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Flu Management in The Workplace

2022 Insider’s View of Employee Health and Government Regulation

Date: 01-27-2022 • Runtime: 1:30:29

Our expert panel features epidemiologist Dr. David Michaels, Nicholas Christakis, sterling professor of social and natural science at Yale University, and Axiom’s very-own chief medical officer Dr. Scott Cherry.

[00:02] – Holly Foxworth

Hello, and welcome to the special 90 minutes Webinar that we have today that’s specific to 2022, an Insider’s View of Employee Health and Culture. So in case, we haven’t met, my name is Holly Foxworth, nurse, and also the manager for content marketing here at Axiom. I’ve been at Axiom for about ten years, and it’s such a pleasure to be able to move forward and advance some of the same topics and be able to help you guys in the areas that you may be struggling. So before I introduce the panel of who it is that is going to be joining us today, I do want to just go over some quick announcements that are here and kind of give you an idea of what you’re looking at there on your Webinar console screen. So the first part is on the right-hand side of the very top. You’ll notice that that is actually where you get your free admission ticket there for the next event that we will have. Actually, it’s going to be on February the 17th. And that is specific to mental health. That’s been a huge topic lately. I know we’ve covered it here. We’ll discuss some of that today, but that’s specifically going into what it is when you’re not feeling okay, maybe you’re struggling, stress things are going on, what it is that you need to say when you’re having those times when things don’t seem like that they’re working as well as they should.

So that will cover perspective, not just from if you have an employee or a co-worker that was presenting with those types of scenarios, but also if you experience it yourself. So great information that’s going to be featuring Dr. Les Kurtay with our Axiom team. And you definitely don’t want to miss that. The next piece I wanted to mention was specifically how it is that you can interact and engage with us. So we’ve had some questions that have already been submitted. I had some from this morning from people that said they might be a little bit later, that we’re going to be logging on any point during the event today that you have a question whether that’s something they’re presenting on or it’s something that’s related to that. Just type that there is the question and answer box right there at the top. And we definitely will make sure that we can circle back to the appropriate presenter and get you some additional information. We usually try to cover those while we’re going through the topics. However, if we need to push that towards the end, we can usually pick them up on the backside there. The last thing I was going to mention was at the bottom of your screen, you’ll see a section where it says “resources”. And so that has some additional information about industry-specific guidelines, it has information about the presentation of the kind of slide deck there, along with the risk calculator that we’ve spoken about before to keep a hand on what’s going on with the community spread and what your particular risk level is at that point. So I think that kind of sums up the announcements. I definitely have a powerhouse of a panel here that’s joining us today. Some of the brightest names in medicine, research, mental health, you name it, they’ve got it covered, especially even into regulations. So some of the faces you may be familiar with, others, maybe not, but we’ll go ahead and let them introduce ourselves. Dr. Cherry, how about we start with you? I think you may be on mute, Dr. Cherry.

[03:08] – Dr. Scott Cherry

Thank you for that. Sorry about that. My name is Scott Cherry. I’m actually Medical’s chief medical officer. My professional background is I’m board-certified in preventive medicine, public health, and occupational environmental medicine. And I’ve been supporting either the government, the military, industry, or corporate operations for the past 15 years. It’s a pleasure to be with you.

[03:32] – Holly Foxworth

Excellent. Thank you. How about we go to your next, Dr. Michaels?

[03:37] – Dr. David Michaels

Great. Thank you, Holly. I’m an epidemiologist. I teach at the George Washington University School of Public Health. Under President Obama, I was the head of the Occupational Safety and Health Administration, actually the longest-serving administrator in the agency’s history. And earlier in my career in government, I was in charge of health, safety, and environment for the nuclear weapons complex. Most of my work now is on COVID. I was a member of the Biden Harris Transition COVID Advisory Board, and now I’m working with a group of other experts. We like to think of ourselves to try to develop what the new normal is covet is going to be with us forever. And so we’re trying to say what should we do to be able to gather our lives back to normality and live with this virus?

[04:25] – Holly Foxworth

Excellent. Thank you so much. We’re looking forward to hearing what you have to add to that. All right. And then on the next one that we have, I think, is Dr. Christakis, would you like to introduce yourself as well? I don’t think we’ve had you on our platform before.

[04:38] – Dr. Nicholas Christakis

No. Thank you so much for having me. Thank you all. I’m a physician and a sociologist. I also have training in public health. I’m a professor at Yale. I run a lab where we investigate many different sorts of topics. I used to practice as a Hospice doctor, but I haven’t seen patients in quite a long time since my primary focus is on research. And I wrote a book about the pandemic called Apollo’s Arrow and have spent a lot of time and most of the resources of my laboratory in the last two years focused on the pandemic, the origins of the virus, the course of the virus, and the ultimate outcome of this virus.

[05:18] – Holly Foxworth

Excellent. Yes. I think that both of you have actually written had some publications that were there. I definitely want to get to those a little bit later in the broadcast here. But I want to give you an idea of what it is that we’re going to be going through today and just an overarching umbrella there. So we’re going to go through we’re going to be talking about this great resignation. I know it’s been a hot topic in multiple areas that came out. And then also we’re going to go through kind of what the differences of the workplace look like. What does that look like before? What does it look like now? What will we look at in addition to the future? And then we’ll pick that up on the backside of that with the regulation, the employer’s duty of care, and then finally wrap up with the predicting social outcomes. So, Dr. Cherry, I’m going to kind of come to you first then and talk us through what we’re looking at in terms of what is this great resignation has been coined? Does it apply everywhere? What do you think is driving this?

[06:17] – Dr. Scott Cherry

This is really an interesting phenomenon like, as you said, coin title here. And so having looked at it, it’s kind of an interesting thing where if you look at this slide where over the years, you’ll see how many people quit their job on average each year. And so over the past 20 years, it’s kind of ranged between 2 to 3 million. And it’s crept up over the last decade or so. But in a very short time, you’re seeing a quite significant kind of surge up to four and a half million. And I actually have to admit, I know Dr. Christakis has probably talked about this at length, and he may even have predicted this. So I’d like to get his thoughts on it. But what you’re seeing really in this last year to two years, a fair amount of people that were maybe at the end or near the end of their career have decided to retire or stop working early based on a host of factors which probably are driving mainly from an increased concern of safety in the workplace or even finding meaning in their work. And so, again, I don’t know if Dr. Christakis you have anything to add there, because I know you’ve spoken on this quite heavily in the recent past.

[07:46] – Dr. Nicholas Christakis

Well, there’s a lot we could say about how pandemics affect labor markets and affect workers. And I don’t want to just talk for ten minutes now spitting out all kinds of stuff. But let me just say a couple because I’m sure we’ll cover more of the points. Let me just say a couple of things. You alluded to the search for meaning. And I think that’s very important. I think during times of plague for thousands of years, people quite naturally rethink the purpose of their lives when death is in the street when people are with fraud at home, they think about what’s important to them and what’s important to them about their societies. And this can prompt a lot of rejiggering. And we’re seeing a lot of evidence for this in our country right now. We’re seeing, for example, that truckers who previously didn’t necessarily think of themselves as being absolutely crucial to the economy now suddenly see the role they play in transporting goods when the whole nation is at home. We see a burst of interest in the caring professions, paradoxically, even though there’s a plague, medical school and nursing schools are seeing booming applications, we see a rise in religiosity during plagues. We saw it during this one, too. People sort of search for meaning. So I think you’re absolutely right to highlight the search for meaning and how it leads people to reconsider and reconsider the kinds of occupations they have. And many people, as you said, are near the end of their working lives anyway. If you’re a teacher or a frontline food service worker and in you’re your early 60s and now it’s quite risky or demanding to be at work, you might say, why should I not just retire now? Why should I wait a few more years? And it doesn’t take many workers to cause the kind of problems you’re alluding to. One or 2% reduction in the labor market in any one of these industries can cause this problem. And I’ll say one more thing, and then I’ll shut up. In addition to the wholesale removal of workers in the great resignation, people say, you know what, I’m 63, I’m going to quit early, or you know what, I’m 40 and I was going to do this career, but because I’m changing my attitude towards life, I’m going to switch careers and withdraw my labor participation in this industry. So you get all of that that you alluded to. But there’s another effect, which is that the immediate burden of illness and of quarantine because your relatives are ill also can cause this effect. So if every worker has lost two weeks out of the last 50 weeks because of COVID-related stuff, that’s a 4% reduction in available manpower across the whole industry. And that adds up to a huge amount, right? If you would cost as well can gum up the machine. It’s like a traffic jam, 1% extra traffic on a highway, traffic is moving very smoothly, you add 1% more cars and everyone slows down. That’s sort of what’s happening from multiple causes right now, in my opinion.

[10:52] – Holly Foxworth

Wow, great information. So we talk about the impact that’s happened with employees, but also we hear the other side of that. We have a lot of HR representatives that have joined us today. And I think that the agreed messaging here are some of the issues that they’re having is that where are these people? Where can I find them? Not only do they have the issue of that they are quitting their jobs, but there are not as many applicants that are applying for things. And the amount of compensation that’s being requested is significantly different. They’re having to give sign-on bonuses, all these things that are coming along with that. So we were actually discussing this last week, and there was a podcast that I brought up and asked, is it really the great resignation or is it really more of the great renegotiation? Is this an opportunity that employees are utilizing to renegotiate the terms of their participation in the workforce?

[11:49] – Dr. Scott Cherry


[11:49] – Dr. David Michaels

I think you’re seeing even maybe an emergence of a kind of organized labor, a revitalization of that perhaps too. So whether you’re staying in the same industry or if you’re searching for a new type of career, I agree there’s a lot of volatility. I did not think about kind of just a small percentage change across several different drivers. So as Dr. Christakis said in the change of career, plus quarantine or even isolation from illness, you’re actually getting a fair amount of percentage across the large population here.

[12:28] – Dr. David Michaels

If I can add, there’s another component of all this that really relates to the themes we’re talking about today. The Bureau of the Census does this pulse survey where they reach out to thousands of households in these two-week periods. And they did a survey in early January, just issued the results. And one of the things they found is based on their responses, they estimate there are 3.2 million workers who have left the workforce because they’re afraid of getting COVID or spreading COVID. And so part of that is the fear of public transportation, but also of being in workplaces where things are crowded and they don’t know who they’re going to be standing next to. And that’s, of course, in addition to the folks who are out because they’re either been sick themselves or they need to take care of someone else. So this really has upended the labor market in so many ways.

[13:25] – Holly Foxworth

Right, definitely.

[13:25] – Dr. Nicholas Christakis

Can I add an idea to that?

[13:27] – Holly Foxworth


[13:29] – Dr. Nicholas Christakis

I think it’s very helpful if you look at the history of plagues going back thousands of years to contrast the impact on society of war versus the plague. During the war, you destroy both capital and labor. In other words, people die during a plague and you destroy a capital, factories, roads, buildings. You expend money to build bombs and then detonate the bombs. There’s no bigger waste of money than munitions, right? You spend all this money to make something, then you exploded and the money just gets vaporized. So during a war, you destroy labor and capital. But during a plague, it’s like a neutron bomb. You kill people, but you leave the capital intact. The factories, the roads, the know-how, the fields, the gold, the mines, all of that stuff is untouched. Just people die during plagues. If you look at thousands of years of history, what you typically find changes the labor-capital ratio in society. So if you look at thousands of years of history, you find that after a serious plague for a period of 40 years afterward, you see echoes. And what you find is that real wages and real dollars rise over that 40 year period above the prior baseline, peaking at around 20 years later, and real interest rates decline because there’s a lot of capital chasing fewer opportunities and then there’s a lack of labor. So labor gets paid more now during COVID is a little different, I have to say. First of all, because it doesn’t kill working-age people as much, it kills the elderly, although we’re seeing a lot of resignation among that age group, and because it’s not as deadly, of course, as bubonic plague or smallpox or cholera or tetanus or typhoid and so on. So it’s not necessarily going to be the same, but we are seeing a lot of these effects. We’re seeing increased demand for wages, increased demand for benefits, demand different kinds of work environments and working from home, and so on. So in a way, COVID is following the prototype that has been laid down by past epidemics in this regard.

[15:48] – Holly Foxworth

Wow. I wouldn’t have thought about it, to put it in perspective that way, but that makes so much sense. Great input. Anything else before we get to the next topic, guys? All right. The other thing that where that kind of leads us to then is this place where we’re looking at the workplace and what the prior workplace was, what it is now, and then what we think that that’s going to look like in the future. Dr. Cherry, do you want to kind of talk us through what some of that look like kind of comparing and contrasting those different time periods of what the transition that we’re seeing occur? Kind of the shift in mindset?

[16:26] – Dr. Scott Cherry

Yes. So the practice of occupational medicine or employee health really, I would say before COVID, maybe absent H1N1 really was very siloed. So you had employee health or occupational medicine and then you had personal health or personalized medicine, and usually, those were quite siloed. And so companies would pay for the employee health programs and preventive services, specifically regarding if there are hazards in the workplace or if the work is physically demanding and for safety-sensitive workers or very physically demanding workers or regulated workers, we would do physicals that looked at personal health to determine fitness for duty. But on average, you really didn’t see broadly personal health dictate fitness for duty for most workers in the US. And so with COVID, what we’re seeing is there’s kind of a potential mix here because COVID is in the workplace. COVID is in the general space, so to speak. And so, again, I think that this is kind of muddying the waters because it really matters if you have COVID and come into your workplace or if you’re exposed. And so I think we’re at a place where things aren’t so strongly siloed. And then also you have kind of resiliency factors that relate to. I’m getting a little bit of echo. Hopefully, it’s not too bad for you guys, but some resiliency factors with personal health that can potentially predict severe disease with COVID. And so NIOSH put out total worker health probably a decade or so ago. And that’s kind of an idea where you take personal health and workplace health and tried to get as much synergy as possible. And really, this is for the best outcome for the person and for the company. And I think COVID may be a kind of a point in time where this pushes us over the edge to where we have broad potentiation of total worker health. Maybe I’d open it up to the panel to see if any of those thoughts resonate with the panel.

[19:03] – Dr. David Michaels

Well, certainly one aspect of COVID, which is really different than almost any other occupational work-related condition, is that the health of the individual worker can have a direct impact on other workers. That’s never really been the case. Usually, the hazard in the workplace that might be making people sick or hurting them, being up on a roof, or being exposed to silica doesn’t have a direct impact on the next worker and if they’re exposed to the same hazard, obviously they show that. But the idea that the worker themselves can be part of the hazard is a whole new ballgame for us, I think, to think about very differently. That’s part of the challenge. I know that’s what the regulatory agencies are wrestling with. That’s what every employer is wrestling with right now.

[19:53] – Holly Foxworth

Yeah. So one of the things that we’ve heard a lot is that when we’re asking about employee health, one of the objections that we got early on was this is a hypocritical protected type of information that you can’t ask what’s going on with people. You can’t ask, what is your status? Are you vaccinated? Do you have conditions that we need to provide accommodations for, etc? Do you feel like there really has finally been this shift of mindset where we recognize that, okay, employers do need to find out some of these things? You do have a legitimate reason to know some of these personal matters because we have a responsibility then and reliable for the amount of exposure that could occur in the workplace to other employees. If they’re there, they’re exposing them to somewhere else.

[20:43] – Dr. David Michaels

I think that’s right. I think what some of the agencies which enforce these rules are wrestling with are the division between what the status of the worker is versus what’s the reason for that. And you can’t ask, why have you chosen not to be vaccinated, for example, unless you’re looking for an exemption, you can’t talk about certain underlying conditions, but you could certainly determine whether or not they’re infectious, for example, or whether they’re vaccinated.

[21:16] – Dr. Nicholas Christakis

I would defer to David and Scott about this. I’m not by far an expert on this, but there are many occupations for which vaccination is a condition of employment. For example, in the healthcare industry, I’ve had to be back, and I have to prove that I’m vaccinated, in the military, you’re vaccinated whether you want it or not. I have friends of mine who are in the Marines who said they would just walk down a row and they got shots on either arm. So I don’t understand this conversation. Maybe David or Scott know, I think many employers can rightly demand vaccinations. It makes public health. I think it’s legal. I’m not an expert in this. And it’s not just for their other coworkers, but it’s also for a liability issue with their customers, right? You don’t want your business. If you have a massive outbreak at your firm, it could ruin your business. And so it’s quite rational to be able to do that. I think now, I don’t know legally, others probably know better than me on this call.

[22:21] – Dr. Scott Cherry

Yeah, I think there’s a lag, I think, for a lot of employees and employers that deal with occupational medicine routinely for medical surveillance for, again, hazards in the workplace or fitness for duty. It’s really kind of a culture that’s been embraced from the beginning of those companies and those employees starting work. But a lot of I would say the majority of employees have never really been in such type of programs. And so our chief legal officer talks about it being a permissible medical inquiry. And so you need to have a policy that applies to everyone fairly. But, yeah, if a company makes the decision, then it is permissible. And usually, you make the business case, like all the points you brought up, Nicholas, are valid. And I think it’s going to be some lag there with culture change. And I think the OSHA ETS was trying to set kind of a federal standard that would support companies across the whole US to have kind of this one at least baseline standard. And obviously, that did not go through. But States and different geographies are moving forward with what they see as best for their business operations.

[23:46] – Dr. David Michaels

That’s right. The federal government says that as a condition of work, you can’t have a requirement that interferes with someone’s medical is driven by medical condition or religious exemption. And so those are the two exemptions. If an employer and many employers have done this. So all of our employees must be vaccinated. They have to take and offer these exemptions, though. The reality is around religion, that’s really the choice of the employer, how hard or soft to be around that. And I certainly know employers who have said you’ve got to make a very strong case that you have a religious objection, not simply that you don’t like this idea. However, it’s now getting more complicated because there are various States that are passing laws saying you can’t require vaccination, and then there are other locations certainly cities that say you must be vaccinated. So we’re going to have this mosaic, maybe a nice way to put it in terms of laws and regulations around the country, around this.

[24:49] – Dr. Nicholas Christakis

What I worry about is this very disturbing politicization of COVID in our society on the right and on the left that has brought to the surface all kinds of matters that have been sort of accepted for the last century in our society, for example, requiring school children to be vaccinated before they go to school. There were a few people who didn’t want their kids to be vaccinated. And as a society, we had some exemptions, and we kind of tolerated it because the number was small. But now I’m very worried that the whole principle of vaccination has been called into question, which is a very odd kind of thing to happen. Vaccination, let’s not forget, took 200 years of human ingenuity and efforts to invent, hundreds of years of effort. It’s a magnificent technology that required thousands of doctors and scientists and hundreds of thousands of patients volunteering for these trials for us to produce this knowledge, to create these miraculous things which most people, the great majority, just took vaccines and thought it was great. And now all of a sudden, we’re having this big conversation about vaccination in our society. It’s kind of an odd thing, right? I think most people on the school when their kids went to school, the school required your kids to be vaccinated because we don’t need outbreaks of mumps and measles at our school and you have to be vaccinated. And that was sort of a settled matter. So I’m a little worried that we’re going to be opening up this vaster kettle of fish in our society, not necessarily with a good outcome from the point of view of public health.

[26:24] – Dr. Scott Cherry

That’s a great point. I wanted maybe to get your point or maybe your opinion, Nicholas, on kind of the social implications of maybe fear or safety in the workplace. As you said, a lot of critical infrastructure employees continue to work and really never faltered. And so they may be looking for additional compensation or benefits, but a lot of they call it the zoom working class that was able to work from home. And you’re seeing now when people are or companies are asking their employees to come back, maybe even over half of those employees are pretty much refusing to come back into the workplace. And so I’ve seen a lot of studies that depending on your pre-COVID condition with regard to mental health. So if your mental health was poor, if you had high anxiety and depressive symptoms before COVID, that may be a predictor for hospitalizations and vice versa. But have you thought at all about the social implications of fear in the workplace with COVID?

[27:32] – Dr. Nicholas Christakis

There’s a lot in your question. Let me just hazard a couple of responses. One is my wife is an elementary school teacher. So she’s a worker that doesn’t get paid much money and never has made much money her whole career. And all her whole career she’s wondered why we constantly speak about teacher shortages and pointed out that we’re a capitalist economy. And if you can’t find a fantastic used car for $500, we don’t call that a used car shortage. We think, well, you’re not paying enough money for the used car, offer more money. So if you can’t find fantastic teachers for $28,000, we don’t call that a teacher shortage. That’s a wage problem. We should pay more money. And for most problems in our society, we solve the problem with money, right? Like it’s a market economy. So it’s not surprising to me at all. Nor will it be shocking if wage demands don’t go up. And that’s, I think, the right thing. That’s the market working, and that’s how it should work. If truckers demand more wages and deserve more wages, they should get more wages, period. Same with teachers. If teachers are resigning because the work is becoming harder, kids have lost school, it’s more dangerous. It’s more demanding. The normal response in our society is to pay them more money, and I think taxes will have to go up and so on. So the pandemic is going to rejigger us in that regard. On the worker attitude and fear.

One of the things I think is extremely important, and I worry about our society more generally. I worry that in our society some people say we’ve gone soft. It’s not that we’ve gone soft exactly, but there’s a kind of over the last couple of decades, there’s been, I think, a social change in our society where people increasingly expect others to fix their problems. The thing you need to understand about a serious pandemic, like the one we’re in the middle of, which is a once-in-a-century event, is that there’s no life without risk during a pandemic. There’s no life without risk. The world has changed. There’s a new deadly pathogen that’s circulating. It’s as if there was radioactive fallout that’s everywhere you can’t escape it, okay? It’s a structural change in our environment. So the fantasy that you will be able to resume your previous life quickly and without consequence or move through life without any risk is just that as a fantasy. And I think many workers and people think that the government should fix this for me or my employer should fix it for me. My employer should make the workplace safe. There’s no practical way an employer can eliminate all risks in this type of situation. So I think everyone has to do their part. I think the government has to do its part. I think employers have to do their part. Regulatory agencies have to do their part, and citizens need to do their part. We need to understand that we have to tolerate more risk and work together as a people to confront this unusual thing that we all happen to be alive to experience.

[30:41] – Holly Foxworth

Excellent information. You brought up the issue of mental health whenever you spoke about this before. Do you feel like there’s a shift there as well? I mean, do you feel like that we’ve always had mental health issues, but we’ve just ignored them before, or do you think it’s been exacerbated by the pandemic and that’s kind of rolled into our work life and now once we were all remote and it becomes an issue with your entire family, what are your thoughts there?

[31:07] – Dr. Scott Cherry

Well, obviously, COVID, I think, has brought a tremendous amount of awareness to mental health. And there are studies that show definitely a worsening of mental health. We’ve been working on mental health for several years now and recognized before COVID, depression, anxiety, and other mental health challenges were at epidemic proportions before COVID. And so as we kind of collaborates on kind of causation, it can be somewhat tough. But what’s very clear to me is, again, mental health was a challenge for many people before COVID, and I do think we’re seeing it as drivers or predictors for severe disease even long COVID and vice versa. So there’s definitely a high correlation there. It’s hard to say causality there. But from a primary care perspective, we were always trained mental health can drive a lot of somatic or just regular complaints in the body. And so it’s absolutely critical that we focus on mental health now more than ever is kind of my view on it.

[32:23] – Holly Foxworth

Yeah. Anything else you guys want to add to that? Any additional pieces?

[32:32] – Dr. Nicholas Christakis

I don’t know. I think David probably should go.

[32:38] – Dr. David Michaels

Go ahead. I have nothing to add to this.

[32:41] – Dr. Nicholas Christakis

I mean, I was just going to say that again, you guys would know more about the trends in mental illness and mental health issues in the workplace in our country over the last few years. But more broadly as a society, there is a concern that for a number of reasons, by the way, including the rise of the Internet and the use of screens and the kind of outlet that this has provided, there is a bit of a mental health crisis in our society. One of the weird things and I don’t have an answer for this is that everyone expected the suicide rate to go up during the pandemic. But my understanding is that that has not happened. But weirdly other kinds of mental illness have gone up. Anxiety, depression, as Scott mentioned, partner abuse is way up. There’s a lot of sort of mental illness in our society and mental health problems and challenges in our society right now. That trend line was up, but I think the pandemic has definitely worsened it. And I think we’re also going to echoes. When you look at, like, for example, the 1918 pandemic, when you look at, for example, babies, mothers who are pregnant with children during the pandemic and you look at the long-term outcome of those kids compared to kids who were born just before, just after the pandemic, you see a long, lifelong impact from immunorviral exposure, from the stress the mother was having because she was pregnant with you during this serious calamity from the fact that your crucial developmental milestones. Think about all the three and four-year-old kids that didn’t have normal school experiences in our society or the kids that reading didn’t learn to read, those kids who didn’t learn to read because they missed school in fourth at the age of five and six the last two years. It will take a long time for them to catch up. And they may have behavioral problems later on because they’re less literate and so on. So they’re going to be long-term implications in a very complex way. As Scott was saying, it will be hard to tease out all the causation, but there is no doubt that this pandemic is going to cause a lot of disruption in our society, in our labor markets and our mental health and our educational status, in globalization, even things like the distribution of workers. We haven’t talked about this, during times of play people flee cities and go to rural areas. They’ve done this for thousands of years and they did it again, right? And people were so surprised that this is a typical response. But now with modern doom technology and other technology, a lot of people are going to be saying, why should I be paying to live in a two-bedroom apartment in New York City with two children when I’m a white-collar worker who could just as easily do this job from a mid-sized city in a rural area and have more room in case there’s another pandemic so I’m not cooped up with my kids again, and I’m safer. So I think there’s a lot that’s going to happen across all the things we’re discussing.

[35:48] – Dr. David Michaels

If I can just add one other point, which we’re talking about mental health, really, we have to at least acknowledge the opioid overdose epidemic is out of control. Just two or three years ago, we were talking about 50,000 deaths a year. Now we’re above 100,000 deaths a year and it’s because of COVID that it’s not getting the attention it would have gotten otherwise. And some of it may be driven by the availability of fentanyl and more toxic materials. But clearly, the isolation that people are feeling and the disruption of their lives is certainly having an impact on this, and it’s devastating in a lot of communities.

[36:27] – Dr. Scott Cherry

David, thanks for bringing that up. David. One thing I was going to add actually was we actually have really good internal data on drug test positivity. And again, these are in populations that know they’re going to get a drug test, heavily regulated population here. And we’ve seen year on year 200% to 400% increase in drug test positivity rates. And so again, this is in populations that know they’re going to get a drug test. So you can only imagine what’s happening in the general population.

[37:02] – Dr. Nicholas Christakis

Absolutely. Those are excellent points. That’s right.

[37:08] – Holly Foxworth

We’ve had some questions that have come in kind of also just adding comments. Let’s see, there was a question about do you think that younger generations are quitting their jobs because of schools constantly closing and reopening, causing a harder time for parents to hold their jobs? That’s a great point. Do you think that there’s an impact that has occurred there? It’s too much pressure. They’ve got too much that’s going on, that they can’t work outside the home. If you have kids that are at your house as well.

[37:42] – Dr. Nicholas Christakis

I have a thought on that. I can’t answer that question directly, but I can answer a kind of related question that may interest the questioner, which is the following. There are many kinds of families in our society. There are heterosexual couples and homosexual couples or single-parent head of households. But the modal, the most typical couple remains a heterosexual couple, a two-parent family, and usually on average, the man is about two and a half years older than a woman. That’s still typical and also typical, but not always is most of the time, 75% or more of the time, the man earns more money than a woman. So look what happens now when a pandemic comes to our society and you have all this labor market disruption. Schools start closing. A couple is sitting around the table in their own household, and the woman says, Honey, only one of us can stay in the workforce, and you’re earning more money than I am anyway. Why don’t you continue to be the primary source of income? I was earning less money, and I kind of like hanging out with the kids more than you do. The husband says you’re right, honey, that’s going to cope with this stress in our society right now, schools are closing. Why don’t you stay home with the kids and I’ll stay in the labor market, and that’s the right of that couple to make that decision.

But now what happens is millions of couples make analogous decisions. And so what we may find is that the pandemic sets back women’s labor market participation by decades because what you’re going to find out is a whole generation of women, especially young women, like the question I was asking with young kids that opt out of the labor market and their reentry into the labor market, will be delayed and more problematic, and they will lose all of the wages, the gains in their salaries than they would have gained over the intervening years more than they otherwise might. So this gendering effect of the pandemic is going to, I think, be quite pronounced in the labor market as well. And we may look back in five or ten years and say, you know, we were making such progress on women’s wages, equality, women’s labor market participation, and so on. And then the pandemic struck and kind of set us back. So I think in answer to the question, I think that the unavoidable in many cases closure of schools and the instability in wages and schooling and all the other problems may have the kind of ripple effects on labor market participation, not just in the 60-year-olds we were discussing earlier, and not just on the kids that are newly graduating from College into a difficult economy, but also on these sort of young people, like, let’s say, in their late 20s, early 30s, that the questioner was asking about.

[40:26] – Holly Foxworth

Yeah, I think we had another question I think was about the generational asking, do we think that this was generational? Do you feel like this does relate to that and what you’re speaking of and that you would have the children that would be at home, and so someone needs to care about it. And so you’re just looking at a completely different type of sample size there whenever you’re talking about who’s quitting their jobs and who’s staying.

[40:52] – Dr. Nicholas Christakis

Holly, was that directed at me?

[40:55] – Holly Foxworth

It was, yes. Either way is fine.

[40:58] – Dr. Nicholas Christakis

I didn’t understand the question. I’m so sorry.

[41:01] – Holly Foxworth

I think they were asking about did you feel like this is a generational issue? Do you feel like that is solely a generational issue, or does it look at both types there? So you’ve got not only the generation issue, but you have to take in the family responsibilities and all the changes to your daily life that occurred specifically.

[41:22] – Dr. Nicholas Christakis

I’m not sure I fully understand the question, but I will say that everyone in our society is affected by this major event. It’s like the Second World War, like a major event. And I think our society is also sort of sleepwalking a little bit through this pandemic. I think we don’t think the person on the street doesn’t fully understand yet what has happened to us. A million of our fellow citizens will have died. A million Americans at least will have died. That is an extraordinary calamity, as David and Scott were talking about, like, opioid deaths and car accidents, and so on. If you talk to public health people like us, like three years ago, and we said 50,000 car accidents a year, should we do something about that? You absolutely. That’s a serious problem. Let’s deal with that. Or opioid deaths. And now we’re having hundreds of thousands of deaths per year from this pandemic, and people don’t seem to quite understand it. And there have been all these other disruptions we’re talking about. And furthermore, our society has been insulated a little bit from this because we are basically borrowing trillions of dollars from the future to insulate ourselves today. But we’re going to have to repay that money. Right? I think we’re in for a course of serious inflation. I think we’re going to have heavy government debts that are going to constrain what our country can do in the future. So I think everybody is going to be affected. The million Americans will die. 10 million Americans will probably 5 million – we haven’t talked about this yet but probably 5 million Americans will have some kind of disability as a result, which will be a burden on our healthcare system. I’m not talking about if you have long or short COVID. I say you’ve recovered, but your body is scarred. You have pulmonary fibrosis or renal insufficiency or pancreatic insufficiency or cardiac or neurologic problems. All those people who will need care will be issued in our workplaces, issues for our insurance companies, and our insurance rates. We’re going to have all the kids that we talked about that are going to have the long-term effects. We’re going to have a million Americans. We’re going to have 10 million people grieving the loss of a loved one. But see, even here, probably the majority of Americans will neither have died nor know someone intimately who died. That is to say, most Americans on the other side of this pandemic won’t have had upfront personal contact with this virus. And so they may think, oh, well, it’s not so bad. That is a misperception. A major thing has happened to us as a society. And I don’t think people fully grasped it yet. And this is not me being alarmist. I’m just trying to give some basic facts so people can understand we shouldn’t be whistling by the graveyard as we go by the graveyard. We should be aware and work together to deal with this situation.

[44:14] – Dr. Scott Cherry

You know, Holly, I know our clients and even everyone probably listening. They’re always trying to determine if the pandemic is coming to an end with Omicron because you hear of overtime, pandemics tend to become less severe, more contagious, and so Omicron kind of fits that bill. But I was just curious from either David or Nicholas, if you’ve had any thoughts from kind of the hardcore epidemiological perspective about when could we think of where are we at in the COVID pandemic spectrum or continuum, so to speak?

[44:56] – Dr. David Michaels

Well, we certainly don’t know. And that’s the biggest problem. A year ago, we’re ecstatic. We had all these new vaccines. In the next few months, things look better and better and better. By June of last year, everyone was very hopeful. And then Delta came, then things looked a little better, and then Omicron came. We will have more variants, and that is for sure. The question is, will we be prepared for them? Will the immunity we’re getting from these other variants help us? What will vaccinations do? The latest estimates I saw was that something like almost half the population of the United States will be infected by Omicron before it’s gone. The number is astounding. But will that help us with the next variant? So we have to be prepared for that. There’s no question we will have more variants. And in the long run from an evolutionary perspective, this will become like the common cold or something like that. But in the very long run, we’re all dead. We need to be prepared for the next five years and ten years. I think 50 years from now, we’re not going to worry about the common cold is a coronavirus, and who knows what it was like when I first got here. So I think we have to be prepared for more rounds of this.

[46:24] – Holly Foxworth

Good point. Yes. Dara Wheeler asked when we look at the pandemic risk and awareness of risk levels, does it just highlight risks that have been here but we haven’t paid much attention to, like driving a car, or is the risk different?

[46:41] – Dr. Nicholas Christakis

There’s a lot of confusion.

[46:43] – Dr. David Michaels

Go ahead.

[46:46] – Dr. Nicholas Christakis

You go, David.

[46:47] – Dr. David Michaels

Well, you know what I’m thinking about? The way we perceive risk is different because of the political situation. I think that’s part of the problem here. There’s a huge range of how we’re thinking about the risk. It’s not necessarily driven by the level of the risk itself, where we often don’t think about the risk of driving cars, things like that. Omicron has become or the pandemic has become something where depending on how you view the world and your politics, you can look at the risk as being very significant or not significant at all, which is really problematic for figuring out how we move forward.

[47:27] – Dr. Nicholas Christakis

I would just add, I agree with everything David has just said. I would just add to that there’s a lot of confusion about this point. You have to think about coronavirus as an additive cause of death. In other words, all the previous causes of death, we had cancer and heart disease and influenza and motor vehicle accidents and renal disease. They’re all still there. And now we have added another thing that can kill you. It’s not replacing other causes of death. It’s not like people say, oh, well, you would have died of diabetes anyway, or some people would have died of influenza. That’s not correct. This is an additional cause. You got to think about it like radiation. It’s like the environment has changed, and now a lot of people are dying of radiation poisoning who would not have died had we not had radiation in our environment before or would not have died as young. So the years of life lost because of this are not trivial. So I think this risk idea like, well, we’re just going to return to the previous baseline. That is not ever going to happen, as Scott said, for our lifetimes. In the long, long run, I think this coronavirus will become another common cold and will enter the bat will be quite trivial in the long, long run. But over the next five or ten years, Coronavirus in the next six months, it’s going to become endemic in the United States, and the death rates are going to fall to 2000 a day. Again, right now, approximately. I don’t know what the latest numbers are, but it’s really shockingly high.

But eventually, everyone in our country will either become immunized, either through vaccination or through natural infection, the latter not being a wise course of action because you run the risk of death in order to become immunized. But if you nevertheless, you’ll either get it or you’ll get vaccinated and we’re going to reach this herd immunity threshold in the next six months. The disease will enter its endemic phase. It’ll still be there. It’s not going to be eradicated. It will still kill us, but the death per day will come down to about 50 to 100 a day, which is the influenza level of death. And then it’ll sort of percolate along. It’ll be in the kind of background welter of causes of death, additive to all the other things that used to kill us. There’ll be another leading killer in our society. And this assumes as David was saying, it assumes that there isn’t the emergence of a new worrisome strain. The thing that frightens me the most and I put the probability of this at between one and 10% is that we could see a new strain that emerges that either fully evades the vaccines. Even Omicron and Delta do not fully evade the vaccine. There’s just partial evasion or is much more deadly because bad as coronavirus is. What you have to understand is it only kills 1% of the people on average that it infects. That’s actually quite a bad killer, by the way, from an infectious disease point of view, but it’s nothing compared to bubonic plague or smallpox or cholera or typhoid and so on. In a way, the plague that our generation of people, humans, is facing is a kind of a plague light. But there are coronaviruses that kill 10% of the people they infect or even 30% of the people they infect, like MERS, Middle Eastern Respiratory Syndrome. So imagine that this coronavirus, instead of getting Omicron, mutated to be 30 times more deadly, which is possible. I think these things are unlikely, but these are sort of tail risk, but it could happen. And the thing that would alarm me the most and I put the probability of this, as I said, between 1% and 10%, is the emergence of a strain that fully evades the vaccine or a strain that is much more deadly. And that would really put us way back, almost back to the basic beginning of this pandemic.

[51:19] – Dr. David Michaels

If I can just go ahead. Go ahead, Scott.

[51:24] – Dr. Scott Cherry

What I was just going to add was I think both of you had great points there, and some of them I hadn’t thought about. I think about risk in a couple of different ways. Is there’s novel risk and then there’s complacency about risk. I think a lot of people in the general public don’t realize how many people die a year of many common conditions from chronic medical conditions or acute like traumatic motor vehicles. And so it’s either kind of being naive to it or you’re complacent you’re in your car and you’re just used to kind of being next to someone else at 60, 70 miles an hour. And I think that’s what’s playing in on people’s mental health is COVID is something that people may not have a firm grasp on absolute and relative risk for death, severe disease, hospitalization, or even minor infection. But they know that it’s scary and it’s concerning. And so I do think that is weighing on people’s mental health who aren’t calibrated to other forms of risk in their life. So kind of interesting.

[52:28] – Dr. David Michaels

And I just want to circle this briefly back to some things we’re talked about before. One thing that COVID has done has very seriously and perhaps inexorably damaged our healthcare system. And so your risk of significant long-term injury following a car accident is much worse now than it was because if you get to the hospital, they may not be able to take care of you. And so the impact will be on people who are not aware. They may not know people who have died of COVID, but their future is very much impacted by it.

[53:02] – Holly Foxworth

Yeah, you’re exactly right. I definitely want to get into that down in the closing sections here. But just to kind of wrap this one section up before we get into the OSHA ETS information, what we are hearing from the workforce and kind of the feedback that we get is that the employee wants to have a voice in this. What they’re trying to say is that I feel like I deserve to feel safe when I’m at the workplace. I feel like I want to be at work if I’m at home because I’m sick, it’s not because I want to be sick. It’s because I have to stay there. And how can I not return to work without you supporting or somebody supporting this idea of me being at home and still getting compensation because I have a family to feed. We’re hearing the information about that, hey, we’re overloaded. Our mental health is struggling here. We don’t have a work-life balance at the moment. So when you take those requests or the demands, I guess at this point of what you’re hearing from the workforce and then you put that into the perspective of what are those future trends for what the workplace looks like, do you see that we would be able to cover these in the different areas? Do you feel like employers will recognize that there’s more of a need for mental health, that we’re going to still continue to need to keep an eye on, making sure that our employees are healthy and safe that it’s not just a personal issue, it’s something that we have to move forward with and keep this going? Is there a marketplace where we can use some of these wearable technologies that prevent some of these things and promote wellness? What are your thoughts there? I think you probably all have ideas about this.

[54:53] – Dr. David Michaels

I think that’s up to the employer. I think there are plenty of employers who recognize the value of their employees and know that they’re going to have to make some different sorts of accommodations. I mean, look, I’ve heard that United Airlines, which required everybody to get vaccinated, made a statement about how they value their employees. And Scott Kirby, the CEO, put out a statement that before they issued this rule, they were having one United employee die every week of COVID. Now they’ve got large numbers of people who are infected by Omicron but none hospitalized. And I think employers can say, well, we know we’re in a different world now. We’re going to have to treat people differently. We have to think about what we need to do to make sure we have a workforce that wants to participate in this work. It’s doable. It’s a challenge, and that’s what we’re talking about now. But if you don’t do that, I think it’ll be a real setback. You’re not going to be able to run those facilities the same way you did in the past, right?

[55:57] – Holly Foxworth


[56:00] – Dr. Scott Cherry

I think it’s kind of an HR aspect where obviously people or business leaders are struggling at times to have enough labor to continue their business operations. And so I think one major strategic component to consider is kind of employee health and safety. And right now there’s not a strict or firm guideline out there. But still, I think it gives the opportunity to tailor a best practice for each client based on their inherent workplace design. And so it could be kind of a difference-maker between does a candidate go from one opportunity to another based on just safety practices. So I think industrial safety with major traumatic injuries or toxic exposures, would make a huge difference. This is well before COVID. And so if you’ve ever been on a chemical side or nuclear side, my last role in the military was being the medical support to a nuclear reactor operator, nuclear reactor facility. And so Nick and David, both of your experiences in the nuclear or examples you’ve given resonate with me tremendously, but you can almost look at COVID the same way but it’s not a physical hazard. It’s an infectious disease hazard that’s invisible. So it may be a difference-maker in the HR aspect of running a business.

[57:40] – Dr. Nicholas Christakis

Yeah, I think you got to think of COVID as a kind of friction. It’s a force of friction in our society. So when you were asking about what are employers going to do with their sick leave policy? For example, early in the pandemic, we saw these crazy decisions by the meatpacking industry where because they were losing production of meat was declining because a lot of the workers were sick. And there’s a very interesting set of ideas as to why meatpacking plants around the world, by the way, so it wasn’t specific to our regulatory environment in the United States became a nidus’s. Other than prisons and nursing homes, meatpacking plants were the places where you had major outbreaks has to do with the work in the meat plants, the cold temperature, the loud, the voices, people screaming to be heard over the equipment, and so on. But anyway, these meatpacking plants put into place ridiculous policies that incentivize their workers to come to work even if they were sick, which is exactly the wrong thing to do, whether it’s a contagious disease because it just leads to a cascade. Instead, what they should have done is raised wages and hire more workers, and that raising of the wages of the meatpackers, of course, will be passed on to the consumers in a higher price of meat. And so this is exactly what’s going to happen in our society. So firms that want to be able to cope rationally with an infectious disease and liberalize their sick-leave policies are going to need to have a higher manpower account, need to hire more workers, because on any given day, more of their workers will be home, and they have to pay those workers to stay home, which basically is a rise in real wages like we talked about earlier that contributes to price pressure and inflation in our society. We are all going to have to pay higher taxes, higher prices for goods, higher interest rates. This is unavoidable. We’ve been shocked. Something bad has happened in our society, and it’s going to cost us one way or the other to cope with it.

[59:47] – Holly Foxworth

Good information. Well, Dr. Michaels, I’m going to come to you for coming next. Then as we kind of jump into this employer duty of care and what happened with the ETS, etc, whoever we had met previously, we were of the understanding that the expectation had been laid out, that we thought that this would move forward. But then all of a sudden it felt like the breaks were put on there where it came to us, reaching calls in some of these areas in terms of whether this was going to be pushed or not. So what are the implications then of the ruling that we have from the Supreme Court? How does that impact where we go next? There’s been some discussion of OSHA had dropped their proposal, though most people didn’t understand that what came behind that was we’re going to make something that’s permanent, talk to us about all of those scenarios and kind of what we need to have on the road map going forward.

[01:00:45] – Dr. David Michaels

Yes, it’s a little complicated, but not too bad. OSHA issued two emergency temporary standards over the last year. The first was for healthcare settings, and that was in effect for six months. As far as I can tell, it was quite effective. It didn’t go as far as I would have liked, but still, it was very useful. That was withdrawn by OSHA in December. And OSHA has said that they’re going to move forward on a permanent infectious disease standard for healthcare settings. That’s what they told the court. It will take them they claim six to nine months. I think it will take longer, but it means for healthcare settings, that rule is no longer in effect. But some of the basic things that OSHA put out there really still should be followed. And OSHA still can do enforcement in healthcare settings for lots of reasons. The other emergency temporary standard, which essentially required that employers mask and test employees who are not vaccinated, that’s the one that the Supreme Court essentially, didn’t officially overrule it, but they issued a stay and they sent it back to the next level down, the appellate court. But it’s dead.

[01:02:05] – Dr. David Michaels

OSHA has withdrawn it, but it will not recover. It would take years to reissue it properly and go through the courts, and we won’t be in the same place. Now what’s interesting is that, well, certainly the rationale behind it made lots of sense, which is that workplaces are safer if infectious workers are not in the workplace. And so many employers will move forward to continue to move forward to do that, making different sorts of accommodations as they can. And as we said before, in some States, they won’t be able to do that at all. Other States or cities, they’ll be required to do that. There are some components, though, of these standards which have changed the OSHA landscape that hasn’t gotten much press. The biggest one really is around respirators, and I try to distinguish between masks and respirators. A surgical mask, whether it’s blue masks or a cloth mask, those are masks.

But the respirator is something that’s really designated for protecting a person who is exposed to a hazard was like a surgical mask is to protect others. It’s for surgeons not to breathe out and breathe into the body that they’re working on respirators, N95, or the Chinese equivalent of the K95. They protect the wearer and they also protect other people as well. And it used to be before COVID that if an employer said to a worker you had to wear an N95, that triggered an OSHA standard, the respiratory protection standard that required the employer to provide a medical exam and a fifth test and various other things. If you’re going to be telling people to wear N95s, that now has changed, and that’s buried in those rules. I know. She tells me they will continue to treat this as a new enforcement policy. You can now require workers to wear N95s if they wouldn’t be normally in a respiratory protection program. In other words, not someone who’s exposed to asbestos or silica like that. But if you’ve got a situation where you’ve got an assembly line, you want people to be safer and you say, okay, right now, you’ve got to wear an N95. That doesn’t trigger that whole program anymore. You’ve got to show people how they work, and you’ve got to essentially show them how to make sure it seals well so they’re not breathing out the side. But that’s a big difference right now. And that’s something I hope a lot of employers will do because it’s clear and CDC has come around on this that you have to be using an N95 or a KN95 to really stop spread in workplaces, and it’s really effective. I have many colleagues who work full-time in the hospital. They’re working with patients with COVID. They’re wearing an N95, and they’re not getting infected.

[01:04:56] – Holly Foxworth

Okay. And I see some of the questions that are here is that it’s like this we’re selling comments that we’re confused about. We’re confused by what we’re being told. We’re confused. We see on one day that we’re told that we should wear masks. We need to do social distancing. I think we had one that had written in here that they’re a primary care provider and they implemented the masking and social distance, etc. But because of local regulations that are being enforced, then they’re getting pushed back on this. So there’s really a question mark here, and I think that’s caused a lot of friction in terms of what is the expectation and why can’t we all get on the same page? Do you think that we’ll see some resolution or some more clarity in that moving forward?

[01:05:47] – Dr. David Michaels

Absolutely not, because the way the Supreme Court essentially said in the OSHA cases, OSHA is not going to be able to issue that sort of widespread generic standard. The majority, the three appointed by Democrats and the three sort of centrists actually did say that OSHA could issue a more targeted standard aimed at, say, meat packing facilities or places where things are workers are in crowded conditions. But I don’t see that happening soon. I think what we’re going to see is States going in very different directions, localities going in different directions, and we’re going to be facing this sort of chaos, unfortunately, from a regulatory point of view.

[01:06:31] – Dr. Nicholas Christakis

Can I add something to that, just as a general principle?

[01:06:34] – Holly Foxworth

Yeah, definitely.

[01:06:36] – Dr. Nicholas Christakis

There’s this kind of subtle point about the pandemic response that I’m sure David and Scott are familiar with, which is that the patchwork response is often worse, paradoxically than a consistent response, whether that consistent response completely ignores the pandemic or is super aggressive. Let me give you an illustration. Let’s say you have two adjoining States and one state says we’re going to close down churches and grocery stores because we want to reduce the risk, and then the next door State doesn’t do that. So you have a patchwork response. Well, what’s going to happen? All the residents of this state where churches and grocery stores are closed are now going to start driving to the other state, which they would not otherwise have done. So what you paradoxically have done is you have increased social mixing, which increases the spread of the virus, and you would have been better off having either neither State impose these restrictions or both States impose restrictions. In other words, having this inconsistency across nearby jurisdictions makes the problem worse than it otherwise would have been. Something similar was seen during the 1918 pandemic in New York City. They tried to reduce social mixing by, for example, closing down having a curfew. So we’re not going to let people interact. Well, all that did is it forced higher densities of people into smaller places over smaller time periods. In other words, instead of having a million visitors into the city over the course of 18 hours, now they had the same million visitors or maybe it reduced some over 10 hours, which was more people per square foot than they otherwise would have had. So there are all these counterintuitive things that can happen, which, incidentally, is one of the reasons why I have been in favor of more federalizing some of this response, making it more consistent. Incidentally, the same thing happens with patchwork vaccination mandates. You can foster the emergence of vaccine evading strains when you have inconsistent vaccination from the point of view of the virus in terms of it evolving to be capable of evading the vaccine. You either want nobody vaccinated or everybody vaccinated. You don’t want half the people vaccinated.

[01:08:59] – Holly Foxworth


[01:09:00] – Dr. Nicholas Christakis

So there are all these things like that that make me very worried about the kind of laissez-faire. Well, let every State and every jurisdiction come up with its own rules. I actually think that’s going to make our situation worse.

[01:09:16] – Holly Foxworth

Interesting perspective. There are some questions that came in on this.

[01:09:20] – Dr. Nicholas Christakis

By the way, in the military, it would be like having every state National Guard, we’re going to wage war in some other country and we send every State national guard to fight, and we let every one of the States decide how they’re going to fight the battle. I mean, that’s absurd. You need some kind of way of organizing the whole army. Right? You can’t just have every truth making its own decisions about what to do. Sorry.

[01:09:48] – Holly Foxworth

No, I get it. So it’s thought then, that without regulation that if we don’t push forth and we have regulation that has all of these mandates in place, do we feel like the workforce will be adequately protected? I mean, is there an implication there of some having it and others not?

[01:10:13] – Dr. Scott Cherry

I was going to let David answer that.

[01:10:15] – Dr. David Michaels

Well, look, I think you’ve got a situation where this or checkerboard given COVID. If some people are not vaccinated, some people are protected, others aren’t, which will essentially ensure that they’re spread in workplaces unless we take more precautions. That just raises the challenge of it for employers. I know there are some questions about N95s, which I think we need to get to. But ideally, you don’t want to get a situation where you’ve got to tell workers you have to wear a mask all the time. For example, you want to begin to think about can you make the workplace safe so people can go about their work under normal conditions? You have to think about things like ventilation and filtration and to show people that the workplace is safe. So one of the things that a lot of the aerosol transmission experts are saying is you can get a very inexpensive carbon dioxide monitor. Essentially, it’s monitoring what people are breathing out. And if you can show that you’ve got enough airflow and either filtration of outside air coming in, you’re keeping carbon dioxide levels low. You can show that you’ve made that workplace safer and that’s what you want to be doing.

[01:11:32] – Dr. David Michaels

But I can see there’s a lot of interest in this N95 question because that’s new information. I was on the phone yesterday with OSHA attorneys to discuss this because, in the withdrawing of the vaccination, testing, masking, ETS, they left one thing, and the last paragraph says OSHA is not withdrawing the mini respirator program requirement. That was in the previous ETS, which only applies to health care. But they said they’re going to apply this widely. It’s called a mini respiratory protection program. So what I would recommend you do to make sure you’re in line with everything is call your local area office and say this is what you understand, that you can now require N95s for people who wouldn’t normally be in respiratory protection programs and have to only provide certain information and essentially a seal test. And what I’m told is that’s what OSHA’s enforcement policy will be shortly, officially it is now, but they haven’t put anything out. But I think that will make a big difference and certainly worthwhile to do because we know that N95s will be protected. You may have seen that in the last couple of weeks, President Biden has started wearing an N95 and told everyone who has to meet with him has to wear an N95. A number of us were wondering what took you so long six months ago? That sort of happens. And that’s what we all should be wearing, either N95s or the equivalent KN95s or KF94s because the electric charge material that they’re made from catches the virus where a surgical mask just doesn’t.

[01:13:24] – Dr. Nicholas Christakis

I’d like to add another perspective to that. One of the good ways of thinking about coping with risk in a time of a contagious disease is what’s known as the Swiss cheese model. You have to think of every layer of protection as a piece of Swiss cheese testing is the protection, border closure, school closure, mask-wearing, vaccination, prohibiting mass gatherings. Each of these is a layer of protection, which is good but not perfect. It has some holes in it. So the virus approaching this layer, if it hits a solid part of the Swiss cheese, will bounce back. But if it hits the hole, it will penetrate and then might not be stopped and reach the target victim, let’s say. So you need to think about the fact that if you have made a sandwich and you have three or four pieces of Swiss cheese, you should have the intuition that when you stack up the third or fourth piece of Swiss cheese, by dumb luck, none of the holes will align perfectly by one layer. You can get through it. In defense, this is known as defense in depth. You don’t just have one anti-aircraft battery on the frontier. You have others 50 miles in because one of the airplanes might miss the first battery. I don’t know why I’m using so many military analogies today, but the virus is like an invading army. The virus is like an invading army. We need to defend ourselves from it. So we need layers of defense. Now, the reason I mention this is that if an employer, the crucial thing is not necessarily which layers you adopt, it’s that you have more than one, because no, even vaccination is not perfect. So, speaking for myself, I think it’s fine if everyone in my family is triply vaccinated and we want to have a dinner party and those people are triply vaccinated. I feel that it’s totally fine to get together with them because the risk is not zero, but it’s tolerably small. If your workplace has 99% vaccination, probably your risk is tolerably small and you wouldn’t need masks. But with the Swiss cheese model, a better idea would be you have that plus ventilation, like the technology that David mentioned, or you have high levels of vaccination plus masking.

[01:15:44] – Dr. Nicholas Christakis

You see, if you have a couple of layers, you don’t need to have everything. And then people can go about their business. You can have big meetings. You can have face-to-face meetings. But again, this goes back to the fact that in the way Americans have come to expect to have their cake and eat it, too. We want to be able to not have to pay any price. Like we just want to go back to life the way it was. We’re done with this virus, but the virus is not done with us. And so if we really want to be able to be mature in how we cope with it, we’re going to have to put up for a while with a lot of these inconveniences, which might include mandated vaccination at high levels for everybody and or masking and or ventilation and or gathering bands and or whatever else we must do.

[01:16:33] – Dr. David Michaels

Dr. Michaels, before we wrap up this one subject and close with talking about some of the social outcomes here, I did want to ask because we put it on multiple occasions. There’s still a question. Do we anticipate that there would be more cases of whistleblowing reports? Will the OSHA inspectors, or is there still an expectation that the on-site inspections will increase? Do you have any inside information on that?

[01:17:01] – Dr. David Michaels

Well, OSHA inspections are not going to increase because limited by the number of inspectors they have. And like every other employer, they’re losing people, and that’s simply the rate limit. You could have people who run OSHA say we’re going to do more inspections, but when I ran OSHA, we did no more inspections than previous under the Bush administration, because that’s all you can do. The question is how they target them and how they follow up on worker complaints. And worker complaints have been sort of going up and down during COVID. They’re way up again. I’m not really sure why they went down for a while. It may be Omicron and people are more fearful, but most complaints are followed up with phone calls at most. I think what we’re seeing also the whistleblower complaints have gone up a lot, and then they went down. Now they’re going up. And that’s really workers who feel they’ve been retaliated against because they’ve raised concerns either because they called OSHA or they’ve raised it with their employer. And those are the ones which I think in the long run will have a big impact because they will be alive for a long time. OSHA will eventually get to them. And you want to just if you can resolve those quickly, that’s what you really want to do. It’s a different group of people within OSHA who do the whistleblower investigations and their resources are stretched even thinner than the safety inspectors. I think we may see over the course of the next few months more sort of enforcement directives and things like that. But I’d be surprised if we see another standard, even an emergency standard other than perhaps something in health care.

[01:18:44] – Dr. Scott Cherry

David, do you think the general duty clause will be utilized at all for this, maybe in egregious cases, or would it be hands-off?

[01:18:54] – Dr. David Michaels

No. The general duty clause is used a lot. The general duty clause says that an employer must provide a workplace free of recognized hazards. If OSHA doesn’t have a standard, it’s much harder to use it, but it’s certainly used in egregious cases. There was a case recently I was reading about of a tax office, a tax accountant in Massachusetts, who refused to let their employees wear masks or even have their customers wear masks. I wish I threw the book at them and multi-hundred thousand dollars fine. It’s much more resource-intensive for an OSHA Inspector to use a general duty clause, and so they often won’t. But certainly, we’ll see more of it. But I think the common sense things that employers need to do to keep employees safe and to encourage them to come back and to feel safe are things. You don’t really need OSHA or fear OSHA to get there. You really need to introduce some of these things we’ve been talking about and make it clear to your employees why you’re doing that, and that will help you and will help them.

[01:20:04] – Holly Foxworth

Kind of moving on. Then to our next topic, which was kind of putting a bow on all of this and looking at what the long-term impact is. Talk to us about what this will look like long term. We’ve talked about the economy. We’ve talked about family structures. We’ve talked about employment, etc. What else are we missing? What else could be a factor here?

[01:20:28] – Dr. Nicholas Christakis

Well, one of the ways that I have framed this pandemic is if you look at the history of respiratory pandemics, you can see that pandemics typically go through three phases. There are the immediate phase, the intermediate phase, and the post-pandemic phase. And the immediate phase is when we are feeling the biological and epidemiological impact of the virus. It’s like a tsunami sweeping across the landscape. The virus is having what is known as an ecological release. We have no natural immunity to it. The virus is like an invasive species. It just spreads and spreads and spreads among us until the whole planet is infected, basically. And then eventually you reach the herd immunity or endemic phase of the virus. And this first immediate phase will take about typically takes about a couple of years, which is what I had said at the beginning of the pandemic and which is what’s happening. And sometime in the next six months, we’re going to reach this threshold in our country, of course, the whole world has to also get there, and we’ll put the first phase of the pandemic behind us. But then what’s going to happen is just like the tsunami metaphor, the waters will finally recede, which is fantastic, but the countryside has been devastated.

[01:21:46] – Dr. Nicholas Christakis

We have to clean up the mess. We’re going to have a couple of years in which we are cleaning up the mess. We’re going to have conversations like this, like fits and starts. What does the new employment look like? Millions of kids will have missed school. Millions of businesses will have been closed. Millions of people will be disabled. As we talked about earlier, millions of workers will have lost their jobs. We’re going to have to clean up the clinical, social, psychological, and economic mess that the virus has created. And then some time and these are approximate, they’re not bright lines. Then sometimes, I think in 2024, approximately, after a couple of years of this kind of chaos, we are going to reach the post-pandemic phase when we finally put the whole pandemic behind us biologically, socially, economically, and so on in the post-pandemic phase. And I think that is going to be a little bit of a party. I think that’s going to be like the roaring 20s of the 21st century, like the roaring 20s of the 20th century after the 1918 pandemic. I think people will have their lives constrained, will have been cooped up.

[01:22:50] – Dr. Nicholas Christakis

And I think that they’re going to be relentlessly seeking social interactions and nightclubs and restaurants and bars and sporting events and political rallies. We haven’t talked about this, but I think there’s going to be a lot of political ferment in our society. I think people are going to spend their money during times of plague, people stop spending historically, and they did this time. Savings rates are way up in our country. I think you’re going to have Liberal spending. I think you’re going to see entrepreneurship and an efflorescence of the arts. So I think we’re going to have a kind of a roaring 20s again at some point. And as Scott, I think, mentioned earlier or David last summer, people thought, oh, it’s good times again. No, that was a kind of false hint of what I think is going to happen when the play finally ends.

[01:23:40] – Holly Foxworth

Wow. So looking at this, then you both kind of had publications. You both put out several different publications. I think that was there that we’ve looked at. But if you could sum up what those were or what the messaging in those, if you could give us one thing that people could implement in their workplaces, what would you say that that would be? What would make the biggest difference?

[01:24:24] – Dr. David Michaels

I think given the next few years endemic, we’re on our way to endemicity. But endemic doesn’t mean it stopped causing problems. Malaria is endemic. There’s lots in Africa, there are lots of endemic conditions that kill many people. Endemic just means it’s not going to go up and down. Once we get to that endemic state, we need to have protections in place. And the model, I think, is our water system. We have this amazing invisible system where you turn on your tap and you get clean water and you don’t worry about cholera. And then we have this other system that removes that dirty water from sinks and from toilets and showers. We don’t think about it except when it breaks down. We need to think about the air that way because if it’s not this pandemic, it’ll be the next one that we need to think about building in systems to make sure that the air in buildings is clean. Masks aren’t the answer in the short run. But we need to have systems and it can be the filtration. It could be bringing in the fresh air. But fresh air has its limits, especially because in our new world, much of the country, we have wildfires occurring through all parts of the year. And if you’re anywhere near one of those, just bringing some outside air is not adequate. So we really need a new paradigm of clean indoor air. I think that’s what we’ll have to be thinking about. And we’ll see that the studies are showing that if we improve the indoor air, we get better cognition, we have academic with more success, we have less absenteeism, and it’ll turn out to be really worthwhile to do.

[01:26:06] – Holly Foxworth

How about you, Dr. Christakis? What would you say the main takeaway would be?

[01:26:14] – Dr. Nicholas Christakis

I mean, my laboratory has published a bunch of papers related to COVID. We had a paper on the earliest phase of the pandemic using mobility data in China, tracing the course of the virus through China back at the beginning of 2020. We’ve had some stuff on mass gatherings. We’re doing a bunch of stuff. I had this book that we mentioned earlier on the pandemic, and I guess not a lot of it is explicitly focused on occupational safety. But I guess if there’s one overarching idea in the book that is relevant may be relevant to many employers. It’s just restating the issue of risk, that there’s no life without risk idea. And that’s this thing, the following idea, the way we’ve come to live right now in this time of plague, natural and it is. But what we need to understand is that we are not the first generation of humans to confront this ancient threat. Plagues are in the Bible. They’re in Homer’s, Iliad, the canonical work of Western literature. They’re in Shakespeare, they’re in Cervantes. Plagues are not new to our species. They’re just new to us. And I think the sooner we accept that, the sooner we see that we happen to be alive at this time facing an ancient threat that our ancestors faced. They tried to warn us. They put it in our religious traditions. They put it in our literary traditions. They tried to tell us, there’s this thing that happens from time to time. It’s called plague. It sucks, and you should know about it. The sooner we come to that recognition, the better we will be able in my mind, as citizens, as workers, and as a nation to work together to cope in the most rational way possible to minimize the adverse effects of this calamity.

[01:27:56] – Holly Foxworth

Thank you. Dr. Cherry. Any closing remarks from you before we wrap up here?

[01:28:03] – Dr. Scott Cherry

I may need a second. Actually, I was kind of fully absorbed in David and Nicholas’s discussion. Maybe what I’ll close on is in occupational medicine, we do deal with indoor air quality and kind of some of the existing air quality standards are called Ashway standards. So I may need to look into that more in-depth. I know carbon dioxide is a driver for indoor air quality, but I like the idea of that being kind of a marker for clean air or kind of diluted out the risk especially. But, yeah, this has been a really interesting discussion. I really appreciate Nicholas and David for joining us. It’s been really helpful for our audience base, and really thank you for that.

[01:28:55] – Holly Foxworth


[01:28:56] – Dr. Nicholas Christakis

Thank you for having me.

[01:28:57] – Holly Foxworth

For sure. Yeah. I think we have talked on this for hours still yet, but what we will do and just kind of mentioned what to expect then for the audience here, what we will do is we will provide you a link that you could review this after the event and then also for those that we tried to cover, the majority of questions I saw there were still just a few that we didn’t get to but we will follow up with you individually. We’ll make sure that you get the answers that you need. So thank you again for joining. And then the only other thing I was going to mention was we do have the resources that are located there on the right bottom side if you haven’t already, please don’t forget to press that Register Now for the next webinar, the webinar that will occur and if there’s anything that we can do, please don’t hesitate to reach out. Thank you. Bye.