Round 19 With COVID-19

okay we're going to go ahead and get started and again thanks everybody for attending today's webinar on round 19 of the covid19 pandemic and my name is jeff dinell and i'm president of enterprise health and i want to welcome you to today's webinar where we're going to talk about some of the latest challenges that employers are facing as we continue to navigate the kobit 19 pandemic this is actually the 11th in a series of webinars that we started last year in response to covid19 and i know today we have uh i think more than 125 people who've signed up for today's session so we we really do appreciate all of you making time to attend uh just a couple of housekeeping items we've muted everybody except for our panelists today so that we minimize background noise we are recording the session and afterwards in the next couple of days we'll send out an email to everyone with a link so that you can access the recording and and certainly that you can share it with others also uh we uh we are uh going to have uh entertain questions at the end after all of our panelists talk so there's both a chat and a q a feature uh in the webex so uh just feel free to use the q a feature um you know post your questions and we'll get to as many as we can toward the end of the session today today we have a we have a great a great group our enterprise health advisory board is going to serve as our panel today and we're very fortunate that we have an outside group of occupational health professionals that provide our organization with insights and guidance and advice and like you all of our panelists have been kind of neck deep in the turbulent waters of the covid crisis and each of our panelists brings a little different point of view with vantage points that include corporate health system legal and consulting settings so what we've done is we've asked each panelist to make a few initial remarks about their observations on today's topic and as i said we'll have a we'll have a q a session so again feel free to to submit your questions uh so today with us we have uh dr fick isaac uh dr bhargav chandra shakar uh dr al riley and dr kenji saito so a gentleman we we appreciate all of you uh joining us today um before we turn it over the panelists i'm just going to give a little bit of a little bit of context on our organization in today's topic and i'm going to start really quickly with the enterprise health elevator pitch and and it goes like this we're the only cloud-based health i. t solution that combines occupational health and compliance clinical care and employee engagement on a single interoperable and certified electronic health record platform and our focus is on equipping our clients and their employees for a healthier future and we work with a group of blue chip global corporations government agencies hospitals and health systems that operate their own on-site employee health clinics and in many cases also provide employee health services to other organizations and this is just a smattering of some of the organizations that we work with today and we've titled today's webinar round 19 because uh believe it or not we are now in the 19th month since the world health organization officially declared the novel coronavirus that was soon to be labeled covet 19 a public health emergency of international concern so not quite to the point where it had been named a pandemic but it was certainly a significant blip on the radar screen and you know while 19 months ago much of the general public uh may have continued to be blissfully unaware that a global pandemic loomed uh i'm certain that many of you were already coming up to speed you were busy planning your response and here we are 19 months later and you know we're still battling this disease and certainly those folks who are involved in occupational and employee health have been on the front lines um and uh you know they've been very very active in managing response for all of their organizations and i know we're all familiar with uh you know the the ongoing set of uh very stable or very sobering statistics um and in the united states as of late last week uh there have been more than 33 million reported uh cases of covid19 and more than 600 000 deaths and by comparison there were just over 400 000 u. s military casualties in world war ii and nearly 117 000 in world war one so uh just in in terms of the casualties from those two world wars combined they don't equal what we've seen in the united states in terms of deaths from covid and of course globally more than 184 million confirmed covet 19 cases and nearly 4 million deaths in terms of vaccinations in the u.

s we are at the point where nearly 70 percent of adults have had at least one covid19 vaccination and worldwide more than 3 billion vaccine doses have been administered and of course we're seeing wide variability by country and in the united states by state and locality of course in many countries access to vaccines is still a major challenge and while in the in the us that is far less of an issue we all know that attitudes toward the vaccine tend to be one of the biggest barriers to getting shots in arms i know for me i live in a rural indiana county and we're only at the 55 mark uh 55 percent of adults have had at least one dose so that's well below the national average and we know that there are states and localities that are doing uh far worse than that and of course the battle continues and you know while copic vaccines decrease case rates and other factors have enabled many of us to return to some sense of normalcy uh the fight does continue well into round 19 and i think we see every indication that more rounds are going to follow and since the early stages of this what has become a battle royale um occupational and employee health professionals like all of you have been expected to keep coming out of the corner round after round leading their employer organizations in a protracted fight with an unending series of twists and turns and i know we had all kind of hoped that by now we we wouldn't be uh continuing to talk about this topic or spend as much time as we are on it that the fact is it remains a a top priority for anyone involved in occupational health and you've all had to deal with symptom monitoring testing case management remote work hybrid work contact tracing telemedicine vaccination and the list goes on and on and on and while the light at the end of the tunnel is not only visible but shining a little bit brighter every day you know we still find ourselves uh wrestling with a new laundry list kind of punch after punch after punch and some of the things we're still dealing with include now new covet 19 variants uh including uh probably the best known right now is the delta variant because it's not only more contagious but according to some research published last week in nature it's able to sidestep antibodies that target certain parts of the virus and and it makes it that much more difficult to deal with of course there's the issue of whether or not to require vaccinations to return to work some employers especially in the health system sector have decided to go this route this route in fact we we have a client that's generated its fair share of media coverage and scrutiny uh for their stance on requiring vaccinations and speaking of vaccinations uh many organizations are contending with whether or not to require proof of vaccination and i know many of our clients are using employee portals to enable employees to answer vaccine status questionnaires upload proof of vaccination or complete declination forms and then once you've collected this information there's also the question of what what do you do with it what can you do with it and that varies certainly by country and of course the vaccination topic goes on beyond that as employers also debate what to do when some people in their population have been vaccinated some haven't and of course some people have no intention of ever getting jabbed so as employees return to work you have to think about how do these various cohorts get integrated into the workplace and how to mask and social distancing policies and the like get properly applied and then uh i think we all know that coveted vaccination has become uh highly politicized there are conspiracy theories out there all kinds of reasons that people have for not getting a vaccination and it's a again a challenge for employers to address this in order to help drive vaccination rates up and then when you think about the topic of coming back to work many organizations are still figuring out how much on-site remote and hybrid work to allow and then how do you fairly and appropriately apply those policies and as so many employees employers move to remote or hybrid work then there's the issue of the economic impact in the communities where they operate so tax revenues impact on local businesses like restaurants and retailers those are all impacted by the decisions that organizations make not only that affect their employees but again that broader economic environment and of course the list of issues goes on and on and on from mental health challenges to ever-changing guidance to new requirements from osha and other regulatory bodies so clearly as we've all seen there's a long haul effect on the individuals who get a serious case of coven 19 and likewise there is a long tail effect on employer organizations and the occupational health professionals like you that are leading coveted recovery efforts so what we've asked our panel to do today is to share some of their observations on these and other issues as they work with a variety of employers who are wrestling with the same things that most of you are so starting us off today uh is dr kenji saito and kenji is the president and chief medical and science officer at med law llc he's also the president of the northeast chapter of acom and is on the acom board and he provides occupational and environmental medicine consultative services to companies professional organizations hospitals and clinics he's also a medical leader for regulatory agencies consumer goods and transportation industries and and kenji is both an occupational health uh physician uh but he is also an attorney so he has a very unique perspective so kenji will uh we'll ask you to go ahead and start things off for us great thank you so much jeff and good afternoon everyone it's a pleasure to be here today and i appreciate everybody's attendance and hopefully we'll have a good discussion today our goal is to hopefully uh allow us to to have a discussion about what's going on and how do we move forward uh during this pandemic so i'm gonna go ahead and share my screen here and just talk about what is round 19 of cobit 19. i think it's a good time to discuss where we were where we are now and where we're hoping to be uh hopefully towards the end of this pandemic so let's chat about what we've done so far and i think to be uh before i get started i want to make sure i do have some conflicts to note uh and and jeff has mentioned all my various rules i have some academic appointments as well uh just a disclaimer that everything i talk about today my opinions uh not necessarily those of the people i work with or people i represent as clients i do have some pictures i'm going to be using today on invoking copyright issues of fair use but i want to jump right into the polling questions because that would give us an idea of where we are as to what we're hoping to talk about maybe geared towards some of the q a towards the end as well so the question right now is are you currently collecting any proof of vaccination at your workplace see if i can make this a little bit bigger make myself smaller and hopefully everybody can start chiming in through their online polling i put the chat at the the link in the chat box and i also put it into the qr code if that's easier for you um so hopefully everybody starts with require uh able to get in wonderful so it looks like some people are starting to respond thank you for that so it looks the majority of us are starting to collect some proof of vaccination well there we go as we get more people logged in uh we'll get more comfortable with this so we do have a couple of slides to warm everybody up with some multiple choice questions and then i'm going to do some word clouding as well so we'll split right now so let's see i'm going to the next question so are you requiring vaccinations to return to work and we'll talk about this too and especially from my background uh from a regulatory perspective it'd be interesting to discuss what the eeoc um has decided about these kind of questions and um i'm just going to go back to the last previous slide so it did shift a little bit so it seems like most of us are not collecting uh that proof of vaccination and uh and sorry going back here again and we're not requiring people to vaccinate return to work so this makes it an interesting concept especially from a public health perspective and perhaps we can talk about this more during the uh q a and discussion session because it really interferes with our idea of the true public health initiatives and and the idea of vaccination rates uh jeff mentioned you know the 70 sort of goal that we've had as a nation in the u. s and we'll talk about this globally as well because this really shifts the idea of individual liberties public health and how do you balance that in between in regards to individual rights civil liberties and what the public needs to be able to advance past this pandemic so next question involves is your employer going to continue to allow remote and or hybrid kind of work or are you mostly requiring people to come back to in-person only you're going to allow all remote um are you gonna allow um other options and i'm curious to see what a majority of us have decided and some people haven't decided or has gone back and forth if you read the news a lot of financial sector initially came out and said you know what we're going to require everybody to come back to the office there's some articles that came out uh suggesting what jeff was talking about some of the economic impacts that we've had especially when uh your employer owns the real estate and and the headquarters of where your offices are and they need that vacancy rate to drop what do we do so it seems like we don't have any of the extremes here with all pers in person all remote seems like a majority people are balancing the hybrid uh when we probably need to define what that means as well uh and some of them are still undecided so now we as we're approaching very different variants um are you approaching that any differently this is more of a open-ended kind of question so we can post uh post as much as you'd like to see what we can uh overall here sorry the question here is overall what is the one word you use to describe how you and your employer is handling the pandemic and we'll go to the variant question next but this is sort of prior to valiant variance um how are we doing this i think people are talking about fluidity good it's being flexible being resilient and we'll talk about some of the uh mindfulness and some of the well-being mental health and behavioral well-being so it's really good that people are talking about how fluid you need to be uh how cautious on the other i need to be as aggressive as we can see this kind of ties in with the idea of vaccinations whether it's going to be mandatory or not and what kind of goals i'm almost scared to ask sort of what kind of goals and where people are at uh nationwide but as jeff mentioned you know indiana is at 55 percent some of the nations are almost at 70 percent uh some of the states that we've had um some good successes there and others not so much so i think majority of us think about flexibility and that's why the grow the word is kind of growing here is that we need to have that sort of idea and occupational health we really transform and morph this past 19 months from a what do you do occupational therapy to all of a sudden wow employee health occupational health we understand uh you know at the end of the day the workforce the human capital truly does have a huge impact not only on local businesses but also to global businesses as well as various economic uh institutions as we can see if you don't have health for the workforce you definitely don't have health in the nation so i think we've learned a lot we're hoping to take some of the silver lining that we've gotten from the exposures we've received in occupational health and hopefully we'll take it to the next uh level and what we can do to be able to be flexible to be fluid and to understand how do we interface with economics uh politics a society overall as we promote health and well-being so this is great we'll come back to this again because i think it's really important to focus on what we all thought about what we've done and then improvement we've seen it in the surveillance program as well so this is very helpful so now will you be approaching the variants any differently than you have done in the past 19 months the question you know that jeff mentioned too was the delta variant hopefully we've learned something this past 19 months and the question then is if we're gonna have variants be introduced because this might not be the first and the last of the pandemics that we'd see uh hopefully the last in this century at least but um we need to learn because there's always going to be other natural disasters uh and i think a huge part of what uh safety security and hr starting to learn in occupational health and what we can offer is that we we can be in our uh we can respond we can help in crisis movements and especially when it involves human capital and human beings and the public and our consumers our patients uh so i think it's really important to learn that we have a process in place now and understand what is the benefits of occupational health so it seems like most of us um are not going to be approaching any differently which is helpful and those who are it'll be nice to have this a discussion as well so the question i have last year and i'll leave some time for us to answer this is what jeff brought up at the end too how are you as employers or representative your employers addressing various economic impacts and communities in which you operate uh such as any kind of impact on tax revenues right for example if you're working in one state but live in another which state is taxing you you know we've always had this question before in sort of neighboring states but now with remote work and hybrid opportunities who should collect the income tax should it be the state the local locality where you work where you live combination of both there's been compact agreements between various states in the past that allow for these things that might need to shift so there's gonna be a whole change in what that means and where you work how you work and who's gonna get taxed for that and i think that's eventually gonna get settled at some point uh whether through legislation or maybe through the courts that it'll be quite an interesting questions the other question that came up is uh how would you address this economic impact of local businesses some businesses were developed around the the community of employers if you look at some large employers who house about a thousand employees in one headquarters and you have all these restaurants and other saloons and other uh businesses that popped up because of that how's that going to impact you as an employer so this is an open-ended question i'll leave this open for a little bit as you want to chime in we'll come back to this towards the end as well as to what do you think these economic impacts are should it matter should we factor that in as we kind of give our opinions as to a return to work model and a lot of questions might be i don't know maybe i'm not really sure how this is going to impact uh and if trust me your ceos will be thinking about this because uh especially if you're working at public health entities there's always a question about you know what is that perception of what your community is offering and how are you supporting your local community where you work so be interesting where people are thinking here we need adapt to the next normal i think it should be the state of the business and the established in that could be it and i think a lot of people are going to ask these interesting questions right because some cities who rely on employees to come back to work in their in their physical locations may go out of business or bankrupt in a short amount of period when there's no income tax to be collected in that state so it's going to be a challenge and an interesting question for the company especially if you're headquartered in that city or locale where they do collect a local and municipal income tax so interesting question we can talk about more during the discussion as well so continue chiming in it's an open-ended uh answer polling there so while we're doing that and thinking about it i sort of want to introduce the idea of public health law uh this article just came out from a colleague at tufts in new england uh talking about sort of why do we need to protect civil liberties especially during a pandemic and this became a really hot topic especially the idea of mandatory vaccinations questions about uh health questions like have you been vaccinated how are we going to address this any differently from the other contagions like the influenza or people have asked well if schools can require mmr or not and have waivers what not are we going to look at the source code v2 any differently as we develop different variants so we're going to respond to that differently so barely comes interesting questions about individual rights versus those of the public and we've had a whole slew of public health law topics pop up saying hey when does the individual right supersede those of the public or vice versa when can the public uh welfare supersede your individual rights and this became a very interesting question especially here in the u.

s i want to give us a bit of a global perspective before we go back and think about the us alone and that is this article uh dr levine actually works over at tufts uh in the civil liberties department and they talked about uh globally so he looked at hungary and poland in the eu and say okay what have we looked at in regards to transparency of laws and not only that but we've had some sort of predictable enforcement as you've seen recently when osha sort of promulgated some of their rulings around covet 19 it was a little later than what the cdc had announced a couple weeks prior so that became a little issue right how because you know as we all know osha is an enforcement branch whereas the cdc and niosh is more of the uh sort of guidance branch so that there's no teeth for what they say unless you can enforce it so what we found in this study that dr levine mentioned was if you're going to have some public health law be implemented we need some really good predictable enforcement opportunities because otherwise it doesn't help curtail some of the civil society organization and sort of their perception of being free from repression and and what does government do and giving a rationale behind that so this really shows that poland and hungary went through the same issues and this is a sort of historical perspective as to what was going on and how it's sort of inflective of what the past couple years was in poland and hungary so bringing it back to the u. s you know it came up at a prime time people wanted to understand what are you individual rights versus the public health are the constitutional protections especially for the uh sort of interference between the federal and state governments but what are the ethical implications of it what are the political aspects of open 19 measures and how are they going to be enforced so i think from the employment perspective we know osho is going to be the enforcer we know nash and cdc can give guidance and the question is how does it interface with public health you know as us of us who are board certified in occupational medicine we're technically under the specialty of preventive medicine you know and we specialize in occupational medicine and for those who are residency trained we're residency trained in occupational and environmental medicine and so we have this short sharing of responsibility with public health preventive medicine the question is how do we balance that how do we harmonize those needs so the question it was a relevant one and there's a whole hour course on this that luckily the cdc has uh promulgated looking at public health law and looking at what the opportunities are for um understanding how does our health decisions impact uh laws so here's a um opportunity here i'm going to go ahead and put into our chat box a link to the cdc uh sort of uh educational series about public health professionals and how do we uh address that so i want to share that with you and we can go through that but like i said it's going to be an hour-long talk if i talk about public health law it's quite interesting how to bounce out our constitution if you think about our founding fathers they really thought things through they really gave us the three branches of government the legislative judicial and uh executive to really have that checks and balances and and public health sort of falls under the executive branch right because the cdc is uh one of the executive agencies uh to direct reports to the president and as we all know niosh is part of the cdc and osha is under another agency in the department of labor so it's quite interesting that these laws kind of intermingle through administrative laws but also through other public health initiatives so be interesting if you'd like to go ahead and take go browse through the course that cc offers and uh we can discuss this more than towards the end as well but going back to our previous questions be curious to see where we are with uh what people are thinking here so i think people ha let's see if there's any other comments no but we can talk about this more towards the end so uh again a warm welcome from new england this is a picture from the uh white mountains here in uh in maine slash new hampshire so for those of us who ever get a chance to visit i encourage you to come and and check out new england and uh if you have any other questions i'll be happy to answer them towards the end so i'm going to hand this back to jeff okay thanks a lot kenji and uh appreciate your perspective and uh you know especially both a medical and a legal one okay next up uh is dr fick isaac and dr isaac offers strategic advisory market research and board level support to both public and private sector clients who are focused on global health and wellness strategies policies and solutions fake is a pioneer in the field of workplace health promotion and global health he's the former vice president of global health services for johnson and johnson and i know that he has been advising a number of different clients in different industries uh about how to navigate their way through covid so vic we'll hand it over to you to share a little bit about what you and your clients are wrestling with these days uh thank you uh jeff and uh a pleasure uh to be part of uh this um this discussion and uh to join uh this elite panelist uh thank you kenji for doing the polling and really helps kind of to guide the dialogue uh for all who are attending um as jeff said um since i i left johnson and johnson i've been doing consulting and what i would reflect on uh some um kind of quick uh remarks on uh what i have seen as it relates to question asked at this stage um most of the um the client that i have been um supporting are either in the large you know mid-size to large corporation um and the more in the i. t uh business uh or the financial uh business and certainly in the pharma or the pharmaceutical uh uh you know uh uh business so that's kind of really where the view will be coming from uh to share uh with you so i think some of the questions asked that are in what uh what you know should you require the vaccination to come back to work and as you saw from um your own uh reflection most of the companies that i have been supporting through the covid pandemic do not require you know vaccination to come back to work certainly that has been quite a bit of a discussion should it be required if we require vaccination would that help us not to really apply a lot of the other measures uh such as the you know office rearrangement the distancing um also to bring people uh quicker back to the office environment versus remote work and i'll reflect on that later on um but overall definitely as as kenji stated you know requiring vaccination does come with a huge number of issues uh whether it is eoc related whether it is ada related uh or others and certainly you have to really it's a complex process it can certainly uh apply in certain categories in certain jobs or sectors but overall the one i've been supporting the recommendation has been and again that reflect my opinion as well as based on what i have seen in the marketplace you know that requiring vaccination might not be the best way to bring people back to work um you know the next to that should you collect the proof of vaccination and and how it has been used and um what i have observed on uh those companies one uh all of them actually look at it from the angle what exactly the purpose why would i be collecting the proof of vaccination um and if you can answer that question because the you know the the the driver uh for collecting the data or the vaccination record has to have a reason why and what i have seen most of them are now uh requiring uh or not requiring asking on a volunteer basis to provide a proof of vaccination and asking the employees to go to their you know hr portal and input their vaccination data or records certainly uh i've seen in the manufacturing sector uh that has been uh you know there is quite a bit of a push however it is not a requirement to have the vaccine record on this uh note uh most of them really were seeking one uh to uh you know apply the incentive many of the companies have implemented incentives to encourage uh people to receive the vaccine and uh that basically would be a proof of vaccination would be required in order uh to uh receive the um you know the the the you know the discount or uh to uh you know to um uh you know apply the incentive uh ruling um others certainly are as i mentioned just uh requesting voluntarily to input the data into the their system and that's kind of really uh what i have seen some are basically uh asking for it just uh kind of to get a a percentage of vaccinated versus unvaccinated and to kind of guide their return to the office type of planning uh and that's kind of really which takes me to you know the next uh question which has been you know how do you manage how do you manage your turn to work with a mix of vaccinated and unvaccinated uh individual and that uh some of the uh the folks have been supporting really requested quite a complex algorithms uh on how do we deal with the vaccinated versus unvaccinated um you know do we require you know uh a home testing uh and a negative test on all versus only on the unvaccinated individuals should we have a designated space for vaccinated versus non-vaccinated to really ensure uh that the unvaccinated uh folks kind of really uh uh do not potentially uh have any issues uh with regard to um being in the in the office setting and as you can tell this is very controversial and i right now the what i see out there is that the the uh the return to work started with doing home testing uh for all vaccinated and unvaccinated certainly designated space really was a extremely controversial that most of the folks decided not to go with that route or in that route because of how complex and also issues related to uh you know uh rules and regulation in bringing people back to work um with that said um you know at the moment actually i do not see uh most of them did drop even the requirement for home testing and or on-site or need site testing prior to return to work and what they are doing is really staggering return to work uh with the mix of vaccinated and unvaccinated individual while is still applying you know the question uh the questionnaire uh sets that people can respond to as it relates to uh symptoms versus you know asymptomatic and i think that's kind of uh again a direction as we see the uh the the the percentage of vaccinated uh moving up uh the ladder uh certainly with some exception in certain region or certain um you know uh states um now the the question also came about about allowing the remote or the hybrid work and um uh as you saw on the response from uh this sample of all of you on online um a lot actually moved into especially in the financial uh you know business moved into uh almost a hundred percent um a a remote for those who are not for certain categories where they do not have to engage face to face with uh customer not customer facing uh most of those roles can be done remotely and actually some companies felt that that will save their money as it relates to real estate especially in you know in the cities like new york uh and or uh in los angeles uh for example um some are actually did uh want uh especially one a financial um investment uh company really wanted all employees to be back in the workplace uh physically despite the fact that you know they have been doing the remote work for almost a year and a half already uh part of the the desire and that may reflect on the next question was actually they are investing quite a bit in real estate businesses and therefore they really want uh to keep um you know the real estate business live and um and avoid you know the issues of uh no occupancy so um you know it varies by the business type uh but most of them really wanted everybody back to the office in some format and the hybrid model appears to be the way most are heading towards with the exception of course in certain setting manufacturing and other types of arrangement where you need people on the on the ground you know healthcare and i'm sure al will reflect uh on that as uh as we get through with that said um uh the hybrid model some uh did apply you know the week on week off working from home uh some actually relaxed their hours uh and allowed people now since they have home based type of setup allow them to take their work and go home and and do that uh others also like fridays they are now given being more uh more flexible as it relates to you know fully being in the office and will be still continue to be a learning curve for corporation and their management on how to handle this as there's still some resistance to the invisible uh or absent you know physical absence in the workplace and and we'll see how how that evolve over the next few months um uh you know regarding the the the implication as i mentioned one example where that was the driver another example where a business really is uh the source of the nourishment uh within their locale or within their city and with their their town and one of their ceo push was really to bring people back to the office because certainly that allows people uh to um you know go out utilize the restaurants um you know have meetings uh hotel occupancy uh improvement and all of these things so bottom line really it depends on one uh the culture within the business it depends on the uh driver of the business as wherever they are on how can they support the communities around them and or if they do have a business reason to bring people into the workplace i'm going to stop here i can certainly keep going but i will stop here and return it back to jeff thank you fick appreciate it okay next up is uh bhargav chandra shikhar dr chandra shikhar is an occupational health physician at glaxosmithkline and he's involved in knockhealth program management across multiple r d and manufacturing clinics for gsk in north america also contributes to employee health and wellness strategy and delivery uh working with safety professionals hr professionals and and other business leaders and he also provides consultation and leadership on population health employee health and well-being issues so bargab we will uh we will turn it over to you thanks a lot jeff and just checking you can make sure you can hear me nice and clear yes okay great thank you so much for the for the opportunity to be a part of this present of this webinar and to be part of the panel um and then thank you kenji and fake for your for your comments and really helpful to see where the audience is coming in um in this conversation absolutely i think that the title is is uh is correct 19 months in that i can't wait for the day we we can stop using the term social distancing um and for me really just a couple high high principles that that i that i noted um really like i mentioned to you jeff before this is this has been the super bowl i think for for occupational health and one of the um just most incredible ways we've been put in the spotlight as a function and and as a specialty and compared to i think the the old time of uh employees interacting with our function as oh i went downstairs to get a respirator fit test for my end you know a tv test or something they came and adjusted my chair or something just really uh really really um different than what we're doing today um i really want to take the time to recognize how much we've all grown in this past year and a half and how much how much we've had to learn and how much uh we've we've had to to lean in and support the business in probably ways that we never expected either through training or just in decades being being in this field and what i found really sort of neat was the comfort i i sensed in the decision making process when the poll question came up are you going to significantly change things when the variants are coming out and most people said no but i still saw keywords coming out that flexibility and fluidity so there is this um what i took apart took from that it was this appreciation for evolving data but a sense of comfort and confidence in decision making that that we've all uh learned through the you know the the first reports of a virus in in wuhan and how it's it's moved across the world so really i would encourage people in the in the audience as well as my colleagues in this panel to continue growing that that skill set and gaining that confidence and always using a data driven approach and i think that's that's certainly served me well as i've supported glaxosmithkline uh through through covid and the the common theme i think through all the topics that we will probably get into if not uh if we haven't already is the notion of trust and absolutely as medical professionals and a lot of administrators i'm sure on the call it's the goal is to not do any harm and the trust is whether employees are wondering what are you going to do with my vaccine data or for at-risk workers or unvaccinated workers am i can i trust you to create that that safe workplace and of course it's you need to have a robust occupational health team and of course the i.

t infrastructure to keep all this data and the more you can constantly say the infrastructure is in place that's going to go a long way in in the decisions you make at in this evolving evolving landscape occupational health professionals have have routinely been at the intersection i think between hr professionals employment law uh say certainly safety professionals and and sort of that that conduit to to business the business and business leaders and helping them navigate we are very comfortable with an accommodation process or or sort of the squishy side of where medicine lands with different different occupations so really tapping into that that strength and that experience that we've built in other situations besides covenant and using that um and just just the last point really for me is the way i i'm looking at this for gsk or for any any um anybody else i would advise that is navigating the situation is when you're when you're dealing with what might osha think about this or you know the the ets just came out and i need to change everything really i think any regulator is looking for a good a good faith effort and for you to take a really a data-driven and sensible approach to whatever you're doing um for example a lot of the osh requirements include providing continuing to provide pp they know you can't completely change the workplace overnight but it's what are you continuing to do do you have a plan in place are you looking at the data whether it's vaccination rate whether it's community case rates or you do you know that they're variants uh happening and and um things like are you giving time off of it for your employees to go get vaccinated the term communal areas has come out for continuing to protect populations unless you're an employer that's going to require vaccination for the foreseeable future you're always going to have a a mixed population and this is this has been there before colgate you've always had people that couldn't get certain vaccinations because they were had allergies to certain components in a vaccine or they were or vaccinations were ineffective if they were they had certain immunocompromising conditions or what is even more pervasive is people that have loved ones at home who either are immunocompromised or ineligible for vaccines so you're always going to have this spectrum and that's why i would i would stress always looking at the workplace and putting sensible things in to protect everybody to the extent possible and for example i just mentioned by communal areas we struggled with how to implement um guidance and i was thinking about the the parts of a workplace that people cannot tell a conference to or have to use by virtue of just being on site we think about you know restrooms or where they may congregate to get food in the cafeteria and really keeping some of those social distancing markers and some of the obvious signage there and versus in an open plan seating you do have the flexibility you can walk away you can you can distance yourself there to to take down some of the signage and this is an approach to take into consideration the increased facts uh subsequently you know i apologize the increasing vaccination rate the low case rate but at the same time you are being cognizant of uh where you you might have a mixed population interacting with each other more frequently or they have they have to use a certain service on site so really the point i'm trying to drive here is to take a a sensible approach be thoughtful about it take your time there's certainly no rush to change things and uh give yourself that flexibility to to keep up with the changes thanks jeff thank you bhargav okay and our final final panelist today is dr al riley and dr al is the medical director of occupational health at massachusetts massachusetts general hospital uh and he uh has been in the occupational health field for quite some time with some of the largest medical facilities in the industry uh and he's uh uh serves as a physician in the department uh at medicine at cambridge health alliance and is also a clinical instructor at harvard medical school so al definitely interested in in hearing your perspective from somebody who's uh working in the hospital and health system space thank you very much good afternoon and again just to reiterate like the other speakers these are my opinions and not necessarily the opinions of my employers or the individuals and companies that i consult with in some ways healthcare specifically hospitals already collected information about vaccination just as background um prior to covid um there was guidance for healthcare workers to be vaccinated against common transmissible diseases like measles mumps rubella there were some states who had legislation for example new york required that if you worked in a hospital you had to show proof of vaccination immunity against measles and rubella in massachusetts if you worked in maternal child health you had to show vaccinations against rubella obviously eeo and ada if someone um had a medical contraindication or sincerely held religious belief or preference if if possible if that uh could be reasonably accommodated that was in place also the federal government a number of years ago required hospitals to report the percentage of hospital workers who had been vaccinated against influenza or declined influenza vaccination so that information already was being captured by hospitals collected and stored confidentially in the confidential medical record some states allowed hospitals to make influenza vaccination required for hospital workers and what some hospitals did if the person had a medical or religious reason why that they couldn't get vaccinated they were required to wear a mask so with kovid some of these issues are still in place and you may have seen in the news that some large hospital systems such as mass general brigham yale henry ford university of california new york presbyterian mercy health university pennsylvania houston methodist are requiring vaccination obviously if someone has a religious or medical contraindication you know they might be eligible for a reasonable accommodation what's going to make this difficult is there are some states that are considering already passed legislation barring coveted vaccine mandates so it's going to be very difficult for corporations hospital systems with a large footprint in multiple states to keep track because there may be local differences currently recommendations for personal protective equipment for healthcare workers remain unchanged so again the current guidance is healthcare workers should continue to wear source control meaning masking when they're in the healthcare facility including break rooms or in other spaces where they may encounter co-workers in march the cdc had updated their guidance to clarify that if a asymptomatic healthcare worker who was fully vaccinated had a high-risk exposure they didn't need to be restricted from work so hospitals were already capturing that information because as part of infection control and source testing if someone had an exposure you would reach out to the employee and find out if they were fully vaccinated they wouldn't need to be restricted from work you may have also seen in the news for hospitals osha came up with a new emergency temporary standard that required new requirements to protect health care workers and healthcare support workers with some exceptions the emergency temporary standard applies to all settings where any employee who provides healthcare services or healthcare support services so the standard again osha enforcement requires uh organizations to have a hazard assessment a written plan and a classification of risk and the idea is that you a hospital would require policies and procedures to minimize the risk of transmission to covet for each employees part of that standard requires that patient screening where direct patient care is provided so employers must limit the number of entrances to the facility screen patients residents and non-employees for symptoms of covid and follow cdc uh guidance about infection prevention and control also with the temporary standard employees have to screen employees before each workday and the employer must require employees to promptly notify the employer of a confirmed positive test for covid a diagnosis or reported suspicion of covet infection or symptoms consistent with covid the standard also requires healthcare employers to provide and ensure the use of personal protective equipment and social distancing if social distancing isn't feasible to maintain a distance of six feet from other people the employer must ensure that the employee is far apart as feasible and that may require overlapping controls such as physical barriers source control hygiene and ventilation so in some ways for for hospitals the workers are still going to wear a mask and still do a lot of the controls that were recommended earlier in the pandemic as was mentioned earlier federal eeo laws do not prevent the employer from requiring all employees physically entering a workplace to be vaccinated for covet subject to reasonable accommodation again as part of that interactive process the analysis for undue hardship depends on whether the accommodation is for a medical contraindication or for religious belief or preference some of the standard reasonable accommodation might be employers with employees who can't get vaccinated that they have to wear a mask well they're already doing that in hospitals uh work at social distancing from co-workers which again is probably already occurring in hospitals where it can occur again or maybe modify their shift if possible they may require periodic tests for cova that remains to be seen for hospitals that don't require vaccination be given the opportunity of teleworking if possible or finally to accept a reassignment if possible so again many hospitals are requiring vaccination what the osha emergency temporary standard also requires employers to support covet vaccination for their employees by giving reasonable time off during work hours and paid leave for the full vaccination series and any side effects experience following vaccination generally osha presumed that if an employer makes available up to four hours of paid leave for each dose of the vaccine as well as 16 additional hours of leave for any side effects of the doses from vaccine osha recognizes that a hospital if they're providing on-site vaccination they don't need to give as much as four hours but again the ocean standard is encouraging employers to encourage vaccination for their employees as i mentioned some large care hospital systems are requiring or a vaccination for clovid and again there are some states that are barring uh vaccine mandates for kovid so it'll again it'll be interesting to see how this plays out in the upcoming months and and thank you very much for your time all right great thank you al appreciate it all right uh we we uh we now have about uh 30 minutes left over for questions uh so again if you have questions feel free to submit those in the q a section uh and one of my colleagues kevin nelson is going to help me kind of moderate um and and kind of keep track of some of those questions um one thing i wanted to to ask um you know bhargov it was interesting you you talked about you talked about trust uh and and the importance of employers building trust with their employer employee populations and and of course you know that's that's a a challenge i mean you you you're doing so in an environment where there tends to be a fair amount of distrust and lots of reasons for that whether it's you know people's concerns about uh you know lack of trust in governmental authorities uh just uh you know distrust because of all the changing guidance and not being able to keep up with what's the latest and greatest i think some of that is probably tied to fatigue as well um but but i'd love to hear from from the panelists on you know kind of how how do how do employer organizations build trust and also how do you do things like you know encourage employee populations who are reluctant to get the vaccine to maybe go ahead and do so you know what are what are some of the strategies that you're doing because that's certainly tied to trust uh hi this is al i can maybe give some examples of some organizations that i've been working with that are not hospitals or health care what they were doing again in facilities for non-healthcare workers they were requiring masking but if an employee was able to document that they were not were fully vaccinated they would show proof of vaccination to employee health that would record that information and then that employee wouldn't have to wear a mask anymore they would wear like a lanyard or a badge so everyone would know it was voluntary if someone was vaccinated and chose not to do that they would continue to wear the mask also the employer was providing time for for individuals to be vaccinated and it seemed like that was a good way that if people knew that if they documented that they were fully vaccinated and they no longer had to wear a mask many people employees were interested in voluntarily taking the employer up on that option so this is kenji um so as a professor of bioethics and a former bioethics researcher this question always comes up a lot about what can we do to help people trust and i think trust and transparency goes hand in hand so whether it's transparency what we do in occupational health for example you know the conflicts interest that we have and we talk a lot about this in our sort of specialty profession is that we are one of the few sort of physicians out there that wear multiple hats whether it's in the business world as one of the company employees or a corporate employee versus being in academics where we look at both the sort of the the financial political and societal impacts of public health initiative weighing it against individuals rights so i think it's really important to understand sort of transparency as as one component but also understanding that it's also what do people perceive as what trust is and how do we accommodate imbalance and harmonize the differences between what we do as a physician what we do as a company employee or government official or academic uh professorship or understanding of research and how do we balance and harmonize those three things and being transparent to not only employees our patients or the population is to the risks and benefits but truly get the idea of informed consent around what we're asking to do when they get vaccinated sharing the best available data evidence-based medicine that we're trying to promote here and be able to gain that trust so we can sustain the level of access and a good example is if you look at japan you know when people think wow you know one of the more industrialized countries in the world advanced technology but the lowest vaccination rates and it comes down to the idea of trust that they've had and looking at sort of the the medical history behind vaccinations in japan and goes back to world war ii what's happened in some of the testing situations so looking at the idea of cultural uh competencies around uh what informed consent means how do we develop that level of trust as a health care provider as a business person as a company it really comes down to being transparent and very informative and risking and weighing the risks and benefits of any action we take and a lot of it is looking at the consumer rights as we look in the u. care