Courtesy Dr. Michael Osterholm

How should the rapid rise in infections in the US, and the fast spread of the Delta variant factor into organizations’ plans for returning to the workplace? To understand better, I spoke on Friday with Dr. Michael Osterholm, a leading US epidemiologist who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. Here is a transcript, edited for clarity:

Should organizations be reevaluating their plans for returning to the workplace based on the current rise in infections and spread of the Delta variant?

The next several months are going to be incredibly challenging around the world, and specifically in the United States. Delta is going to rewrite the epidemiology of Covid-19 for at least the next several months. It is clearly a much more infectious virus. Take for example, England. Right now today they are going to report out almost 50,000 cases. If you were to equate, based on population size, what's happening in England, that would equate to over 200,000 cases a day in the United States. If you look at what's happening in our country right now—this is all so fluid that it's almost hard for me to give this information to you because I know it'll change tomorrow.

But just within the last hour, basically all 51 states [including the District of Columbia] are now showing increases over the last 14 days. Twenty-three states including DC have increases over 100% in the last 14 days. And 39 over 50%. If you look at cases overall, they've been increasing 128% over the last 14 days nationwide. That's while testing has dropped 14%. So actually this is even with less testing. At the same time, hospitalizations are up over 26% in the last 14 days and deaths are now up 14%. And of course, deaths and hospitalizations are lagging indicators. So this has taken off. Wherever it's at, it's taken off. And globally the same thing is true. We just have to recognize that for the foreseeable future, this is going to be a real challenge.

If you're in the shoes of people making plans for bringing employees back to the workplace, what would you do?

I am sitting in those shoes. I have to direct a center at the University of Minnesota that is supposed to come back. I think it's going to be a function of two things. One is this is largely going to be an outbreak of serious disease, hospitalizations, and deaths among the unvaccinated. But we still have 100 million people in this country who are unvaccinated or not having protection from previous infection. Of those who are vaccinated, there will be an increasing number of breakthrough infections. They typically will be mild, not requiring hospitalization, or causing death. We're going to see some serious breakthrough infections, however, in the immune compromised and in those who are in long-term care, for example, those with immunosenescence. That doesn't typically obviously impact the workplace, except for long-term care where ADA issues come into play right there, just in terms of making accommodations for them.

The real challenge is not about just the disease. It's about the psychology of the disease and how comfortable people feel being in public places. People have just gotten back into the mode of feeling really comfortable. The vast majority of the country has said that the pandemic is done from their perspective. For those of us who have been saying, that's not true and have been pounced upon for the last 12 weeks for being scaremongers—this is what we worried about. I just did an interview this morning with Minneapolis Star Tribune newspaper here about modeling. And I was interviewed first of all, eight weeks ago for the story and said, you have no idea what's going to happen over the next few weeks.

And at that point, Delta was just emerging. I said, take this Delta variant. This could be the game changer. People didn't want to hear it. Now we know it's going to happen. So what we have to do is navigate at least for the next several months to get through Delta. That will get us to another endpoint. But it still doesn't mean we're not going to see another one. What's going to be the Lambda or some other one down the road? The one thing that so far still is the winning hand is the vaccinated hand. Get vaccinated. So I very strongly support widespread vaccination and where you can do it, I even support mandated testing. I don't support it, for example, in our university, I don't support it because there are exemptions anybody can drive a truck through. If we do make people now in our place be vaccinated or exempt, once they sign that exemption form, it's harder to get them back. But in a workplace setting, you actually have the ability in many cases to mandate.

You're in favor of workplaces mandating vaccination, where there aren't a lot of exemptions?

The exemption piece is the part that's hard because I want to get as many people vaccinated as possible. And if you have a segment that are on the cusp of maybe/maybe not getting vaccinated, but now you force them today to play their hand, they're going to largely not get vaccinated. And they're going to sign the exemption form, which means it's going to be much harder to get them back. That's the one group where I really am worried. The vaccine hostile—they won't get vaccinated. They'll take the exemption for sure. It's that vaccine-hesitant group that's in the middle. And I think that'll be true in the workplace.

When you think about the workplace, apart from vaccination—encouraging and mandating it where possible—are there other measures that you think people should be thinking about?

Ventilation. You have to look at building ventilation. How do you improve that? And it's not just simply opening windows. Long-term this is going to hopefully create kind of a sea change in how we look at indoor air and what you can do to maximize on basically providing a disease-free air system. That's hard for a lot of older buildings. But then what do you do to retrofit them with, for example, portable filters and so forth. Can you do that? That's going to be a major issue for anyone who owns a building today, or anyone who works in one of those buildings.

How do you think about continued masking in the workplace?

The masking issue I can support. But we've been the group that's showing masking only has limited protection. If I'm in a room today like your room right there with someone who is infected and infectious, I will often take in an infectious dose within 15 minutes, meaning the concentration in the air. But if I put a cloth face covering on, I get 15 more minutes—that's it. And so in a half an hour, I'm still infected. If, on the other hand, you have an N95 respirator that's face fitted, you get over 2,500 hours of protection. So it also gets back to what kind of masking you are talking about. And unfortunately we've never really commented on that. Go look in the media today. We've done this on a systematic basis. We can often find 25% to 30% of people who wear a face cloth covering are wearing it underneath their nose. That like fixing three of the five screen doors in your submarine. What good did you get out of that?

So, on net, what do you think about masking in the workplace?

It's additive. It's like the old seatbelt. But today we have a lot more than just the seatbelt. We have airbags. We have body frames that will collapse. We have glass that will shatter as opposed to shards. That's what makes for cumulative safety. Today by far the most important and definitive means of protection is vaccination. But then you have the indoor air, you have the issue of respiratory protection. These are all additional things.

Given factors including the acceleration of infections, the presence of Delta, the large unvaccinated population, should organizations now planning for a post-Labor-Day return consider delaying that?

I think people are, if nothing else is because of the psychology. I'm guaranteeing you, the media will change dramatically on this issue over the next three weeks. When it's a lead story night after night about Covid and Delta, it's going to be harder to bring people back in.

Putting media aside and looking at the public health dimension, is there enough matter for concern for organizations to delay beyond September?

I don't know about beyond September. If you have an organization that's highly vaccinated, you could come back right now. If you don't, then you're going to have a bigger challenge. Now, one of the concerns that I do have is the people who may not be concerned about coming back are the same people who won't get vaccinated, who believe they're invincible. 'I haven't gotten infected so far, so I'm not gonna.' I've had far too many of those. I've actually had families who have had to watch loved ones die just in the last month after having proclaimed for the last 18 months 'I'm not going to get it. If I was going to get, I would have gotten it by now.' There's a hundred million people in this country not yet vaccinated.

So the bottom line, as I'm hearing from you, is there's the psychological element, because as Delta ramps up, people are more concerned about going into the workplace. And the second consideration is that the level of vaccination among the staff in a workplace is basically determining.

Yes. I think that's huge. And just do whatever you can to get your staff vaccinated. That's, that's the key. That is the castle wall. If you have that, that's what will protect you.

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