7/2/20 COVID-19 Brief: Some Thoughts for Independence Day

During this time of national crisis – a health crisis that poses a threat to all, but which has somehow succeeded in dividing us – it would do well for all of us to read and take to heart the rights and responsibilities of our citizenship.

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

The Rights and Responsibilities of Reopening – Some Thoughts for Independence Day

I just Googled “COVID Cases Rising.” Among the top headlines:

I could go on, but I don’t need to.

You are acutely aware that our well-intended efforts to reopen economies across the country have had the result many feared – a sharp rise in cases, followed in due course by increases in hospitalizations and deaths.

The same story is playing out in cities big and small: Restrictions are lifted; people (led by young adults) pack into restaurants, bars and parties; some of them get sick; of those, some infect friends, family members, coworkers or patients; of those, some are vulnerable to serious illness; of the vulnerable, some need to be hospitalized; and of those hospitalized, some die.

Those of us who have the wisdom of age wonder how the young can be so reckless. Those of us who are honest about who we were in our 20's can recall the feeling of invincibility and humbly admit that we may well have been among the reckless if we’d had the opportunity.

As restrictions have fallen away, people have been encouraged to do the right thing, but there are vastly different views about what “right” means. To the healthy 20-, 30- or even 50-something, the “right” thing to do is to reconnect with friends, support local businesses, and even get the virus so as to help build herd immunity. To those who are vulnerable or who are caring for vulnerable family, friends or patients, the “right” thing is to stay safe. To do anything else is not only not right, it’s morally wrong.

In last week's article I proposed that we adopt a new social contract around COVID-19 that is modeled after the contract we’ve formed around things like shellfish allergies. The contract is built on a foundation of responsibilities – both for those who are vulnerable/care for vulnerable people; and people and businesses who are unconcerned about COVID-19 risk.

Rights and Responsibilities – The Foundation of Who We Aspire to Be!

We will celebrate Independence Day in the US in just a couple of days. That got me thinking about our nation’s (and other nations’) fundamental reliance on the broader social contract of citizenship – the rights of being a citizen and the corresponding responsibilities of citizenship.

I wondered if the rights/responsibilities contract was spelled out anywhere, so I Googled it.

The top item in the search return was this page from the United States Citizenship and Immigration Service. It is written for people seeking citizenship in the US. It begins:

Citizenship is the common thread that connects all Americans. We are a nation bound not by race or religion, but by the shared values of freedom, liberty, and equality.

Then a few paragraphs later, it reads:

Below you will find several rights and responsibilities that all citizens should exercise and respect. Some of these responsibilities are legally required of every citizen, but all are important to ensuring that America remains a free and prosperous nation (emphasis mine).

During this time of national crisis – a health crisis that poses a threat to all, but which has somehow succeeded in dividing us – I think it would do well for all of us to read and take to heart the rights and responsibilities of our citizenship. We should then consider the implications of our citizenship on how we operate our businesses, live among our neighbors, and teach our children about the rights they enjoy and the responsibilities to which they are bound, both in good times and bad.


Happy 4th of July. Be safe, have fun, and do your part to build goodwill in your community.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.


Area Reported Cases Deaths Recovered
Global 10,689,547 516,383 5,856,455
United States 2,751,043 130,390 1,146,785

The US could see as many as 100,000 new COVID-19 cases a day if the current trajectory is not averted, infectious disease expert Anthony Fauci said during a Senate committee hearing yesterday. The US is currently seeing around 40,000 new cases daily, but many states that moved quickly to reopen businesses are finding themselves having to shut things down again in response to spikes in cases. “What was thought to be unimaginable turns out to be the reality we’re facing right now,” Fauci said, adding that “outbreaks happen, and you have to deal with them in a very aggressive, proactive way.”

Overall, the Eastern Mediterranean Region remains a global hotspot as well, representing 5 of the top 10 countries in terms of per capita incidence: Bahrain (#1), Qatar (#2), Oman (#4), Kuwait (#8), and Saudi Arabia (#10). Additionally, nearby Armenia is #5. Notably, Bahrain overtook Qatar as #1 globally in terms of per capita daily incidence. Source

Only two US states are reporting a decline in new coronavirus cases compared to last week: Connecticut and Rhode Island.

A rise was reported in a staggering 36 states, including Florida, which some experts have cautioned could be the next epicenter for infections. Officials there and across the US are also warning of an increase in cases among younger people.

Pool testing, a method of testing patients for SARS-CoV-2 as a group instead of as individuals, is one potential option to dramatically increase testing capacity. Pool testing combines samples from multiple individuals in order to reduce the amount of testing materials needed to conduct tests (compared to multiple individual tests) and return results to individuals more quickly. If the pooled sample tests negative, then it can be assumed that nobody in that pool is infected, and no further testing is necessary. If a sample is positive, then each person in that pool can be tested individually to determine who among them is infected. In low prevalence settings, pooling the samples can reduce the overall tests performed.

A Cochrane systematic review has found that, when it comes to antibody testing for COVID-19, timing is everything.

The review of 54 studies found that antibody tests carried one week after a patient first developed symptoms detected only 30% of people who had COVID-19. Accuracy increased in to 72% at two weeks and to 94% in the third week.  

“If you use them at the wrong time they don’t work,” said Jon Deeks, professor of biostatistics at the University of Birmingham and the review’s lead author. This reinforces data presented at the infancy of antibody testing several months ago which stated to increase the sensitivity and specificity of serologic tests, testing was ideal at 3-4 weeks post infection.

The Centers for Disease Control and Prevention broadened its warning about who is at risk of developing severe disease from COVID-19 infection, suggesting even younger people who are obese or have other health conditions can become seriously ill if they contract the virus.

The new advice, timed to influence behavior going into the July 4 weekend, came as CDC Director Robert Redfield acknowledged serology testing the agency has conducted suggests about 20 million Americans, or roughly 6% of the population, has contracted COVID-19. Redfield said for every person who tests positive, another 10 cases have likely gone undiagnosed.

Mitigation / Suppression:

Researchers have completed a new study of how well a variety of natural and synthetic fabrics filter particles of a similar size to the virus that causes COVID-19. Of the 32 cloth materials tested, three of the five most effective at blocking particles were 100% cotton and had a visible raised fiber or nap, such as found on flannels.  Four of the five lowest performers were synthetic materials.

Florida, Texas and California also closed bars and reeled back reopening measures either statewide or in high-risk areas. Some believe that bars can be epicenters of community transmission, particularly among younger individuals. The United States continues to report decreasing COVID-19 deaths, but health experts warn that increasing COVID-19 mortality could be coming in the near future. The age distribution of recent COVID-19 cases in the United States is shifting toward younger individuals, particularly in areas that are reporting surges in incidence. While younger individuals are at lower risk for severe disease and death, there is concern that increased transmission among younger, healthier portions of the community could drive increased transmission among higher-risk parts of the community.

Analysis published by The Philadelphia Inquirer identifies an association between state-level COVID-19 incidence and mandatory mask policies. States that mandate mask use in public reported a 25% decrease in incidence over the past 2 weeks, and states that require mask use by employees and patrons of businesses exhibited a 12% decrease. In contrast, states that only require mask use by employees (but not patrons) reported a 70% increase in COVID-19 incidence, and states with no mandatory mask policy at the state level reported an 84% increase. There is a broad scope of factors beyond mask use that influence COVID-19 incidence, so this is likely not a direct causal relationship. Mandatory mask use could be associated with other state-level social distancing and response policies, however, which could be driving the success of states’ containment and mitigation efforts.


Challenges of “Return to Work” in an Ongoing Pandemic

The current pandemic poses challenges — unprecedented in the modern developed economy of the United States — for a broad range of workplaces, businesses, and institutions. All are struggling in their activities and on their premises to prevent transmission of a dangerous, highly infectious airborne pathogen.

EU Sets New List Of Approved Travel Partners. The U.S. Isn't On It. US travelers won't be among those allowed to visit the European Union when the bloc begins opening its external borders on July 1. EU ambassadors endorsed a list of 15 travel partners on Tuesday, including South Korea, Japan and China – countries that were hit early by the pandemic but have been able to bring the coronavirus under control.

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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