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Coronavirus: What U.S. employers and employees should know

Health and Benefits|Corporate Risk Consulting
COVID 19 Coronavirus

By Jeff Levin-Scherz and Deana Allen | January 27, 2020

The deadly coronavirus has spread from China and entered the United States. Knowledge, caution and preparation can help protect employees and businesses.

Coronavirus has health authorities on alert following 64 deaths and news that it has spread across Asia and to the United States. Similar to Severe Acute Respiratory Syndrome (SARS) MERS (Middle East Respiratory Syndrome), which both caused global public health emergencies, the virus concerns authorities because it has no cure or vaccine. An expected increase in travel across Asia for the upcoming Lunar New Year adds to authorities’ anxiety.

About the coronavirus

The initial outbreak of coronavirus, which causes flu-like symptoms and severe pneumonias, centered around an animal market, in Wuhan City, China, though there has now been transmission from person to person (including medical personnel) since the initial reports. While the Chinese government reports about 600 cases, including 17 deaths as of January 22, this number is likely to climb.

Cases have also been reported from Beijing and Shanghai, as well as Japan, Taiwan, Hong Kong and South Korea and as of January 21, 2020, a case in the United States.

Although there are reports of antibiotic stockpiling, there is no antibiotic or antiviral agent shown to be effective against this disease. There is also no immunization available.

CDC taking preparedness precautions

While the Centers for Disease Control and Prevention (CDC) considers coronavirus a serious public health concern, the agency considers the immediate risk to the American public low at this time. Nevertheless, CDC is taking proactive preparedness precautions.

Screening for fever of those who fly from China has already begun at San Francisco International, Los Angeles International and John F. Kennedy International, while Chicago O’Hare and Atlanta International are soon adding it. The CDC, working with the Department of Homeland Security (DHS), will funnel all travelers from Wuhan, China to the five airports conducting entry health screening, effectively covering all travelers arriving in the United States whose travel originated from Wuhan, China.

On January 23, 2020, CDC again updated its interim travel health notice for people traveling to Wuhan City who get sick. The travel notice was raised from Level 1, “Practice Usual Precautions,” to a Level 2, “Practice Enhanced Precautions,” advising travelers that preliminary information suggests that older adults and those with underlying health conditions are at increased risk for severe disease.

The CDC has also deployed a team to support the ongoing investigation in the state of Washington in response to the first reported case of 2019-nCoV in the United States, including tracing close contacts to determine if anyone else has become ill. The agency developed a real time test that can diagnose 2019-nCoV. Currently, testing for this virus must take place at CDC, but in the coming days and weeks, CDC will share these tests with domestic and international partners.

Guidance for traveling employees

While the threat of coronavirus remains small at the moment, employees should be aware of the following precautions to protect themselves from respiratory infections:

  • Avoid contact with those with respiratory symptoms to the extent possible. Business travelers should also not visit live or dead animal markets.
  • Traveling employees should seek medical attention if they have respiratory symptoms and fever – especially if they are traveling to China or East Asia. They should call their health care providers before scheduling a visit to be sure that they are treated with precautions such as masks to avoid spreading disease within the medical setting.
  • Those who have traveled to China or east Asia and exhibit symptoms (fever, cough) at the workplace should immediately be sent home with instructions to seek medical attention. (Employers should contact their local health departments or the CDC for further instructions.)
  • All employees should practice careful handwashing and cough or sneeze into their elbows. Consider avoiding shaking hands too.
  • U.S. based employees are far more likely to have influenza than coronavirus, but the same precautions are reasonable.
  • Employees based in China or East Asia should pay special attention to potential news of the spread of this virus. They should avoid potential exposures, where possible, and get prompt medical attention if they have respiratory symptoms and fever. Early identification and treatment can lead to better clinical outcomes and can reduce the transmission of the virus.
  • Employers can also give their expatriate or global employees access to experts in infectious disease via telemedicine.

Guidance for those who become ill

Employees should be reminded that if they feel sick with fever, cough, or difficulty breathing, they should:

  • Stay home, except for seeking medical care and avoid contact with others.
  • Seek medical care right away. Before going to a doctor’s office or emergency room, call and inform them of symptoms. Advise of any travel to China or east Asia.
  • Shield sneezes and coughs with a tissue or shirt sleeve (not hands).
  • Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.

These recommendations are appropriate for all employees and others during influenza season regardless of travel history.

Determining organizational preparedness

Is your organization really prepared for this outbreak? Consider the following:

  • Review current human resources policies and procedures in reference to communicable disease management.
  • Place educational posters in key areas (especially during flu season) and provide hand gels, tissues, etc.
  • If you do not have a business continuity plan (BCP) in place for communicable disease or have not reviewed recently, now is the time to do so. (See below.)
  • Review internal and external communication measures. Communication is critical to ensure everyone knows what is happening, reduce anxiety and continue business operations.
  • Consider information and advisories via hotlines, websites or text message system alerts.

Healthcare providers

Additional considerations for healthcare providers:

  • Healthcare providers should obtain a detailed travel history for patients with fever and respiratory symptoms. For patients who traveled to Wuhan on or after December 1, 2019 and had onset of illness within two weeks of leaving, consider the novel coronavirus outbreak in China when evaluating a patient with these symptoms and notify infection-control personnel and your local health department immediately.
  • CDC recommends a cautious approach to interacting with patients under investigation given that health care workers have already been infected with 2019-nCoV. Patients with respiratory symptoms and fever should be told to wear surgical masks as soon as they are identified. Conduct evaluations in privates room with the door closed, ideally an airborne infection isolation room, if available. Personnel entering the room should use standard precautions, contact precautions, and airborne precautions and use eye protection (goggles or a face shield). For additional infection control guidance, visit CDC’s Infection Control webpage.
  • Verify that appropriate personnel have met all training requirements in PPE (personal protective equipment) and infection control, including using PPE correctly, have been fit tested for use in aerosol generating procedures or more broadly as desired, and are trained on the communicable organism
  • Consider observation of correct use of PPE and infection-control practices.
  • Review communications with key stakeholders such as laundry, medical equipment, emergency transport, public health department, media and others.
  • Hold a joint meeting with local, regional and state Emergency Management Services and Public Health Services.

As a reminder, business continuity plans should include regular review, both during (including someone taking notes) and after an actual event. For example, if employees were exposed to this virus at the workplace, a review should focus on what could have been done better to prepare and respond. Hold a critique post-event so you can be better prepared for the next disruption, because as we see today another virus has emerged.

Your organization will mitigate risk and can gain competitive advantage by having strong processes in place to address this type of public health emergency. Your response plans must be ingrained in your thinking and be ready to implement on a moment’s notice go.

Practice BCP plan implementation

Remember to explain to employees when you perform a planned exercise that it is not a test, since a test implies something you either pass or fail. Here, the emphasis is on practicing and learning. Consider several types of exercises and training steps, potentially using different modalities for different groups of employees. Remember that we all learn more from participatory education than from lectures.

  • Web-based training, where employees complete a computer-based learning module and successfully answer questions to achieve a certificate.
  • An informal orientation that lasts about an hour is one way to educate personnel on the function and processes of the plan.
  • In a tabletop exercise, staff reviews and discusses the actions they would take, but no one actually performs any of these actions. This may take two to four hours.
  • A functional exercise simulates a scenario as realistically as possible without moving personnel, equipment and resources to the actual backup sites. This may take four to six hours.
  • In a full-scale exercise, personnel, equipment and resources are deployed to specific locations for a real-time simulation of a scenario. This can last six to eight hours. This requires the most investment of resources, but immersive learning is most effective.

We will continue to provide new blog posts as the situation unfolds.

Resources

CDC updates on the coronavirus outbreak

CDC Traveler’s Health: novel coronavirus in China

CDC Health Alert Network Advisory: Update and interim guidance on outbreak

CDC Health Alert Network Advisory: Information for state and local health departments and health care providers

CDC Information on Coronaviruses

World Health Organization

Authors

M.D., M.B.A.
Senior Consultant co-leader of North American Health Management Practice at Willis Towers Watson

RN, B.S.N., M.B.A., CPHRM, AIC, ARM
Senior Vice President, National Healthcare Industry Practice

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