Stay Informed About COVID Procedures with Epidemiologist Dr. Trivedi

The Hartford

Over the past year, there’s been a lot of debate regarding
both the prevention and treatment of COVID-19. Most of this uncertainty has been due to the ever-changing data surrounding this fatal disease. Still, as difficult as it might be to keep up with the latest CDC (Centers for Disease Control and Prevention) findings, small business owners must stay informed if they want to ensure the safety of both their staff and their customers. In this episode, Jon Aidukonis and Gene Marks, along with special guest and epidemiologist Dr.
Kavita Trivedi, discuss how small business owners can adjust their current practices to comply with the most recent CDC updates.

Executive Summary

1:21—Today’s Topic: How Do I Adapt My Small Business to Conform to CDC Guidelines?

2:53—If you are symptomatic, the CDC strongly suggests that you get tested to prevent the spread of this virus and continue to isolate yourself in the event of a false negative.

3:55—The most accurate form of testing for screening purposes is a rapid antigens test that provides immediate results, rather than the PCR or the serology antibody tests. It should be administered by a healthcare provider every couple of days.

11:58—Because this virus has exhibited unpredictable behavior by medical standards, rushing to resume “business as usual” could lead to a resurgence of infection rates.

17:12—While cleaning surfaces can certainly help prevent contamination, your business needs to focus more on preventing person-to-person transmission by encouraging your employees to wear masks, observe social distancing and stay home when they are sick.

21:32—Although restaurants and businesses can legally resume indoor activity in a limited capacity, you need to assess whether your client base is actually comfortable with those conditions. Your business might need to adjust its practices to accommodate both your customers’ needs as well as CDC regulations.

24:13—Even though there is a COVID vaccine currently in the works, there is no way to speed up the process without compromising its safety or efficacy.

27:33—In lieu of a vaccine, the medical community has used therapeutics to help alleviate some of the symptoms of this virus.

30:31—Right now, it’s best to hold off on attending any business trips unless they are absolutely necessary. If you must travel, do not touch or remove your face mask for the duration of your flight; be sure to wear a face shield in addition to a mask if the airline doesn’t observe social distancing.

Links

Transcript

The views and opinions expressed on this podcast are for informational purposes only, and solely those of the podcast participants, contributors and guests, and do not constitute an endorsement by or necessarily represent the views of The Hartford or its affiliates.

You’re listening to the Small Biz Ahead podcast, brought to you by The Hartford.

Gene: Hey everybody. This is Gene Marks with John Aidunkonis from The Hartford, and welcome to The Hartford Small Business podcast. We are really pleased to be here and talking to you about all things today about keeping your business safe and healthy with our favorite guest here, Kavita Trivedi. Kavita is an epidemiologist. I always have a hard time pronouncing that, Kavita. Did I do that correctly?

Kavita: Yes, I’m an epidemiologist.

Gene: You’ve got your own consulting firm in the Bay Area and you consult with companies big and small on, basically, how to keep their businesses safe and clean and hopefully in a good shape as we’re bringing employees and customers back. Is that also a fair statement to say?

Kavita: Yes, correct, and just providing education as the science changes around COVID.

Gene: Good. The website, by the way, is Trivedi Consults, with an S on the end, dot com.

But hey, look, let’s get into some of the details. Both John and I’ve got a bunch of questions to hammer you with, Kavita, because there is so much conflicting information, and again, as business owners, we’re trying to figure out how to do things the right way, and we also, at the same time, we don’t want to overdo things. Let’s start with John right now. John, I know you’ve got some burning questions that you want to ask Kavita. Go ahead. Ask one.

Jon: Yeah. Kavita, one, thank you for joining us again. It’s great to talk to you. I’m really happy with where we landed last time, but where we started to leave off, before I talked too much, when we ran out of the time, it was around the notion of testing en masse. And with the recent changes from the CDC encouraging folks to not necessarily get tested if they haven’t been exposed or if they were asymptomatic or exposed to someone who is asymptomatic, I feel like it changed about three times in one day, or I could be misremembering, and then re-encouraging that testing.

I just wanted to get a pulse check. Especially as we think about bringing people back to work, as people start to adapt to these more broad phases of reopening, how important is it to get tested right now? And if you have the time and capacity to do so, is there a shortage where we should really be saving those for people who seem symptomatic and presumably positive? Should you be doing such if you’re not in a more severe risk scenario? What is that right now? And does the volume of testing help us get to somewhere sooner, the more we can learn?

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Kavita: Yeah, good questions. Firstly, I think everyone agrees, including public health providers, that if you are symptomatic and you have symptoms that are consistent with COVID-19, which that list of symptoms continues to grow, but if you have any of those symptoms, you should be tested. We also are having difficulty with false negatives. So, let’s say somebody goes in and gets tested who has symptoms consistent with COVID, yet the test is negative. The recommendation would still be for them to isolate themselves in order not to spread the infection to others. So, diagnostic testing is, of course, highly recommended. I think where we start to get a little bit of disagreement is when we talk about screening larger populations, when we talk about testing prior to activities. In terms of screening, this would be something you might do for a school or something you might do for a larger setting of people that are going to be interacting with each other.

There is also now some consensus that in that setting, it makes sense to have a test, but to have a test that you get the results quickly. Right now, many of our PCR tests that are being run across the country are taking up to a week or longer to get results back, and that’s just not really that helpful. So, when you’re talking about screening, you really want to look at what test is available in your area and how quickly you can get the results back. I think the other thing people are missing about these screening tests is that just because you get tested doesn’t mean that that result holds for a few weeks. That test is simply a data point for that period of time. So, for the prior two weeks before you got that test, that test is then telling you if you potentially have the virus, whether it’s via a PCR test or an antigen test. Just because you’re negative on one day and then you go about living your life and doing things and exposing yourself to other people for the next 10 days, that test still doesn’t hold up, and I think that is not quite understood. That test is only valid for that moment when you receive the information.

I think the other thing that we’re seeing as well around testing is really understanding which test you’re getting and how to interpret those results. This is all more complicated than your listeners probably want to hear about, but it is important to qualify, “Hey, I got a test and this was the test I got,” so that the person on the other end can then interpret the positive or negative test results in an inappropriate fashion. And I agree with you. I think the testing recommendations have changed. I think many of us in the medical field did not necessarily agree with some of the recommendations that came out of the CDC a few weeks ago, but I would say in general, diagnostic testing is still recommended. That should be done through a healthcare provider, and even if those are negative, we would still consider symptoms that are consistent with COVID to equal isolation. Secondly, if you’re doing a screening test, just understanding that that test has limitations, but also is just one data point in probably all the tests people will receive in the next year.

Gene: Kavita, how accurate are these tests in the end? I hear so many different opinions as to their level of accuracy, and is there one test that’s more accurate than another?

Kavita: Yeah. Good question, also complicated. The PCR test, which is the polymerase chain reaction test, that test is considered by many as the gold standard approach. That test essentially takes the sample and then amplifies the sample multiple cycles, multiple times in order to decide whether or not that person has the virus. Even if the person has a very, very low amount of virus in their body, the PCR test may come back positive. We are not sure. Actually, we know for certain that not everyone who tests positive by PCR is still infectious. Just because you have a very small amount of virus in your body three weeks after you’ve had symptoms, and your PCR test is positive, that doesn’t necessarily mean that you’re still spreading the virus to others or that you have the ability to do that. It just means that the PCR test is super sensitive and it was able to find that virus in your body.

Now, the other test that we’re talking about is the rapid antigen test, and that test does not use amplification in the process. If you’re positive on that test, you have a very high viral load, and our interpretation of that means that you then are at a high likelihood of transmitting the virus. So, what we are talking about in terms of screening tests is not using the PCR test because we don’t really want an overly sensitive test that identifies everybody with any amount of virus in their body, but we want to identify people that need to be isolated, which are people who have high viral loads. So, there is a lot of discussion about moving over to the rapid antigen test as a screening test and then doing it more frequently, maybe every three days, so that the population you’re trying to look at, you can quickly identify people that have a high viral load and take them out of circulation so that they don’t transmit the disease to each other.

I think there is a distinction between the two, and again just because I hear this all the time, “Oh, I got a test. I’m negative.” Well, which test did you get? And let’s talk about what that result really means.

Gene: John, what do you think?

Jon: The PCR test, is that a newer development or are they both the swabs? How would you know the difference? Would you just have to ask your provider because of how it’s actually managed in the lab?

Kavita: Yes. You would have to ask your provider. Early on, we simply have the PCR tests, and that was when you did the nasal swab that went all the way up to essentially your brain. It went really high up into your nose. That was the only test we had available. But now, you can get a PCR test either with saliva, you can get the PCR test with a lower anterior nasal swab, and then the antigen tests are also available in both ways. You can get those either with a nasal swab or with a saliva test.

You must ask your provider which tests you’re getting. That’s the only way to know which one you are having. I will say that most of the tests where you go to an urgent care center and get a result back in 15 minutes, those are rapid antigen tests. Most of the ones that we’re doing in those settings are the rapid antigen tests. And then of course, there’s a whole other that we didn’t talk about, the serology, the antibody tests that people were talking about early on. We’re not even talking about those because I think we were pretty clear that in the acute situation, that is actually not a very useful test to obtain at this point.

Jon: Right, and that’s more to say if I had it. You would show that you at some point had been exposed but might not have any virus or an active case.

Kavita: Correct. We are not clear how long those antibodies stay around in the body. We think at least three months. Just because you’re antibody positive on one day doesn’t mean four months later, you’re still going to have those antibodies and that you’re not going to get the virus again.

Jon: What’s interesting there is, and I think this might be where our listeners are thinking too, when we talked about testing, that’s obviously how a lot of these states and districts are determining what they consider their positivity rates, which seemed to be a big indicator on what you can do as a business or how you can operate. But I think what we’re starting to see too is that states that were pretty gung-ho about, “Okay, when we hit this percentage we’re going to do phase three, phase four, phase whatever,” they did start to see some spikes.

In the Northeast, I feel like we’ve been a little bit more conservative with our opening. In Connecticut specifically, we’re still in phase two, and phase three is, I think, indefinitely on pause because of the findings that happened in other metros and other states, and to try and avoid a fall time spike. Do you anticipate that becoming looser soon, just from your exposure to data and what we’re learning? Is there still a lot unknown or is it still like, we need to go through the motions of the calendar year and see what really can compound it between fall and allergies and flu season and back to school and all that?

Kavita: Yeah, I think a couple of comments to that question. I think, number one, this virus has not behaved the way many of us epidemiologists or clinicians expected. We had expected there to be a decrease in the number of cases over the summer. We did not see that, necessarily. We thought because it was warmer that we would see a decrease in cases. We didn’t see that. And in fact, we also did not expect to see children have this inflammatory syndrome. We didn’t expect that. This virus, I think, overall has behaved in a way that we had not expected. I think I may have talked about this before. I think the other thing about this virus that is really hard is that the spectrum of disease is so broad. Some people can have the virus and have zero symptoms, and other people have the virus and are in the ICU fighting for their life.

There’re not many other pathogens or germs that cause this spectrum of disease. I think that is one thing. I know there’s a lot of confusion in the public about, why are the recommendations changing? Well, because we just met the virus in December and January, and we are learning as we go. We have predicted things unfortunately sometimes in the wrong way. I think the other thing is that the infection prevention measures that are very clear to those of us that study this virus, such as wearing a face mask and physical distancing, we are now seeing some communities are just sick of it and not interested in continuing to engage in this way. As we’re seeing some communities get tired of the infection prevention measures, I think the implementation and behavior change piece is not a small thing to consider.

For example, in the Bay Area right now, we’re not only wearing face masks, we’re also dealing with poor air quality. I think as all these things get compounded, people get tired of living the way we’re living. That’s when you’ll see spikes in infections, because people will say, “I haven’t seen this friend down the street. I just want to have a drink with them. We’re not going to have a face mask. We’re going to be inside the house.” That’s when I think we’re going to see more and more spikes occur. To that, I would suggest really trying to continue the infection prevention measures that we are saying work. Time and time again, we are seeing that if people wear their face masks and are even exposed to people that are sick, they’re not getting the illness. We have some really wonderful case studies showing us that face masks really work. I would just encourage our listeners to really consider persevering in their infection prevention household protocols. And the more we do this collectively as a community, the more we keep one another safe and keep our economies open, which I know is ultimately what people are really hoping to do, continue their livelihood.

Gene: Kavita, let me ask you about cleaning surfaces as well. There are a lot of measures that are being recommended to businesses, schools as well and other facilities. Obviously, you wear a mask. It helps to reduce the chance of the virus being spread. That’s obvious. And obviously, social distancing also helps that as well. But boy, I do get some pushback from some of my clients. They’re like, “I’ve got this person going around cleaning our surfaces,” and the minute one person touches it, particularly that person might be infected with COVID, that’s it. Does cleaning surfaces really make a difference, or do you think that it’s more for show than anything else?

Jon: I got to give a shout out [to a local business.] I had been really trying to stay home, but I had to pick something up. It was incredible how they were rinsing and washing. They had the plexiglass up at the counter and the credit card machines and the surface. They’d only let one person up at the counter at a time who’d come out, wipe everything down with what smelled like an ammonia-based cleaner, and then go back and do the same thing. It took a little while, but it was impressive to see the attention to detail.

Gene: First of all, I think if you’re going to go to that level of diligence, John, I think that would actually have an impact. But now, I’m talking about, I was at a client yesterday and they’re a distributor of machine parts. There are people all over the place working and going here and there, and they don’t have the time to sit there and follow all the employees around and wait for them. They’d spray disinfectant right behind them. So, when I just had the owner, I asked him, I said, “This is crazy. You clean this place once a day or twice a day, but is that even really making a difference here? Are we wasting our time?”

Kavita: I think, again, this is where we messed up with public health a little bit in the beginning. The focus in the very beginning, I think, was don’t wear the face masks and clean surfaces. That was what we initially heard.

Gene: Yeah, like your shopping bags. I’d get a delivery from Instacart and we’re sitting there wiping down our shopping bags for an hour, which now, nobody seems to be doing.

Kavita: Although it is still a viable theory on how you can get sick, we know now that the person-to-person transmission, the transmission between adult to another adult, that is more of a concern. That is where we are having outbreaks occur. Although the surface transmission, like I said, in theory, it makes sense. You are sick, you cough on something, you cough on your hand, you touch a surface, then somebody else comes by, let’s say, in that factory that you were in, Gene, and then another worker happens to touch that exact surface maybe within 15 minutes, the virus happens to get on their hand. Then, they have to touch their eyes, their nose, their mouth for it to actually enter.

There are many steps that need to occur for that transmission to happen. Whereas, let’s say two of the workers in the break room, eating lunch, sitting near each other, that’s a much more viable transmission story. They’re talking, droplets are flying between them even just in talking, and that’s how they get infected. I think the focus really needs to be back on person-to-person transmission, wearing the face masks, and physical distancing, as you already stated. I think cleaning surfaces is certainly a good practice, but does not need to be the main focus. I think things like making sure workers don’t come into the office sick with symptoms or having a really non-punitive sick leave policy in these times is really important. I think making sure you have a good screening protocol in place, whether that’s electronic or maybe even a paper form they have to fill out before they come in so they’re attesting to their lack of symptoms. And also, of course, within the workspace, wearing a face mask all the time, especially if you’re indoors and physically distancing.

I make fun of the two workers sitting in the break room having lunch, but that’s a real issue. We’ve had outbreaks in hospitals where people are taking care of COVID patients, because they’re sitting in a break room having a pizza party, 17 people get sick. Those things I would rather companies focus on, as opposed to the cleaning and disinfection. I want them to clean. I want them to use a disinfectant from the EPA list that is active against this coronavirus, but I’m not sure that I need them to be cleaning all the time in the space. I’d rather them focus on the other things that we just talked about. Screening protocols, a non-punitive sick leave policy, and where do people take their masks off safely and have lunch, have snacks. I think those things are actually going to be more effective than worrying about cleaning the premises often.

Gene: Got it. Now, Kavita, you live in the Bay Area. Are restaurants allowed to serve indoors yet in your area?

Kavita: No, we have not seen that. We are only seeing restaurants serve outdoors. And then, like John just mentioned, we have some really great policies about touchless delivery. You can order from a restaurant and go up and just pick up the bag outside, or the guy comes to your car and drops it off in your car in your trunk. So, no, we don’t have any indoor eating as of yet.

Gene: The reason why I asked that is that, in Philadelphia, they just opened up to 25% capacity, and in Pennsylvania, now it’s 50% capacity. Hopefully, Philadelphia will make its way up. At some point, the Bay Area where you live, restaurants are going to be allowed to let people sit indoors, and it’s probably going to start out at the 25% capacity. When that happens, will you eat inside of a restaurant?

Kavita: I will not. I’ll tell you, in the last six months since March, we have not gone inside anyone else’s home. We have only interacted with people outdoors. We have had meals with other families outdoors, but we sit 10 feet apart when we have the meals. So, no, I’m not going to feel comfortable going inside a restaurant here, especially if transmission rates continue to stay as high as they are or even continue to go up. I will not take that way.

Gene: At what point do you think you will feel comfortable? I ask this because we have a lot of people that own restaurants and retail stores that listen to this podcast. When will you be comfortable to go into a restaurant?

Kavita: I think that’s an interesting question. I will say the CDC came out with a study just this week, just yesterday I believe, where they looked at 500 patients, COVID positive people, in the past few weeks, and a large majority of them had eaten indoors. That was the number one risk factor that the people that were positive endorsed across the board. So, I will continue to support our local restaurants by ordering takeout. We order takeout at least a couple of times a week just for that purpose, just to make sure that we’re supporting the local economy. Just as John has mentioned, I take note of what infection prevention measures are in place at the restaurant that make me feel comfortable with going back again. And I may consider eating outside if I feel like the tables are sufficiently distanced at some point, but it really will depend on transmission rates, and I think also when and if a vaccine does come out. I know a majority of people have gotten it in the community. I think that would be the time that I would really feel comfortable going into a restaurant and eating without a mask on.

Gene: Fair enough. John, what do you got? Anything else?

Jon: What’s interesting there was actually the comment on the vaccine. Obviously, that’s a hot topic right now, and people talking about one, this is a vaccinatable disease. And then, two, something that we can expect to see this year, next year, or even as soon as, they’re saying before November. And a range of opinions and debate on if we see something that fast, if it would have had the time to go through the proper channels of testing to really explore its safety, to understand its long-term impact. But do you have any thoughts there, just as someone who’s closer to that type of work?

Kavita: Yeah, definitely. Yes, a lot of discussion about vaccines. We have, at this point, I believe eight companies that have vaccine trials in the phase three in that realm. We need to go through the phase three trials in order to be sure that a vaccine is both safe and efficacious. These vaccines and the data safety monitoring boards that the data has to go through. These are boards that have been in place for decades. They have algorithms and protocols for how they deal with adverse events that may be due to the vaccine. So, I don’t see how that process can be sped up, and I don’t see how those data safety monitoring boards pressured in any way to show that the data is more positive than it actually is. I highly doubt there will be a vaccine available before November, but I will remain very interested in what the data out of these vaccine trials shows us.

If they enroll the 30,000 patients, and the majority of patients after a few months still don’t have any side effects, the ones that receive the vaccine itself, that will be very promising and very positive. I think the other thing to note is that, these vaccine trials need to go on for some time to enroll all the patients, but also to see if there are any longer term side effects from the vaccine itself. So, I’m really excited. I think that the data we have coming out so far has been quite positive out of the phase one, phase two trials for these vaccines. I’m cautiously optimistic, I would say, but I also will be very interested in reading the safety data that comes out of the trials.

It’s exciting to have all this attention on a vaccine. We’ve never had this much attention in our lifetimes on the development of a vaccine, but I really hope that folks are swayed into taking it, because if we make a vaccine that is safe and efficacious, and then the majority of the population is too worried to actually take it, well then, that’s actually not going to help us in getting back to pre-pandemic ways. So, I hope people are open to taking it if the medical community can show that it is indeed safe and efficacious.

Jon: As a follow-up there too, I know there’s also been talks about therapeutics. So, not pure vaccines, but things that might reduce your risk or be effective if you do catch it. There’s been a lot of interest now in HIV medicine and things. I think of what’s been in some of the medical journals around like TRUVADA or, I’m going to say this wrong but, remdesivir.

Kavita: Remdesivir. Yeah.

Jon: Remdesivir, yeah. Those seem to be showing some promising correlations to lack of either impact of the disease or ability to contract. But do you think we might be in a situation where it is something that there’s more of a consumer therapeutic before a true vaccine, or is everything up in the air right now?

Kavita: No, we have made a lot of strides just in the last six months around therapeutics. Something that I may have mentioned on the last podcast is that we have approximately 4,000 papers published on COVID-19 every week, and the majority of funding that is happening right now for researchers across the country is funding towards COVID-19. So, people that were studying, let’s say, hypertension before are now studying hypertension in COVID. There is a lot of information coming out about COVID, and we do know more about how to treat patients if they do get the infection. Promising studies have showed us that remdesivir definitely helps if you are in the hospital and require oxygen. We know that steroid treatment, when you’re in the hospital, also, and sick, can reduce your needing mechanical ventilation.

So, we have a few therapeutics that we know are helpful and are being used right now in our hospitals and are certainly reducing the length of stay for some of these patients and are improving survival. We know much more now than we did six months ago, and we will know even more in another few months about how to treat patients successfully with this virus. The only other caveat to that I’ll just mention is that we do also unfortunately know that young people, there was a study that also just came out a couple of days ago, young people are having difficulty fighting the virus as well. I think early on, we were really focused on our vulnerable populations, our nursing home patients, our patients with underlying health disorders, but we are learning that even young people are having some difficulty with the virus as well. So, I think this isn’t one of those times where young people and children should feel that, “Oh, we’re not getting as much of this virus. We can just go out and do our thing.” We are seeing some really sad outcomes and poor outcomes in the younger population, also. We’re in a much better place now than we were six months ago, certainly in terms of therapeutics.

Gene: Kavita, I know we only have a couple minutes left, and I just wanted to end it with a personal question. I’m looking at my calendar now and I am scheduled to fly to Minneapolis on October 27th and spend a night there for work things. There are a lot of other people like myself that are getting back to traveling or will be getting back to traveling in the next few months, we hope. What advice do you have for me for not dying?

Kavita: If you travel by car, you certainly have a higher risk of dying than you do by airplane. That’s certainly number one. Number two, I would say, many airlines are doing a really good job of requiring face coverings and airports are also requiring that as well. I think that that is very positive. We have some case reports of people who were ill when they got on the plane, but because they were masked and other people were masked, the virus was not able to be transmitted. So, my recommendation would be, well, number one, decide if it’s really that important to go on this trip. I think we only should be making trips at this point that are really crucial. That’s number one. Number two, if you still need to go on the trip, definitely of course make sure you wear a face covering. If I were you, I would not touch the face covering once you put it on in the airport. Maybe once you get on the airplane, and just don’t fuss with it again until you get out of the airport on the other end in Minneapolis, if that’s possible.

Secondly, if you are flying on a plane where they are not able to keep the center seats open, or not able to keep distance between people, then I would consider a face shield. That was going to be one of the things I mentioned today. A face shield in addition to a face mask. I may have mentioned this before, but a face covering provides source control. You decrease the amount of virus in the environment. But the face shield provides you barrier control. It’s like the plexiglass that you see in the grocery store. The face shield allows you to have a barrier against the virus that may be traveling in the environment that gets around other people’s face covering. I would suggest considering a face shield and a face mask in any setting, and an indoor setting like an airplane where you cannot maintain physical distance from other people.

Gene: Kavita Trivedi is the president, founder, CEO, of Trivedi Consults, which is T-R-I-V-E-D-I Consults with an s, dot com. This has been a great conversation. If you’re looking for help in getting some advice and consulting work to make your business safe and healthy for your workers and your employees and your customers, Kavita is definitely a great person to speak to. John, thank you. My co-host is checking in by phone, made this conversation really good, and we appreciate, Kavita, all of your time and the answers to our questions. For more information and advice in running your business, please visit us at The Hartford Small Biz Ahead website. Thank you everyone for listening to this podcast, and we look forward to joining you on our next segment. Take care.

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