News

5/22/20 COVID-19 Brief: New Insights Require Fresh Thinking

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:

New Insights Require Fresh Thinking about How to Maintain Social Distancing at Work

This space in our March 27 COVID-19 Brief talked about the fact that our ability to safely re-open businesses would increase as we learned more about the disease and how to prevent its spread. This past week, we’ve received some important new insights that should have companies taking fresh look at steps they’re taking to maintain social distancing among employees on and off the line.

New Insight

We’ve known for some time that the risk of disease transmission is higher when people are close together inside for an extended period of time. What we did not fully appreciate is the important role/added risk of talking – particularly talking loudly and singing, both of which increase the introduction of droplets into the air. We also did not understand the magnitude of overall impact these close-quartered situations have on creating outbreaks of disease. To learn more, click on these links:

Based on the research, the most important thing businesses can do to reduce the spread of COVID-19 and prevent business-disrupting outbreaks is to eliminate situations where people are indoors, not socially distanced and talking (it’s reasonable to assume) without masks on.

A Gap in Compliance

Based on what I’m hearing from peers and learning through the contact tracing we’re doing for customers here at WorkSTEPS, most companies have done a reasonably good job of modifying where, how and when people do their work to reduce the sort of close-quartered contact that appears to be a major culprit in disease transmission.

The glaring gap in corporate efforts to maintain social distancing seems to occur mostly when employees step away from the line or leave their desks. Once off the line, employees tend to congregate in hallways, nooks and break rooms, with mask-less faces encroaching on each other’s 6-foot safe zones, talking, joking and laughing, sometimes loudly in order to hear each other over the din of machines.

“That’s not happening in our facilities,” you might say. Well, don’t be so sure. Enlist some of your colleagues to help you observe what’s going on at your sites, and take note: How many people? Where are they gathering? How far apart they are? What is the nature of the interaction in terms of talking, laughing and the volume of speaking? How many are wearing masks?

I suspect that what you’ll find is that the strong desire people have to be together – to share a story and to laugh – is taking precedence over policy imperatives to maintain separation.

The Need for Fresh Thinking

When it comes to maintaining social distancing at work, something is broken, and in light of the insights above, it’s important to find ways to fix it. I don’t have the solution, but here are some things to consider:

First, revisit some of the changes you’ve already made. Knowing how important it is to reduce close-quarter contact, look with fresh eyes at:

  • Reducing risks in places where people gather: Is there enough space for people to keep their distance? Are areas well-ventilated? Are areas loud, requiring people to talk over noise? Are there opportunities to create alternative spaces for people to gather outside or near open air sources (e.g., unused loading bays)?
  • Reducing crowding through scheduling: Are there particular times that are most problematic in terms of crowding, and can schedule changes alleviate over-crowding situations?
  • Educate employees and communicate policies: Make sure employees understand the new insights and the importance of maintaining a 6-foot separation and wearing masks to reduce transmission risk.

Then, consider some things you may not have tried yet:

  • Engage employees in crafting solutions: Identify informal leaders and influencers, educate them on the challenge and enlist their help in finding workable solutions.
  • Use technology to help alert employees when they are too close together: Some companies are already using bracelets/watches that buzz to alert employees when they are closer than 6 feet from fellow employees, and many more are looking into it. Some devices track information for contact-tracing, which can be helpful in arresting outbreaks. These technologies may be helpful, particularly if part of a more comprehensive effort and where there is employee buy-in to the objective of maintaining a safe distance.
  • Enforce the policy: While companies will not hesitate to reprimand employees for things like failing to wear proper PPE or not complying with lock-out/tag-out procedures, few are enforcing compliance with COVID-19 policies with the same seriousness. Policy enforcement, preceded by a concerted effort to educate employees about the importance of the policies, should be considered.

Have you had success with any of the above tactics or others not mentioned? Please contact us to share your experiences and lessons learned and perhaps will share your ideas in a future column.

Be well and stay safe.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

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

Medical:


Area Reported Cases Deaths Recovered
Global 5,129,268 331,021 2,044,614
United States 1,598,437 95,169 371,111

Source: WHO Situation Report May 19

On Wednesday, the WHO announced 106,000 new cases in 24 hours which the agency stated was more cases than had been reported than any time since the beginning of the pandemic. Almost two-thirds of the cases are in four countries at this time. The four countries are the U.S, Russia, Brazil and India.  

Recent studies suggest that SARS-CoV-2 seems to disable the short-term attack against viruses, while turning up the mechanism that calls on reinforcements. The result: no real brakes on the virus' attack, and instead a continuous storm of inflammatory molecules in patients' lungs.

STAT News Article

Two studies in monkeys find that coronavirus infection produces antibodies that seem to protect against future illness. In one study, researchers infected nine adult rhesus macaques with SARS-CoV-2. The animals got sick but recovered after 28 days. When the researchers exposed the monkeys to the coronavirus a week later, none got sick, even though there were trace amounts of virus in some of the animals' lungs. In the other study, 25 monkeys were vaccinated using prototypes of a COVID-19 vaccine from the scientists leading the study and Johnson & Johnson, while 10 remained unvaccinated. The vaccinated monkeys developed antibodies, and when all the monkeys in the study were exposed to SARS-CoV-2, the vaccinated monkeys didn't have high levels of virus in their lungs, while all the unvaccinated monkeys did. The findings will need to be replicated in humans, but study lead Dan Barouch told the Boston Globe he's hopeful since humans and rhesus monkeys share 93% of their genetic makeup.

Emergency department volume is down nearly 50% as the United States struggles with the COVID-19 epidemic. While a substantial portion of the decrease can be attributed to fewer trauma patients—eg, due to fewer automobile accidents—patients with other emergent conditions, including heart attacks and strokes, have decreased as well. Patients may avoid or delay seeking care for truly emergent health conditions due to concern about exposure to SARS-CoV-2 in the hospital, which can result in death if treatment is not received in time.

Full Catalyst Article Here

A research letter published in The Journal of the American Medical Association (JAMA) describes a study that evaluated the seroprevalence of SARS-CoV-2-specific antibodies in adults in April 2020. Based on tests performed on 865 individuals, the researchers estimate that approximately 4.65% of the Los Angeles population would have antibodies against SARS-CoV-2, which would total approximately 367,000 individuals. At the time of the study, Los Angeles had reported a total of 8,430 confirmed cases, which suggests that there could potentially be more than 40 unidentified infections in Los Angeles for every confirmed case.

Mitigation / Suppression:

A report by the CDC showed that during March 6-11th, 92 people attended a rural church in Arkansas. After services 35 attendees or (38%) developed laboratory confirmed COVID-19 and 3 people died. The church attendees infected an additional 26 people in the community, including one additional death. A total 61 people infected were linked to the church services. High transmission rates of SARS-CoV-2 have been reported from hospitals, long-term care facilities, family gatherings, a choir practice and in this report, church events. Faith-based organizations planning to resume in-person operations should be aware of the potential for high rates of transmission.

On Monday, Notre Dame became the first major university to say it would resume in-person classes for the fall semester. In fact, it will start early, on August 10, and finish by Thanksgiving with no break, so that most students won’t be leaving and coming back during the term.

Ithaca College, on the other hand, announced that it would start its classes later, on October 5. And the California State University system said last week that it would not reopen at all in the fall; most classes will be held online.

Chinese officials have outlined the plan to implement widespread testing of Wuhan’s 11 million residents following the recent detection of a cluster of COVID-19 cases. The plan is scheduled to be completed in 10 days, an unprecedented scale for SARS-CoV-2 testing in any country. After excluding those who have already been recently tested, Wuhan authorities would still need to conduct at least 730,000 tests per day to meet the 10-day timeline.

Corporate:

The CDC released more detailed guidance to support states’ efforts to relax social distancing measures implemented in response to COVID-19. The guidance—CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again—includes both “gating criteria” and recommendations for each of 3 phases. The 60-page guidance  adds greater detail to six flow charts that the CDC had released recently. The guidance provides specific instructions for different sectors to detect and trace the virus based on exposure and risk after the pandemic.

The U.S. Department of Labor announced adoption of revised OSHA enforcement requirements related to COVID-`9. OSHA has issued two revised enforcement policies to ensure employers are taking action to protect their employees.

First, OSHA is increasing in-person inspections at all types of workplaces. The new enforcement guidance reflects changing circumstances in which non-critical businesses have begun to reopen. OSHA staff will continue to prioritize COVID-19 inspections and will utilize all enforcement tools as OSHA has historically done.

Second, OSHA is revising its previous enforcement policy for recording cases of coronavirus. Under OSHA’s recordkeeping requirements, coronavirus is a recordable illness, and employers are responsible for recording cases of the coronavirus, if the case:

  • Is confirmed as a coronavirus illness;
  • Is work-related as defined by 29 CFR 1904.5; and
  • Involves one or more of the general recording criteria in 29 CFR 1904.7, such as medical treatment beyond first aid or days away from work.

Under the new policy, OSHA will enforce the recordkeeping requirements of 29 CFR 1904 for employee coronavirus illnesses for all employers. OSHA’s guidance emphasizes that employers must make reasonable efforts, based on the evidence available to the employer, to ascertain whether a particular case of coronavirus is work-related. Recording a coronavirus illness does not mean that the employer has violated any OSHA standard.

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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