of SARS-CoV-2. By using lasers, researchers found that one minute of talking loudly can produce more than 1,000 virus-containing droplets that could linger in the air for more than eight minutes. This study adds data to the importance of wearing a mask, as recommended by the CDC.

Mitigation / Suppression:

Epidemiologists from CIDRAP at University of Minnesota released an analysis at the beginning of May regarding COVID-19 over the summer and beyond. They predicted three possible future scenarios.

We wanted to further explain the scenarios: In the first scenario, we experience a huge wave; which is the current outbreak. Then followed by multiple smaller crests and dips every few months with fewer cases in the dips’ but never zero. In the second scenario, this current huge wave is followed later this year by a larger, wave, as the outbreak rebounds after the summer correlated with relaxing physical distancing more than was safe. In the third possible future, the current huge wave creates a new normal, with the nation taking a circuit breaker approach to combat future COVID-19 outbreaks duration through the end of 2022. The best-case scenario is that an effective vaccine arrived by that point; or by then at least half of the population has been infected, with possible immunity.

The coronavirus that causes COVID-19 could become endemic like HIV, the World Health Organization said on Wednesday, warning against any attempt to predict how long it would keep circulating and calling for a “massive effort” to counter it.

Reuters article here – ‘This virus may never go away,’ WHO says

An updated list of states reopening / releasing restrictions: full list here

The international alarm about the COVID-19 pandemic was sounded first not by a human, but by a computer. HealthMap, a website run by Boston Children’s Hospital, uses artificial intelligence (AI) to scan social media, news reports, internet search queries, and other information streams for signs of disease outbreaks. On 30 December 2019, the data-mining program spotted a news report of a new type of pneumonia in Wuhan, China. The one-line email bulletin noted that seven people were in critical condition and rated the urgency at three on a scale of five.  AI is playing a more significant role in the pandemic and will likely see widespread use in future crisis.

Science Magazine article from the American Association of the Advancement of Science.


COVID-19 has caused a reverse globalization and promotion of isolation.  The Economist explores the uncertain global economic future:

Even before the pandemic, globalization was in trouble. The open system of trade that had dominated the world economy for decades had been damaged by the financial crash and the Sino-American trade war. Now it is reeling from its third body-blow in a dozen years as lockdowns have sealed borders and disrupted commerce (see Briefing). The number of passengers at Heathrow has dropped by 97% year-on-year; Mexican car exports fell by 90% in April; 21% of transpacific container-sailings in May have been cancelled. As economies reopen, activity will recover, but don’t expect a quick return to a carefree world of unfettered movement and free trade. The pandemic will politicize travel and migration and entrench a bias towards self-reliance. This inward-looking lurch will enfeeble the recovery, leave the economy vulnerable and spread geopolitical instability.

The US CDC published a series of “decision trees” to provide guidance to state and local governments, schools and childcare services, restaurants and other businesses, and others regarding when and how to safely relax social distancing measures for various aspects of society. The guidance documents address public transit, workplaces, restaurants and bars, schools, childcare, and camps and other youth programs. Each document provides guidance regarding criteria and metrics to consider with determining whether or not it is appropriate to resume operations as well as recommended “safeguards” for both health and safety and disease monitoring.

Source: CDC Workplace Decision Tree

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