From an interview with Western Medical Consulting and Dr. Scott Conard:

While COVID-19 cases continue to rise throughout most of the United States, most companies and businesses have “reopened” or are making plans to resume operations as soon as they can.  Particularly for businesses in which on-site attendance in either required or critically important, they face unique challenges.  Everything is about mitigating risk so that operations can resume while protecting staff and customers/clients and avoiding massively disruptive shutdowns.

Western Medical finds itself in the middle of many of these conversations as we provide critical supplies ranging from testing kits to university hospitals; face shields to clinics; and respirator masks and 3 ply masks to businesses (and their employees), home health agencies, and hospitals.   To aid our clients we are bringing in leading experts to offer advice and tips on responding intelligently and responsibly to the pandemic.

We are starting with Dr. Scott Conard. 

Dr. Conard is a practicing family physician, long time Professor, and chief medical officer and a leading consultant to several companies that are “reopening”. We spoke to him regarding his advice to companies on coming back to work during COVID-19:

Importantly, we are referring to “return to office or plant” as most of these workers have never stopped working and in fact, many have been working harder than ever.  While most of these companies that have remained partially or completely shut were planning on returning on July 1, due to the virus surge being experienced in many parts of the US, many re-openings were delayed or canceled, and are slow in moving ahead.

We have deployed different strategies for the different type of companies but there are certain commonalities:

In all cases the foundation of the return to office strategy is based upon “the big 3”:

• Social distancing
• Using PPE appropriately
• Careful hygienic standards

Social Distancing:

There’s a lot of information out there on basic common-sense strategies (do not have workers on top of each other, install plexiglass separating cashiers from customers, etc…) but we have been working on deeper strategies.  For example, our companies have told us that while people are working hard remotely what has suffered most is collaboration which is critical in certain industries.  How do you allow the resumption of collaboration and working in teams while mitigating risk?  

 Some of our companies wanted to divide up the staff and have them come in on different days (for example divide into 5 “teams” and have everyone start in the office one day a week) but that’s not a COVID-19 compatible strategy for several reasons.  Instead, we suggested a different strategy — divide into teams by what they do and who needs to be there for teams to function best for collaboration — for example, suppose a drafting/design team needs an architect, engineer, draftsman, marketing person, and finance support. Create 3 “teams” and bring them back together at the office for one week at a time (Team A is in during week one then Team B comes next week then team C) and of course monitor everyone.  If there is exposure during the week the worst-case scenario is only one entire team is exposed BUT by the time they are due to come back they can have treatment (86% of people who get COVID-19 experience low impact) and by the time their “turn comes up” to come back to the office they will have effectively served a full 14 day quarantine period — thus mitigating risk to the company at large but allowing teams to function properly.

 Another strategy that clinically makes sense is to risk stratify those returning to work (remember this is just from the medical perspective and is not legal advice — must work with HR and legal team) 

 Divide the entire staff into 4 groups:

• Low risk — personally, low risk and no contact with vulnerable people regularly
• Low risk but contact with high-risk people at home (elderly or high risk)
• High risk
• COVID-19 impacted — in some type of protocol

The idea is not to treat all employees the same with respect to COVID-19 mitigation strategies and have more stringent precautions in place for the latter 3 groups that require more protection.  Again, it is important to work with legal counsel due to ADA and EEOC concerns. This usually requires companies to come up with ways to voluntarily obtain this information and to then educate the staff. 

 The challenge with COVID-19 is this virus turns people into weapons to spread itself and we do not know who these people are until too late.

 Thus the importance of foundational practices 2 and 3 — it is vital to have and use PPE and to have policies and procedures in place to ensure hygienic conditions in the workplace — but these policies and procedures must not only be established but followed as well.

 Wrongful death suits have begun to appear with the claim that employees went to work, got sick, and died because while the companies had policies and procedures, the managers were not consistently educating and enforcing them.  Companies must have complete alignment throughout their business:

1. C suite completely educated, knowledgeable, and aligned with policies and procedures
2. Managers/director level educated and enforcing procedures
3. Staff Returning to work understanding how COVID-19 works and their responsibility to stop the spread

Training/education is super important, lip service is not enough.  For example, one company had very strict policies in place on the use of masks and face shields (due to the vulnerability of eyes we recommend both masks and face shields or goggles to employees that come in regular contact with people and social distancing is not feasible at all times) and regular use of hand sanitizer but the company didn’t provide any! Cannot just be words must be supported through action.

Testing

We advise our companies to employ a testing protocol based on the conditions (that is, what is the prevalence of COVID-19 on the worksite and in the community).  Testing is costly, disruptive, stressful, and challenging logistically. At this time, based on the data we only recommend the use of PCR testing as the rapid antigen testing is simply not accurate enough at this time. For example a sample strategy developed for a company in a moderately affected community is:

• With low prevalence (less than 5%) we recommend a symptom-based testing strategy however if the rate goes up in the community and workplace be more aggressive.

• At 10% more aggressive — we are tracking people that may have been exposed to any outbreak.

• At 15% random testing and testing entire departments that may have been exposed even if no direct contact/exposure

• Above 20% — global testing for the entire workplace.

Case study:

Logistics warehouse: Manufacturers bring products a warehouse where it is unloaded, is gets taken into the facility, sorted, redistributed and taken back out to the retail outlets.

One of the drivers from the manufacturer had COVID-19 — infected the person receiving the inventory, who then infects his coworkers on the dock before he developed any symptoms – so 7% of the facility had COVID-19 by the time the first person was diagnosed.  We advised that the company test everyone within the “next ring” – regardless of symptoms.  When  half of them were positive we immediately advised the company to test and monitor everyone in the facility, implemented very strict “big 3” protocols -ensuring that all protocols re PPE and hygiene were being strictly followed, and thus we were able to contain COVID-19, and keep the warehouse open with only 14% of the Employees being affected.

In summary, following the 3 critical points (effective social distancing; use of PPE; and proper hygienic practices), ensuring that the policies and procedures in effect for these requirements are understood by everyone from entry-level workers to executives, supporting and empowering managers to strictly follow the protocols, and scaling testing based upon a high risk situation resulted in a successful health and business win for the company.

For more information on how your company can mitigate risks associated with COVID-19 contact Dr. Conard directly at Scott@scottconard.com.

 For assistance with any medical supplies contact us at Randy@westernsurg.com.