Covid19 Update – Part 1

It’s probably fair to say that, since March, most of us have been manoeuvring through unchartered territory. Most recently, with the talk of the plans for lifting the lockdown, the focus, effort and energy has been switching between getting through this phase, and wondering when the next step will start, and what that will look like. And then what? What will the “new business as usual” be, and what will it mean?

We’re sharing this – the first of three articles - with the hope that you’ll find it a useful discussion document to help prepare for and navigate the next phases of this pandemic and lifting of the lockdown. We’re not claiming to be clairvoyant, rather we’re basing this on global research and our clinical understanding of testing and treatment.

Now

Two things are dominant at the minute: testing for Covid-19, and the welfare of remote workers who would otherwise be at their usual place of work.

Testing

While there are plenty of test kits available, not all tests are equal: the accuracy rating differs, as does what is being tested and how this is done. For example, one such test, available to the market as a white-labelled kit, is an antibody test that has an accuracy from as low as 80% to mid-90%. By comparison, the one we use at Recovery4Life is rated as 98.7% accuracy. You may argue that 92% accuracy is okay, but we wouldn’t use it1. That said, the test’s accuracy isn’t the main problem: the most important component of testing is how you use the test, and where it fits into your wider approach to managing risk in the business.

1 At the time of writing, PHE have not set what accuracy levels they will accept for antibody testing – despite considerable and on-going pressure from the testing industry - and have not approved any antibody tests to date.

When using antibody tests, please remember that an antibody test does not tell you if you currently have the Covid-19 virus; it tells you if your body may have created antibodies as a reaction to exposure to the virus.

Two things here are key to understanding risk to the individual (and risk to others):

1. the accuracy of the tests used
2. understanding where in the cycle of exposure someone may be.

WHO guidelines are very clear that only a back-to-lab PCR test can be used to formally identify the virus. Antibody tests are purely a blunt tool to act as an indicator; they neither indicate whether you have had the virus nor confirm whether your body has developed long-term immunity. We are aware that both claims about antibody testing are regularly made.

Given the vagaries around testing, the approach we have been taking with our commercial clients is one of risk management – i.e. making the best judgement on the information known at the time. This doesn’t just rely on an individual test but on four areas:

a. Symptoms of the employee and family members living with the employee (with start and end dates) – to limit as much as possible transmission into the workplace;
b. Underlying health conditions of both – to limit the impact on the family/individual;
c. Social/job factors – including identifying high risk roles of partners and individual roles – identifying other risk factors;
d. Screening – on-going checking for symptoms including temperature checks, and testing – both antigen PCR testing (back-to-lab) and instant antibody tests (identifying IgM and IgG). We are also now able to offer back-to-lab antibody tests where there is a specific question around concerns re antibodies.

Testing is essentially a blunt tool, but by taking the above approach and using the different testing mediums at different points in time, we can – and have been able to – provide a framework for informed decision-making. This is a different approach to that taken for clinical assessment or treatment; we are trying to look for trends to assess ‘well-ness’ not prioritise ‘illness’. These are still early days and we will need to constantly review, assess and develop our approaches as things change.

Remote

Remote workers and those who have been furloughed have been facing new challenges. While it’s a broad spectrum of issues being presented, we’re supporting, and, very sadly, expecting to see many more individuals who are suffering from depression and anxiety. While “remote” may mean safety and comfort for some, for others it means danger.

Both physical and mental health are being impacted on now, and if there are to be future phases of isolation, the role of Mental Health Programmes, such as MHFA, will be even more important. The key factors to be aware of include:

• Physical health is likely to suffer with reduced fitness and already poor diets made worse.
• Anxiety and depression have significantly increased in the general population
• Recent reports have seen up to a 33% increase in alcohol use, which over time greatly increases the chance of dependency
• Shortages of over-the-counter medications with codeine in them would indicate either/or/and stock-piling and increased usage – the North East already has the highest level of codeine usage in the UK and this is set to rise.
• Experience from confinement following the SARS outbreak showed between 28% and 40% of people being isolated experiencing signs of PTSD, more recent studies in Wuhan have shown around 7% experiencing PTSD (though PTSD often occurs months after the event, so it will be too soon to judge).
• Domestic violence has increased significantly
• Debt and worries around debt are on the rise.
• Increased online gambling to problem levels, leading to associated gambling harm, potentially fuelled by the lack of live sporting events.
• Suicide and attempted suicides are on the increase according to the Police Federation.

These issues are clearly things to consider in terms of revising Health & Well-being strategies, and they also have a direct impact from a behavioural health & safety perspective, as it is unlikely that things will return to exactly how they were before the pandemic.

We recommend that businesses start planning for this sooner rather than later and effective testing will be key in supporting this.

Please do access our site and contact the team at Recovery4Life if you are looking for advice and assurance on testing and treatment for yourself and your colleagues. In the meantime, stay safe and healthy.

Next time we’ll look at phased returns to work, including the associated stress and impact.

http://www.recovery4life.co.uk/