COVID-19 Briefing - Tuesday, July 7th

Exclusion Chart Updates

It’s that time again! We’ve made some changes to our exclusion chart based on new guidance from the CDC. See the full chart here, new changes are highlighted in yellow. 

Today’s Recap:

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Lots going on this week, including:

• Positives already rolling in from Fourth of July weekend festivities
• ‍Testing shortages, delays and false negatives and positives‍
• Confusion about positives on follow-up testing 
• States and municipalities rolling back openings‍
• Ever-changing new travel quarantines
  

• A group of scientists have raised a concern that COVID-19 may remain airborne, a theory that the WHO has not embraced.  This will certainly change strategy for combating COVID-19 if proven.
  
  
• Becton Dickinson had a new COVID test approved by the FDA that has 15 minute results. The BD Veritor, which is slightly larger than a cell phone, is currently in use at more than 25,000 hospitals, clinician offices, urgent care centers and retail pharmacies in all 50 U.S. states. 
  

• A huge percentage of COVID-related cases (and deaths) have happened in nursing homes. The US appears to be repeating it’s mistakes as case counts continue to rise in nursing homes and assisted living facilities. 
  

• Only about 1 in 12 coronavirus infections are being identified, estimates Dr. Scott Gottlieb, former FDA commissioner. These numbers mirror what we saw during the April peak in New York. And at this rate, case counts will top 3 Million by this weekend. 
  

• Despite their initial promise, contact tracing apps haven’t made much of a difference in fighting transmission of the virus.
  
  

Best Questions of the Day:

Should we consider rotations or A & B teams for our corporate offices?

Yes, many of our clients are implementing shifts, daily rotations, or work teams so that if one group is excluded, the other can continue to work. This is a great best practice to protect your company!

We noticed you’re not recommending return to work testing.  Can you discuss that?

That’s correct - we’re not recommending return to work testing.  The CDC has confirmed, after six large studies, that someone who is not sick enough to be hospitalized is no longer infectious ten days after onset or a positive test.  These six studies all documented that there is no infectious coronavirus detectable anywhere in the respiratory tract.  Yet, they are also finding that patients are testing positive 89+ days later.  Their theory is that the PCR tests are detecting coronavirus that is no longer live.  So, they are not recommending that employers require return to work (Negative) testing as it is clinically insignificant - unless you are in a specific jurisdiction that requires it.

Vacation season is here and people are traveling.  Who needs to self-quarantine for 14 days afterwards?

This is a complicated question and one that is literally changing by the hour (NY, NJ and CT added three more states to their list earlier today).   Some of you have employees who grocery shop in Tijuana or visit their families in Ensenada on weekends.   This is an issue that needs to be addressed by each company, remain fluid and be updated regularly.

Does someone need to self quarantine for close contact exposure if they’ve already had lab-confirmed COVID, and then are exposed again?

No! If someone has already had lab-confirmed COVID, they do not need to be excluded in the future.  They can also travel to states with travel-related quarantines (but should carry their results and/or a doctor’s note in case they get stopped). 

How do we handle when someone has repeated or continuous exposure to family members becoming ill,  or is exposed again as other family members or close contacts become sick after the employee has already been excluded once (or more than once) for fourteen days? 

According to CDCs contact tracing guidance, asymptomatic contacts who test negative should self-quarantine for 14 days from their last exposure (i.e., close encounter with confirmed or probable COVID-19 case).  

When in doubt, however, "individuals should always follow guidance of the state and local authorities." Community transmission can be quite different in different localities these days, and the clinical, public health, and work contexts can be different as well.

This means someone does need to be excluded again and again for exposure if they don’t test positive or become symptomatic.  This is difficult and going to be challenging for management and employees. 

Should I be asking employees to get tested or provide a doctor’s note when they’re sick with symptoms of COVID?

Here’s the CDC’s direct response:  “Employers should not require sick employees to provide a COVID-19 test result or a healthcare provider’s note to validate their illness, qualify for sick leave, or to return to work. Healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely manner.”

Can an employee taking Tylenol or Advil safely return to work after COVID?

The CDC says no.  Those medications reduce fevers and could mask that a fever is still present.  Their repeated guidance to us is that the employee must be symptom free without fever reducing medications for at least three days.  Some employees take these medications for chronic pain which is proving to be problematic in getting them back to work post COVID.

Best Read of the Day:  

As we hear more and more about COVID being airborne, there may be HVAC, engineering and other physical changes needed to reduce indoor transmission - impacting every industry. Here’s a good intro to get you thinking about what steps your organization may need to take (and of course, they all have some expense associated with them):

Airborne Coronavirus: What You Should Do Now

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Best Laugh of the Day:  

So many of you know that we advised the ZHH team to stock up in late February and have recently asked if I’ve stocked back up.  Answer is yes….our house doesn’t quite look like this, though...

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