9/8/21 COVID-19 Brief: See Clearly Through the COVID Information Storm

Much is being reported about the SARS-CoV2 Pandemic; the information is complicated, contradictory, and often political. Misinterpretation and misinformation are flourishing. This poses a significant problem for responsible business leaders relying on media sources to educate and communicate accurate information.

To be effective and help business leaders maintain business continuity, profitability and worker safety, programs and policies must be embraced and implemented by workers.  Assisting employers with objective, sound, and accurate information based on the current knowledge of Covid 19 is exactly what we aim to do to assist employers in these endeavors!

A paradigm shift is needed. The merger of scientific evidence and daily business operations must occur for a business to remain profitable. The goal of pandemic policies and programs to end or shorten the pandemic at high cost must change to an approach that mitigates the effects of the natural course of the pandemic on the workforce while maintaining the continuity of business operations.    

Looking to history, the SARS-Cov2 virus is following along characteristically as the viral pandemics before it. These characteristics have been 3-5 peaks of disease, lasting 24-36 months  and followed by a lower smoldering steady pattern of disease called an endemic state. The Influenza pandemic at the turn of century followed this course, and its endemic state is the seasonal flu we see today.

As the COVID virus moves through its natural course, it randomly has RNA errors and mutations that give rise to its numerous variants due to the fragility inherent to RNA. The World Health Organization has identified 23 COVID-19 genetic variants. Four are variants of concern (VOC), including the Delta variant, and four are variants of interest (VOI). This is contrary to the anti-vaccination dialogue being argued today which cites vaccination as the root cause for the rise of viral variants. The randomness of RNA mutations in a non-living virus has hundreds of causes none of which have to do with vaccination as a primary cause. RNA mutations occur due to the natural instability of RNA.

The reason to encourage vaccination is simple. The current evidence clearly shows the known risks of the COVID vaccines occur less often than the risks of short- and long-term complications caused by COVID. We also acknowledge that there may be unknown long-term risks, however small, associated with vaccination.  Because of this we advocate a policy of informed consent with factual information. At the same time, we respect and understand the right of each business making a vaccination policy based what it believes is the safest for its family of employees and business continuity.

COVID vaccines were not designed to prevent the SARS-CoV2 virus, but to minimize the severity of the disease, so that those vaccinated would not be severely affected, hospitalized, and possibly die. The most recent studies show that the vaccines are effective against the variants when the endpoint of mild disease is used. The most recent studies show that the vaccines are effective against the variants and dramatically reduce the risk of hospitalization and death.

Plasticity and adaptation are the keys to success for a business to remain safe with a productive compliant workforce. Universally we saw our clients relax the mitigation measures that were once in place early in the pandemic. Most are now reimplementing restrictions or more conservative measures to combat the recent surge in cases seen with the Delta variant. There is frustration and resistance among some of the workforce to return to these policies largely due to misinformation and ‘all or none’ policies. To work effectively, mitigation strategies must be practical and overlapped. This is best described as a “swiss cheese model of protection”.  Each layer, or slice, of swiss cheese has holes in it, but when lined up with the holes in different areas, the virus cannot pass directly through all layers without being stopped.

Masking is one such layer. Overall, simple masks (non-fitted, non-filter types) add approximately 15-30% of risk reduction, while high quality masks (N95, KN95, fit-tested types) add approximately 70-90% risk reduction clinically against airborne inhalation of diseases like COVID.  Similarly, increasing air movement by HVAC units or fans also reduces the risk of airborne transmission.  Social distancing, alternating work hours, limiting group size, vaccination, testing programs and screening all reduce risk of transmission. While each alone may have only minimal impact, some greater than others, when combined create a levels of effective risk reduction with each combination.  

The implementation of each mitigation measure should be determined by the level of risk in the community as well as the level of risk a business is willing to tolerate within its operations. Limiting the effects of the natural course of the COVID pandemic on each other and our families is the goal of our mitigation practices. This approach over time becomes an accepted and understood concept of the ebb and flow of restriction and relaxation of policies. Once an understanding of the dynamic nature of the pandemic and flexibility of our safety policies occurs, buy-in and compliance by the workforce follows.

At the current risk level of the COVID-19 pandemic, based on the evidence to date we suggest the following recommendations:

1. Mask use for all employees regardless of vaccination status.

2. Implementation of serial testing programs with rapid antigen tests.

3. Limiting business travel to essential only.

4. Limited group settings such as meetings, lunch areas, common areas with policies limiting the mixing of unvaccinated and vaccinated in non-social distanced areas.

5. Return to work policies incorporating CDC guidelines as follows:

a. Close Contact Exposure – Unvaccinated: 14 days quarantine safest - less than 3% missed) or 10 days quarantine no test (risk up to 10% being infectious) or 7 days quarantine + negative test at day 5-7 (risk up to 10% being infectious)

b. Close Contact Exposure – Unvaccinated with Covid recovery within past 90 days:

i. WorkSTEPS recommendation (safest / most conservative): quarantine after exposure until tested at 3-5 days after exposure with a rapid antigen test, may return to work with negative test

1. Alternative: no quarantine, require masking, test 3-5 days after exposure, may return to work with a negative test

ii. CDC recommendation: no quarantine, no testing if within 90 days of recovery

c. Close Contact Exposure - Vaccinated:

i. WorkSTEPS recommendation (safest / most conservative): quarantine after exposure until tested at 3-5 days after exposure, may return to work with negative test

1. CDC is not clear about which type of test. WorkSTEPS recommendation is to use a rapid antigen test, and it is best to use two antigen tests 24 hours apart to avoid false results. 

2. If the exposed vaccinated person becomes symptomatic, they are to isolate for 10 days regardless of test result.

ii. CDC recommendation:

1. After exposure - no quarantine, wear mask, test at day 3-5, if negative return to work.

2. If no test is performed, vaccinated exposed person to wear a mask for 14 days and may continue to work.

6. Incorporate CDC guidelines into policies related to exposure and illness quarantine and isolation periods.

We hope this update gives some clarity to the challenges we’re all facing and those that lie ahead.  Well built mitigation policies that have the ability to tighten and relax mitigation measures depending on the risk at hand will allow for the safety of the workforce and business operations to continue with minimal impact.  


The WorkSTEPS Medical Team

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Newsletter written by WorkSTEPS CMO Dr. Ben Hoffman and WorkSTEPS’ expert medical team.