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Coronavirus – Answering Your Questions Transcript

Host: Hello and welcome to today’s webinar: Coronavirus, Answering Your Questions. Note that all attendees are in listen-only mode. Today’s program will be approximately 90 minutes long, and you can submit written questions and comments at any time during the presentation. Simply enter your question or comment in the box on the bottom of your screen and click submit. Our speakers will address questions verbally as time allows during the webinar’s three Q and A sessions. Your submitted questions will be visible only to the moderator. Webinar resources are available in the resources list to the right of the presentation. Please note that today’s program is being recorded. Now here’s today’s moderator, Melanie Bennett.

Melanie Bennett: Thank you and welcome to our program. I’m Melanie Bennett, risk management council at United Educators (UE), and I’m pleased to introduce our speakers: Jean Chin, Debbie Beck, Doreen Perez, and Kate Leveque. Doctors Chin, Beck, and Perez serve on the American College Health Association (ACHA) COVID-19 Task Force, and Kate Leveque is a partner at the Husch Blackwell law firm. You can view the speakers’ full bios on the side of the page. I want to welcome the speakers and thank you all for taking the time, while managing this ongoing crisis, to share your expertise with us.

A few housekeeping items before we begin. First, the webinar audio recording plus the PowerPoint deck, transcript, and resources should be available on our risk management website, www.edurisksolutions.org within the next two weeks. Second, this is our first completely remote webinar, so please bear with us. If you experience major technical issues, please submit your issues using the Q and A box.

Third, I want to reiterate that today we’re addressing risk management concerns created by the coronavirus pandemic. We’re not addressing coverage considerations in this webinar. And finally, although Kate and I are lawyers, the webinar is not designed to provide legal advice.

So let’s talk about the agenda for today. We’re going to start with a COVID-19 primer with the American College Health Association guidelines. We’ll then move to institutional emergency response. After that, we’ll talk about employment considerations, and we’ll end by talking about wellness and moving forward in some of our UE resources. As [our host] noted, we’ll have a total of three Q and A sessions during the program. The speakers will address as many of your questions as possible. Now let me turn it over to Jean, so she can provide you with an overview of ACHA’s COVID-19 guidelines, a really important and informative resource for colleges.

Jean Chin: Thank you, Melanie, and I want to also thank United Educators for putting this webinar together in really a brief timeline. And I also want to thank the American College Health Association and the rest of the COVID-19 Task Force for their tireless work in this area. As Melanie said, I’m going to introduce COVID-19 to you primarily through the lens of college health, and so that’s why we’re going to start with the ACHA guidelines.

The ACHA Task Force wrote these guidelines in just five days, urging campuses to prepare for this virus. But because things were changing so rapidly, we had to scrap this document before the ink was even dry, and rewrote it in just three days to reflect the community transmission, which was just in its early stages out on the West coast. When we released this document on March 3, there were only 80 cases in the United States, and five weeks later, here we are today approaching 450,000 cases and over 14,000 deaths. So we are well past preparing for COVID-19. If campuses have not prepared for COVID-19, they’re in trouble. We are right now in the middle of a surge, and we are now in our next phase of preparing to reopen campuses, which Debbie Beck will be talking about in greater detail. But I’m going to talk with you about some of the things that we talked about in the guidelines.

Debbie, Doreen and I, we are all college health professionals. And college health professionals approach health through a holistic wellness model, meaning health is not just the absence of physical disease, but it encompasses emotional health, mental health, physical health, etc., that array of juggling balls that healthy dog has in the air around him. So with the time I have, I want to review COVID-19 through the lens of the physical, emotional, and social wellness aspects of students. And maybe in future webinars there’ll be time to talk about these other ones, but that won’t be for today.

So first we’re going to talk about physical health. By now, you should be aware of those most common presenting symptoms of COVID-19. And those actual common presenting symptoms are fever, cough, body aches, and shortness of breath. What you’re seeing here, these are emergency medical symptoms, and I want to show you these because these symptoms require immediate medical attention as they may signal more serious disease, such as viral pneumonia, a bacterial superinfection, or significant inability to move oxygen throughout the body. We didn’t think young people could get these, but sure enough they can. So if you have these symptoms, you need to call your medical professional.

How long are people with COVID-19 contagious? That’s the next question most people are going to ask, and that’s in this next slide coming up. The answer to that question is most likely from 24 to 48 hours prior to the onset of symptoms to at least 72 hours after the resolution of fever and cough.

And if you look at the incubation period, which is in that next slide, the incubation period is the time between catching the virus and beginning to have symptoms of the disease air. There it is. So it’s in that white arrow. Most estimates of the incubation period for COVID-19 range from two to 14 days. Most commonly it’s around four to five days. People are most infectious or contagious, you can use those words interchangeably, during the time they have symptoms.

That is classic of most contagious illnesses. Though now we know some spread can occur during that pre-symptomatic, that little short orangey-looking arrow phase, and that’s why the Centers for Disease Control and Prevention (CDC) has recommended that people don those cloth face masks when they go out in public, to prevent inadvertent transmission when people don’t realize they’re infected. Newer research shows people with COVID-19 begin to develop antibodies to the virus typically within six to 12 days of infection, which may explain why 80% of those infected with a virus do not go on to develop more severe disease, and that’s our young people. They tend not to develop severe disease.

Let’s look at social health now. So in the wellness model, social wellness is about building healthy relationships, and that means fostering supportive, nurturing, genuine connections with those around you. Since our containment strategies failed miserably, mitigation strategies, like closing residence halls, moving to online classrooms, canceling gathering events were implemented. Recently [the] World Health Organization advocated replacing [the] term social distancing with the term physical distancing to highlight the need to maintain physical distance but retain our social connections.

So social connections are critical to maintaining social wellness on campus. You’ll begin to see that shift in terminology, and actually you should be using that term yourself. Many of our millennials were just not getting it. They didn’t get the message. They were seen clustering on beaches and bars, hosting COVID parties during spring break, and just basically cutting loose. This behavior is partly explained by the early evidence from China that pointed to generally mild disease in young people, giving them that false sense of security.

That, in combination with that universal sense of invincibility all young people have, made them dismissive of our warnings. But in mid-March, [the] CDC opened our eyes up, and they published data that about a third of the U.S. cases at that time were in young people. And of all the people admitted to the ICU at that time, 12% were young people. So not only could young people get sick, they could get real sick.

Now, we addressed in the guidelines, xenophobia, and community values at great length, and so I need you to look at that section of the guidelines, which is still incredibly relevant. Because this virus emerged from China, there was a variety of racist and xenophobic attacks on people, either perceived or known to be of Chinese or other east Asian descent. These attacks range from racial slurs to denial of service to acts of violence, and these behaviors threatened the social wellness of our campuses and all of those values that we hold dear. Those inclusivity, diversity, and social justice values of campus. So please look at the guidelines at that, because we have a lot of tips on how to address xenophobia on your campuses.

I’ve listed in the next slide a few considerations addressing social wellness. The most challenging, I think, are going to be that second bullet: building community during the time when we are all physically separated. I’ve included a link on a YouTube video. It’s a short YouTube video, so go look at it. It’s fun. It’s created by Providence College students advocating adherence to public health practices. This is just a great example of the power of this generation to connect with other students highly positively. Students listen to other students, good or bad, and our role is to make sure the message is accurate.

And finally I’m going to give you a little minute about mental health. The emotional, social, and financial disruptions, all of those other wellness balls that healthy dog was juggling, all in combination with a 24/7 media and the uncertainty surrounding this pandemic is finally taking its toll on students, causing them increased stress, anxiety, and fear, even in those without underlying mental health conditions. And this can manifest in a number of psychological and physical ways that I’ve listed for you in that second bullet.

But what’s been fascinating to me has been this panic buying. Loss of control and fear of the unknown has contributed to the public’s panic buying of paper products, cleaning products, and even ammunition. Buying these products seems to give people something concrete, something to protect themselves, in a world where they can’t see this little virus [that’s] attacking them, in a world where they’ve lost control.

So one approach we’ve taken with students, regarding their mental health, is implementing telemental and telemedicine services on our campuses to improve access and continuity of services. And frankly this is a talk all by itself. At the very end of this discussion, Doreen Perez is going to be talking about wellness to wrap it all up for us. So she’s going to give us a number of tips on wellness, suggestions to address mental health. And on that note, I’m going to turn this back over to Melanie.

Melanie Bennett: Thanks, Jean. And I’m actually going to pause here and stay with you for a moment, because we’re receiving a lot of questions about telemedicine. Do you have any best practices for schools that are new to telemedicine?

Jean Chin: Actually that gives me an opportunity, Melanie, to give you a shameless plug for the COVID-19 webpage on the American College Health Association website. Because this is just an hour-long talk all by itself, we had a roundtable on telemedicine that features a number of practical tips and lessons learned. So go to that website. Three schools presented: NYU, University of Central Florida, and Sam Houston State University. So there are a lot of lessons learned from those three schools. And we also had an attorney discussing some of the Centers for Medicare & Medicaid Services (CMS) and Office for Civil Rights (OCR) changes regarding HIPAA, etc. But some quick tips: Figure out what services you want to provide and who you are serving. Are you referring students only? Are you providing clinical services? Are you triaging by telephone? Is it in-state only? Out-of-state students? Because there are still a number of barriers with interstate licensing, and you have to ensure providers’ malpractice covers telemedicine across state lines.

Work with your electronic health record (EHR) vendor, work with your general counsel, map out your processes, give your providers more time per appointment. We usually have three appointments an hour, so 20 minutes per appointment, but you’re going to need 30 minutes per appointment. So you need to stretch that out a little bit. Training, training, training, and ensure you have proper consent forms. It’s not just like the patient was sitting in your exam room. So those are the quick ones, but again, go to the website.

Melanie Bennett: That’s really helpful. Thank you, Jean. Now let’s move on to Debbie for guidance on the institutional response.

Deborah Beck: Thank you, Jean and Melanie. That was a great overview of the coronavirus. The next section of this is going to talk about the importance of an institutional emergency response. Although college health has a very specific role in handling COVID, the university as a whole has a greater role in managing this throughout the campus. So we look at activating an emergency operations center. I think that is the key component in instituting your emergency response plan. Many universities have these in place, and it’s very important to activate that system very early.

Deborah Beck: This slide sort of talks through the different steps that would be needed in order to activate an emergency operations center. One of the things is that when that center is activated, we need to look at the public health and the medical health components of that. We certainly need to look at the admissions and enrollment. How is that going to be affected? How will academics and research be affected? Especially our financial situations and how we recover? What is the risk management in public health and safety? How do we communicate that? And also, we need to look at our athletics department.

But most importantly on that emergency operations center is creating and updating mitigation strategies, which Jean talked about earlier, is how are you going to operate, given the triggers that happen throughout on your campus? So the next slide talks about the understanding the real time spread of COVID on a campus and your surrounding area. Later in the webinar you’ll see numerous sites where you can go and actually study and watch the spread of COVID throughout your community and perhaps on your campus. It’s so critically important to track those cases to really inform what decisions are made on your campus and at what point in time those need to happen.

The most important part of understanding the real time is working with your local, state, and national resources throughout your community. What are they seeing? How are they working to help you isolate and identify your cases that may be subject to your campus? Most important, again, is your infection control. How are you going to handle that isolation in quarantine, and what are you going to do when all that is over with? How do you clean, and how do you inspect those areas? We also need to determine the risk of our students. Perhaps looking at your campus body and determining what percentage of your students may be of high risk. Send them emails or information, letting them know that they may be at risk and really concentrating on their health and well-being, since we know that this virus is a particularly fierce against ones that have comorbidities or may have chronic health conditions.

All college campuses need to determine what their surge capacity is. Many colleges and universities have been asked by local hospitals and communities if they could have local hospitals or urgent care centers on their college campus. So you really need to evaluate that. Are you capable of doing those things, and does it make sense for your campus. As you’re planning for your college health centers, how much can your staff take care of on your college campus? Do they have enough personal protection equipment (PPE)? Your continuity of operations, do you know how many staff you will have to rely on as the virus spreads through your staff? So those are all really important features in that.

So if you look at the next step in your emergency response, the most important part of that is how do we stop, slow, and limit the spread, and sustain the infrastructure of the university. We know that the primary [goal] is saving lives and reducing the overall adverse effects of COVID, but we also need to look beyond that and start planning to sustain the infrastructure of the university when it’s all said and done.

We already kind of mentioned a moment ago about making sure that you have adequate supplies in your PPE. The other thing we need to model that physical distancing, that Jean spoke of earlier, is remote meetings. Instead of having people in the classrooms or in meetings or conference rooms, we need to make sure that we’re doing those remotely.

We need to really pay attention to how the workforce is impacted. We know on college campuses and workforces throughout the United States, there’s severe depression, anxiety. There’s fear of loss of jobs. How are we going to pay these individuals? How are they going to be able to work from home? I think those are all very important factors when we’re looking at stopping and slowing and limiting the spread, not only from a public health perspective, but also from a human perspective as we have to go toward closing down our campuses.

The next slide again kind of reinforces that surge capacity and expanding that health care system. We need to really assess our risks and our resources, not only on our campus, but within our local community. Communities that have very limited resources, whether it be medical or mental, they have absolutely no capacity to handle what is happening on your college campus. Many times we think the large college campuses in urban areas may have less resources due to the number of students and faculty and staff. However, it may be those communities with a very small university and absolutely no community resources that may have to stand on their own. So small colleges and universities need to really plan for pandemics and these things, because they may be left with very limited resources on their college campuses. It’s very important to look for opportunities to conduct research in times of these pandemics. It will help us to decide how we plan, how do we move forward, what can we learn from each pandemic.

Another very critical part of it is looking for mutual aid agreement. As you’re doing your emergency response planning, understanding your vendors, understanding who your partners are, and developing a mutual aid agreement so that when things like this happen, you are on their priority. You know who your vendors are and that you will be on the top of their list whenever you need your supplies or regulated information.

The next slide talks about expanding communication and community engagement. Once again, this is critical. I really like what Jean talked about, physical distance but social connection. We really need to kind of keep that in mind. But it’s so important to communicate, and communicate often, to faculty, staff, students, parents, your local community.

Oftentimes if people don’t hear things, that’s where rumors start. And then they make things seem worse, or sometimes better and then we not ready to prepare for those things. So have your chief information officer a huge part of your emergency response so that they can communicate often. And in fact, it’s suggested that maybe we should be communicating two or three times a week to our key partners, and that includes our parents and our students who are no longer a part of our campus community.

We also need to utilize our emergency alert systems. A lot of the states are having stay-at-home orders, and allowing your college campus and your community to use those emergency alert systems to reach the community is very important. But it’s also very important when we release this type of an emergency alert, that we also release information [about] where people can get help. Looking at mental health resources, and Doreen will talk in a few moments about the importance of that. But when we give out information, and oftentimes this type of environment, we’re giving bad information or sad information, and we want to make sure that we can do something to pull our community together and give them the energy to move forward as we are sustaining this energy to move forward as we are sustaining this pandemic throughout the system. As I mentioned before, we can’t downplay the crisis. We need to tell it straight. We need to let everyone know how we’re suffering, what are the good things, but also, we need to make sure that we provide accurate data.

It’s so critical that everyone, as you’re planning to respond to COVID, that you are using best practices. You’re going to scholarly sites and data, and you’re using data that is very evidence-based, so that we can provide the best information and adopt the best practices and procedures how we’ll go through this.

We also need to support our local and state agencies. We know that everyone is going to be inundated during times of crisis and the pandemic. Reach out to our local hospitals, and doctors’ offices, and urgent cares, if we’re able to help support them. I know PPE has been a huge debate. To college campuses who may not be operation, can you loan? Can you give your PPE, or vice versa? So, I think it’s really important to support those.

The next slide talks about mitigating the economic and social consequences. Jean talked a little bit about the social consequences earlier. It’s really, really important for us to stay connected but physically apart. When we start looking at mitigating the economic impact, we all know that this is going to have a devastating effect on college enrollment across the country. Many schools are looking, how are we going to maintain our students? Are we going to come back in the fall? I think it’s really important.

We also have to think about graduation and grade completion. Students have worked so hard, and this is a prime time for graduation. How will we do our graduations? Can we do those? I think will be a very important part as we start recovering.

Now, the next slide talks about, “When is it safe to return to campus?” This is a whole different webinar in itself, but there is a great document that is listed at the end of the webinar and it talks about how you return safely.

Now, it’s geared a little bit more toward community, but you can take this document and use it. So, the first thing, phase one is we’ve got to slow the spread. We’ve talked about that, slow and limit transmission. But during phase two, states will start coming back as they are capable of based on the surge in their area, the death rate, how many cases are being put in there. But as we start coming back phase two, are we going online? Are we going to only bring a portion of our campus population back? There’s going to be a huge, a hybrid model to consider as we are coming back, state by state and campus by campus.

The third phase is one that was most important, and unfortunately we don’t have a lot of those factors in phase three right now. So, that hybrid model is going be very important. That is lack of immunity. We still don’t have a vaccine. Vaccine is probably not in the very near future. Also, the treatment of this virus is not known. So, it’s going to be very important that our mitigation strategies, and as we start bringing our students back to campus, that we understand that that immunity is not going to be there and the treatment will not be there.

And then last but not least, it is so critically important for us to rebuild our readiness for the next pandemic. This has made us all very vulnerable to see how quickly these viruses can change the world. The world was changed in less than three weeks, or a 30-day period of time. So, we’ve got a plan for that and we need to be ready for that.

The next couple of slides have a little bit of information that can help you. Not only does the American College Health Association have awesome resources and guidelines, but also the CDC guidance for institution of higher ed. And I encourage you to go to this site, look at this information. It is updated on a regular basis.

And those that are in K-12, the CDC also has lots of great guidelines for K-12, which brings up a lot more variables that maybe college health does not have to look for. So again, I encourage you to look at all these resources at the end of this webinar to understand where you go to get your information and how do you utilize best practices.

So, at this time, Melanie, I’ll take it back to you.

Melanie Bennett: Great. Thank you, Debbie. And so now we’re going to open it up for our first question-and-answer session. Jean, before we go into the deeper questions, there was a request that you repeat the information on where people can find the telemedicine resources you were talking about.

Jean Chin: Oh, great. It’s the American College Health Association website. So, just type in American College Health Association and go to our webpage, and then go to the COVID-19 site. And then there’s just all of our webinars that we had our presentation, and it should be listed under telemedicine.

Melanie Bennett: Perfect. And I believe that’s www.ACHA.org.

Jean Chin: That’s it. Melanie, you’ve got it.

Melanie Bennett: Wonderful. Thanks, Jean. And I’m going to stick with you for our first question.

Jean Chin: OK.

Melanie Bennett: The participant asks, how should schools and colleges plan to address sanitizing classrooms, laboratories, and public spaces before reopening?

Jean Chin: These are always the hard questions, and I guess that’s why people are asking them ─ because they’re really hard. The short version of this answer is the sanitizing ... Well, before we reopen, it needs to be systematic, needs to be organized, an using all of those Environmental Protection Agency (EPA)-approved products that [the] CDC has already outlined. You need to prioritize those really highly trafficked public areas and then determine how frequently you’re able to clean them because they’re going to require a lot of cleaning, frequent cleaning. And maybe leaving those back office spaces as the lowest priorities. So, establish priorities, basically. And fortunately, all of that is well established on [the] CDC website.

But I will tell you one thing: We have made being in this role as chair of the COVID Task Force, we have made a lot of partner organization friends. So there’s one, their initials are APPA, which has nothing to do with their name, by the way, because their name is Leaders in Educational Facilities. But they have some really great tips and infographs on cleaning and sanitizing. And we just did a webinar with them a couple of weeks ago, and that’s how I know about them. They have, example, protocols from different colleges and universities. And Melanie, I’m going to give that website to you. I’m going to type it out for you or email it to you so you can put it on your resource page for people. It’s a really great site for this question.

Melanie Bennett: Oh, that’d be perfect. Thank you, Jean.

And Debbie, we’ll go to you for the next question. And continuing along this line, have you seen any particularly helpful resources schools should know about?

Deborah Beck: Absolutely. Including the ACHA guidelines, there’s also guidelines on emergency response that’s on the American College Health Association’s website. The other area that I would encourage people to look at is the Johns Hopkins website. It really does a great job at [providing an] overview of the cases and how things are happening.

There are two other sites that I would recommend. One is COVID@now.org, which is on one of the slides at the end of the presentation. That is an area that you could actually separate the information by your state. You can click on your state, it will tell you your surge capacity, what’s happening in the hospitals, what’s the death rate, what’s the number of cases, so it’s an excellent site.

The other one is World Leaders, which is another great site that kind of helps you to look at the trends from other countries. It helps us to understand what’s happened in China and the things that we can learn from. All of these are listed on a slide later in there, but I think all of these are excellent resources for people to go and review after the webinar is over.

Melanie Bennett: That’s really helpful. And Jean, we’re going to go back to you with the next question. When facilities are reopened, what cost-effective and time-efficient procedures should be introduced to minimize the spread of illness on campus?

Jean Chin: Again, another really hard question because the way this virus spread. So, kudos to your audience for asking the tough ones. When we reopen, it’s incredibly important to have high awareness still of hand hygiene and cough etiquette. But as the semester goes on, I know all of that is going to fall off very quickly as students, faculty, and staff, they all get back into their routines and everything else they are going to be involved in. Short of a vaccine though and serological surveillance to determine herd immunity. It’s going to be really difficult to minimize spread of illness on this campus.

But the one thing we have going for us, Melanie and listeners, is that this virus has an Achilles heel. It is highly susceptible to soap and water. So, we have to get this virus before it gets into our body. So, at a minimum we need to continue to push all of our public service announcements and messaging about good public health practice, good hand hygiene, put those hand sanitizers and alcohol rubs out in highly trafficked areas. Put those flyers up. We have to maintain a high level of suspicion when we see symptoms reemerging. And at a minimum, we have to push vaccination for influenza, which is a different family of viruses, but you’ve got to at least eliminate one set of viruses and continue to clean high trafficked areas. There’s just so much to do with so little time, Melanie.

Melanie Bennett: That’s really helpful. And the last question is for both of you, but we’ll start with Jean. Did your institution learn any unexpected lessons during the pandemic response that other institutions can use?

Jean Chin: I don’t know [about] unexpected … but I think as Debbie mentioned, communication flow was just erratic. Our pendulum would swing from no information to suddenly the information was so overwhelming, you didn’t know where to act first. You couldn’t prioritize. We were having trouble building community, and as students were getting isolated, it required some intentional work from leaders, and some were doing it better than others.

Our college students were not getting our early messages like the rest of them. They were probably going out to Jacksonville and laying around on the beaches and doing Lord knows what else college students do. And we didn’t go to a pass-fail model at [University of Georgia], and that’s been problematic, getting professors up to speed on delivering Zoom classes. Some classes just aren’t appropriate for Zoom classes. Some students don’t know how to use this, they didn’t have good streaming capability. So, we were caught in a bind without really good information technology (IT) expertise.

Melanie Bennett: And Debbie, did you have any unexpected lessons?

Deborah Beck: I think, to reiterate what Jean said, is the importance of communication. I think in the very beginning as our state started having lots of cases, the thought was maybe we don’t need to communicate as much. But as we started doing town hall meetings, we realized it was a critical part of what we wanted to do. The other thing that was really important is to stay calm and plan. It seemed like as the cases were increasing, a lot of people wanted to do something, they didn’t know what to do, and we actually started doing things duplicate. So it’s stay calm, plan, communicate, and talk, and involve the parents in your community. It’s so critical because their parents want to stay involved, they want to know what’s going on. So, I think those are some lessons we learned very early on.

Melanie Bennett: Thank you Debbie and Jean, and thank you all for the great questions. Keep sending them in. We’ll have two more opportunities for Q and A, but for now let’s go to Kate for an overview of the employment considerations.

Kate Leveque: Thank you so much for having me. We know that COVID-19 presents institutions of higher education with really unique challenges. You’re attempting to balance employee health and wellness while preserving your operations. And you’re constantly making decisions that impact your workforce and your broader campus community, and you’re making those decisions extremely quickly.

So today, I’m going to talk briefly about compliance with employment laws, including the Families First Coronavirus Response Act (FFCRA), the Americans with Disabilities Act, and the Family and Medical Leave Act in this new environment where many of your employees are likely working from home and you have a very limited staff on campus. I should note that the information I’m providing is based on the current understanding of the pandemic and the current state of the laws. And as you all know, this is an extremely fluid situation. What we knew three weeks ago is completely different than what we know now, and new guidance is issued almost every day by the relevant governmental authorities and agencies. And so, you’ll want to make sure that you are keeping up to date on those changes and talking with your personal employment advisor to the extent you need any assistance.

So, there’s been a lot of new legislation that’s been passed related to COVID-19, and I know that if you’re anything like me, your inbox is filled with legal alerts. I can’t take you through every single state and local change, but I can tell you that there are new state laws being issued all the time related to paid leave that should be provided to employees in light of COVID-19, and unemployment benefits that will be provided to workers who are out of work.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act included a huge unemployment stimulus package which will provide unemployment benefits to more individuals who are out of work. And it also includes an additional $600 per week in benefits to employees who are eligible for benefits under their existing state laws. And so that’s something that is really designed to help our workers who have been impacted by this.

Another significant piece of legislation that many of you are navigating right now is the Families First Coronavirus Response Act. This legislation was passed March 18 and includes two major components for employers. The first is the Emergency Paid Sick Leave Act, and the second is the Emergency Family and Medical Leave Expansion Act, and I’ll provide you a few details about those, that legislation, in a moment. Both laws were effective on April 1, and they will automatically expire at the end of this year. And in general, the legislation provides leave to all of our employees, though health care providers and emergency responders can be exempt from receiving the leave.

Now on the next slide, you’ll see that both laws apply to private institutions with less than 500 employees, and they also apply to all public institutions regardless of the number of employees that you have. So, if you’re a private institution with more than 500 employees, you likely are not required to comply with this law at this point. The 500-employee limit is measured at the time that an employee requests the leave. So you’ll want to keep an eye on the calculation of your employees throughout this coronavirus pandemic. And as you make changes in your workforce by laying off workers or furloughing workers, the number of employees that you have may change. So, you want to make sure they are always keeping an eye on your employee count. You would calculate all employees that you have, including temporary employees, and employees on leaves of absence. But the regulations that were issued last week made it clear that employees who had been laid off or furloughed are not included in the employee count.

All of your faculty and staff will be included, including those employed adjuncts and students. And while guidance has not been issued that is specific to student workers, the FFCRA points to the FLSA, the Fair Labor Standards Act, for the definition of employees. And the FLSA generally covers student workers, except for residential assistants and students who perform work associated with their area of study, such as research or graduate assistants who are receiving course credit or other credit related to their program of study.

Tax credits are available to the private employers to recoup 100% of the payments that the employers are making for this paid leave. But unfortunately, those tax credits right now are not available to public institutions, and so that relief has not yet been funded. I know that there is a push to expand those tax credits, but right now that has not happened.

So, let’s talk a little bit about the emergency paid sick leave. Those of you who are navigating this know these six categories, and so I’m not going to spend time reading them off to you. You’ve got them here and I’m sure you’ve seen them in those full alerts. In general, the Emergency Paid Sick Leave Act provides employees with two weeks of paid leave for the reasons on the screen related to COVID-19. The amount of time that an employee will get will be based on that employee’s schedule, but it’s capped at 80 hours, so no one will be entitled to more than 80 hours of leave under the Emergency Paid Sick Leave Act. Employees are eligible for emergency paid sick leave on the first day that they are employed, and the leave is in addition to any other leave that’s available to your staff or faculty or employees under your current policies.

Pay can be capped, and it depends on the reason for the leave. So, on your screen, the ... numbers one, two, and three reasons for leave would be paid at the full regular rate of pay, but could be capped at $511 a day. For the last three reasons, employees are only entitled to two-thirds of their regular rate of pay per hour up to $200 a day. It doesn’t mean that you can’t be more generous. It just means that those are the limits of the tax credits that are available.

Notably, employees who do not have work to do or have been furloughed are not entitled to take leave under the Emergency Paid Sick Leave Act or the Emergency Family and Medical Leave Expansion Act, which is what we’ll talk about next.

So, the Emergency Family and Medical Leave Expansion Act is also available to employees. It provides up to 12 weeks of leave under the Family and Medical Leave Act, so the existing FMLA, but it applies to employees who have been employed for more than 30 days. Generally, the FMLA only covers employees who have been employed for one year and I’ve worked 1,250 hours in the preceding 12 months. Those requirements have been lifted and this FMLA provision will apply after someone has been employed for 30 days. This leave can only be used to care for a child whose school is closed or whose care provider is unavailable. The first two weeks are unpaid, but employees can use paid leave under the Paid Sick Leave Act or other policies that you have during the period. The final 10 weeks would be paid at two thirds of the employee’s regular rate up to $200 a day. And again, if you choose to pay more than that, you can, you just wouldn’t be able to recoup those costs through the tax credit.

This is not in addition to other leave that’s available under the FMLA. Employees are only entitled to a total of 12 weeks of FMLA during a leave year. So, if you have an employee who’s already taken eight weeks of leave and they’re still within their same leave year, they would only be entitled to four more weeks of this expanded leave during the same leave year.

Also, if the expanded family medical leave goes over to leave years, so, let’s say you start your new leave year with the new academic year, that doesn’t mean that an employee gets a new 12 week period under this expanded family medical leave. It’s a total of 12 weeks between April 1st and the end of the year that an employee can take under this statute.

So, that’s some additional information that we’ve learned from the regulations that came out last week. So, as you’re implementing these plans and programs, and preparing your policies and forms, that’s some information that might be helpful in the limitations that are available. So, one of the other questions that we’ve been getting a lot is whether the ADA still applies and the EOC has made it clear that the Americans with disabilities act and the rehabilitation act still apply, even though we’re in a pandemic. However, the EEOC has provided really good guidance to answer some of the questions that we’ve had. So, one of those questions is, can you take an employee’s temperature, or require the employee to take their temperature before coming to work? Require the employee to take their temperature before coming to work, and the answer there is yes. While that would normally be a prohibited medical examination, the EEEOC has confirmed that such testing is acceptable. The EEEOC has also confirmed that employers can ask employees whether they’re experiencing any symptoms associated with COVID-19, including those that you saw at the beginning of the webinar. While those sorts of questions would normally be prohibited because of the time that we’re in, the EEOC has acknowledged that those questions are OK.

While the rules have been relaxed a bit, remember that the duty to maintain confidentiality of employee medical information and documentation and any diagnosis information that you have, that duty remains intact, and so you would not be able to disclose any information about employee medical conditions to others within the university community. Also, the duty to accommodate individuals with disabilities also hasn’t changed. That means that individuals who might need to stay out of work because they have a condition that puts them at higher risk, you’ll want to engage in the interactive process and talk about what, if anything, you can do to accommodate that disability.

Another common question that we’ve gotten relates to the Family and Medical Leave Act. We talked about the FFCRA and how that expands the Family and Medical Leave Act, but remember that the original FMLA provisions still apply, and they might be available or applicable to employees in this situation. Also, the Family and Medical Leave Act covers employers who aren’t covered under the FFCRA because they have more than 500 employees. If an employee used Emergency Family and Medical Leave [Expansion] Act, that could reduce what is left for them to take under the, what I’ll call, original family medical leave, but some leave time may still remain.

Now generally under the FMLA, employees can only take leave to care for their own illness or to care for an illness of a family member of a spouse, a parent or a child. Employees generally are not going to be entitled to take FMLA leave to avoid exposure or related to fear of exposure or to care for individuals who are not ill. And so while the FMLA, they may apply in certain situations, certainly if someone is diagnosed with COVID-19, if a parent is, is caring for a child or a spouse who is diagnosed with COVID-19, they would be entitled to leave under the Family and Medical Leave Act. But if someone just says that they would prefer not to come to work because they don’t want to be exposed, generally the FMLA would not apply to that leave.

So at this point, I will pass it back, and I think we have some questions.

Melanie Bennett: Thanks, Kate, we absolutely do. So we’re going to move into the second Q and A, and just to give you fair warning, Kate, all of these questions are for you. We have a lot of employment questions.

Kate Leveque: All right.

Melanie Bennett: The first question is how should colleges manage and document reports of ill employees? And are there any special considerations related to workers’ compensation?

Kate Leveque: Yeah, so you know, three weeks ago when we were getting this question, people were saying, “If we have an employee who is exposed...” I think that now at this point where we are in the pandemic, it’s a question of when, not a question of if, and if you’re lucky enough not to have had this happen yet, I would highly recommend that you put in place, and you start thinking about how you would respond.

While I know that many of your employees have been working remotely for longer than 14 days, for those people who are still coming to campus or as the limitations are released, and you have your members of your campus communities start coming back, we don’t really know how the virus is going to react, and whether there will be additional waves after employees get back to work. And so that’s why we’re really recommending that people put their emergency response plans in place now.

Now remember, like I just said, information regarding employee medical conditions is confidential, and it has to be maintained in a confidential manner. But the first thing that we recommend that people do is to speak with the employee who is diagnosed, give them the information on the quarantine period, try to determine where they were for sanitizing purposes and with whom they had close contact, so that you can determine what notifications you need to provide. In providing those notifications, again, you would not release the employee’s name. You would then look at whether buildings need to be shut down or certain areas need additional cleaning based on where the employee was, and you would speak to the employees who had close contact and let them know what you are requiring that they do.

The CDC actually yesterday released new guidelines about potential employee exposures. The old guidance was that those employees who potentially were exposed would be sent home for their own quarantine period. And that guidance has been reduced or limited a little bit, and so you’ll always want to check the CDC’s website about what they are currently recommending in your situation.

You also want to go through the steps with Clery [Act notifications], follow your emergency notification policies and procedures to analyze whether a larger campus community alert is required. Where possible, allow your employees to continue to work remotely and really slow people coming back to campus. You also want to consider whether the exposure or the employee’s positive test is connected with work and analyze whether any Occupational Safety and Health Administration (OSHA) recordable events have occurred or reportable events have occurred.

And finally, your question about workers’ compensation as a really good one. Unfortunately, we don’t have any clear answers. This is going to be determined on a state-by-state basis, and on a case-by-case basis. And really what the states are going to have to do is looking at the claims that come in and figuring out if there was a tie to the employee’s illness and work. Many states are moving toward covering COVID-19 positive tests as a workplace exposure for health care providers and first responders. But for others, they would be determining it on a case-by-case basis. But again, that’s all done at the state level, and there is no clear overarching rule that’s going to apply.

Melanie Bennett: Thank you for that thorough answer. The next question is, ‘Will receiving funds from the CARES Act trigger Title IX, FERPA, or Title V compliance for K-12 independent schools?’

Kate Leveque:So I think this question is probably getting toward the Payroll Protection Program and receiving funds through that program. There are also some funds that are available for higher education institutions that would also require compliance. But under the Payroll Protection Program, small businesses are entitled to some loans and part of that application process includes a statement that the recipient must comply with all non-discrimination laws and post the EEO poster. And so if the recipient receives those funds, they will be required to comply with Title VI, Title IX, the Age Discrimination in Employment Act (ADEA), the Rehabilitation Act, all of those non-discrimination laws will apply until the receiver of the funds finishes their repayment of those loans.

Melanie Bennett: Thank you. And the next question asks, ‘Do you have any recommendations for schools that are revising their communicable disease employee policy?’

Kate Leveque: Yeah, I think this is a really common policy that has been revised in addition to revising leave policies and other things. This is one of the common questions that we’ve gotten. One of the things that you want to make sure is in there is a non-discrimination provision. You also want to make sure that you are putting in provisions related to employee privacy of medical information, and I recommend that you include a definition of communicable disease that allows you to add more diseases at your discretion based on CDC or governmental guidance. And that way, hopefully, this situation never arises in the future, but if it does, your policy would already potentially cover that new virus.

Obviously you want to look at what you are actually doing, what your actual campus practices are, and then outline those in your policy. And those could be different, the steps that you’ll take, the people that the students or employees need to report to, all that is going to be unique to your campus. So you really want to look at what are we doing, what is our response plan and outlining that in your policy.

Melanie Bennett: Great, and one final question for this segment. Some exempt employees are currently unable to fill their work job responsibilities ─ such as athletic staff. Can we assign additional job responsibilities or pay a reduced salary?

Kate Leveque: This is a really good question, and it’s a question that we have been getting a lot. As this goes on longer, I assume that this is going to be a question that you’re looking at even more. The first thing that I’ll tell you is that you need to look at whether those staff members have contracts or are subject to collective bargaining agreements, and you want to thoroughly review the terms of those contracts, because the terms of those contracts are going to govern over and above any other laws that might apply, that would normally let you change someone’s salary or change their job responsibilities.

To the extent that the employees are at will or they don’t have contracts, you’re going to have a little bit more leeway with those employees. One option is to furlough those workers if they don’t have work, meaning that they would not be working, but they would still be covered under your benefit plans. Non-exempt employees would likely not need to be paid for hours that they do not work, assuming that that’s OK under their contract or they don’t have a contract. Salaried exempt employees do not need to be paid if they don’t work at all during the workweek, but in general, if an exempt employee works at all during the workweek, they have to be paid their normal predetermined salary for the entire workweek. So that’s one issue that comes up with furloughs.

The question also asks about reducing pay, and that’s also possible. Again, you want to follow any contracts that might restrict your ability to cut pay unilaterally or would violate the amount that it says in the contract the employee will receive. You also need to follow state laws that might require you to provide notice to employees of pay reductions. For example, I’m sitting here in Missouri. We have a law that says that you have to provide 30 days’ notice to employees to reduce pay, and there are other states across the country that have similar laws, so you’ll want to take a look at that.

Also beware with your exempt employees who are not classified under the teaching exemption, you need to ensure that your exempt employees, their salaries are not cut so that they fall under the relevant salary threshold, which in general is $684 a week. And so if you’re looking at cutting pay, you want to make sure that you’re not cutting pay down below that threshold.

Also, you can assign additional tasks. I would recommend that any additional tasks are still within the general scope of the employee’s job. In other words, you might not assign an administrator to be part of the maintenance staff, but if you have grounds crews and you would like to give them some additional responsibilities of potentially cleaning inside the buildings, not just outside the buildings, that could be something where you could expand the scope, again, looking at any applicable contracts or collective bargaining agreements that apply.

Melanie Bennett: Great. Thank you Kate, and thank you for all of those questions. Keep sending them in. We’ll have a final extended opportunity for Q and A in just a few minutes. And now let’s go to Doreen to learn about wellness and moving forward. And Doreen, you may be on mute right now.

Doreen Perez: How's that? Better?

Melanie Bennett: Better, thank you.

Doreen Perez: Okay, good. Well good afternoon, and thank you Jean, Debbie, and Kate. Great information. I thought I was given an easy section for this presentation, but as I got deeper into creating and pulling my slides and information together, it actually dawned on me that our wellness is one part of our lives that we have the greatest control over right now. Most of us had never lived through a global emergency such as COVID-19 or what we’ve read about past pandemics, and some of us have even studied and wrote academic papers about past outbreaks. As a retired captain in the United States Army, I even planned for these types of emergencies, but planning for and actually being in the middle of an emergency are two different realities.

Right now during this pandemic, many of us feel like we’d been thrown into the deep end of the pool. The swimmers are staying afloat, but there are others who need our help. We hope that some of the suggestions were given today can be a small valuable life that we can all hold onto for the next couple of months.

We should be looking at slide number one now, taking care of our emotional health. This is a picture of the top of a mountain pass. My husband and I were actually here last May. It’s the Rockies, and the park ranger told us, he pointed to that ledge of snow at the very top and he said, “That’s going to be the next avalanche.” He might’ve been exaggerating, but needless to say we couldn’t get off that mountain pass fast enough. We had to find a safe place for ourselves. And during this crisis, our safe place, hopefully our homes, feeling and staying safe is really important and it’s going to involve wearing our masks out in public, washing our hands properly, and taking care of our nutrition, fitness, and spiritual selves. Emotionally, we wake up every day feeling anxious and stressed, so it’s important that we’re able to reach out to a support group and stay virtually connected with our family and friends.

In the next slide, we’re going to start taking a look at what the new norm is going to look like for all of us, and how it’s going to change the way we live. The term social distancing has really come to mean physically being separated. We’re talking about 6 feet apart, staying home, working at home, and these can be huge challenges, especially in large households. Also, we are learning that we’re being successful and productive at home, and will this new norm be something that’s going to continue? Will we continue to have the opportunity of teaching at home and doing our banking and providing IT support from our homes when this crisis is over?

Currently, most of my health care providers are offering telehealth, and many of the colleges and university campuses have converted to this form of health care for certain conditions. Actually last Saturday, I scratched the surface of my left eye and my health care provider made recommendations over the phone. Two months ago, they would’ve sent me to the emergency room.

Here in the state of Florida, we have a multi-state licensure opportunity for nurses. We’ve had it for a little over a year now, and this act extends our ability to practice in other states, as long as these states are a part of the compact group. It’s about 32 different states, but it’s making it a little bit easier for us to provide health care across state lines. The states that have not been offering this type of licensure hopefully will start complying with some of the issues that we’ve dealt with, and moving forward to telehealth, and we’ll have better movement between states and we’ll be able to send health care providers to the viral hotspots that we’re looking at right now.

Jean, as you had mentioned, this virus does have an Achilles heel, soap and water and handwashing is extremely important. I think we as nurses and teachers have been singing the benefits of handwashing since Florence Nightingale, so after this particular pandemic is controlled, it’ll be interesting to watch if people continue the proper habits of handwashing. I’m actually optimistic that it will continue.

The next slide please. Being safe, being healthy is one of my family’s new mantras. We say [it] to each other as we walk out the front door. Not many of us have this type of isolated cabin we can retreat to until the pandemic has passed, but we can create an environment where we can try our best to stay healthy. Restful sleep is always important, but now it needs to be a priority. Most authorities recommend that we get seven to nine hours, but if that’s not your typical amount, at least try to be consistent. Create a restful, quiet, dark technology-free haven, decreased caffeine and alcohol consumption, and please try to turn off those electronics 30 to 60 minutes before you actually close your eyes.

Anxiety, we could do an entire webinar on what’s going on with anxiety right now, but I just wanted to share a few tips with you. Focus on what you can control and stay grounded. If you feel the need to speak with a health care provider, reach out for that health and help. And let me repeat that, reach out for help. There are crisis lines, there’s telehelp. Help is available in our community, and it is as close as your telephone.

As far as a grief goes, we all know that this is a complex phenomena. And any kind of loss can involve the grieving process, even if that loss isn’t exactly tangible. There’s a lot of grief going on right now. We have a collective loss of normalcy. We are feeling the loss of our connectedness, our routine. We certainly have feelings of insecurity about the future. Some of us have already lost jobs and even loved ones. Proms and graduations have already been canceled, and most if not all of us have a lingering sense that some this loss is still to come. That sense of fearful anticipation is called anxiety and anticipatory grief. Make no mistake about this, this pandemic is personal. If grieving becomes overwhelming again, I repeat, reach out for help.

Exercise is really important right now. Choose your favorite activity and stay safely separated. Walk, bike, do online yoga and exercise classes. Set aside a time and consistently partake. Physical movement lowers our stress, our anxiety, and improves mood. Try to eat well, make healthy choices. Fruits and vegetables are excellent opportunities for improving your immune system. Please try to avoid those high-sugar snacks, but we understand what’s going on right now. Do your best. Even if you’re just working on one healthy meal a day, it’s going to become a habit. Everyone can take a second right now if you will, just one second, and write down what you think is your new norm today. I’m going to ask you to take a look at it next April and see if you’re still enjoying the change.

Next slide. I was actually on this deserted beach in Puerto Rico four weeks ago, being productive. I was cutting my vacation short and trying to book a flight home, feeling very anxious, not knowing if the airports were going to close and feeling a bit out of control about the entire situation. During this time, being productive does not mean being perfect. The mental health folks are actually warning against over-productivity right now. They do recommend taking control over a normal routine, and if it’s OK, you normally wake up at 8:00 and you want to sleep in to 8:30, 9:00, go right ahead. Hey, try to shower on a daily basis. Being fresh will be appreciated by all your housemates. One of the webinars I was listening to this week encouraged people to dress for the social occasion you’d like to participate in. Here in Florida, the new home business casual includes shorts, because after all, you can’t see below the waist on a Zoom presentation.

Direct your attentions. There is an enormous amount of chatter going on right now, whether it’s from the TV, both local and global news, constant updates, phone calls, conferences, checking in on family and friends. Recognize that all this information overload can, at times, and it needs to be, redirected positively. There’s a lot of rumination going on in our minds such as, “Will I get this fatal illness? Will I lose my job? Will I lose my house or experience financial ruin? Will things ever be the same again?” Please understand that we can’t completely control some of these thoughts that are going through our heads, but we can redirect our attention and focus on positive things.

Be present, like, “Tonight, someone else is cooking dinner,” or, “I didn’t have to pay my car payment today.” How about what the mayor of New York said? He just reported that the stay home order has affected less accidents on the road. There’s less trauma care needed in the ER so that they can concentrate their care on the folks coming in with the virus.

It’s important for you to take a break and unplug. I was reading an article the other day about Dr. Gillian, a clinical psychologist, and he recommends setting aside time to release nervous energy. Turn off that TV, turn off the computers and the phones and just breathe. Most of us know that breathing activity where we close our eyes and take a deep breath for two to four seconds, let our bellies rise and expand and then exhale slowly. Simply doing that exercise two or three times a day, you can just feel the tension getting released from your body.

Serve. If you are not on the front lines right now of health care, you can still feel like you’re contributing. We’ve seen things all over the newspapers and the televisions about not only the nurses and doctors doing a good job in the hospital, but also the folks doing the cleaning and serving the meals. Everyone’s important right now, but if you’re not there, send over a meal to your 70-year-old neighbor, or just pick up some supplies next time you go shopping. Dust off that old sewing machine and make some cloth masks, or take a turn at cooking a meal in your home.

Be good to yourself. If you enjoy being with people, do so virtually, emails, Facebook, Skype, FaceTime, enjoying TED talks. Find time each day to check in on your family and friends, and also go outside in nature. Sit back in your backyard or on your balcony. If you can’t do that, at least turn on the Animal Planet. That channel will virtually get you outside. Pets are wonderful right now. They’re wonderful companions and they love to go for walks. If you’ve not already done so, please try to identify that one person you call the life giver in your circle and stay connected.

My last slide, the next one has some of the references I had just mentioned, but it also has my mermaid muse that I’d like to share with you today. At the end of the day, what really matters is that your loved ones are well, you’ve done your best, and that you’re thankful for all you have. Be safe and be happy. Thank you.

Melanie Bennett: Thank you, Doreen. We also want to remind everyone that United Educators will continue to answer your questions and provide resources throughout the ongoing pandemic. UE members are always welcome to submit risk management questions to risk@ue.org. Additionally, all of our coronavirus response resources, including an extensive FAQ, are available on the coronavirus webpage, www.edurisksolutions.org/coronavirus. We will continue to update this page with new resources over the coming weeks.

Now let’s move right into our third question and answer session. With that, we’re going to go right back to Doreen. Doreen, we have a question for you. Do you have any ways school administrators can help students manage stress?

Doreen Perez: Yes. Melanie, I tell them, first of all, take care of yourself. Make sleep a sacred priority. Encourage your staff and students to request and offer help on an everyday basis. Asking others what they need will help you feel grounded and connected. I think it’s also important to remember that we’re not in this epidemic, this pandemic alone. Reinforce this to your staff, to your faculty and students, and be positive about it. We’ve got this. Together, we are going to not only survive, but thrive.

Melanie Bennett: Thank you for that. The next question will go to Kate. How would you advise institutions with employees who are teleworking but also have child care obligations? Does the answer change if the employee is a faculty member or if they’re non-exempt?

Kate Leveque: Sure. This is a good question. I saw a couple of questions in the Q&As that touch on telework. If an employee is unable to telework due to child care obligations or any of the other reasons protected by the Emergency [Paid] Sick Leave Act, the employee may be entitled to leave under the [Emergency Paid] Sick Leave Act or the Emergency Family and Medical Leave Expansion Act. That’s one option that is available to the extent your institution is covered by that act.

For individuals who are not covered by the act, you might consider accommodations to allow the employee to work outside of, ‘normal business hours.’ This can apply even if your institution is covered by one of the acts. The acts make it really clear that an individual who is able to telework, and where the employer and the employee work together, engage in that interactive process, and agree that perhaps the employee is going to work between 7 and 10 and then log back in at 4 p.m. and work until 9 to get their hours in, that that individual, we should be good to each other and think about whether those options might apply. That’s an option that’s out there.

In terms of someone who just cannot perform their job because they have child care obligations, those employees could take leave. You might be able to place those workers on a furlough, meaning that they wouldn’t work. Non-exempt employees, again, wouldn’t need to be paid for the hours that they don’t work, and then the exempt employees, you would need to be careful to make sure that if they’re not working, that they’re not working for an entire workweek if you want to not pay them for that week. But in general, I would say that you should really work with the employee to determine what you can do to assist in these times. I think a lot of times what our employees need right now is flexibility. To the extent that that’s possible, I highly recommend that you do that. To the extent that it’s not possible, you might need to look at some of those other options like a leave or a furlough or paid or unpaid time off using their vacation pay, etc.

Melanie Bennett: Thanks, Kate. Now let’s go to Debbie to talk a bit more telemedicine. The question for you Debbie is, ‘Do you have any technology security recommendations for schools that are starting to use telemedicine options?’

Deborah Beck: Absolutely. I think that is a really hot topic right now with all kinds of warnings about what type of platform you may use. I think all universities need to really investigate the best platform that they have to be able to use that security and privacy system as best they can. We know that HIPAA has sort of backed off of some of their compliance regulations related to HIPAA in regards to telemedicine. However, we need to really interpret this very carefully because those are some of the things that, if they’re still intentional or negligence with getting information out, we could still be held accountable both from monetary and civil penalty. Just encourage everybody to think about that. Try to use a consistent platform across your organization so that everybody has the opportunity to make sure it is safe as possible. Do the best you can to maintain that privacy of each person that you’re trying to provide that telemedicine to.

Melanie Bennett: Thanks, Debbie. In addition to reminding everyone about the ACHA telemedicine resources, I did also want to mention that on United Educators’ coronavirus page, we also have a short piece on telemedicine as well. Then the next question is for Doreen. When schools eventually return to campus, do you have any tips for re-acclimating students and faculty? Should we expect to experience additional stress when we return?

Doreen Perez: Oh, yes, that’s a very good question. Be prepared. Many health professionals are discussing the potential for an increase in post-traumatic stress disorder when we return, this mental health problem that some people develop after experiencing or witnessing life threatening events like combat, natural disasters, pandemics, car accidents or sexual assault. We know that symptoms may not start right away, they could start later on, and that they come and they go. Before the pandemic, we saw about seven to eight out of 100, about 7 to 8% of the population will have some form of post-traumatic stress disorder in their lifetime. That’s about eight million adults here in any given year. That’s only a small portion of people who have gone through trauma. We would be wise to plan on seeing these numbers increase, especially in schools K-12 and higher education. I think this is where telehealth is going to have a tremendous impact in schools and on campuses. I think it’s important for us to be prepared to amp up our services for those reasons.

Melanie Bennett: Thanks, Doreen. The next question goes to Kate. Can institutions require a doctor’s note to return to work?

Kate Leveque: Yes, they can, but I put a caveat on that just to say that the EEOC has warned that employers may need to alter their normal processes given the current crisis, because some of our health care providers are not as available to our employees right now. Certainly, if an employee has tested positive for COVID-19, you would want to obtain something before they return to work, giving you some indication they are healthy. If the employee is able to be retested, the CDC has said that an employee can obtain two negative tests within 24 hours apart from one another. That’s a good general rule that they have recovered from the virus, but the CDC also acknowledges that due to the lack of tests, employees may not be able to obtain those two tests 24 hours apart to get a negative result. The CDC has a non test-based strategy used to determine when an individual with COVID-19 can end isolation, and that’s when the individual has gone at least three days without a fever, without fever-reducing medications, and they’ve seen an improvement in their respiratory symptoms and it’s been at least seven days since the symptoms first appeared.

What we’ve recommended is that if you’re going to use that second option that does not include two negative tests, that you have the employee certify that they have seen a resolution in their fever for three days, there is a resolution in their respiratory symptoms, and it’s been at least seven days, and to put that in the file as the return to work note, since they may not be able to get the negative test results.

Melanie Bennett: Thank you, Kate. Next we’ll go to Debbie. The person asks, they say that it feels like we’re all in emergency management mode all the time now, and they ask, "Are there ways that institutions should start planning for recovery from the pandemic?"

Deborah Beck: Absolutely. I think recovery is a very important part. I think we need to be thinking about that now, because if nothing else, it kind of helps us to see that there is a light at the end of the tunnel and we will get through this. There are lots of great resources. Again, American College Health Association has some [information] about emergency management, and also just going out to the FEMA website. I think it’s really important that colleges and universities can kind of build a structure very similar to what FEMA is [recommending] with the emergency response and that you can start rebuilding. Continuity of operation plans are very, very critical in that recovery when you get to that point. I think we all need to look that the recovery is going to be very different, I believe, than any other pandemic that we’ve had. Doreen and Jean and I all kind of worked through the 2009 [H1N1 pandemic], but this is going to have long-lasting financial implications for the admissions and enrollments of college students across the nation.

As we start thinking about our recovery, we have to start thinking about that. Will students choose online more and more? Will there be a reduction in enrollment? How will the state funding affect how you recover? I think the financial implications are really, really important to start thinking about as we start moving into the recovery mode and then preparing for that next pandemic. This will be the first of others that will come, and we need to make sure that we’re able to respond quicker, put those physical strategies in place to where we can distance ourselves from each other and stay connected. It’s going to be a long road to recovery, and we need to have patience and understanding of how to get there.

Melanie Bennett: Great. I do want to mention, so we have resources available for this webinar. If you click on the resources, in addition to the ACHA guidelines, we also have mitigation strategies to consider that Debbie wrote. It’s a grid of strategies that schools will want to consider as they’re going through this ongoing emergency response. It’s well worth taking the time to look at. Now we’ll have one final question and I’ll pose it to a few of you, but I’ll start with Jean. The question is, ‘What can we learn from this pandemic to prepare our institutions for future crises?’ Jean, do you have any thoughts on that?

Jean Chin: Well, actually I’ve been starting to write something about this for ACHA, because I think lessons learned are really critical in any test. If we’ve learned anything, Melanie and our listeners, we’ve learned from this nation’s health care response that there are at least 51 different health systems in this country with at least 51 different ways to acquire PPE and ventilators. We’ve learned we can’t take a siloed approach to future crises anymore. We’ve learned there’s been an anti-science, anti-fact, anti-data approach to this pandemic, which has hamstrung this response. Some of the things that Debbie mentioned earlier are critical, that communication has to be frequent, brief and fact-based. I think we’ve learned that we have to invest, our universities have to invest in public health and research and science and vaccine development. We have to invest in our primary care folks and our nurses.

We have to have sound pandemic plans that are reviewed and drilled annually, and the plan has to be flexible. We have to create these critical partnerships with local public health departments and hospitals. We have to invest in technology and staff training. As Debbie was just saying about financial implications, we have to save for a rainy day. When I ran the health center, I made sure we had 100 days of cash on hand just for this kind of emergency. For us, that was $6 million. I had $6 million buried away somewhere, always, for this kind of emergency. Those are some of my lessons learned. Again, I thought about this a lot recently because I’m starting to write something for ACHA next, but thank you, Melanie.

Melanie Bennett: Thank you, Jean. I’ll ask the same question to Kate. Is there anything you want to add, anything we can learn from this pandemic to prepare institutions for future crises?

Kate Leveque: Yeah, I think all of the responses have been really good. The only thing that I would add is that to the extent you are putting new procedures in place, that you don’t forget about those and that they are well-documented or incorporated into your written policies. Many of us are working quickly on the fly right now. When we get time to come up for air, I would say write down the policies and procedures that you used with your employees so that you can pull them back out when or if this happens in the future.

Melanie Bennett: Thank you for that final word. Unfortunately, we’re all out of time. I do want to thank our speakers, Jean Chin, Deborah Beck, Kate Leveque, and Doreen Perez, for giving time to this webinar while helping manage the ongoing crisis. We hope you found the program helpful. Remember that the audio recording, the resources and the slide deck will be posted soon on EduRisk Solutions. Note that the last three pages of the slide deck are filled with resources that you and your schools can use that our speakers put together. That concludes the webinar. You may now disconnect.