It’s probably safe to say that so far, 2020 has been a wild ride for the entire world. Every month seems to present a new surprise to wrap our heads around—and by the time we adjust to one crisis or disaster, the next one is here, giving us little time for preparation or prevention.

Luckily, we are already aware of one of the next big “surprises” of 2020: flu season. While it’s not really a surprise since it happens every year, it’s pretty certain that most of us are so distracted by everything else that we barely registered the looming influenza season.

One of the things to remember is that every fall/winter brings us a new version of the flu virus, bringing a fresh “plague” possibly running through the staff at your practice. While many people acknowledge the season by getting a flu shot, that’s usually the extent of preparation and prevention.

Despite Center for Disease Control (CDC) recommendations that you stay home if you have flu-like symptoms, most of us muster up the energy to still come in to work so we don’t leave our co-workers high and dry. Now thanks to the novel coronavirus pandemic, if you even cough or sneeze a few times in the workplace, you’ll likely be asked to go home by management. So, what does this mean for the impending flu season and your practice?

Influenza vs. COVID-19: Similarities and Differences

Both COVID-19 and influenza viruses most commonly impact the upper respiratory system, so many of the symptoms are the same—but there are some differences. Check out these charts created based on information from the CDC:

Signs and Symptoms

Signs/ Symptoms	COVID-19	Flu
Fever or feeling feverish/chills	✓	✓
Cough	✓	✓
Shortness of breath or difficulty breathing	✓	✓
Fatigue (tiredness)	✓	✓
Sore throat	✓	✓
Runny or stuffy nose	✓	✓
Muscle pain or body aches	✓	✓
Headache	✓	✓
Some people may have vomiting and diarrhea, though this is more common in children than adults	✓	✓
Change in or loss of taste or smell	✓

How Soon Symptoms Appear After Exposure and Infection

	COVID-19	Flu
Time window for onset of symptoms	2 to 14 days, on average symptoms develop after 5 days post infection	1 to 4 days post infection

How Long Someone Can Spread the Virus

	COVID-19	Flu
How Long Someone Can Spread the Virus	How long someone can spread the virus that causes COVID-19 is still under investigation.   It’s possible for people to spread the virus for about 2 days before experiencing signs or symptoms and remain contagious for at least 10 days after signs or symptoms first appeared.   If someone is asymptomatic or their symptoms go away, it’s possible to remain contagious for at least 10 days after testing positive for COVID-19.	Most people with flu are contagious for about 1 day before they show symptoms.   Older children and adults with flu appear to be most contagious during the initial 3-4 days of their illness but many remain contagious for about 7 days.   Infants and people with weakened immune systems can be contagious for even longer.

So What Should I Do As An Employer?

Since the pandemic arrived in the United States, workplaces nationwide have had to adjust their philosophies when it concerns sick employees coming to work. Most practices have put policies in place that require employees to stay home if they have any symptoms that could be related to COVID-19.

But based on the charts above, you’re probably wondering how you’re going to know if it’s the flu or COVID-19. Indeed, how do you handle anyone who is symptomatic during flu season?

Assume It’s COVID-19 And Hope It’s the Flu

The bottom line is that there’s really no need to have a separate policy for how to handle illness in the practice during flu season. We suggest you treat all symptoms that could possibly be either illness exactly the same—just ensure your policy addresses:

• How the practice will handle employees with symptoms
• How the practice will handle employees with sick family members at home
• How the practice will handle employees that have been exposed to someone who is COVID-19 positive
• Specifically how and when an employee can return back to work

It is also important to note that per the CDC, people can have both influenza and COVID-19 at the same time. Since this double whammy is possible, you might want to consider sticking to the CDC’s recommendations for ending home isolation based on COVID-related symptoms.

Those guidelines currently are:

• Fever-free for 24 hours without the aid of medication
• 10 days since the onset of symptoms
• All other symptoms have improved

You should also remind employees of what paid and unpaid leave they have available to them if they are ill and/or suffering from COVID-related symptoms. Keep in mind that the Families First Coronavirus Response Act and the Emergency Paid Sick Leave Act are still in effect until December 31, 2020. 

Double Down on Sanitation Protocols

We’ve heard from a lot of clients that one upside of this pandemic is that their hospitals have never been cleaner. We recommend continuing that focus during flu season!

Ensure that all high touch surfaces are being properly cleaned and disinfected multiple times a day in accordance with CDC recommendations. Ensure all employees have access to resources to allow them to regularly wash their hands for a minimum of 20 seconds with soap and water or use alcohol-base hand sanitizer.

Testing and Vaccinations: You’ve Got Options

Luckily, there is a test for both COVID-19 and the flu, so an employee can seek medical attention to determine which virus is causing their symptoms. If an employee gets tested for both the flu and COVID-19 and discloses those results to their manager, management could consider allowing the employee to come back sooner than the CDC’s 10-day recommendation for COVID-19 isolation.

According to research, individuals impacted by the flu are most contagious within three to four days of the onset of symptoms. However, they can still transmit the virus for up to seven days, so it could be argued that a sick employee should stay out of the practice for at least seven days after they become symptomatic.

Please note: we do not recommend that you require an employee to get tested for the flu or for COVID-19. In most states, if an employer makes a task a requirement of employment, that business could be financially responsible for any fees incurred for the test, any time spent to get the test, and in some cases, even the travel expenses to and from the testing facility. By making testing optional, employers should not be held financially responsible. We recognize that this is a fine line you will be dancing, so it’s imperative that you choose your words carefully when discussing testing.

Speaking of optional tasks that are probably a good idea: We suggest you ask your team to consider getting a flu shot this year. Have an all-staff meeting and discuss with your staff how the practice plans to continue to handle illness in the practice, as well as how they can do their part to prevent the spread of influenza by getting vaccinated before November. Again, it’s important to note that we do not recommend making the vaccination a requirement.

Give Your Team A Boost

There are many scientific studies that link stress to a compromised immune system. Right now, everyone is stressed—most veterinary hospitals are busier than ever, and teams are often shorthanded because they have someone out sick. We suggest looking for ways to help your team “reset their batteries” and hopefully give their immune system a boost prior to the start of flu season. Some ideas include:

• Consider giving each employee a “Me Holiday”. This entails coordinating an additional paid day off for each employee during a certain time frame. Essentially, it’s one extra PTO day you’re adding on to this benefits year, but you choose when they get to take this paid day off. We suggest having only one or two people out at a time so the rest of the team doesn’t feel team doesn’t feel understaffed, defeating the purpose of lowering stress levels. This option definitely takes some planning but will ultimately pay off with employees who feel rested and appreciated.

• If coordinating a day off for each person isn’t possible, consider closing down the practice for one day to give the whole team a break. We know, we know—losing a full day of revenue sounds like crazy talk, but hear us out. Clients will understand and appreciate that you are going the extra mile to take care of your staff so they can get reenergized. The staff will also appreciate the day, boosting morale. Consider writing the question “What are you going to do with your extra day off?” on one of your white boards and letting the team share fun ideas. It’s a great distraction from everything else going on in the world! You’ll hopefully be compensated for lost revenue by a boost in productivity and a mentally and physically healthier staff. 

• If the business cannot afford to give everyone a day off or shut down the practice for a day, consider finding alternate ways during the day to help the team pause. Consider blocking off an hour just before lunch for everyone to do an online yoga class or a mindfulness meditation. You and the team could take the time to pause the day and have a socially distant cup of coffee together and talk about life. Laughter and connecting on a deeper level are always a great way to give your battery a quick little charge.  

We know this added complication of flu season is probably one of the last things you want to think about right now, but our hope is that these suggestions can help you feel better prepared for this next 2020 hurdle. Control what you can control within your hospital. While you may not be able to stop the spread of these viruses, you can help your team focus on their well-being, which ultimately makes for a much healthier practice.

On August 17, 2020 Oregon OSHA released their proposed plan for addressing COVID-19 risks within the workplace. This ruling is currently still in the draft phase and is open for public comments until August 31, 2020. The projected timeline for these temporary rules would be from September 14, 2020 through March 13, 2021 (180 days). Most of the proposed plan outlines precautions that most veterinary hospitals are already taking at this time, so this hopefully will not be too much of a burden on you and your practice.

All Workplaces Requirements

The Oregon OSHA’s temporary rule addressing COVID-19 draft currently outlines the following requirements for all workplaces in the state:

1. Social Distancing (Social distance whenever possible. Barriers may need to be installed)
   1. All employers must ensure social distancing of 6-feet between individuals. If an employer can demonstrate that social distancing cannot be done practically, the employer must ensure that face coverings are worn and that as much distance as practical is maintained.
   1. The 6-foot social distancing measure can also be met by having an impermeable barrier that creates a “droplet buffer” of at least 6-feet in distance as measured between the mouths of the affected individuals.
   1. The rules go on to define that whenever employees are transported in a motor vehicle for work purposes, the center points of the seats of any passengers not part of the same household must be separated by at least 3-feet.

Note: How we are interpreting this portion of the rules is that you can meet the 6-foot social distancing portion by either spacing your employees within the workplace out by 6’ or by installing impermeable barriers. If neither options are feasible then employees must wear face coverings and social distance as far as possible when feasible. We are hoping they will clarify this more in the final draft.

• Face Coverings (Wear face coverings at all times while in the workplace)
  • The employer must ensure that everyone in the workplace or other premises subject to the employer’s control wears face coverings (masks, cloth coverings, or face shields) in the following scenarios:
    • whenever the 6-foot distancing requirement cannot be consistently assured,
    • whenever customers, vendors, or other visitors are present,
    • when work requires employees to be within 6-feet of one or more individuals for more than 5 minutes either in a singular instance or in all cases when work requires such contact more than 30-minutes total in the course of a single working day,
    • whenever 6-foot distancing cannot be reliably maintained between individuals (for example, face coverings must be worn in corridors, restrooms, elevators, and stairwells),
    • whenever employees are transported in a motor vehicle for work purposes all individuals in the vehicle must wear face coverings, regardless of the distance involved, unless all individuals in the vehicle are members of the same household

• Sanitation (Routinely clean all high touch surfaces multiple times a day)
  • All employers must ensure that all high-contact surfaces used by multiple employees (door handles, telephones, cash registers, computers, drinking fountains, seatbelts, etc.) are thoroughly cleaned at the beginning of each shift.
  • All shared equipment and high-touch surfaces must be cleaned before use by another employee.
  • The employer must ensure that employees have the supplies necessary and are able to use proper hand hygiene before and after using shared equipment or tools and before eating, drinking, applying cosmetics, or smoking.
• Social Distancing Officer (Identify someone for role)
  • Employers with at least 25 employees at any time must designate one or more employees who will be responsible to assist the employer in identifying appropriate social distancing, proper face covering use, and sanitation measures and ensure such policies and procedures are implemented.
• Employee Information & Training (Post poster, talk about policies, ensure team is trained)
  • Employers must provide information and training to their employees:
    • Employers must post the “COVID-19 Hazards Poster,” which will be provided by Oregon OSHA.
    • Employers must notify their employees about the social distancing requirements and how they will be implemented in the workplace, and employers must provide an opportunity for employee feedback about those practices (through the Social Distancing Officer and through either the Safety Committee, an interactive safety meeting, or both). Such notification must be conducted in a manner and language understood by the affected workers.
    • Employers must provide an explanation of the employer’s policies and procedures for employees to report signs or symptoms of COVID-19. Such explanations must be conducted in a manner and language understood by the affected workers.
• Medical Removal (Allow employees to take FFCRA Leave or OR Paid Sick Leave)
  • Employers will also be required to address the medical removal of employees with symptoms, undergoing testing, or otherwise requiring isolation:
    • Employers must provide information about any paid leave to which employees would be entitled by company policy as well as under the federal Families First Coronavirus Relief Act (FFCRA).
    • Whenever a medical provider or public health official recommends isolation or quarantine, the worker(s) must be reassigned to duties that do not involve in-person contact. Such reassignment must continue until the need no longer exists, based on guidance from the medical provider or involved public health officials.
      • To the degree reassignment is not possible, the employer must allow workers to use leave to which they are entitled under the FFCRA. If the employer has previously opted out of the paid sick leave provisions of the FFCRA, then the employer must provide up to two weeks of paid reassignment leave in addition to whatever benefits to which the worker would otherwise be entitled.
        • Exception: Employers otherwise required to provide paid reassignment leave who experienced a reduction of more than 20 percent in gross revenue between the 2nd calendar quarter of 2019 and the 2nd calendar quarter of 2020 are not required to provide additional paid leave.
    • Employees who are reassigned for medical removal reasons are entitled to return to their previous job duties without any adverse action as a result of the medical removal.

Workplaces at Heightened Risk

In addition to the requirements for all workplaces, Oregon OSHA’s proposal also goes on to provide guidelines for “Workplaces at Heightened Risk.” At this time, the draft does not clearly define whether the veterinary industry would fall into this category or not. Currently the document defines a “Heightened Risk Workplace” as: any job duty or work operation that requires an employee to be within 6-feet of another individual for longer than 15 minutes and that includes the direct touching of the individual with the employee’s hands or by the use of instruments or tools.

Since our industry regularly has scenarios of individuals being in close proximities of each other for extended periods of time, it could be argued that veterinary hospitals could fall in the “Workplace at Heightened Risk” category. If Oregon OSHA classifies veterinary hospitals as such, these additional rules would apply:

1. Conduct an Exposure Risk Assessment (Conduct an assessment created by OR OSHA)
   1. Each employer covered by this subsection must conduct a COVID-19 exposure risk assessment, without regard to the use of personal protective equipment or face coverings, that considers 10+ risk elements.
2. Document Exposure Risk Assessment in Writing (Have documentation ready in case of audit)
   1. Each employer covered by the subsection of this rule must document their exposure risk assessment in writing and include the employee’s information conducting the assessment and some information about the jobs that will be potentially impacted. By COVID-19.
3. Enhanced Employee Information and Training (Provide training from an expert)
   1. In addition to the training requirements for all workplaces of this rule, enhanced employee training must include the following provisions:
      1. The training is overseen or conducted by a person knowledgeable in the covered subject matter as it relates to the workers’ workplace, service, or job operations;
      1. The training material is appropriate in content and vocabulary to the education, literacy, and language of the affected workers; and
      1. Provide an opportunity for interactive questions and answers with a person knowledgeable in the program’s subject matter and basic epidemiology as it relates to the workplace, service, or operations.
4. Enhanced Sanitation (Setup a cleaning schedule)
   1. In addition to those sanitation measures required in all workplaces under this rule, each employer covered by this subsection must develop and implement an appropriate schedule for routine cleaning and decontamination of contaminated materials between each customer and between each employee shift change.

As previously mentioned, this proposal is still set as a draft and is not official yet. Since it is a draft the proposal could stay as is, could have slight adjustments made to it, or could be completely overhauled prior to its expected implementation date of September 14, 2020. Oregon OSHA should finalize this proposal in the first two weeks of September, and will hopefully give businesses a reasonable amount of time to comply. Once we have the finalized requirements, we will update this information for you.