This week look at the NFL COVID19 experience and what this can teach us for mitigation. The National Football League (NFL) study (Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9–November 21, 2020) offers some valuable insights into how COVID19 disease spreads, some successful mitigation strategies that were founded on an extensive testing program and some innovative use of tracking technology to bolster the contact tracing activities and even preemptively warn players and staff if they were spending too much time in close proximity. They applied an intensive response protocol imposing stricter infection prevention precautions which successfully reduced and prevented high-risk interactions and reduced transmission.
Listen in to hear the other topics including the challenge of deferred or delayed care, mental or brian health, and what goes into creating a safe workspace for your students and employees
Raw Transcript
Fred Goldstein
Hello, everyone, this is Fred Goldstein and welcome to This Week COVID insights to action discussion group. I’m joined this week again by our two esteemed physician colleagues, Nick van Terheyden. And Louie Sal donya. This week, we’ll be discussing the post pandemic employee health improvement. However, we wanted to find post pandemic is we’re still sort of in it it’s going on. But obviously, things are gonna change over time as we move forward. And how might you as an employer, look at those issues. So let’s start this discussion with an interesting article that came out a few days ago regarding what the NFL has done for their employees, in essence, their players and the rest of them. And I know, Luis, you found this out, it’s centered around all of us. So why don’t you give us some background on what the NFL learned and what they did? Yes, this actually came out of the CDC sent us out a nice case study, which really kind of demonstrated a lot of things that are that go around the workplace, I think, you know, we consider the, you know, the NFL as a workplace for these football players. And really, they’re trying to manage the players and all the surrounding staff around or, and so I think there’s a lot to manage to prevent outbreaks. And overall, I think most people feel like they were very successful this year, they pulled up the whole season Super Bowl Sunday coming up, you know, so I think a big success to them. And I think that, you know, they were an example of the importance of the fundamentals, though, you know, those nonpharmaceutical, you know, interventions, and that’s, you know,
Luis Saldana
frequent testing, they were, they did an astounding number of tests, I think, averaged over over three per person per week. Remember, you kind of shared that number, it was, it was, it was an astounding number of tests that they, that they gave as far as that. But then also the, you know, the contact Tracy, as you know, was also an important thing. And they did use a wearable device to help them address this. And the good thing about this is they really used the data from this, to really try and learn where outbreaks were happening. And they quickly shut down any dining areas and things like that, because they saw those were areas of transmission. And, you know, especially with the virus being mostly airborne, where, you know, that was a big concern. So they really adapted rather quickly. And that so that’s what makes it such a good example, is the fact that they really it was data driven or data guided, you know, type of work and and, you know, overall, I think they it was it’s again, it’s a great example, moving forward of how specific workplaces or let’s say you have a group coming together to finish a certain specific project, how you keep them safe. And I think thinking about that, as we look forward to returning to work. I think all those things are going to be really very important for us to to start thinking we know work is not going to be like it was we’re not going to have these big offices it’s going to be I think we’re going to be mostly hybrid. environments but you know, in person, and, and remote work and things. So. So with that, I think, you know, this this case study is a good one. And I’d suggest a for, for people to read, it’s very available on the CDC website to kind of read through and see the details on it as to as to what they did. But, you know, some of this work led to changes in the guidance for contact Tracy, and actually, they, you know, the original one, he had to be 15 minutes kind of sustained. Within six feet, they actually did work from this actually led to some of the tweaking of that that came out.
Fred Goldstein
Yeah, I think, before I turn it over to you, Nick, some interesting points from just in terms of numbers you talked about, essentially, they did 623,000 tests over 14 weeks. So the players were, were tested six days a week, and then others three days, and then staff that didn’t get a lot of contact were one day a week. But what was interesting is they did have an outbreak at that during this. And that led to some changes that they went to seven days a week for the players. But obviously, the way they were able to track it, Nick was interesting. And I know you’re going to be interviewing that individual from that company. As I understand in the coming weeks. On your podcast, you talk a little bit about that tracking and what they learned from that.
Nick van Terheyden
Yeah, so this is a great example of augmentation with technology. So we’ve we’ve been going round and round with apps that we can install on our phone and tracking and register for this and you know, supporting the contact tracing. And they all suffer from you know, some privacy issues, security challenges, compliance, all of these things. What’s really interesting about the NFL was it was a sort of opt in small device, it was separate from Bluetooth, Wi Fi, all of these other technologies. And you know, as Luis rightly pointed out, it provided some insights that changed the way that we thought about contacts. And you know, what I found really intriguing about this was it was proximity based. So it wasn’t just oh, you know, I happen to be, it was within a certain amount of time, it was cumulative, so it started to understand. And then interestingly, not only did they do that data analysis, but there is also capabilities built into the technology, at least based on what I’ve learned so far. And I’m going to learn more and obviously share that as I interview and talk to some of the folks there that can provide real time feedback. So you and I, Fred could be talking and we get to the, you know, the cumulative amount, whatever that number is, and it goes beep, beep, you guys got to stop talking. That’s actually really intriguing. You know, I know, it’s irritating. But you know, what, if we could get a little bit more of this interaction, you know, and support by the technology that’s intelligent, that’s a great piece of progress. And, um, you know, like you and Luis, I love the fact that we’re learning from this. Yeah, they have lots of money. You know, they could throw it at the testing, I got to believe that all those NFL players had some pretty sore noses at the end of it, but God bless him for doing it because we learned a lot from it. Right. And it’s, it’s, it’s
Fred Goldstein
fascinating to think about that. The one the infections weren’t on the field, in essence, on that. And that even points more to us, as employers or people that are have employees in a space, it really gets back to the smaller rooms where they had meetings, or watching film, or things like that, which is what happens in a workplace, we can forget about what we’re doing. We’re out there with the customers or with our vendors, or whatever. And then we go back into a break room. And suddenly we’re all together and just the masks drop, and we’re chatting away. And and as you pointed out, it also talked about much smaller periods of time that had originally been considered to actually become infected short duration contacts, I believe some of them were shorter than two minutes. In some cases with that study.
Nick van Terheyden
I think the other thing that I would sort of call out as a learning point for businesses and colleges and so forth, is the constant refinement and learning that took place the incremental improvements that they said, okay, we’ve seen something, we understand that we’re going to flex and change direction, change the guidelines, appropriately informed by science, and some of that could be going back on what we said originally, but it’s driven by the data and driven by the science. That’s exactly the way that you make progress, and you make progress fast by doing that.
Anything else you’d like to add on that Louise?
Luis Saldana
No, I think good. Nice. I think it’s it’s really interesting to kind of kind of tease that apart. I, I think you’d probably look even deeper around the masking piece. I kind of wonder, you know, because we haven’t talked much about you know, ventilation, but we all we’ve always been all around ventilation and how important ventilation is how locker rooms are. I don’t recall if it touched on If the study touched on ma may or may not kind of miss that case in the case study, but I bet they did look at ventilation. But it makes you wonder about what we know now about the increased transmission rates, whether even considering everybody with nit fights for the locker rooms or, or something like that I’m not talking about on the field or that or the bench. But for the locker room areas or things like that, where people are kind of congregated in something like that could have even been something that could have been done as we as we look at the, you know, importance of masks right now.
Fred Goldstein
So let’s look a little bit on a broader issue now and step away maybe from the NFL and talk about this whole issue of post pandemic or whatever we’re going to find its post pandemic, employer health improvement. And you know, over the years, I’ve been working, obviously, with a lot of employee health improvement programs, whether we did things for the state of Nevada employees, or Ayaan or these others through our health improvement programs at the companies I worked at. And we were looking at things like were they following USP STF guidelines for screenings and testing. And we know that over the past year, now that we’ve been involved with this, the utilization of a lot of these types of services, these outpatient services are going to see your physician dropped off? How should employers be looking at that on a go forward basis?
Nick van Terheyden
Well, I have to say, I saw a report just today in my inbox that talked about the plummeting levels of, you know, standardized screening, you know, colonoscopies down by 60%. And, you know, if you consider the impact of that, based on the numbers that we know, of what’s picked up and so forth, there’s gonna be some downstream. And the question is, can we recover some of that, so, you know, short delays or, or delays of some period of time, but returning to that, I think you can help recover or at least restore, so if you miss it, but go back to it maybe six months, a year later. So I think one of the things that we would see, or certainly I would be encouraging, is reviewing that and starting an educational program with employees, you know, folks, to help them understand that this is really important. I mean, you know, let’s all hold up our hand and say, you know, colonoscopy, not on the list of things that I really, you know, a lot of is 60% of the population is happy about that. But in fact, you shouldn’t be because there’s good science behind this. And we’ve really got to get back to that, because it was doing good things in terms of preventative. So understanding that and then going off to those, you know, particular groups to help them educate and also flex back towards where they ought to be in terms of the screening process. I think
Luis Saldana
I just kind of agree with Nick Yeah, man, see, man, I’m the same one. But the amount that it’s dropped is, is so alarming that even insurers were concerned about it, and they saved money, they, they were profitable, because of the decreased utilization, but they also see the downward downstream impact potential downstream impact of this, and they’re concerned and want to look at, so I think there’s gonna be a lot of synergy for employers, the worker themselves and the payers, to find good ways to recoup, you know, kind of recover, get back and get some of that back, because that has to also impact you know, hypertension management, diabetes management, there’s all kinds of things beyond kind of prevented, you know, health maintenance type of thing. So, so, I think the impacts of this are potentially huge and we’ll have to really look at it and see but a good thoughtful employer will really think through this and and, and try and address these guys, you know, address these kind of needs going forward at proactively.
Fred Goldstein
Right? And so, a couple of questions for you guys, as we think about this, you know, you can think colonoscopies, mammograms, all of these various screenings, you have your annual physical when you reach a certain age, etc. And some of these potentially can be solved through different methods, different medical methodologies or testing or your uses of technology. What should people be considering around that? or How can they find out that kind of information?
Luis Saldana
Yeah, I think that that’s Friday. That’s the reason why has to be kind of a partnership and doing this. I think one thing you’ve seen with the colonoscopies going down and number and number gun is the vehicle. It’s called a fit test to replace that it’s a it’s essentially a DNA test of your of your stool. as kind of a screening test for for colon cancer, not not, it does not have the sensitivity and specificity that that colonoscopy had. So be very clear about that. So it’s, it’s a lesser kind of substitute for that. But But you know, in the current environment, a good probably a good feeling. But you also have to think, how do we backfill some of these? Or how do we look at these people to, to ensure that we’re capturing the risk of not putting somebody off? In Canada, in the margins there, I think is going to be a case and I think you’re spot on, and that there’s a lot of ways we I think this is gonna, you’re seeing the digital health space moving into these longitudinal management as telehealth or self management of conditions like diabetes and hypertension, mental health issues, which are, you know, critically important, how do you manage those a lot more to yourself, it’s pushing some of the management out to you almost self service, in a way, but you know, it’s evolving care, you know, caregivers on on the front end, looking at the data and things like that, but you’re more actively involved and, and those type of things, the only concern there is the digital divide potential digital divide of, of who gets that kind of technology and screening and, and things available to them and who doesn’t, you know, you look at essential workers that may not get that kind of thing, but I think every it’s in everybody’s best interest to look at this, you know, very, very proactively and with a population health plans before it.
Nick van Terheyden
Right. And the other thing, I would say, you know, I hesitate to bring it up, but it’s, it’s snowballing is a problem, in my mind is the brain health, mental health has been compounded by isolation, living in the matrix, you know, lack of social interactions, all those things that, you know, have pushed people into a circumstance that, you know, they might have coped with in different circumstances, but are now struggling with even more. So the demand and the need around mental health services, to really address and focus and I think, you know, we’ve talked about in the past, it’s not just the individual or the employee or the student, but the associated groups around that, that, you know, maybe are not voicing or expressing some of those challenges. But I, you know, it’s impossible to believe that this is just not going to be a massive problem. And we need the resources, we need to augment it with technology. And we’ve got to find a way to sort of help mitigate and treat some of that so that you can see some positive flex away from these challenges. I mean, I’m just terrified to look at suicide rates, which is just one of the most awful outcomes from mental health problems, and see that escalate beyond where it is already, which is already too bad.
Fred Goldstein
Right. And I think we saw that, as we’ve discussed a little bit in terms of, there was an article in the Las Vegas school district, and the number of suicides they’ve had of their students. And so they’re really pushing to get them back into classrooms specifically, because I can’t believe it was 15 or 18. But it was a very high number. And definitely the mental health is a big issue. I’d also say from an employer perspective, one of the things to look at is check out your benefits package, does it allow for telehealth? And has it broaden that I mean, there are a number of things you can do with telehealth you can do dermatology with telehealth, there’s some really good programs around that, obviously, your standard family practice visits and things like that. But that’s broadening. But at the same time, as you consider that make sure one is Louise pointed out that they have that your employees have access to this, they can access it themselves, they have internet in their home, you know a way to do that. And then the other thing to consider is vet or or ensure that somebody vetted the service. There’s a lot of stuff out there. And some of its very good. And some of it can be a little bit questionable. So it’s always important to vet that service and make sure that whether the health plan is looking at it, and they’re all certified, you know, and licensed practitioners to do it. Because you always see people kind of getting into some of the space sometimes with a little bit less than the quality you would like to see. So there are other ideas employers should consider on this. Go ahead, Nick,
Nick van Terheyden
it’s worth amplifying that point. You bring it up and I saw a whole thread around this from an internet access standpoint. And the idea that the internet you know is a luxury item is just not appropriate in this day and age especially given COVID-19 we’ve seen we saw a little bit of a pullback or reversal of some of the limitations that were placed artificially. In many cases to reduce bandwidth or, you know, access, and we’re starting to see the return of that by some of the organizations that provide this. So from an employer standpoint, I think that’s one of the things that you’ve got to sort of take account. So when you do an itss, which you ought to be doing, because of security, and all of those things, thinking about this just purely from a health standpoint, and by the way, it now becomes a sort of essential tool, not just for the telehealth, but also if you’re doing any monitoring, replacing some of the things that Louise talked about, you know, these tools and technologies, they all depend on that pipe, if that pipes, just a little dribble, it ain’t going to provide much data that’s going to be valuable. And you know, people end up stopping using it. So it’s one of these areas that I think really warrants an awful lot of focus and attention. And sort of, you know, oh, yeah, that’s internet. But it’s more than that.
Luis Saldana
At school, I mean, I think it just goes back to the school piece in the mental health piece and, and thinking about school, but school kids, if kids are going to score using this, as well, we’re seeing that, that the digital divide that’s happening is exacerbated issues with vaccinations, every site almost every, you know, it’s great when you can use technology use, you know, your epic my chart to sign people up, or different technology tools to find people that can make a point. But that leaves behind a huge number of folks that, that either are digitally savvy or capable, and or don’t don’t have access, as you said, to, you know, to good, reliable internet, internet service, it’s not part of their DNA on how they operate on a day to day basis, your essential workers, and things like that. So we really I think your your point is, is spot on there, Nick, is that we need to start looking at it as that’s like essential like your, you know, electricity and gas and water as well.
Nick van Terheyden
It sits in Maslow’s hierarchy, no question in my mind.
Fred Goldstein
So as employees think about, you know, going forward, obviously, you talked about there’s going to be Luis, this sort of hybrid, we’re going to have people who are going to continue to work from home, we’re gonna have others who are central workers and have to go in, then there’ll be some offices that re establish, how should they look at things, I mean, you know, employers and a number of them have these wellness programs out there, or health improvement programs. And oftentimes those included, while on Fridays, we’re going to get together and have a healthy lunch, or we’re going to do walks at lunch, or we’re going to do these things we get together. Are there other ways they can look to potentially solve some of these or to continue on with those programs? How much modification Do you think they might need?
Luis Saldana
Well, one thing I think they there’s kind of a couple of big, kind of big, big items they should be looking at is I’m sure they all are looking at their their office spaces in general, what what is actually our feasible capacity to have people in the office safely, that forces you to look at ventilation, your open plans versus otherwise, I mean, so it really forced you to really do an evaluation of kind of the workspace and, and optimizing attic ventilation, we said if you want to prevent spread, is so critical. And I think we really need to, to really kind of keep ringing that bell to people that ventilation it as somebody if you own a business that has people coming in, or you have you know, employees that you that come into your office, that should be a critical thing that that that you need to, you know, be looking at the other part is business travel, what’s going to happen with business travel? And and, you know, will it will it return? So then this brings up the issue of vaccinations should we require vaccination, as a you know, at that point, and I think, you know, you really have to, I think each, that’s, these are all evaluations, that companies should be going through themselves, and walk you through all of these questions, you know, probably a day long type of, of scenario and, and assign people to kind of fix these things and, and such, and certainly, we, you know, I think we can help kind of, you know, help businesses on that, that type of thing to think through the issues that are going to kind of come up here and, and help to identify these problems before or before their problems to identify things. So you make that workplace safe. And I just think those types of things. Also testing you can’t ignore testing, you’re gonna have to have capabilities for testing for for the foreseeable future, I would say as well. So, so I think that those are just a few that come to mind for me.
Nick van Terheyden
And I think Fred, yo, yo, you’ve got deep experience in this whole ventilation, you know, all the different filters actually. You know, translate All the different terminology or reference versions that they have, before you talk about that I want to talk about, you know, just a basic assessment and I did it you know, I did it like I created by level stick with me my little floaty things to see where the airflow would go directly driven by that South Korean study that showed essentially this tracking of an, even though they had filtration and you know, distance and all the rest of it, there was essentially a corridor of air that was happening as a result of the flow. So I went about that, in my local circumstance to understand what the airflow was. Now, I’m not a deep expert in this, but I certainly understand you know, some of the elements of that. And I think that’s where you need help in this whole process is going through, it’s almost room by room thinking about those circumstances, what’s appropriate, you know, you want to have the best safest experience for everybody. And there are so many things to consider. It’s a full time job keeping up, which is why we spend our time doing that.
Fred Goldstein
That’s right. And I’m going to sort of flip this a little bit, Nick, because this past week, and you know, everyone has limited resources, the obviously the NFL could spend a boatload of money to do that testing, etc, etc. But even May, at some point probably would limit out on resources. But other companies don’t have all that. And one of the things has been fascinating. I know, you’ve looked at this, Nick, and talked about it, is this concept of are we over utilizing our cleaning efforts? So do you want to touch on that a little bit?
Nick van Terheyden
Yeah, no, absolutely. I mean, I, to be clear, you know, current guidelines, you know, sanitation, cleaning surfaces, and so forth. But I think the data is pretty clear at this point that transmission could occur through surfaces. So there’s no question what we can’t do is completely excluded. So the idea that, you know, there is no transmission through surfaces, of course, is almost an impossible task to prove out. But what we know is the majority of it comes through air transmission. Now, people are spending enormous amounts of money technology, electrostatic sprayers, and I’m not saying none of that is is valuable. What I’m saying is, we ought to reassess in the pool of limited resources, actually thinking about where we focus that attention? And is that the best, next best available use of the dollar that I’ve got to be able to spend? And, you know, again, thinking about that thoughtfully, understanding the science and then maybe saying, well, we’re going to do it, but we’re not going to do it 24 times a day, whatever it happens to be in terms of frequency, and you know, the process and what we use, maybe not quite the same, I can tell you my gym, I can barely touch any of the equipment. It’s so sticky from all the electrostatic
and and once that the place you walked around with the little error state was you see where the flow was coming through? Yeah, Jim. Yeah,
Nick van Terheyden
I got some funny looks, I can tell you.
Fred Goldstein
But it raises a great point, there are all these confounding issues going on, as you think about this virus reopening your space versus somebody else’s, that Jim’s versus the the other place down the street that has a yoga class. And those are all different, and have different potential risks and impacts. And so understanding the cleaning versus the air, that the location when you might have vaccines, where your people work from and live. All of those things require some thoughtfulness that may not be within the expertise of the organization itself.
Nick van Terheyden
Right, and that you’ve gone $10 what proportion of that do you spend on air handling on protection on cleaning a cut? You know, those are all real decisions that I think you rightly highlight Fred, and, you know, helping navigate that so that you get the best value for your economics. Ben, I think he’s absolutely right in our wheelhouse.
Fred Goldstein
Fantastic. I know, we’ve got just a couple of minutes left. I don’t know if anyone who’s attending has any questions they’d like us to address. But we’re happy to do those in these final few minutes. If you do just go ahead and put them down in the chat box. Otherwise, as we think about the the six 812 months down the road, just a quick thought on where you think will be from a vaccine perspective and how that might impact what we’re looking at.
Nick van Terheyden
Well, let me give you the the stat that I saw that I thought was really telling in terms of, you know, what’s necessary to achieve coverage and, you know, there’s some assumptions in here about what percentage of the population If you include children and so forth, but if we manage to vaccinate, nought point five, so 500,000 people a day, it will take us about one and a half years to vaccinate the US population or three years considering two doses. So to get to the standard that we’re essentially, people are looking for I want to be back, you know, some level of normality. You’ve got to attain somewhere of the order of 3 million vaccinations per day to get you to three months or six months in the case of two doses, which is the predominant version of vaccination. So when it comes to, you know, turning things around, that is one of the critical elements actually delivering and executing on that. And it’s not just putting them in refrigerators, it’s getting them into people’s arms. And we’ve not done a terribly good job of that, but I think there is some turnaround.
Oh, fantastic. I know. Go ahead, Louise. No, no, I
Luis Saldana
think that we’re running low on time, I think. I think that’s those are really good points. And, you know, I think EU is way behind us. So I think we’re like as we look at travel, I think travel, we don’t really look if you’re vaccinated, but what’s the percent of vaccination of the place you’re going to is an important thing. So we need to look at this very globally as well. That’s all I’d say is we have a global view of this as well.
Fred Goldstein
Well, fantastic. Once again, another great week, we came up on the half hour right at it. So thanks, everyone, for joining us this week. We’ll be back next week. If you want to reach out to us, please go to veilig health.com. You can find it down the bottom would be in the link there. And we’d be happy to talk to you about your specific situation. So thanks again, guys. It’s been a great week.
