Post on 04-Jul-2020
COVID-19 UpdateNavigating the Coronavirus: Vaccines, Testing and Wellbeing
Thursday
May 28TH 2020
HOSTED BY:
Kate Moher
National Employee Health
& Benefits Practice Leader
Marsh & McLennan Agency LLC
Our Speakers
Monte Masten, MDChief Medical OfficerMarsh & McLennan Agency
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Betsy Nota-Kirby, MSNational Director, Health
Management ConsultingMarsh & McLennan Agency
Lisa Comerose, RNNational Director of Clinical
ManagementMarsh & McLennan Agency
Divya Patel, BSNational Director of Data
AnalyticsMarsh & McLennan Agency
Marsh & McLennan Agency LLC 2
Clinical Update
- Monte Masten
Marsh & McLennan Agency LLC
U.S. Prevalence as of 5/26/2020 (10 am EST)Total Cases 1,708,597
Deaths 99,847
Recovered 465,668
Active 1,143,062
Mild (98%) 1,120,201
Serious/Critical
(2%)
22,861
New Cases/Day 19,790
Deaths/Day 505
www.worldometers.info3
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1. New York State Department of Health as of 05/07/2020 (link) 2. JAMA (link). 3. JAMA. (link) 4. El Pais (link) 5. Medscape (link)
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States with Lifted Restrictions
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Return to Work
- Lisa Comerose
Marsh & McLennan Agency LLC
Looking Ahead, Opening Up America Again
Proposed Gating Criteria
• Symptoms: Downward trajectory of influenza-like illnesses (ILI) and a downward
trajectory of COVID-19 syndrome cases both reported within a 14 day period.
• Cases: Downward trajectory of documented cases and positive tests as a percent of
total tests within a 14-day period.
• Hospitals: Capacity to treat all patients without crisis care, and robust testing
program in place for at-risk healthcare workers, including emerging antibody testing.
Source; https://www.whitehouse.gov/openingamerica/
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After Satisfying Gated Criteria, Phased Approach
Source; https://www.whitehouse.gov/openingamerica/
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Phase 1Social distancing guidelines get relaxed but
gatherings of more than 10 people should be
avoided.
Non-essential travel should be limited and at-
risk individuals should continue to shelter in
place.
Continue leveraging remote or telework and
plan for a phased approach to return to
work. Limit congregation in common areas
making special accommodations as needed.
Restaurants, sporting venues, churches, and
parks can reopen if they observe strict social
distancing guidelines.
Elective surgeries can resume when
appropriate on an out-patient basis.
Phase 2Social distancing guidelines get relaxed further,
limiting gatherings to no more than 50 individuals.
Non-essential travel can resume, but at-risk or
vulnerable individuals should continue to shelter in
place. Continue to encourage telework whenever
possible.
Common areas where personnel are likely to
congregate and interact, enforce moderate social
distancing. Strongly consider special
accommodations for personnel who are a vulnerable
population.
Schools and organized youth activities can reopen.
Large venues can operate under moderate physical
distancing. Gyms can open if they adhere to strict
physical distancing and sanitation protocols.
Elective surgeries can resume, as clinically
appropriate, on an out-patient and in-patient basis at
facilities.
Phase 3Vulnerable individuals can resume public
interactions, but should practice physical
distancing, minimizing exposure to social
settings where distancing may not be practical,
unless precautionary measure are observed.
Employers can resume unrestricted
staffing of workplaces. Large public venues
can operate under limited social distancing
rules. Visits to senior care facilities and
hospitals can resume.
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MMA Compliance Centers Of Excellence
Mandatory COVID-19 Testing
• Many employers cannot require all of their employees to
submit to COVID-19 testing because one or more employees
likely fall into some sort of “protected class” and requiring
testing will violate one or more of their legal rights.
• An employer can require testing before employees enter
the workplace, and send home employees who test positive or
who decline to test. This shifts the conversation to whether the
employee can work remotely from home or should receive
paid/unpaid leave.
Guidance from the
EEOC supports this
advisement and
addresses concerns
under the ADA. [1]
[1] EEOC FAQs on ADA, Q/A #3 and 6, also
referenced by the DOL in its COVID-19 FAQs
for the FMLA.
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CDC May 2020 Update to Guidance on Test UsageUse of Antibody Testing
Antibody Testing currently has little role in the diagnosis of acute disease.
The uses of antibody testing fall into two broad categories:
Surveillance of populations
Testing of individuals for proof-of-prior infection
Source; CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again May 2020 17
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CDC May 2020 Update to Guidance on Test Usage Populations without symptoms and Antibody testing
Testing Populations without Symptoms should focus on
• Persons with an increased likelihood of infection
• Settings with at-risk populations including but, not limited to:
– Contacts of known cases (with or without symptoms). Includes testing contacts 1-2 weeks
before the onset of symptoms
– Residents and staff of long-term care facilities
– Other healthcare facility workers and first responders
Source; CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again May 2020 18
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CDC May 2020 Update to Guidance on Test Usage
Antibody testing provides a more complete picture of how much
infection has occurred already in the population.
Considerations with Testing:
– Case-based surveillance for anything with a wide spectrum of severity of symptoms
will always miss cases (since many people are without symptoms).
– A positive test result shows you may have antibodies from an infection with the
virus that causes COVID-19, or possibly from infection with a related virus from the
same family of viruses (called coronavirus), such as one that causes the common
cold.
– Employer must include 2 serial tests to confirm all positive results.
Source; CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again May 2020 19
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CDC May 2020 Update to Guidance on Test Usage Proof-of-Prior Infection (Immunity)
The use of antibody testing for a back-to-work strategy would likely benefit fewer
than 10% of the population currently per CDC.
Employer must include 2 serial tests to confirm all positive results.
• Example: New York City with the highest incident rates in the country:
o Survey conducted among customers of retail outlets found 22% had positive antibody test.
o Preliminary data at the CDC for the remainder of the clinical specimens in the NYC area found
about half that rate (estimated 11% were positive for antibodies).
Source; CDC Activities and Initiatives Supporting the COVID-19 Response and the President’s Plan for Opening America Up Again May 2020 20
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Some Employers May Require Employees Get Tested for COVID-19 Before Coming Back to WorkTIME Magazine; May 7, 2020
21Source; https://time.com/5833633/employer-coronavirus-testing/
Florida’s Harris Rosen’s hotels near Disney
are testing 4,000 employees at their health
clinic and drive-thru testing.
Hotel Opens:
Employees regularly fill out questionnaire
about health and travel history.
All employees will get their temperature
taken when they arrive to work.
Those with fevers above 100.4 degrees
Fahrenheit will not be allowed on the
worksite.
Those with fever, receive testing.
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Returning to the Workplace
Per CDC guidance, people with COVID-19 who have stayed home (home
isolated) can stop home isolation under the following conditions:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
Source; https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
If you will not have a test to determine if
you are still contagious, you can leave home after
these three things have happened:
1. You have had no fever for at least 72 hours
(that is three full days of no fever without the
use of medicine that reduces fevers), AND
2. other symptoms have improved (for example,
when your cough or shortness of breath have
improved), AND
3. at least 7 days have passed since your
symptoms first appeared.
If you will be tested to determine if you are still
contagious, you can leave home after these three things
have happened:
1. You no longer have a fever (without the use of
medicine that reduces fevers), AND
2. other symptoms have improved (for example, when
your cough or shortness of breath have improved), AND
3. you received two negative tests in a row, 24 hours
apart. Your doctor will follow CDC guidelines.
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Back-to-Workplace Strategies
StrategyImplementation Scale
(Easy to Difficult)
Effectiveness Score
(low 0 – high 5)Cost
Social Distancing 5 $
Cleaning/Disinfecting 4 $$
Masks 3 - 4 $
Employee Communications 4 $
Enhanced paid sick leave policies 4 $$$$
Screening Questionnaires 2 $$
Temperature Screening 2 $$
Antibody Screening 2 $$$$
Virus Screening (i.e. Diagnostic) 3 $$$$
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Behavioral Health
- Betsy Nota-Kirby
Marsh & McLennan Agency LLC
State of Mental Health Prior to COVID-19
Americans experience symptoms of
depression, anxiety and stress. Those who
have both a chronic and behavioral
health condition(s) can cost up to 3
times more to treat.
63%Of employees reported that workplace
stress had significant impact on their mental
and behavioral health. This can have a
direct impact on work productivity and
employee retention.
80%Of workers with a mental health condition
attribute their non-treatment to shame and
stigma. Relatedly, the average person
waits 8 to 10 years after the onset of
initial symptoms before seeking
treatment.
31%Of employees would be afraid of being
labeled as weak, and 22% fear it would
impact their promotion opportunities.
Source: Catalyst For Payment Reform: State of Mental Health Report Marketplace
1 in 5
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The Costs of Mental Health Inpatient Treatment Prior to COVID-19
70%of Americans with
depression are in the workforce
$105 billionis the cost of
untreated mental illness in the U.S.
each year
35 millionworkdays lost each year due to mental
illness
$6,990 for 8.4 days for depression
$4,591 for 5.2 days for drug use disorder
$5,908 for 6.2 days for alcohol use disorder
$4,356 for 5.5 days for bipolar disorder
*This does not include lost days from work
Because most employees are not
seeking treatment or are unable
to access care, employers are
losing an estimated $225.8B
annually due to stress, anxiety,
depression and substance use
disorder.
Source: National Alliance of Healthcare Purchaser Coalitions, 2019
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- U.S. National Library of Medicine National Institutes of Health
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COVID-19 and Need for Action for Mental Health
The United Nations recently released a policy brief which stated “The mental health and
wellbeing of whole societies have been severely impacted by this crisis and are a priority
to be addressed urgently.”
Specific population groups showing high degrees of COVID-19-related psychological
distress are:
• Frontline healthcare workers and first responders
• Older adults and people with pre-existing health conditions
• Women, children and adolescents
• People caught in fragile humanitarian and conflict settings
27Source: United Nations Policy Brief: COVID-19 and the Need for Action on Mental Health May 13, 2020
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Source: Optum 2020
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To What Extent Have COVID-19-Related Work/Life Changes Impacted Your Wellbeing?
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Source: Optum 2020 29
To What Extent Have COVID-19-Related Work/Life Changes Impacted Your Wellbeing?
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Source: Optum 2020
To What Extent Have COVID-19-Related Work/Life Changes Impacted Your Wellbeing?
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Source: Optum 2020
To What Extent Have COVID-19-Related Work/Life Changes Impacted Your Wellbeing?
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Marsh & McLennan Agency LLC Source: ESI America’s State of Mind report 2020
Percent Change in Prescriptions Filled Per Week For Mental Health Medications
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By select weeks from
January 19, 2020 to
March 15, 2020
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Mental Health and Overall Wellbeing are Mutually Supportive
A foundation of mental health
Purpose
Social
Financial
Community
Physical
The Essential Elements of Wellbeing are Foundational to Overall Mental Health
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Strategies for Mental Health
Promote and/or develop company policies and practices focused on whole person wellbeing
Mitigate organizational stress
Offer programs on mindfulness
Rebrand EAP to reduce stigma around mental illness
Ensure organizational readiness by offering Mental Health First Aid to human resources, managers and supervisors
Promote greater use of tele-behavioral health services
Become a NAMI StigmaFree Company to reduce stigma around mental illness
Leverage the MMA Mental Health Communications Toolkit for employers
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Mental Health First Aid Training
The National Council for Behavioral Health manages the Mental Health First Aid Training organization.
• 8-hour certification class for traditional in-person training OR a 2-hour, self-paced class followed by a 4-hour, instructor-led class using video conferencing technology.
• Teaches participants how to identify, understand and respond to signs of mental illness and substance use disorders.
• Provides skills needed to reach out and provide initial help.
• Training is offered through a third party. Visit https://www.mentalhealthfirstaid.org/to locate a local training course.
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Fully virtual Training session
coming soon.
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MHFA Carrier & Private Training
Some carriers or other private entities have certified MHFA instructors available to provide private instruction. All trainers have completed the Mental Health First Aid USA training program. Note: Any trainer offering virtual training will be required to complete new instructor training program.
Carrier Programs:
• Cigna (pilot)
Private Training:
• MMA Minnesota HMC Team
• State of Virginia
• State of Georgia
• Select MMA Regional Offices
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Community-Based TrainingState of Georgia
The Mental Health America of Georgia manages the Mental Health First Aid Training.
Options for Training:
1. The Mental Health First Aid training is provided in a one-day, 8-hour format for employers with 15 - 30 participants with a dedicated training room and audiovisual equipment visit.
http://www.mhageorgia.org/mental-health-first-aid/ and click on the green button to locate trainings.
2. MHAofGA also provides additional Outreach Wellness Learning (OWL) mini-training resources. OWLs are 1-hour seminars covering a variety of topics: Mental Health 101, Mood Disorders, Workplace Wellness, Effective Stress Reduction Techniques, etc.
3. MHAofGA distributes a monthly newsletter highlighting programs and upcoming activities. To subscribe: http://www.mhageorgia.org/fundamental-matters/.
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National Alliance on Mental Illness (NAMI): Initiatives for the Workplace
StigmaFree Company Initiative: Be recognized as a StigmaFree company through NAMI’s partnership initiative. Resources provided include sample CEO and leadership announcement correspondence, videos, posters, guides for employees, and more. Individuals can also take the pledge to become StigmaFree at https://nami.org/stigmafree
Campaign manifesto: There’s a virus spreading across America. It harms the 1 in 5 Americans affected by mental health conditions. It shames them into silence. It prevents them from seeking help. And in some cases, it takes lives. What virus are we talking about? It’s stigma. Stigma against people with mental health conditions. But there’s good news. Stigma is 100% curable. Compassion, empathy and understanding are the antidote. Your voice can spread the cure. Join NAMI, the National Alliance on Mental Illness. Together we can #CureStigma.
NAMI Programs: NAMI offers six different educational programs, two support groups, and four presentations for a variety of audiences.
In Our Own Voice is a free 40-, 60- or 90-minute presentation which provides a personal perspective of mental health conditions, as leaders with lived experience talk openly about what it's like to have a mental health condition.
COVID-19 Resources: https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources
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NAMI COVID-19 Information and Resources
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Mental Health America COVID-19 Resources
As the number of cases of COVID-19 increases, so does the associated anxiety. For the past several weeks, Mental
Health America (MHA) has been using its unique database to monitor daily this increase in anxiety.
According to MHA screening data, there was a 19 percent increase in screening for clinical anxiety in the first weeks of
February and a 12 percent increase in the first two weeks of March. MHA will continue to monitor anxiety screening
rates.
MHA has compiled a range of resources and information including:
• Mental Health Information for Disease Outbreaks
• Financial Support
• Tools and Information on Anxiety
• Tools to Connect with Others
• Resources for Immediate Response
• Webinars, Live Events, And Workshops
• And much more
To access these resources, visit https://mhanational.org/covid19
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COVID-19 and Your Mental Health
Downloadable Resource in the GoToWebcast
Platform, covers:
• Signs of Anxiety
• Managing Anxiety
• Your Concerns are Valid
Available online:
https://hr.iu.edu/relations/coronavirus/COVID19-and-Your-Mental-Health-
Infographic.pdf
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Returning to the Workplace (RTW) Toolkit
Return to the Workplace
Employer Considerations
FAQs
Face Mask Article,
Utilization and Limitations
FFCRA RTW Template
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MMA Mental Health CommunicationsToolkit
Through our comprehensive Mental Health Toolkit, your employees can learn more about a specific condition they may be facing and review national resources and tips to help facilitate healing.
The Mental Health Toolkit encompasses five common topics that can affect an employee both in and out of the workplace. It also includes an educational piece that directs employees where to go for care depending on their unique situation.
1. Stress2. Anxiety3. Depression4. Sleep Disorders5. Substance Abuse
To access the Mental Health Toolkit, click https://mma.marshmma.com/MA_Mental_Health_Toolkit
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Data Analytics
- Divya Patel
Marsh & McLennan Agency LLC
PATH & Artemis Health, COVID-19 Story
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PATH & Artemis Health, COVID-19 Story
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PATH & Artemis Health, COVID-19 Story
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5/25/2020.
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PATH & Artemis Health, COVID-19 Story – Heart Disease
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PATH Behavioral Health Story
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PATH Behavioral Health Story
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PATH Behavioral Health Story
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PATH Behavioral Health Story
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Resources
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Resource Roundup
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Resources from Today’s Presentation
Resource What is it? Where to access
John’s Hopkins COVID-19
Status ReportAbility to drill down to county level and learn up-to-date
health care details. https://coronavirus.jhu.edu/us-map
Clean Hands Campaign CDC campaign. https://www.cdc.gov/handwashing/campaign.html
Mental Health First AidWork with your local MMA team to schedule a virtual
course (anticipated availability July 2020). https://www.mentalhealthfirstaid.org/
National Alliance on Mental
Illness (NAMI), StigmaFree
Resources provided include sample CEO and leadership
announcement correspondence, videos, posters, guides
for employees, and more. https://nami.org/stigmafree
Mental Health AmericaResources and tools to help with anxiety, financial
support, mental health information, and more. https://mhanational.org/covid19
MMA Coronavirus Resource
PageMMA sourced content to support employers with
educational resources and tools related to COVID-19.https://mma.marshmma.com/coronavirus-
outbreak-resource-page
MMA Mental Health
Awareness ToolkitEncompasses five common topics that can affect an
employee both in and out of the workplace.https://mma.marshmma.com/MA_Mental_Health_T
oolkit
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Resources on MarshMMA.com
• Dedicated page added to
MarshMMA.com.
• Includes resources,
helpful links, upcoming
events and post-event
replays.
• Use the sign up link to
receive email notifications
when the page is updated.
Sign up for real-time updates
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This document is not intended to be taken as advice regarding any individual situation and should not be relied upon as such. Marsh & McLennan Agency, LLC shall have no obligation to update this publication and shall have no liability to
you or any other party arising out of this publication or any matter contained herein. Any statements concerning actuarial, tax, accounting or legal matters are based solely on our experience as consultants and are not to be relied upon as
actuarial, accounting, tax or legal advice, for which you should consult your own professional advisors. Any modeling analytics or projections are subject to inherent uncertainty and the analysis could be materially affective if any underlying
assumptions, conditions, information or factors are inaccurate or incomplete or should change. Copyright © 2019 Marsh & McLennan Insurance Agency LLC. All rights reserved.