6/25/20 COVID-19 Brief: Reopening Amidst the Threat - Lessons from Our Social Contract Around Shellfish Allergies

In most parts of the country, laws surrounding COVID-19 are weak or non-existent. State, county and local governments are leaving it up to individuals to do what’s right. The problem is that there are vastly different views about what “right” means. Where laws are failing us, we need a social contract.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Reopening Amidst the Threat – Lessons from Our Social Contract Around Shellfish Allergies

I have a number of friends who are allergic to shellfish. For some, accidentally consuming a bite of shrimp means they will break out in hives; for others, just the slightest contamination of their meal can be life-threatening.

And yet, my friends with shellfish allergies still dine out and attend parties where they consume food they did not prepare.

How is this possible? How have we managed as a society to protect the health of people allergic to shellfish without confining them to their own homes and kitchens?

I propose that it’s because we have developed a sort of social contract around how we protect people with life-threatening shellfish (or peanut, etc.) allergies. The contract rests upon these core responsibilities:

  • The person with the allergy is responsible to: A) Be aware of their allergy; B) Avoid high-risk situations (e.g. seafood buffets); C) Communicate with others (wait staff, friends throwing parties) to alert and educate them as necessary; and D) Be prepared for emergencies (e.g., carrying an Epi-pen).
  • Others (restaurants, party hosts) are responsible to: A) Take seriously the risk; B) Be transparent about the presence of shellfish in various recipes or about possible cross-contamination during food preparation; and C) Execute on procedures needed to make sure the food served to people with shellfish allergies is free of shellfish.

Needed - A Social Contract to Protect People Vulnerable to Serious Illness from COVID-19

Current news on COVID-19 in the US is not good. Cases, hospitalizations, ICU occupancies and deaths are all on the rise, and sharply in some parts of the country. Against this backdrop, we’re seeing animosities simmer between those who want to see protections ramped up and those who yearn for their old normal. People are yelling at others for not wearing masks, or for wearing them. Some businesses have established “no masks allowed” rules, while others require masks for their employees and customers. And where mask requirements meet anti-mask patrons we’ve seen violence…even deadly violence.

And the attitudes that simmer in the public square are creating tensions in the workplace. While some employees behave as if there is no threat at all, others refuse to come to work for fear of their own health or the health of those they live with or care for. They don’t think companies are doing enough to protect them, or they don’t trust their fellow employees to comply with the polices that have been put in place.  

Fueling the interpersonal conflict is the fact that – in most parts of the country – laws surrounding COVID-19 are weak or non-existent. State, county and local governments are leaving it up to individuals to do what’s right. The problem is that there are vastly different views about what “right” means.

Where laws are failing us, we need a social contract.

A Proposed Social Contract around COVID-19

To begin, I want to acknowledge that my thoughts on this topic have been strongly influenced by an article titled “As Cities Move Toward Reopening, How to Manage Risks” by Dr. Darria Long and Dr. David L. Katz. It is a terrific and constructive article that I hope you will read and share.  

The social contract I propose mirrors the contract we have created over time to protect people with shellfish and other life-threatening allergies.

Individuals who are at high risk (or who live with or care for high-risk people) are responsible to:

  • Understand their risk and risks of others in household or under their care: Figure 1 (copied from the article) presents an easy-to-understand risk classification based on age and health risks.
  • Avoid high-risk situations: Regarding risk, Long and Katz focus their guidance around the risk of being exposed to high doses of virus in various settings. Figure 2 summarizes four factors that drive higher levels of exposure.
  • Communicate with others: Open and honest communication about risk tolerance is needed. Coworkers, family and friends need to be aware when someone is highly concerned about getting sick with / becoming a carrier of COVID-19 so they can take appropriate steps to avoid spreading the virus.
  • Be prepared: People who are concerned need to be prepared to guard their own health by carrying sanitizer and masks and being willing to exit situations where the risk appears too high.

Other people and places of business are responsible to:

  • Take the risk of COVID-19 seriously: People who are unconcerned about the risk personally need to understand the very real threat it poses to others either directly (fear of contracting COVID-19) or indirectly (fear of infecting others in the same household or under their care).
  • Be transparent: People who are less concerned – and thus are willing to engage in activities where they risk exposure to higher doses of the virus – need to be honest about their exposure so that those who are highly concerned can protect themselves.
  • Take actions to keep vulnerable people safe: When in the presence of people who are vulnerable and concerned about COVID-19, those who are relatively unconcerned about their own exposure need to protect the health of others who are vulnerable or otherwise concerned.

Applying the COVID-19 Social Contract at Work

So, how does this contract play out at work? Here are a few examples:

  • Joe invites his colleagues to go out for dinner and drinks after work. Tom is a caregiver for his mother who is in segment “A” above, so tells the team he won’t be able to join them. Amy is in segment E, so tells the team she can join them for a quick drink on the restaurant’s outdoor patio. At the event, everyone respects Amy’s desire to keep her distance and brainstorms ways they can get together where Tom will feel comfortable attending.
  • Jan manages operations in a senior living center. She uses the segmentation grid and dose exposure factors to educate her staff about the importance of controlling their exposure to risk as a way of protecting highly-vulnerable residents as well as to emphasize the importance of compliance with the facility’s COVID-19 staff screening and prevention protocols.
  • James manages a team of twenty. Despite a comprehensive COVID-19 prevention strategy, some team members remain reluctant and uncertain about returning to the office. Pete uses the risk stratification and dose exposure information to help employees accurately assess their risk and to understand how the firm’s prevention strategy has greatly reduced the potential for high dose exposures in the office.  

I don’t know about you, but one of the most frustrating things about this pandemic is that – rather than uniting people, it has divided us. In the absence of legal solutions, we need human kindness, understanding and a willingness to make even small sacrifices for the well-being of others. Until we solve this among ourselves, we will be held back in our ability to truly re-open our economy, our businesses and our communities.

Was this article helpful? Are there other topics you want us to cover? Let us know.

Finally, if your organization needs help developing or implementing COVID-19 policies and practices, know that we have built up a full range of capabilities to meet your needs. You can learn more about our services here.

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 9,430,755 481,658 5,094,763
United States 2,440,170 123,780 1,022,768

Texas, Arizona and Nevada set records in their COVID-19 outbreaks for a second week. In Texas, cases and hospitalizations have doubled over the past month; COVID related hospitalizations rose from an average of 1,600 a day to 3,200 a day. On Tuesday, Gov. Abbott, urged residents to keep safe: “Because the spread is so rampant right now, there is never a reason for you to have to leave your home unless you do need to go out. The safest place for you is at your home.”  Arizona and Nevada reported record increases in new cases on Tuesday. In the U.S overall cases rose 25% last week with 10 states reporting a greater than 50% rise in new infections. California and Washington state announced mandating facial coverings statewide this week.

On Tuesday, Pirbright Institute, in collaboration with the University of Oxford, released encouraging news regarding their vaccine trial in animals. They revealed that with an initial dose followed by a booster dose they  saw a marked increase in neutralizing antibodies, which bind to the virus in a way that blocks infection. They will be moving to study the level of immune response required to protect humans. The ChAdOx1 nCoV-19 vaccine, was originally developed by Oxford University scientists, who are now working with AstraZeneca on development and production. AstraZeneca says it hopes to have data on efficacy later this year. Preliminary data from a trial in six monkeys found that some of the monkeys given a single shot developed antibodies against the virus within 14 days, and all developed protective antibodies within 28 days.

On Thursday, a  study published that levels of an antibody found in recovered COVID-19 patients fell sharply in 2-3 months after infection for both symptomatic and asymptomatic patients. The research supports the prolonged utility of public health interventions such as social distancing and caution for high-risk groups. The research studied 37 symptomatic patients and 37 asymptomatic patients. Findings were that of those who tested positive for the presence of the IgG antibody, over 90% showed sharp declines in 2-3 months; with a median percentage decrease of more than 70% for both groups studied. For neutralizing serum antibodies, the median decrease for symptomatic individuals was 11.7%, while for asymptomatic individuals it was 8.3%.

Mitigation / Suppression:

On Friday, the FDA issued a warning pertaining to 9 brands of hand sanitizer because the products contain methanol, a substance that can be toxic when absorbed through the skin or ingested. FDA has identified the following products manufactured by Eskbiochem:

  • All-Clean Hand Sanitizer (NDC: 74589-002-01)
  • Esk Biochem Hand Sanitizer (NDC: 74589-007-01)
  • CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-008-04)
  • Lavar 70 Gel Hand Sanitizer (NDC: 74589-006-01)
  • The Good Gel Antibacterial Gel Hand Sanitizer (NDC: 74589-010-10)
  • CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-005-03)
  • CleanCare NoGerm Advanced Hand Sanitizer 75% Alcohol (NDC: 74589-009-01)
  • CleanCare NoGerm Advanced Hand Sanitizer 80% Alcohol (NDC: 74589-003-01)
  • Saniderm Advanced Hand Sanitizer (NDC: 74589-001-01)

Consumers exposed to hand sanitizers containing methanol should seek immediate treatment which is critical for potential reversal of toxic effects of methanol poisoning. Substantial methanol exposure can result in short term and long-term health effects.

New modeling study out of Cambridge and Greenwich universities showed that face masks may be even more important than originally thought in preventing future outbreaks of the new coronavirus. To ward off resurgences, the reproduction number (R0) for the virus (the average number of people who will contract it from one infected person) needs to drop below 1.0. The modeling indicated that when multiple mitigation strategies are combined with 100% face mask use, disease spread is vastly diminished, preventing resurgence for 18 months, the time frame that has frequently been cited for developing a vaccine. It also demonstrated that if people wear masks in public, it is twice as effective at reducing the R number than if face coverings are only worn after symptoms appear. With a policy that all individuals must wear a facemask all of the time, a median effective COVID-19 R0 of below 1 could be reached, even with facemask effectiveness of 50% (for R0 = 2.2) or facemask effectiveness of 75% (for R0 = 4).

An app developed to track football fans from North Dakota making the annual trek to Texas for the national championship game is now at the center of a contact tracing effort for COVID-19. Microsoft engineer and app developer T. Brookins in collaboration with Gov. Doug Burgum, retooled the app to develop the Care19 app which could augment contact tracers efforts.  During interviews with infected patients, contact tracers ask COVID-19 patients to open the app and walk through their recent whereabouts, paying close attention to whether they’ve had close contact with others who can then be located and instructed to isolate. The technology cannot replace health care workers, they may be used to bolster their efforts, so long as enough people use them.


A new Commonwealth Fund survey finds that around 40% of adults who experienced job disruption due to the pandemic relied on health insurance that was provided by either their job or the job held by their partner. An additional 20% of these adults now say they don't have health insurance. Employer-based coverage remains an important source of health insurance for workers reporting coverage through a job affected by the pandemic.

We covered topic of COVID-19 mis- and disinformation in an earlier brief. This continues to present 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.

Tips to avoid misinformation:

  • Learn the basics of the diseases
  • Verify images and videos related to the pandemic: the situation is ripe for out of context and misleading visuals
  • Double check case numbers and fatalities on reputable sites including: WorldometerJohns Hopkins dashboard; and state and county sites
  • Beware of attempts to downplay or amplify the threat of the pandemic
  • Don’t share prevention or treatment methods without consulting official sources

We provide a list of expert-recommended reliable sources:

Look for what’s still unknown: scientists are actively working to learn more about the pandemic. Avoid falling for alternative explanations.

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.