PART 11. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

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CORONAVIRUS TRACKING – Jonathan M. Metsch, Dr.P.H. PARTS 1-11 (and prequels). March 5, 2020

“This epidemic is a wake-up call for companies to carefully review the strategies, policies, and procedures they have in place to protect employees, customers, and operations in this and future epidemics. Here are eight questions that companies should ask as they prepare for — and respond to — the spread of the virus.

1. How can we best protect our employees from exposure in the workplace?

2. When should we exclude workers or visitors from the workspace?

3. Should we revise our benefits policies in cases where employees are barred from the worksite or we close it?

4. Have we maximized employees’ ability to work remotely?

5. Do we have reliable systems for real-time public health communication with employees?

6. Should we revise our policies around international and domestic business travel?

7. Should we postpone or cancel scheduled conferences or meetings?

8. Are supervisors adequately trained?

Diligent planning for global health emergencies can help protect employees, customers, and the business.  But plans are only as good as their execution. Companies should use the current situation to optimize and battle-test their plans. Whether or not Covid-19 becomes a full-blown pandemic, these capabilities will prove invaluable as the emergence of a global pandemic, caused by this coronavirus or another agent in the future, is not a matter of “if” but “when.” “(A)

“Some companies have already taken precautions like limiting travel to affected countries or big international conferences. Others have asked employees to stay home because they visited a country with a more serious outbreak.

But with new unexplained cases being reported in the United States — and the first domestic death from the illness reported on Saturday — a growing number of American workers could soon be asked to alter their routines, or just stay home.

Exactly how that affects you will depend on many factors, including the generosity of your employer’s benefits and where you live. Here’s what labor lawyers and business groups say could potentially unfold in your workplace — and what rights workers have.

The situation is ever-evolving as the virus continues to spread — and policies are being revised daily as employers monitor public health notices.

Nobody wants employees to come to work if they are sick or have been exposed to the virus, but U.S. workers are less likely to be covered by a paid sick leave policy than those in other developed countries.

“This can put hourly workers in a bind, and make employees in the U.S. more likely to show up for work when they are sick,” said Joseph Deng, who specializes in employment and compensation law at Baker & McKenzie in Los Angeles.

The Centers for Disease Control and Prevention has recommended that employers establish “nonpunitive” policies, encouraging employees who are sick or exhibiting symptoms to stay at home.

“We may see companies develop more flexible and generous sick leave policies,” Mr. Deng said. That could reduce the hard choices that employees have to make…

What can my employer ask me to do?

Will I be paid if I’m told to stay home?

What happens if I or a family member get sick?

What are my rights if I’m worried about going to work?

Can my employer ask me to wear a mask?

Will my employer tell me if a colleague is infected?” (B)

“Amber Clayton, who directs the Society for Human Resource Management’s Knowledge Center, which fields calls from HR professionals seeking guidance, said many employers have business continuity plans in place for atypical situations, and some even have infectious disease management plans, but still it has been getting questions from companies, some about employees coming back from China: “Do they have to come back into the office right away? Can we require them to stay at home?”..

Even though technology can help facilitate some workplace decisions, Clayton said employers can find themselves in “unknown territory” with labor law implications, especially if the coronavirus outbreak in the U.S. gets much worse and forces more widespread business impacts…

The issues are more complicated for workers who are not on salary, and whose employers do not offer paid time off for leave, since often these hourly-wage employees have no legal protection for any nonworking hours, based on the Fair Labor Standards Act, which in other cases does protect them, such as in cases of overtime-pay claims.

Clayton said firms should consider paying employees for time they will be out, even if not covered by medical-leave laws or other company policies, but without a legal requirement this could hit hourly workers hard in sectors where there is no remote work option, such as restaurants and hospitality; or furloughed factory workers without specific protections in an existing collective-bargaining agreement…

“The idea that if you’re not coming in, staying home sick, that you will not get put on the next big project or not get the next promotion, this is the time to combat that … to change the norms,” he said. “At the majority of companies, that is still not the case. Employees are still worried in normal flu season about this, even though it saves a company money when people stay at home, and in this environment it’s a whole different ball game.”

SHRM’s Clayton said she is less sure about permanent changes to workplace culture resulting from the current outbreak, but she said that, in the least, for companies that don’t have business continuity plans and infectious disease management plans in place, it is time to implement them.” (C)

“The authorities confirmed on Tuesday a second case of coronavirus in New York, a man in his 50s who lives in Westchester County, just outside New York City, touching off an intense search by health investigators across the region to determine whether he had infected others.

The inquiry stretched from a hospital in Bronxville, N.Y., to a nearby high school, to both a law office and a college campus in Manhattan. The effort provided one of the first glimpses in New York of the kind of comprehensive efforts that health officials in countries across the world have mounted to stem to spread of the coronavirus.

New York health officials were tracking down doctors and nurses who treated the man in a hospital for days before he was confirmed to have the illness — and placing some in quarantine. And they were growing concerned that his son, a college student who officials believe lives in university housing, might be showing symptoms of the illness, too, raising fears of further transmission.

“I think we have to assume this contagion will grow,” George Latimer, the Westchester County executive, said at a news conference on Tuesday.

The man became ill on Feb. 22 and was admitted to a hospital in Westchester on Feb. 27., according to Dr. Demetre C. Daskalakis, the deputy commissioner for disease control at New York City’s Department of Health and Mental Hygiene. Officials acknowledged that the patient might have exposed doctors, nurses and others to the illness.

“We believe that a couple of the medical professionals have been quarantined,” Mr. Latimer said, adding that state health officials were examining “what exposure might exist” to the staff at that medical facility, the NewYork-Presbyterian Lawrence Hospital in Bronxville.

The patient has since been transferred to a Manhattan hospital. He is a lawyer who lives in New Rochelle, N.Y., and works in Manhattan.

Two of the man’s children have links to New York City. One child attends a Jewish high school in the Bronx’s Riverdale neighborhood, and the school was closed on Tuesday as a precaution. The other, the college student, attends Yeshiva University but had not been on campus since Feb. 27, according to a statement released by the school. Additionally, the statement said, a student at the university’s law school was in self-quarantine after having contact with the law firm where the Westchester man works.

City officials said the stricken man’s son, the Yeshiva student, exhibited light symptoms that could be the coronavirus, or perhaps nothing at all.

The city’s disease detectives were trying to recreate the son’s movements to learn whom he had close contact with. They have also been in touch with the small Midtown law firm where the Westchester man works and they have spoken with the man’s close colleagues to evaluate their level of exposure, officials said.”  (D)

“New Jersey has yet to see any cases and state officials insist the public health system is ready to respond, but it is now a question of when — not if — coronavirus will be discovered in the Garden State…

 “My Administration is actively engaged in a multi-level, whole-of-government approach — from our hospitals, to our schools, to our ports — to implement a preparedness and response plan for the potential spread of the coronavirus in New Jersey,” Murphy said. “Together, we are prepared to respond properly and swiftly to any future individuals who meet the (CDC) guidelines for coronavirus testing.”

The DOH has also launched a webpage with a host of resources for communities, businesses and schools. Persichilli said she is working with other government officials, local health departments and hospital leaders to ensure they are planning properly for a potential outbreak.

“As you know, hospitals are on the front line of this response,” Persichilli said. “We are actively working with the (New Jersey Hospital Association) and hospitals directly to ensure they have sufficient plans in place to prepare for and respond to a surge in ill patients or a (medical goods) supply chain disruption.”

The CDC also issued new guidance for hospitals designed to help them maintain proper stocks of medical supplies, including very limited re-use of certain respirators used by clinical staff. NJHA president and CEO Cathy Bennett, who previously served as state health commissioner, said this input allows facilities to help plan how best to protect staff and patients.

“The updated testing criteria can be helpful in improving disease surveillance,” Bennett added. “The more insight the better in honing our preparations and response.”

State Department of Education Commissioner Lamont O. Repollet, who joined Murphy’s briefing, said his department has been working to update school districts on the outbreak and urged local leaders to remain in contact with county school officials, who are serving as a conduit to the state. He reminded districts they should already have in place a policy for home instruction, consider rescheduling group events, and properly report any communicable diseases identified at school.

Repollet also reminded school officials not to allow concern about coronavirus to evolve into fear, stigma or racism against individuals of Chinese or other Asian descent. “Let’s make sure we are better than that. Stigma hurts everyone. Bullying and harassment hurt everyone,” he said.” (E)

“As confirmed cases of the COVID-19 coronavirus spread in the U.S. this week, school leaders nationwide are preparing for their worst-case scenario emergency plans. Some are already shutting down schools or considering online learning if the health threat persists.

And some are simply saying: Wash your hands.

So, who’s right? Perhaps everyone.

District leaders are right to emphasize hand washing, staying home if you’re sick and covering your cough with a sleeve or tissue, school and health leaders said. But they should also disclose their emergency plans to parents about what will happen if the virus becomes more widespread – even if it unnerves families, leaders said this week…

So far, the response from schools and health officials has varied depending on whether a locality has confirmed cases – and experts’ views on how much action is appropriate is rapidly evolving. But the uncertainty of how far the virus will spread has put school leaders in a difficult spot of projecting a sense of calm while also acting with an abundance of caution for student safety…

The Centers for Disease Control and Prevention late last week offered different guidance to schools and daycare centers depending on whether they have a locally identified case of COVID-19.

For institutions that don’t have a confirmed case, the CDC said schools should review and update their emergency plans, emphasize hand-washing, communicate with local health departments and review attendance policies – including dropping rewards for perfect attendance.

For institutions located in areas with COVID-19 cases, the CDC recommends schools  talk with their local health officials before canceling classes. Together, they can determine how long schools should be closed. And schools can also determine options for distance or online learning so kids don’t fall behind…

In the event of a school closure, he said, “there’s also a huge cost to not doing anything.”” (F)

“As state and local public health offices scramble to respond to the coronavirus outbreak, they do so against a backdrop of years long budget cuts, leaving them without the trained employees or updated equipment to adequately address the virus’ growing threat, former public health officials say.

In the past 15 years, public health, the country’s front-line defense in epidemics, lost 45% of its inflation-adjusted funding for staff, training, equipment and supplies. The Public Health Emergency Fund, created for such disease or disaster relief, is long depleted. And much of the money the federal government is racing to come up with now to combat the COVID-19 outbreak will be pulled from other often-dire health needs and probably will arrive too late to hire the needed personnel. 

Florida, with two cases so far, and Washington, where six deaths have been reported, have declared states of emergency, and state and local officials there and elsewhere assure they have staff, equipment and procedures ready. But early testing glitches in California, the failure to protect federal health officials from the virus in cruise ship patients and a climbing number of U.S. cases raise questions about that confidence.

Health and Human Services Secretary Alex Azar told a Senate panel last week that only about 30 million of the 300 million face masks needed for health care workers are available.

“Once again, we’re not that prepared,” said Dr. Boris Lushniak, a former deputy and acting U.S. surgeon general who spent 13 years at the Centers for Disease Control and Prevention and is now dean of University of Maryland’s School of Public Health.  “When those (basic public health efforts) aren’t supported well, in the time of emergency you don’t have the infrastructure to shift gears and go into emergency mode.”

The prospect of contending with an epidemic hits often-ignored public health departments already taxed by at least 70 homegrown threats, including a host of sexually transmitted diseases and tuberculosis.

It has been 16 months since President Donald Trump declared opioid abuse a public health emergency and less than a year since Kentucky warned it might have to close 42 of its county health departments amid the country’s worst outbreak of Hepatitis A. In New York City, an explosion of measles among unvaccinated children that ended just six months ago cost the city more than $2 million to fight and involved 400 public health employees, according to the Big Cities Health Coalition…

Time is also a problem, said Oscar Alleyne, program director at the National Council of County and Local Health Officials. State and local health departments have lost about 30,000 people over the past seven years, he said, and now have to find or wait for money to hire recent public health graduates and train them for these new, often short-term jobs.

It takes six to nine months to find and hire the people capable of doing the testing and other surveillance work needed, said Dr. Lamar Hasbrouck, a former CDC medical epidemiologist, who was Illinois’ health secretary from 2012 to 2015.

“The time lag is so significant, by time the people get hired, the whole thing can be over,” he said.

Dr. Nirav Shah, who was New York’s state health commissioner from 2011 to 2014, said that in addition to supplies and other department resources, funding will be needed for staff to trace the contacts of infected people. He worries most about cuts to the Epidemiological Intelligence Service, which can go straight to the source of the virus…

The health care system relies on public health agencies.

In a full-blown outbreak, coronavirus patients will be spread across many hospitals that are usually competitors, so public health agencies have to be the connective tissue that coordinates the response, said Dr. Tom Talbot, chief hospital epidemiologist at Vanderbilt University Medical Center.

“They are my heroes,” said Talbot, “because they are drastically under funded and still on the front lines helping to fight this thing.”” (G)

“Looser regulations on who can develop tests for the virus will allow for a significant increase in the number of Americans likely to be screened, the F.D.A. commissioner said.

The Trump administration said on Monday that it could have the capacity for nearly a million tests for the coronavirus by the end of this week, as the government prepares to escalate screening as the American death toll reached six and U.S. infections topped 100.

Private companies and academic laboratories have been pulled in to develop and validate their own coronavirus tests, a move to get around a government bottleneck after a halting start, and to widen the range and number of Americans screened for the virus, Dr. Stephen Hahn, the commissioner of the Food and Drug Administration, said Monday at a White House briefing…

 “We expect to have a substantial increase in the number of tests this week, next week and throughout the month,” Dr. Hahn said, flanked by Vice President Mike Pence and top federal health officials.

Dr. Hahn’s initial comments caused some confusion about the number of tests that would be administered by the end of the week, but the administration clarified that he was speaking of the capacity for increased testing, not the number of Americans that would be tested. That number is still unknown…

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said in an interview with NBC on Monday that the virus had “reached outbreak proportions and likely pandemic proportions.”..

Earlier in the day, Mr. Pence discussed the virus with the nation’s governors, and later joined the president in the meeting with pharmaceutical companies where Mr. Trump said he heard that a vaccine would be ready in three to four months. Dr. Fauci, who was in the room, clarified that deploying a vaccine was at least a year away…

Restrictions on testing have severely constrained local health departments, which were desperate to catch up with and contain the spread. Dow Constantine, the executive of King County, Wash., said the county was preparing to buy a motel in the Seattle area where people who were infected with the coronavirus could stay to remain isolated.

On Saturday, the F.D.A. said that hundreds of academic medical centers that have developed and validated diagnostic materials for the virus could begin testing patients immediately, even before the F.D.A. completes an emergency authorization review, which laboratories run by states and private companies have also applied for.” (H)

“Vice President Mike Pence said the Centers for Disease Control and Prevention was lifting all restrictions on testing for coronavirus, and would be releasing new guidelines to fast-track testing for people who fear they have the virus, even if they are displaying mild symptoms.

“Today we will issue new guidance from the C.D.C. that will make it clear that any American can be tested, no restrictions, subject to doctor’s orders,” Mr. Pence told reporters at the White House.

The federal government has promised to significantly ramp up testing, after drawing criticism for strictly limiting testing in the first weeks of the outbreak. But health care supply companies and public health officials have cast doubt on the government’s assurances, as complaints continue that the need for testing remains far greater than the capacity.

“The estimates we’re getting from industry right now — by the end of this week, close to a million tests will be able to be performed,” the head of the Food and Drug Administration, Dr. Stephen Hahn, said at a White House briefing on Monday.

But some companies developing tests say their products are still weeks away from approval.

And even if a million test kits were available, public health laboratories say they would not be able to process nearly that many within a week. A spokesman for the Department of Health and Human Services said on Monday that public health labs currently can test 15,000 people daily, though that figure is expected to grow.” (I)

“An outbreak of coronavirus disease in a nursing home near Seattle is prompting urgent calls for precautionary tactics at America’s elder care facilities, where residents are at heightened risk of serious complications from the illness because of the dual threat of age and close living conditions.

As of Monday afternoon, the emergence of the novel contagious illness at the Life Care Center of Kirkland, Washington, had left four residents dead and others hospitalized, local health officials said. A health care worker also has been hospitalized. In total, Washington state has reported six deaths, officials said.

Officials previously said that of the nursing home’s 108 residents and 180 staff members, more than 50 have shown signs of possible COVID-19 infections, the name given the illness caused by a novel coronavirus that emerged from Wuhan, China, late last year. Visits from families, volunteers and vendors have been halted and new admissions placed on hold, according to a statement from Ellie Basham, the center’s executive director…

The situation may be akin to the spread of coronavirus on cruise ships, such as the Diamond Princess that was quarantined off the coast of Japan, with one key exception, Steinberg said. People on cruise ships can be confined to their rooms with minimal interaction with staff and fellow residents. People in nursing centers are there because they need help with activities of daily living, he noted…

In the Washington state center, Duchin said, officials are advising health workers to separate cohorts of sick patients from those who remain well and to don personal protective gear, including eye protection, to avoid infection. “It’s a very challenging environment with so many vulnerable patients to manage an outbreak,” he said.” (J)

“New York is among the first states in the country to waive some fees and expenses for people who undergo testing for the coronavirus, as public health officials are increasingly worried that medical bills will discourage the poor and uninsured from getting medical care.

The federal government is also considering paying for care for those affected, possibly based on funds available through federal disaster relief programs. There are “initial conversations,” Dr. Robert Kadlec, a senior official at the U.S. Department of Health and Human Services, told Congress on Wednesday.

In addition to the nation’s 27.5 million uninsured, some lawmakers are concerned that the tens of millions who are underinsured — Americans with high deductibles or limited insurance — may also be at risk of unexpected expenses as more and more people are exposed to the virus.

The health insurance system “is designed to make you think twice to seek care every time you get a runny nose, fever and cough,” said John Graves, a health policy expert at Vanderbilt University. Even though identifying people with the virus in the early stages is critical to preventing a spread of the disease, Dr. Graves said, many people are likely to wait out any symptoms to avoid expensive care.

New York said it would require some health insurance companies to waive any cost sharing for coronavirus testing, including the cost of going to the emergency room, doctor’s office or urgent care center if within a plan’s network.

“Containing this virus depends on us having the facts about who has it — and these measures will break down any barriers that could prevent New Yorkers from getting tested,” Gov. Andrew M. Cuomo said in a statement on Monday.” (K)

Bergen New Bridge Medical Center said March 3 that it has expanded its Telehealth service Bergen New Bridge Cares to screen patients for COVID-19.

Along with partner Air Visits, Bergen New Bridge Cares offers urgent-care screening and assessment by a licensed physician of patients who have medical complaints and symptoms. Telehealth consultations with an infectious disease physician are available if necessary. Patients can access Bergen New Bridge Cares at 201-204-0712.

The COVID-19 screenings are based on the most current CDC Evaluating and Reporting Persons Under Investigation (PUI) guidelines. If further evaluation is necessary, a physician will evaluate each patient and coordinate additional care.

“With the rapidly evolving health crisis, we felt extending the reach of our services into the home was crucial in identifying patients and expediting care while also limiting community exposure,” said Deborah Visconi, president and CEO at Bergen New Bridge Medical Center.

“It is our hope that by putting our experts at the fingertips of the community, people’s fears will be eased and they will be more willing to seek early evaluation and treatment,” Visconi added.”  (L)

“In early February, Royal Caribbean’s Anthem of the Seas docked in Bayonne, New Jersey, in need of a hospital. The cruise ship was carrying patients who had traveled from China, where an outbreak of COVID-19 had taken root. Four passengers needed to go somewhere for further medical observation.

The obvious next step was University Hospital in Newark, a major academic medical center equipped with isolation rooms. “The hospital is following proper infection control protocols while evaluating these individuals,” Gov. Phil Murphy said in a statement. The patients tested negative, but the governor was clear. The state’s first coronavirus cases would go to University…

But infection control has been a recurring problem at some of the very hospitals that would likely be called upon to treat COVID-19 patients, a ProPublica review of hundreds of hospital inspection reports found. This raises concerns that they could become hotbeds for disease, putting patients at risk and rendering infected workers unable to care for others.

“Health care workers are my top worry,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. He noted that in China, so far, about 15% of infected hospital workers have become severely ill. “If this takes place in the U.S., and we see those numbers of workers sent home or in the ICU, being taken care of by their colleagues, things will start to unravel. This is the soft underbelly of our preparedness system right now.”

At least two health care workers in Northern California had preliminary positive tests for COVID-19 at NorthBay VacaValley Hospital, pending CDC confirmation. The hospital had treated a patient who later tested positive for the disease. Other health care workers who came into contact with the patient are also in quarantine.

There is no list of designated centers to handle the most critical COVID-19 patients, experts said. But the Centers for Disease Control and Prevention, during the 2014-16 Ebola outbreak, named 55 hospitals it considered to be in the first tier of treatment centers to handle that kind of crisis — mostly large, urban teaching hospitals capable of complex care like blood transfusions and ventilation.

ProPublica analyzed five years of federal hospital inspection reports for these facilities and found violations for infection control failures or other factors that could hamper the response to an outbreak at more than half of them. About 1 in 5 of the facilities had four or more violations; the analysis found more than a hundred overall. It’s not clear by looking at the reports how many of the violations led to patient infections. Problems that get cited on the inspection reports are required to be corrected as part of the regulation process.

But it’s also true that inspections only flag a small number of the actual problems in hospitals. American hospitals, overall, are so bad at preventing infections that hospital-acquired infections are considered a leading cause of death in the United States. The hope would be that the sites designated as specialized infection-control centers would do better…

Medical experts say they wonder: if hospitals can’t control the spread of pathogens under normal conditions, what happens if they face a rush of patients with a disease as contagious and serious as the one caused by COVID-19?

During the SARS outbreak in the greater Toronto area, 44% of the total cases were among health care workers. A retrospective study, published in the journal Emerging Infectious Diseases in 2004, hypothesized that “lapses in infection control measures may be responsible,” noting that caregivers were particularly at risk during procedures like intubation…” (M)

“Gov. Andrew Cuomo said he would amend his budget proposal on paid sick leave to include a provision that would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus. The announcement of the change came at a press conference Tuesday morning at the state Capitol where Cuomo signed a controversial new law expanding his gubernatorial powers in the event of such an emergency.

“I’m going to amend the paid sick leave bill that I sent to the Legislature to where there is a specific provision that says people, who because of this situation with coronavirus, have to be quarantine should be protected,” the governor said. “Their employer should pay them for the period of quarantine and their job should be protected. And I’m going to make that available to be paid sick leave, bill that I sent up.”” (N)

“A cruise ship was being held off the coast of San Francisco on Thursday amid fears that more than 3,500 passengers and crew may have been exposed to the coronavirus blamed for almost 3,300 deaths worldwide.

California Gov. Gavin Newsom said the Grand Princess was sailing with 62 passengers who company officials say had been on the ship’s previous voyage with a 71-year-old man who eventually died from the virus. The current cruise was scheduled to arrive in San Francisco on Wednesday but will not return to port until testing can take place, Newsom said. Test kits were being flown onto the ship, he said.

More than 20 passengers and crew members have developed symptoms consistent with COVID-19, Newsom said.

“We will be able to test very quickly… to determine if these individuals that are symptomatic just have traditional colds or the flu or may have contracted the COVID-19 virus,” Newsom said.” (O)

“In the wake of a series of avoidable mistakes, Donald Trump and his team have confronted quite a bit of criticism over their handling on the coronavirus outbreak. For the most part, the president has responded by arguing that the unflattering assessments are part of a “hoax” cooked up by his political enemies.

Yesterday, however, during a White House event, Trump switched gears a bit, implicitly acknowledging the missteps, but insisting that Barack Obama deserves the blame. From the official transcript:

“[T]he Obama administration made a decision on testing that turned out to be very detrimental to what we’re doing. And we undid that decision a few days ago so that the testing can take place in a much more accurate and rapid fashion. That was a decision we disagreed with. I don’t think we would have made it, but for some reason it was made. But we’ve undone that decision.”” (P)

“The House voted to approve a roughly $8 billion emergency funding deal to address the coronavirus on Wednesday, the latest step in a race to contain the outbreak that has killed nearly a dozen in the US.

It included more than $3 billion for the research and development of vaccines and diagnostics, roughly $2.2 billion to fund public health programs, and $1 billion for medical supplies and other preparedness measures.” (Q)