What we should know about the pandemic (Part 3) with Dr. H. Westley Clark

The views expressed on today’s program are those of the speakers and are not the views of Today’s Workplace, the speaker’s firms or clients, and are not intended to provide legal advice.

Summary:

Our understanding of how the coronavirus spreads and affects the human body has evolved since March of this year. Though many businesses and workplaces have taken the necessary precautions from March until the present day, we find that individuals have now entered the period of what some would classify as pandemic fatigue. With the constant reminder to practice social distancing, masking up, and keeping your hands washed, people are feeling demotivated to follow recommended guidelines that would protect them and others from the virus.

As individuals attempt to regain the old way of life, cases for COVID-19 have risen to an all-time high. Given the fact that human beings are social creatures, in order to curb the spread of the virus, it is advised that we must learn to change our behavior and outlook towards the pandemic. Our failure to do so has resulted in several countries, such as those in Europe, that are now in the process of implementing a quarantine shutdown. This is due to laws that have been previously relaxed to allow certain freedoms in terms of people’s ability to circulate socially without these protective measures.

While the race to find a vaccine is still in motion, many factors contribute to the time of its release to the public. The question remains, however, as to when we will be clear of this pandemic and will citizens and employees be forced to take the vaccine when the time comes. Joining us is Dr. Westley Clark.

H. Westley Clark, MD, JD, MPH is currently the Dean’s Executive Professor of Public Health at Santa Clara University in Santa Clara California.

He contributed to the US Surgeon General’s Report on Alcohol, Drug Abuse and Health as a Section Editor for Treatment. He is a member of the National Advisory Council of NIDA. He is a member of the Board of Directors of the non-profit Felton Institute, He is also on the Board of Directors of the Pacific Institute for Research and Evaluation.

Dr. Clark received a B.A. in Chemistry from Wayne State University; he holds an MD and an MPH from the University of Michigan; He obtained his Juris Doctorate from Harvard University Law School. Dr. Clark received his board certification from the American Board of Psychiatry and Neurology in Psychiatry. Dr. Clark is licensed to practice medicine in California, Maryland, Massachusetts and Michigan. He is also a member of the Washington, D.C., Bar.

Contact

Today’s Workplace: https://todaysworkplacepodcast.com/

Dr. H. Westley Clark

28s Summary of the previous episode with Dr. Westley Clark and an Update about the virus

1m 57s The latest update on how the virus spreads

4m 30 How effective have popular methods being used to mitigate the virus been?

7m 36s Countries resuming shutdown mode due to the spike in COVID-19

9m 39s What countries are doing the best job as far as containing the virus.

12m 25s Understanding the fluctuation of the numbers and what they mean when handling with the virus

15m 20s Do the numbers tell us anything about our rate of infection versus other countries?

16m 38s Children being infected and the likelihood of them transmitting the disease to adults in schools

19m 57s With places opening up, what kind of concerns or warnings are they providing to patrons?

23m 32s What is the process used to test and approve vaccines and when will they be ready for the public?

26m 47s What are the predictions on when we might see a vaccine fit for people to take?

28m 24s Can the government require citizens or can employers require their employees to take the vaccine?

31m 06s What is the timeframes that is being discussed for when society will be safe from the Coronavirus?

33m 59s What are Dr. Clark’s top three pieces of advice to employers adjusting to the coronavirus impact?

Transcript

Belinda: During an earlier episode, we had a great discussion with Dr. Westley Clark, an expert in public health, about the arrival of the COVID-19 pandemic and its far-reaching impact on the communities, businesses, and overall economy of the United States and across the globe. We learned that the very new and novel nature of this deadly virus has caused the scientific community to go into overdrive, finding ways to detect it, prevent it from spreading, and treating the virus. Today, Dr. Clark is back on the show to give us an update on the new scientific information about the virus and implications for today’s workplace. So, we want to extend a warm welcome to Dr. Clark and say to you all welcome back to today’s workplace.

Dr. Clark: Thank you.

Barbara: Yes. Welcome back to today’s workplace, Dr. Clark. It’s fair to say that our understanding of how COVID-19 spreads has evolved since March of this year. I think of all the precautions folks were taking at the grocery store and those rituals before bringing food inside. And that doesn’t seem to be the preferred approach to avoiding contracting the disease now. When we spoke a few months ago, there was a new theory that had developed as to how COVID-19 spreads. The theory that the COVID-19 virus spreads as an aerosol rather than droplets, help us understand what the latest thinking is about how the virus spreads.

Dr. Clark: Well, according to the CDC and others, the virus is still spread through person to person contact. Aerosols are now deemed suspect and people are advised to invoke the same basic measures that we’ve been traditionally addressing from earlier this year. So, it is now known that it can fill in a closed space with poor ventilation and you’ve got somebody who’s infected, that person’s projectile, either coughing, sneezing, or even talking, depending on how forceful their speaking patterns are, that can carry. But the six feet distancing is still the prevailing notion one, and two, wearing a mask is still deemed the best approach to protecting you from exposing other people and being exposed yourself. So, despite the awareness, aerosols are an issue, the most important thing is that people are protecting themselves and others by social distancing and wearing a mask.

The notion of disinfecting your workspace, it’s still relevant because again, you don’t know who was there before, and we’re finding that the virus can live on hard surfaces for a longer period of time. Although again, that does not seem to be the controlling or the most prevalent way that people are getting infected. They’re getting infected from super spreader events where a lot of people in close proximity, or they’ve got at least 15 minutes of contact with someone who’s infected. Those are things that we have to keep in mind. So, disinfecting hard surfaces is still appropriate. Social distancing is still appropriate. Wearing a mask is still appropriate.

Belinda: So, I guess next we want to ask a little bit about some of the popular methods, and you mentioned a couple of them being used to mitigate the virus, spread like a contact tracing, social distancing, wearing a mask, and either quarantine or shelter at home. How effective over time have those shown to be in really controlling the virus spread?

Dr. Clark: Well, they’ve actually been quite effective. The problem with some of these strategies is that we may have pandemic fatigue, which is that you’re dealing with the behavior of the average person, being able to conform your behavior to those– people see as constraints on your behavior, is turning out to be a complication. If you follow those basic guidelines, we were able to flatten the curb, we’re able to avoid what we now are experiencing is, depending on who you talk to, the second or third wave of the infection but people don’t seem to be inclined to do that. People want to be able to go into the stores without wearing a mask. They see it as an encroachment on their individual liberties. They don’t seem to understand that what we’re doing is not only just protecting you but protecting people in your environment. So, your individual liberties trumps your obligation as a citizen to other people in your environment. So, people aren’t wearing masks, and many situations people are having massive events where masks are not being worn and social distancing is not being encouraged. So, we see an uptick in the spread of infection, that is turning out to be an issue. I was in a grocery store that was actually handing out mass to people who didn’t have them and I saw gentlemen absolutely refuse to take it and the poor lady who was trying to facilitate the rules just had to relent and the guy went storming through the store with his card and his child with no mask, even though she had given him one. If citizens, members of the society don’t have a stake in the outcome, then we’re not going to change the spread of disease.

Belinda: Yeah. I think we’re seeing some examples of that even overseas, because even today, both France and Germany–

Dr. Clark: Yes.

Belinda: Announced that they’re going back to quarantine shutdown modes because they had allowed certain freedoms in terms of individual’s ability to circulate socially without these protective measures and it resulted in tremendous spikes and spread of the disease. Did you happen to see those reports?

Dr. Clark: Yes, and in fact, I suppose what it represents is that we’re social creatures, social animals, and it’s really difficult for us to limit our behavior. Even though, I guess in other times, France and Germany, both or countries with war experiences. People made accommodations to the reality of the exigencies. We are in a situation that, not as comparable, but certainly, a pandemic is a disaster in the making; people need to exercise judgment. So instead of rushing on Moz, back to the status quo ante– this is the way we’ve always done it, let’s get it back to that. We’ve got to change our behavior, and that I think is the thing that we’re seeing in France and Germany and Italy, Belgium, and other countries. This is what we’re seeing in the United States. We don’t have to go abroad to look at that. We’re seeing a number of rural communities and jurisdictions that previously had low prevalence, suddenly spiking because indeed the attitude was, it’s not going to affect us and we don’t have to change our behavior. So, if you see public health as an encroachment on your constitutional right to be free of all encroachments, then you risk those exposures because the virus doesn’t respect your constitution.

Belinda: Yeah. You were talking about what’s going on in some countries, but talk with us a little more about what is going on globally with respect to COVID-19 on what countries are doing the best job as far as containing the virus.

Dr. Clark: We keep hearing of some of the Asian countries, but I don’t like to get it to this comparative thing, in part because it’s somewhat– what you have to ask is, what countries are conforming their behavior to good public health strategies. I think that’s the key issue. And you also then have to ask, can the United States do that? Can we in the United States do that? Comparing the United States to Japan or China or Korea is a non-sequitur If we’re not going to change our behavior. And I think, seeing the European countries suddenly confronted with, as was pointed out, with this dilemma. We’ve done well and now look, what’s happening. The virus hasn’t gone away. We’re now hearing a period where we’ve got the double whammy of the flu and the virus. So, what are we prepared to do? Because if we don’t change our behavior, nothing happens. And if other countries are willing to do that, then why aren’t we willing to do that? The protocols are the same. It’s not that they have some secret sauce that works for them that wouldn’t work for us. It would work for us if we would only do it. So, wearing a masks, social distancing, if you are sick or infected, quarantining, self-quarantining, those are the things that we have to work for.

And I’m not trying to avoid your question. I just think that what employers and workers and citizens have to understand is, it’s not a magic formula. It does wear on you. It can be boring. It does mean we have to change our behavior. But if we don’t do those things, the fact that somebody else is doing them as irrelevant, we’re still going to get sick. And if we get sick, then our senior citizens get sick, our working-age adults get sick, and that poses a problem for us and not for somebody else in some other country. I think that’s key issue. That’s what we’re seeing. People believe they have a constitutional right to keep their faces bare. Maybe it’s a permutation of the second amendment instead of having the right to bear arms, we have the right to bear faces.

Belinda: So, I wanted to ask you a little bit about the numbers that we see reporting because a lot of times in the mainstream we see the numbers, but really kind of don’t understand the meaning of the numbers. So, we just know that they’re large, in terms of the number of cases and the number of deaths. And so, from the beginning of this virus to now, can you take us on a journey as to the fluctuation of the numbers and what they mean in terms of how we’re proceeding with getting this under control and where it might lead us?

Dr. Clark: We are doing okay. So again, United States is a big country. So, you have to look at the United States in that way. So, we currently have 227,000 deaths in the United States. We have over 8 million people who have tested positive in the United States, 8.8 million to be closer. We lead the world in the number of positive, but India is following us,

Brazil follows us. So, the waxing and waning of the disease seems to track the behavior of people. When you have these major events like South Dakota, when you have these major events like political rallies, when you have these events where people refuse to wear a mask, then you start getting an uptick, which we are currently experiencing. There’s been an uptick in positive rates. We are doing a lot of testing, but the testing shows that if you look at it from an epidemiologic point of view, we really shouldn’t be spiking. We are spiking because we’re picking up new infection, and we’re picking up new infection because people are not changing their behaviors so that’s an issue. So, we’ve got these 227,000 deaths. We’ve got these 8.8 million cases. We’ll continue to have cases. Ball games are being canceled; the events are being canceled. Schools are rethinking, opening in part because of how we’re being exposed. So, if I can’t go to the supermarket, because someone’s adamant about wearing a mask then that person may expose me, or I may expose that person, that person goes back and exposes somebody else, et cetera, et cetera. And that whole notion of [inaudible 15:16] hasn’t changed.

Belinda: So, do the numbers tell us anything about our rate of infection versus, you know, some of the other countries who are wrestling with this?

Dr. Clark: Like you’ve mentioned Germany and France, the rate of infections is rising. So the numbers tells us that we are getting more infection, but the question is why? It was predicted that because of the flu season we would, and the close proximity of people, we would start having more problems. Businesses opened up, some restaurants and bars were very adroit in social distancing, others were not. So, what the numbers tell us is that people are being exposed. And question is, where is this exposure occurring? Is occurring in social settings, in social situations. So, the numbers tell us, what should we be doing? And the epidemiologist keeps telling us what we have been doing, even though it’s toxic, as far as some people are concerned, but we’re not ready for prime time yet.

Barbara: When schools around the country are struggling, you just mentioned schools, and the approaches vary from hybrid models to completely online. What do we know as far as children being infected and the likelihood that they can transmit the disease to adults, and are there differences in how children are impacted?

Dr. Clark: Yes. Children don’t seem to get as sick. They don’t transmit as often, but you have to keep in mind when you use the word children, you’re dealing with an age range. So those who are five and six, seven, have a different experience in those who are 16, 17, 18. So when people invoke schools, they invoke K through 12, but it’s not K through 12. So, the elementary school kids are in a different situation. Although there are those who do get infected. So, it’s not zero but there are low risk, but there are teachers and the staff, the administrative staffs are not in that same age range. So, children can’t teach themselves. So that’s the conundrum. Children can’t teach themselves so they’re relying on people who are at greater risk to teach them. Now, we know that once you get into high school, you’re at a different setting and with different kinds of behaviors. We know college students are getting it. So, in fact, one of the reasons why many colleges are doing remote learning is because of that. And we’ve seen that in some of the athletic settings where, oops, we have been too zealous. On the other hand, some schools have had a positive experience, it’s cooling off. And that requires the participation and cooperation of all participants, the students and the faculty and those places where students are cognizant of their vulnerability, they appear to be having fewer problems with new infections. So again, what are we willing to do? What is the employer willing to do? What is the work we’re willing to do? The employee? What are we willing to do to avoid getting ourselves exposed? We’ve got new studies on airlines, for instance, about reduced transmission, possibility flying because of the way circulation and the requirement that people wear a mask. And yet there were videos recently and people refusing to do that. It’s like, I don’t want to wear a mask. Oh, excuse me. You’re in a closed space. Even though the ventilation issue is a very positive one, but people move up and down the aisle, people go to the restroom. So, it’s not a perfect setting. In the studies, I’m not that comprehensive. So, what we’re asking people to do is to behave in a careful way.

Belinda: Having flown recently, I noticed that, you know, there’s, there’s not much regulation around how people wear those face masks once we get situated inside of the plane. So, people are going to make sure they have it on entering the airport and the gate in the plane and sitting in their seat. But once you’re in flight, people get real comfortable and it’s very easy to pull the mask down at your nose or off so I understand that. What about restaurants and retail businesses? Because we see in most states and cities, the retail businesses and restaurants starting to open up. They’re starting to serve indoors; those that already weren’t doing that, bars are starting to open up. So, what is the science and medical community talking about in terms of the major health concern around these sorts of openings? Or what kind of warnings are they providing to patrons?

Dr. Clark: Well, we’re back to the fundamentals. If I have a small restaurant with tables close to each other and poor circulation, I’ve got a hotbed for a spreader event. If I’ve got a larger type restaurant with tables that are not close together, and that we wiped down after every person, every party moves, leaves and I got good circulation then it appears that it’s not much of an issue, but if I can contain people’s behavior or rather they can’t contain their own behavior, because I think it’s unfair to impose on the restaurants and the retail setting the responsibility for all of us. I think they have a responsibility for their setting and each party, each consumer, has a responsibility for himself or herself. And if we can’t get that, we can’t change things. Retail’s the same thing. They’ve gotten kind of lacks, i’ve noticed in terms of the six feet thing. People still want to crowd each other. There was lot of care to wipe down surfaces that it’s kind of gotten loose. So pandemic fatigue is going to be the problem. So, what are the obligations in those settings? Be mindful. The epidemic is still upon us. Don’t relent. That becomes the approach. In some communities, in California, the weather is a little better, we don’t have in Northern California, the winters and not that severe, but some of the streets have now been devoted to outdoor eating so that people are not eating indoors or eating outdoors, so there’s a lot of circulation. And then the tables are set six feet apart and so these kinds of restaurant settings seem to be surviving. People again, want to get out, they want to socialize, but you have got to wear a mask. You got to sanitize after each party.

Belinda: Let’s take a few minutes to talk about vaccines. There’s been so much discussion about pandemic. Won’t go away until we have a vaccine, but let’s start by talking about the process that’s used to test and approve vaccines and then we can get into the predictions for when it is that we might see one that’s actually ready for people to start taking.

Dr. Clark: Okay. What do you want to know about the process? As you already know, the FDA is in charge of the process. We also know that there are a lot of companies jockeying for position to make vaccines. So, we talked about that before. There are roughly 170 trials in part being made, and we go from there. The truth of the matter is, there are, in the preclinical setting, roughly 170 plus preclinical experiences. So, the FDA has this algorithm, preclinical phase one, where you test a small number of people to assess the safety of the product. Phase two, you’ve broadened to a larger number of people, including people at higher risk of illness, phase three, you now tested on thousands of people to check the effectiveness and safety and then the next phase is that it’s approved. And then once it’s approved, there’s the post-marketing surveillance. So, the FDA is fighting to make sure that at each step of the way, care is taken, so that what we’re doing is making sure this stuff works and that people don’t get hurt as a result of this stuff.

Now, in the clinical trial is some people may have adverse events, but people volunteer for that. We don’t want the population at large signing up for something that they’ve been assured is going to be okay with minimal risk. And suddenly there’s a large risk. The FDA is looking at a vaccine that will either reduce symptoms or eliminate disease or prevent disease, and roughly 50% of the people who get it. So, it’s not even foolproof for everyone, but that process is underway. So, we’re 170 preclinical trials, 12 vaccines in phase one, 15 vaccines in phase two,10 vaccines in phase three, nothing has been approved. The Chinese are gonna use it in the military. The Russians are going, and they’re not waiting for the phase three trials. The Russians are not waiting for the phase three trials, but the question is, do we behave like the Chinese and the Russians? And we rush things to market and then we say, oops, we don’t want that oops kind of situation. It’s an awkward situation. That’s awkwardness and it’s an embarrassment and it people feel that they’ve been experimented upon.

Barbara: Okay, given all that, what are the predictions on when we might see one that’s fit for folks in this country to take?

Dr. Clark: Well, we’ve got operational work speed. The federal government has invested billions of dollars in that. So, June maybe, we might get something a little earlier than that, but as you know– have been some experiences already where people had to halt the trials while they sorted things out. So some believe by the end of the year, January, others believe more practically June, but they psyched, the experiences that we’ve had in the world with other vaccines, polio vaccine took seven years, measles, nine years, chickenpox, 34 years, mumps, four years, HPV, 15 years now, the coronavirus virus, we think we will be able to do it much faster because we’ve got $9.5 billion being invested in the development. So, January, if you’re lucky, June pragmatically speaking, but you’ve got a host of countries working on it. So, it’s not just the United States. So, there’s a lot of activity going on. So, in place between January and June.

Barbara: So, here’s a very intriguing question. I think, first of all, can the government require citizens to, in this country, to take the vaccine and whether employers can require employees to take the vaccine. And I know you’re familiar with the court holdings dealing with vaccines historically. So, what are your thoughts there?

Dr. Clark: Well, in the past, the courts have said yes, or pay a fine. There are standards that have been employed, you know, are you allergic? Are you medically eligible? So, I’m allergic to the vehicle that carries the vaccine then I don’t have to take it. So, there are going to be medical exceptions. How painful is the vaccine? That’s a medical exception, but if you’re not an accepted category, then the courts in the past have required to have allowed jurisdictions to impose vaccines on people, or people can pay a fine that’s an old case it’s been contested and so we’ll see precedent, unfortunately, is not as convincing these days, but if you’ve got some respect for state’s rights, states will have the option. But then as we are seeing with regard to masks, I mean, some jurisdictions are refusing to require mass. So, the real question is, can you have a federal requirement rather than a state requirement? How painful, inconvenient is a mask? If I don’t have to, if there’s a requirement for me to wear a mask, why should there be a requirement for me to take a vaccine? So that’s what we’re really dealing with. So yes, there are precedents. Some jurisdictions will impose on their citizens and we’ll see, and there will be challenged and we’ll see where the new Supreme court is. You know, we now have a six, three conservative court, but conservatives often respected the rights of jurisdiction’s states to do their thing. I always liked to invoke Plessy V Ferguson as an example of deferring to state’s rights.

Belinda: Well with all of that, what then are some of the predictions and timeframes that are being discussed for when society will actually be free and clear or safe from the Coronavirus? The last time we talked to you, I think we may have mentioned the fact that most businesses we’re seeing the February, March timeframe is being [inaudible 31:32]. And since then, businesses have stated that they don’t see that coming until the end of the year. But it’d be interesting to hear in your circles, in the scientific community when they see them free and clear.

Dr. Clark: Well, I think people are hesitant to make those predictions, in part at this point in time, there’s a lot of promotion of the diseases over, we’ve got it under control, yada, yada, yada. Again, if we’ve had the concerted cooperation of our respective citizens, then we might be in a different situation. But if I can’t get people to wear a mask, if I can’t get people to socially distance and I’ve got an infection, then what I’m actually relying on is when does the infection burn itself out? Rather than what can we do? So, for the employer, the issue is, depending who her employees are, who his employees are, how they behave, what is the nature of the setting of the entity, the company, or the business that we’re talking about. If you’ve got people who are behaving in a high-risk fashion, or who are at a high risk, then you’re going to get one result. If you’ve got people who, or settings that have reduced risks, then you’re going to get another result. So, remember the vaccine is operating on a premise that it can hold. Now, there are some studies that are showing that the immunity that we thought that we would get from people who were previously infected just doesn’t seem to be holding. So, if you only get a three to four-month immunity from even having the disease, then it’s going to take a little longer. But operation warrants speed, the investment of multiple governments. We’re going to know a lot more. We’re also going to know a lot more about people’s behaviors. So, for the employer, the question is, what am I obligated to my employees? How can I help my employees behave in a reasonable fashion? And where do I go from there?

Belinda: Those are some good questions

Barbara: In terms of last words Dr. Clark, what are your kind of top three pieces of advice that you give to employers out there trying to figure out how to adjust to the realities, the impact of this new normal created by the coronavirus?

Dr. Clark: Well, you got to work with your employees. First of all, you yourself, as an employer have to realize that this is a new normal, that we’re not going to return to the status quo ante, anytime soon, that, of course, you’re in business to make money, but given all the legal stuff and the public health stuff, you’re going to have to figure out how to be flexible and adaptive and innovative in that new environment. If you’re not committed to doing that, then it may make it difficult for you to expect things to radically change, and then, of course, your workforce, because if you’ve got a sick workforce or injured workforce, then even if you can replace people, if you’ve got policies where people are continually getting ill, then your goals and objectives won’t be met. So, flexibility, being agile, understanding the need to adapt to the new environment. Those are important. Then what are you saying to your employees? How are you communicating with your employees? How are you getting them to go along with the program? As we’ve talked about people on a plane, people are not willing to– I can’t tell you how often I’ve seen people with their noses above their mess. And I’m convinced that most of those people are not sick. So, in terms of having breathing difficulties, they just find it inconvenient. So how do you have a workforce where people are willing to compromise and protect each other? Because that’s the theme. It isn’t that I’m just worried about myself. It’s I should need to worry about my fellow employees. My, if I’m in a retail business, the customers in the business, because you don’t want to get a reputation of having people coming to your business and getting sick from having been in your business. That doesn’t go, if you’re a restaurant tour or a retail business where you’re stocking traders, consumers who come and go.

Belinda: Right or that workplace

Dr. Clark: The workplace, that’s true. So those are two things that I think, and then the third thing is paying close attention to what’s going on in your local community, the rules and from the public health community, and the uptick in disease. A lot of information keeps coming in that’s locally driven. So, you just need to track that, but we need business in our society. People need jobs. So, it isn’t about forcing people out of businesses. It’s about adapting just as we’ve always adapted. I mean, people talk about new technology, changing the workforce and employers adapt to the new technology. So, we’re capable of doing that. I don’t know how many companies deliver their goods by horse and bucket. So, they made the transition. So, and what I talked to young people that I teach about typewriters, how many still use typewriters?

Belinda: They know what that is?

Dr. Clark: So, we’ve changed and we’ve adapted to new technologies. People are on the internet. People have Twitter accounts, people have this, we can do this. So that’s the bizarre part. We had done it over and over and over again. And yet here we have something that’s just another challenge. And people have said we can’t do.

Barbara: You’re, you’re very bright in that respect. Well, once again, we’d like to really thank you for providing us with these updates on how this pandemic has evolved. Since the last time we spoke, you’ve provided us with so much valuable information and insight, and who knew that these discussions would continue nine, to a full nine to 10 months after-

Dr. Clark: Who knew?

Barbara: It was boarded. Appreciate all the brilliant and excellent information you’ve provided Dr. Clark and we thank you for being such an effective and informative friend of Today’s Workplace.

Belinda: Thank you.

Dr. Clark: You’re welcome. Thank you.

Barbara: Thanks very much.