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The Executive Briefing - Friday, March 11

Noro & Hep A activity on the rise 📈

This week’s ZHH Alerts / Issues:

  • Norovirus: Central Michigan, Pennsylvania, Oregon, Washington, southern Texas and Minnesota. Emergency rooms in Toledo, OH diagnosed 120 cases of Noro this past weekend - which means the community incidence is very high.
  • Hep A: Roanoke, VA is reporting a 10x increase in case counts YTD (unrelated to the Famous Anthony’s outbreak).

COVID Recap:

  • Its officially been two years since the WHO declared a global pandemic.
  • OSHA is still prioritizing COVID and working to release permanent standards for workplaces, starting with healthcare but possibly for other key industries. (Bloomberg Law)
  • Nearly 1.2 million workers are now disabled from long COVID and likely to impact the work disability landscape for years. (American Progress)
  • If we get a second booster in the fall, Pfizer and Moderna want it to be a new, specialized vaccine that’s targeted for Omicron or multiple strains. (NBC)
  • United Airlines will let unvaccinated employees back to work on March 28th. (WSJ)
  • As contact tracing ends in many places, cough drop sales could be used to track COVID. (Bloomberg)
  • The federally imposed mask mandate for airlines and other public transportation will be extended through mid-April. (NY Times)  
  • Researchers are finding COVID at a “stunning rate” in deer, with major mutations that could spell trouble for humans in the future since we know it can spill back over to people. (NPR)
  • Scientists are developing treatments for the loss of smell associated with COVID. (Deseret News)
  • The global death toll from COVID may be more than 3x higher than the official numbers, as many as 18 million deaths, according to a study in the Lancet. (USA Today)
  • Some restaurants in NY are still asking for proof of vaccination. One of them drew angry anti-vax protesters this week. (NY Times)

Today’s Health News:

  • A new poll shows Americans are besieged by stress, with inflation and the invasion of Ukraine at the top of the list of concerns recently. (NBC)
  • Pennsylvania health officials are warning about the Deer Tick Virus, which has been detected in high levels throughout the state recently. Symptoms can include fever, vomiting, and weakness, and can be deadly in rare cases. (Philadelphia Inquirer)
  • This year’s flu vaccine was a poor match for the dominant strain that circulated during this year’s quiet flu season, though they still prevented serious illness. (NBC)
  • Trader Joe’s Crunchy Slaw salad was recalled this week after plastic was found in the salad dressing.  (USA Today)
  • Don’t forget to move your clocks forward this weekend - though Congress is yet again considering making daylight savings permanent with the support of many health organizations. (Washington Post)

Best Questions:

We’re seeing some patterns of COVID blips after groups of employees attend large gatherings like sporting events. How worried should we be about that?

Unfortunately, this is the new reality of living in a pandemic without major masking and vaccination requirements for large events and indoor gatherings. When you notice a mini-outbreak among your staff, find out which other staff members they’ve spent time with. Exclude any unvaccinated people who have been exposed for five days (10 if you’re in California), and enforce mask-wearing for any vaccinated people who were exposed. If you’ve gotten lax about daily wellness checks or you’ve switched to a sick call only model, this is a good time to reinstate daily wellness checks for a few days, to be sure you’re catching any symptomatic people who think it’s “just a cold.” If you focus on masks for those who were exposed, and ensuring that no one works sick, you should be able to interrupt the cycle of illness relatively quickly.

Should we call the health department when we suspect Noro?

We almost always advise calling the health department before they call you (or just show up). They may be able to tell you there’s a community based outbreak already occurring. But it also lets you be in the driver’s seat - sharing all the best practices you’ve followed, and being prepared for an inspection. There are many jurisdictions that require you to notify them if one or more guests report complaints regarding illness (and similarly for employees with a reportable disease). However, if the employee is not a lab-confirmed or diagnosed illness, reporting requirements don’t always apply.

Lately we’re seeing more lab confirmation of Noro than we used to. Is that a pattern you are also seeing?

Yes. Years ago, ERs and urgent cares didn’t do any testing for foodborne illness when someone presented with GI illness. While now they still aren’t doing full GI panels, lately we’ve seen more testing for Noro.  Some of that is based on better or more readily available testing. It wasn’t that long ago that every specimen needed to be sent to a state lab for a Norovirus confirmation. Now, that’s no longer the case.  We’re also seeing health departments test one or two people to confirm a diagnosis of Noro, and then not testing anyone else. Once you know it’s Noro, you can assume that others who present with the same symptoms within the same timeline are likely additional cases.

What should our messaging be to managers about this current uptick in Noro?

What we’re hearing over and over again is, “It’s not COVID so I kept them out for a day and let them come back.”  And then two days later, they had multiple coworkers sick with vomiting and diarrhea.  We know everyone is tired, short staffed and generally stressed.  The incentive to bring someone back more quickly is real - your manager won’t need to stay later or pay overtime or work short-staffed. But the message needs to be:  Norovirus is highly infectious from one day before symptom onset (which we can’t do anything about) through at least 48 hours after symptoms end (which we CAN do something about).  So it’s critical to keep someone with vomiting and diarrhea out 48 hours after their symptoms stop.  We know it’s hard to tell the difference between hangovers and IBS and the person who just vomits one or two times from Noro (that’s what we’re here for).  But erring on the cautious side with that first employee will prevent an outbreak.

The key messages are:

  • Don’t work sick
  • Don’t work for 48 hours after significant GI symptoms
  • Handwashing is more important than ever
  • Even though it's not COVID, working sick or returning too quickly can be devastating to your business.

Best Read:

American Psychological Association:  Stress in America

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Disclaimer: This post is meant for general information and educational purposes only and does not constitute, and is not intended as, any form of medical, legal or regulatory advice or a recommendation or suggestion regarding the same.  No recipient of this information should act or refrain from acting on the basis of this information without first seeking legal advice from counsel in the relevant jurisdiction.