A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman
Some facts to begin with:
As we invite employees who are not critical infrastructure workers to return to the office, it is important that we not miss the fact that we are asking them to leave the relative security of their own home, community and safe routines. Work-from-home employees now have control over who they allow in their space and how often their doorknobs are disinfected. Once they leave home, they cede that control, and for some, that’s a big deal.
My observation is that most companies are doing an admirable job of thinking through their RTW priorities and how they can return people to work in waves. They are also working to engineer changes in office environments and to establish policies designed to mitigate the risk of COVID-19 transmission in the workplace.
Employers are increasingly ready with their staged plan and set to safely welcome their people back to the office. But where many employers seem to be struggling is in the communication of their RTW strategy, and as a result, employees are left to wonder: “Am I supposed to go back to work now?” “What if I’m not comfortable with the risk?” “What if I want to return, but my group has not been called yet?” “How can I make sure I’ll be safe?”
In an article about COVID-19 messaging that appeared in our May 8 Brief, I invited readers to request a communications tool – a set of questions designed by our communications partner Chuck Reynolds to guide the creation of clear, consistent and trustworthy messaging. Here are some thoughts about using these questions to communicate with non-critical infrastructure workers about RTW:
First, because we are in a fluid situation, it will be important to keep employees informed. Regular communications should update employees on the status of relevant community data, how things are going with the current RTW wave and what’s coming next. In the absence of regular communications during times like these, rumor mills will run hot.
Second, words need to be backed by actions. If employees in the first RTW wave don’t feel safe, they will find ways to express their concerns to colleagues, and it will be all the more difficult to convince concerned employees in the second wave to return.
I have just scratched the surface. The tool includes additional guidance to help you answer each question. I recommend you request it and use it to map out your RTW communications.
As always, if you’re doing something on RTW communications or anything else to keep your employees safe and productive, let us know. Perhaps we’ll share your story.
Be well and stay safe.
Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS
For more from Dr. Hoffman, connect with him on LinkedIn.
Early in the coronavirus outbreak, as the first infected patients trickled into Zuckerberg San Francisco General Hospital. An infectious disease specialist noticed a troubling trend. Most cases the hospital was seeing were Hispanic young men. The infectious disease specialist proposed collecting data on what it meant about how this new virus was traveling through San Francisco. In a four-day blitz in April, they swabbed and drew blood from 4,160 adults and children, including more than half of the residents in the 16 square blocks that make up San Francisco Census Tract 229.01. About 2% of people tested positive for the coronavirus. Nearly all of them, 95% were Latino. The other 5% were Asian or Pacific Islander. 34% of the tract’s residents are Caucasian, but not a single one tested positive. According to the U.S. Census; 58% of the residents in the testing zone are Hispanic. Questionnaires handed out prior to testing revealed 90% of those who tested positive could not work from home. Most were low-income, lived in households with three or more people, and were low-wage essential workers in food service, delivery, or cleaning services.
It’s not just the coronavirus: In New York and New Jersey, the two hardest-hit states, thousands more people than usual have died in the past few months from causes like heart disease, diabetes and Alzheimer’s disease.
Experts say some of these deaths, which started to rise in early March, may be undiagnosed COVID-19 cases. It’s also possible that some patients with chronic illnesses may have chosen to stay home rather than risk exposure to the virus by going to the hospital.
A study was released identifying ‘superspreading’ events as a large contributor to the transmission of COVID-19. In the study, just 20 percent of cases, all of them involving social gatherings, accounted for an astonishing 80 percent of transmissions. (That, along with other things, suggests that the dispersion factor, k, of SARS-CoV-2 is about 0.45). Another 10 percent of cases accounted for the remaining 20 percent of transmissions — with each of these infected people on average spreading the virus to only one other person, maybe two people. This mostly occurred within households.
No less astonishing was this corollary finding: Seventy percent of the people infected did not pass on the virus to anyone.
The initial dose of virus and the amount of virus an individual has at any one time might worsen the severity of COVID 19 disease. Viral load is a measure of the number of viral particles present in an individual. Higher SARS-CoV-2 viral loads might worsen outcomes, and data from China suggests the viral load is higher in patients with more severe disease. The amount of virus exposure at the start of infection – the infectious dose – may increase the severity of the illness and is also linked to a higher viral load
After high-risk or moderate-risk exposure to COVID-19, hydroxychloroquine did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.
A review study of asymptomatic carriers with COVID-19 showed that asymptomatic people likely account for approximately 40%-45% of coronavirus infections. The study reviewed data from 16 cohorts and these are the findings. Asymptomatic people can transmit SARS-CoV-2 to others for an extended period, perhaps longer than 14 days. Asymptomatic infection may be associated with subclinical lung abnormalities, that are detected by computed tomography. Because of the high risk for silent spread by asymptomatic persons, it is imperative that testing programs include those without symptoms. To supplement conventional diagnostic testing, which is constrained by capacity, cost, and its one-off nature, innovative tactics for public health surveillance, such as crowdsourcing digital wearable data and monitoring sewage sludge (eg. Biobot Analytics), might be helpful.
In Phoenix, the number of Arizonans hospitalized with COVID-19 shot past 1,000 on Monday. Arizona State University data shows there has been a steady increase in the number of new cases starting May 26th to current time. Using a seven-day average, the institute says the state is generating an average of 519 new cases a day. By contrast, on May 15, when the social restrictions expired, the average new cases was 378 a day. According to the Arizona Public Health Association, this data shows two concerns: as social distancing restrictions end, we see this associated uptick; additionally, there may not be a significant seasonal effect since Phoenix experienced average high temperature over the past two weeks. State public health officials’ stated, “We know COVID-19 is still in our community, and we encourage everyone to take steps to remain healthy, especially those most vulnerable to COVID-19.”
Preliminary data has also shown an increase in cases over the past two weeks in several southern states: Mississippi, Louisiana, and Texas. It is unclear if this is the beginning of a resurgence of COVID-19 or due to increased testing efforts.
Mass protests against police brutality that have brought thousands of people out of their homes and onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases.
NYTimes – Will Protests Set Off a Second Viral Wave
The Defense Department has begun an effort to collect 8,000 donated units of plasma from
patients who have recovered from COVID-19 to support the development of an effective treatment against the disease
The race for a COVID-19 vaccine has a dark horse entrant. Billionaire scientist and businessman Patrick Soon-Shiong announced in a May 27th investor call and press release that an experimental vaccine being developed by two of his companies is on the short list of 14 candidates being evaluated by Operation Warp Speed, the Trump administration’s push to deliver 300 million doses of safe and effective COVID-19 vaccines by January 2021
C.D.C. Recommends Sweeping Changes to American Offices
Temperature checks, desk shields and no public transit: The guidelines would remake office life. Some may decide it’s easier to keep employees at home.
“Is It Safe for Me to Go to Work?” Risk Stratification for Workers during the COVID-19 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.
