The Return-to-Work Roller Coaster

okay we're going to go ahead and get started hello everyone my name is Jeff Donnell and I'm president of Enterprise Health you'll be glad to know I'm going to spare you the video portion today you won't you won't have to see me with Mike Ovid beard and Rolling Stones t-shirt I want to help join our panelists and welcoming everyone to the return to work roller coaster this is a webinar that's focused on the strategies that some of the leading corporations and health systems are planning using refining and wrestling with as we all begin to return employees to the workplace at scale we know this topic is extremely timely as evidenced by the fact that at least just a few minutes ago we had over 380 individuals who had registered to attend today's session so we want to thank all of you for carving out time on a Friday during what we know is an incredibly hectic period I want to start off with just a couple of housekeeping items we've actually muted everyone except our moderators and our panelists on entry so that we minimize background noise and we are recording this session so we'll send out an email to everybody early next week with a link so that you can access the recording and feel free to share it with colleagues also I want to point out that given the uptick in virtual conferencing use we've seen a few WebEx glitches here and there over the past couple of months hopefully we won't encounter any of those today but I'm happy to report we have assembled an outstanding panel it's a group of occupational and employee health experts and these are folks that are our clients and our advisors and we've asked each of the panelists to make some initial remarks about their return to work approaches and then we'll have a Q&A session if you have any questions as we go you can submit questions via the chat feature in WebEx and we'll we'll get to as many of those as we possibly can joining me today to help moderate is dr. Fikri Isaac Fick retired from Johnson and Johnson a few years ago where he was chief medical officer and he now operates well world cancer consulting and also serves on our advisory board so thank you thick for joining us today and before we turn it over to the panelists I'm going to quickly provide a little bit of context on our organization as well as today's topic so if we were trapped on an elevator together or better yet on a webinar and you asked me who Enterprise Health is here's what I'd say we are the only cloud-based health IT solution that combines occupational health and compliance clinical care and employee engagement all on a single interoperable certified electronic health record platform equipping enterprise clients and their employees for a healthier future and we work with a number of blue-chip global organizations government agencies hospitals and health systems all of whom operate their own on-site employee health clinics and many of whom also provide employee health services to other organizations and over the last 90 days or so we've been collaborating very very closely with our entire client community to rapidly respond to kovin 19 and we've been modifying our existing pandemic response medical surveillance case management encounter documentation employee engagement and reporting capabilities all to help our clients with their specific use cases including things like travel employee monitoring testing and case management we've all been working together at a breakneck pace and not just with individual clients but with clients as part of an overall collaborative group and we've been really refining and tweaking on an almost daily basis as this very dynamic situation unfolds we actually took a lot of the functionality we developed with our clients for koban 19 and a couple of weeks ago we launched a standalone Cova 19 monitoring application for any organization that could use it because we heard that a lot of people were trying to manage their employee populations using paper or spreadsheets and then during that same period we also developed and rolled out new telehealth capability which we were actually able to develop and deploy in just a matter of days and of course now our collective focus is on return to work however is I think we all know return to work guidance is confusing at best you've got organizations like a calm the CDC the World Health Organization publishing guidance business leaders in the business media have their own take on how all of this should work and then of course governments at the country state county and city level are all contributing to the mix and we're left to sift through it all and try to tease out a sensible path forward earlier this week we published a blog post to promote this webinar and I want to read the opening paragraph because I think it frames things on what we wrote was planning for widespread return to work over the next few weeks and months is starting to look like a wild roller coaster ride and unlike the permanent well maintained and predictable path of coasters found at reputable amusement parks this ride looks like a rickety hastily assembled never expected inspected atrocity erected by a pair of beneath knee berated carnies with fourth-grade education and aspirations that don't extend beyond the County Fair circuit further this unattractive attraction is likely to have loops corkscrews and long stretches of missing track unfortunately that paragraph describes the situation that we find ourselves in today however we're very fortunate to have with us a panel of experts we're all very well educated very intelligent and willing to share their approaches and insights with us and this group certainly doesn't pretend to have all of the answers especially as every one of us on this webinar finds ourselves in a fluid changing every hour of every day environment but we are going to hear about some very practical solutions that various organizations are pursuing so with that what we're going to do is have each panelists spend a few minutes kind of telling us what they're up to what they're wrestling with and then we will we will open it up for questions and leading off for us today is dr. peter lee peter is the global medical director at General Electric he also does consulting work with Boston Medical Center and other organizations and he's actually been dealing with the corona virus outbreak on a global scale for months before it was even labeled coated 19 so Peter if you could open things up to us thanks Jeff hi everyone appreciate the intro there Jeff so I'm gonna just spend a few minutes you know really targeting sort of the global perspective around the over nineteen response you know ge is a large company we operate in many parts of the world and you know have over 200,000 employees and so hopefully you know my comments will share some insights with other Global's representatives on this call and as to sort of cross learn and think about how best to manage it on a global basis okay so we this this has been a fascinating experience to say least for us we you know very rapidly had to address issues in China as the you know you know the pandemic started to happen sent around Ohan and it spread throughout China and one of the interesting dynamics here is that we then got to see how the our colleagues in China sort of unwound everything that was put into place to address the outbreak and hence getting people back to work and so one of the first things I want to share with everyone on the call is that it is possible to get everyone you know essentially back to work okay we are we've clearly seen it in China our operations that had to be shut down due to the government directives are all up and running again okay and you know so in China they they're they took a unique perspective and that they essentially looked at you know every province city you know town if you will and then they risk stratified you know each of them into low-risk medium risk high risk and so high risk is there are more than 50 cases or there's a you know community transmission or local epidemic or you're seeing clusters of cases in the medium risk there's less than 50 tastes 50 cases during a 14 day period and only sporadic cases no clusters and then the low risk is the absence of new code in 19 cases for 14 days okay and so you know we implement it we follow the the Chinese government's directives to you know throughout the country where we had operations and you have to meet you know all the way down to the low-risk before you know things can open up and so you know as as each of us you know helps our companies and corporations think through return to work you know one of the first things to do is you know you know think through the risk profile that exists in the community in which you operate right so here in the US you know it's probably gonna be a little bit different in terms of how we respond in New York City versus how we you know respond in you know Aspen Colorado right so think through that and definitely you know follow all the regulatory demands that exists both you know from a country level down to maybe province and stay to the city and towns and because we in in this case now that we're dealing with this massive pandemic you know the the government is all involved and it's got some very interesting you know downstream impact for a company like ours so I'll share really quickly one a few lessons learned for us okay so we we try art we always follow the government directives but let's use temperature screening as an example so in China and in India they set you know across the country the definition of fever is actually 37.

3 or 99. 1 here in the US the CDC has a definition of fever 100. 4 but then they also have a surveillance definition a fever of a hundred right when we went but then we we have operations in Ohio and when the governor of Ohio requested you know that proposed his plan for employers he used a hundred point four based on the CDC's guidelines but then you know the mayor of Dallas who then recommended his proposal or the direct executive orders used ninety nine point six so they're there and and on top of all this we actually you know four months ago already had agreement on what geez definition of fever would be and so one of the first lessons learned here is you know you need to have a definition for your you know your team's to work with but you need to you know each of us need to allow some flexibility to meet the regulatory demands you know in some places it will be country specific and other places they may be down to you know the city or the town okay and you know probably you know like us you have you you have lots of very astute employees and that everybody's trying to do the right things don't forget to make it very very clear whether you're trying to say equal to and greater than or just greater than once if we don't have that clarity upfront once it you know your guidance gets out in various documents it can be very challenging to clarify that issue and obviously there at downstream you know consequences right so let's say we're dealing with a let's say we set up temperature screening at one of our facilities and someone's at that exact temperature and maybe you know you have to deal with you know employee population that's a union based that that one degree can cause a big difference in whether someone can work or not and so it's really important to be very very clear on how you want to roll out you know these types of you know actions for the company um I also quickly say that you know having site leadership is really important we're taking a very you know we're having each site meet various criterias and standards that we've put into place and we need someone that's accountable and every site to also drive all the actions that we're putting into place and I really recommend that you know appointing someone to be in charge to make sure that all the items that are in the metrics and the checklists are done properly are and as well as getting the communication of new information of updated information is key as all of you know you know our understanding of Tsarskoe v2 is constantly evolving and so we you know in our understanding of the therapeutics and you even vaccines you know maybe a year or two from now you know will need to be rolled out appropriately as well okay so I'm make sure those two things are in place and then I would just you know lastly if you think about site preparedness you know you may want to do a lot of different things like you know making sure there's enough space six feet apart from you know desk to desk maybe shutting down fitness centers you know cafeterias having only you know take the goat meals and or the seats need to be at least six feet apart you know also thinking about maybe you know having you know hand sanitizers in in more available for employees or requiring you know a face protection right and face coverings and PPEs and or thermometers there is a real challenge at the current moment in terms of supply chain for the material and so it's really important that once the plan is set into place to very rapidly work with you know reliable suppliers to get all the equipment and supplies that's needed for all the sites you know around the globe I think one last thing you know before I hand it back to you Jeff is that we we also learned just how important data management is you know Kovan 19 you know what's so unique is that I think it's such a dynamic process for the employee / patient so you know why don't we have really great ways of categorizing you know where our employees fault which categories our employees are in right so they've been tested and confirmed to have it or their presumed to have it based on a clinical clinicians diagnosis without testing because testing wasn't available you know someone may be a close-contact you know of a confirm Katie's tents there's you know suspected to have Kovac 19 our employees will migrate from category to category over time right and you know the amount of time it takes for someone to reach some sort of disposition status is also gonna vary and so you know if you we can have an employer it's uh you know rather sick requires hostile hospitalization and maybe may be out for a couple of months while others may you know just be out for fourteen days and so you know it's super super important to have some you know system or you know technology platform to be able to capture the data but in this case not just capture but be able to maneuver you know the the data as as you know the situation changes for each of the employees and lastly if you know if you're gonna do this work on a global basis or if you have to do this work on global basis pay you know very very close attention to the data privacy balls around Europe in particular you know it's it hasn't been easy for us you know in in France and also in Russia and the CIS states there are just some very particular data privacy laws that requires some expertise to navigate and it's it's not out of the realm of possibility to need to carve out you know another approach to being able to you know you know provide contact tracing or provide data management okay so with that Jeff I'll turn that back to you and that's sort of where we are we've a little bit of the insights from the journey that we've been on for the last few months great thank you so much Peter that was that was very helpful next up we'd have dr.

al Reilly al is the medical director of occupational health at Mass General Hospital and he's going to be able to provide us with a little bit of the health system point of view now same very much so I as many of you know sort of Covent is evolving all the time so we're using an algorithm based approach to our employees return to work but you know we've had to modify it over time we're using a test based strategy with PCR with the nasal pharyngeal swabs and we were finding that we were getting employees even though they no longer had symptoms it had been a number of weeks we're still testing positive so a few weeks back we had altered our algorithm to what's in line to what the CDC just came out with last night so to step back a little bit for our employees what we're doing now is there there's an app-based or a computer-based they have to log in before every shift and they ask about questions about symptoms for kovat and any temperature and they have to to answer all the questions and if they answer you know all the questions negatively then they sort of get a email message that they show at the door to be allowed into work if they have any symptoms they can't go to work it'll be flagged and then be followed up to determine if if they need additional testing also at the worksite basically there's a you have to wear a mask at all times within the clinical facility our algorithm is again a test based strategy so what we're doing is if someone is symptomatic with confirmed kovat by PCR we're waiting until they're at least ten days from the first test before we'd even consider testing again they have to have resolution of fever and all respiratory symptoms were requiring two negative swabs at least 24 hours apart and if it returns positive we're waiting at least five days the test again what we were also doing if someone in our community people are starting to be offered testing even if they have no symptoms and we're seeing employees who have always been asymptomatic and if there have a positive test we're managing them as if they were positive so we're waiting at least 10 days after they were initially positive and if they have no development of symptoms or Tork after one at nasal pharyngeal swab what we're also starting to do is do some validation of some of the Eliza serologies the city of Boston is asked Mass General to do community testing in some of the hardest hit areas in addition to that we're doing serology testing on asymptomatic employees just to get an idea of the prevalence again we're doing a test based strategy right now I think as the science gets a little better what we'd like to do is kind of move into perhaps making use of some of that serology but it's not there yet at least for us I think one of the big issues has also been in terms of contact tracing because we still are managing and tracing some of the employees that turn positive and we're seeing some workplace issues which I think will become important as we try to scale back up to return to work so for example even though there's a mass policy for all employees when they're in the facility what people were doing they were going into break areas and they were eating lunch together and we found a number of clusters that way where someone who was asymptomatic took off their mask in the break room with other employees and then and those other employees became infected so we're finding that we have to also alter kind of the work place practices as well I think in Massachusetts the cases haven't really started to decline yet we're kind of plateaued so I think for us it's a little early to really start scaling back up but I think hopefully with the social distancing and some of the improved testing in Massachusetts as the cases go down then I think we're going to start to see how we're going to scale up we've done a number of redeploying of employees a lot of employees are working from home and also doing a telemedicine visits and that's been a change for a lot of the providers to get used to but I think as things start to improve a little bit there are a number of clinics that we'd like to have people go back into like orthopedics even occupational medicine where we are doing employee health we've really kind of limited replacement visits also some of our do T and OSHA surveillance like a spirometry has been put on hold so I think as the cases start to improve then we're gonna have to start to see about how we're gonna scale that back up but again I think it's still changing right now hopeful that serology might be able to provide some assistance but for right now we really don't have enough data to really make positive changes right now okay great well thank you al and yeah it's really interesting your comments about you know about making workplace changes and you know for example realizing that behavior in the break room is contributing to the issues and I suspect that that all of us are going to are going to find that that's the case and we'll have to make adjustments on the fly well thank you again al so next up we're fortunate to have actually two individuals with us from Phillips 66 we have Tim Ray Cobb who is a physician assistant and director for medical compliance and policy as well as dr. William Parsons who is the chief medical officer and they're actually on the forefront of antibody testing for their employees and have some really interesting data this year so Tim let me pull up your your slides here real quick thank you Jeff let me start off just by giving a little background here in mid-march dr. Parsons and our executive leadership wanted to determine if there was a way for us to start testing our employees to ensure their safety and well-being at the workplace and make sure that we were not having potentially infectious people come in contact with naive employees and around that time was one habit came out and FDA announced that they had approved a emergency use authorization for their new reverse transcriptase PCR point-of-care test and dr.

Parsons and the rest of the health services leadership got into a little bit we discussed it and we decided at that time that it was not real an appropriate test we really the guideline is that your you should only be testing symptomatic employees we did not want to be bringing potentially infectious employees who may have been asymptomatic into the workplace to test and expose her health care providers and and so at that time we decided we needed to look for something else around that same time we found that FDA had also approved a way for some serology testing so we looked into that and around April 6 we found or April 3rd we found two companies one based out of Colorado one based out of Canada that had serology tests available we contacted them and ordered some serology tests we ordered 8,000 from the company in Colorado because they had them immediately in stock and then the company out of Canada we ordered we actually have a rolling order in place to get two to four thousand tests every two weeks from them we then work with our legal department to set up a consent program and and then the health services group developed a protocol and policies and and workflows on how we're going to do i GM IgG testing for our population and so on April 15th we got final approval from legal and our executive management team and we started testing our population next slide please so this is the results of our antibody testing since April 15th and these numbers are actually off these numbers were wrong around 10 o'clock yesterday morning so they're off by about a hundred tests but as of yesterday we had run almost 1,400 tests we had eight come up i GM positive only twenty come up i GM and IgG positive and twenty come up i GG positive only so that equates to just about three and a half percent of the test population which interestingly is very much in line with the numbers that Stanford got when they tested their Santa Clara population California so it kind of shows that our population is pretty much in the same exposure weight the curious thing or the interesting thing is that 30 of the 48 cases that came up positive came from four sites of which are considered hotspot sites when you consider that we're doing testing at 26 different sites and that four sites are accounting for over 60 percent of or 65% of our positive results it was just kind of an interesting finding so one of the things that we decided when we initiated this serology testing is that we needed a new encounter build-out and Enterprise Health to help us not only document our findings but be able to run reporting metrics often so I'm sure you know this is just a small screenshot of our part of our dashboard so one of the things that we asked enterprise view was build out what we antibody visit and it's one of our portlets just like you know I'm sure many of you have similar portlets but when you click on that antibody visit it takes you to a screen next slide please and what we have is a standard procedure that you select that serkova die Gigi IGN rapid test it comes in a cassette form there's too little it's it's a colorimetric filter paper test with a control line at the top and then in Jian and M to show what the witch antibody was present in that sample and then the test date you know just her usual lot information so uh as you if you look at that kovin 19 anybody result you'll notice that there's five radio dials that you can select the negative one if you selected it says pretty much that you have no antibodies in your system you are eligible to be cleared to return to work you know maintain social distancing in facial coverings good hand hygiene etc if you test positive for IgM only it says that you have to home quarantine for seven days or until asymptomatic for 72 hours without the use of medications and then you'll see employee instructions those employee instructions are automatically sent we can either print them out right there while the employees on site or it can be sent directly to their employee portal and they can access those instructions if they're positive they're told to immediately go home self start self quarantine contact our primary care provider and get a confirmation PCR test done and then when they when they're done with their quarantine period they have to be cleared not only by their primary care provider but they have to be interviewed by a Phillips 66 health care provider before they're allowed to return to the workplace next slide please so you can see there this is someone who's IgG IgM positive and again employee instructions which are very similar we know that if your IgG and IgM positive that you know we don't know exactly where you are in the infectious stages are you are you mid stage infection or you a convalescent stage because if you're mid stage you're most likely still capable of transmitting viruses and so they have very much same directions as someone who has only IgM positive antibodies next slide please and then if they have just i GG it says you have full antibodies are in our potentially immune to code at 19 and may be protected you don't need to take any further action and then they're advised to maintain the standard CDC recommendations regarding social distancing and facial coverings so I think what it shows you know we're testing that population and and we're not doing it so much as to try to find active infectious cases what we're trying to do is find out what percentage of our population may be infectious may have recovered but more importantly how what percentage of our population is still naive and therefore still susceptible and then how do we develop a plan to protect those naive employees so that they can continue to work as we are considered a critical infrastructure and that's really what testing program is designed for and that's all I have and I believe doctor person next good afternoon actually I don't have any slides to tell you that as far as on the antibody testing we did make it completely voluntary and that it was basically for informational purposes for the individuals and we had great reception for it we did of course started in our refineries approximately 70 percent of our employees in the US were labeled as essential employees and still work their jobs during this lockdown periods at various sites the rest work from home and of course we had a handful that were placed on short-term disabilities because of underlying health problems as far as what we have done getting our people back to work we have large populations in both Oklahoma and Texas which have stopped there of their lockdown procedures and we are planning to reopen our offices in phases starting May 4th both in Oklahoma and Texas where we have approximately 4,500 people that are in office type facilities or research facilities and we're going to do that in phases over a four-week period with hopefully full back to work right after Memorial Day this has been received pretty well one thing on many of our Millennials they do have child care problems we're letting them work with their supervisors and giving them to come opportunities to come in later in the month and also we are getting lots of emails regarding possible health problems that would push them back and they're using were using the CEC list of possible complicating factors for coverage overall though our people are very much wanting to get back to work and as I say 60-some percent of them have already been working on a daily basis we are offering the antibody testing basically to our operational people on the office based people who could work from home the antibody testing is really clearly being done on those people who have a history of possibly having excuse me possibly having the disease but with that I will turn this over because I believe there's other people that need to talk thank you very much thanks Tim and Bill that was great all right so last but certainly not least is Amy a delay and Amy is Labor and Employment Practice Group chair at Creek DeVault which is a law firm that specializes in occupational and employee health among other things so Amy thanks so much Jeff thanks for having me as part of today's discussion certainly over the past week or so we have seen the discussion quickly pivot to these return to work issues and planning for this next phase of the coded 19 pandemic I will say that we are already seeing an increase in OSHA complaints from employees who are back to work already and you know claiming whether correct or incorrect that their employers are not following CDC and OSHA guidance so just want to cover from a legal perspective a few things as far as considerations as employees return to work and the issues that are that are cropping up as that occurs one topic I'd like to cover is just the health care providers notes that employers are requiring one thing I would note there is to check your local and state executive orders and so forth sometimes those executive orders are actually prohibiting employers from currently requiring return to work notes so you know while in normal times it's something that we require and there are sick leave policies and therefore various types of leave you know you may have a local or state directive that's currently either suggesting or prohibiting you from requiring those as it relates to kovat Ellis's but a couple of other topics there on providers and notes in there we we are seeing them you know several different types of situations one several have talked about today where someone has an underlying health condition that makes it more likely that they would suffer you know serious illness if they were to contract köppen 19 you know employees are looking for four notes on that from their providers to provide to their employers because now that they're being asked to return to work they need to request reasonable accommodations so those notes must indicate that due to this underlying medical condition it's medically necessary for that employee to have a particular commendation the other area we're seeing requests for notes are certainly if you know someone's under your care for a co good related illness and much of the time you know return to work dates are currently available I would encourage all organizations and are caring for patients and developing those notes to come up with a standard note in that circumstance that's going to be provided to all patients I've seen a lot of clients doing that as well next area where we see notes is you know where you're advising someone to stop quarantine or you know somebody's experiencing symptoms of front of iris and seeking a medical diagnosis so these notes are going to come into play as again as people go back to work and may begin requesting leave under the familiesfirst coronavirus respond to act I think we'll see an uptick in those requests now that's employers are reopening employees are going being asked to go back to work next area I'd like to quickly cover is an issue that several others have talked about as well relating to monitoring employees and the ability of employers to ask medical questions and require medical examinations so first of all under the Americans with Disabilities Act employers can ask medical questions and can require medical examinations but only if those questions and examinations are job-related and consistent with business necessity the EEOC has said employers you can meet this standard where it's necessary to exclude an employee who has a medical condition that would pose a direct threat to the state health or safety of themselves or others and they have clarified Co in nineteen is certainly one of those situations now that it is a pandemic so yes you know any employers you are permitted to ask about symptoms you're permitted she you know ask about travel you're permitted to take temperatures which are considered a medical examination under the ABA I've given that this is currently a pandemic last week the EEOC finally came out and said yes employers you can also test or you know have mandatory testing requirements for Hogan nineteen so there was some question lingering as to whether the EEOC would approve mandatory code of nineteen testing and they have said yes you can require that your employee needs to be tested for covered nineteen I think the antibody testing is is fascinating and really enjoyed listening to Tim especially talk about it last week on the webinar you know and as as we've heard you know Phillips 66 is making this the antibody testing voluntary not mandatory my guess is that that part of the legal team's reasoning in that was you know would this be a permissible mandatory medical examination in the eyes of the EEOC I think it's possible that as we move forward in the next few weeks we'll get some additional guidance on that from the EEOC because it's certainly you know a direction where employers are moving towards and looking to get more information and therefore you know could we require in a body testing and an effort to figure out especially you know who is still susceptible so I think we should have our ears peeled for more information from the EEOC on antibody testing finally I'll just mention a few other issues I'm seeing as employers plan for the return of employees or more employees you know first of all they're developing their written plans are finalizing them or tweaking them if they already have it in place many are just now now finalizing those written play you know they're incorporating the White House's opening up America again playing and it's three phases as I've pointed out to several clients you know you'll see the CDC logo right up in the corner of that plan so it's certainly something that employers should be considering as they're developing their own plans and considering the CDC and OSHA guidance and also taking into account state and local requirements you know also keeping in mind that if you're not following you know that federal guidance then you're opening yourself up to OSHA claims workers comp claims etc you know under OSHA there being this obligation to create a safe workplace you know duty you know furtive duty to create a safe workplace for employees another issue that's popping up is employers who have employees who don't want to come back to work what I haven't been advising employers is that you need to take the next step and ask that individual why what is their reason for not wanting to return to work it's possible that the answer is there's an underlying health condition that makes them you know more at risk and therefore the employer may have an obligation to accommodate that employee it may be that that employee is afraid that safe practices haven't been put in place in the workplace to keep them as safe as possible so it may just be a matter of educating those employees on the steps that have been taken to create a safe workplace and really be on those issues you know that an individual is not really protected simply because they're afraid to come back to work and so employers are having to wrestle with what decisions are we going to make if we have these groups of employees who don't have a legitimate lawful reason not to reach this time but are just afraid of contracting covered 19 you know we're certainly getting clarification from unemployment systems that you know those individuals who are simply afraid to come back to work are not going to qualify for unemployment at least that's the position of most states on the topic of unemployment you also have employees who are saying well I don't want to accept you know would that work you're offering to me or those hours I'm just going to collect I'm just stay on unemployment issue there is certainly if you have work available to them they need to be taking it otherwise you know for you the employer to allow them to continue to collect unemployment in that circumstance you know you the employer are committing unemployment fraud so also not a workable solution final thing on a return to work as as other others have said just making sure that when employees do return to work you're enforcing these rules and standards that you've spent so much time putting into place because you know if they're not enforced that not only are we going to have increased spread but we're going to take you know then steps backwards which which still may be necessary in terms of retreating from from reopening and so forth but you also as I mentioned earlier you know run risk of increased OSHA claims workers comp claims potential third-party liability claims if you're not then enforcing you know these practices that you've spent so much time putting into place so making sure you know really taking a firm Irvine stance on those and with that I'll turn it back over to you Jeff great thank you Amy that was wonderful and again thanks to all of our panelists for for sharing with us and being so open we're now going to turn it over to fik Isaac to facilitate facilitate Q&A with our panelists we've got about about 20 minutes or so remaining we'll go until about 2:15 and remember you can pose questions using the chat feature in WebEx dick thank you Jeff you know what our fascinating discussion and really great input from all the panelists looking at it from multiple angles as it relates to the prices we're in I'm gonna basically try to you know oppose a couple of questions and I'll call who on the panel since we're all virtual here and and then hoping we will also have some time at the end for the audience who are joining us to ask the questions and you can answer them that would be great if not again as Jeff said we'll follow up my first question you know goes to actually Amy what about the potential and or the process as it relates to you know workers compensation we heard few from the panelists related to the fact that you know they noticed some clusters within their facilities or within the workplace the question is did they bring it from the outside is it from the inside asymptomatic people versus not what is your advice on that yet so a few things and really this is going to vary state by state we are seeing some states change their workers compensation laws to make it very clear that there may be coverage for individuals who contract coded nineteen in the workplace other states are not changing those laws you know obviously the the question there is well can you actually or how accurately can you trace that infection back to the workplace you know and that would certainly be to be in any of those workers compensation situations you know and maybe that someone could say and I'm the only place that I came in contact with an infected person is through work other than that I haven't gone anywhere you know it just just all of those factual considerations you know the other thing you know the perverse thing is you know it may be more more likely that someone who is working as a first responder are working in health care will have a greater success of you know establishing that that contact tracing that contact back to the workplace so it's certainly not out of the question that some individuals will be able to successfully obtain workers compensation as a result of Kovan nineteen well the one thing I would encourage employers to do here on the front end before those issues start coming in is to reach out to your workers comp carrier and have this discussion about what is our approach is going to be when you know we got one of these claims and are we going to presume that there is coverage etc soar so we reaching out to you our workers comp carrier and figuring out a plan before these issues come in particularly given where you're located you know what state you're in and what your current workers comp law might be thank you I'm gonna move fast that we do have a limited time but this question is for Peter what a story about you know the global application and you know the diversity approaches that you are facing between countries but I want to bring you down to the you know the US as you plan mix the phase you know you've mentioned earlier about the risk stratification that was followed with the number of cases and and the guidance how are you gonna apply that here in the US do you have a system how are you tracking those numbers to say it's 50 cases or more or clusters and all that do you have a system in place that could monitor and track so that's one a quick question and the second one is who is really in charge of you know who makes the call at the end of the day whether you know this operation is low-risk medium risk or okay so thanks for the great question in terms of what we're doing in the US and you know again my employer you know always follows the law and we try our best to you know keep on top of it in this case it's a little challenging you know as described given there are 50 states and but look you know what we did but what we are continuing to do is we know where our operations are right and so it's not like we have to track every state and every city we we are paying very close attention to any regulatory guidance or directives in places where we operate and so much of you know our risk stratification you know actually starts by being a good partner to the government what whether whether that's at the state level or country level or you know down at the city level what was the thinking you this part - unison yeah the the second question is who is who would be making the fall within your operation organization is it a a business continuity planning is the final fall yeah so we are we're so fortunate that we have an incredible incredible head of human resources and he's a very operational very detailed and what he did early on was you know establish you know are essentially our task force our kovat task force and you know we pulled in you know experts from the various functions like you know communications environmental health and safety you know security obviously you know medical and this collective group we meet you know initially early on we were meeting daily to you know drive essentially guide that's applicable you know throughout the entire globe and so we've set standards for each of our site and site leaders and businesses to follow now at some point right you know we're not gonna it's always a it's always a balance we don't want to overburden you know our businesses you know our manufacturing plants but we feel that it's extremely important to have a consistent approach across the entire company and so I'll give you an example right like we talked a little bit about temperature screening you know while we will dictate you know what what were we gonna you know set as that as a temperature cutoff we're not gonna sit there and say you need to use X Y & Z brand of thermometer you know at all the sites we're just not gonna do that we realize that you know the sourcing process is gonna differ from you know sometimes from businesses to businesses and sometimes you know very often from from country to country and so it is a it is kind of a fine dance between you know what what we want to say you have to do and then you know allowing some room for the sites and the businesses to decide how to go about doing it thank you Peter yeah now I just want to ask actually a question for both from a health system perspective and what uh what a fascinating approach you are applying within a healthcare system with the different protocols and the algorithm followed but also to you know dr. Carson and Tim as it relates I think Amy mentioned the issue of fear so from a consistent perspective we know and here about burnout with you know the healthcare providers and service delivery aspects and then certainly in workplaces you know the concern and in the fear of what is coming next or not and my question to both of you and maybe it will start with Alan in the follow up with Bill and Tim is how are you supporting your employees and their families as you go through this very stressful unresting times thank you very much you're absolutely right employee well-being is very much a big concern I know when I'm in the call center sometimes talking to employees you know I get a lot of those questions you can see many people have fear about themselves about their family I know some of the things that partners have done they have resiliency groups that people can participate in they also have mental health webinars one of the facilities that's affiliated with Mass General is McLean psychiatric hospital and they've done some great webinar some of the psychiatrist's there and they also are using some smartphone apps that were clinically vetted like headspace and ever mind just you know I think that the main thing is it is educating and communicating with employees every day there's sort of an email that goes out kind of listing what's been going on resources and then also for employees that may not be able to access email they also have texting on the phone if people want to participate where they will get daily updates about what's going on and also resources that they can access if they choose to maybe will live you from Tim and Bill what are you doing related to the population that either are back to the actual workplace or working from remotely okay well of course and as I had said before about 65 percent of our people are working still in the refineries and pipelines and basically they are doing business as usual we do have a couple of hotspots we do have a refinery in Linden New Jersey and we have one just south of New Orleans we also have three in California it's kind of interesting on the antibody test the first thing we did is test all my health care workers and I've got about thirty four of them and all were naive except one nurse practitioner in California it was IgG positive so we've done pretty good being I feel as far as keeping up our sanitary protocols but again I have not we do have EAP services available of internal and also a contract with Aetna for family problems and I've been a little surprised that they haven't been used as much as I would have thought the people who are working from home seem to be doing quite well in fact we're having a little static on them trying to get them to come back to the office you know our will in our industry people do know we're making a product that needs to be used and and most of our people are very well paid so the unrest really has not been there I can certainly keep going I have so many questions to go through but I think take a few questions from the audience at this point yeah that would be great thank you so much on the heels of the last question actually I think dr. person and Tim you'd be great to take a first stab at this there is a question on liability for the antibody screenings if they're not accurate if it turns out that they're not accurate what type of liability have you been advised that they're I think Amy could certainly you know chime in on that as well but for for Tim and dr.

bill what what have you been hearing from your teams on sort of liability there on the the antibody screening well we make it very clear in the both FAQ s and the and the consent that they sign that these are FDA emergency approved test the accuracy is you know we tell them what the accuracy is as listed by the manufacturer we tell them not to use this as a diagnostic test that is completely voluntary and if results should their questionable it should be followed up with a PCR viral testing so we our lawyers have been very good about making sure that we kind of cover our bases sure yeah I know I worked with Tim to put your consent form together and I joked with them that you're going to get an award for the world's most intense consent forms this year but and you know in all seriousness it was very thorough and very informative so I think that's certainly critical anything to add to that Amy or Tim I don't another question around kind of employer responsibilities when doing the testing is if you are required to report that to local or state health department or to the CDC based on the results that you're seeing on your antibody screening we are not we're not required to the especially in areas where we have quite a bit of positives we are planning to report to the county where in our refinery is or on the pipeline will report to the state great thank you another question on testing sort of from the other side here if an employee is tested outside of the employers organization and this may be a question for Amy can the employer ask for a copy of those result or for the outcome of those results before they would return to work it's going to depend on where you're located as I mentioned earlier you know there are some governor's who issued directive saying employers are not required or they're not permitted to a require return to work authorization before employees can return I mean obviously the goal there is that we're not overwhelming and over and already overwhelmed you know health system and health care providers with additional requests for documentation so it is going to depend on where you're located but as a general matter assuming you have no you know state or local directive you know it's a kind of order saying you can't do that then yes you absolutely could require that information you know a copy of those test results before allowing the return to work okay okay great yeah another question from the group here on symptom monitoring this might be a great one for Peter have you incorporated any po-2 values in addition to temperatures when taking employee screening we we've been studying that and you know especially after they the really well-written New York Times article you know from the emergency medicine physician I think it's dr. Levenson but we have not incorporated that into our screening process at the current moment you know there's a lot to think the right so you can you know one is obviously we mentioned supply chain got to get the pulse ox to is you know how do you disinfect the pulse ox after every use and three we are not sure whether that you know counts as more so that you know medical record if you will and how to store all that in many ways the temperature you know I think more more people are accepting of it as Amy alluded to and but we're not so sure on the pulse ox side yet so what the last piece is changing everyday yeah exactly yeah also have to think about what the cutoff is right so based on the benchmarking market work we've done you know folks seem to think that right around 90 you know below 90 92 you know may be a good cutoff so I think CMS reimburses for supplemental oxygen below 90 so you know look that lots of variables to think through so but the short answer is we haven't we haven't incorporated that yet okay great thanks Peter excellent question from the chat here that I'd love to throw in just one last one and and across the board for the panel who anyone for anyone who's dealt with us as how are you combative misinformation that employees are encountering you know obviously social media and maybe less than desirable websites that they might be running into information that's just not clinically accurate or not accurate even of your organization for the panel how are how are you all tackling that misinformation that's floating around oh this is Peter I'll contribute to this a little bit we we realize that's a real issue so we've won we always have our you know communication teams involved in our decision-making through the task force but you know we've also they've helped us create a dedicated covin 19 webpage so that our employees can go get very updated in you know real-time information that's already been vetted by you know our team our I mentioned that our C djaro is an incredible leader and he actually hosts you know webinars you know podcasts we are chairman also sends out information alongside with our C HR o we also have set up what's called what we're calling the covetous this line or employees can call a number anywhere from around the world to a team that we are working with who then can who are that staff by you know clinicians and can answer any kovat related questions and provide you know education on this topic ok what one one final question from the from the from the panel or from our audience and this one I know Peter actually brought up the importance of having good information technology and and this certainly goes out to anybody but I know Tim and dr. you