MBRE Webinar with Dr. Emily Landon, University of Chicago Medical Center
Chicago, IL | September 03, 2020
Tuesday, August 25, MBRE hosted another webinar with Dr. Emily Landon, Associate Professor of Medicine and Executive Medical Director of Infection Prevention and Control at the University of Chicago Medical Center. Broadly, Dr. Landon discussed not just the current state of the pandemic but the continued return of tenants and visitors to office environments.
We built on our previous June 4 seminar with Dr. Landon, which you can view here, in several ways. With the general managers of MBRE-managed properties and their teams as the main attendees, we asked questions we felt were relevant to our tenants. In addition, to those of us here at MBRE, coronavirus preparedness is not only about returning to the office, but also ensuring a safe return to schools for our kids and the continued health of our employees and their loved ones. It is with these concerns, along with the specific concerns of office space, that we conducted this latest webinar.
Dr. Landon started the webinar with a discussion of the current state of COVID-19 in Illinois and Chicago. Watch the full seminar above, or read our topic summaries, which we have paraphrased from Dr. Landon's comments, below.
The Current State of the Coronavirus Pandemic in Chicago, Illinois, and Beyond
July saw increases in infection rates across the country, particularly among younger adults. The leading cause is likely younger individuals frequenting bar and restaurant environments. This has hit smaller counties in Illinois harder than Cook County.
In general, people of all ages should continue to avoid close and unmasked contact within groups.
What Have We Found Out About COVID-19 Transmission?
One thing we are more certain about: coronavirus is airborne.
Respiratory viruses are spread via droplets or small particles. The latter are called aerosols. It's still not well-known how frequently each of these different types of transmission spread.
Having no transmission is unrealistic; therefore the goal is to get to a point where exposure to COVID-19 is so low that individuals do not get sick. Droplets are important to avoid, as they can get into your eyes, ears, and nose when in close contact with other people. Aerosol infections can also become dangerous in specific situations.
It's become clear that surface transmission of coronavirus isn't very common, since the amount of virus on surfaces—thanks to the nature of droplets and also people's cleaning efforts—isn't enough to make people sick. COVID-19 likes to be in moist droplets in the air, not surfaces where it dries out.
How to Fight Transmission in the Workplace
Firstly, making sure people have enough space around them is the most important thing you can do to fight transmission in offices and other enclosed spaces. Then, making sure surfaces are clean and that people aren't touching their faces with dirty hands is also vital.
Making sure the space is not too crowded, requiring masks, and cleaning shared and high-touch surfaces regularly will go a long way.
What is Considered "Close Contact"?
According to the CDC, close contact is considered to be within six feet of a person with COVID-19 for 15 minutes or more. Of course, if you are around someone who's noticeably sick, you probably don't need 15 minutes to contract COVID-19; and if everyone near you is wearing masks, 15 minutes is a conservative estimate—this 15-minute estimate is a middle ground. What does this mean for employers? You don't need to track every single step a sick person has taken, you just need to know where they spent a significant amount of time up close with other people.
An example: Is it safe to pass someone in a hallway? If both people are wearing masks, a quick pass in the hallway is not enough contact to get or give coronavirus. However, if someone loitered in a poorly-ventilated hallway, there might be enough aerosols in the air to then get you sick. But if people are wearing masks and generally following rules, that probably won't happen.
When Should Someone Be Quarantined?
If employees have had encounters in which they were exposed to someone with COVID-19, they should be under a two-week quarantine.
The goal is to contact trace and find individuals who are high-risk contacts. With this method, these high-risk individuals are sent home and don't even get sick—the effort was all for naught. With the right precautions, secondary people won't get sick, but these extra precautions are still necessary and vital.
How Much Ventilation Does an Office or Other Enclosed Space Need?
There are two ways to get COVID-19 out of your enclosed area: more fresh air introduced into your HVAC system, and better filtration. The goal is to have the air in a room exchanged as many times as possible per hour with fresh or filtered air. The only filter that works are HEPA filters. If your HVAC system cannot use that efficient of a filter, then you have to rely on fresh air.
How many times an hour does the air need to be exchanged to fight coronavirus? We do not know.
In hospitals, most rooms have air exchanges of six to 11 per hour. Operating rooms have much higher exchanges, in the range of 15 to 20 per hour. In non-healthcare environments, on average, one or two air exchanges per hour occur, which likely isn't enough. We know that six to nine air exchanges per hour is probably good enough to keep coronavirus rates low, if you're also wearing masks and social distancing. What we don't know is how much lower than six we can go. This is something we will learn over time.
Masks should be required within offices no matter what, but this is doubly true if you're not circulating enough air with fresh or through HEPA filters. If you're recirculating air, you may want to have employees wear masks even in their own offices, though the evidence on this scenario is inconclusive.
Do portable HEPA filters work against coronavirus?
Older hospitals have used portable HEPA filters for better air turnovers, but we don't know if it's necessary or effective. This is a case-by-case situation for poorly vented areas. Ideally, places without windows, with poor ventilation, no HVAC, etc. should be closed off or offer limited access.
What You Need to Kill COVID-19 in the Office
Extreme cleaning tools are not needed. Oftentimes, the fancy stuff comes with a higher price tag, needs more training, and does not even work well. The focus should be cleaning shared surfaces with common disinfectants. These surfaces include but are not limited to: light switches, doorknobs, printers and other shared areas. Also, hand hygiene dispensers should be in these places and other places like the break room. Finally, signage reminding people to use these hygiene dispensers will help.
When office space is shared space, it's important to leave time between people traveling in enclosed spaces to ensure aerosol droplets are removed. And encourage individuals to clean and disinfect areas when they get to them, and upon leaving them. Redundancies like this should be the pillars of your safety measures.
People aren't perfect, masks aren't perfect, and other safety measures have their own downsides, which is why we need a multilayered approach. If you have all your layers in place, one lapse will not cause an infection.
How Effective are Fabric Masks?
There is clear evidence fabric masks are better than first anticipated. But there are different masks for different occasions. The one you're wearing as you're walking in a park may not be the same mask you'd wear in a hospital visiting sick people or the same mask you'd wear in another higher-risk situation, like while riding public transportation.
Wear the mask that fit the activity.
Masks to Avoid:
- Masks with valves actively release droplets into your environment, especially indoor environments. If you have a mask with valves, place a surgical mask over the top of the valves.
- Gators have gotten a bad rap but aren't quite as bad as some have said recently. Some Gator-like coverings have specifically been created to filter, like dust gators, and those are better than the ones intended specifically for warmth. The Gator-like masks that are stretchy are probably not great, and they should not be used inside.
Masks to Use:
- Plain, pleated, rectangular masks with two layers made up of 400 or 500-count cotton work well. If you're near people and inside, at the workplace or grocery store, these should work well.
- Fitted masks of similar construction are even better. Some fit over your nose better and tie behind your head instead of your ears, allow a better shape and seal around your face. Masks that shape around your face and ensure air isn't getting out around the sides of your face work really well.
- Masks that fit well around your face and are composed of a cotton layer, a silk layer, and a 600-count-sheeting material are superb. If it fits well and makes a seal around your face, a mask like this will work as well as an N95 mask.
Even rudimentary masks hold in the majority of respiratory droplets. But you're losing that protection if the person near you isn't wearing a mask. You can filter out 90 percent of your own droplets, but that may not be an efficient amount if the other person is maskless.
You also have to worry about your eyes, which are left unprotected. Even regular glasses are not enough, as they leave too much space around the top or sides. That is why we recommend people wear shield masks if you're near someone without a mask on, or if you're on a plane, or in a similar situation.
Vaccines and Therapeutics
Right now, all the vaccine trials are being conducted in the usual fashion. No one within the medical communities is advocating, recommending, or acting on a desire to cut corners in the scientific process to determine if a vaccine is safe. Even after a vaccine is approved, it will realistically be a year before people are able to get vaccinated.
If You Already Had COVID-19, Can You Get Re-Infected?
It's difficult to prove if someone has been re-infected with coronavirus. The virus has a long tail of virality, so we've yet to prove it without a doubt. We don't know much about immunity, but what research there is about reinfection seems to indicate that it could happen after about four months. Also, the reinfection cases we see present less-serious symptoms. There is a lot more to learn about this.
Should Schools Open? What Age Groups Benefit from In-School Learning?
For younger kids, children under the age of five, it is true that they do not get as sick from COVID-19, but that doesn't mean they can't transmit coronavirus to more vulnerable populations. Also, the jury is still out regarding the long-term effects of COVID-19, even for those who prevent tame symptoms who are younger. Studies have indicated there are long-term heart problems associated with COVID-19 infection.
So, should schools open? This question is based on several things. Firstly, local epidemiology should be considered—what are the virus rates among individuals in the community the specific school is in, for example.
Then you must ask if a school is equipped to open safely. To open a school safely, schools require the same mitigation as businesses—six feet of space, masks, and cleaning. Do schools have enough space allocated in classrooms to obey social distancing? If we don't have the space, or we don't have enough staff, or we don't have enough PPE equipment to protect teachers, then we shouldn't be opening a school.
Finally, we must consider personal behavior and acceptance of what we're doing to prevent COVID-19. Can younger kids and older kids alike accept personal responsibility for protecting themselves and others?
While younger kids might not understand coronavirus, it's a mistake to think they are unable to wear masks or keep distance. Kids are really adaptable, and younger children have fewer contacts outside of school and are less able to do online learning. Younger kids are also more likely to respond to role modeling and positive influencing, and it's easier to keep younger kids in smaller cohorts. So younger kids might be better off at school when you consider all of this and the fact that they're less likely to get sick.
When it comes to personal responsibility, it's harder to decide what to do with kids who are middle school and up. They are individuals now with their own social groups regardless of class structure, and they may want to see their friends up close despite what parents are telling them what to do. Also, they have higher academic needs that demand specialist teachers, which means they must move from class to class. Therefore, older kids may be able to get more out of a virtual learning experience than they would an insular 12-person class that doesn't go anywhere else.
So mostly, older kids need to be more remote, and younger kids may be able to benefit from in-person classes. That does not mean schools have to be closed completely though. Not closing buildings means you can still have special experiences, clubs, or activities that meet partly online and can pull kids in for limited experiences with small groups, masks, and social distancing.
Communities that do not embrace mask-wearing and social distancing should not open schools.
Are Hand Dryers Safe?
There has been evidence that hand dryers can blow germs around the rooms, but since people only use them after washing their hands, they should only be blowing clean air, not germs, around. I wouldn't retrofit or change air dryers, but if you have an alternative, you could turn them off. It wouldn't be overkill to avoid them, but if air dryers are your only option, I wouldn't close them off. You could also decide to limit the number of people in the bathroom at a time, and people should also wear masks in the bathroom. Also, air dryers that blow outwards or upwards, like some wall dryers meant for drying your hair, shouldn't be used.
Is Temperature Testing Effective?
Temperature testing shouldn't be the only method you're using to determine if people may be sick or contagious. It should be part of a system where we ask people how they are feeling and ensuring they don't have symptoms as they come through the door. Only 60 percent of people ever have a fever, so you will miss a lot of people if you are only checking if people have a fever. Thermal scanning is not the panacea people thought it would be. At the very least, make sure to have signage that says you should not be in this workplace if you have any symptoms. The best situation is people standing at the door telling others to clean their hands as they enter.
What Kinds of Coronavirus Tests are Best?
Saliva tests and nasal swabs—which are mostly PCR tests—are two prominent types of tests. Saliva tests are only 50 to 60 percent sensitive, and nasal swabs are 90 to 95 percent sensitive at picking up COVID-19 presence.
This difference in effectiveness means different testing strategies.
For the rapid tests that are less effective, everyone should get tested frequently. And for the more effective tests that take longer, it is usually people with symptoms getting tested. Until there is a nationwide plan for testing, we'll need to deal with this patchwork system.
Has the Death Rate Gone Down? Why?
The death rate is low because most cases happening are in younger individuals. We know why they get it: because they're going out to bars, parties, out to eat etc. Some of them are dying, but in much lower numbers than adults 45 and over. There's a lot of issues with this, and potential trouble down the road even though death rates are lower now.
It takes a long time from the opening of public places to see the real impact. It will start in a community with low death rates, and this happened early on in places like Texas and Florida, and the death rate goes up as those younger people transmit to older adults.
The death rate also seems lower because we're testing more people and seeing more people with lower-grade infections.
The problem with COVID-19 isn't the death rate, but the percentage of infected who need hospitalization—15 percent. At that level, the requirement for the people needing medical care is unmanageable if infection rates increase. And some places already saw this, and in response, people started wearing masks.
Lower death rates and fewer symptoms among young people who are infected should still worry us. We do not know the long-term effects of coronavirus. Right now, we're seeing evidence that people are taking a hit to their hearts. That is even happening in young and healthy people, people who have completely recovered, people who had a light flu-like course. We are seeing study after study indicate lung tissue damage and heart muscle damage. Everyone's heart muscle devolves over time, but you don't want to start that process at 30 just because you got COVID-19. We cannot afford an epidemic of people needing heart transplants 20 to 30 years from now.
Can You Boost COVID-19 Immunity?
We don't know much about boosting immunity against coronavirus. We have found that Vitamin D is important. Spending time in the sunshine is good. Not too much time, and wear your sunscreen, but getting enough Vitamin D is important. Make it outside for five to 10 minutes a day, or talk to your doctor about taking a supplement.
Vitamin C may be helpful, but it's unclear.
It's important to keep yourself as healthy as you can be. If your other medical conditions are optimal, whether you have asthma, heart disease, or diabetes, you'll be better off. Do not avoid the doctor—hospitals and doctor offices are safe. Get your checkup, get your labs done, get your colonoscopy, get your kids vaccinated, do everything you normally would do to stay healthy. The healthier you stay, the better you'll be able to fight off COVID-19.
Right now, the best thing you can do for your health is to wear a mask, keep your distance, and wash your hands.