I want to thank you for coming to have a conversation with us with regards to this topic, and our title of our presentation is Sophito Marketing as a Framework for Exploring Employer Perceptions of COVID-19 Interventions. We'd also like to thank employers, employees, and those of you in this room that worked with your employers and employees to maintain a safe working environment and business operations during the past three years. It's been really hard. All right. My name is Cynthia Ball. I am a physician and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here today with Dr. Tron Huynh, Ph.D. and Associate Professor of Occupational Environmental Medicine at the University of Texas at Tyler. I am here to adjust the whole entire ventilation systems throughout the building in order to increase as many air changes as possible. They also upgraded filters to at least MERT 13 or 14. And then another participant in healthcare mentioned that they were only able to install HEPA filters and some UV air purification systems in portions of the clinic but probably not the entire clinic. And then another participant in the transportation industry said that they were able to put in clean air technology on their buses. Many participants also shared with the challenges trying to implement engineering controls, such as not having their requests approved by upper management or if they were renting the space, they weren't allowed to make changes to the building structure or the existing HVAC system. So for example, here's a quote. I attempted to have upgrades to the ventilation system but those were rejected. I attempted to have windows put in that would open for air flow but those requests were rejected. And another one says we don't own our office so we weren't allowed to do that. So when people tried to ask for engineering controls but were rejected, they resorted to the next best thing, which is administrative control, which is the next section. So admin controls refer to organizational programs and policies that were put in place in order to help curb COVID infection and its spread. And so the most common policy and programs that we found in ArcTranscript were related to reorganization of work, such as limiting occupancy, working with groups, remote work, and social distancing. There were also themes relating to management of illnesses, such as screening, contact tracing, case management, and tracking cases. Some employers mandated vaccines with exception. Others only recommend them with incentives. So these policies varied widely by industry and states due to local regulations and rules. So this last point refers back to place, which we already mentioned. So we have some quotes to share. And so for companies that were able to function remotely, they quickly pivoted to remote work. So for example here, one nonprofit organization switched to remote work as early as the second or third week of March 2020 during the early part of the pandemic. When remote work wasn't feasible, many of our employers used various strategies for social distancing for both employees and customers. For instance, an employer in transportation limited the number of people on each bus. In another warehouse company, they limited the number of people on each bus. In another warehouse company, they used AI technology and video to enforce social distancing. And then in construction, they tried to avoid train stacking, which is a practice in construction where many subcontractors are brought on site to work on a construction project together at the same time. There were also limitations to administrative control. For example, some administrative interventions were perceived as comforting to the workforce, but some were perceived as punitive or overreach. And this intensifies as time went on and employers tried to extend their reach to outside the work site, as suggested by the second quote. This drove me crazy. Not only did we want our folks to be safe and understand COVID on the job, but off the job. So we started with some of our contractors pushing the information home. When it comes to personal protective equipment, participants mentioned about shortages of PPE, such as gowns, gloves, respirators, and fit testing supplies. Typical challenges of wearing PPE, even like before the COVID, were noticed such as discomfort, especially in the summer. So people would only put them on when necessary. There were several occasions participants talked about mask use. And we think in this context, some participants probably love respirators, KN95, and face coverings under the broad mask category. So one participant in healthcare observed that people were initially against wearing the mask all the time, but over time people get used to it. Oh, so next we have Cynthia talking about the promotion aspect of social marketing. So when Claudia did the initial thematic analysis, these are four of the themes that came out with promotion. So sources of information, what were they? What were some of the challenges with those sources of information? How were those communication materials used, and what communication strategies were utilized? So it was actually gratifying that all of our respondents listed credible sources as their sources of information. And most of our respondents mentioned multiple sources of information. By and large, CDC was the most commonly mentioned, but other government agencies were mentioned, state and local agencies, national organizations, in particular some industrial hygiene organizations, corporations that were similar to them, universities, and recognized experts. And among those recognized experts, specifically physicians and epidemiologists, either on a national or local level, they did specifically, a few of them mentioned occupational medicine physicians and occupational health nurses and ACOM. And then there were a couple that said they went directly to the literature. So these are a few quotes that illustrate the types of sources that were used. So, you know, in the construction industry, Society of Human Resource Management, American Society of Safety Professionals, National Safety Council. In the nonprofit sector, so this is a nonprofit agency that provided training and health and safety to companies across the country. And they noticed that more technical people tended to prefer more technical professional agencies, whereas people who are not in the safety field technically tended to go for public health agencies. And then from health care, everyone in health care mentioned CDC, OSHA, and NIOSH in addition to other sources. We definitely looked at CDC and OSHA, and you know NIOSH is part of CDC. So the challenges with the sources, these were four of the major themes. Our respondents sought guidance that was more tailored to the industry, the specific job situation, or a diverse workforce. When they talked about difficulties with the differences in guidance and the requirements, they were primarily talking about the differences at the federal, state, and local level and having to reconcile those differences. There were some that also talked about, you know, having to make sure that they were consistent in the type of guidance that they were putting out, even within their own company between departments. Rapid change, not unexpectedly, was a common theme. Difficult to keep up with all the changes that were occurring. And then some expectations of agencies were not always aligned with the mission or role of an emergency response. And we'll explain a little bit more about that. So here's some quotes with regards to tailoring. So these quotes from construction and electrical basically needing to tailor it to be more specific with the industry. This quote from healthcare, needing to tailor it to make the verbiage easier to communicate. So these three quotes are representative of some of the different challenges that people encountered with the information. So I'm going to read all three of these. So for an environmental cleanup company, one of the challenges with the CDC information was it was on so many different webpages that it was difficult to keep up with checking all of them all the time. It was very layered. It required a lot of clicks sometimes to get to the information, so finding that information was difficult. From this biotechnology company, when they made changes in isolation or quarantine time periods, for example, sometimes we felt like it didn't come with enough explanation. I'll preface this by saying the overarching tone was that everyone really thought the CDC was doing the best that they could, but sometimes during these times of rapid change, they just wished there was a little bit better explanation because they were going to have to go back to their workforce and convince people that now we're going to have to do this. And then the last quote from construction, we would go to wherever the county employee were working and to make sure we were following those jurisdictions. We also developed policies in different states and areas. This was a pretty consistent theme of having to juggle these different types of guidance. So expectations of government agencies. We really didn't lean on CDC guidance prior to this because we followed OSHA regs, but everybody trusted the CDC was putting out there and they were adjusting as they needed to adjust recommendations. So this came from the construction industry and there was a general sense that among those who utilize OSHA because it's regulatory, they needed to be in compliance. OSHA provides good training materials. They weren't able to pivot because that's not their role during this pandemic response, and therefore people started to rely a little bit more on the CDC NIOSH guidance. And this is illustrated in this next quote. People had high expectations also for guidance that would come from OSHA, and a lot of that was, a lot of those expectations were not met. Most of the groups, their kind of takeaway was we wish OSHA would do more, and I think as opposed to would do more, it's actually could do more because there are some limits and constraints on what OSHA's able to do. And then from the wholesale industry, I didn't see that CDC really dropped the ball or failed to give me meaningful information, but I also wasn't looking for them to tell me how to manage distribution and warehousing. So understanding that CDC was doing the best they could early on, and understanding that they're not going to be able to give in the weed-specific guidance for every type of industry and every type of job. And therefore, the reason why people have relied on the CDC as well as other sources that were industry-specific to try to put together their recommendations for their own company. So the communication materials, there's really just three themes. They either tailored it or they didn't, and they all used pretty much multiple sources. And among those who tailored it, as I mentioned previously, it was either tailored to the industry, tailored to make it easier to understand, and the tailoring was a team approach. So let's just read one of the quotes on tailoring so we can get to the rest of the slides. We did the pre-pandemic to work with a variety of different industries, different groups. So we always had to tailor whatever we were doing. So this particular nonprofit organization already had experience working with different groups and having to tailor the information so they felt like they were ahead of the game. And then there were a few people that used the sources as is, and the interesting quote on this one is from the food services industry. We don't create posters. We get the posters from the state or federal agencies, and we will move from there. There's very little time on our end to be able to produce posters ourselves. This understanding that it was frantic, these companies were trying to maintain business operations, and to the extent possible, they wanted information that they could directly use. Okay. And so as far as communication strategies, multimedia, everything from posters and in-person meetings to electronic, social media, and 24-7 phone lines, they wanted the communication strategies to be relevant to their geography, industry, culture, or the educational status of their workforce, and an overarching theme of keeping an empathetic, understanding tone in your communication with your workforce because there was pushback during various times. So these are some quotes that are representative of the communication strategies, and I'll just read the shortest one here. We would distribute the material, you know, through toolbox talks or safety stand-downs. We started a text group for everyone on project site. What I found in looking through the themes with regards to communication that most of these companies are relatively innovative in how they try to communicate the material. All right. All right, next. Let's get to the meat. All right, now we're going to talk about what this all cost in many, many different kinds of ways because when we look at the last P in the marketing mix, it gets a little complicated because we have to look not only at the direct cost of interventions but also against what they were being judged, which was the cost of the pandemic itself. So price also is going to include the social and psychological costs that were associated with implementing some of these strategies. By far, the greatest cost of the pandemic was lost days of work due to illness and quarantine, and thankfully, most of our respondents did not report much death among their workforce, which is remarkable and a blessing. But, you know, when they expressed what they were actually losing in the way of money, they are talking about billions and millions of days that were lost, billions of dollars that were lost. And I noted one of the quotes that came from higher education where she said when higher education is hit, that low student enrollment carries through every year. I work in a university. I know that's true. It's like four years, six years. You're still feeling the economic impact of what COVID did. Of course, in transportation, our numbers are down, and without the CARES funding, we would have gone bankrupt and had to shut down. And that was from a major transportation industry in the Southeast. Other kinds of costs that were involved in costs included the direct cost of implementing some of these interventions. So, for example, in the first quote, we're looking at a cost of doing an engineering control where they revamped every one of their office buildings. In the second quote, the cost of an administrative control where they're paying for sick leave for all of their workers because they really felt that they had to keep paying them even though it wasn't necessarily, they weren't covered by CARES funding, and it wasn't normally that, for example, construction workers or these particular per diem workers would be getting paid if they weren't working that day. And then something that maybe we don't think about, the little things to prevent cross-contamination, such as the difference between making sure that everybody has their own water bottle on a work site versus bringing these water jugs that they would drink from. So these things all added up in the way of costs that they had to lay out. Here's the rest of the story from that biotech company that sent 24,000 staff to work from home, and I was very surprised, and I called up my contact at NIOSH, and I said, you know, they're seeing more injuries now that people are working from home, and it's because they're not set up to work from home. And so they're tripping on wires, or they're working hunched over at a desk like that, and so all of a sudden their injury numbers are going up with the workforce working from home. I said it's something we're absolutely going to have to be thinking about as we move forward with this. Several of our participants mentioned the psychological cost of not having people around to speak to them, that you don't build relationships, and certainly if you were bringing new workers in during this period, you just never really got to sort of acculturate them, I told you I was an anthropologist, into the company and have them really understand what's going on. Some of these costs, as you're aware, are still lingering. Some of those have to do with distractions. So, for example, while you're all worried about COVID, you forget to set your parking brake on your truck, or you didn't even put on your fall protection. The attitudes that have been developed. So the lady in food service mentioned to us that some of her staff now feel it's not necessary to give service, and in terms of the customers, they feel it's not necessary to pay full price for any type of service. As we heard about in the healthcare industry, eventually they felt that it was second nature to start wearing masks. Someone working in a public utility had the other experience, where she said, you know, I really had to meet people where they were. If they weren't willing to wear a mask, well, at least they would wear a gaiter, and I'm like, something beats nothing. Okay, they had to eat lunch in their own vehicle, because we bought them a lot of lunch, because we weren't going to let them come in here. So these were the kind of costs that are still sort of part of what's going on, and people are still dealing with this. So lastly, let's look at our customer. And who is our customer when we're, say, a government agency putting out information? Well, we have to really treat those customers, these employers, as any other business-to-business client. But they are these great big companies that we're working with, right down to the smaller ones. They are eventually responsible to the public at large. They are very influential to the public at large. And many of ours that we interview, we're delivering essential services. And these are knowledgeable and resilient customers. So we really, getting to know them, I think what we have to understand essentially from social marketing, I think what I said in the beginning, is we have to go and do the research in order to figure out what is the right way to be promoting an intervention to this customer. So let's look at how did they define the problem that they were coping with during COVID-19 pandemic. They were seeing extensive illness and some mortality. They had days lost and a huge financial hit. They had stress and mental health issues. And I say had, I mean, this is still have really. They had loss of engagement on a psychological level with their workforce. And for some, they looked at, for example, the engineering controls that Tron was mentioning of putting in ventilation systems. Well, they had deferred maintenance anyway, so it was a chance to catch up on it. But that was really not the reason for most of them. This shows you a positioning map where we lay out products, those interventions in terms of their price. And so going from the top to the bottom, kind of red color down to green color, what was perceived to be the most expensive to them? And going from right to left, what was perceived to be the most valuable in terms of the benefits to the left? And as we see, this is really our sweet spot, which is mostly a combination of administrative controls and good communication. Many, many people, we did it with the question we asked after we got them to speak about everything was what was most impactful to you? And virtually every one of our employers included their ability to communicate. I think what you noticed with Dr. Ball's presentation is how much they were doing themselves. And that really surprised me. They weren't just taking material from one source for the most part. They were checking it, and they were checking against multiple, multiple sources. And some of them did not feel expert in doing that. And I bring that back to the occupational medicine group, that a lot of people who are out there working in these jobs, they have more of a safety background. And so they really felt like medicine and this infectious disease was something that was really something they hadn't been prepared to deal with. So there's some need for more cross-fertilization there. I'm probably speaking out of turn here. Okay. In terms of place, the rules for reporting positive cases, contact tracing, return to work guidance, that vary by locality, as we said. And it could be confusing for multi-state or county companies. I'm leaving out the international ones. There were some that had international footprint too, but this is focused on the U.S. Only those in healthcare saw vaccination, vaccine, as conveniently placed. For everybody else, it was a whole, we could do a whole thing like this just on vaccine. Construction used place and its regulations as a reason to be vaccinated. And so basically they would say to workers, I'm not telling you to get vaccinated, but you can't be at that job site if you're not. So it's up to you. Choose what you want to do. And very often they would say to us, and we just said, you know, it's the agency that's telling us this, or it's the boss, or it's the job site. I'm not telling you you have to do it, but if you want to work that day, you're going to have to get the vaccination. Some of our key thoughts around promotion. As I mentioned already, industry partners are not the public at large, but they protect the public at large. And government agencies, professional trade and industry associations are all respected sources of information. But a business-to-business client, and any of you who are in business knows this, wants and needs a solution that's tailored to their industry or they're going to go elsewhere. They're going to find someone who understands them, gets them, and communicates to them. They're doing the tailoring right now. They have a wealth of knowledge, and I'm asking you, how can this be tapped to plan the next time response? And so that's one of the things I want to put out there for us to be thinking about is how can we engage more with the companies who feel they have certain expertise, they've now amassed these giant playbooks of what they would do. How can that be harvested and how can we prepare for the next time? My very last point here before I turn it over to Tron to lead us in a discussion is we've been hearing a lot about how do we regain the public's trust in science, which to me is like absolutely scares me to death, right? And what I'm going to tell you is from our interviews, and we also did quantitative studies in between the two sets of qualitative interviews, is that employers and your people, the people that you work with, who you consider your clients, never lost that perspective. And so I'm thinking that to work back to the public, we need to go through the employers. We need to go through occupational medicine and occupational health to get there. And I'm saying that from a purely public health perspective of working with community members. I'm going to turn it back over to Dr. Nguyen for, she's by the way the Philadelphia girl here, so that's why. Hello, can you hear me? So that actually concluded our presentation, and now we would like to have a conversation with you, our audience, about your experiences during COVID and what interventions you thought were most beneficial, protective, and cost effective, and the cost effectiveness of it for your organization. So we're putting this slide up for a reference, but if you have any questions or actually comments, because we really welcome some feedback for those of you who worked in this arena. Yes. Thank you for the presentation, it was very insightful. I just had a few quick questions, actually one was on this slide. When you had testing PCR quarantine, and I believe the benefits were perceived to be low, was this information captured before the CDC issued guidance or after? Because you know the pandemic, there was a spectrum on the sensitivity and the specificities and you know the false positive rates of those who were actively infected. I was just curious about the testing and PCR when you captured that data, and I had a follow up on that on the grid, but I'll start with that. Do you want to answer? So the short answer is no, because we basically just asked them to look back over the timeframe of the pandemic. Our early study, I'll let Claudia talk to you a little bit more in depth about that. We did that study and asked about testing early, before some of the guidance had come out when it was still a little bit confusing on which testing did what. Okay, so we have to factor that in the map, thank you. And then the cleaning of spaces, was that specifically in high touch point areas that weren't necessarily metallic, or that was just cleaning the entire complex? We didn't get down into that much detail. These were pretty in depth conversations, but we didn't cover down to that, yeah. But what I can tell you is that the idea of cleaning, they felt they were doing an extensive amount of cleaning, which is why they felt it was expensive, but they were not, like the stuff sort of towards the middle, it's like, I don't know how much benefit I got from it, maybe some, maybe not. So I don't think that they're saying it was worthless, but it felt expensive to them against the value that they got for it. Okay, sorry. Okay. And then the last point was on this is the PPPP masking. The first thing is when you captured this data, was it offered complimentary by state and local health officials when you were factoring in the cost, the price versus, because I know at some point it was high, there was accessibility issues, and then at some point it was low. And then also, was the PPE a NIOSH certified mask, or this was anything like a bandana? That could be like a whole, that could be a whole conference in and of itself. I don't see benefits being low, I just see that as, you know, communication. But you see it moves, it moves in terms of, in the beginning, like in the 2021 timeframe, they felt it had more value, and then later they felt it had less value. And that's more because they were having a hard time getting people to do it. Because they were getting, but not necessarily the type of PPE. Right. Okay. So we weren't able to distinguish when they were talking about PPE, unless they were very specific and they said respirator, if what they were actually talking about was actual PPE, respirator, versus a face covering or mask. Those of us in this audience, you know, really understand that distinction. But I'll tell you, even having gone through this with a health care facility, getting everybody in your facility, even at this point in time, to understand the difference between a respirator and a face covering is still an ongoing battle. Okay. Thank you. So that's going to lead me to question slash comment on all of this. So when I was engaging with different organizations and communities, you know, factoring in cultural differences, economic differences, and values that the members have. One thing I found was, let's say if PPE masking with benefit was perceived to be low, is providing consistency of medical information and reconciling the conflict, and then the behavior would change. I want to know, have you studied that? Like for instance, temperature screening has not been found to be valid in certain populations as much as let's say PPE. Because it's easy. Right. So, but I'm very surprised at the mapping of it. And was that, is there any plan of studying that and using social marketing to, tools to educate or to? Well, when we share this, as we share it with NIOSH, they might consider that, you know, we work for, at their pleasure at the moment. And you know, when we present this stuff to them, they take it and they're like, I want to think about that. Because all we're doing is we're interviewing people. This is what 29 people, there's really 30, but two of them from the same organization, thought about this stuff. And so this is qualitative. We said that was, it was qualitative, right? So. Correct. Yeah. But from qualitative, you can. Yeah. Right. But it's very deep. But it's very deep. Exactly. Yeah. Yeah. Yeah. Attempted. Right. Yeah. Okay. It's just a comment. Good information. Good information in there. You know, one of the things, I was struck, too, by just the positive comments, you know, in general. And it very much goes against, you know, at least some of the comments that I would have been expecting. And I also was struck by the fact that they felt that they weren't getting enough explanation from the, from, I guess, the CDC. And I wonder, do you get a sense, mostly the CDC was mentioned as opposed to specifically NIOSH. If, was NIOSH communicating the right information for, from changes in recommendations based sort of on from a business perspective? Did you get that sense? And they were, these businesses were going directly to CDC sites, and that wasn't sufficient? They weren't, and NIOSH wasn't supplying the information, or? NIOSH was also mentioned, and sometimes they were mentioned concurrently, but CDC was mentioned far more often, and we didn't really get into the meat of why that was during these conversations. Yeah. I mean, I can imagine. I, you know, NIOSH has been so much part of my life, my career, it's hard for me to separate it out. But I think if I was a business, that I would think I'd go to the CDC, that's just more well-publicized. And maybe it suggests the need for the NIOSH perspective to filtrate into the CDC websites for access to the larger community, sort of the changing of how information's conducted. Yeah, because we all know as time went forward, more specific guidance came out from NIOSH for various industries. They added more and more information. Yeah. And just one of my own experiences with this was we were asked from UT Houston to go up and talk to Tyson employees, and they asked us to go up for the very last people, it was the last couple of weeks before these employees were going to lose their jobs if they didn't get their vaccinations. And so we were, I was going up there with kind of, you know, tense, wondering what the experience would be. Tyson had started out not requiring vaccinations, but they had a very high rate of COVID transmission in their groups, and they kind of went 180 degrees and required it. And so from that population, I actually was met with pretty much open arms. They respected us coming up there. And there was a small group of people that were really just kind of sticking it to Tyson a little bit. They didn't want to get the vaccination until the last day, just for whatever reason, but there were also a group of people that valued kind of an outsider's perspective on this. And so I think that that is just maybe, you know, kind of one of the messaging here is that businesses partnering, you know, with occupational medicine or primary care doctors with interest in ARCMED, it's kind of an impartial observer so that you don't have that employee-employer conflict. So it's kind of a natural thing that maybe going forward, that might be a more powerful tool. Well, yeah. And even in Texas, as you know, we have a free service through the Texas Department of Insurance where you can get a free consultation at your side of employment to try to develop mitigation strategies for risk for your employees. Thanks. Thank you. And thank you to all of you for a very intriguing presentation. And so many elements of it resonated with me. My name is Brian Davey. I'm with the World Bank Group, and we have staff literally in about 120 different countries. But I think looking at any of the areas you talked about and trying to respond, you know, which was most valuable, et cetera, there just was no single thing. It depended on who you were talking to, which country they came from, and what the communities in those countries perceived as beneficial. And in terms of what we offered, the reception of that was very different in different places. And to give you some examples, I mean, early on, I think one of our biggest problems, we operate according to a mantra of stay and deliver. And so being a development company or organization, very similar to other parts of the UN, there is a strong expectation that when a crisis hits, you don't just uproot and leave. But you've got a lot of international staff there that could, if they made a personal decision, leave. So they had to be confident enough to stay. And one of the biggest disruptions was the loss of any kind of capacity to medically evacuate people that were seriously ill. And the traditional reliance on groups like International SOS and others just disappeared in the first months. And with a huge cooperation across the UN and World Health Organization, we were able to put in place an evacuation capability and had a number of countries that came together to offer themselves as destinations at government level, of course. No hospital can decide that in the middle of a pandemic. But ultimately, the system evacuated about 350 people that were critically ill with COVID in the early days, which was an unheard of achievement, 20 of those were from my organization. But the thing that had benefit was not that it happened to those people, it was others knowing that there was a source of assistance should it go wrong. Unfortunately, we didn't have that many, so it was reassurance. But on a different level, temperature screening, I fully agree, there's very little, if none, scientific evidence that it works. But take, for example, West Africa and their experiences through recent Ebola epidemics. It just became the norm that if you entered a building, you washed your hands in a bucket of chlorine water, and you had your temperature screen. And everybody did it. And if we didn't do it, there was a perception from our staff, well, hey, how come everybody else is? And you're not doing what you could to keep us safe. And ultimately, we just gave in on that one, because their peace of mind was more important than enforcing some kind of a scientific standard. And we just had to go with the flow. Of course, you can't always do that. So really, the experience was varied totally across the world, but ultimately aimed at having people confident that you're doing everything that is possible. And on the communication side, beyond any website information, was simply being there to talk. And I can't tell you how many town halls and meetings that I was in, but just to be there to have questions asked, and to be able to say, we don't know the answer to that, but we're going to do everything we can to find it. I think that was one of the most important interventions. Thank you for that international perspective. Yes. I think that empathy was also an important thing that came out in our interviews, is being willing to meet them where they were, to understand their doubts and their concerns, and empathetically address those doubts and concerns. And understand sometimes their behavior is not going to change. I thought from the international perspective, I hadn't thought about evacuation as an intervention. But it is, from an international perspective, a very effective one. And I'll just share one of the quotes pertaining to that temperature screening, if it worked, as one of our participants said, they're not going to come in if they think they're sick, because they know we're going to catch them. So it worked, because they didn't come in with a temperature. Not because temperature screening, it was the fear of being caught and sent home. So it's an interesting thing, yeah. How about you guys? Any of you have something that we didn't capture here, but you thought was particularly beneficial? Well, with that, then I guess we will end this presentation. Thank you so much for participating. Actually, we're right on time. Thank you. Thank you.

COVID-19 Interventions

Employer Perceptions

Engineering Controls

Administrative Controls

Personal Protective Equipment

Communication Strategies

Costs

Psychological Impact

Tailored Interventions