This week Fred, Luis, and I review the challenges of re-opening, what companies and schools need to consider as they think about reopening. Are there measures that you need to think about, what does herd immunity mean and how is it relevant and how do you track and process all the various options that individuals may have around testing, symptoms, vaccines (including which ones), and more.
Our weekly question and answer session with Fred Goldstein, Dr. Luis Saldana, and Nick van Terheyden, MD on our COVID Insights to Action Discussion webinar that takes place live every Wednesday at 4pm ET You can register here. You can also find our training modules and services available to help businesses, education facilities, and employers get their employees, staff, customers, and students back to work and school safely in the context of COVID19
Raw Transcript
Fred Goldstein
Hello, everyone, welcome to this week’s COVID insights to action discussion group. I’m Fred Goldstein. And I’m joined again this week by our two esteemed physicians Louie Saul donya and Nick Vander heyden. This week we’ll be discussing returning to work, when and how. So it’s an interesting topic, obviously, a lot of things going on, we can obviously take a look at things going on around the world and some other locations, etc. But perhaps we start off with you, Nick, what are some of the key things employers should be considering now as they as they look at when to come back and how to do it?
Nick van Terheyden
Well, the first thing I’m not going to say is herd immunity. Because Paulie define factor, it’s, you know, unfortunately, as I heard on a recent call, I think, you know, the best description of that I heard was, you can know what herd immunity is, in hindsight, but knowing it going forward is very challenging. So that’s not a good measure to sort of decide on anything, really. But it’s also used as shorthand or short, sort of form to be able to reference safety. I guess. From a work standpoint, I think each of the individual circumstances have to be considered in terms of what’s going on in your community. What does your community look like? Is it a disadvantaged community? So what’s the level of prevalence of the disease? How much testing is taking place? So one of the things that I saw today that I thought, kind of interesting, because I talked about this in the past was the fact that Zambia had promoted the fact that they had had very little disease. Well, it turns out that they had very little testing. And in fact, when they went and looked, they had over 100, it might even be 1000 times. So it’s not just the the amount or the number of cases, it’s also how much testing is going. And also whether that testing is proactive. So are they doing it? So understanding all the underlying details of the testing, then, obviously, from a vaccination standpoint, do you know what your community that you’re dealing with if you’ve got work, colleagues, how many people are vaccinated? If they are? Are they fully vaccinated? So great, you got your vaccine yesterday? Well, that’s good news. But it doesn’t mean so you can come to work today. Because there’s a time delay. It also depends. So there’s a number of factors. So this isn’t just great. We’re ready to open you know, herd immunity has been reached power on it. It is testing, prevalence, vaccination. And then also what do you have in place? Do you have controls in place that say, Gosh, even if we had the the COVID-19. And it was, you know, in our community, we could actually bring people in safely into our environment, because we’ve created enough distance, we’ve got the ventilation, we’ve got half a filter. So I large number of inputs. I’m sure I’ve missed some.
Fred Goldstein
Any any additional thoughts on that? Luis?
Luis Saldana
Yeah, yeah, I think, you know, I think Nick touched on a lot. But yeah, I think I think he touched on this but the, you know, the most important thing on returning to work is what kind of work are you talking about? What what’s your what’s your role? Because, you know, frontline and essential workers, you know, in some cases don’t have a lot of choice. They got to show up and and, you know, grocery stores, there’s so many, and hopefully we’ve done a good job. I’m not sure we’re there yet. Include teachers of getting those frontline essential workers vaccinated to protect them. The other reason it’s important is I think there’s some indirect evidence that and since this CDC also released guidance this week about vaccinated individuals, which Nick kind of touched on. And the biggest being that vaccinated individuals can, can can start meeting in small groups. And I think that leads to the work the work thing as well. And, and may have some implications for that. But, but really looking at at the tree, there’s some hint there that the expected people that are vaccinated, transmit the virus less, because also they may, if they do get it, they have very low virus levels and thus are less transmissible. And so that’s why I think maybe we’re seeing some of the slow down and in current numbers, but we still I think people still forget that we have, we’re at a plateau, we’re not and we’re not at low numbers, like we were early in this pandemic, we’re kind of in that he is still at a high play, what I would consider kind of a high plateau, probably a lot due to the barians, I think the barians still have pretty high transmissibility. So that’s the other important thing is the three W’s are still important, you know, watch your distance, you know, wash your hands frequently, and, and wear your mask, as you were, you know, kind of regardless, we’re seeing all kinds, all kinds of things happening in various states. You see how fragmented the response to all this is. But I think if if a company is trying to think about the safety of their workforce, they do this very, very, in a very disciplined way, you do this where you still keep the risk low, because it doesn’t benefit anybody to do this in a way that that exposes, exposes people to the virus and and kind of keeps this plateau was a more protracted phase.
Fred Goldstein
Right. And two things I want to point out. One is I believe that the CDC recommendation, if I’m correct, is they can meet in small groups without a mask, correct? Correct. Yes. And so it’s, which is it’s really great, you know, make sure you limit it, obviously, and know that everyone’s been vaccinated. And the second point you brought up is really critical, those frontline workers. So when you think about your employer groups, you may be wanting to really ensure that early on those individuals who are frontline who are face to face with with the outside community and, and customers etc, have access to getting themselves vaccinated perhaps earlier than somebody who may be working in the back, you know, who doesn’t have that kind of an interaction with a lot of people or things like that. And so as you look at that, as also we’ve talked about early on, is this whole idea of, perhaps in sending some of that, in sending individuals to get vaccinated, it’s we’ve seen with companies either providing to hours of time off, some of them are providing money, some of them are providing, you know, other kinds of incentives to try to help individuals move into getting those vaccines so we can then create this sort of safer workplace that just grows out in terms of the individuals who are who are at much lower risk. And, Louise, you mentioned also this issue of the variance. And we’re now beginning to see, you hear some people just going bonkers over the variance. Other people are saying, yes, there’s an issue around it because of X, Y, or Z, but it’s not really this. Where is the true issue with the variants? Luis, as you look at this currently?
Luis Saldana
Yeah, I think from what I’ve been seeing, just from different areas on this, and and and, you know, they’re the they’re starting to ramp up the, the identification of these by doing the surveillance for for these variants more and more. But what we’re seeing, I think, is clusters that come out of these variants. And I think that’s the transmissibility is leading to these clusters of cases. And that’s that’s kind of what I’ve seen here locally, as far as that goes. And, and and so I think that really speaks to the essentials, how stained with with the fundamentals is going to be really, really important on this, because we could really see a jump everybody still seeing the numbers going down, despite the fact that the variants are there. But we are seeing these clusters. So it’s a kind of a two edged sword, I’d say bear beware in in in these groups and thinks about, about about laying down your card.
Fred Goldstein
And I guess, Nick, it’s really about increased transmissibility of that virus, those variants that they’re easier to, in essence, infect others.
Nick van Terheyden
Yeah, I think the term I keep hearing his his escape, they escaped the immune response that is mounted, and it’s because they’ve changed sufficiently that the immune system is not able to recognize it as accurately so you know, if you think of a very accurate fit, in the case of the vaccination and the antibodies that are produced in response to those vaccines, you know, there’s some small changes And, you know, this is a three dimensional puzzle that fit. Now, the good news is that the immune system is incredibly complex. And it’s not just one thing. It’s a whole spectrum. And in fact, there is extraordinarily brilliant innovation in our bodies to fight these things, that allows some of the immune system to recognize these variants that have changed slightly, but they’re still seeing pieces. And still to mount a response. The question we have at this point is, you know, how significant is that escape? Do the neutralizing antibodies? So when we talk about that, that’s the antibodies that go in, attack the virus and destroy it, they lice, it they, you know, it disappears? That’s a neutralizing effect, is it sufficient. And if so, then it’s a neutralizing antibody. But it doesn’t always need to be fully neutralizing. Because again, there are other activities that are taking place in our body. So we continue to watch it, I think the the key thing here is, speed is of the essence. Because when the virus gets to change 100 times, one of those might be, you know, an escape variant. When it gets to change 1000 times, then it’s 10. You know, if those are the percentages, and the more opportunity that it has to spread, and you know, replicate, the more opportunity that there are for these escape variants. So the quicker that we can focus and get everything done. And that’s vaccination. But also, all of the other things, we can’t stop or less up on the gas at this point, we are so close to the finish. And it’s I have to say a little bit troubling that, you know, everybody’s going, whoo, we’re not quite at the woohoo moment.
Fred Goldstein
Yeah. And I think, Nick, you know, you’re addressing this from the point of view of escape from the vaccine itself. Whereas the also the issue of just the the new variants are just in general, more capable of transmitting between individuals. In other words, whether they’re binding stronger to the cells or whatever. And that’s obviously raised an issue as you talk about Louise, when you think about clusters, and it’s these indoor activities, where it’s really so critical to be sure you’re wearing masks, if you can open those windows, you’ve looked at your AC, all the things that we’ve talked about, really, as you guys have hammered home for a while, double down on those now. And and that’ll help us then get through it, because we’re clearly get the numbers are down, but they’re still as high as last summer, as I understand the last ones I looked at. Go ahead, Nick,
Nick van Terheyden
they worked in 1918. They work in 2020. And
Fred Goldstein
yeah, we’ve got cooler looking ones now to all kinds of cool looking masks. So I was just looking them up on one of the sites to talk about put some logos on him. So and I know a number of universities and others have done that as well. What are we learning now from? Let’s take a look, you know, other places like Israel, where they really vaccinated a fairly substantial proportion of their population? And how might that then influence work as we go forward?
Luis Saldana
Yeah, I think what I like about the one, the Israel experience has spun out so much data, and really been a precursor to what we’re doing in terms of vaccination at a much slower rate in terms of the overall population, obviously, much, much smaller. But what they have achieved is basically vulnerable populations. The the number of hospitalizations and deaths in those groups has has plummeted and and and essentially, you’re taking away the kind of superpower of this, of this virus and now you can’t predict it’s it’s deadly nature. That’s that’s one of the challenges except the one thing we do know is, is the elderly are particularly vulnerable. And here we’ve seen in the United States, nursing home deaths have dropped significantly. So see the same things. But in terms of their experience, that as they are starting to open up, open things up, using their kind of either witnessing, for when it’s called Green badge or something like that, that they have that if you’re a vaccinated individual, you have this green badge that lets you do things. What I like about that is, is in, as you said, rather than a mandate, you’re incentivizing the vaccinate vaccine with freedom. So to me, the vaccine equals Freedom, freedom to go to restaurants for you to travel for freedom to gather, you know, all those things, the more we can do that that’s why even some people felt like the CDC fell short on their guidance and vaccinated people actually, I think could have gone a little bit further but but that you know, that’s that’s always a tough thing. And I hate to be critical as far as that goes. But but I think this approach of vaccination equals freedom is one that especially employers need to think about, as they go through this, and how do you
Fred Goldstein
message that, as you first started talking about that Luis, it was almost like you’re reading the Bill of Rights. And it’s associated with, you know, with the vaccine freedom to congregate the freedom to, you know, and it’s, it’s true in a sense, it is going to allow us and communities and employers to begin to open up. I know, in Israel the first night, apparently, after they announced they were opening things up, they were saying that the downtown restaurants etc, were really packed like they used to be, but they felt much better. Now, obviously, we’re gonna have to monitor that over time and see, but and because clearly, there are some there, it’s not 100%. But I think it’s now manageable. The other issue that this has raised is, and I don’t know how much you want to go into this is, you know, you don’t really want to scare people. But the issue of long COVID is still there. And I know, Nick, you looked at an interesting study about that in regards to asymptomatic individuals potentially, and stuff like that. You walk through that a bit.
Nick van Terheyden
Yeah, I So, before I answer that, I just want to call out something else that Israel did that I think, you know, is really important and has added and Louise touched on it. But I, I want to highlight it, they said, we’re going to collect this data, and we’re going to share this data, it was, you know, Truly this treasure trove of information. And that’s why we’ve got all this insight. so fantastic. Good on them. You’re exactly right. And I have to say I read this, and I was just so concerned to see the the statistics or the numbers relative to this. So there’s a lot of work now coming out, obviously, because we’ve got more cases, we’ve seen more, we’ve got the survivor core, which is the group set up by Diana barent. You know, that is all the people that have been enduring long COVID and also were contributing, they were many of the folks who are providing plasma freezes donating their plasma for, you know, supporting patients that were subsequently getting it. But, you know, the data that’s now emerging, that really bothered me, was the fact that fully 1/3 of these folks who are suffering long, COVID symptoms, and we’re talking 60 days, and you know, it’s a wide range, I looked at the stats and all the various things, you know, everything from just brain fog, to you know, General malaise. You know, it reminds me a lot of, you know, the, the chronic diseases that we’ve seen occur and emerge that we can’t fully explain is occurring in people that were asymptomatic. So they had a test, they were confirmed as positive, yet had no symptoms, you know, went through their isolation and everything, but now have subsequent, you know, conditions that are preventing them from working, enjoying life doing all the things. And what bothered me about that is that my immediate thought was, what group does that essentially appear to be? It’s not exclusive, but the majority of the folks that have the asymptomatic presentation of the disease are all the young folks. And they’re all the ones go, Well, I don’t have any symptoms, it doesn’t matter. It does matter. And that’s why, above all else, we have to try and prevent people from getting it and allow them to be vaccinated so that they don’t get it and don’t suffer from this.
Fred Goldstein
Yeah, and I think Go ahead, Louise,
Luis Saldana
I was gonna say I was gonna add one more thing about what Nick said two things. One is that this is going to clearly be a chronic disease burden on the on the world and United States going forward. But the other promising thing that seems to be at least some immunologist think that vaccine, the vaccine itself gain the vaccine may ameliorate some of the symptomatology on this and may actually be a treatment hasn’t been gone through, you know, we can’t say that’s not an evidence based as far as that goes. But there’s some suggestion that, that that may, they may really help these folks with long COVID.
Fred Goldstein
So getting them a vaccine, when they’re suffering from long COVID, in some cases, has shown that those symptoms go away.
Luis Saldana
Yeah, at least at least improved significantly. It’s not like, Wow,
Fred Goldstein
good, good. And, you know, it’s interesting, I was actually pulling up and just taking a look at some of the data. And, you know, Israel now is it 44.4% fully vaccinated, and almost 57% has had at least one of the doses. So, you know, you start seeing the changes there. Obviously, hopefully, as we begin to see our numbers go up, we’ll see that as well
Nick van Terheyden
as a percentage of folks that have had the disease so that adds to the immune pool. So you know, What is the level of immunity that exists in that population? I’m not sure. But it’s certainly higher than that. And that’s, you know, approaching the numbers that we would think about and say, gosh, that gives us some resistance and starts to suppress the spread of the virus. Yeah.
Fred Goldstein
And the other point I wanted to add to what you said earlier, Nick, is, you know, you think about the younger people. And typically, you know, I’m thinking, Oh, yeah, it’s the college age kids who say I’m immune to this. But you actually see it in older individuals who are sub 50, or sub 60, who think Well, look, it’s just, it’s just the people who are over 80 years old, or seven years old, dying, but these are people in your employee age ranges, who need to understand the risks, potentially, of Yeah, the first hit from COVID, didn’t do a whole heck of a lot. But suddenly, I have these long term symptoms I’m dealing with, whether it’s fatigue, or some of the other things that we’re seeing in these folks, it’s not just the college kids that think that but oftentimes, people you know, in the 30s, and 40s, are operating under that belief system as well. Right, employers need to really make sure they double up on what they’re doing at their workplace to try and minimize the risk of anybody getting COVID or suffering through with it,
Nick van Terheyden
and and take into account that they’re going to have to deal with this on a long term basis, depending on what the sort of prevalence has been of the disease and the folks that are suffering from it. I haven’t seen the numbers to sort of suggest that, but it’s not confined just to the clinical symptoms. And this long code here. I you know, for me, the Far, far bigger aspect of this is the mental health impact, not just on, you know, the individual, but the extended family in the network. I think it’s just, it was already bad. It’s a whole lot worse now. Yeah,
Luis Saldana
now, I’ll throw one more thing in there, because I think it’s going to be important for us as a society is that and medical professionals as well, some of actually believing these people when they have these symptoms, I think it we’ve seen different type of syndromes that are vague, poor, you know, poorly defined, not necessarily falling into a neat box of diagnosis. And it’s really important, I think, to have some empathy and least people and really work to identify that. So I think that’s gonna be a real burden for the healthcare system to really work through the issues around this. And there’s lots of issues around this, including that one, you know, yeah,
Fred Goldstein
that raises an interesting point from the side of the healthcare professionals, where I’ve sort of seen two, two approaches. One is you’re beginning to see those centers of excellence, say, we’re going to study this, we’re going to bring patients together who are suffering from the the syndromes and try and figure out what’s going on. And then I’ve heard from some others who say, well, there’s nothing I could do, why would I even want to see him? And hopefully, as you said, there’s some empathy recognizes is real, we got to help solve it. And let’s be available for those individuals who come forward and are suffering from long COVID are the various symptoms. Are there? As you think about it, from an employer perspective, are there things they should be looking at perhaps from, you know, as they consider you mentioned, obviously, mental health neck and their benefits plans and some of their programs? And, you know, we’ve touched on a bit in the past?
Nick van Terheyden
I actually look at it slightly differently. I think that’s a good question for you, Fred. Because you’re sort of deeply invested in that area, I think more of an identification and mitigation early on. So you know, do you know in your population, who has had COVID, and, you know, recognize not trying to overstep the boundaries and, you know, dive into people’s personal conditions. But, you know, if they have, and they’re suffering from that, do you have a toolkit that allows you to identify them, and allow for this, give them some special accommodation, more importantly, get them into whatever treatments and opportunities that are available so that you can start to mitigate that and return them to the workforce? You know, quickly and effectively. Yeah,
Fred Goldstein
and your point regarding that is really fascinating. There was an article I read earlier, and we sent around everybody and some others on a university at University of Southern California, one of the professors in the chemistry and physics department, had a small group working in the lab, and recognize that that there was just a lot of stress going on, and actually went out, found a counselor with some expertise in this and brought them in to the worksite. And they they meet monthly with the team. And the individual actually said, I’m stepping out that way they can talk to you honestly about what’s going on. And after two months, they said, should we keep this going or not? And the staff was unanimous, yes, we really appreciate this. It’s helping us a lot to deal with all of the various issues. We’re struggling with, whether it’s at home with COVID work, etc. And so these kind of unique approaches are something that people need to start considering, you know, not only do you have the benefits, but are they easily accessible? Are they accessible without any kind of guilt or stigma associated with them, particularly from a mental health perspective? Which is always so important? And then do they? Are they able to be accessed in new ways? You know, one of the things when I was running psych hospitals and the clinics, etc, there was always a question, especially in some of the smaller communities I lived in, nobody wanted to park their car there, if somebody saw it, or saw their license plate, or something like that, and recognize it. Oh, that’s Fred over there, you know, and they and, and so providing these in ways and particularly with telehealth now, where you’re seeing so much mental health delivered by telehealth, and the studies are showing it’s as effective and can be as effective, if done correctly with individuals to get resources like that available to employees is obviously something will help quite a bit.
Luis Saldana
Yeah, a lot of one more thing for him to know along those lines. I think the big thing or over the topic that we’re covering is the answer. It lies in having a team within your your work, you know, your companies, your workspaces. With some good health care, leadership’s and some health advisors, along with your teams to work through some of these, these things, I don’t think you can, you most organizations probably don’t have the capabilities to understand all the implications, especially now, the health implications and things that really should seek to have health guidance, if they don’t have a chief medical officer or chief health officer or something like that, I think they really should, should look towards that look, to get some capabilities like that as well.
Fred Goldstein
Yeah, it makes a lot of sense. You know, typically, for an employer group, you’ve hired individuals to do a specific job, you want to keep them doing that job, it’s critical to your work, you don’t want to pull them off and have them try to do something else and figure out COVID, or figure out air handling, or figure out their mental health things. And so obviously, bringing in a group to help would be critically important to do that.
Nick van Terheyden
Yeah, and I think the external group is key in this because, you know, that’s one of the things that’s really come out from COVID, from my perspective, is the opportunity to learn from innovation in other places, other similar facilities, businesses where, you know, you go, gosh, I wouldn’t have thought of that. So the transfer of knowledge across different organizations, colleges, and so forth, has really been eye opening for me. And that’s facilitated with external resources. So even if you’ve got a large organization with a chief medical officer, you may well want to have access to that, because that’s the way that you really learn and shake things up a little bit. Yeah, and
Fred Goldstein
I think to reiterate that point, we’ve heard that from some of our clients, you know, we really appreciate this sort of independent third party, everybody can kind of get stuck into little chasms or things to be viewing through or narrowing lenses, and having somebody else that maybe has a different lens on it, or seeing something else obviously can play a critical role in that. We’ve got just a couple minutes left, I don’t know if anyone has any questions, we’d be happy to answer those. But again, as you’re thinking about now, reopening, and how do you operate? It’s it’s still going to be complex and perhaps more complex, as you have some people vaccinated, and some people who aren’t.
Nick van Terheyden
And were they vaccinated? Was it vaccinated? Too soon, before they showed up? Or is it too long of a period of time? You know, how long does that vaccination last? Which vaccine? You know, there’s, I can only imagine the complex decision making that you add to this sort of, you know, clear pass or whatever you have you had some testing, where it was symptoms, you know, do you have a temperature or these things and, you know, positive test. Now, you’ve got to add in all that complexity, that’s just going to add,
Luis Saldana
yeah, I’ll throw one other thing, because I heard about this, and And what if they had a non FDA approved vaccine? I know of cases where they had the Chinese vaccine. So So what do they do with that? So that’s, again, why I think you really need some some expert guides, because these are these are not they’re not simple things to work to work through there. They’re not there. They’re really not there. They require some, some discernment, some gray areas, and really a lot of research and, and collaboration as using what you’ve said, Nick,
Fred Goldstein
right. And as Nick, as you as you, and I’ll say this in a positive way, as you glossed over it, because you’re a tech expert, as is Luis, you mean he said, Oh, we’ve got their app. Which app You’re right, who’s using an app? Is it paper? You know, all of those things need to be dealt with too. So it really starts you say, the the permutations through this thing of rather gigantic as you start to build it out.
Nick van Terheyden
Yeah.
Fred Goldstein
So with that, thanks again for joining us this week. I’m Fred Goldstein and really appreciate if you have any questions or want additional information, please go to veilig Health COMM And Nick and Luis, another fantastic week. Thanks.
