The WorkSTEPS team continues to carefully track what is happening with the COVID-19 pandemic.
5/8/20A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman:
As companies have prepared to restart and ramp up operations in the past few weeks, they’ve worked hard to develop and implement strategies and systems of mitigation measures to protect their employees and customers from COVID-19 infection, and to prevent disruptive and costly disease outbreaks.
Well, here’s an example: Earlier this week I was performing contact-tracing on an employee who was flagged by a pre-shift temperature screening. Not only did the employee decide to go to work that day despite having symptoms, he admitted to not feeling well two days prior (before his temperature spiked/while he was likely contagious). And, in responding to questions about close contact with others, he admitted that he and his colleagues were not practicing social distancing while on breaks, and nor had he distanced himself from friends and family when away from work.
And this is not an isolated example. My colleagues and I have conversations like this every day – conversations that at once make it clear that: A) companies have the right policies in place; but B) employees are not adhering to those polices and guidance at work or at home.
Why the gap between policy and practice? Based on what we’re hearing, it has a lot to do with a breakdown in communication – a breakdown that has to do with language, clarity, consistency and trust. Let’s take these issues one-by-one.
For all these reasons, communications need to come from people and parts of the organization that employees trust when it comes to their health and safety. This is why in his blog, Chuck advocates that operational leaders with strong safety reputations and trusted corporate health and safety leaders play key roles in delivering of COVID-19 communications.
“Protesters Say Wearing Safety Glasses is a Sign of Weakness”
Imagine seeing that headline in your morning news feed. I pose the ridiculous to emphasize the reality: There are voices in the public square focused on downplaying the danger of COVID-19 and discouraging people from doing many of the things your policies prescribe - from social-distancing to handwashing and mask-wearing. So even if you succeed in gaining policy compliance within the walls of your facilities, employees are being exposed to mixed messages and cultural pressures outside of work that may increase their risk, threaten the health of others and disrupt your business.
Make no mistake about it, the COVID-19 communications challenge is unlike anything we’ve seen – at least in my lifetime. It is critical, therefore, to give as much attention to the clear, consistent and effective communication of COVID-19 policies as you give to the policies themselves.
To help, we are working on creating some essential COVID-19 communication tools that we will soon make available. Let us know if you think you’ll be interested, and we’ll forward information when available.
Be well and stay safe.
Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS
* Speaking of fluid policies and practices, reflecting new RTW guidance from the CDC, we have updated our Return-to-Work flow charts. What has changed: Prior guidance indicated that employees could return to work 7 days after having first noticed symptoms or testing positive for COVID-19. The new guidance recommends waiting 10 days.
Click here for more info on our Coronavirus Medical Hotline for Employers & Employees
Coronavirus (COVID-19) treatment update: FDA Issues Emergency Use Authorization for Potential COVID-19 Treatment. The US Food and Drug Administration issued an emergency use authorization for the investigational antiviral drug remdesivir for the treatment of suspected or laboratory-confirmed COVID-19 in adults and children hospitalized with severe disease. While there is limited information known about the safety and effectiveness of using remdesivir to treat people in the hospital with COVID-19, the investigational drug was shown in a clinical trial to shorten the time to recovery in some patients. (FDA, 5/1/20)
The FDA decision is based upon the Phase 3 SIMPLE trial of Gilead Sciences Inc’s antiviral drug remdesivir primary endpoint. The study supplies positive data that COVID-19 patients administered the drug early fared better than those treated later. From 397 patients, the study revealed that 62 percent of patients treated early were discharged from the hospital, against 49 percent of those treated late.
The U.S. Food and Drug Administration included, under the ventilator emergency use authorization (EUA), a ventilator developed by the National Aeronautics and Space Administration (NASA), which is tailored to treat patients with COVID-19. The ventilator was added to the list of authorized ventilators, ventilator tubing connectors and ventilator accessories under the ventilator EUA that was issued in response to concerns relating to insufficient supply and availability of FDA-cleared ventilators for use in health care settings to treat patients during the COVID-19 pandemic.
UK Study Suggests a Third of COVID-19 Hospital Patients May Die:
The prospective observational cohort study, which has not been peer reviewed, was carried out by a consortium of researchers, known as ISARIC4C, and was led by the University of Liverpool, University of Edinburgh, and Imperial College London (ICL).
A total of 16,749 people with COVID-19, with a median age of 72, were involved in the research.
Overall, the findings showed that:
How Can Evidence Synthesis be Conducted at the Speed of a Pandemic? The CDC conducted a search in PubMed for the term COVID-19 and found more than 7,000 articles published between January 1 and April 27, 2020. This does not capture the thousands of studies shared on preprint servers. The speed at which new information is now available about COVID-19 is far outpacing our ability to synthesize the cumulative evidence in a timely fashion.
Currently, systematic reviews of COVID-19 topics are being published at a very rapid pace, running the risk of synthesizing data from flawed, poorly designed studies, or studies with overlapping data. The CDC conducted a more recent search on April 27 and found at least 90 published systematic reviews or meta-analyses. Systematic review protocol registries can help to reduce duplication of work and increase transparency during evidence synthesis. PROSPERO, a prospective registry of systematic reviews, contains information on well over 600 protocols for systematic reviews of human studies relevant to COVID-19.
A Northwestern University researcher, Dr. Huang, has received funding to develop a new self-sanitizing medical face mask that deactivates viruses on contact. The project received a rapid response research grant from the National Science Foundation.
The research team is investigating anti-viral chemicals that can be safely built into masks to self-sanitize the passing respiratory droplets. Huang's team aims to design a drop-in solution that works with current masks to provide the additional function of deactivating viruses. The modified mask would help reduce the level of viruses in droplets exhaled by infected wearers, and better protect healthcare workers and others around them.
CDC changes its guidance on home isolation (click here to request our updated flow charts)
Symptom-Based Strategy to Discontinue Isolation for Persons with COVID-19
This change increases the period of recommended isolation by 3 days, from 7 to 10 days. This more cautious approach is intended to more stringently limit transmissions that may occur from persons following recovery from illness and thereby enhance ongoing efforts to control COVID-19 illness. Although this change increases an individuals’ isolation period, as illness incidence decreases it will affect fewer persons and thereby limit overall societal burden of time spent in isolation.
While this strategy can apply to most recovered persons, CDC recognizes there are circumstances under which there is an especially low tolerance for post-recovery SARS-CoV-2 shedding and risk of transmitting infection. In such circumstances, employers and local public health authorities may choose to apply more stringent recommendations, such as a test-based strategy, if feasible, or a requirement for a longer period of isolation after illness resolution. Entities enacting such policies should do so explicitly, with clear justification, and in coordination with local public health authorities.
While the U.S. policy approach to COVID-19 should continue to support big breakthrough initiatives like vaccine and drug development and building massive test and trace capacity, we should not ignore the potential cumulative impact of the many small things we already know how to do or might try that together could make a big dent in the current crisis. Most are things we are already being told to do (like fastidious handwashing). Each probably just makes a small difference. But when harnessed together in a comprehensive program aimed at implementing them more rigorously, they could potentially make a big enough difference to get our economy and society functioning sooner rather than later. Getting a majority of our population, businesses, and government entities on board with these actions is the key challenge facing our public- and private-sector leaders.
Harvard Business Review – We Shouldn’t Wait for the Breakthrough in the COVID-19 Pandemic
The Work From Home WorkSTEPS Medical Team:
Ben Hoffman, MD, MPH
Chief Medical Officer
Tony Nigliazzo, MD
Loraine Kanyare, MSN, MPH, RN
Director of Case Management
Robert L. Levitin, MD
Lynda Phillips, LVN
Nurse Case Manager
Codey Church, LVN
Nurse Case Manager
Kerry Womack, LVN
Nurse Case Manager
Strategic Communications Consultant