>> Hello, and thank you for joining us.
My name is Dr. Tamika Smith,
and I would like to welcome you
to today's CDC Partner Update Call on COVID-19.
This call serves as a way for CDC
to share weekly updates on COVID-19
and our latest resources and guidance,
especially for the private
sector and other partners.
Our topic of focus today is on
Considerations for the Agriculture Industry,
but we will also cover more general
updates and information from CDC.
Our plan is to hear an update from our
Chief Medical Officer about everyone,
about what everyone should know about
protecting themselves and others.
We'll then hear from three of our
experts about CDC's new guidance
for agriculture workers and employers.
Afterwards, our speakers will
take questions from the audience.
This call is not intended for media.
Media can direct their questions
to media@cdc.gov.
Again, that's media@cdc.gov.
This call will be recorded and later posted on
the CDC COVID-19 website as well as on YouTube.
Similar to last week, our call
today is at 3 PM Eastern Time
as opposed to our usual 4 PM time slot.
We are considering shifting the
time of these calls in the future.
We will deploy a poll while
transitioning from presentation to Q&A
to ensure a strong contingent of
participants are able to participate.
During the poll, you'll be provided two time
slots: Mondays at 3 PM or Tuesdays at 4 PM.
Both times are Eastern Standard Time.
I would like to remind all participants that
the CDC website has the latest information,
guidance, and communication resources.
There are now close to 1800 documents providing
information and guidance for individuals,
businesses, and the public on our website.
In addition to the tools we'll
highlight today, some resources posted
within the last two weeks include
When can you be around others
after you had or likely had COVID-19?
COVID-19 in Racial and Ethnic Minority Groups.
Household living in close quarters.
Stress and coping considerations.
Workplace decision tool.
Testing strategy for Coronavirus in
high-density critical infrastructure workplaces
after a COVID-19 case is identified.
An overview of testing for SARS CoV-2.
Thank you to those who sent
questions in in advance.
We have teed up some of those questions, and
I'll also be keeping an eye on the Q&A box,
so feel free to, so feel free and welcome
to submit questions there as well.
Note: we will not be viewing the chat box, so
please utilize the full functionality of Q&A.
I am pleased to be joined
today by four CDC experts.
Dr. John Brooks, who is the Chief Medical
Officer for the COVID-19 Response here at CDC,
Dr. Jennifer Lincoln who is the Associate
Director of the CDC's National Institute
for Occupational Safety and
Health also known as NIOSH.
Officer of Agriculture Safety and Health, Dr.
Megin Nichols who's a veterinary epidemiologist
on the Food Systems Working Group, and Captain
Kenneth Dominguez, a medical epidemiologist
in the US Public Health Service, serving on
our Minority Health and Rural Health Team.
For those of you logged into
the webinar platform,
there will be very few slides
used today, so don't be worried
if they don't seem to be advancing.
However, a transcript will be
provided along with this video
when it's posted online to YouTube.
You now see a very quick agenda.
I'd like to now turn it over
to Dr. Brooks for some updates.
Thank you!
Dr. Brooks, it's over to you.
>> Dr. Smith, thank you so much
for that kind introduction.
As Tamika mentioned, my name is John Brooks,
and I'm the Chief Medical Officer right now
for the CDC's COVID-19 response, and
what I want to do when we get started
with this presentation today is just bring
everybody up to speed where we are nationally
by giving you a brief update on the
COVID-19 response at CDC and also just some
of the latest scientific
developments and guidance
that I think you might be interested in.
So as I'm sure all of you know, we are
very deep into this global pandemic.
As of yesterday, there were 6.6 mil--
over 6.6 million cases globally
diagnosed, and over 425,000 deaths.
We've made progress in the United States
at flattening the curve, so to speak,
and just to give you a sense of where things
stand, this, we'll give a couple of points.
The first is that nationally levels
of COVID-like illness and mortality
or deaths continue to climb and generally
remain at stable or declining levels so that
in the United States, as of yesterday
there were a total of 2,063,812 cases,
and 115 million, 115,000-rather, -271 deaths.
In addition to this stable or
declining trend in diagnoses and deaths,
the percentage of lab tests performed coming
back positive has increased very slightly.
We're not sure exactly what that means yet.
We're watching it closely, but that's the
kind of thing that would give us pause,
and we obviously want to
give it a lot of attention.
And we also know that although the
trends are generally going down
or stabilizing that's not true when you start
to hone in on individual parts of the country.
The virus has not affected
everyone the same way,
and some jurisdictions are
seeing important increases
in the daily number of reported infections.
In the coming weeks, we expect that we
could see other, other increases in COVID
as states continue to reopen,
and we get America back to work.
It's too soon to tell right now if this is
going to happen for sure, but as I noted,
we watch the data very closely for
early signals and work with our state
and local health departments and
other entities to monitor activities
so we can make sure we know what's going on.
So looking forward as we head into the summer
months, many of us are sort of there already,
but we know that this is a time of year that
Americans really look forward to reconnecting
to family and friends and doing things together,
and we want these events
to be as safe as possible.
The first thing I want to emphasize
therefore is that this epidemic
and this pandemic globally has not ended.
You know, we are beginning to emerge
from lockdown and stay at home,
but we're in a new normal until there is
some kind of a vaccine or other intervention
that can protect all of us
against this infection.
Right now, we're going to have to keep
doing many of the things we've been doing,
but find ways to do them in a way that lets
us get back together and reopen society.
And we want to provide you the
information you need so you can help decide
which activities you'll resume, and what
level of risk you would be willing to accept.
The general rule of thumb in all of this is the
principle that the more closely you interact
with other people, and the longer
that that interaction lasts,
the greater the risk of acquiring COVID.
So social distancing and
limiting time very close to people
within that six-foot bubble are some
important ways that you can reduce your risk.
Last Friday we released two new resources
to help people conduct their daily activities
while protecting themselves and others.
We've released this information on our website
to help people decide whether to go out
and when to take precautions if they do.
It's hard to obviously anticipate
every single way that people interact.
We're a very complex species in a remarkable
country, and we all have different ways
of celebrating together, but these do have sort
of practical tips and principles of guidance
that can help you with things like
is it safe to go dining out right now
at a restaurant, and what do I need to consider?
Or visiting the gym or having
folks over for a family cookout?
We've also added a page on our website
with suggestions that could help people
who are planning or attending an event or
gathering thing about ways that they can make
that event or gathering as safe as possible.
So having shared this information, now
I want to shift gears just a little bit
and spend a few minutes updating you on what
we know on a couple of scientific hot topics.
And the first one was in the news a lot last
week, and that is asymptomatic transmission,
and I'll talk about presymptomatic
transmission as well.
I imagine some of you heard the press conference
that took place at the World Health Organization
where the speaker suggested that
asymptomatic transmission is a rare thing.
But really can, let me come
back to this a minute
and ask the first question
which is what do we know?
Can you get COVID from someone who doesn't
have symptoms, and what's that level of risk?
So the bottom line here is absolutely yes.
We have good evidence that
people without evident infection,
with no symptomatic illness
have transmitted the infection
to others either before they developed symptoms,
so that would be the presymptomatic period,
or also in persons who have
never shown symptoms.
We call those asymptomatic cases.
Now we don't know exactly how often
that happens, and I want to clar--
let me clarify one thing
we hear a lot in the press.
Asymptomatic, when we use the term asymptomatic
as an epidemiologist, that means we're referring
to people who retrospectively never had
symptoms while they had the infection.
And presymptomatic refers to those
who appeared healthy without symptoms,
but then later developed symptoms.
So the, the question that people heard
from the, the question people had related
to the statement made by WHO has
to get broken down into two parts.
The first part is how many people who
are infected will not show symptoms.
Will either have, will be truly asymptomatic
throughout the course of their infection,
and the second question is okay, among those
people as well as people who are presymptomatic,
before they get ill, how likely are
they to transmit the infection compared
to someone who is symptomatically ill?
So the regard of the first question, sort of how
many people appear to be able to get infected
and never develop symptoms, the range
is quite wide, but a safe estimate,
and this is part of a review published in
the Annals of Internal Medicine last week,
a safe estimate is that probably somewhere
between 30- to 35% of people infected
with COVID will never show symptoms.
Now we know that these people from the small
amount of data that's available probably are,
have lower viral burdens, and may recover,
they may clear the infection a little faster,
but we really don't yet have an exact
figure for how often and how much more
or less infectious those persons
are compared to symptomatic persons.
This is something that's
of intense interest to us.
It's very important.
It's something unusual about this infection
which keeps surprising us at every turn,
and we're paying close attention and really
trying to really hone in on that, that figure.
We've had a couple studies out there doing that.
But this is why we often, you'll hear
us often stressing the importance
of wearing a cloth or a fabric face covering.
We know that face coverings, masks, respirators,
all of these were originally developed
to detect our lungs from getting
personally infected by bacteria and also
to prevent inhalation of harmful particles
like ash and dust and things like that.
But you know, we, we're now advising
the use of fabric face coverings more
for preventing what we call source control,
to prevent a person who may be infected
and not know it yet, or may never
know it because they never get sick
from inadvertently transmitting infection
to somebody else although we don't know,
we don't know how perfectly these
fabric factor coverings work.
We know that they offer some reduction in the
exhalation of potentially infectious particles.
And so we really recommend those for everyone.
And part of the principle here, and I
think our Surgeon General, Jerome Adams,
really summed it up nicely
recently was that the more that each
of us wears a fabric face covering in public
when we may be within six feet of someone else,
the more we are all helping protect each other.
You know, the more of us that do
it, the more of us it protects.
And just, you know, I think I when this--
when we first made this recommendation,
I had some misgivings as to how
acceptable it was going to be
as sort of an extreme thing for us.
It's not something we've done traditionally,
but we have some news now that shows
that Americans actually are doing it, and,
and following other of our recommendations
to help slow the spread of the virus.
This is a survey conducted in May, looking
at adherence to public health recommendations
in New York City, Los Angeles, and
other parts of the United States.
And we learned that in addition to the
majority of folks reporting that they always
or often wore a fabric face covering in a
public area, we also saw that a majority
of persons supported stay-at-home orders,
supported limiting non-essential
business closure and travel,
and believed that their state's restrictions
at that time struck the right balance
between protecting the public
and not being too restrictive.
So I really want to say how gratifying it
is for all of us in public health to see
that everyone is really helping
together to fight this problem.
I take my hat off to all the American people
for helping us get through the last few months.
This is really a terrific achievement,
and we need to begin thinking
about now how are we going to sustain this?
Because as I said, this is part of a
new normal we're learning how to live
with until we get that big solution.
So we're going to also ask for your continued
efforts, and I know it's hard to make changes
in your daily life because I've had to
make a lot of changes in my daily life.
My patients have had to learn to make changes.
My friends, family, neighbors,
and I'm sure all of you as well.
This is something that's affecting each one of
us, and we're not quite out of the woods yet.
But it's getting easier to
walk through those woods.
As I mentioned in the coming weeks,
we might see a surge in COVID-19.
Not, it's not, it's too soon to know when it
will happen, but know that we're working closely
with health departments across
the country to monitor activity,
and the more we can do these
efforts that I just mentioned,
the more we'll help reduce
that risk of it coming back.
There may be new challenges like protecting
seasonal farm workers and other workers
and people living in close quarters.
And I know that Dr. Lincoln who's coming
up has some important information to share
on that front, so I'll pause
here, now, and ask her to speak.
But before I do, I just want to also say
we really look forward to your questions.
I'm going to keep an eye on the Q&A box
and see if I can respond to some in person.
And now it's my great pleasure to turn this
over to my good colleague, Dr. Jennifer Lincoln.
Jennifer, would you like to go ahead?
>> Yeah, sure.
Thank you, Dr. Brooks, for that
excellent introduction and overview.
Hi, everyone.
My name is Dr. Jennifer Lincoln, and I'm
the Associate Director of NIOSH's Office
of Agriculture Safety and Health here at CDC.
Today I'm pleased to share information on CDC's
guidance for agriculture workers and employers.
This guidance is co-branded with the
Occupational Safety and Health Administration,
or OSHA, and was published just last week
on June 2, on CDC's Coronavirus webpage.
I just thought it was two weeks ago, wasn't it?
Time flies when you're on the response.
We also have an agriculture employer checklist.
Now this was posted last
week, and this checklist is,
was created to basically
operationalize the, the guidance,
the agriculture guidance that was published.
It's the work plan or this checklist
is to assess, is to help assess
and write the control plan, and that,
that corresponds with the guidance.
The link for this is located
here at the bottom of the slide.
The guidance is meant to assist those
in the agriculture industry in efforts
to decrease the spread and impact of COVID-19
at agricultural worksites, farms and ranches
and other production agriculture
worksites are an important part
of America's food supply chain, and ensuring
this critical infrastructure can continue
operations while remaining safe and healthy.
And this is a priority for CDC.
The agriculture guidance was written with
many types of agriculture workplaces in mind,
including produce growers and
processors, ranches, orchards,
and other production ag worksites.
This guidance is intended to be a tool
to help owners and operators to respond
in flexible ways, to varying levels of disease
transmission across our agriculture communities.
US Agriculture worksites, shared worker housing,
and shared worker transportation
vehicles present unique challenges
for the prevention and control of COVID-19.
And, and we believe that those of you
involved in the work can best set priorities
and assess how realistic these recommendations
are for specific situations at your facilities.
So I'd like to go over a few things
that are in the guidance document.
The document encourages that management conduct
worksite assessments to identify COVID-19 risks
and infection prevention strategies.
And in addition, these prevention
strategies implemented
in the worksite should also be
considered to be implemented
in employer-provided worker
housing and transportation.
The control strategies included in the
guidance follows the hierarchy of controls
which is a fundamental method of
protecting workers, workers from hazards.
And our application of the hierarchy of controls
in the guidance document, we grouped actions
by their likely effectiveness in
reducing or removing the pathogen.
Our preferred approach is to eliminate
a hazard or hazardous process.
So for example, in our scenario,
excluding sick workers or visitors
from the worksite is our
first level of protection.
Our next set of guidelines focuses on
installing feasible engineering controls
that would isolate the worker from the pathogen,
and finally, in administrative controls,
we suggest things as implementing appropriate
protocols for cleaning, disinfection,
and sanitation to further
reduce exposure to the pathogen.
And until such controls are in
place, or they are not effective,
the other administrative control measures are
needed as well as personal protective equipment.
Under the elimination of the hazard that this
is the preferred approach to the hierarchy
of controls, and this includes screening
and monitoring of workers prior to entry
into the worksite or if possible,
prior to boarding shared transportation
and encouraging workers who
have symptoms to self-isolate
and to contact a healthcare provider,
or when appropriate, provide them access
to direct medical care or telemedicine.
If a worker becomes or reports being sick,
clean and disinfect the work area, equipment,
common areas used by the
person such as the break areas,
the bathrooms, the vehicles, et cetera.
And any tools handled by the symptomatic worker.
If a worker is in employer-furnished
housing, consider providing a dedicated space
for the worker to recover away from others, and
then clean and disinfect the living quarters,
cooking and eating areas,
bathrooms, and laundry facilities.
And don't allow other workers to use these areas
until they've been cleaned and disinfected.
Employers should follow the CDC's critical
infrastructure guidance when determining
when a worker can return
to work after being exposed
to COVID-19 but who remains symptom-free.
In the engineering control section, these,
these types of controls isolate employees
from a pathogen at a worksite or, and are the
next approach in the hierarchy of controls.
Some examples of engineering controls
include adjusting workflow to allow
for a six-foot distance between farm workers,
installing shields or barriers such as plastic
between farm workers when a six-foot
distance between them is not possible.
And our guidance also includes a special section
on cleaning, disinfection, and sanitation.
It discusses hand hygiene and encouraging farm
workers to wash their hands often with soap
and water for at least 20 seconds.
Disinfection and sanitation
also discusses that farm owners
and operators should develop sanitation
protocols for daily cleaning and sanitation
of worksites where it is feasible to
disinfect the worksite, as well as cleaning
and disinfecting procedures for
high-touch areas such as tools, equipment,
and vehicles used by farm workers
following CDC guidance on cleaning methods.
Also conduct targeted and more frequent
cleaning and disinfecting of high touch areas
of shared spaces such as time
clocks or bathroom fixtures,
vending machines, railings, and door handles.
Lastly, administrative controls
are also important elements
to include in your control plan.
All communication and training for
workers should be easy to understand
and should be provided in languages
appropriate to the preferred languages spoken
or read by those receiving the training.
Training should also be delivered
at the appropriate literacy level
and include accurate and timely information.
We also recommend examining leave and sick leave
policies to make sure that ill workers are not
in the workplace or are not
penalized for taking sick leave.
Make sure that workers are aware
and understand these policies.
We can also promote social distancing by
reducing crew sizes, staggering work shifts,
mealtimes, and break times, and having farm
workers alternate rows and fields to facilitate
that six-foot distance between each worker.
The guidance discusses the option of grouping
workers together into separate cohorts who work,
sleep, and/or travel together, and this
cohorting practice may slow the spread
of COVID-19 among agriculture workers by
minimizing the number of different individuals
who come into close contact with each
other over the course of a work week.
It may also reduce the number of workers
quarantined because of exposure to the virus
and therefore be less disruptive
on the overall operation.
My colleague, Dr. Dominguez, will speak more
to shared housing considerations in a minute,
and so I won't go into the topic right now,
but I would like to briefly mention a couple
of ideas listed under the special
considerations for shared transportation.
The guidance talks about providing as much
space between riders as possible, and to group
or cohort workers in the same crews or those
who share living quarters
together when transporting.
Also increasing the number of vehicles and the
frequency of trips to limit the number of people
in the vehicle is also an option.
We know that farm operations vary across
regions of the country, and our challenge was
to write guidance that could be
applied to all of these operations.
These guidelines provide a template of action
to protect agriculture workers from COVID-19
and should be applied as
applicable to specific operations.
The consistent application of
specific preparation and prevention
and management measures contained in
the guidance can help reduce and risk--
can, can help reduce the risk
of transmission of COVID-19.
I'd like to now turn it over to Dr. Nichols
for some testing guidance that's applicable
to agriculture and other
high-density workplaces.
Dr. Nichols?
>> Thank you so much, Dr. Lincoln, and
I'm really honored to be here today.
My name is Megin Nichols, and
I'm a veterinary epidemiologist,
and I've been working alongside the
food systems working group at CDC.
I'm here today to add a little bit to Dr.
Lincoln's guidance by speaking briefly
about some testing considerations in
high-density critical infrastructure workplaces,
such as worksites for workers in really
close contact or long periods of time,
and for example, that might be
an eight- to twelve-hour shift.
So this might include those who are in
agriculture facilities, distribution centers,
meat and poultry processing
facilities and others.
So the CDC received some new
guidance on this over the weekend.
Recent outbreaks of illness among workers
in our critical infrastructure food producing
facilities has really highlighted the need
for a testing strategy as
a tool that might be used
to augment existing disease control measures,
and aid in identifying infectious individuals
who might require either isolation
or quarantine to reduce transmission
and prevent outbreaks in these workplaces.
Workers in high-density settings in which
they're in the workplace for a long period
of time, and I mentioned that eight-
to twelve-hour shift and have long,
prolonged contact, so again, our definition
being within six feet for 15 minutes
or more with other coworkers might be at risk,
increased risk for exposure to SARS CoV-2
and early experience from these outbreaks in
a variety of different settings has suggested,
and as Dr. Brooks also mentioned,
that there can be asymptomatic
or presymptomatic workers with
the virus in the workplace.
And testing is really important to
identify some of these individuals
as they might not know they're infected.
So SARS could lead to transmission from
asymptomatic or presymptomatic people can result
in additional illnesses and
transmission of the virus,
and even potentially outbreaks of COVID-19.
Critical infrastructure employers also have an
obligation to manage the continuation of work
in a way that helps protect their
workers and the general public.
And so that's part of the reason
this team at CDC has come together
to develop this testing strategy to again, aid
and identify the infectious individuals so that
if they test positive, they can be
excluded from the workplace with the goal
of reducing transmission of SARS CoV-2.
There's two tests that are
currently available for COVID-19.
Viral tests to detect current
infections and antibody tests
that can help identify previous infections.
The testing that is most useful and that
is described in this particular guidance
for this testing strategy is viral testing
because it can be used to inform actions
that are really necessary to keep
the virus out of the workplace,
to detect COVID-19 cases quickly, to
exclude them and stop transmission.
So now I'm going to talk a little bit about the
testing strategy, and I highly encourage those
of you that are interested, there's
a screen shot of it up on the slide,
but I really encourage you
to go to the website to read
through the testing strategy
and take a look at the diagram.
So our prioritization of risk is really based
on the likelihood of exposure in the workplace,
workplace characteristics, and
contact investigation that can be done
when a COVID-19 case is identified.
And once this is done, there can be a
progressive, tiered approach to testing
of coworkers, and you can see on the slide that
we have some graphic representation of what
that could potentially look like.
So this testing strategy is optional, and
again, designed to augment existing guidance,
but not replace any existing guidance to
help reduce transmission in the workplace.
So when a case of COVID-19 is identified,
a review of facility and work records,
conducting facility walk-throughs
and employee interviews may add
in categorizing workers according
to the risk of exposure,
and then subsequently prioritizing them for
testing in what we're calling a tiered approach.
The tiered categorization
is based on the likelihood
of exposure given this workplace assessment
with those who are most likely to have exposure
to the COVID-19 case in tier one, those
less likely to have exposure in tier two,
and those least likely to have
exposure to the case in tier three.
And the way we're looking at tier-one
workers, and again, I encourage you to look
at the strategy online, is that those
workers can be identified in two ways.
The first is through contact investigation,
finding out if the case of COVID-19 carpooled,
worked on the same line in the
same room, or other characteristics
that would identify them as
a potential close contact.
So contact investigation, and then again
those working during the same shift,
or overlapping shifts in the same area, for
example, the same line or the same room as one
or more of the workers with COVID-19.
Now, this does include other factors that
employers would want to take into consideration
in terms of kind of looking at this tier one,
and that might include the layout and size
of the room, and the design and implementation
of design and engineering controls and adherence
to administrative controls of
which Dr. Lincoln mentioned.
So once the workers are categorized
into tier one, two, or three,
or even those that are not
exposed, the next step is to look
at a potential strategy for testing.
And again, looking at this the way
we've designed the strategy is there
in the lower right-hand, so workers in tier
one who've had close contact or been exposed
to a coworker with confirmed COVID-19
should be tested and quarantined,
and then various strategies can be considered
for when these critical infrastructure workers
in tier one would return to work.
So in looking at this testing strategy, the
most protective approach for workforce health
and to keep those who might be shedding
the virus out or might be exposed
and then subsequently become
ill out of the workplace is
for tier one critical infrastructure coworkers
to follow the existing recommendation
regarding exclusion, exclusion from work,
meaning these workers who are
exposed would ideally be excluded
from work and quarantined for 14 days.
Now we know that in many critical infrastructure
workplaces, employers are also considering how
to maintain continuation of operations given
there might be an exposure in the workplace,
so this testing strategy comes into play because
there can be a serial test-based approach
that can be used for earlier return to work.
So this would be basically looking at your
tier of coworkers or that cohort of coworkers
who were exposed and applying a testing
strategy to those who were exposed
which if you identify positive workers, they
could be quickly excluded from the workplace.
And then we recommend serial testing
of those workers every three days
until there's no more positives in that
group of cohort of exposed workers.
Workers who test positive or become symptomatic
should be excluded from the workplace,
and that's again discussed in the guidance.
So this is a tool that can be used which
will aid with these specific workplaces
to identify a cohort or group of
people who they think might be exposed
and then provide a test-based approach that
would help to detect somebody who's infectious
and then remove them from
the workplace more quickly
which might help reduce transmission
in the workplace.
And that's our goal, to protect
worker health and safety.
Again, the link is there on the website.
So next I'd like to introduce Dr. Ken
Dominguez to talk a little bit more
about worker housing and guidance.
Over to Dr. Dominguez.
>> Alright, thanks Dr. Nichols.
This is Dr. Ken Dominguez, and I'm a
medical epidemiologist and a Captain
in the US Public Health Service, and I serve on
the Community Interventions At Risk Task Force,
and I'm part of the Minority Health and Rural
Health Team, and so I want to talk a little bit
about special considerations for shared
housing since it's an important topic
for agriculture and many other industries.
So there are a few general considerations.
First, family members should be
kept together in housing facilities.
In addition, grouped or cohorted workers can
be considered a single household or family.
Farm workers that are in the same shared
housing unit should follow the housing,
living in close quarters guidance
that can be found on the CDC website.
This guidance can be found on the, on
the link that's posted on the slide.
Most importantly in employer-furnished housing,
the owner/operator should provide a dedicated
and segregated space for sleeping quarters,
kitchens, and restrooms for farm workers
with confirmed and suspected COVID-19
to recuperate without infecting others.
So what happens if a household
member becomes sick?
Recommend to provide a separate bedroom and
bathroom for the person who is sick if possible.
If you cannot provide a separate room
and bathroom, try to separate them
from other household members
as much as possible.
Keep people at higher risk
separated from anyone who is sick.
If possible, have only one person in the
household take care of the person who is sick,
and this caregiver should be someone who
is not at higher risk for severe illness
and should minimize contact with
other people in the household.
Identify a different caregiver for other
members of the household who require help
with cleaning, bathing, or other daily tasks.
If possible, maintain six feet
between the person who is sick
and other family or household members.
And what about sharing bedrooms and bathrooms?
If you need to share a bedroom with someone who
is sick, make sure the room has good airflow.
Open the window and turn on a fan to bring
in and circulate fresh air if possible.
Maintain at least six feet between
beds if possible, sleep head to toe,
put a curtain around or place
other physical divider--
for example, it could be a shower
curtain, a room divider, a large cardboard,
cardboard poster board, quilt, or large
bedspread to separate the ill person's bed.
If you need to share a bathroom with someone
who is sick, the person who is sick should clean
and disinfect the frequently touched
surfaces in the bathroom after each use.
If this is not possible, the person who
does the cleaning should open outside doors
and windows before entering,
and using ventilating fans
to increase air circulation in the area.
Also wait as long as possible to enter the room
to clean and disinfect or to use the bathroom.
If you are sick, do not help prepare food.
Also, eat separately from
other members in the household.
Those are some quick recommendations,
but I'm happy to take more detailed
questions later if they come up.
With that, I'll hand it back to Dr. Smith.
>> Thank you so much to all of our experts
for sharing such wonderful updates.
Very, very informative.
Before we transition to Q&A, as I
mentioned at the top of the call,
we are considering changing
this call's day and time.
Racine, could you please deploy the poll?
As you can see, there are two options.
Please indicate the day and
time you would prefer.
The two options are Mondays
at 3 PM, or Tuesdays at 4 PM.
Note both of these are Eastern Standard Time.
Your opinion is welcomed and
appreciated, so please, please,
please make sure you click one or the other.
The next part of the call is our Q&A.
We received some questions in advance,
and we will start with a few of those.
You're also welcome to submit
questions via the Q&A button in Zoom,
and it looks like you guys are
very comfortable with that.
Please keep those coming in.
I'd like to start with some general questions
that I think may be relevant to everyone
on the call, including the business audience.
So we'll start with you first, Dr. Brooks.
Can you give us an update on who was most at
risk for COVID-19 at this stage in the epidemic
as well as who is getting sick, and
who is suffering severe illness?
>> Thanks, that's a, a great question.
I appreciate answering that.
I want to alert folks that MMWR
was published today reporting some
of our early surveillance data which contains
some information around this question.
But just let me start by giving you some of
the general information about what we know.
So what we know with this disease is
that among the, there are a certain set
of medical conditions which we have evidence
for now that increase a person's risk
for either more severe disease
or increasing the risk of death,
and there are also some other factors that can
alter the risk, increase the risk for infection
and for poor outcomes, severe
infection and poor outcome.
In terms of the medical illnesses,
those generally fall into a list
of categories you may already know or you've
heard of with regard to other diseases.
So in this case, cardiovascular disease.
That includes hypertension, severe obesity,
which is defined as a body mass index greater
than 40 kilograms per square meter.
Chronic liver disease or chronic lung disease,
active immunocompromising
conditions, and autoimmune conditions.
Oh, there you go.
Sorry, my screen just got obscured by something.
There we go.
And then persons with chronic kidney disease.
So those are the main underlying medical
conditions that we know increase risk
for COVID being more severe or having
a very poor outcome, fatal outcome.
In addition, increasing age has
a very strong effect on your risk
for severe disease and poor outcome.
We typically have been saying that people over
the age of 65 are higher risk than others,
but as I hope all of us recognize, there's
nothing magic that happens the day you turn 65,
and in fact, it's more of a spectrum that
starting around age, maybe late 30', late 40's,
it sort of depends a little bit on
the population that you look at,
the risk for severe disease and for
death continues, steadily increases.
Where that biggest flex point
occurs has so far been mostly
around the early 60's to the middle 60's.
But I think we will soon be having
some additional clarification
of these risk factors coming out, and you
may see that it speaks more broadly about age
without so much of a distinct cut-off
related to just one specific age.
To give you a sense of how these
differences play into a person's risk,
I want to share with you some of
the data that was in today's MMWR.
And so for instance, if we are looking at the
risk, how many people were admitted to the ICU,
what percent of people who were hospitalized--
sorry, if a person who's diagnosed were admitted
to the ICU, considering people who had no
underlying health condition versus those
who had one of those underlying conditions
I just mentioned, and possibly a few others
that I didn't mention that were
included for part of the study.
So if among people who had no
underlying health conditions,
about 1.5% of them ultimately
ended up in the ICU.
Now that compares to 8.5% for people
with an underlying medical condition,
and the difference is even more stark when
we look at the number of people who died.
So among persons in the ICU who died,
those without any medical conditions,
that was 1.6% versus those with
underlying medical conditions, 19.5%.
So this is the reason we
want people to pay attention
to the underlying medical
conditions is for two reasons.
First, so they recognize that they need to be
especially careful to make sure to the best
of their ability that they don't get
exposed to this virus and infected with it,
and secondly so that if they do
have any concerning symptoms,
or they think they might have had
a serious exposure and need a test,
that they seek out that healthcare
as soon as possible
because this is not a disease
where you want to delay.
And I want to reassure everyone that our
health system is now safe for you to go to.
It's early in the, in this
epidemic you heard the message over
and over, stay at home, stay at home.
Don't go to the doctor, call
the doctor ahead of time.
Call the ER ahead of time,
and we recommend you doing
that if you have the luxury of time to do it.
But if you are having chest pain, a
cough, you can't breathe, call 911.
They will come and they will get you and bring
you to the hospital, and if you have to go
to the hospital on your own, they are ready
to receive you safely and take care of you
so that you don't get, so in case you don't
have COVID you don't get infected from someone,
and if you do, that everyone
is protected against that.
The last two things I want to say
about risk factors really are a bunch
of broader risk factors related to bigger
issues, and first is the effect of sex.
So it turns out that men have a slightly
more difficult time with COVID than women.
They're a little bit more
likely to get infected,
15.6% of infected men were hospitalized
versus-- sorry, were hospitalized.
I didn't mean to say infected,
I meant to say hospitalized,
that among people who are hospitalized,
15.6% of men who were diagnosed were
hospitalized versus 12.4% of women.
Another thing we look at is race/ethnicity.
I'm certain that if you haven't heard already
that you need to know that there are differences
in terms of race/ethnicity
in who is affected by COVID.
The bad news here is that it is very clear
that people of minority race/ethnicity are
at higher risk for becoming infected, and
there's a lot of complex reasons for that,
and we now have a Chief Health Officer
for Health Equity who's working with us
to address these, better understand the
disproportionate burden of this disease
on people of minority race/ethnicity,
and to address that.
The good news is that when you get
to a hospital and get into care,
and if you get the care you need, that there
is no very big difference in terms of outcome.
The biggest difference in terms of outcome
is if you're in a group that's more likely
to get sick, then as a whole, you're more like,
there are likely to be more
deaths in that group.
So it all really starts with
reducing the risk for getting exposed,
and to the extent that you're able to
help us share the message with people
that to the extent they can do it, how
to protect themselves, that's very,
very useful and would be welcome.
So let me stop there, and if
there's a follow-up question
or anything you want to ask,
otherwise, we'll go on.
>> Thank you so much, Dr. Brooks.
The next question I'll grab from the Q&A.
in developing outbreaks in an agriculture
facility, do negative tests of workers need
to be retested to avoid false
negatives and a restart of the outbreak?
I'm going to shoot this over
to Dr. Megin Nichols.
Dr. Nichols, are you on mute?
>> Thank you.
I do hope, I saw Patrick's question and thought
it would be a good one to address as well,
so I do hope that our guidance or
our strategy for testing is helpful.
If there is an outbreak, first definitely
making sure you're working with your state
or local health department
I think is, is very key,
and the second thing I would say is this
testing strategy may help you to kind of look
at where you might be having cases in the
agriculture facility, and potentially look
at prioritizing some of those workers
who were potentially exposed for testing,
and then taking some concrete
action based on that.
So in this particular testing strategy, if
you do have workers who were exposed and meet
that tier one description where they were
most likely to have contact with the person
who has the COVID-19 case, those would
be good people to consider testing,
and in this particular case, it could be
serial testing, meaning that you're testing
at three-day intervals, and that's based
on when we believe people would be likely
to develop symptoms and to test positive.
The other thing to make sure you're
doing, and this is something that is
in Dr. Lincoln's guidance is screening.
So not only can testing be used as a tool,
but that even more critical is
potentially screening workers for symptoms
and monitoring body temperature so that those
workers in the event that they have symptoms
or feeling ill are excluded from the workplace,
and that should happen before
the testing strategy is employed.
So great question, and I hope
our testing strategy helps you
to address some of those issues as well.
>> Awesome, thank you.
Dr. Dominguez, I just found a question that
seems like it might be perfect for you.
Many businesses, especially in agriculture and
food industry have a very diverse workforce.
Many of these workers, English--
excuse me, for many of these workers,
English may not be their first language.
Does CDC have COVID-19 health
information in different languages as well
as different levels of, of interpretation?
>> Great question.
It's really critical that we
communicate health information in a way
that your audience can understand, and so this
includes providing critical COVID-19 health
information in languages
your workers actually use.
So in light of that, CDC provides fliers
and health information on its website
in over 60 languages and in various formats
including videos, recorded PSA's and posters
that are free and available
for sharing and downloading.
For additional COVID-19 materials
in other languages,
we invite folks to visit the
CDC print resources page.
Also much of our web information on COVID-19
is available in Spanish, Chinese, Vietnamese,
and Korean, and at the top of each
webpage, there's a drop-down list
for you to select other languages.
However, note that the website is updated very
frequently, and information may be available
in the English before it's
available in other languages.
For more information in Spanish,
please visit the CDC in Espanol
which is CDC's dedicated
hub for all Spanish content.
CDC also has a dedicated COVID-19
communications toolkit for migrants, refugees,
and other limited English-proficient
populations.
Thank you!
>> Okay, thank you for that.
I've seen a couple of questions regarding face
shields and cloth face coverings and humidity,
so I'm actually going to
hop over to Dr. Lincoln.
Dr. Lincoln, what if it's
too hot or uncomfortable
for workers to wear cloth face coverings?
Can workers wear a face shield
as an alternative?
Dr. Lincoln, are you on mute?
Okay, we may have lost Dr. Lincoln.
Okay, we'll come back to that
question and Dr. Lincoln.
Alright, let me ask Dr. Nichols,
another question for you.
One of our most frequently
requested topics for discussion week
after week is screening workers
for symptoms of COVID-19.
What are your recommendations
for the agriculture industry
and other high-density workplaces including how
to make sure temperature readings are accurate
and the right questions are
asked during screening?
>> This is a great question, and you're right,
it does seem to come up week after week.
So as I mentioned, screening workers and others
entering the workplace for symptoms of COVID-19
such as an elevated body temperature is really
a key component of preventing transmission
and protecting workers, including those in
high-density critical infrastructure workplaces.
Uniform policies and procedures for screening
workers should be developed in consultation
with state and local health officials
and occupational medicine professionals,
and that really helps you tailor
this approach to the workplace.
This might include guidance on how to protect
personnel who are conducting the screening.
Making sure you're conducting the
screening in a confidential manner,
manner that is in compliance
with the Equal Opportunity,
Equal Employment Opportunity
Commission and OSHA guidance,
and the other applicable laws and regulations.
And there is more information on this on
our business frequently asked questions page
as well as the agriculture guidance.
There's possible options to screen workers
for COVID-19 symptoms such as again,
screening prior to entry to
the workplace, or if possible,
before boarding any shared transportation.
Checking temperatures of workers at the
start of each shift to identify anyone
that might have a fever of 104,
100.4 degrees Fahrenheit or greater.
And then asking workers in appropriate languages
per Dr. Dominguez' recommendations that to see
if they have a fever, respiratory symptoms, or
other symptoms of COVID-19 in the past 24 hours.
And then CDC's website, if you have questions
about what are the latest symptoms associated
with COVID-19, we're working to make
sure that the website is up to date.
So with regard to temperature screenings, it's
really important to train temperature screeners
to use those temperature monitors
according to manufacturer instructions,
and this might include calibrating
devices before use or taking steps
to validate the temperature readings, and then
employers should provide temperature monitors
that are accurate under conditions of use.
So this includes extremely hot temperatures or
cold weather, and we're headed into the summer,
so this is an important consideration,
and making sure those conditions are
properly accounted for when developing any
of the standard policies that I mentioned.
And of course, any workers who become
sick either during their work shift
or if they have a positive screen for symptoms
or fever at the arrival to the workplace,
they should be sent to their home or
healthcare provider as appropriate
and referred for further evaluations.
So just a note there.
Thank you.
>> Alright, thank you.
Alright, back over to Dr. Lincoln.
As I noted before, there's a number of questions
about cloth face coverings
versus wearing face shields.
So if it's hot and humid or just uncomfortable,
just too uncomfortable for workers
to war cloth face coverings, can workers
wear a face shield as an alternative?
>> Thank you for that question,
and I'm so sorry about before.
I'm coming to you from a one-room
little farmhouse, and I have puppies
in the background that get
out of hand sometimes.
[Laughter] Full disclosure: I'm sorry
I was unavailable a few minutes ago.
This is a really important question,
and I actually get this quite a bit,
even from my family as they're working.
So cloth face coverings may be difficult
to wear, as you already mentioned.
Whether it's for a long time, but
especially in hot and humid environments.
These environments require, you know, sometimes
touching your face which is not what you want
to do if you-- sorry, I'm going in here--
which is not what you want to do if you're,
if you're wearing a cloth face covering.
That's the whole reason you're wearing
it, so to keep things off of your face.
So social distancing will be very important when
using cloth face coverings, and when that's,
especially when if that's not available, you
really need to be wearing cloth face coverings.
Employers may also consider providing workers
with alternatives, as you
mentioned, face shields.
So face shields may serve both as source
control which is what we talked about earlier.
It's preventing other workers or other
people from respiratory droplets produced
by the person wearing the shield.
Face shields are also PPE, so they can protect,
face shields will protect the eyes and the face
of the wearer from hazardous splashes.
It's really important to note that
cloth face coverings are not PPE,
and neither cloth face coverings or face
shields are appropriate substitutes for PPE
such as respirators, like N-95 respirators,
or medical face masks like surgical masks
in workplaces where respirators
or face masks are recommended
or are required to protect the wearer.
So thanks very much for the question.
I'm sorry about the distraction, and I
welcome any other questions that I can answer.
>> No problem at all.
As noted on some of the Q&A,
people would actually love
to see your puppies, so it's quite okay.
[Laughter] Quite okay.
>> Okay, thank you [laughter].
>> Yes, yes.
Oh gosh, we've actually reached the
end of this wonderful time with you.
We've only got four minutes
left, and we've got to close up.
So I want to thank everyone
for joining, Dr. Brooks,
Dr. Lincoln, Dr. Nichols, and Dr. Dominguez.
Do any of you have any last
closing remarks you guys may want
to add or any last thoughts to share?
>> Well, I'll take the opportunity.
This is Dr. Brooks, and I'll just say I first
want to thank you guys for being on this call.
It's encouraging to know so many people are
interested in this, and if you have ideas
for topics, is there a place where
they can submit them, Dr. Smith?
>> Now, now I had the problem
with getting unmuted.
[Laughter] Sure.
They, they can submit them
to EOCEvents337@CDC.gov.
EOCEvents337@CDC.gov.
>> This is Ken Dominguez, and I also wanted
to leave a couple of parting thoughts,
and one is really for folks to remember
to really work to be proactive in terms
of implementing a lot of
the mitigation strategies
for agricultural workers who
are, are essential workers.
And also to remember that according to
the National Agriculture Worker Survey,
82% of farm workers are non-migrant workers.
Only 5.2% follow the crop, so this has important
implications on mitigation strategies both for,
for workers who travel, and
those who are in our local areas.
So please keep that in mind as you
develop your mitigation strategies.
Thank you.
That was the perfect ending.
Thank you, Dr. Dominguez.
Alright, hearing no further
questions and/or comments,
I again want to say I appreciate you guys
for filling out our poll this afternoon.
We will make our decision soon regarding
the final time for our future meetings.
And lastly, thank you again.
Please, please, please join us next week
for yet another exciting time with CDC
and our update on COVID-19 with you.
Okay, have a wonderful day.
Bye-bye!
