News

5/29/20 COVID-19 Brief: Sam Just Called in Sick. Now What?

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

Sam Just Called in Sick. He Thinks It May Be COVID-19. Now What?

I’ve written more than once about the things companies should be doing to protect their employees, contractors and customers from COVID-19. Last week, I even used the analogy of a 4-part cocktail to help communicate the combined value of screening, distancing, mask-wearing and hygiene measures.

Notably, I’ve consistently set the expectation that the goal of mitigation strategies is to contain the spread of COVID-19 and prevent disease outbreaks among your workforce. I’ve not indicated that the goal is zero cases. Because asymptomatic and pre-symptomatic people can spread the virus, zero cases is just not feasible.

So, back to the title of this article: “Sam just called in sick. He thinks it may be COVID-19. Now What?”

For companies returning people to work in larger and larger numbers, the answer to “Now What?” is: Contact Tracing.

Contact Tracing – Why Employers Need to Act

While the term “Contact Tracing” is new to the ears of the average person, it is a well-developed and proven practice that has been used for decades to successfully fight the spread of infectious diseases. Contract tracing breaks the disease transmission chain by preventing newly infected people from infecting others. From AIDS to SARS to Ebola, contact tracing has helped save lives and prevent pandemics around the world.

Contact tracing is a well-developed practice that is typically in the domain of public health professionals; however, the SARS-CoV-2 virus presents some special challenges that require employers to take action. Consider these facts and implications:

Facts about COVID-19:

  • The virus is highly contagious.
  • People can spread the virus without knowing because people tend to be contagious before they feel sick, and some people never experience symptoms, even though they can still shed the virus.
  • The virus spreads through unremarkable activity. It is now believed that the primary means of transmission is simply close contact in a confined space. So having lunch, commuting, being in a meeting or just working with an infected person are enough to transmit the virus. And of course, people living in the same household as infected employees are at risk of getting sick.
  • Contact tracing often involves addressing language barriers, cultural differences, difficulties in recalling recent close contacts and trust issues.
  • COVID-19 has hit the world fast and hard.

Implications of the above facts:

  • Lots of people become infected.
  • For each infected person, there are lots of contacts that need follow-up.
  • Speed is of the essence in order to identify contacts who have been infected so they don’t continue to spread the disease.
  • Contact tracing needs to be thorough. Anyone with whom an infected person has had close contact (within 6 feet for 15 minutes or more) needs to be reached, interviewed and counseled.
  • Contact tracing is difficult and time-consuming work.
  • Our public health infrastructure is not prepared to handle the COVID-19 challenge.

Conclusions

  • In most areas of our country (and particularly in more densely populated areas) our public health departments are simply not equipped to handle the volume of contact tracing activity that is needed with the speed and thoroughness required. Note: We recommend companies reach out to their local public health agency to gauge their capacity and responsiveness, keeping in mind that those things may change if there is an outbreak in your area.
  • Therefore, to prevent workplace outbreaks and avoid further business disruptions as they return employees to work, employers need to develop internal resources or engage trusted partners who are capable of providing timely and robust contact tracing support.

Contact Tracing – How To

Building contact tracing capabilities internally is not out of the question, but it isn’t easy. Certainly, this article is no place to go into the details. There are a couple of resources worth reviewing to get a sense of the task at hand. Both are written from a public health perspective, so it’s more than any company would need to do. First, a link to the CDC's Resource Page, and then a link to this Contact Tracing Playbook, which provides a good overview and some detailed guidance.

One More Thing – The L-Word

There is one additional item I am reluctant to bring up in this article because it begs more detail than I can provide in the space I have. It has to do with Workers’ Compensation Liability. Looking out at the marketplace, we are seeing a sharp rise in suits being filed by employees claiming that they became sick with COVID-19 at work/because of work. In addition to the cocktail of measures to help prevent the spread of COVID-19 in the workplace, employers should put in place a robust contact tracing program to make sure one case doesn’t become three or four or ten+ cases.  

As always, let us know how your organization is dealing with this topic. And please contact us if you’d like to learn more about our contact tracing services.

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 5,846,624 359,532 2,537,267
United States 1,753,297 102,559 494,006

Source

CDC releases Interim Guidelines for COVID-19 Antibody Testing:

Data that will inform serologic testing guidance is rapidly evolving.  Recommendations on the use of serologic tests to determine protective immunity and infectiousness among persons recently infected with SAR-CoV-2 will be updated as new information becomes available.

Wastewater testing gains support as early warning for COVID-19:

In the absence of rapid, accurate, and widely available swab tests, examining wastewater for the presence of the virus that causes COVID-19 is increasingly becoming a more plausible way to track community spread. As early as this fall, communities around the U.S. could be testing sewage samples for coronavirus particles, a method that was only recently shown to be a viable approach. Other countries, including Finland, the Netherlands, and Germany, have already instituted such programs and are monitoring sewage for COVID-19 in real time.

A follow-up survey from the American Cancer Society finds that 87% of cancer patients say the pandemic has affected their ability to get care, up from 51% who said the same in April. Nearly 80% of those actively being treated reported delays, up from 27% last month.

A new study comparing a small group of asymptomatic COVID-19 patients in China to those showing symptoms finds that the former group tended to be younger, female, and tended to show faster signs of lung recovery on CT scans. Asymptomatic patients were still found to be shedding virus particles — albeit for a shorter duration than those with symptoms — underscoring the need for testing even those without COVID-19 symptoms.

ANTIBODY PRODUCTION IN COVID-19 SURVIVORS: Researchers at The Rockefeller University published (preprint) data from a study of 149 COVID-19 patients to evaluate the presence of antibodies in blood serum after their recovery. Their analysis identified a broad scope of immune response among the participants, including the production of various types of antibodies. The researchers found that the majority of the COVID-19 patients did not produce the appropriate type or quantity of antibodies necessary to result in the “neutralizing activity” necessary to prevent SARS-CoV-2 infection, including 33% whose neutralizing activity was below the minimum detectable level. They did identify “remarkably high” neutralizing activity in 2 of the participants. The researchers were further able to identify and clone key neutralizing antibodies from these “‘elite’ responders,” and they are working to translate them into a potential COVID-19 treatment.

Federal Scientists Finally Publish Remdesivir Data: A clinical trial led to the authorization of the only drug shown to work in COVID-19 patients. But until now, few experts had seen the numbers. The long-awaited study, sponsored by the National Institute of Allergy and Infectious Diseases, appeared on The New England Journal of Medicine website on Friday evening. It confirms the essence of the government’s assertions: Remdesivir shortened recovery time from 15 days to 11 days in hospitalized patients. The study defined recovery as “either discharge from the hospital or hospitalization.”

WHO Halts Hydroxychloroquine Trial Over Safety Concerns (NPR): The World Health Organization says it is temporarily halting its clinical trials that use hydroxychloroquine to treat COVID-19 patients over published concerns that the drug may do more harm than good. A study found that hydroxychloroquine was associated with higher mortality in COVID-19 patients; the WHO said Monday it had paused enrollment in the hydroxychloroquine portion of its multiarmed Solidarity Trial to review the safety and efficacy of data generated so far.

The full study can be found here: The Lancet Study

Mitigation / Suppression:

US SOCIAL DISTANCING: Reuters published analysis of state-level COVID-19 incidence data—from The COVID Tracking Project—to evaluate epidemic trends. The analysis found that 20 states reported increased weekly incidence (for May 18-24) over the previous week, compared to 13 states identified last week.

Nationally, new cases of COVID-19 fell 0.8% for the week ended May 24, compared with a decline of 8% in the prior week. All 50 states have now at least partially reopened, raising fears among some health officials of a second wave of outbreaks. The increase in cases could also be due to more testing.

COVID-19 Tracking

The New York Times continues to track state-level COVID-19 incidence, with a focus on state policies regarding social distancing. A number of states began to relax social distancing measures—including resuming operations at restaurants, retail stores, and barbershops/salons—at the end of April/early May, and mass gatherings associated with the Memorial Day holiday weekend (US) could have provided the conditions to drive increased community transmission.

In a simulation study, face shields were shown to reduce immediate viral exposure by 96% when worn by a simulated health care worker within 18 inches of a cough. Even after 30 minutes, the protective effect exceeded 80% and face shields blocked 68% of small particle aerosols, which are not thought to be a dominant mode of transmission of SARS-CoV-2. When the study was repeated at the currently recommended physical distancing distance of 6 feet, face shields reduced inhaled virus by 92%, similar to distancing alone, which reinforces the importance of physical distancing in preventing viral respiratory infections.

The past few weeks have seen an explosion in misleading claims about COVID-19. These are mostly online, and many are intended to sow doubts about vaccination as a way to protect against infection. For the individuals and organizations involved in such disinformation, the pandemic is a gilded opportunity. They are capitalizing on both the many unknowns about the SARS-CoV-2 virus and the disease it causes, as well as the many legitimate questions about safety and efficacy as vaccines are being developed at unprecedented speed.

Corporate:

COVID-19 mis- and disinformation are presenting substantial challenges to the global COVID-19 response, as rumors and conspiracy theories may be linked to increased transmission and unnecessary disease. Claims related to disease severity, government response, and vaccine or treatment efficacy are circulating widely, and it is extremely difficult to provide fact-checking or verification in real time, particularly across the myriad of traditional and social media platforms available worldwide. COVID-19 has presented optimal circumstances for the spread of rumors, including increased stress and anxiety around the virus that can make individuals more susceptible to mis- and disinformation. An investigation by the BBC identified a number of events—including mass poisonings and threats or incidents involving physical violence—linked to misinformation regarding COVID-19.

Prescribing Paid Sick Leave—An Important Tool for Primary Care During the Pandemic (JAMA Health Forum) Researchers in Israel found that 94% of people would comply with advice to self-quarantine when their earnings are guaranteed vs just 57% when this would mean the loss of wages. Congress has stepped in to help address this aspect of the pandemic by requiring many employers to provide paid sick leave for any person given medical advice to stay home related to COVID-19 as of April 1, 2020. But this policy only works if patients know about it. This is where primary care clinicians enter the picture, with perhaps the most important prescriptions they will write during the pandemic.

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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