“We have an incredible safety record; no OSHA recordables for the 6 years I’ve been here and I attribute that to Axiom’s involvement.

The nurses are so wonderful and so attuned to the Employees and help them return to work safely after an injury. They listen very well and the education is the most important. Our employees and managers love them.

Thank you for all that you do.

Rhonda Wright

HR Manager, Tremco CPG Manufacturing

Mark Robinson

President & CEO

Dara Wheeler

Chief Marketing Officer

Dr. Scott Cherry

Chief Medical Officer

Chuck Kable

Chief Legal & HR Officer

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EVP of Sales

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Chief Financial Officer


Flu Management in The Workplace

Are You Prepared for a Workplace Twindemic

Date: 9-27-2021 • Runtime: 1:01:43

Like two trains barreling toward each other on the same track, your workplace may soon face one of its biggest challenges to date – a twindemic! With resources already stretched to max capacity for COVID-19, what impact will the upcoming flu season bring?

Join us as Axiom Medical’s Chief Medical Officer, Dr. Scott Cherry, and Houston Methodist’s Emergency and Critical Care Physician, Dr. Kabir Rezvankhoo, discuss Preparing for a Workplace Twindemic.


We’ll be answering questions, such as:

  • Are flu and COVID-19 symptoms different?
  • Is it possible to have both at the same time?
  • What employee health screening measures should be implemented?
  • Should the workplace make modifications to leave policies and procedures?
  • What steps can be taken to proactively mitigate exposure and transmission risks?
[00:00] – Holly Foxworth

Hello, everyone, and thank you for attending today’s Webinar, which is Are you prepared for a Workplace Twindemic? My name is Holly Foxworth. I’m a registered nurse here at Axiom Medical, and I’m joined by Axiom’s Chief Medical Officer, Doctor Scott Cherry, and Emergency and Critical Care Physician at Houston Methodist, Doctor Rezvankhoo. So they’re going to explain what it is that we need to know, what a pandemic is, what a twindemic is, and what it is that you’re going to need to know for your individual workplaces.

Before we get started, though, I would like to briefly cover several quick announcements and just give you an idea of what you’re looking at here on the Webinar platform. At the bottom of your screen, you’ll see that there are multiple application widgets that are there. They’re all resizable and movable. In the resource tab, you can find additional information about white papers, Axiom’s on-site mobile COVID testing, and flu clinics, along with checking to work and checking the school information. Right there on the right-hand side of your screen, you’ll see that on November 29, so that’s going to be two weeks from today. We’re going to be hosting another webinar on recognizing and responding to suicide morning signs in the workplace. Obviously, anytime that there’s a tragic loss of life, many lives are impacted. And you know that a lot of people have faced a lot of issues this year with pandemic along with the added stress of the quickly approaching holidays. So sometimes the best thing that we can do is definitely educate ourselves and know how it is that we can take action when some of those warning signs are recognized. So if you click right there on the right-hand side of your screen where it says Register Now, that button there, that’s going to get you signed up without having to enter any additional information. And we look forward to seeing you there.

As I’ve mentioned before this webcast series, is a town hall type of format. We want to know what’s on your mind and hear what your questions are. So please feel free to submit those throughout the broadcast using the Q & A widget. And then should we run out of time before we get to your specific question, we’ve also added a live stream follow up on our social media channel, so that’s going to be LinkedIn, Facebook, and YouTube, and so you can join us there next Thursday at 1:00 PM Central. A copy of today’s slide deck and additional health materials are available there in the resource list, and you can also find some additional answers to common technical issues located right there in the Help Widget. Finally, an on-demand version of this webcast will be available after the broadcast, and it can be accessed using the same link that was sent to you earlier. We’d like to thank all of you who’ve been submitting questions to our Webinar events using the email address. We have some great ones that came in this week, and so we’re going to be addressing those at the end. But for those of you that haven’t used that form of communication with us yet, this is direct access to our team of experts. Obviously, we’re invested in making sure that your schools, your businesses, that they’re all able to succeed and thrive. And we’ve handled a vast number of cases throughout this entire pandemic. So whatever question that you may come across or challenge that you’re facing, we’ve likely covered that with other clients across the nation, and we can quickly get you the answers that you’re needing. So please feel free to utilize that email address. So at this point, I’m going to go ahead and turn it over to our speakers, our presenters, Dr. Cherry, I’ll let you introduce yourself. And then we’ll get started with Preparing for a Workplace Twindemic. Dr. Cherry…

[03:19] – Dr. Scott Cherry

Thanks, Holly. Good afternoon, everyone. Thanks for tuning in. Just a little bit about my professional background. I’m board-certified and preventive medicine, public health, and occupational and environmental medicine. I’ve spent about the last 15 years supporting either the military, corporate or industrial operations, and it’s been a pleasure to be part of this webinar series where we’re helping explore how, as science unfolds COVID-19 and how it’s affecting our clients, our populations. And so again, thanks for tuning in.

[04:04] – Dr. Kabir Rezvankhoo

Hi. My name is Kabir Rezvankhoo. I’m a board-certified emergency medicine and critical care, I did my training in New York City, and then did my critical care training in Washington, DC. Currently, I’m working out in Houston, primarily critical care full time. And so I have experience with the COVID ICU and also in the Emergency Department and what they’re seeing since the pandemic.

[04:33] – Holly Foxworth

I’m sure that gives you a firsthand view of what’s going on, and we look forward to hearing what you can share, definitely. They’re both joining us today, I’m just kind of getting things started. Dr. Cheery, speak to us in general about what this term is, a twindemic, what does that actually mean?

[04:51] – Dr. Scott Cherry

You know, as we come into flu season, while we’re trying to help manage COVID-19, we’re really looking at trying to manage two outbreaks at one time. And so that’s where the term twindemic comes from. And so really, it’s the coronavirus outbreak. And every year we actually have seasonal flu. And so you’ll see flu campaigns that support or try to provide protective measures like annual vaccinations, hand hygiene, environmental hygiene, cough etiquette, things like that.

[05:38] – Holly Foxworth

And so kind of breaking that down a little bit. Let’s dive into both the COVID-19 and the flu aspect, so maybe give us an overview of what COVID-19 is, and then we’ll jump into the flu. I’m sure everyone has some basic knowledge, but just to kind of tell us a little bit about what’s involved in that, what the common symptoms are that you’re looking for, etc.

[06:01] – Dr. Scott Cherry

Sure. From a population health perspective, COVID-19 stands for Coronavirus infectious disease 2019. And so this was a new type of Coronavirus that was identified in late 2019. Coronavirus, in general, is not new to causing infections in humans. And really, there are four types of coronavirus that are part of the infectious diseases that cause the common cold. But in the past 20 years, there have actually been two other outbreaks of a novel or new Coronavirus that has not been seen previously. You have SARS and MERS from 2003 and 2012, and those outbreaks have a very high case fatality rate. So for every person that gets infected, what proportion would potentially die. And so you have case fatality rates of 15% and 37% respective and so a very high case fatality rate. Fortunately, with COVID-19, the case fatality rate is not that high. I think early on in Wuhan, there was a concern about also another high fatality rate because there wasn’t a better understanding of the full prevalence or how many active infections were out there. But I’d like to kind of turn this over to Dr. Rezvankhoo too to see about what he’s been seeing in the ERs and the ICUs from a direct patient care perspective.

[07:49] – Dr. Kabir Rezvankhoo

Yeah. So I think what we’ve been seeing with COVID-19, what’s very unique about it is that it is very infectious. And I think the biggest problem with this is that the average duration of time where someone runs around asymptomatic is probably around four to five days and probably around five to ten days where people start to develop symptoms. And so there’s a lot of exposure that is happening in asymptomatic patient populations and the disease spreads in a very cryptic way where asymptomatic individuals are spreading the disease. Now, what I’m seeing inside the hospital are those who have severe COVID-19 illnesses and warrant hospitalizations. So by that means, it usually is someone who has very severe pneumonia and is requiring oxygen for some form of support. Now we get to mortality rates with COVID-19. I think the CDC is probably causing it around a 2.3% case fatality rate. But what that means for us is if you’re young and you’re healthy, you probably are going to be okay. I mean, the odds are totally in your favor in terms of the rates per 100,000 population. When you look at those who are passing in the hospital, it’s really those that are 75 years and above. But it can also happen to those that are 40 to 74. But it also comes with risk factors. So those who have underlying cancer, some form of chronic kidney disease, lung disease, diabetes, hypertension. I think that probably the biggest one that we’ve noticed that really has had a huge impact on our mortality rates comparing other nations is probably obesity. So I think that in itself has had an impact on overall mortality rates.

[10:15] – Holly Foxworth

So the patients that you’ve been treating, have they required a lot of intubation and ventilators and things that come with that?

[10:25] – Dr. Kabir Rezvankhoo

Yes. I work in the Intensive Care Unit, so I see only the sickest ones. And the individuals that I see by large are over the age of 65, or if they’re younger between the ages of 40 and 65, they usually have a lot of chronic comorbidities, which make their bodies much more susceptible to the virus, diabetes, heart disease, kidney disease, those who smoke or have emphysema and obesity. The risk factors really can have an impact on the severity of illness, but age is still, I think one of the strongest risk factors by itself.

[11:16] – Holly Foxworth

Well, let’s talk about the flu. You guys are going to give us just kind of an overview of the flu as well. And then we’ll kind of get into some of the similarities and differences between the two.

[11:33] – Dr. Scott Cherry

I can take a shot at it first and then I’d like to hear Dr. Rezvankhoo’s view on it as well. And so I think flu, we’re quite complacent with every year. Really, there’s a new strain of flu that can cause a significant amount of disease in America and across the world, and a vaccine is created every year to try to really target what they expect the genetic drift would be in the flu. But the flu is quite capable of changing its genetic makeup enough to where it’s relatively successful in causing an outbreak every year. And there’s a significant amount of deaths every year. And I think high-risk individuals that Dr. Rezvankhoo was alluding to. And what’s interesting is and I’m probably stealing a little bit of thunder from the next slide. But comparing maybe for young individuals and children, the flu actually can have high rates of morbidity and mortality, where we’re not really seeing that with COVID. And so again, from a population health perspective, we’re always trying to support our clients with proactive and preventive measures and providing vaccines on-site or within the population and trying to remove those barriers where people may not have time to go see their doctor get again that vaccine and then also promoting safe behaviors, which now are much more commonplace in this COVID area.

[13:21] – Dr. Kabir Rezvankhoo

Yeah. I totally agree with Scott on this one. With COVID-19 and influenza, the symptoms are nearly exactly the same. You really can’t distinguish it based on symptoms at all. In fact, when patients come in with cough and cold-like symptoms, we always describe it as an influenza-like illness. And with COVID-19, the symptoms that you see are going to be fever, cough, fatigue, decreased appetite, shortness of breath, muscle aches, and pain. So those are the exact same symptoms of influenza. The difference is in the adult population, there’s a couple of differences. COVID-19 is a far worse virus to get than influenza and then secondly, influenza we have vaccines for it, we have therapies for it, medications that actually reduce the duration of illness, whereas, for COVID-19, we don’t. So it’s really important to try to separate these two diagnoses, if possible. And we do it pretty much on every patient that comes in. We do both influenza or a viral panel study that identifies influenza patients. And then we also do COVID testing separately to make sure we can identify what’s the culprit in these patients, because that’s the only way to tell the difference, really.

[14:48] – Holly Foxworth

So what would you say then, if you had to specifically identify what symptoms are different between the two? Where would you see that? Because there are some that are similar there. But what would you identify as really being the different symptoms for COVID versus the flu?

[15:02] – Dr. Kabir Rezvankhoo

I think the symptoms are exactly the same.

[15:08] – Holly Foxworth

Alright, so there’s not like the loss of taste and smell and things like that.

[15:13] – Dr. Kabir Rezvankhoo

I mean, the loss of taste and smell is not specific nor sensitive enough to say that this is what’s going to differentiate. I think, unfortunately, social media has such a grab on people’s minds that I think there’s one person who was being an athlete that lost their sense of taste, and all of a sudden that’s like the test to know to have COVID-19, but in fact, it’s fevers, my allergies, and cough. I mean, you really can’t differentiate just by symptoms alone. You’re going to need testing.

[15:53] – Holly Foxworth

And then in terms of the duration of when you’re seeing symptoms, how long would those last? What would that range be?

[16:01] – Dr. Kabir Rezvankhoo

So again, it’s case by case. I think that the duration of the illness varies. Well, I can say that the duration of illness if you’re a healthy person, could be three to five days for influenza. If you’re a healthy person for COVID-19, it could be three to five days as well, or maybe ten days. But you have to remember, a majority of these people with  COVID-19 can be run around asymptomatic for the first five days and then they develop symptoms on day five, and then maybe for another five more days they’re symptomatic. So they’ve been infected and symptomatic for only five days. But you know, their symptoms, their illness has been ongoing for probably ten days or more.

[16:59] – Dr. Scott Cherry

I’ve been thinking about this. Just let me have one extra point there. As we’ve been thinking about our guidelines and protocols to help differentiate flu and COVID, it has been exceptionally challenging, even just trying to differentiate symptoms for COVID. I agree there’s a lot of support now that shows there’s a large proportion of infected people are asymptomatic and that also there’s a tremendous amount of, there’s a lot of evidence now that shows there’s a lot of atypical symptoms that you would not expect in upper respiratory illness. Where again, you have people with potentially no systemic signs like fever, chills, muscle aches, but potentially just gastrointestinal symptoms and things like that. So in general, when I look at these two infectious diseases, I’m quite comfortable with flu and COVID is very challenging from a clinical perspective. You really cannot provide, any of the symptoms that the CDC has listed as potential or probable symptoms, you cannot put weight on them about which symptoms would be more predictive than others. And so again, it’s just very, very challenging.

[18:24] – Holly Foxworth

So in terms of whenever we look at the workplace impact, because obviously that’s kind of a little bit, and that’s what our focus is here. So what are we looking at? We talked in great detail about some of the things that you would need to implement and what can occur in the workplace from the COVID-19 aspects. But when you add in the additional piece of the flu, are there any additional precautions that they need to cover, or how could that impact their work and their employees?

[18:55] – Dr. Scott Cherry

I can add a little bit here. Obviously, we want to promote the safe behaviors and environmental protocols for hygiene and cleanliness that we do every year in flu. We’ve been doing that now for COVID. I think a significant change with COVID now is the idea that we’ve been promoting zero tolerance of illness in the workplace. And so I think we’re all guilty of coming into work when we’re sick, potentially during flu season or just throughout the year where we’re dedicated to our jobs and getting our or functions completed. And it’s somewhat of a badge of honor to come into work sick. I think with COVID now we really need to shift to where we have policies and culture change to where if you are sick, you should not be coming into work. And then additionally, the impact to the workplace from a case management perspective, COVID has a much longer duration of social isolation requirements. And so really, the primary working guidance from CDC for social isolation would be to have at least 10 days since your symptoms have begun before you could return to work or go into public. And that timeline is much shorter for flu. Usually, the working guidance for that is 24 hours once symptoms have resolved, you could discontinue social isolation and then another component is managing exposed but asymptomatic personnel. And so we manage exposed personnel by keeping them out the whole incubation period of COVID-19, the range of incubation period for COVID-19 is up to 14 days, with the median time being five days. So again, exposed employees to COVID-19, whether it’s a household contact or a close contact, they’re going to be out for 14 days. Where for flu, if such a policy was to be enacted, would be approximately five to seven days. So you have a much shorter duration of the incubation period. And also for those that are testing positive, presumed positive, or symptomatic, they would be out for a much longer duration of time.

[21:54] – Holly Foxworth

Anything to add to that as well?

[21:58] – Dr. Kabir Rezvankhoo

Yeah, I echo in with what Dr. Cherry is saying, I really believe that the duration of illness and the duration of time that you need to be out is different based on the CDC guidelines and the process of which we need to sort of isolating the individuals that are sick out and have the duration of illness be specific to the illness that they have will ultimately require testing. So I’m in agreement with what Dr. Cherry is saying.

[22:42] – Holly Foxworth

You know, another point that has come up that we’ve had people ask about is previously in the workplace you would have some employers that would require physician notes verifying that they had been sick, but that they could come back to work. We saw whenever COVID was initiated, that we kind of moved away from that about requiring that people have noted before they come back, etc. Do you feel that there are any similarities there in terms of how we should manage the flu from that perspective, or do you think that we should stay on the same path, everybody out for longer periods and then returning?

[23:19] – Dr. Kabir Rezvankhoo

So in my opinion, I believe that flu and influenza, if you’re just talking about symptoms and not having a diagnosis, are the same thing. I think when we talk about how long you have to be out of work or how long you have to be out of school, whatever that may be, is depending upon what you have. If we don’t know what you have, I would assume that you have to probably go with a longer route of being out for 10 to 14 days and assume it’s COVID-19. When New York City hit in March, everyone that showed up to the ER, many of which we never even tested because they were not hypoxic and they did not need oxygen therapy or warrant admissions to the hospital. We would tell them, listen, We think you have COVID-19 you just have to go home and sort of isolating yourself. And so overwhelming the healthcare system for doctor’s notes, I think in the midst of a pandemic is probably not the right thing to do. I think if individuals can get tested, they can know exactly what they have, and then it’d be better for these workforce industries to actually have their own protocols in place to know how to manage their patients, because not every doctor is going to be up to date with the medicine, not every doctor is going to practice the same way. And I think that in order for you to really effectively protect other employees would be to bolster up some sort of a program where there’s better monitoring and control of what’s happening to the employees in the middle of a pandemic

[25:10] – Holly Foxworth

Before we get into some of the proactive measures may be that they can implement at the workplace, talk to us a little bit about the risk factors. Do they both have risk factors that would be associated with COVID and the flu?

[25:24] – Dr. Kabir Rezvankhoo

Yeah. I mean, ultimately, the risk factors or severity of illness really correlates with risk factors, age being one of them. But for those of us who are in the years of working, which is probably somewhere between 30 to 65 let’s say, there’s going to be medical conditions that are going to make individuals higher risk or more susceptible, one of which is going to be just being overweight with a BMI of over 30-35, those who smoke, those who have heart disease, cholesterol, those who have underlying autoimmune diseases or cancer. So these individuals are very susceptible to getting sick. And that’s just based on the statistics of what we’ve seen happen across the world with COVID-19. The same is true for those who get influenza, when influenza hits we definitely see patients with influenza in the Intensive Care Unit. And again, it’s based on risk factors. So those who have chronic lung disease, those who are very overweight, or those who have diabetes or high blood pressure that’s poorly controlled. So all these variables are going to be risk factors. And so it’s hard to really separate the risk factors between who’s going to get more sick if they had influenza versus COVID. I think COVID, in general, is a far more serious disease than influenza for working adults. But I think, at least for influenza we have medications that you can take, whereas COVID-19, you just kind of hope that you don’t need oxygen and don’t end up landing in the hospital or in the Intensive Care Unit.

[27:23] – Holly Foxworth

Let’s talk a little bit about implementing some of these proactive measures. And then we’ve had a lot of discussions whenever in the early days of talking about screening employees and really looking at different factors that need to be implemented, everything from hand washing to face masks, etc. Are those the same types of measures that need to be continued and within the workplace to kind of prevent the spread of influenza and COVID-19?

[27:52] – Dr. Kabir Rezvankhoo

Scott, I’ll let you take this one.

[27:54] – Dr. Scott Cherry

Sure. Yes, I would say really the primary measures with regards to hygiene in the workplace or even in public, with regards to especially hand hygiene, where you’re washing your hands frequently, you’re not touching your face while in public. And then also cough and sneeze etiquette is really a major prevention component. And then what we’re seeing again with COVID especially is trying to prevent any illness in the workplace. So having people screen themselves daily, whether it’s just a personnel policy or some type of technological solution that helps kind of change the culture for one, but also shows compliance to screening. From an occupational medicine perspective, we are looking at what OSHA and some of the regulators are doing with regard to infectious disease preparedness plans that historically have only been issued in health care settings and research type of venues that deal with infectious disease, and now COVID is almost considered presumptive work-related unless there’s a very strong workplace investigation that can show more likely than not it was contracted outside of the work. And so I think this is now starting to show that general precautions like we used to do in the hospital or what I used to do when I was in the hospital. I’m sure Dr. Rezvankhoo is still doing, but you really want to make sure that people are not coming into the workplace sick and that every employer is going to be responsible to a degree for infection control. So kind of interesting time and culture change in occupational medicine.

[30:06] – Dr. Kabir Rezvankhoo

Yeah, I can just add on to that a little bit. I think common sense is the most important thing from a healthcare standpoint. I mean, honestly, everyone getting vaccinated for influenza, at least, is good. Wearing a face mask really helps, social distancing really helps. These have been great measures that have really decreased the risk of spreading the disease. In fact, there was a nice research study that was done that looked at health care workers and the risk of health care workers that are going into patients rooms that are known to be COVID positive, and the risk of getting infected is lower than that health care worker as long as they have the necessary PPE and the policies and procedures than if they were to go into a person’s room that is unknown or like in the community. And so I think the important thing of having a sort of a systematic approach to these kinds of scenarios is very important for the overall health of people.

[31:23] – Holly Foxworth

Dr. Cherry, do you agree that the concept of pre-screening, like what we’ve kind of done with the app, etc., of making sure that people are attesting to what their health status is before they’re actually coming into the office or they’re coming into the factories, etc., that that’s a practice that would need to continue forward?

[31:42] – Dr. Scott Cherry

Yeah, I believe so. And I think with flu coming on, it’s even more important because the risk of having contagious illness in the workplace from a crude perspective, is almost doubling. And so again, if you can have a systemic approach to having employees screen themselves, doing some type of temperature check as well is also key. And I just want to echo what Dr. Rezvankhoo was saying about wearing face masks as primary prevention, especially with that large proportion of asymptomatic infected COVID cases. And then just to touch on environmental cleanings, usually, most corporate offices or businesses will do cleanings once daily I think, during lunch breaks or just doing high touch areas, having someone do more frequent cleaning is also crucial. Having hand sanitizers throughout the building and also in the common places will help kind of encourage utilization of that type of hygiene practice.

[33:05] – Holly Foxworth

What would you recommend in terms of having conversations and just kind of educating employees? We’ve got the holidays that are going to be coming up. We now have flu and we’ll have COVID-19, they’ve been very forthcoming and kind of warnings that these cases may continue to rise, especially as we have people doing a lot of traveling and they’re going to family gatherings, etc., so what type of education should they be providing their employees about personal behaviors?

[33:39] – Dr. Scott Cherry

Part of our internal strategy and trying to assess risk for traveling employees is one looking at the areas infection rates. And so early on, there were very well-defined hot spots in the US and in the world. And then over time, those infection rates became more homogeneous across the geographies. And so we started really pushing to encourage safe behaviors during travel. And obviously, before face masks were fully or widely utilized and adopted, we were recommending that I think knowing the crowds, if you’re going to be in public areas, you want to be very mindful of only being nearby people who also have a facemask, because really, the face mask is protecting essentially everyone but the wearer so you don’t want to be in close contact with anyone without a face mask. You want again, maintain that hand hygiene and cough etiquette type of concerns. And then I also think from a general recommendation is everyone should see their physician to see about their current health status. Are they potentially in one of the vulnerable populations that Dr. Rezvankhoo was discussing? And so you may know you have certain chronic medical conditions, but this may be the perfect time to seize the day and try to optimize your health as much as possible through lifestyle change and through even medication management if needed. And there’s probably a percentage of employees that don’t go to a doctor regularly, so they may not know they have pre-diabetes or high blood pressure, or some other chronic medical conditions. So I think it’s a great time while there’s not a huge surge in cases to determine if you might be in those vulnerable populations. And I don’t know if Dr. Rezvankhoo, has anything to add there?

[35:54] – Dr. Kabir Rezvankhoo

Yeah. I mean, I definitely agree that everything you’re saying and common sense goes far away. And I think that with the weather getting colder, I think being sort of in the Southern States, we’ve been lucky with having warmer weather. And I think that people are going outside more rather than being indoors more. And so I would anticipate that as fall and winter kind of come forward, what will happen is that people will start congregating indoors more. And so I think that limiting your exposure to risk will obviously reduce the risk of getting sick. And so it’s just a time wherein my mind, I’m just watching to see how things are going to go in the next coming weeks as the temperature continues to kind of cool down. But I think common sense goes such a long way, but primary prevention, hand hygiene, wearing a mask, all of these things can really make life a lot easier in the workforce. And I think if everyone sort of had a standardized practice, it may even reduce the anxiety level that people are having.

[37:26] – Holly Foxworth

Excellent points. We had lots of town hall questions that were submitted this week, and we’ve had lots that have been coming in ever since you guys have been speaking. The first one was from Jill and was saying that she was a little bit worried about their employees assuming that the illness was COVID-19. So she was asking, Are there specific pre-screening questions that would rule out COVID-19?

[37:50] – Dr. Scott Cherry

Yeah. I think professionally it’s very challenging for me to have not been able to come up with a screening protocol that is specific enough to differentiate between COVID and flu and I echo Dr. Rezvankhoo’s approach, that testing would be really needed to help differentiate those two. And so we have come up with testing solutions that either exclude COVID and can kind of default to an alternative diagnosis or potentially do more specific testing with regard to flu, strip, RSV, and things of that sort. So again, I think from just a screening questionnaire, it would be very difficult to come up with something sensitive and specific enough to differentiate the two.

[38:54] – Dr. Kabir Rezvankhoo

I’ve got a question for Scott, because this is something the co-infection rates if you remember when the COVID first came out, what we were doing as we were saying, Okay, if they’re influenza-positive, then we’re not going to do a COVID test. At least that was sort of the practice of a lot of hospitals, but we nonetheless, as people stayed sicker or got worse, well, this is kind of strange. We started doing testing for both, and we saw co-infection rates up to, like, 20, 30% in some of our patients where they have both influenza and COVID. So I’m wondering when you’re saying you can do a test to do one and not the other. I’m wondering, is that just you’re doing, like, a battery of tests on everyone, or is it you’re somehow assessing them for, let’s say, for the strip?

[39:48] – Dr. Scott Cherry

That’s a great question. And I know we’ve discussed this on and off over the course of the pandemic, and I think your direct experience in the hospital may be a little biased towards kind of having a heavier co-infection rate. But there’s definitely evidence to have co-infection in the milder cases as well. Probably it’s significantly lower than what you’re seeing in the hospitalized or ICU patient population. And so we do have those discussions with our clients about risk management and how much to invest in the employer-sponsored testing, or do we defer to the employee’s personal physician? And so we’re kind of just in the early phases of that now. But right now, from what I’ve been seeing from kind of the general population, the co-infection rate is low, and it may be below the risk tolerance of some of our clients. So if we can feel relatively confident COVID’s excluded, then we would assume it’s one of the other pathogens. And so we look at the longest duration of symptoms or return to work guidelines for that. So, again, COVID is usually the longest 10 to 14 days, but the other ones are usually significantly shorter. Usually, we’ll get several days of short-term disability taken off the table for our clients with large populations, which can make a huge difference from, like, human capital planning.

[41:37] – Dr. Kabir Rezvankhoo


[41:40] – Holly Foxworth

The next one was from Amy. And I think we may have started to cover some of these, but she was asking, should they recommend that all of their employees have a COVID-19 test if they have symptoms that were either of COVID or the flu?

[41:56] – Dr. Kabir Rezvankhoo

That’s an easy one. That’s yes.

[42:00] – Holly Foxworth

Correct. Yeah. Is there anything else that you wanted to add to that? That maybe they should have both types of tests like we were just discussing.

[42:09] – Dr. Kabir Rezvankhoo

I kind of like what Scott was saying. I mean, Dr. Cherry’s saying, I agree. I feel like the most important one is whether or not you have COVID-19, because that will really have you out of work for probably 10 to 12, 10 to 14 days. But I guess from treatment guidelines, if you did have influenza, then I would probably write a prescription, if you have strep throat, then I can probably give you some antibiotics. So I’m just thinking more of treatment-based. But again, what Dr. Cherry is saying is maybe referring them to their primary care doctor to get the rest of the workup done is definitely not a bad idea.

[43:01] – Holly Foxworth

The next one was from Jake that was asking, how likely would it be for someone to have COVID-19 and the flu at the same time?

[43:13] – Dr. Scott Cherry

I think Dr. Rezvankhoo was specifically talking about that. I don’t think we’ve revisited this specific topic for a couple of months, but I know that was something I actually had come to him before previously to get a sense of what he was seeing in the hospital. But it’s definitely some homework for me to do to look at the non hospitalized population because we do treat those two different populations significantly differently in the case management of them. I think even for hospitalized patients, their concern for them being contagious usually will bring them beyond the 10-day mark to potentially the 20-day mark. But again, looking at potentially, seeing if there’s an order of magnitude less than what Dr. Rezvankhoo’s experiences at that 20 to 30%.

[44:10] – Dr. Kabir Rezvankhoo

Yeah, I definitely think I agree with what you’re saying. Not enough research has been done yet to figure that out.

[44:20] – Holly Foxworth

And then the next one from Paula, she was asking, would the treatment be any different for the flu if an employee was positive for COVID-19?

[44:40] – Dr. Kabir Rezvankhoo

So we’re saying you have an employee who has done testing for both influenza and COVID-19, and they were positive for both, correct?

[44:53] – Holly Foxworth


[44:54] – Dr. Kabir Rezvankhoo

Okay. So in that scenario, I would probably treat them with Tamiflu and recommend them to stay home for 10 days because of their COVID-19 and then come back 24 to 48 hours after being without a fever, without taking Tylenol or Motrin.

[45:20] – Holly Foxworth

The next one was from Casey, she said, when can we let an employee come back to work after having the flu? Is there a specific number of days that they should isolate?

[45:34] – Dr. Kabir Rezvankhoo

I guess I would just recommend the CDC guidelines and what their recommendations are. Scott, do you know them offhand or for influenza?

[45:45] – Dr. Scott Cherry

Yes. Yeah. So really, there’s a significant difference between COVID and flu. And so it depends on which flu but I may have influenza B. I’m sorry, I was having a kind of a glitch going on there, but, you know, influenza A, I believe, will be seven days and then influenza B would be four days, and I will just double check that. But again, that’s significantly shorter than COVID being at a minimum of 10 days.

[46:31] – Holly Foxworth

The last town hall question that we had was from Joseph, and he was asking, do we need to identify close contact exposures for employees that have flu and/or COVID-19? There’s been a lot of discussions. We’ve had those conversations with clients about the importance of identifying close contacts for COVID-19 and that contact tracing, etc. I think he’s asking, is that something that would need to be continued even if it was for the flu?

[47:01] – Dr. Scott Cherry

Yeah. You know, there’s really a requirement to do contact tracing for COVID-19. I think there’s actually kind of at least from a regulatory or a request from the CDC. I believe that’s currently they’re silent on that right now. But historically, again, we have a flu outbreak every year. And there has not been, like public health engagement by local public health or by the CDC, unless it’s a novel flu-like H1N1 in 2009. And I think from a requirement perspective, it may not be there, but just because COVID is such a threat to the continuity of operations for employers and for businesses, I think being able to fully understand through medical surveillance, flu, and COVID is really kind of a critical metric for which businesses need to be aware of that’s, not again, a requirement. But I think it’s something that would help companies manage the risk of trying to stay at work or if there are needs to be other types of safeguards put into place.

[48:24] – Dr. Kabir Rezvankhoo

And I would echo with Dr. Cherry saying here because I think if you look at how medical research is done when it involves surveys when someone gets a survey, which let’s say this app of how you feel if you’re having any symptoms. A lot of that is sometimes we’re just clicking the buttons and we’re not really thinking too much. But if someone, let’s say, had a close contact or close exposure to an individual who is confirmed COVID-19, let’s say there are five individuals, those five individuals, if they were just to be simply notified and maybe they can pay closer attention to their symptoms and maybe they can be more accurate with their surveys. And that survey would actually be more valuable if someone told them potentially that there was some exposure so that they can get testing early. And that would probably avoid sort of an outbreak by simply just informing them alone because usually the symptoms they could be asymptomatic for up to four to five days of disease. And so that would potentially help them self-diagnose quicker so that they don’t continue working if they happen to become positive.

[49:48] – Holly Foxworth

And then from the perspective of just kind of maintaining things and best practices for their homes, we’ve been doing a lot of education about how it is that you need to maybe to isolate to one area of the house and separate from other family members that aren’t ill, will that same concept be applied for the flu as well?

[50:10] – Dr. Kabir Rezvankhoo

Well, I think it just depends. I’ll just speak on my behalf because I’ve been working in the COVID ICU pretty much almost every day since this mess has happened and I come home and I’m going to change, and then I go hug and kiss my kids and my children. So I don’t like isolate myself in some dark place and away from people. So I think that if I was to develop symptoms, this is what I would do. If I was to develop symptoms, then I would be tested, if I’m tested, then I would at that point isolate myself and minimize interaction for 10 days to prevent the infection to others. That being said, is it possible that my family members could have gotten infected when I was asymptomatic? It’s possible. But the bigger thing is if you do your due diligence when you’re outside of the house by wearing a mask, keep your hands clean, and wiping down surfaces. You can be comfortable that when you get home if you just change your clothes, wash your hands, do the same thing one more time, you’re going to be okay. I wouldn’t recommend to kind of go home and self-quarantine automatically, because a lot of times I walk into a patient’s room that is COVID positive, and a lot of times I’m just wearing a face shield and a mask and some gloves. And then once they get out of there, I take off the gloves and wash my hands, and I’m okay so it just depends. And if someone has COVID-19 and they’re wearing a mask and you’re wearing a mask, the likelihood of you getting COVID-19 is still low. Unless you’re really in their face, you know, doing a procedure.

[52:07] – Dr. Scott Cherry

Yeah. Maybe I’ll just add a little bit of discussion here, too. Dr. Rezvankhoo being a healthcare professional, when he’s taking care of his patients, he’ll wear a mask that has at least a certain level of protection beyond what the CDC recommends for the general population of just the face covering. And so I would assume you’re wearing at least an N95 or maybe something even more protective. And so a lot of times our view on health care workers is as long as they have the appropriate PPE, we do not consider them exposed. And so obviously, if there was a PPE shortage, then that would change. And Holly, I don’t know if your question was more with regards to the general population than health care workers, but I think a strategy would be if someone was actively symptomatic in the household because the household is one of the highest risk transmission venues, we do try to counsel if the house or the home is large enough to try to really segregate the sick personnel in a certain part of the room and then bring them food and supplies socially distant things like that. So I just wanted to again highlight those differences.

[53:43] – Holly Foxworth

Let’s see, we’ve got some questions that came in while we’ve been talking. The first was from Scott and says, are there any differences in workplace PPE or emergency supplies as we head into the cold and flu season that you perceive as necessary versus the standards that we’ve been operating under COVID?

[54:11] – Dr. Scott Cherry

No, I think really the PPE is the same in a non-healthcare setting it’s the same, and probably in a health care setting it’s the same. Unless I’m missing something. Do you have any different thoughts, Dr. Rezvankhoo?

[54:27] – Dr. Kabir Rezvankhoo

Yeah. The only time I wear an N95 mask or a device is when I’m doing an actual procedure on a patient involving their airways or if they’re on like a BiPAP mask where they’re aerosolizing the virus into the room. But if I’m just walking in and doing a quick exam, I think a simple surgical mask and maybe a face shield is more than enough as long as I’m not touching the patient with my dirty gloves and then rubbing my eyes. I mean, I think a lot of self-contamination happens because our hands become contaminated and so like the simple thing of taking your mask off, putting your mask on, where you put your mask on your desk let’s say if you’re sitting in an area, you’re eating food. How you take off your mask, where you put your mask, so like having clean surfaces and having some sort of a structured processor that each individual kind of does, like if I’m going to be using for the day, I normally just give it a quick wipe with a Lysol wipe or some sort of like a bleach wipe and let it air dry and then I just go on about my day. So I think these sort of hygiene things are very important for the individual but I think we wear a regular mask throughout the hospital and I’m not sure what happens in the workforce but if everyone’s wearing some sort of a face covering or face mask, I think you’re essentially working as a hospital. I mean, that’s the only thing we wear walking around in the hospital, it’s just a simple surgical mask, which you can get at Costco. In fact, I think that the mask that we use is the one that you can buy at Costco because it looks similar.

[56:42] – Holly Foxworth

The second part of this question and I know we’re getting close to time but we’ll just do the second part and then we’ll wrap up. The second part was, do you see another shortage in any supplies as cold and flu ramps or due to possible political changes in the country?

[57:08] – Dr. Kabir Rezvankhoo

So I’ll tell you, before COVID-19 the way we used to use these masks was frankly quite wasteful. I mean, face masks, we would wear one, go into one room and then we would throw it away and then we would maybe in another room, we would use another mask and throw it away, and N95s were the same thing. So now, we’ve gotten to this way of recycling our masks and I’ve been essentially recycling masks since March and we have not gotten sick and we’ve gotten a lot of usage out of our one mask or our N95 mask and so I don’t anticipate a shortage as long as people are being thoughtful about how they’re using their masks. I would try to get the maximum amount of use out of it, if possible.

[58:11] – Holly Foxworth

Dr. Cherry, anything to add to that?

[58:16] – Dr. Scott Cherry

No, I don’t have a good sense of – I know early on, there was a concern about stockpiles and this and that but I don’t have any good data but it is very promising to hear about the hospitals being able to more judiciously and more effectively use their current stocks, that does sound very very reassuring to me but I don’t have anything else to add to that.

[58:42] – Holly Foxworth

That was great information. Well, before we wrap up, do either one of you have some closing remarks that you want to share?

[58:52] – Dr. Kabir Rezvankhoo

For me, I would just say get vaccinated for influenza at least, wear your mask when you’re out there, and just be smart.

[59:02] – Holly Foxworth

Good point. Dr. Cherry?

[59:05] – Dr. Scott Cherry

Yeah, I agree, and I think maybe I’ll just echo again, one of my personal interests is wellness and so this may be a great time to see your doc or develop a relationship with a personal physician. Get your physician to determine if you potentially are in a vulnerable population. There are many things that can be done to help improve those conditions acutely and chronically. I think it’s a great time, maybe before COVID-19, when we were diagnosed with a chronic medical condition we just felt very complacent with it but actually with COVID-19 having these vulnerable populations it’s a great motivator to say, Let me optimize my health for the acute risk of COVID-19.

[1:00:01] – Holly Foxworth

Okay. Well, thank you all for attending. We appreciate you joining. I know we had a lot of questions that were here and if we didn’t get to your question today we definitely will take it in the live stream this next week. But if you haven’t already, please make sure and hit that Register Now button on the right-hand side of your screen, that’s going to get you signed up for the Recognizing and Responding to Suicide Warning Signs in the Workplace webinar. We also have an additional white paper that’s new, you’re welcome to access that right there in the resource tab, that’s Risk Stratification of COVID-19 so that really kind of talks about some of the employee categorization of behavioral risk and how it is that you can speak with them about that and narrow that safe and healthy environment. So if you haven’t already, be sure and sign up for those, we hope that we were able to answer all the questions that you had and we look forward to seeing you on Thursday. Again, that is at 1:00 PM Central on any of our social media streams. Thank you.