Infectious disease specialist, on reopening economy: ‘Do things very slowly and gradually’

Dr. Cole Beeler knows people are itching to get back to business and resume their normal lives. But he warns employers and workers not to rush back to the old way of doing business, at least not all at once.


Beeler, an infectious disease physician at Indiana University Health and medical director of infection prevention at University Hospital, said workplaces should follow a gradual, methodical plan laid out by the federal government, in accordance with directions from state and local health departments.

Some gatherings, such as conventions and sporting events, will take longer to get back to normal than others. The bottom line: The virus continues to spread, and people need to take appropriate precautions.

From a health perspective, how close are we to getting back to normal in the workplace?

I’ve talked to a lot of people that are really anxious to get back to business as usual. And I think that what we’ve seen in the last two weeks is certainly encouraging in the numbers and trends that this is not going to be as bad as we initially thought. And we should be grateful that that’s the case, certainly, but we still need to approach things the same way right now. Currently, we are very cautiously moving forward.

Should we keep working from home indefinitely?

I would still recommend hunkering down, not doing mass gatherings or exposing yourself to other people. As the weather gets nice, I think there’s a temptation to go back to business as usual and do your summer routine and, you know, having cookouts and being around people.

But in general, this whole strategy really is contingent on people uniformly approaching things the same way, which is just a very gradual exposure—based on guidance from public health departments—to other people and to the loosening of the social distancing recommendations.

So, we are getting close, but I would not yet jump on the desire to reintroduce yourself and put yourself at risk by being around other people that may be infected.

Is there a playbook for how to reopen a workplace—an office, a store, a restaurant or factory—in the midst of a pandemic?

There is. I think each company is probably doing things a little bit different. We do have guidelines from the White House that actually suggest how to open up businesses. And in my impression from reading it, it seems like it’s pretty well thought out, with a tiered approach to how you start exposing people to each other.

The take-home point, I think, is to do things very slowly and gradually so that we can understand the implications and the consequences of the exposures.

Can you summarize those guidelines?

Yes, so it’s President Trump’s Opening Up America Again plan. It has criteria the medical community would consider to be promising trends in pandemic response. It looks for a decreasing, over a two-week period, of influenza-like illness reports, COVID positivity, COVID syndrome and positive tests, as well as the ability of hospitals to treat patients effectively.

Every two weeks, you can start gradually exposing businesses to varying levels of more exposure.

How gradual is it? How long before businesses can reopen?

There are essentially three tiers to it. For the first tier, you go through two weeks of decreasing epidemiology and appropriate response from the public health department. You still kind of take things conservatively, but you start considering more necessary services.

And then once you’ve done four weeks straight and met all of those conditions, then you start liberalizing. You’re still doing telecommunication and conferences as much as possible, but you start phasing in certain aspects of business life, where workers should probably still be wearing masks but could be integrating a little bit more together … in person.

And then in the final phase, what it eventually comes down to is essentially business as usual. And that’s after three two-week intervals.

As you know, this virus has killed more than 40,000 Americans, and it’s still spreading, with no vaccine available yet. Are we all susceptible to getting infected at work?

This is one of the main debates that we’re having in the infectious disease community. Is everyone going to get infected or exposed no matter what? And I think what we’re trying to get to is the potential for herd immunity, meaning that the people who have been exposed or infected are able to protect the people who haven’t been exposed or infected.

I think it’s such an infectious virus and we’re only seeing the tip of the iceberg. I think that we’re learning right now, especially with new data out of California, that the much larger fraction of patients who are infected are actually asymptomatic or never knew that they had the infection.

So that to me says there’s a lot of people who have already been infected, but probably still a lot more who are going to get infected. But it seems like the mortality rate is a lot lower than initially anticipated. So yes, very infectious, but maybe not as deadly as we initially thought.

Is there a way to make the office environment safer, perhaps by moving desks farther apart or putting arrows on the floor to show that people should not be walking toward each other?

Yes, there are a lot of creative things that I’ve heard like this. The [Centers for Disease Control and Prevention] actually does have guidance on this.

Certainly, spacing people out, making sure that common-area usage is at least discouraged as we start opening up.

Companies need to make sure that people have access to masks, to alcohol-based hand hygiene products, and wash their hands frequently.

Also, the office workspaces being decontaminated or cleaned on a regular basis is probably the best way to make sure that office staff is protected.

What exactly would contaminate an office?

People who are infected. A potential way to contract COVID is by touching something that someone else coughed or sneezed or breathed on and touching your mucous membranes like your eyes, your nose, your mouth.

That’s thought to be a potential way to transmit the virus. And the best way to prevent that is just by making sure that you’re cleaning off your workstation and that the high-touch areas, we call them, are cleaned on a regular basis to try and eliminate the virus that’s on them.

With all the emphasis on keeping 6 feet apart, is it safe to get into elevators?

At this point, we’re nowhere close, in my opinion, to being comfortable with a bunch of people together.

Overall, I think there’s still a lot of work that we need to do as it relates to building up the public health infrastructure for contact tracing as well as being able to test people rapidly and as many people that need to be tested.

So, until that time, I’d be cautious around close contacts in elevators. The one thing about elevators that’s not super scary to me is that you’re usually in and out of them pretty quickly. And as far as we know how this virus transmits itself, you need prolonged close contact with people. It probably has to be upward of 10 minutes that you’re spending with people, and I don’t know many elevator rides that take 10 minutes.

Should workers across Indiana wear masks when they go back to work? If so, for how long?

I think it kind of depends. I think it’s kind of embedded in our culture right now—there are going to be people who want to wear masks. I think that the recommendation for society will be to wear masks until we’re not seeing COVID at the rate that we have.

It’s hard to know when that will happen. I think it will eventually go away. But throughout this tiered response, I think that that’s going to be a potent way to help protect ourselves when we need to be closer together when some of these social distancing mechanisms dissolve.

Should restaurants start spacing tables farther apart? Should the servers wear masks?

Places like restaurants where you have clustering of people need to be treated a little bit more conservatively. I think it’s important to restrict the amount of people that are in a given space until … there’s been more time. In general, I think that masks and appropriate hand hygiene will be probably universal, even throughout all of this tiered response.

How about business and social lunches? When will it be safe to dine together again?

At this point, I would say it’s probably premature. We’re just now starting to see decreases [in COVID cases] in Marion County, at least at the hospitals that I serve around. And while I think that’s encouraging, we need it to be a durable decrease.

It needs to be a consistent decrease over a two-week period, before we even start considering interpersonal interaction. And even then, if it’s just been two weeks, I would say it should only be the essential stuff.

When we start stringing together serial two-week periods—so maybe we go four weeks, maybe we go six weeks, then that’s when we can start feeling a little bit more comfortable with being around people in non-essential ways and enjoying company together in the ways that we used to.

How about business conferences, sporting events, conventions and other mass gatherings?

I think it’s the same sort of thing.

What would be the worst thing for a company to do at this point?

I think the worst thing for business to do would be to jump all in at one time, go all the way back to business as usual. That could really end up hurting people.•

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