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7/23/20 COVID-19 Brief: Evidence Helps Reduce the Cost of Returning Employees to Work

This week, the CDC updated its guidance regarding when and how people with Covid-19 can safely return to work. Overall, this is good news for employers.

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

Evidence Helps Reduce the Cost of Returning Employees to Work

This week, the CDC updated its guidance regarding when and how people with Covid-19 can safely return to work. Click here to receive our soon-to-be-updated flow chart which summarizes and simplifies RTW guidance. In the meantime, here are my take-aways:

  • Researchers are now confident that people with mild-to-moderate Covid-19 (the vast majority of patients) are no longer contagious after 10 days, so it is safe for them to return to work. Testing is not necessary because it is of no value.
  • People with severe illness may remain contagious for up to 20 days.
  • People who never develop symptoms but who test positive for Covid-19 can return to work 10 days after the date their first positive PCR test was administered. Again, these people should not be tested again.
  • For those who remain asymptomatic after recovery from a confirmed case of Covid-19, retesting is not recommended for a period of 90 days, even if they have been in close contact with an infected person. This is because evidence indicates people who have had Covid-19 have immunity for at least 90 days, and because PCR testing may detect RNA that is not “replication-competent” – a false-positive test that would trigger an unnecessary quarantine.
  • There are other important nuances in the CDC’s update that we will reflect in the revised flow charts we will soon make available.

Overall, this is good news for employers. By implementing the changes, companies can confidently rely on time-based RTW approaches and avoid spending money on testing that has no added value. Further, the guidance can reduce unnecessary testing quarantining of employees who have previously had Covid-19 (at least for a 90-day window). Notably, these sorts of efficiencies require that companies maintain an accurate account of employees out with Covid-19, testing, quarantine dates, etc. As such, companies should consider engaging clinical support services such as those offered by WorkSTEPS.

Finally, we should recognize that this update is another example of how scientists around the world are using data to improve the effectiveness and efficiency of strategies to reduce the spread of Covid-19. Last week’s article on the importance of HVAC systems is another example. As we noted in this post back in March, data-driven insights enable us to open up our businesses and economy more completely.

What’s on Your Mind?

The primary goal of this Brief is to provide useful information and insights. What issues are on your mind that we’ve not covered or that you’d like us to revisit? If you have suggestions, please let us know.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

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

Medical:


Area Reported Cases Deaths Recovered
Global 15,450,444 631,642 9,407,799
United States 4,113,939 146,378 1,943,698

U.S Latest Map and Case Count
Coronavirus in the U.S:

Covid-19 has left no state unscathed.  However, the burden of illness has been uneven. New York, California, Florida, and Texas have had the most known cases. Less populated states including Vermont and Wyoming had had fewer than 3000 people infected. However, it’s not just big cities that have been hit hardest. Small cities and rural communities that were spared at the beginning of the pandemic in the Midwest and Sunbelt cities are currently hot spots. In the county that includes Dallas, case numbers rose from less than 11,000 in June to more than 39,000 in mid-July. Other cities around the U.S are, at times, averaging more than 2,000 daily cases.

Vaccine trials trigger immune response:

In promising developments on Monday, researchers from Oxford University and  CanSino Biologics from China reported in The Lancet that two different COVID-19 vaccines trials prompted an immune response and appeared safe. In the Oxford vaccine trial with British-Swedish drug maker Astra Zeneca, researchers enrolled 1,077 healthy adults ages 18 to 55 in the United Kingdom and reported findings 56 days after vaccination. The vaccine induced strong antibody and T-cell immune responses with no serious side effects. The second vaccine was developed by CanSino and included 508 healthy adults ages 18 to 80.The vaccine prompted neutralizing antibodies, and more than 90% showed T-cell responses with minor side effects. Above vaccines work by altering the genes of another common virus, the adenovirus so that it harmlessly mimics the coronavirus and induces an immune response.

True Covid-19 case count could be higher:

On Tuesday, a new study published in JAMA estimated the true number of Covid-19 cases in the U.S. could be anywhere from six to 24 times higher than the confirmed cases. The study based on serological tests reported that in seven of the 10 sites, the estimated number of cases was 10 times the number of reported cases. One limitation is that it relies on data from April - May when total cases were lower; a lot can change during two months. The data reflect what CDC Director Robert Redfield recently said that true case numbers are ten times higher than confirmed diagnoses.

Mandatory mask use:

Mask mandates are becoming increasingly common across the US. Available evidence continues to support mask use as an effective mechanism for reducing transmission risk, and many elected officials continue to recommend mask use, even if they are not mandating it. Masks use is now mandatory in more than half of US states; however, the exact details vary by state.

U.S. Navy deploy medical teams to hotspots:

On Sunday, medical professionals from the U.S. Navy were deployed to aid hospitals  to aid hospitals in four cities across southern Texas as nearly half of the state’s counties have recently been designated "red zones" by the White House Coronavirus Task Force. Five U.S. Navy teams were sent to four locations across Texas' southern region: Harlingen, Del Rio, Eagle Pass, and Rio Grande City. Public health experts are increasingly seeing small outbreaks in the community from families and friends gathering, to people congregating at summer destinations.

Trial data support dexamethasone:

On Friday, data from a large randomized controlled trial in the UK showed further benefit from use of the steroid dexamethasone in hospitalized Covid-19 patients. The study showed that in patients needing mechanical ventilation, dexamethasone reduced deaths by 36% compared with usual care. In patients on oxygen, the incidence of death was 18% lower for patients on dexamethasone.

Mitigation / Suppression:

Aerosols in COVID-19 patient rooms contained live virus:

University of Nebraska researchers published a small study in pre-print server MedRxiv reporting that aerosol samples collected from the hospital rooms of six COVID-19 patients in April contained infectious virus. This adds to mounting evidence that the coronavirus is spread via aerosols in addition to large respiratory droplets. Airborne transmission of a virus is defined as spread via aerosol particles smaller than 5 micrometers (µm) in diameter containing live virus produced by an infected person that hangs in the air long enough to be inhaled by another person, who is then infected.

Some Seriously Ill Patients Could Be Treated at Home:

Northwell Health system in New York brought medical workers, oxygen tanks and intravenous equipment into patients’ homes to deal with the surge in coronavirus cases that New York experienced in spring. They deployed home visit nurses, and physicians made daily calls to support patient care. This model may help relieve health systems in parts of the U.S. where rising numbers of cases are putting pressure on hospitals, filling ICU’s. The program also provides post discharge care for patients who still have lingering symptoms, and helps evaluate the long-term effects of Covid-19.

Corporate

Risk stratification: a reminder

Duration of Isolation and Precautions for Adults with COVID-19

CDC has reviewed the independent research data to date and made several conclusions regarding the behavior of the COVID-19 virus. Some the findings are direct while others are indirect. This has led the CDC to become more specific in their recommendations regarding isolation and discontinuation of isolation. Significantly, these recommendations provide legal support for the clinical actions already applied to patients today.

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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