Good afternoon and welcome to today's webinar, Lessons from COVID, United Kingdom and United States. It's developed and presented by the Medical Specialty Societies for Occupational Environmental Medicine in the UK, Society of Occupational Medicine, Faculty of Occupational Medicine, SOMFAM, and the US American College of Occupational and Environmental Medicine, ACOM. My name is Danielle Feinberg and I'm with the American College of Occupational and Environmental Medicine. There are two features available to communicate with the panelists and other attendees. You may post general messages in the chat box. Messages can be shared with either the panelists or all participants. Use the drop down menu box to select who you want to share your message with. Please go ahead and give it a try by introducing yourselves to all panelists and attendees. Let us know your role and where you are from. Questions, on the other hand, must be submitted to the Q&A box. Panelists are monitoring this for questions and not the chat box, so be sure to post all questions here and we will address them at the end of the webinar. We are joined today by Dr. Robert Bourgeois, Dr. Douglas Martin, Dr. Carl Ricard Mowen, and Dr. William Ponsonby. Dr. Bourgeois has been practicing clinical, occupational, and environmental medicine with a group in South Louisiana for over 30 years. They provide OEM services to many maritime, construction, shipyard, and energy sector workers. He is the immediate past president of AECOM. Dr. Martin was installed as president for 2022-23 of AECOM, the nation's largest medical society dedicated to promoting the health of workers through preventative medicine, clinical care, research, and education. Dr. Martin is certified in family medicine by the American Board of Family Medicine, and is a member of the American Board of Family Medicine, and is a certified MRO and FAA aviation medical examiner. He is also listed on the FMCA's NRCME. He received his MD from the University of Nebraska Medical Center College of Medicine in Omaha, and is a member of the central state's OEMA component. Dr. Martin joined AECOM in 1994 and became a fellow in the year 2000. He has served on the House of Delegates Executive Committee and Board of Directors. He has been on the AECOM course faculty since 2008. Dr. Ricard Mowen is chief medical officer and co-founder of Zello, and chairman of the faculty of Remote, Rural, and Humanitarian Health Care, Royal College of Surgeons Edinburgh, with a focus on leading clinical excellence across remote health care around the globe. Dr. Mowen is a consultant occupational health physician with 20 years of extensive global experience in corporate occupational health and well-being, both in the UK and overseas. He holds an MSc in occupational health, as well as FFOM UK, FAC OEM, FFOM Ireland, and FRCP awards. Ricard was recently appointed registrar and vice president at the Faculty of Occupational Medicine and recognized as a fellow of the American College of Occupational Environmental Medicine, and as a fellow of the Royal College of Physicians for his services to health around the globe. Dr. William Ponsonby qualified in medicine in Birmingham, UK, 1986. Dr. Ponsonby is trained in general practice and emergency medicine. In 1996, he ran the medical service for the AIOCBP in Baku, Azerbaijan. He was the ISOS regional medical director for Russia and Kazakhstan for four years, 2000 UK, trained and board certified in occupational medicine, and worked for Shell UK looking after the North Sea offshore workforce. In 2006, transferred to the Hogg for Shell corporate health advisor for exploration and production international. In 2010, Shell regional manager for the Middle East and Africa based in Dubai, including health management of Iraq projects. He joined the Rio Tinto as head of health in August 2015, which is based in London and Singapore. He is the president of the UK Society of Occupational Medicine in 2018 and 19, and a senior lecturer in Occupational Medicine, University of Manchester. I will now turn our presentation over to Dr. Ponsonby. Thank you very much, Danielle, and good morning, good afternoon, good evening to everyone, and welcome to the presentation. Can you put my first slide up, please, Danielle? So what I want to talk about today are some of the challenges within healthcare within the United Kingdom, and in particular, risk management. Health risk management is a core skill and a core tool. Next slide, please. A core skill and a core tool for managing exposure to health hazards in the workplace. In the United Kingdom, it's actually a legal requirement to carry out health It's actually a legal requirement to carry out health risk assessments under several pieces of legislation, including COSH, which is Control of Substances Hazardous to Health, and the COVID virus counts as a biological hazard under COSH. So therefore, all workplaces had to have health risk assessments in place for COSH and had to have controls in place which they were monitoring and have those documented. And what I'd like to do today is to talk about some of the things that went wrong with the health risk assessment process and some of the learnings that we need to take from that. Next slide, please. At the start of the pandemic, we had a novel virus, and I think because of that, we had to make some assumptions. And I think we made different assumptions depending where we were in the world. Certainly in the United Kingdom, we assumed that it would be like an influenza virus, and a lot of our planning was for an influenza pandemic, and those were the controls we were initially applying. And I think if you looked at Asia, because of their experience with SARS, they assumed that COVID would be more like a SARS virus and reacted in that way. And I think as it turned out, as we know, it probably was more like a SARS virus than an influenza virus. And I think therefore the Asian countries and economies were more successful initially. Some of the assumptions that we made that fomite spread would be very significant, that turned out not to be the case. I think that initially we tried not to apply lockdowns in Europe, where they were applied very quickly in Asia. Controls such as temperature screening were widely used. Travel bans were introduced very early by many countries, even though they were not recommended by the WHO. Testing regimes initially were very limited because of the lack of tests. Lockdowns were introduced, work from home was introduced, critical workers had to continue working, obviously, and attempts were made to shield vulnerable workers. And in many countries, schools closed. There were some exceptions to that. I mean, Sweden in Europe never actually locked down and never closed its schools, but most of Europe and North America eventually followed Asia and locked down. In the United Kingdom, we locked down towards the end of March, and that was when there were predictions of over a million deaths coming out of Imperial College London. Next slide, please. So one of the things that happened in healthcare by the end of 2020, nearly 1,000 healthcare workers had succumbed to COVID. Not all of those had died from work-acquired COVID. Some of those cases would have been community-acquired, but a sizeable proportion were probably work-caused fatalities caused by COVID contracted at work, and that was out of proportion to the rest of the population. And obviously, people were having exposures at work. One of the things that we noticed, though, was that people expected the highest exposures to be in areas like intensive care, and therefore the most attention was paid to applying controls there. But actually, a lot of the fatalities were occurring in ancillary staffs and occurring in areas away from the intensive care, such as the normal hospital wards. Next slide, please. The reaction to that was an outcry to improve PPE, and that was led by the workforce unions, politicians followed suit. And indeed, there were problems with PPE. In the initial phases of the pandemic, there were problems with supply of PPE, having adequate PPE. But even when PPE became widely available, there were still issues about what type of PPE should be used, who should have access to it, and also problems with training. As occupational health professionals, we all know that PPE is not the answer, or is not a complete answer. It's part of the answer, but we need to have comprehensive health risk assessments to ensure better protection. Next slide, please. So, what went wrong? So, the Health and Safety Executive, which are the UK's equivalent of OSHA, the regulatory authority, carried out a survey of acute hospitals in December of 2020, and looked at their health risk assessments. So, of the 18 acute hospitals they surveyed, only five were highly compliant. Four were given advice, and eight of them had improvement notices issued. So, this means they were issued with notices to say that they had to kind of improve quickly, or they would face prosecution. And if we look at the areas that there were problems with, eight of them, their risk assessments weren't up to standards, and some of the management arrangements weren't adequate. Social distancing in eight of them were not adequate. This usually reflected staff away from the clinical areas. So, it was staff in offices, staff in breakout rooms, and staff in changing rooms were not obeying social distancing and controls, although well applied in the clinical areas, often broke down in areas away from the patients. Surprisingly, cleaning and hygiene was a problem in six hospitals. Ventilation was also inadequate in five, and PPE was a problem in five. So, there was a lack of understanding of the risk assessment process in some hospitals, and also the application of the hierarchy of control. Employers were not clear on what constituted a PPE program. In many places, people weren't having adequate fit testing for respirators, and as I said before, hospitals were not able to as I said before, often only the clinical areas were covered, and ancillary staff such as cleaners and porters were neglected and didn't have the same level of control and protection. Next slide, please. So, lessons learned. One of the things British Occupational Hygiene Society did a survey of health and social care sector in the United Kingdom, which employs over two million people in total, and there were only three occupational hygienists working in support of that sector. So, there was a need for more expertise, more occupational hygiene expertise. Many of the physicians had basic training in health risk assessment during their training and board certification, but hadn't had refreshing training and hadn't been using those skills subsequently, and the same went for the nurses. So, there was a need for refresher training for occupational physicians and nurses, and also greater expertise in the area of health risk assessment. We needed to have comprehensive health risk assessment examining all potential areas of exposure, applications of basic principles, hierarchy of control, PPE programs, etc. Adopting best practice from other industries, and here we're thinking about, for instance, things like health risk assessment, bowtie methodology from oil and gas, incident investigation, incident reporting and investigation, as, you know, as we find in the airline industry, and learning from incidents. We also needed more flexibility to change controls as we went through the pandemic and learned, and that was obviously, it's often slow to happen, and indeed in the United Kingdom they're still discussing which the best type of, which the best type of face masks and respirators are to use the clinical staff, and I think we've also seen examples of that in China, who stuck to their zero Covid policy for the last three years, and then very quickly changed it without managing the change particularly well, and are now suffering a huge surge in cases. And the other thing is, we're lobbying to have HRA included in the scope of the national Covid inquiry, which we'll be holding in the UK. So that, I think those are some of the kind of challenges and some of the areas where we feel that health risk assessment could be improved, and we need to learn those lessons so we can apply them in the future. I'm now going to hand over to Dr. Doug Martin, who's going to talk about challenges in the agricultural and meatpacking sector. Fantastic, thank you Dr. Ponsonby, and welcome everybody to the webinar today. My name is Doug Martin, current president of AECOM. I practice occupational medicine in the Sioux City, Iowa area, kind of where the Iowa, Nebraska, and South Dakota states all kind of come together. And what I'd like to do is to share some of my experiences as a clinical-based occupational medicine doctor taking care of a community that largely is agricultural focused in the sectors of food processing and meatpacking in particular. So could I have the next slide, please? Looks like we're having a few technical difficulties. Well, as Danielle is helping with the slides, I'll tell you from the perspective of someone who takes care of a lot of the agricultural-based industries here, and again, primarily meatpacking, that there are some particular challenges at the beginning of the pandemic that we had to deal with. And as Will has pointed out, a lot of times trying to figure out a health risk assessment, I will tell you is not only important from the standpoint of the individual company client that you're dealing with, but even internally within your own organization. And this is something that as I look back on it, we probably could have done a better job at trying to figure out exactly what it is that we wanted to do. But obviously the agriculture industry is an essential industry, and essential workers were identified early on on this. I mean, people have to continue to eat. That's not going to change. The challenges in food processing and agricultural processing in general is that typically you have large facilities that have many workers that are in close proximity. If you've ever been on the floor of a meatpacking facility that does both the kill and the packaging processing part of it, you'll understand what we're talking about. Now, the good news about this is that those folks in these industries already have a baseline, a basic understanding and some degree of experience with regards to PPE. Because of the current OSHA regulations with regards to those workers, they already understand how to don gloves, face shields, helmets, and in some cases, face shields and face masks and those sorts of things. So it is not as though that we're starting from scratch. However, it became important early on about the importance of N95s, and I'll tell you a little story background that in a little bit. Next slide, please, Danielle. So when I talk about trying to plan what it is that you're going to do yourself, I can't underscore how important this was in our success in Sioux City of making an impact on this. Within our department and occupational health, within our hospital system, we are not on the hospital campus. And I will tell you in retrospect that that was actually a blessing in disguise. And the reason is, is because we had the ability to sort of carve out our clinic for specific uses. And early on, we decided that we were not going to deal with COVID testing or the treatment of COVID patients. We were not going to be, you know, the drive-through facility to do the drive-through testing or any of that sort of thing. The reason behind that is, is that early on we came to a conclusion and a decision that someone needed to continue to be open to take care of the injured worker. And if you think about it, you know, the other alternative would be, well, you know, should we go move to a telehealth or, you know, those sorts of things? Well, you can't sew up a laceration via telehealth. You can't, you know, help somebody set their fracture if they're run over by a forklift, et cetera. And where else are you going to have those people go? The only other alternative would be urgent care or emergency room. And guess what? All the urgent cares and emergency rooms were filled with COVID patients. So if you have a focused strategy on trying to prevent the virus from, you know, wreaking havoc throughout the entire workforce, I think this decision was important and the right step to take early on. Our clinic never closed. Now, part of that, frankly, has to do with regards to the environment and the politics of the Midwestern portion of the United States. And without getting into a political discussion, there are clear differences between how the leadership of the states looked at the COVID pandemic compared to, for example, the East or the West Coast. And there's much, much differences between the approach to that. So that obviously was a good thing from our perspective. Next slide, please. So that's the same slide. So there we go. Okay, so things that we did with our client companies that helped. Education, I cannot underscore enough how important this was at the very beginning to get the employers and the employees educated about COVID and what it all meant. And in particular challenges that we had, one particular facility that we do a lot of work with has got 72 different languages that are spoken within that facility on any given day. And then also trying to bridge the gap with regards to cultural and ethnic differences in perspectives, just about health in general, about how significant it plays a role in individuals' livelihoods and so forth. And we did as best as we could here. Of course, we could have done, I think, a lot more, but the rapid communication of information, I think, did make a big difference. Now, of course, there are some things that there's nothing that you can do about. You cannot do anything about someone who has, for example, seven or eight workers. in the same facility that live out of a two bedroom or certain things that we simply just could not experience with that. So some of the other things that we did is in these larger facilities, people tend to do things in mass or in congregate. And we decided that that was not a good idea. Obviously we're trying to keep people distance as much as possible. So how are some approaches that you can institute to do that staggered times starting at the workplace? Not everybody has to go through the gate or hit the punch card at the same time. You can stagger approaches and you can do the same thing with regards to breaks, lunch breaks and those sorts of things. And then the same thing with regards to staggered departures you know, a lot of the culture in some of these client companies and meat packing facilities and so forth is people have a tendency to congregate after their work shift is over and trying to discourage that and explain to people why that's not a good thing in a pandemic I think proved to be beneficial. So just discouraging that overall concept of mass mobility I think made a big difference. Next slide please. So we lucked out and I don't know who I can give credit to on this about how this popped into my mind really at the beginning. But early on we recognized the importance of having N95 protections. And luckily we had a stockpile of this. And I know that everybody else was scrambling but for whatever reason, we did not have a shortage on this. We had the right staff in place to do the fit testing the right way. There was a lot of overtime hours that were spent on this to get people, you know, fit tested correctly at the beginning, but that's okay. I mean, we had to do this in a quick fashion widespread approaches to things and that sort of thing. And I'm lucky that we had staff at our disposal that were able to do that. We also instituted a rather aggressive screening procedure. And of course, you know, to try to go back and revisit what that looked like. Things in the CDC world were literally changing by the hour. And of course we were trying to keep up on the science but we were sort of like, you know, going boldly where no man has gone before to steal that line from Star Trek. We were sort of making this up as we were going along. I will say that we had a tendency to set the bar quite low with regards to our screening process. Meaning that if we identify a risk factor we intervene fairly quickly with respect to that. And I think that that probably led to a lot of positive outcomes in the future. One of the challenges that we have in our local community here is, is like I said we have three different States that we have to deal with. So guess what? We have three different public health departments that are on the County level and trying to get these people on the same page was a little bit of a daunting challenge for sure which took a lot of behind the scenes type of work not just by myself but a large portion of the medical community to try to get the one focused communication point and not have three different messages all this sort of thing. We did finally convince the County health folks to move a vaccination clinic on site to a large part of these larger facilities when the vaccine became available. That was no easy lift by any stretch of the imagination because of staffing issues, timing issues, storage problems, et cetera. But I think that was a move that made a tremendous difference with regards to the success in the agricultural industries that we had here in Sioux City. Next slide. So in conclusion, I will tell you that just from a practical standpoint, the things that we did great I think were easy recognition, early access and early identification of the N95, things that we could do better, mobilization of the public health infrastructure to align with regards to client company and worker needs. I think definitely we have a lot of work to do on that. I don't have to tell anybody on this webinar that the public health infrastructure definitely needs to be bolstered and improved. And so hopefully when this occurs next time around pray that it never happens, but when it does happen we'll be a little bit more prepared. So thanks. And I think at this point I'm turning it over to Dr. Moen. So Dr. Moen. Hi, good morning, everyone. Yep, thanks. Thank you very much, Douglas. So I'm gonna give this from the UK perspective and gonna try very much not to be political, but at the time I was CMO for the UK's largest OH provider looking after most of the public sector. And let's just say, as Douglas mentioned, we kind of had to make it up as we went along without a huge help really from the government. If anything, it was a hindrance. This always tickles me. In 1962, we had been claiming that infectious diseases had been eliminated. Well, look what we've had since then. So this will be a recurring pattern. This is a slide I always enjoy showing because it's the journey we've been on. And if you look at the sort of the wellbeing aspect and how we sort of coped through it. Thankfully now we're all on reconstruction. I think some of us are still recovering from grief through the tough times that we've had. So I'm gonna try and give a balanced approach. I say not gonna be political. It would be a different presentation if I am, but in Philadelphia, I may well give a different version of this. But at the top, just very quickly to put into context what the timelines were, just to give you an idea. I mean, very similar to the US, three waves, three lockdowns. I think the key thing that's really important is the first lockdown did not occur until late March. So what were the lessons learned, things that went wrong? I think it was already touched upon, very poor planning. We'd seen this coming, we'd seen SARS and really all that modelling had been done, but that disaster management plan was left on the shelf and we were caught short. And as Will said, in the UK, we were focused on influenza style pandemic and that's why we did as badly as we did. I very much remember February, March time when it was obvious what was going on in Italy. And there's about a six week lag between Italy and the UK and trying to explain to people this is coming our way was a very tough time. And the government didn't react to that. Did they seem to think that viruses couldn't get across the channel? Not sure. And another sort of controversial one, which has been denied by government was that there was a feeling the government were going for similar to the Swedish model, but it's actually hard to get that out. We didn't close the borders. You compare that to New Zealand, we are an island. We could have done that quite easily. And as a result, we ended up like the US, like Brazil with significant mortality, 1% of our cases. Compare that to Germany and France, 0.4%. And here's the really interesting curve of that period where UK really missed its timing. And there you see the number of deaths during that period. UK, USA and Brazil, we were the three that were caught behind the curve. And, but if you look at the countries at the bottom, the countries that did well, that's really where that was planning preparation and actually realizing that it was a SARS type virus that was coming. Big problem in the UK was that during it really, depending upon where you lived and your socioeconomic group, only about 10 to 59% actually adhered to the isolation rules. And as Will has mentioned, there was a poor supply and there wasn't any procurement of PPE. And even if there was, there was a very much a confusion on mask wearing. I do remember the government were instructing people to wear face coverings of any kind. People were wearing socks and ladies underwear on their face, which was actually, as we all know from the science, if you're wearing that, it's actually worse for you than better because that material and the moisture just attracts the virus rather than protects you. So that was a big error at the time. And here's just a quick example. It's what I call the Austria lesson of, so if you look at the curve there, you look at the United Kingdom heading up high, but you look at Austria at the end of March, they mandated mask wearing and you see how their mortality rate rapidly dropped as a result of that. That's really one of the best examples of how a public health measure can work. There were, and crucially, and really one of the several sad things came out of the pandemic. And this was one of them, that there were a great disparity dependent upon socioeconomic and your ethnicity. The black British, 55% were vaccinated, whereas the white Caucasians were 93%. And for various factors, including healthcare access, there's a significant worsening of mortality and health outcomes in those groups, what we ended up calling the inverse care law. And here, I think, is one of the most upsetting charts to come out of the pandemic in the UK. If you look at the mortality rates using the white British as a baseline at one, you look at black African, Bangladeshi and black Caribbean, three to four times more people died within those ethnic groups. And that's, as a society, that's unforgivable. We didn't have enough testing capacity. I think many struggled with that, but that really was. Early on, the contact tracing, it was actually abandoned quite early on. The government moved from a WHO-contained to delay. That was an error. And the restrictions were eased much too early, which inevitably resulted in an earlier second wave. All the local restrictions were not working as well as they should. The public messaging was not really ideal. And there was a fair amount of non-compliance and non-buy-in certainly towards the latter stages of the first wave. And many of the public health measures were too late, moved too early and inconsistent. And as a result of a lot of this, and probably one of the major causes of that was the diminished trust of the UK government. It's actually very interesting to compare Scotland as a devolved government. And it was interesting to see the different types of messaging and how England and Wales compared to Scotland complied and followed with the advice. And Scotland did a much better job. And our hero, Chris Whitty, who was amazing, very much had a difficult time trying to, a bit like you did in the US. And this is, you know, that's Chris Whitty on the left. I think we've all been in that position, knowing what's being said. And certainly in the US, your poor CMO in the US was in that position. And her face tells a thousand words. You know, what do you do in that situation? I can't even imagine. Our test and trace, where we tested and tried to trace the population to try and keep them at home was outsourced. That was a critical and a costly failure because the compliance wasn't as good as it should be. And the other one of the greatest shames from the UK was the elderly were being dumped from the hospitals into care homes with COVID and spreading COVID like wildfire throughout the care homes. And it's estimated there was 50,000 unnecessary deaths as a result of that. I mean, that is something that will very much come out in the public inquiry. I'm not sure about the US, but interesting to hear what happened in the US with mental health, but certainly it was a huge difference in mental health burden. And again, this was related to, or worsened by your ethnicity, your age, and if you had a disability. Think about it, I'll come back to that in a sec. Our health and safety, our OSHA really left it to companies to try and risk assess what we were going to do. It was sort of, well, you assess it, do risk assessment and manage it. It wasn't as vague, it was vague. Certainly in the US, CCD, you had a much better approach. To be honest, during COVID, I spent most of my time looking at the CCD rather than what was coming out of the US because certainly from my perspective, I thought they were giving really good and solid advice. And all the social determinants for health were severely affected. I think it was touched upon by Douglas. Again, in the UK, long-term public health underfunding was a major underlying factor. Going forwards, long COVID. So about 5% of cases in the UK have long COVID, and there's probably about 25% of those who are still absent from work. We have limited programmes and there's poor support for the people within those programmes. Again, that's another huge shame because we're talking about almost a million people who have fallen within that programme. Wellbeing, obviously impacted. I mean, really each of those squares represents various things within that, most of which I've touched upon. In the UK, there was a vastly increased abuse of drugs and alcohol, and tragically also domestic abuse. Again, I'd be interested to hear what happened in the US. And as you can see from the two charts there, which are really demonstrating that, the levels of increased mental health and increased alcohol consumption. Okay, those are the negatives, but you have to be balanced. What went well? Well, the early bulk procurement, it was a huge gamble by Boris Johnson, but it paid off. He rolled the dice, and I would say in some ways got lucky, but that's fine, because that's what saved the UK. All of the lessons learned, the negatives that I show you, could have ended, if we hadn't had the vaccination campaign, it would have ended up an absolute disaster, but we were saved by the vaccination campaign, which was a huge success. The speed, the scale, we created hyper supersized, almost like Costco type vaccine centers, on a high scale. And we vaccinated millions of people, within a matter of weeks. And that was really one of the huge successes, and it saved the UK from an unmitigated disaster. and we had a 93% uptake in vaccine. So we got very early immunity within the population and then the public messaging within that really, it changed the whole context and the whole approach to COVID when those campaigns started. All of a sudden the messaging became positive. One of the real positive things about it was our care workers, huge massive public support for them, the work that they were doing and for you who are in clinical roles, working in the hospitals during that time must have been absolutely awful. We had a thing, clap for carers every Thursday. We would stand outside our house, our workplace on an oil rig anywhere and actually clap. I think it was at seven o'clock every evening to show our appreciation for the health workers. And that created, so I'll touch upon the next slide, that community cohesion, that community support. And because of that, that did end up better, public understanding and motivation. The one thing that there was really good compliance on, I would say would be that was the lockdown. That actually went really well. And the mask wearing, whether it was a pair of socks or ladies underwear, it was highly compliant. But I think British people generally are quite compliant individuals, so that helped. But those two things worked well. But that was that community support, that community adhesion. The NHS, our National Health Service, the State Health Service did an absolutely fantastic job. I mean, that touched upon the absolutely amazing, the level of health delivery, the staff motivation to turn up for work every day, especially in the early days when we didn't really know what we were dealing with. And, you know, a lot of the NHS workers didn't even know if they were going to survive the period. We built what we called Nightingale Super Hospitals. With military efficiency, we set up, I think, five almost warehouses. The one in London, which I was honoured to help set up, you'll see in the top right picture there, had something like 2000 beds. Now, you could criticise this, because actually, even in the London one, there was only about 50 beds occupied at any one time. But at that time, we did not know the number of people, the number of beds we were going to need. So I actually thought that was a hugely positive thing, even though it could be argued it was a waste of money. The community, the support between people, despite the government's best efforts to confuse us. Some things the government did do very well was they created a thing called a furlough retention scheme, where the government paid for people to, for 70% of their salary, things like the hotels, all the industries where, you know, which were all closed down during that period. And at one point, we had 20% of the UK population, 70% of their salaries were being covered by the government. And coming out of COVID, you know, that has been a huge, you know, a huge success, as was the government gave guarantee loans to businesses, bounce back loans, to help businesses continue to help businesses run. Again, I'm very interested to hear what was done in the US on that. Ironically, homelessness was improved, they were really prioritised, evictions were banned. And within the workplace, you know, the, as I say, in the workplaces, we sort of just got on with it ourself. And, and kind of made it up as went along in some ways, or looked at the government, what they were saying, threw it in the bin, looked at what the CDC was saying, and then sort of followed that to try and keep the workplaces going. And I felt the industry in the UK really did a great job, and particularly at the outset of COVID. I mean, you know, as a country, we switched overnight to, to remote learning. So that was a, that was a huge success. And that, that is, that is myself very interested to hear from that context, what, what experiences were within the US. I'll just stop sharing. There we go. And it is with great pleasure that I pass on to our good friend, Bob Bourgeois, the previous president there in Sunset, Louisiana, who is going to talk about the oil field workers, the maritime pilots, and the pipeline workers within, within his sector. Bob, over to you. Thank you, Dr. Mohan, I appreciate it. And thanks again, ACOM and SOM for putting this together. This is a wonderful cooperation. So, so down here, I'm down right near the Gulf of Mexico. And early on, we realised that critical infrastructure was not just healthcare workers, first responders, and the police or whatever, but also offshore energy workers, maritime transportation, and that sort of thing. Next slide. So on some of these offshore installations, there are anywhere from up to 300 persons on board on any one of the assets. And some of these are so critical that if that if they have so many wells on some of these, and if that shuts down, your gas prices are going up pretty quickly, because of the decrease in supply. So it's critical to keep these places running. These are assets where all the personnel live and work remotely, they stay on the asset for anywhere from 14 to 28 days, or even more during COVID. So what we did is we had them drive as in, you know, solo to the, the hotel or heliport depending on if they were going to be in a quarantine setting or not, where we had some issues with some of the contractors rode in vans with up to eight people, and we saw a significantly higher number of positive COVID test pre flight. And a lot of those folks are actually symptomatic, they did not disclose that or denied it when they got in the van. And, and actually, because they were close contacts, everybody was was barred from the flight. These helicopter flights, you know, you have anywhere from it's two crew members in anywhere from, you know, six to 18 passengers, you're sitting shoulder to shoulder, they're anywhere from an hour to three hour flight each way. All the flights were in 95 mask, everybody in flight were in 95s the entire time. Some of the companies had quarantine, whether it was a home quarantine, and or a hotel quarantine for up to five days before the hitch. So this increased the hitch duration, the home quarantine was basically trying to keep folks at home until they went out. In the home quarantine, and the hotel quarantine process, these individuals were screened pre pre quarantine, and had health questionnaires every single day. We had medics or RNs looking at the questionnaires, helping with the screenings. Each person had a single hotel room, and they were single meals or single individual meals, not not in group settings. The serial testing, the screening was pre quarantine during quarantine, pre flight, and then again, throughout the hitch. Most of the most of the companies had everyone masking whenever they were in close quarters or indoors offshore, and trying to maintain some distancing. However, space is at a premium on some of these assets. So it is pretty difficult to do a lot of what we tried to do. So entering quarantine during the flights, most of the time at work, unless you're in a room alone, and then all the way back to returning to base or the heliport, you are actually masked up. We had a couple of things we did to try to minimize some of the risk. We were able to significantly increase makeup air in that HVAC system. We had staggered mealtimes. So instead of everybody being in the smaller galleys eating together, they either ate in their room, ate at the desk, or during the staggered mealtimes, we split them up as much as we could. We had some large group screenings on occasion whenever they had outbreaks. When that happened, we identified close contacts, tried to isolate them, and did, you know, daily screening or seroscreening on them. Each of the positives were actually medevaced to shore for a pretty long duration of time during COVID. But these were single patient flights, they're very expensive. And there was a lot of times where there was so many folks going in from all the different companies that it took you a couple of days, up to three days or so to get everybody in. Once the vaccines were available, many of the companies made it mandatory. They did have a few folks that did not want to get them, but most of the folks were compliant and got them. We did not have many significant severe disease type patients with COVID offshore. Part of that was because we got them in as early as we could. They also offered that some of the folks that had high risk, you know, the older diabetics, folks with heart disease and lung disease or whatever, some of those actually stayed home during COVID and didn't go back to that offshore setting. The manning issues were significant because sometimes it did get pretty critical trying to make sure these were all manned appropriately. Because when you were screening and looking at close contacts and everybody else, it was sometimes difficult to get, you know, replacements offshore. The single rooms come at a premium because most of the time you're not in a single room offshore, but we knocked the manning down to just critical numbers so we could do that. And then we also figured out that if we put the recently positive but recovered in a room with someone else, if they couldn't give it to them, it made sense to try and put them in there and see if that would be, you know, a way to keep the place manned appropriately. There were some difficult times. I mean, mental health stressors, we talked about mental health issues. Imagine being away from home, you know, 30 something days at a time worrying about friends or family that were sick at home with COVID. And you're living alone in each of the rooms, basically. So it was difficult because you felt like you didn't have, you were kind of helpless sometimes. This was slightly better on some of the bigger assets or those with good internet access because, you know, a lot of people when they were, a lot of employees when they were on downtime, were able to Skype or FaceTime with their family. And I think that helped a lot. Going on to maritime pilots, the busiest port in the US is down here. And they usually have one big boat offshore and a smaller boat near the port. But this is a 24-7 operation. Boat crews include the master of the vessel, and the deck hands, or other workers that assist the pilots getting on and off the vessels. And then you have the pilots who guide the big ships in and out of the harbors. There's a constantly changing persons on board on the boats, the pilot boats. The work schedules are all kind of skewed a bunch of different ways. And it's not everybody on the same schedule. The large boat actually had single rooms. So again, we increased the makeup air for HVAC. And you would mask with an N95 whenever you're out of the room. Now that did make it a little bit more difficult for some of the pilots on boarding and getting off of some of the vessels because you can't really see down as well when you have a N95 on, you know, on your face. And it does increase the risk of the work of breathing some. So some of the older pilots had a little bit of problems or said it was a little more difficult climbing with the mask on. Some of the issues we had for them, some of these domestic and foreign vessels, a lot of times they picked up COVID in the last port, and now you have 18 of the 23 crew members that are positive. So to protect the pilot, the pilot was always masked at all times when he was in close quarters or around the other crew members of the vessel in transit. And then certainly in the bridge, we tried some other options. We actually had opened doors to the bridge to try to increase ventilation. Sometimes the pilots were able to actually work from the bridge wing if the weather wasn't bad and communicate to the captain of the vessel from there. We also tried to avoid having positive crew members on the bridge. So there was a lot of planning for every vessel transit whenever we had something like that going on. We also again paired the recently positive but recovered pilots with others to try and decrease the spread there. In gas pipeline control rooms, if you don't have natural gas, a lot of the utility plants around here run on natural gas and you would have shut some of that down. So there is critical manning to safeguard the pipelines. So we did questionnaires every morning and there was some home quarantine going on, serial screening. The RNs, the occupational health nurses, would follow up with any positive questionnaires and they would actually coordinate the screening and evaluations, return to work process and all that. We did increase the HVAC makeup there on these places also. We were able to in some instances have individual control rooms set up because we were able to get the computers moved to other buildings, side buildings or whatever, or other floors where if someone was positive but not very symptomatic, they could work in isolation and then with no contact with any other workers. So in that instance they had individual bathrooms, eating facility, rest area, whatever, but we were able to do that. And then again with the recently positive that helped us put them in areas where if we needed to put two people in the same room that helped. The contact tracing issues were interesting here because with everybody going in and out every day, there was a lot of community acquired infections and you were trying to figure out how much of it was work, what it wasn't from outside, but majority in these instances because of the work we did were actually community acquired disease. And then again these are multiple shifts. Everything's open 24-7. You have to keep the gas flowing so that made it a little difficult to man on occasion. So just to close this up a little bit, the OEM physicians and other health care providers working with the out health nurses, offshore medics, industrial hygienists and safety work very hard as a team to keep maritime and energy sectors working. Echoing again Dr. Martin's clinical guidance, we were a well clinic only. We didn't screen or evaluate anyone for COVID in the office or treat COVID here because that helped us to protect staffing and manning for companies. So in this way we were able to keep the healthy well and the sick away from them. And I think without the OEM team efforts we would have been in the dark cold and hungry. So I think all of us did a great job as a team and I think it was well received by most industry. And again I'd like to thank ACOM and SOM for making this webinar possible. Back to you Danielle. Thank you so much, Dr. Bourgeois. We are actually going to open up for the Q&A right now. We've got about six or seven minutes to have the Q&A, so I will start at the very top, and we'll see how we do kind of going from there. First question is, why didn't the CDC and WHO assume a novel pathogen could be transmitted via an airborne pathway at the outset? I compare this to responding to a chemical release where the agent is unknown. Contact and inhalation ingestion pathways are addressed with PPE. Why wasn't this the case at the outset of the pandemic? I'll have a go. I can't actually answer for the CDC and their thinking, but I think that the initial thinking was that the pathogen was passed by aerosols, and the aerosol generating procedures within hospital would be the likely cause of spread. I know that there was a lot of debate in the opening months of the pandemic about the mode of spread, and a lot of scientific work went on, but it took them several months before they actually realised that it was spread, that the virus was spreading within the air as well. We also had the debate about face coverings that went on in the UK and in the US as well, about the effectiveness of face coverings, and that continues today. I think that, you know, we recognise now that N95, N99 respirators do give a good level of protection for the virus. Surgical masks, less so. I see that further down someone's posted a link for a recent study on that, and I'm not sure what the results of that study were, but I'm assuming it was that respirators give more protection than surgical masks, but that question is still being debated in the UK. Thank you. Yeah, I've got that study somewhere. I'll try and pull it out, and it compares face masks or face coverings, beg your pardon, similar to sort of what the bikers use, which is essentially what face coverings were compared to the N95 and the FFP2, and FFP2, not FFP3, but actually it's got some very striking graphs about penetration of the virus through that, and if I can find that, I'll forward it, that can be shared with you. Thank you. Next question. Is there a defined process for a patient who presents at an ER and is determined to be ill with an unknown infectious agent? Are they typically placed in respiratory isolation? This is a really good question, and I do not know the answer to that. It's been some time since I've worked in an emergency room. I would guess that there probably is some screening process of some sort that differentiates those patients and puts them maybe not in respiratory isolation, but perhaps in a different area of the ER away from everybody else. Bob, I don't know, you worked at an ER as well. Do you think that's probably right? Yeah, I mean the ERs down here, they actually had a fairly high rate of positives. They actually moved the ER out to a, basically like a mash tent outside to see the COVID patients and try to, I mean the non-COVID patients, to try not to keep them out of the hospital, and did just COVID symptoms and screening in the hospital, but the rates of infection in the ER and the ICU were actually higher than on the floor. All right, we have time for one last question. At any point were portable HEPA air cleaning devices utilized in these facilities? They had a lot of them offshore in different HVA systems, but I'm not sure how well that worked. There were some other attempts to put UV light in them. There were a whole bunch of different things that were attempted, and actually I know that there are some ongoing studies to look at some of the data from different assets that had different methods on board to see if there was much of a significant improvement in the reduction of COVID positives, but that's ongoing. I don't, I hadn't seen anything out yet to tell you that that was, which one was more effective or not yet. Okay. Sorry about that. Give me one moment. Okay. Thank you so much to everybody for attending today. For updates on future webinars, as we have some technical difficulties, I'm okay with that. For updates on future webinars, please visit ACOM.org webinars. We do have our annual meeting, AOHC 2023, coming up April 16th through 19th in Philadelphia. Registration is now open to that. Please visit ACOM.org. I would like to thank Dr. Bourgeois, Dr. Martin, Dr. Moen, and Dr. Ponsonby for their time today, their expertise, and sharing their knowledge with us. Thank you, gentlemen, so much. And to everyone that has joined us today, we will send out a link to the archive presentation, as well as the slide handouts, within the next 24 hours. Thank you all, and please stay safe.

COVID-19 pandemic

occupational and environmental medicine

healthcare workers

essential workers

quarantine protocols

PPE usage

vaccination campaigns

social determinants of health

mental health impacts

long COVID patients