Recommendations to prepare for Corona (CDC & Prof Gardee)

  • March 18th, 2020

Plan, Prepare and Respond to Coronavirus Disease 2020

Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.
Find more information here.

This interim guidance is based on what is currently known about the coronavirus disease 2019 (COVID-19). The Centers for Disease Control and Prevention (CDC) will update this interim guidance as needed and as additional information becomes available.

CDC is working across the Department of Health and Human Services and across the U.S. government in the public health response to COVID-19. Much is unknown about how the virus that causes COVID-19 spreads. Current knowledge is largely based on what is known about similar coronaviruses.

Coronaviruses are a large family of viruses that are common in humans and many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people, such as with MERS-CoV and SARS-CoV. The virus that causes COVID-19 is spreading from person-to-person in China and some limited person-to-person transmission has been reported in countries outside China, including the United States. However, respiratory illnesses like seasonal influenza, are currently widespread in many US communities.CDC Industry Guidance

OSHA/HHS Guidance

CDC Business Sector Call for COVID-19

Dr. Jay Butler, CDC’s Deputy Director for Infectious Diseases and Senior Response Official for the COVID-19 response provided a situational update for CDC partners, including members of the private sector, public health organizations, universities, and clinical societies.

The following interim guidance may help prevent workplace exposures to acute respiratory illnesses, including COVID-19, in non-healthcare settings. The guidance also provides planning considerations if there are more widespread, community outbreaks of COVID-19.

To prevent stigma and discrimination in the workplace, use only the guidance described below to determine risk of COVID-19. Do not make determinations of risk based on race or country of origin, and be sure to maintain confidentiality of people with confirmed COVID-19. There is much more to learn about the transmissibility, severity, and other features of COVID-19 and investigations are ongoing. Updates are available on CDC’s COVID-19 web page.

Recommended strategies for employers to use now:

  • Actively encourage sick employees to stay home:
    • Employees who have symptoms of acute respiratory illness are recommended to stay home and not come to work until they are free of fever (100.4° F [38.0° C] or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants). Employees should notify their supervisor and stay home if they are sick.
    • Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
    • Talk with companies that provide your business with contract or temporary employees about the importance of sick employees staying home and encourage them to develop non-punitive leave policies.
    • Do not require a healthcare provider’s note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way.
    • Employers should maintain flexible policies that permit employees to stay home to care for a sick family member. Employers should be aware that more employees may need to stay at home to care for sick children or other sick family members than is usual.
  • Separate sick employees:
    • CDC recommends that employees who appear to have acute respiratory illness symptoms (i.e. cough, shortness of breath) upon arrival to work or become sick during the day should be separated from other employees and be sent home immediately. Sick employees should cover their noses and mouths with a tissue when coughing or sneezing (or an elbow or shoulder if no tissue is available).
  • Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees:
    • Place posters that encourage staying home when sick, cough and sneeze etiquette, and hand hygiene at the entrance to your workplace and in other workplace areas where they are likely to be seen.
    • Provide tissues and no-touch disposal receptacles for use by employees.
    • Instruct employees to clean their hands often with an alcohol-based hand sanitizer that contains at least 60-95% alcohol, or wash their hands with soap and water for at least 20 seconds. Soap and water should be used preferentially if hands are visibly dirty.
    • Provide soap and water and alcohol-based hand rubs in the workplace. Ensure that adequate supplies are maintained. Place hand rubs in multiple locations or in conference rooms to encourage hand hygiene.
    • Visit the coughing and sneezing etiquette and clean hands webpage for more information.
  • Perform routine environmental cleaning:
    • Routinely clean all frequently touched surfaces in the workplace, such as workstations, countertops, and doorknobs. Use the cleaning agents that are usually used in these areas and follow the directions on the label.
    • No additional disinfection beyond routine cleaning is recommended at this time.
    • Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by employees before each use.
  • Advise employees before traveling to take certain steps:
    • Check the CDC’s Traveler’s Health Notices for the latest guidance and recommendations for each country to which you will travel. Specific travel information for travelers going to and returning from China, and information for aircrew, can be found at on the CDC website.
    • Advise employees to check themselves for symptoms of acute respiratory illness before starting travel and notify their supervisor and stay home if they are sick.
    • Ensure employees who become sick while traveling or on temporary assignment understand that they should notify their supervisor and should promptly call a healthcare provider for advice if needed.
    • If outside the United States, sick employees should follow your company’s policy for obtaining medical care or contact a healthcare provider or overseas medical assistance company to assist them with finding an appropriate healthcare provider in that country. A U.S. consular officer can help locate healthcare services. However, U.S. embassies, consulates, and military facilities do not have the legal authority, capability, and resources to evacuate or give medicines, vaccines, or medical care to private U.S. citizens overseas.
  • Additional Measures in Response to Currently Occurring Sporadic Importations of the COVID-19:
    • Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
    • If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID-19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.

Planning for a Possible COVID-19 Outbreak in the US

The severity of illness or how many people will fall ill from COVID-19 is unknown at this time. If there is evidence of a COVID-19 outbreak in the U.S., employers should plan to be able to respond in a flexible way to varying levels of severity and be prepared to refine their business response plans as needed. For the general American public, such as workers in non-healthcare settings and where it is unlikely that work tasks create an increased risk of exposures to COVID-19, the immediate health risk from COVID-19 is considered low. The CDC and its partners will continue to monitor national and international data on the severity of illness caused by COVID-19, will disseminate the results of these ongoing surveillance assessments, and will make additional recommendations as needed.

Planning Considerations

All employers need to consider how best to decrease the spread of acute respiratory illness and lower the impact of COVID-19 in their workplace in the event of an outbreak in the US. They should identify and communicate their objectives, which may include one or more of the following: (a) reducing transmission among staff, (b) protecting people who are at higher risk for adverse health complications, (c) maintaining business operations, and (d) minimizing adverse effects on other entities in their supply chains. Some of the key considerations when making decisions on appropriate responses are:

  • Disease severity (i.e., number of people who are sick, hospitalization and death rates) in the community where the business is located;
  • Impact of disease on employees that are vulnerable and may be at higher risk for COVID-19 adverse health complications. Inform employees that some people may be at higher risk for severe illness, such as older adults and those with chronic medical conditions.
  • Prepare for possible increased numbers of employee absences due to illness in employees and their family members, dismissals of early childhood programs and K-12 schools due to high levels of absenteeism or illness:
  • Employers should plan to monitor and respond to absenteeism at the workplace. Implement plans to continue your essential business functions in case you experience higher than usual absenteeism.
  • Cross-train personnel to perform essential functions so that the workplace is able to operate even if key staff members are absent.
  • Assess your essential functions and the reliance that others and the community have on your services or products. Be prepared to change your business practices if needed to maintain critical operations (e.g., identify alternative suppliers, prioritize customers, or temporarily suspend some of your operations if needed).
  • Employers with more than one business location are encouraged to provide local managers with the authority to take appropriate actions outlined in their business infectious disease outbreak response plan based on the condition in each locality.
  • Coordination with stateexternal icon and localexternal icon health officials is strongly encouraged for all businesses so that timely and accurate information can guide appropriate responses in each location where their operations reside. Since the intensity of an outbreak may differ according to geographic location, local health officials will be issuing guidance specific to their communities.

Important Considerations for Creating an Infectious Disease Outbreak Response Plan

All employers should be ready to implement strategies to protect their workforce from COVID-19 while ensuring continuity of operations. During a COVID-19 outbreak, all sick employees should stay home and away from the workplace, respiratory etiquette and hand hygiene should be encouraged, and routine cleaning of commonly touched surfaces should be performed regularly.

Employers should:

  • Ensure the plan is flexible and involve your employees in developing and reviewing your plan.
  • Conduct a focused discussion or exercise using your plan, to find out ahead of time whether the plan has gaps or problems that need to be corrected.
  • Share your plan with employees and explain what human resources policies, workplace and leave flexibilities, and pay and benefits will be available to them.
  • Share best practices with other businesses in your communities (especially those in your supply chain), chambers of commerce, and associations to improve community response efforts.

Recommendations for an Infectious Disease Outbreak Response Plan:

  • Identify possible work-related exposure and health risks to your employees. OSHA has more information on how to protect workers from potential exposuresexternal icon to COVID-19.
  • Review human resources policies to make sure that policies and practices are consistent with public health recommendations and are consistent with existing state and federal workplace laws (for more information on employer responsibilities, visit the Department of Labor’sexternal icon and the Equal Employment Opportunity Commission’sexternal icon websites).
  • Explore whether you can establish policies and practices, such as flexible worksites (e.g., telecommuting) and flexible work hours (e.g., staggered shifts), to increase the physical distance among employees and between employees and others if state and local health authorities recommend the use of social distancing strategies. For employees who are able to telework, supervisors should encourage employees to telework instead of coming into the workplace until symptoms are completely resolved. Ensure that you have the information technology and infrastructure needed to support multiple employees who may be able to work from home.
  • Identify essential business functions, essential jobs or roles, and critical elements within your supply chains (e.g., raw materials, suppliers, subcontractor services/products, and logistics) required to maintain business operations. Plan for how your business will operate if there is increasing absenteeism or these supply chains are interrupted.
  • Set up authorities, triggers, and procedures for activating and terminating the company’s infectious disease outbreak response plan, altering business operations (e.g., possibly changing or closing operations in affected areas), and transferring business knowledge to key employees. Work closely with your local health officials to identify these triggers.
  • Plan to minimize exposure between employees and also between employees and the public, if public health officials call for social distancing.
  • Establish a process to communicate information to employees and business partners on your infectious disease outbreak response plans and latest COVID-19 information. Anticipate employee fear, anxiety, rumors, and misinformation, and plan communications accordingly.
  • In some communities, early childhood programs and K-12 schools may be dismissed, particularly if COVID-19 worsens. Determine how you will operate if absenteeism spikes from increases in sick employees, those who stay home to care for sick family members, and those who must stay home to watch their children if dismissed from school. Businesses and other employers should prepare to institute flexible workplace and leave policies for these employees.
  • Local conditions will influence the decisions that public health officials make regarding community-level strategies; employers should take the time now to learn about plans in place in each community where they have a business.
  • If there is evidence of a COVID-19 outbreak in the US, consider canceling non-essential business travel to additional countries per travel guidance on the CDC website.
  • Travel restrictions may be enacted by other countries which may limit the ability of employees to return home if they become sick while on travel status.
  • Consider cancelling large work-related meetings or events.
  • Engage stateexternal icon and localexternal icon health departments to confirm channels of communication and methods for dissemination of local outbreak information. When working with your local health department check their available hours.

Resources for more information:

CDC Guidance

The Facts

From Prof Rafik Gardee

Hi friends, and especially South African friends. I have posted a few stats in the early days of the novel coronavirus outbreak to encourage people not to overreact until more information was known. As I am an epidemiologist, I study how diseases develop, behave, and spread and have been trained in how to appropriately evaluate the evidence and information related to a health issue. I have been keeping up with the news and developments on COVID-19, which includes seeing a lot of misinformation being shared on social media. Instead of calling out every questionable post I see, I have decided to do my part by sharing an educated opinion on the situation. In particular, I wanted to share some thoughts specific to South Africa to help put people’s minds at ease, but also to keep people vigilant about what we as individuals can do to keep us and our communities safe from a potentially bad situation. Please note that this information is by no means exhaustive, and as we learn more about this new virus, this information may become less relevant.

According to recent disease models, between 30-70% of populations will become infected with COVID-19 (the disease caused by the new coronavirus). Many people may not show symptoms or have only mild symptoms similar to flu or a cold, but about 10% of those infected (between 3-7% of the population) in an otherwise healthy population will require hospitalisation. In South Africa, that would mean 1.7 to 4 million people would require hospitalisation.

By and large, the lessons from China and Italy are this: we must slow the pace at which the disease is spreading. This may not prevent those 1.7 to 4 million people from needing to be hospitalised, but it will help to ensure that they don’t all need to be hospitalised at the same time. Doctors in Italy, who were largely unprepared for how quickly the disease would spread, have reported that there are not enough hospital beds, ventilators, and healthcare staff to deal with the high volume of people requiring hospitalisation and they have had to make difficult choices about whose lives to save given limited resources. As South Africa has very few cases of COVID-19 to date, we have an opportunity to implement measures that can help slow the spread of infection now, so that people do not all get sick at once and overwhelm the health system. Groups of people that are more likely to die from COVID-19 from the data that has been reported so far are people over the age of 60 and/or people with chronic health conditions that affect the immune system.

I suspect that once COVID-19 is more established in South Africa, the numbers of people requiring hospitalisation for pneumonia and other severe complications will be higher than 1.7 to 4 million if we do not take preventive steps now because of specific health issues in our population that affect the immune system of younger populations as well; specifically HIV, tuberculosis (TB), and malnutrition. To date there is no data on COVID-19 in people who have these specific conditions, but here are my thoughts given what we already know about HIV, TB, and malnutrition:

– For people with HIV, those who are on ARV treatment and have a high CD4 count will likely be ok. People who do not yet know they have HIV or who are not on ARVs will be more likely to develop pneumonia and require hospitalisation.

– Because TB commonly affects the lungs (pulmonary TB), people who have undiagnosed pulmonary TB or are in the early stages of treatment for TB (first 2 weeks) may also be at a greater risk of developing severe complications from Covid-19 compared to the general public.

– When the body is not getting enough nutrients, it becomes harder to fight disease. This means that people who are malnourished may be more likely to have severe complications from COVID-19.

These three issues are of particular concern because they disproportionately affect people living in poverty, which will put a large strain on an already over-burdened public health system. It will therefore become doubly important to SLOW THE SPREAD OF THE VIRUS in South Africa.

To do so it is important that we share correct information. COVID-19 appears to spread via contact with surfaces that someone with the virus has also been in contact with. If a person that does not have COVID-19 touches a surface with the virus and then touches near their mouth or eyes, they can become infected. Washing of surfaces (including hands) with normal soap and water after exposure to the virus appears to remove this risk. We may also be breathing in the virus if someone near us coughs into the air (instead of coughing into their arm or into a mask) and we inhale droplets that are invisible to the naked eye.

As individual citizens, we can slow the spread starting NOW by:

– Washing our hands regularly, especially after being in public spaces.

– Trying to consciously avoid touching your face (easier said than done, but try to make a habit of it), and also avoiding touching other people in public spaces (hugs, kisses, shaking hands, etc). This is only a temporary measure until the pandemic has run its course.

– Avoiding spaces with large numbers of people gathering whenever possible. If you have been to a large gathering, follow above steps.

– Staying home from work or school if you have any signs of illness to avoid making others sick.

– If you have symptoms like cough, fever, or shortness of breath, calling the NICD helpline on 0800 029 999 (if in South Africa) to determine if and where you should go in to be tested for COVID-19, and wearing a mask when you go. Please note: If you have symptoms of cough and sneezing, a mask can prevent you spreading the disease to others through the drops of saliva that go into the air when you cough or sneeze, but wearing a mask if you are healthy will not prevent you getting disease because the virus is small enough to be breathed through standard surgical masks. Do not wear masks unnecessarily so that they will be available for sick people to wear.

– If you have recently travelled outside of Africa or been in contact with someone who is sick with COVID-19, be particularly vigilant about watching for symptoms and distancing yourself as much as possible from others (e.g. standing 2 metres away from others) for at least two weeks.

– If you are diagnosed with COVID-19 and are asked to go home and self-isolate, please stay home. Continue to wash your hands regularly and do not share plates or cups with other household members. Try to stay at least 2 metres away from others in the home, if possible, until the symptoms have passed. Wear a mask if you need to leave home.

As South Africans, we can also get ahead of the virus in the following ways:

– Know your HIV status. I want to encourage everyone to have an HIV test if you have not tested since the last time you had penetrative sex without using a condom. Yes, even those in committed relationships because it takes two to tango, and you do not know 100% that your partner has been faithful. You can encourage others to get HIV tested by letting them know that you too have been tested. If you have HIV, start ARVs and continue to take them. We are fortunate that ARVs are free of charge in South Africa. Please also support anyone you know with HIV to make sure that they can routinely access their medications (you can offer to fetch their meds or drive them to a collection point if not).  This will help slow the spread.

– Know the common symptoms of TB: cough, fever, night sweats, unintended weight loss. If you have two or more of these symptoms, you should ask a healthcare worker to screen you for TB. Cough and fever could be TB or COVID-19 (or both) in South Africa. Talk to your healthcare provider about your risk factors and they will be able to determine what to test you for.

– Do not spread misinformation about the virus. If someone sends you information about COVID-19 on social media that sounds different from the messages above, verify it first with a trusted source (e.g. Department of Health website) before passing it on to others. By sharing only correct information, we avoid panic and encourage others to protect themselves in the best way possible.

– Finally, support one another. There is no need to panic. If the epidemiologic models are correct, the majority of us will be exposed to COVID-19 at some point in the coming months. For those with otherwise healthy immune systems (including infants, children, and pregnant women), Covid-19 will likely cause flu-like symptoms or maybe no symptoms at all, and then it will pass. If you know someone who develops the disease and they are self-isolating, ask how you can support them. You could offer to bring them groceries and check in regularly via WhatsApp to make sure they’re not feeling isolated.

In sum, we must brace for the possibility of our health systems (both public and private) becoming overwhelmed if COVID-19 spreads too quickly. If we can slow the spread with these few small sacrifices, then if a time comes when we or someone we love requires hospitalisation, there will be space enough to help them get the care they need to properly recover and return to normal life.

Most practical advice yet on CoronaVirus  — From a member of the Stanford hospital board. This is their feedback for now on the Coronavirus:

IMPORTANT ANNOUNCEMENT – CORONAVIRUS —

 1. If you have a runny nose and sputum, you have a common cold.

2. Coronavirus pneumonia is a dry cough with no runny nose.

3. This new virus is not heat-resistant and will be killed by a temperature of just 26/27 degrees. It hates the Sun.

 4. If someone sneezes with it, it takes about 10 feet before it drops to the ground and is no longer airborne.

5. If it drops on a metal surface it will live for at least 12 hours – so if you come into contact with any metal surface – wash your hands as soon as you can with a bacterial soap.

6. On fabric it can survive for 6-12 hours. normal laundry detergent will kill it.

7. Drinking warm water is effective for all viruses. Try not to drink liquids with ice.

8. Wash your hands frequently as the virus can only live on your hands for 5-10 minutes, but – a lot can happen during that time – you can rub your eyes, pick your nose unwittingly and so on.

9. You should also gargle as a prevention. A simple solution of salt in warm water will suffice.

10. Can’t emphasis enough – drink plenty of water!

THE SYMPTOMS

 1. It will first infect the throat, so you’ll have a sore throat lasting 3/4 days

2. The virus then blends into a nasal fluid that enters the trachea and then the lungs, causing pneumonia. This takes about 5/6 days further.

3. With the pneumonia comes high fever and difficulty in breathing.

4. The nasal congestion is not like the normal kind. You feel like you’re drowning. It’s imperative you then seek immediate attention.

Serious excellent advice by Japanese doctors treating COVID-19 cases:

    Everyone should ensure your mouth & throat are moist, never dry. Take a few sips of water every 15 minutes at least. Why? Even if the virus gets into your mouth, drinking water or other liquids will wash them down through your throat and into the stomach. Once there, your stomach acid will kill all the virus. If you don’t drink enough water more regularly, the virus can enter your windpipe and into the lungs. That’s very dangerous.

The new Coronavirus may not show sign of infection for many days. How can one know if he/she is infected? By the time they have fever and/or cough and go to the hospital, the lung is usually 50% Fibrosis and it’s too late (Fibrosis is not reversible).

Taiwan experts provide a simple self-check that we can do every morning. Take a deep breath and hold your breath for more than 10 seconds. If you complete it successfully without coughing, without discomfort, stiffness or tightness, etc., it proves there is no Fibrosis in the lungs, basically indicates no infection. In critical times, please self-check every morning in an environment with clean air.

Please send and share this with family and friends. Take care everyone and may the world recover from this Coronavirus soon.

*Summary of Presidential Address concerning the Coronavirus 🦠 *

1. Declared national disaster.

2. Limit contact between person.

3. Imposing travel ban between high risk countries.

4. Cancelled/revoked visas.

5. Reframe all forms of international travel.

6. Self isolation and testing on citizens returning from international countries.

7. Strengthen screening at airports.

8. SA has 72 ports of entries, 35 will be shut down effective Monday.

9. Discourage all national travel.

10. Gatherings of more than 100 people prohibited.

11. Small gatherings unavoidable prevention and control needed.

12. School closes 18 March till Easter week-end.

13. Visits to all correctional services are suspended for 30 days.

14. Businesses to intensify hygiene control.

Source: HJW – ILF Partner