Is it possible to take aggressive steps to fight the coronavirus pandemic—while also ensuring business continuity? According to Leslie Michelson, executive chairman of Private Health Management, the answer is yes.
A health expert who has served in the U.S. Department of Health and Human Services in the 80s and 90s, Leslie has been involved in the fight against HIV/AIDS, MERS, SARS—and now, the coronavirus. Leslie shared his expertise with the CareerArc community last week in a unique #TalkHR webinar: A Special COVID-19 Pandemic Briefing for All Employers.
In this briefing, Leslie gave us timely information on the steps employers can take to reduce workforce infection to ensure business continuity while protecting people’s health.
American employers have the power to dramatically impact coronavirus impacts
Immediate and aggressive workplace interventions will protect public health and essential business continuity, Leslie said, linking public health, workforce health, and workforce safety. He emphasized that the coronavirus cannot be controlled without aggressive employer interventions to dramatically reduce exposure and infections for workers and families—and enable essential businesses to operate uninterrupted.
In the U.S., the employer-employee relationship is strongly linked to the health of the population, Leslie pointed out. For one, about half of Americans receive health care through employer-sponsored health plans. In addition, many of the most important interventions to mitigate the spread of the coronavirus are work-site based.
Interventions to spread the risk of coronavirus infection can save millions of lives
Leslie shared the PHMC19 (Private Health Management COVID-19) Intervention Model, a highly-sophisticated infectious disease model created by a consortium of doctors, medical researchers, and business experts including epidemiologists and risk management professionals. The model objectively projects the number of people who could be infected, require hospitalization, or die from COVID-19, using all known information about the disease.
Using the model, Leslie showed the dramatic difference early and strong interventions can have in mitigating the spread of the coronavirus. The model showed five levels of interventions, ranging from no intervention at all, all the way up to using every intervention possible, including remote work for employees.
What the model showed was that stronger interventions have much stronger effects in limiting the spread of disease. For example, a level 1 intervention that involved increased use of hand sanitizers and disinfection and a ban on handshakes would result in only an 8% reduction in infections. A level 2 intervention that added face masks to those efforts, however, would take that number up to 35%. To reach 54% reductions, a level 3 intervention—which added social distancing and electrostatic spraying (use of sprays with antimicrobial components)—would be necessary. A level 4 intervention would mean closing all public areas on top of levels 1 to 3 interventions; this would cut transmission by 60%. The highest intervention, level 5, would create “circles of safety” by limiting contact between public and employees through remote work—and reduce transmission rates by 68%.
Leslie brought the numbers home by showing what taking these interventions would mean for California. Using illustrative graphs, Leslie showed that if no interventions were used, virtually everyone in California—close to 40 million people—would contract the disease by May or June. “We cannot let that happen,” Leslie said. In contrast, if level 4 interventions are taken, only a quarter of the population would be affected by the end of the year. “It’s a very different scenario,” he said.
Leslie also showed how many people would become sick enough to require hospitalization—and how many would likely die from COVID-19—depending on the interventions taken. For a close look at the findings, watch the full recording and get the slides from the briefing.
Specific populations are much more vulnerable to COVID-19 than the general public
Most people who contract COVID-19 experience only mild symptoms, like a common cold, Leslie pointed out. In fact, 87% of people have very little chance of dying from the coronavirus. The outcomes are dramatically different, however, for most vulnerable populations—the .7% of people at high risk of dying from the virus.
Leslie explained that men are more vulnerable to the virus than women, and that risks increase for older populations. He also said people who smoke, take immune-suppressive medications, have diabetes, hypertension, autoimmune conditions, or lung, kidney, or other cardiovascular diseases, are also at increased risk.
Employers must take steps to protect workers from the coronavirus
Employers must act now, Leslie said, despite the fact that some of the interventions may require short-term awkwardness, expense, and dislocation. “Everybody needs to step up” because without intervention by businesses, COVID-19 would be a disaster.
Leslie called for bold and rapid intervention by business leaders aligned to worksite conditions, using the model to pick strategies, prioritize efforts, allocate resources, communicate, and manage many of the risks. This would dramatically reduce infection, illness, and death while enabling critical businesses to continue to function.
After the briefing, Leslie answered pressing questions from the webinar attendees.
As businesses address this increasingly dynamic and critical situation, what do you think is the most important action business leaders should take today?
“Business leaders do need to act, and I think that there are four realms in which they need to act.
“The first is, every single business I’m aware of is modeling and stress testing their balance sheet … and they need to incorporate in that stress testing the incidents of infections and morbidity among their employee base and their dependents.
“The second thing is, every business needs to go from either all on or all off to a more moderated and more intelligent way to enable business to continue in a way that keeps the employees safe and the customers safe. And that can be done in virtually every single business. So business leaders need to come together. They need to tap into people who’ve done it before. They need to look at the literature, because there is a path to strike that balance. So the second thing is to develop the implementation plan for the intervention to keep the business open and keep people from being exposed unnecessarily.
The third thing is communication. Communication is so important in a time of stress…. Business leaders can put out the same communication to employees, to customers, to vendors, to all the stakeholders, to get them to understand that their business is doing the right thing and the specifics about it, so the customers return to stores, vendors are comfortable supplying, employees are comfortable taking those supplies, and doing all of that.
“And then the fourth piece is to adjust. This is a time where we need to let go of things that we thought were going to work that didn’t and make very rapid adjustments based on data so that we can continuously improve and do a better job.
“So it’s stress test design, the implementation, communicating about it, and being prepared to change it rapidly. It’s a four-part harmony.”
Related: Coronavirus HR Action Plan
All nonessential businesses are closed, but grocery stores, liquor stores, et cetera, are still open. Restaurants are doing to go orders only. Would you consider this to be intervention 5?
“No, it is not an intervention 5, because they have not put in place the kinds of very specific approaches that we’ve learned about from the countries that have been most successful in order to keep those doors open and those functions open. So we’ve studied very carefully the success of the countries that had been successful in containing this, in particular South Korea, in Singapore, in China after they wobbled at the beginning, in Taiwan. And we’ve seen the work that they have done so that you can do safe take out, you can do safe grocery store shopping. So the vendors who are permitted to operate now need to put in place those protocols which involve metering people in the store, keeping physical distance, having people wearing masks.
“So there are things like that that need to be done to get us down to level five. And then for the quote nonessential businesses, there are many of those businesses that can restart functioning using the kinds of approaches that we’re talking about as well.”
We don’t have masks. What should we do? Should we all work from home until we have access to them?
“I’d be particularly cautious about being close to other people .. without a mask if you’re in the most vulnerable population, and certainly if you’re symptomatic…. I think the mask situation is going to be getting better, and as it does … we’ll be able to use them.
“But if you’re just going outdoors, for example, and you’re not going to be within six feet of other people, you’re not going to be indoors any place else, it’s really quite safe almost any place in the country to be walking around without a mask. Part of the point of a mask is protecting others from your droplets and on the off chance that you’re closer to someone than twice the blast radius of a sneeze or a cough, it will protect you from them as well.”
Would it be safe to assume the model shown for California would be the trend in other states, such as New York and Florida?
“Well, every state right now is at a different stage in the evolution…. New York, unfortunately, has become a real hotspot…. But the important point here is even in those cities, states, and regions where there are very low recorded incidents of positive COVID-19 cases, it makes sense to put in place these controls now because they work so much better if you do it before what might otherwise be a single lit match that becomes a forest fire. It’s much easier to put out a single lit match than 200 square miles of a burning forest.”
What is “flattening the curve,” exactly, and why is it so important?
“We’ve all seen that drawing. It’s an abstraction. What we need to do is reduce exposure because if you reduce exposure, you reduce infection. If you reduce infection, you reduce morbidity, you reduce the toll on the healthcare system. And you reduce, most importantly, mortality. So by reducing exposure, you drive everything lower and further out.
“The way in which the reducing the curve has been flattening the curve has been talked about is to reduce the overwhelming stress on the healthcare system. And that’s a legitimate goal that everyone needs to have. But more importantly, putting in place the kinds of interventions that we’re talking about that other countries had done with great success, that certain companies are implementing right now, will not only reduce that imbalance of demand and supply in the healthcare system, but will very dramatically reduce the morbidity and the mortality of COVID-19. That’s the justification for doing it.”
Can you speak to any increased risk for pregnant women? Are they considered a high risk? Do they have a higher mortality rate?
“There is no evidence to date that women who are pregnant are at any greater risk from COVID-19. Clearly their bodies are going through different changes. There was an expert, an epidemiologist, who herself is 38 weeks pregnant who had studied this very carefully, and she said, there’s no evidence to believe that there’s any incremental risk. The data coming out of the largest volume of cases out of China also did not indicate any increased risk for pregnant women. Fortunately, all the pregnant women biologically are younger and not in the age cohort where there is accelerated risk.”
For those who may not have the authority to make changes, for example, about work from home policies, what is your best advice to them, using the data that you’ve shared today?
“There’s got to be a channel within your organization to feed information, out and up into the organization. So talk to … your supervisors, and have them talk to whoever’s in charge. There is a path forward for companies here. This is good news. We can do this. There are other countries who are ahead of us who are now opening up stores, reducing the types of interventions that have been so constraining. Get the information to your senior leadership in the company, get them to recognize that inaction doesn’t work. Decisive, bold, creative action informed by the success stories around the world is what they need to do. And use your voice. Everybody’s got a platform. We’re all in this together. This is an equal opportunity threat. Use your currency, your relationships, your capacity to influence your organization from whatever level. Get it to do the right thing.”
Is mild asthma considered a high risk? And what about in children?
“Children do really well. There’s very little data to suggest that any child up to the age of 25 or even 35—that’s not really child, but people in those younger cohorts—have a profoundly reduced risk as you saw in the tables of morbidity, and certainly mortality. Those who have very meaningful pulmonary issues and other comorbidities do a little bit worse, but they’ve got their youth working for them. There’s something about the vitality of the immune system, its capacity to identify even this particularly vicious virus to put a flag on it and to surround it and destroy it, that works better in younger people than older people.
“I wouldn’t want to give medical advice at all, but for someone who’s got just a mild case of asthma … that would not suggest to me that they are at meaningful additional risk. But if that were my child, I’d want to be as protective as I could in ensuring that we minimize to the maximum extent possible their exposure by doing the kinds of things that we’re talking about.”
I’ve heard multiple times that the population doesn’t need to wear a mask and now you’re saying we should wear a mask. What is the reasoning?
“Well, there’ve been two views on that. The guidance that’s come from the federal government up until very recently is that people should not wear masks. From the very outset, our research scientists thought that that was exactly wrong, frankly, because when we studied very carefully the success stories in battling COVID-19 globally, and the stories where it hasn’t worked out so well, masks were an extremely important part and component of the interventions.
“So the thinking is the following: The recommendation against using a mask was that it’s not going to be as effective as you might think in preventing you from inhaling into your nose or your mouth the virally infected droplets from someone who’s been infected. And there’s probably wisdom to that if that were the only perspective that would lead to that recommendation. But our view was, we looked at it more broadly from a societal perspective, from the exact opposite perspective, and imagined the situation in which we could put everyone who was infected in a mask so they would, to use the vernacular, keep their droplets to themselves…. What we have seen … is approximately … on the order of a 30% reduction in the incidents of people who get infected with this thing and the consequent downstream results of that. So we’re big believers in masks, for yourself as part of your social responsibility to protect yourself. But as importantly, if everybody wore masks, we’d all be protecting one another. Let’s do it.”
What about the N95 masks that we’re hearing about? Are homemade masks enough to prevent the spread of the virus?
“The N95 masks really are not necessary to achieve the exposure control objectives that people outside of the healthcare system need to have as their goals. The N95 mask reduces about 95% of all particles coming in. They’re extremely uncomfortable and are not necessary to achieve the goals that we have here. The N95 masks, unfortunately, are in short supply. It’s an ethical, cultural responsibility to reserve those that are available to the first responders in the healthcare system because those are the people that are at greater risk. You can get almost the same efficacy, from everything we can tell, either with a regular surgical mask or making your own.”
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