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By Peter P. Greaney, M.D.
WorkCare Executive Chairman and Chief Medical Officer
A great deal of effort has gone into the “COVID-19 War” to achieve greater understanding of the virus. The past few months have been marked by considerable scientific collaboration, and remarkable amounts of innovation and creativity.
However, we are now stalled at a crossroad. A third of the nation seems to be holding steady with vigilance and self-preservation. Another third of Americans aren’t sure about what direction to take. The remainder appear to be in denial, don’t care or don‘t believe the pandemic exists and want to resume the life they used to have.
I have spoken with more than 1,000 employees in the past few weeks, many of whom did not stay home while feeling ill. A few days ago, a worker told me, “I don’t have COVID-19 because it’s a respiratory illness and all I have is an upset stomach.” I asked him if he had diarrhea. He said “yes.” Headache? “Yes.” When he acknowledged that whatever he had involved more than one symptom, he became less defensive. Unfortunately, he had gone to work the previous day.
Initially, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) advised us to look for a respiratory Illness with three main symptoms: fever, cough and shortness of breath. This helped set the stage for misunderstandings about the illness. Very few of the cases I have reviewed have had these three symptoms in combination, at least at the start of their illness.
Even the name of the virus that causes COVID-19 – severe acute respiratory syndrome or SARS-CoV-2 – implies a respiratory condition. However, the illness involves multiple organs. The virus does not discriminate when it comes to where it will manifest in the body. Changing its name to better describe its multi-organ nature would be advisable. This message needs to be globally broadcast.
Early in the pandemic I wrote a blog about poor understanding of the hidden “reservoir of infection” and asymptomatic carriers. In my opinion, the focus on control and prevention should have been on children long before they started closing schools.
Children and those under 21 have adaptive immune systems. They may have a day or two of fever and quickly bounce back. (The exceptions are those who develop a cytokine storm.) Children spread the disease in the home setting. Family members do not isolate from a mildly sick, very contagious child. In turn, they get exposed and potentially become carriers. It only takes 1,000 viral particles to become infected.
The time from exposure to symptom development varies from a minimum of 5 days to 14 or more days, perhaps even longer. Some asymptomatic carriers have high viral loads, and some may even be “super-spreaders.” Evidence suggests that 80 percent of COVID-19 cases come from just 10 percent of carriers.
Even low viral load carriers are capable of passing it on to a partner through close contact, including physical intimacy. In a New York study, 64 percent of people with confirmed cases had not left home.
We know from a Seattle nursing home study that 50 percent of initially asymptomatic residents never felt sick. We also know that some asymptomatic people are capable of clearing the virus without developing antibodies. We don’t know why this happens or how long it takes.
Despite these findings, the stay-at-home message if ill or exposed does not resonate with everyone. We need to address this issue with workplace-directed training and re-enforcement.
On June 2, I spoke with six employees with probable COVID-19, most of whom were exposed to the virus the previously week. It is believed they came into contact with co-workers who had ventured out over the Memorial Day weekend. Pre-work screening, temperature checks, diagnostic testing, social distancing and contact tracing at work possibly could have stopped this domino effect.
With comprehensive preventive measures in place, their employer would have a better chance of avoiding six potential OSHA recordable cases and work-related claims while reducing costs associated with 14 days of absence per employee, potential regulatory and legal scrutiny, and unfavorable publicity.
Another part of the puzzle is the host, i.e., it’s not about the virus, it’s about the person who is providing a home for it.
As part of our preventive strategy, we need to focus on prevention in high-risk groups, which include older Americans, people of African American or Hispanic descent, those who have compromised immune systems, and people who have diabetes, high blood pressure, asthma or COPD, and/or are obese. These groups need special attention and should be a focus of continuing non-pharmaceutical interventions in the coming months.
The COVID-19 battle has just begun, and we cannot look back.
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