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Thoughts and recommendations concerning COVID-19 and business openings

May 14, 2020

Adapted from an online blog. The writer, who wishes to remain anonymous, consults with organizations to help support reopening. Taken as a whole, this represents the best standards for protecting personal safety from COVID-19.

State of the bug: While COVID-19 cases in the U.S. continue to rise (except in the places already ravaged), the downward trend in the hotspots is now giving us hope. Whether it is herd immunity or that COVID-19 has just successfully wiped out the most vulnerable is an open question.

We know a lot more about this virus than we did a month ago:

    1) The mortality rate across the whole U.S. population is pretty low. 1% of those exposed may actually now be an upper bound of what we will ultimately experience. Mortality for healthy people under 40 is very low. However, this means that the risk to older, less healthy people is very high. Mortality for a male over 65 years of age in the U.S. might be 5% or even higher if they are not healthy.

    2) The trick is identifying who is at risk and doing everything we can to keep them from being exposed. Those particularly at risk are individuals with cardiovascular disease, diabetes (type 1 or 2), obesity, hypertension, chronic lung diseases, chronic renal disease, neurologic diseases or cancer. The at-risk groups are: (1) everyone over 65, (2) everyone over 50 who has 1 or more of the above conditions, (3) everyone over 40 who has 2 or more of the above conditions, and (4) everyone with an active serious chronic condition (type 1 diabetes, cancer, lupus, etc.).

    3) Part of the reason that flu season is not worse than it might be is that we mostly have all had the flu a few times in our lives. Even if we don't carry the antibodies to this exact strain of the flu, having antibodies to a strain that is "close" genetically to the one you catch is better than nothing. This would say that getting that flu shot is a good idea, even if the makers of the vaccine don't guess perfectly as to what strains will be. The COVID-19 virus is brand new; if it gets into you and takes hold, you have no defense.

    4) The amount of exposure counts. There are enough anecdotes of young, healthy, healthcare workers, police officers, bus drivers, etc. getting a face full of virus and then falling seriously ill, such that it appears that more exposure means more risk. If you get a small exposure, it may give your body time to adapt and give you some protection. Limiting exposure, wearing masks, avoiding close contact with others (the 6-foot rule) remain good ideas.

    5) The virus is very infectious. In practical terms, if you sit in a room and have conversation with a person who is a carrier and neither of you is wearing masks, there is a pretty good chance that you will get enough virus exposure to get infected. If someone in that room is coughing, expelling more virus-laden air, you are more likely to fall ill.

    6) The experience of a choir in Washington state helps to illustrate this. One or more of the members were carriers. Not visibly sick. Singing produced more air flow, expelling more virus as well as helping the whole choir to inhale more virus laden air. 45 out of the 60 members became COVID-19 positive, 3 hospitalized, 2 died.

In spite of all this, like it or not, the country is going to reopen. We should try to do it carefully. Full reopening plans for an organization to reopen can't be easily summarized, but here are a few tips to support a smart reopening:

    1) Maintain social distancing. Hand shaking is gone, no greeting with a hug. Avoid being close to people wherever possible. This has to be part of the culture.

    2) Wear protective equipment. Wear masks at all times around people, gloves in the grocery store. We will need public service announcements about how to use gloves and masks correctly.

    3) Companies should phase in coming back to work. Phase 1: Under 40 only, no underlying chronic conditions, then after a month, Phase 2: Under 50, no underlying conditions, then after a month, Phase 3: Under 65, no underlying conditions. After that, evaluate and see how things are going. We will know a lot more in 3 months. If you are "at-risk" don't come back to work for the rest of 2020, period. The danger is just too high.

    4) Be ready to adapt. Test as much as possible, monitor symptoms like crazy. If things start to go South, change the plan.

    5) Anyone with flu like symptoms or shortness of breath should stay home. Period.

    6) No restaurants, malls, or grocery stores or gatherings of any kind for anyone in the at-risk groups. Help your at-risk neighbors stay isolated.

    7) Our offices and public spaces have to be a lot cleaner. We need to be wiping things down all the time, clean doorknobs, bathrooms, etc.

    8) Think about limiting exposure. No conference room meetings, open cookie trays or buffets. No company kitchen.

    9) And finally, the most important of all. Every employee who can work from home, still should. This is key. It reduces the number of people in the building, making everything easier to reduce the spread of the virus.

Of course, the big hole in this plan is that we don't all live alone. We go home and interact with our families. There is no way we are going to be able to open the country and keep at-risk people safe from their family members who are venturing out. All we can do is improve their chances.

And no group is going to be more impacted by opening than the health care workers. Cases and hospitalizations are going to go up. Opening could let every part of the country eventually be impacted as seriously as NY and NJ have been. Every time you interact with a health care worker, thank them for their service. They are putting their lives at risk to help you and the people you care about.


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