6/2/20 COVID-19 Brief: Being “In This Together” When We’re Worlds Apart

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

Being “In This Together” When We’re Worlds Apart

Over the course of my career, I’ve had the opportunity to deliver care and promote health in places ranging from a leper colony in Africa, to a Native American Reservation in Arizona, to villages in Central America. I’ve also studied the impact of cultural differences on disease in Asia. And for the past three decades, I’ve worked with businesses, promoting health and safety in factories, offices and boardrooms around the world.

A lesson I learned early and which has been reinforced by each consecutive experience is: 1) to improve health, you need to impact behavior; and 2) to impact behavior, interventions need to reflect an understanding of culture and ways in which individual identity is rooted in culture.

Whether cultural differences are due to nationality, job role, region of the country or other factors, those differences need to be understood and accounted for in efforts to influence health or safety behaviors.

COVID-19 – A Uniquely Big and Complicated Culture Challenge

The challenge of ramping up operations and returning people safely to work amidst this pandemic feels bigger and more complicated than anything we’ve dealt with before because it is. Consider:

  • COVID-19 is a threat to every employee in every location around the world, regardless of their role in the company. Members of the Executive Committee, field workers in North Dakota and analysts in Mumbai are all faced with the threat that they or members of their family could be infected, become seriously ill or even die from COVID-19.
  • Failure to adequately protect against the threat can have substantial and lasting impacts on employee health, workforce trust/morale, business operations and company reputation.
  • To keep themselves and each other safe, companies need employees to comply with new policies, and that means adopting new behaviors both on the line/at their desks and while on break.
  • Ideally, behavior changes extend beyond work, with employees protecting themselves and others commuting to/from work, at home and in the community.  
  • As companies in the meat and poultry processing industry and others have found, there is an added layer of challenge engaging, communicating with and influencing behaviors of immigrants and refugees who often live in close-quartered and tightly knit communities.
  • Oh, and just three months ago, COVID-19 was not on the radar for most companies, and most companies have little or no “muscle memory” from having faced similar challenges in the past.

Whew! Yes, the dimensions and complexity of this challenge are truly unprecedented.

Addressing Culture in Your COVID-19 Strategy

I don’t have “an answer” because there is none. Instead, there is a way of thinking about your COVID-19 strategy and some elements that I recommend companies consider as part of their approach.

  • Keep Culture Top-of-Mind: Too often, solutions are formulated apart from consideration of how they will be implemented within different cultures. I recommend introducing cultural insights earlier and letting those insights drive creative thinking about solutions and solution implementation. To be clear, the fundamental policy components (e.g., screening, sanitation, social distancing, mask-wearing) should not change, but how employees are educated, engaged and encouraged to comply will vary from culture to culture.
  • At Every Facility, Designate a Lead for COVID-19 Policy Implementation: You know the saying: “If everyone’s responsible…” Each site should have someone who is responsible to: A) make sure every employee understands the policies (regardless of language); 2) help managers and supervisors problem-solve compliance challenges among individuals and sub-groups; 3) monitor and report on compliance and gaps; and 4) enforce consequences of non-compliance.
  • Position Compliance with COVID-19 Policies as a Safety Issue: Health is deeply personal. Safety is more about a shared responsibility. It is easier to get people to comply with a policy meant to keep others and the business safe than to get people to adopt behaviors that are “for your own good.” If you have a strong safety culture, use it. If you don’t, consider COVID-19 as a “rally cry” moment when employees need to work together to protect each other, customers and the future of the business.
  • Identify and Engage Natural Leaders: Particularly if there are powerful sub-cultures within an organization or site, it is important to identify leaders within those sub-cultures and to work to engage their support for COVID-19 policies.
  • Engage Public Health and Other Community Resources: Companies with immigrant and refugee populations should reach out to public health leaders to exchange information and potentially coordinate efforts to educate, equip and encourage those populations to adopt safe practices. Also consider reaching out to faith leaders and others with influence within cultural sub-groups.

Finally, do all the above with a bigger picture in mind. By building or strengthening your safety culture, you will help employees understand what it means to be “in this together,” a commitment and sense of identity that doesn’t have to end when COVID-19 fades into memory.

What are you doing to meet the culture challenges at your company? Contact us with an overview of what you’re doing, and perhaps we’ll interview you for an upcoming issue of The Brief.

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 6,302,150 374,554 2,866,574
United States 1,839,698 106,262 599,925

Even in some of the hardest-hit cities in the world, the studies suggest, the vast majority of people still remain vulnerable to the virus.

Some countries — notably Sweden, and briefly Britain — have experimented with limited lockdowns in an effort to build up immunity in their populations. But even in these places, recent studies indicate that no more than 7 to 17 percent of people have been infected so far. In New York City, which has had the largest coronavirus outbreak in the United States, around 20 percent of the city’s residents have been infected by the virus as of early May, according to a survey of people in grocery stores and community centers released by the governor’s office.

A report from Imperial College estimates for the U.S show that the percentage of individuals that have been infected is 4.1%, with wide variation between states. In New York, for example, they estimate that 16.6% of individuals have been infected to date. Predictions coming from the college show concern that increased mobility following relaxation of restrictions will lead to resurgence of transmission. Predictions are that deaths over the next two-month period could exceed current cumulative deaths by greater than two-fold, if the relationship between mobility and transmission remains unchanged. They recommend a continual increase in testing, contact tracing and behavioral precautions (hand washing, masks, disinfection) to offset potential effects associated with loosening of social distancing. They found no evidence that any state is approaching herd immunity or that its epidemic is close to over.

Airborne spread from undiagnosed infections will continuously undermine the effectiveness of even the most vigorous testing, tracing, and social distancing programs. After evidence revealed that airborne transmission by asymptomatic individuals might be a key driver in the global spread of COVID-19, the WHO recommended universal use of face masks. Masks provide a critical barrier, reducing the number of infectious viruses in exhaled breath, especially of asymptomatic people and those with mild symptoms.

What only a month ago had been merely an intriguing laboratory finding about analyzing wastewater to detect the virus that causes COVID-19 has quickly leapt to the threshold of real-world use.

With swab tests still plagued by capacity issues, inaccuracy, and slow turnaround, testing wastewater for the novel coronavirus’ genetic signature could give communities a faster way to spot a rebound in cases — as soon as this fall

Serological Saliva Test Researchers from Emory University and Johns Hopkins University conducted a study (preprint) to determine the feasibility of using saliva specimens for serological tests. The researchers developed a multiplex SARS-CoV-2 antibody immunoassay and tested 167 saliva and 324 blood serum specimens, including from patients that tested positive and negative for SARS-CoV-2 infection utilizing molecular diagnostic assays. They found that the antibody assay exhibited similar sensitivity and specificity for both the saliva specimens and serum specimens and performance consistent with other existing serological tests. They also demonstrated that the “temporal kinetics of IgG, IgA, and IgM in saliva were consistent with those observed in serum.” Further research is required to fully characterize the performance, accuracy, and reliability of saliva-based serological tests, but if available, they could potentially provide benefits to conducting large-scale serological testing. Participating individuals can easily collect their own specimens, as opposed to blood samples required for existing SARS-CoV-2 serological tests, and the saliva specimens can be transported and stored at ambient temperature. The US FDA has already issued an Emergency Use Authorization (EUA) for a saliva-based molecular/diagnostic test that utilizes specimens that individuals can collect on their own at home.

South Korean Study Shows No Evidence Recovered COVID-19 Patients Can Infect Others (NPR): South Korea's Center for Disease Control has reassuring news about people with COVID-19 who test positive for the coronavirus weeks after their symptoms have resolved. Health officials there studied 285 patients who tested negative for the virus after recovering, but weeks later tested positive again. the scientists followed up with nearly 800 of those people's personal contacts, such as family members. They found no evidence that they had contracted the virus from the people who had a fresh positive result. The scientists also tried to grow the virus in secretions from these patients. They could not.

Mitigation / Suppression:

States are trying to contain continual spread of COVID-19. New York City contact tracing program began on Monday with a newly hired force of 1700 contact tracers with a plan to increase to 5,000-10,000 tracers. Utah has retrained 150 state employees to work as contract tracers. Contact tracing involves seeking information from COVID-19 patients about their contacts with other people. The goal is to obtain information on close contacts defined as people the infected person spent significant  time with within six feet. Experts estimate that at 100,000 - 300,000 contact tracers are needed in the U.S. Utah’s Gov. Herbert announced  public beta testing phase for Healthy Together, a symptom checking mobile application that helps augment current contact tracing efforts. The app is designed to help the Utah residents work together with public health officials to slow the spread of COVID-19.

To suppress their epidemics to manageable levels, countries around the world have turned to contact tracing — tracking down people who might have been exposed to the coronavirus to ensure they don’t pass it to others, a way of stalking routes of viral spread and severing them before they reach more people. And, to varying degrees, it has worked. But, for it to succeed in the United States, experts are cautioning that it’s going to take more people, more money, and more cooperation than the country has in place.

Shortage of Testing Machines: Following a series of challenges and delays in distributing a variety of supplies needed to scale up SARS-CoV-2 testing in the United States—including test kits, reagents, and nasal swabs—the next barrier may be a shortage of the machines needed to perform the tests. Multiple manufacturers of these machines—including Hologic, Inc; Roche; and Abbott Laboratories—have reportedly confirmed that they have not been able to manufacture enough of the testing machines to meet the existing demand. The machines are capable of processing hundreds of specimens at a time, and increased availability is critical to expanding testing capacity to the volume that health experts argue is necessary to conduct large-scale testing and surveillance and support efforts to relax social distancing. Both private labs and government laboratories, including those operated by the US Army, have reported challenges obtaining additional testing machines, and even some orders placed prior to the pandemic have not yet been filled. While the manufacturers have stated that they are doing everything they can to increase production, there are concerns that unpredictable future demand could hinder incentives to scale up production capacity. Increasing production requires substantial investment and funding, and the units themselves are expressive. The economic impact of the COVID-19 pandemic means that available funding for many governments, health systems, and other laboratories may be limited, which could make it challenging to justify a substantial investment in new equipment, especially if the future demand could be low.


The CDC released recommendations for employers on May 27.  Workers in office buildings may be at risk for exposure to the virus that causes COVID-19. Office building employers, building owners and managers, and building operations specialists can take steps to create a safe and healthy workplace and protect workers and clients.

CDC Employer Information for Office Buildings

CDC answers: When You Can be Around Others After You Had or Likely Had COVID-19

At this point in the pandemic, Harvard Business Review answers some of the lingering questions:

8 Questions Employers Should Ask About Reopening

  • 1. When is the right time for employees to return?
  • 2. Who should return to the workplace?
  • 3. How can we protect employees who come to work?
  • 4. What role can testing play in making workplaces safer?
  • 5. What should we do if we discover an infected employee in the workplace?
  • 6. When can employees return to business travel?
  • 7. How can we meet employees’ growing mental and emotional health needs?
  • 8. How should we communicate around return to the workplace?

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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