COVID-19 Briefing - 9/18

Today’s Recap:

• CDC reversed course on testing for asymptomatic people (again), after deep criticism from experts and recent news stories that the recommendation not to test came from HHS and the White House, rather than scientists. 
• Wildfires continue to rage, largely uncontrolled, across the West Coast, complicating the diagnosis of COVID-19 because smoke inhalation symptoms are very similar. 
• A superspreader wedding in Maine with 65 attendees has led to seven deaths, none of whom attended the wedding. 
• China has banned imported poultry products from two large US plants that had widespread COVID outbreaks.
• Don’t underestimate that someone can be infected with both Flu and COVID at the same time, experts say. Get your flu shots!
• And in Massachusetts, parents sent their COVID+ child back to school after only a few days of quarantine, apparently confused about how long they needed to isolate. 
• More than half of pregnant women with COVID had no symptoms, according to the CDC’s Morbidity and Mortality Weekly Report. 
• It appears antibodies decline significantly in just 60 days, with over half of people who tested antibody positive at the start becoming antibody negative by day 60. This has implications for understanding how many people have been infected in the past, and for research into whether and how long someone who had COVID might be immune from reinfection. 
• When we do get a vaccine, it might be inhaled rather than injected, according to early research in the UK showing two candidates for vaccine were more effective and required lower doses when inhaled.
• Nearly 4 in 10 Americans now know someone who was hospitalized or died due to COVID, according to a new study, with higher percentages for African Americans and Latinx survey respondents. And 1 in 7 people say they either have definitely had COVID or are “pretty sure” they had it. 
• Unfortunately, there likely “won't be a clear end to the pandemic,” writes the Atlantic. Instead, it will be more of a petering out, with many experts believing that coronavirus will be popping up in ERs and doctor’s offices for years. 

Best questions:

Should we recommend or require testing for close contacts with confirmed positive cases, now that the CDC is saying “you should get tested”?

Our recommendation is to be cautious before recommending or requiring as an employer that someone gets tested. It can be complicated, and should probably be run by your legal counsel. Generally, we tell individual employees who ask our clinical team if they need to be tested that testing is an individual decision, and to consult their doctor and CDC guidelines. It's important to note that a negative test usually doesn’t allow someone to return to work sooner, because there is still a high false negative rate for COVID-19 tests. 

Are there any safe ways to get an exposed employee back to work sooner than 14 days?

Unfortunately, generally not. 

Negative test results aren’t a reliable way to confirm that someone doesn’t have COVID. Rapid results are wrong upwards of 50% of the time, and even molecular PCR tests have up to a 30% false negative rate, which means 3 in 10 people who get a negative test might actually have the virus and be infectious.

Not having any symptoms is also not a good enough reason to return someone to work.  Experts believe that up to 45% of people with COVID never have any symptoms, and even more have very mild ones. 

There are rare cases when someone is excluded for 14 days out of an abundance of caution when a family or household member is sick, but not yet confirmed to have COVID. If that person ends up getting an alternative diagnosis and is fully recovered, the exposed employee might be able to get back to work earlier depending on the specific diagnosis and circumstances. 

But in most cases when an employee was exposed to someone with COVID, there’s really nothing to be done except wait to see if that person gets sick, which can take up to 14 days. Allowing employees who were exposed to return earlier, even with negative tests and no symptoms, could lead to widespread outbreaks. ‍

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Does an employee get excluded for just one symptom?

It depends. If an employee has a fever above 100 degrees, new or changed cough, new shortness of breath, or new loss of taste or smell, any of those alone are concerning enough to keep someone out of work for 10 days because they are often the primary presenting symptom of COVID. 

Other symptoms like stomach issues, headache, fatigue, muscle aches, congestion, runny nose, sore throat, etc. are usually not enough on their own to put someone out for a full 10 days, but might get someone anywhere from no exclusion (if a headache is common, for example) to 24 hours (to see if it gets better on its own and was just a mild, passing thing) to 2 or 3 days (especially in cases with gastrointestinal issues that might be foodborne). ‍

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Wildfires are wreaking havoc for our teams.  Coughs.  Headaches.  Shortness of Breath.  Are you excluding them all for 10 days?

No. When employees let us know that they think their symptoms are related to wildfire smoke, our clinical team makes sure they don’t have other unrelated symptoms (for example, smoke doesn’t usually cause fever or diarrhea). If their symptoms are reasonably all smoke related, we’ll usually give them an exclusion of anywhere from 24 hours to 3 days for those to resolve. 

This is tricky because these symptoms are SO similar to those of COVID, so we don’t want to dismiss them because, unfortunately, those affected by wildfires may also have COVID (and are more likely to have forgone social distancing, hand washing, and other COVID precautions while evacuating fires, for example). ‍

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My employee told their manager they had a headache and then your clinical team excluded them for ten days.  Why? 

Often your employee will not divulge all of their symptoms to their manager - sometimes because they want to work, sometimes because they’re not comfortable talking about medical or digestive problems with their manager and sometimes your manager disregards the other symptoms.  For those using our Employee Wellness Check program, our clinical team asks lots of questions and gets a lot more information than your shift manager who says, “Oh, it's just a headache...”  or, “He gets fevers every night”…. 

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Best Read  

Thanks to MJ Schult from Brinker for forwarding this best read.  It’s long but worth reading (more than once).  So many of you are struggling with how to get an exposed or symptomatic employee back to work sooner and frustratingly, testing is still not a reliable solution.

Why a Negative Test Doesn’t Guarantee You Don’t Have the Coronavirus

Best Laugh:

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