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7/30/20 COVID-19 Brief: Reducing Risks Employees Take Outside of Work

The reality of our situation is this: As states eased safe-at-home orders and eased restrictions on businesses and public gatherings, we’ve seen a surge of cases, hospitalizations and deaths across the country. To have any chance at reducing risk-taking, we need to understand why some people are taking risks.

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

Holding Back the Tide – Reducing Risks Employees Take Outside of Work

The reality of our situation is this: As states eased safe-at-home orders and eased restrictions on businesses and public gatherings, we’ve seen a surge of cases, hospitalizations and deaths across the country. In the most extreme instances, we’re seeing health care capacities pushed to the limit, but few communities are escaping the impacts of rising trends. Schools, sporting events, places of worship, and businesses are among the victims of COVID-19 and the threat of infection.

The truth of our situation is that rising numbers are being driven by the choices being made (mostly, but not exclusively) by younger generations to gather without masks in crowded bars, restaurants and parties. Predictably, as younger people with COVID-19 have come into close contact with older and more vulnerable family, friends and coworkers, serious illnesses, hospitalizations and deaths are following.

Businesses are becoming increasingly frustrated with the situation. We know because we’re on the phone with them daily, helping them react to disease outbreaks that often spread among employees outside of work. Costly slow-downs and shut-downs are increasingly-common, prompting businesses to ask: “How can we get employees to stop taking risks when they’re not at work?"

Understanding Risk-Takers

To have any chance at reducing risk-taking, we need to understand why some people are taking risks. Here are some of the explanations I’ve come across:

  • Masculinity: As this article bluntly states: “Real men don’t play it safe.” Or so many men seem to believe. And this idea is not new to COVID-19; men are more likely than women to not wear their seatbelt, take physical risks and suffer accidental deaths.
  • Belief Bias: In this article, professor Dennis Proffitt explains that the reason many are choosing not to comply with prevention recommendations is that they don’t believe COVID-19 is a serious threat and/or that the recommendations offer effective protection. In a climate of uncertainty with polarized sources of information offering competing stories, it is easy for people to have their beliefs reinforced.  
  • Reactance: I think we can all relate to this idea, which boils down to: “When you tell me what to do, part of me wants to do the opposite.” Related to COVID-19, this article notes that reactance is made worse by: 1) a general antipathy toward science and experts; 2) the (initial) lack of direct experience with COVID-19 in many parts of the country; and 3) a polarized news environment.

It is a frustrating reality that the insights above don’t point to any simple solutions. However, they do guide us toward some pragmatic action steps companies can take.

Action Steps to Reduce Risk-Taking Outside of Work

1. Double down on your internal COVID-19 strategy: It is essential to focus first on controlling what you can best control – the policies, practices and enforcement that happens when employees are at the worksite. Comprehensive strategies not only strive to keep the virus out but are built on the assumption that pre-symptomatic and asymptomatic employees will show up at work, able to spread COVID-19. Persistent, unrelenting vigilance in prevention measures (including HVAC adjustments) is your best protection from workplace outbreaks.

2. Take a fresh look at your communications: If your people aren’t getting the message about COVID-19 policies and prevention practices, take another look at your communications strategy. Review your communications for language, clarity, consistency and trust as I wrote about here. In terms of message clarity, make sure your COVID-19 communications reflect thoughtful consideration of these critical questions: 1) Who is the message for? 2) What do you want them to do? 3) What do they need to know? 4) What do they need to believe?

3. Engage your leaders: Your formal leaders should to be talking the talk and walking the walk of COVID-19 prevention at work and outside of work. Do they know that they are expected to model things like mask-wearing at the grocery store or social distancing when at restaurants and bars? Critically, you also want to identify and engage your informal leaders in this regard. If Joe, who informally influences many of his coworkers, heads to a crowded bar after his shift on Tuesday, others will follow.

4. Educate about risks and risk avoidance outside of work: Perhaps your company has been overwhelmed just communicating workplace policies and practices. Even if you have more work to do there, consider extending communications to focus on risks and risk-avoidance outside of work. Three tips:

  • Make it local: As noted above, COVID-19 is affecting schools, sports, worship services, etc. You have an opportunity to connect the dots between the choices people are making, local disease trends and impacts on community institutions and activities.
  • Make it personal/make it real: If possible (and it’s not always easy), identify individuals in your workforce or community who have suffered directly (personal illness) or indirectly (illness or death of a loved-one), and help them tell their story.
  • Inform decisions: Provide employees with information that will help them make good choices. If cases are rising in the community, help people understand what that means in terms of their own exposure risk. Provide simple guidance that helps people identify and avoid risky situations. To that end, we’ve created a couple of flyers we invite you to download, including one that translates recent CDC guidance on gatherings and events. Click here to request the flyers.  

5. Advocate for/support state/local controls: Laws that limit gatherings, regulate bar and restaurant operations to promote safety, and mandate mask-wearing can all help reduce the spread of COVID-19. Your company and company leaders should engage in supporting such laws.

In formal communications, the initials MD MPH follow my name. The MPH stands for “Master’s in Public Health.” So, I’ve long been engaged in public health in both worksite and community settings. COVID-19 is providing us with a strong object lesson in how the health and wellbeing of citizens affects the health of the workforce and the prosperity of businesses.

Beating COVID-19 will require a commitment from leaders and organizations in all sectors to promoting prevention. Businesses are uniquely able and incented to not only implement comprehensive COVID-19 prevention strategies for the workplace, but to educate employees and influence public policies to help curb the spread of COVID-19 in the community.

If your company needs help developing, evaluating or implementing its COVID-19 strategy, or if you would like help with COVID-19 communications, let us know. More about our full array of services can be found here.

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 16,959,864 664,665 10,508,350
United States 4,516,453 152,738 2,191,005

Source

U.S. COVID-19 resurgence:

The US continues to battle a resurgence of COVID-19, driven largely by states that were not severely affected early in the US epidemic. As noted above, the US reported 1 million cases over the past 2 weeks alone, and numerous states are exhibiting concerning trends. Current data indicate stark regional differences in the severity of the current COVID-19 resurgence. States in the Northeast, including New England and the Mid-Atlantic region—particularly the northern portion, including Connecticut, New Jersey, and New York—appear to be faring considerably better than the South, Southwest, West, and Midwest. These differences are evident across all major indicators, including incidence, mortality, test positivity, and hospitalizations.

States deemed as red zones:

New COVID-19 cases in Texas, Arizona, and Florida appear to be the main drivers of the summer surge of in the U.S. Hospitalizations in the three states are starting to level off, but daily fatalities remain in the triple digits in both Texas and Florida. A new federal report published findings showing there are 21states with outbreaks large enough to place them in the “red zone”. The states were designated red zones  because they had more than 100 new cases per 100,000 people in the past week. The 21 states are:  Alabama, Arizona, Arkansas, California, Florida, Georgia, Idaho, Iowa, Kansas, Louisiana, Mississippi, Missouri, Nevada, North Carolina, North Dakota, Oklahoma, South Carolina, Tennessee, Texas, Utah and Wisconsin. The report includes recommendations for each state.

Around the world:

Globally there are several current hot spots, such as Latin America, the U.S., and India. Meanwhile countries such as Vietnam, Australia and Greece had brought their disease levels down are currently scrambling to target flare-ups with ramped up measures.

Symptom duration:

On Friday, the CDC COVID-19 Response Team, published a study in the MMWR documenting that COVID-19 can result in prolonged illness *even among those who have milder illness *and are not hospitalized. Thirty-five percent of those who tested positive for the disease reported that they had not returned to their usual state of heath two to three weeks after testing. Of 292 U.S. adults surveyed, 274 (94 percent) reported experiencing one or more symptoms at the time of testing. 26 percent of respondents between 18 and 34 years old reported not having returned to their usual state of health. Researchers emphasized that effective public health messaging is warranted to target populations that might not perceive COVID-19 illness as being severe or prolonged, including young adults and those without chronic underlying medical conditions.

Source

Pfizer and Moderna vaccine trials:

On Monday, the first large study of the safety and efficacy of a coronavirus vaccine in the U.S began as a collaborative effort between the NIH and Moderna. The Phase 3 clinical trial, will enroll 30,000 healthy people at 89 sites around the country. Half will receive two shots of the vaccine, 28 days apart, and half will receive two shots of a placebo in a double-blinded study. Pfizer also announced it had also begun late-stage study of a coronavirus vaccine as well. Pfizer is working collaboratively with Germany’s BioNTech. Their study will also include 30,000 people, from 39 states in the U.S., and Brazil, Argentina and Germany.

Research reveals heart complications in COVID-19 patients:

Two German studies published today in JAMA Cardiology show abnormal heart imaging findings in recently recovered COVID-19 patients, and cardiac infections in those who have died from their infections.  Cardiac magnetic resonance (CMR) imaging revealed heart involvement in 78 patients and active cardiac inflammation in 60, independent of underlying conditions, disease severity, overall course of illness, and time from diagnosis to CMR.

On Amazon, Dubious 'Antiviral' Supplements Proliferate Amid Pandemic (NPR):

The federal government has repeatedly warned Americans about scammers trying to sell dietary supplements as a remedy for COVID-19 when medical experts say supplements are neither safe nor effective for treating the disease. But if consumers type "coronavirus supplement" or "COVID supplement" into the search bar at Amazon.com, not only does the online retailer auto-complete the search, it serves up pages and pages of supplements without any warning about the scientific evidence.

Mitigation / Suppression:

Testing delays worsen the pandemic:

As coronavirus cases surge across the South and other parts of the country, an increase in testing demand has caused supply shortages and the slowdown at commercial labs. The delay could have implications for contact tracing efforts, making it harder to slow the spread of the virus. The delays in testing are caused in part by COVID-19 spike in states like California, Florida and Texas, which has strained laboratories nationwide with average wait times of five to 10 days. Improved testing and faster turnaround times for test results are crucial to containing clusters.

Coronavirus (COVID-19) Update: FDA Authorizes First Diagnostic Test for Screening of People Without Known or Suspected COVID-19 Infection (FDA):

The U.S. Food and Drug Administration reissued the LabCorp COVID-19 RT-PCR Test emergency use authorization (EUA) to include two new indications for use: testing for people who do not have COVID-19 symptoms or who have no reason to suspect COVID-19 infection, and to allow pooled sample testing. The FDA reissued the LabCorp COVID-19 RT-PCR Test EUA to expand use of the test to anyone, after the company provided scientific data showing the test’s ability to detect SARS-CoV-2 in a general, asymptomatic population.

Pandemic Is Overwhelming U.S. Public Health Capacity In Many States. What Now? (NPR):

A return to more restrictive shutdowns of businesses and public gatherings is likely necessary in many places, public health leaders say, to bring the number of cases low enough that "test, trace and isolate" can be used to douse epidemic embers.

Schools:

On Tuesday, American Federation of Teachers (AFT) -  the second-largest teachers’ union in the U.S. - announced that it would support its 1.7 million members if they choose to strike in districts and states that move to reopen in-class learning without adequate safety measures. The organization laid out several safeguards before schools open for face to face learning including: comprehensive contact tracing,  isolation protocols, mandatory masking and updated ventilation systems in facilities.

CDC Releases New Resources and Tools to Support Opening Schools:

Today, the Centers for Disease Control and Prevention is releasing new science-based resources and tools for school administrators, teachers, parents, guardians, and caregivers when schools open this fall. (CDC, 7/23/20)

The Effectiveness of Eight Nonpharmaceutical Interventions Against COVID-19 in 41 Countries (MedRxiv):

We model each NPI's effect as a multiplicative (percentage) reduction in the reproduction number R. Our results suggest that, by implementing effective NPIs, many countries can reduce R below 1 without issuing a stay-at-home order. We find a surprisingly large role for school and university closures in reducing COVID-19 transmission, a contribution to the ongoing debate about the relevance of asymptomatic carriers in disease spread. Banning gatherings and closing high-risk businesses can be highly effective in reducing transmission, but closing most businesses only has limited additional benefit.

Corporate

The international Labour Organization has produced an excellent guide for employers “Managing work-related psychosocial risks during the COVID-19 pandemic”.  They tackle many of the difficult topics surrounding psychological and social issues affecting employees during today’s stressful times. The full publication can be found here.

Illness-Related Work Absence in Mid-April Was Highest on Record (JAMA Internal Medicine):

Information from population employment surveys could shed additional light on the pandemic's effect on the health and behavior of the nation’s workforce.

Defense Production Act (DPA): Recent Developments in Response to COVID-19:

The Administration has employed the Defense Production Act of 1950 (DPA) as part of federal countermeasures to the Coronavirus Disease 2019 (COVID-19) pandemic. The DPA confers presidential authorities to mobilize domestic industry in service of the national defense, broadly defined, including emergency preparedness. The DPA includes provisions under Title I to prioritize the acceptance of contracts, and to allocate scarce goods, materials, and services; and under Title III, to provide for the expansion of productive capacity (CRS, 7/27/20)

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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