Posted on behalf of Dr. Chandler, Occupational Medicine Director

Dear Colleagues,

The purpose of this communication is to keep Jefferson Lab staff updated on the coronavirus outbreak and provide information about lab actions to protect our workforce.

Biological Considerations. I recommend that we think of this as a cold with an unusually high death rate. So far, the Wuhan coronavirus appears to have a death rate around  2.3%. Typically, as more cases are identified, we find that initial death rate estimates were too high. By comparison, seasonal influenza in the U.S. has a death rate of between 0.04 and 0.10% while on the other extreme the SARS outbreak in 2003 was caused by a coronavirus that yielded a 10% death rate.

Epidemiological Considerations. Thus far, it appears this virus is primarily transmitted by droplets (the "mode of transmission"). Those wet particles come from the mouth, not just when coughing or sneezing, but also when talking. They can transmit disease when they are inhaled or touch the mouth, nose or eyes. In addition, they can transmit after landing on inanimate objects like tables, phones, door handles, etc.

For many droplet-transmitted diseases the concentration of virus in the droplets seems to be greatest about one day before symptom onset and for a day or two thereafter. Transmissibility then steadily decreases and ends after symptoms completely resolve.

For the Wuhan virus, shedding into droplets appears to begin significantly before symptom onset. For practical reasons, the current assumption is that transmission might become possible up to 14 days before symptom onset, so the incubation period is said to be 14 days. However, it's likely that most transmission is from symptomatic individuals.
 
Exposure Control. This refers to steps you can take to decrease the probability that you will contract the disease.  Currently, there are no Wuhan-coronavirus-specific guidelines. However, it's a safe assumption that the steps recommended to decrease the spread of all droplet-transmitted diseases will help with this one too. Those steps include:

• Stay home when you are sick.
• Frequently wash your hands thoroughly or use hand sanitizers thoroughly.
• Cover your mouth and nose and walk away from others when you sneeze or cough.
• Avoid touching your face, especially your mouth, nose, and eyes.
• Disinfect surfaces that are frequently touched. 

The CDC also provides the following workplace advice:

• Routinely clean frequently touched objects and surfaces, including doorknobs, keyboards, and phones, to help remove germs.
• Make sure your workplace has an adequate supply of tissues, soap, paper towels, alcohol-based hand rubs and disposable wipes.
• Train others on how to do your job so they can cover for you in case you or a family member gets sick and you have to stay home.
• If you begin to feel sick while at work, go home as soon as possible. 

JLab Responses. Last week, Jefferson Lab activated its longstanding Pandemic Response Plan (PRP). The plan follows a risk stratification tool advocated by the DOE. The approach is to stratify risk into levels 0-6, termed "MEDCON (medical condition) Levels," with 6 representing the highest risk. The Plan also calls for a Pandemic Advisory Team (PAT) to support lab management as it follows the steps specified in the PRP. Those steps are keyed to MEDCON Levels which are based on the extent and proximity of the virus to the Jefferson Lab population.

The PAT has advised lab management to follow steps listed for MEDCON Level 3 at this time.  These steps involve the following travel restrictions:

• Travel to China: The DOE has directed that all work related travel to China be suspended. Jefferson Lab employees will not be authorized to travel to China until further notice.  
• Travel from China: Jefferson Lab Occupational Medicine will be responsible for determining when individuals coming from China are medically approved for campus access. We will conduct phone interviews with all people (be they employees, Users, or guests) who have come here from China, either for the first time, or as a recurrent return. 

During these phone interviews, we will apply the following criteria for medical approval to access our campus: The individual must have been away from Hubei Province for the directly preceding 14 days. During that period, s/he must have been asymptomatic and must not have had known contact with a coronavirus case or the contact of a case. (A case "contact" is a person who had "close" contact with someone who had the disease.) For employees, if those criteria can't be met, the individual may be medically approved to work from home (if approved by the supervisor and Human Resources) until sufficient time has passed to then satisfy the criteria for on-campus work.

We believe these are the most appropriate actions given what we know about the risk today. Please bear in mind this has been a rapidly developing outbreak and travel and site access restrictions may be further expanded with little advance notice. If you have questions please contact Human Resources and/or Occupational Medicine.
 
Sincerely,
Dr. Chandler

CONTACT: Dr. Smitty Chandler, chandler@jlab.org, X7455

Thu, 01/30/2020 - 11:13