Bring Employees Back to Work, Health, and Safety

In this webinar, you will learn about:

• How a new increase in obesity could undermine work safety
• What decreased physical activity means for medical costs
• New findings on lingering COVID-19 symptoms and mental health
• Two forms of presenteeism and the nature of risk-taking behavior
• Helpful solutions for all these concerns within easy reach of your business

Presented by:

Shelby Mendez, DPT, PT, FAAOMPT, CSCS
Director of Therapy Operations,
East Florida

Michael Morgan, DPT, PT, OCS
Associate Director of Therapy Operations,
Arizona

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Opening

0:00-0:42

Hello, and welcome to the Concentra® webinar, Bring Employees Back to Work, Health, and Safety. Today’s webinar will be presented by Shelby Mendez, director of therapy operations in east Florida, and Mike Morgan, associate director of therapy operations in Phoenix, Arizona. At the conclusion of the presentation, we will have a 10-to-15-minute question-and-answer session with Mike and Shelby. You can submit your questions throughout the presentation to be answered during the question-and-answer session. They will answer as many questions as possible during the time allowed. A recording of the webinar and a copy of the presentation will be emailed to you after the webinar. You can review it at your convenience.

Shelby, Mike, we’re ready to begin.

Introductory remarks and agenda

0:57-2:01

Briefly, here is a look at the information we will be covering today.

As more businesses prepare to bring employees back to the workplace, we need to consider how the status of employee health has changed potentially over the last year or more. We will look at four areas of impact:

1. Post-Acute Sequelae of SARS-CoV-2, or persistent COVID symptoms after the virus has cleared. This includes both physical symptoms and new findings about neurological and psychological symptoms
2. A reduction in musculoskeletal health and potential increase in injury risk
3. A general rise in obesity and a decline in fitness and
4. Two forms of presenteeism you may confront in returning employees

In each case, we will suggest proactive occupational health steps you can take to mitigate adverse health impacts, as well as potential costs and injury risks. So, let’s begin.

Going Back to the Office

2:06-4:51

Going back to the office – something we’ve all been anticipating and hoping for. We’re actually getting close. I know in south Florida, we are definitely seeing an increase in traffic. So, it’s all good and exciting.

Next slide.

Many companies are accelerating plans for employees to return to work – many on a limited basis at first. You know, some at work and some still at home. We’re seeing a lot of businesses looking at an expected return date of Labor Day and some a little bit earlier.

In fact, Google – one of the first companies to send employees home when the pandemic began – is one of the first that’s calling employees back.

What’s has really changed? There are two big and very welcome changes.

First, we are seeing more widespread availability of COVID-19 vaccines and vaccine administration.

Second, many states are reporting positive progress more consistently than we’ve seen in the past in terms of a decline or at least a leveling of COVID-19 cases overall and a slowing or reduction of serious COVID cases and hospitalizations.

That’s very good news for all of us.

As we begin talking about returning to workplaces, it’s important to remember what hasn’t changed: the CDC’s recommended guidelines for protecting ourselves and others at work. Those are still in place and should be monitored very carefully. Those include:

• Stay at home when sick or if a family member or recent close contact has COVID-19
• Monitor your health and temperature daily
• Wear a mask
• Use social distancing to keep a six-foot berth from others
• Wash your hands
• Cover your cough
• Avoid shared objects and
• Clean and disinfect workspaces, surfaces, and objects frequently

The CDC strongly recommends that these practices continue in the workplace, even when you’re returning employees back to work. I can tell you that we practice this at Concentra. Everybody is monitored very closely, whether employees coming through the door, our own staff, and vendors, as well.

Next slide.

Post-Acute Sequelae of SARS-CoV-2 (PASC)

4:57-8:16

Post-Acute Sequelae of SARS-CoV-2 or PASC is the clinical term for the persistent, long-term COVID-19 symptoms that you may have heard the media refer to as “long COVID.”

In clinical circles, PASC is the accepted way to describe symptoms that may last for weeks or month after a person who contracted COVID has cleared the virus.

These symptoms can include:

• Severe fatigue
• Shortness of breath
• Cough
• Joint pain
• Chest pain
• Muscle pain
• Headache
• Rapid heartbeat
• Loss of smell
• Hair loss
• Rash
• Difficulty thinking or remembering

A new study published in the journal The Lancet Psychiatry found that 34 percent of COVID-19 survivors were diagnosed with a neurological or psychological condition within six months of their COVID infection. The most common diagnosis was anxiety, found in 17 percent, followed by mood disorders in 14 percent.

So, if your employees are experiencing PASC symptoms, they need to be monitored and addressed in a clinical setting, whether their own primary care provider or one of our nearly 520 Concentra medical clinics nationwide.

The Centers for Disease Control and Prevention (CDC) also uses the term “post-COVID conditions” to describe health issues that persist more than four weeks after being infected with the virus that causes COVID-19. Experts do not know why or how often some people experience post-COVID conditions. Other infectious diseases also have been associated with longer term symptoms for a variety of reasons, so this is not unheard of. Several multi-year studies are underway to investigate post-COVID conditions.

Beyond steps to prevent COVID-19 infections – like masks, social distancing, and sanitizing workstations, many employees remain fearful about returning to the workplace. So, how can we help employees ease back into work?

The presence of an onsite clinic can support resumption of business operations by:

• Easing employees’ fears
• Providing worksite access to knowledgeable medical experts
• Conveying an ongoing message that their employer cares about them
• And, finally, if any of these symptoms arise, the employee easily get an initial consultation without leaving work to go to a family doctor

Onsite clinics are available in a variety of staffing and service models to meet most budget needs. Onsite program pricing does not go up as the number of employees visiting the clinic increase, so you can’t lose by providing an onsite clinic to support employees through this vital transition back to the workplace.

Musculoskeletal Health and Injury Risk

8:21-20:22

Next, we’re going to talk about what happens to employee health, injury rates, and your costs when musculoskeletal health and fitness decline in your workforce, as can be expected after a year of pandemic lockdowns and reduced physical activity.

Let’s look first at what happens when fitness levels are reduced.

A large research review of 66 studies involving almost 90,000 people appeared in the journal, BMJ Open Sport & Exercise Medicine. Researchers found that COVID-19 lockdowns significantly reduced physical activity with concurrent increases in sedentary behavior or sitting.

Reduced physical activity is detrimental to employee health because physical activity is associated with health benefits. For example, aerobic activity, like running or playing ball, benefits heart and lung function, as well as overall health. Other kinds of activity increase strength, flexibility, and balance – all very important attributes for employees in the most physical jobs.

Please note, researchers found that even people highly dedicated to physical activity, such as elite cyclists, reduced their physical activity during lockdowns, even while increasing time spent in endurance training.

The fourth point on our slide is an important one, too. Physical activity has been found beneficial for people with serious or chronic medical conditions like heart disease or diabetes. During the COVID-19 lockdowns, people with medical conditions also reduced their physical activity and that has two impacts – not just for their level of fitness but also the status of their pre-existing health condition.

Specifically, the lower back is one of the most injured body parts and this often leads to chronic pain. Lower back injuries account for high absenteeism, medical costs, disability, and lost productivity.

COVID-19 lockdowns, in addition to reducing physical activity, also increased low-back pain for adults between the ages of 18 and 64. The greatest increases in low-back pain intensity were found among adults between the ages of 35 and 49 with:

• Obesity (body mass index ≥ 30)
• Higher levels of stress
• Non-ergonomic working conditions
• Extended sitting times
• Low levels of physical activity

So, as you can see from this slide and the prior slide, all of these things really have to do with a decreased level of activity. We have seen low fitness and an increase in pain intensity from COVID-19 lockdowns. Let’s tie what we’ve learned back to musculoskeletal injury rates at work.

Here’s a little bit more research for you. A lot of research demonstrates a correlation between reduced fitness and an increase in injury. One study involved firefighters.

Firefighters tend to be physically fit. They need to be obviously for the demands of their job. So, you might think, well, all firefighters are fit so they have minimal injuries, right? That’s not what the study found.

Even in a population where all members are fit, those individuals with the highest levels of fitness, or the greatest aerobic capacity, tended to have the fewest work-related sprains, strains, and other musculoskeletal injuries.

Over the five-year study, two thirds of all injuries were sprains and strains. Thirty percent of injuries led to lost time on the job.

The study produced these important findings:

1. Risk of injury was 2.2 times greater for the least fit firefighters compared to those with higher fitness.
2. Lower fitness resulted in injury an average of two years before more fit firefighters.
3. Lower levels of fitness increase the risk of microtraumas. Microtraumas are injuries in the muscles, ligaments, vertebrae or discs that can arise from repetitive motions;  for example, lifting several times a day or poor mechanics. They seem minor but they are not allowed time to heal. Microtraumas not given proper attention can result in more serious injuries.
4. And, last, the study found that when injuries did occur, the firefighters who were the least fit required more time to heal or recover than more fit firefighters.

How fit were your employees before the pandemic lockdowns, isolation, and work from home? I would say it’s probably likely they will be returning to work with less fitness than before. We’ve seen that lower levels of fitness have significant effects on musculoskeletal injuries. Let’s wrap up this section by looking at how musculoskeletal injuries can impact costs.

Next slide.

Even before the pandemic, the costs of musculoskeletal injuries were high. Musculoskeletal injuries are the single largest category of workplace injuries and are responsible for almost 30 percent of all workers’ compensation costs. Direct costs of musculoskeletal disorders are estimated to be $50 billion, with indirect costs up to five times higher.

A few more quick facts:

Musculoskeletal injuries account for 30 percent of days away from work – that was in 2018, so pre-pandemic.

Retail, manufacturing, health care, and social assistance account for 50 percent of all musculoskeletal injury cases.

It’s easy to see that musculoskeletal conditions are an immense challenge for work-related health and safety and for your efforts in holding down costs and keeping productivity strong.

You’ll very likely want occupational health support for musculoskeletal conditions and to prevent these costly types of injuries as employees return to the workplace post-pandemic.

One of the best solutions, as we will see, is an athletic trainer, a medical professional that remains largely unknown in many industries despite making substantial contributions to work-related injury prevention to end the old repetitive cycle of work injury.

The skill of athletic trainers in the sports world has come to the factory floor, the construction site, warehouses and distribution centers, and in the field along power transmission lines and oil rigs. The idea here is getting employees back into work with the support of an athletic trainer, just as professional athletes have that support on the field.

The value of the athletic trainer in preventing injuries and helping employers hold down OSHA is not their only compelling feature as we emerge from the pandemic. The services of an athletic trainer cost less – much less – than many other options you might explore.

If your budgets are feeling pinched because of shutdowns and partial reopenings, take time to talk with an occupational health expert about how an athletic trainer may help you.

So, there are other options:

Pre-employment functional testing gives a clear, quantifiable view into an employee’s capabilities to handle specific job-required tasks. These assessments are carefully designed based on objective measures of job tasks. They may be used for pre-placement assessment or for acute, post-injury return-to-work assessments to make sure those employees are truly ready to come back to work and aren’t at risk for a work injury.

Musculoskeletal screening:

• Can be for new hires, annually, or episodically
• Can be based on a musculoskeletal scoring system commonly used in police, fire, military, and athlete populations or can be simple movements tests such as a sit-and-reach, shoulder scratch test, and so on
• May include numerical rating of strength, flexibility, and balance followed by customized consultations to work on and influence the deficits in these areas
• Proactive approach instead of waiting for an injury to happen

Early reporting programs allow for earlier identification of musculoskeletal vulnerabilities and these programs help reduce the cost and duration of recordable injuries. Early reporting programs include direct symptom evaluation, first aid-level interventions, and medical assessments. They may include an incident investigation, work task and medical review, work rotation planning, and education.

Regarding pre- or intra-shift exercise programs, the Centers for Disease Control and Prevention said in 2021 that worksite exercise programs – regardless of size, resources, setting, or type – provide a lot of different benefits, including:

1. Lower direct costs linked to health care expenses
2. Increased productivity
3. Reduced absenteeism
4. Increased morale and
5. Lower risk of diabetes, heart disease, stroke, some types of cancer, and depression

So, as you can see – with folks working from home or not working at all – the pandemic has increased the risk for some musculoskeletal injuries, but there are different options you can utilize.

And now, I will turn it over to Mike Morgan to speak about obesity.

Rise in Obesity

20:25-26:33

Thank you, Shelby. We’re going to turn to obesity – obviously not a new problem but one that has been exacerbated by COVID-19 effects and the response to the pandemic. New research has come out showing that 61 percent of Americans say they have put on some weight over the last year or so. This has been caused most specifically by:

• Lockdowns
• Stress
• Limited physical activity
• Time spent in non-ergonomic home workspaces

In the next slide, we’ll look at new research that makes this connection.

In the academic journal, Nature, researchers recently reported that measures used to slow the spread of COVID-19 – including lockdowns, social distancing, and isolation of millions of individuals – combined with stress and economic hardship – are likely to lead to increases in obesity and changes in metabolic health.

This is due, in part, to:

• Altered eating behaviors
• Stress-related changes in the body’s neuroendocrine systems and
• Stress-related changes in how the brain maintains systemic homeostasis, or the body’s “steady state”

• The prospect of a higher prevalence of obesity following the pandemic is a concern because of what we know about:
• Pre-pandemic obesity rates
• A frequent comorbidity of obesity and serious chronic disease and, most important to many of you,
• he impact of obesity on workers’ compensation costs and injury rates

Let’s drill down into each of these points in the next couple of slides.

The rise in obesity pre-pandemic was certainly not a pretty picture, as you can see here. Obesity has been a serious problem in the United States for years. The prevalence of obesity has been steadily increasing for more than 20 years.

• In 1999, about 30 percent of adults were obese.
• By 2017-2018, that number grew to more than 42 percent.

This slide shows a breakdown of obesity by age group. No age group escapes the burden of obesity. Young adults ages 20 to 39 have a 40 percent obesity rate, which rises steadily and is close to 45 percent at middle age, and then there is just a very slight decline to 43 percent at age 60 and over.

Across the board, obesity prevalence is 40 percent or more, and this data is pre-pandemic.

So now we are looking at several of the common comorbid conditions associated with obesity. First, there are serious diseases like heart disease and kidney disease.

Obesity is also associated with:

• High blood pressure
• Type 2 diabetes
• Sleep apnea
• Depression and anxiety

So what if this shows up in the workplace? Research also demonstrates that employees who are overweight or obese commonly face a higher risk of injury at work.

• These employees are 1.4 times more likely to have a back injury than normal-weight employees.
• They are over 1.5 times more likely to experience all other types of musculoskeletal injury.

Next, let’s look at what obesity means in terms of your direct and indirect costs.

Looking at the work-related cost of obesity, researchers examined more than 86,000 claims from January 2010 to March 2017, using Optum Health data.

Their research rolled up the impact of obesity related costs for:

• Health care
• Workers’ compensation
• Absenteeism
• Disability

Direct and indirect costs per patient per year were 188 percent higher for employees with obesity compared to normal-weight employees.

Researchers also found that employees with obesity were more likely to be among the 20 percent of employees with the highest healthcare costs compared to normal-weight employees.

If your workforce is affected by obesity – which likely it is – and if obesity increases as a result of the responses to the COVID-19 virus over the last year, which likely it will, this is something we all want to get ahead of. Acting proactively can help you avoid high costs like these, as well as higher injury rates associated with obesity. So, what can you do and how can occupational health experts help you?

Let’s look at the next slide.

For new hires and when bringing back an entire work classification (all employees in the same job) after an extended absence, return-to-work or fit-for-duty physical exams are an option.

• A standard return-to-work physical is a good fit for employees in non-safety sensitive positions.
• For employees in safety-sensitive positions, a fitness-for-duty physical is an option and could include functional testing and drug/alcohol screening services.

Employees with obesity or any of those comorbid conditions we talked about can receive information on the health impacts and guidance from a clinician.

Next, this is an ideal time to brush off your employee awareness campaigns to encourage good health and physical activity – or to initiate new outreach efforts if you have not done a campaign like this in the past.

Make employees aware of the need to reset their focus on their own health and well-being – beyond the COVID-19 considerations of the last year. You may even decide to initiate on-site exercise programs. But I want to caution you to take a phased approach. You can look at this article, “Help Employees Snap Back from Sedentary Time.” It’s very important after long sedentary periods to go slow in resuming exercise. Don’t begin a new exercise routine in extremely hot weather; and start with easier exercise. Hold off on the “no pain, no gain” approach for a while as you get a sedentary population back into exercise programs.

Next, I am going to talk a bit about two forms of presenteeism.

Two Forms of Presenteeism

26:35-28:53

Besides being fearful of COVID-19 infection, employees may also be fearful that, if they don’t return to the workplace, they may lose their jobs. The fear of economic loss could lead to a growth in presenteeism.

Presenteeism is defined as employees habitually coming to work when sick or injured. Research has shown there are at least two forms of presenteeism.

• In the first type, an employee goes to work when ill out of feeling pressured by heavy job demands, including excessive workload, understaffing, required overtime, or now, because of the pandemic, simply the need for businesses to accelerate operations back to pre-pandemic levels.
• The second type and, perhaps, not seen as frequently, occurs when an employee is highly committed to a company and/or highly engaged in their work.

As mentioned, job insecurities and economic circumstances may motivate more risk-taking and presenteeism among employees than you have seen previously.

What can we do about this?

The implementation of telemedicine and its popularity have soared during the pandemic. This is one of the very positive trends to come out of the pandemic experience. More employers and employees have now gained experience with telemedicine than ever before. Some of the past hurdles to acceptance, adoption, and implementation have disappeared.

You can take advantage of this energized interest in telemedicine to combat presenteeism. Telemedicine can address this issue in three ways:

1. Clinicians accessed through telemedicine can support the vital need to stay home when ill and present the risks of not doing so.
2. Telemedicine removes the time and complexity of making an appointment and traveling to a physician’s office.
3. Telemedicine can be accessed at home and avert a potentially infectious employee from coming to the workplace.

An occupational health expert is a tremendous partner to help Bring Employees Back to Work, Health and Safety – whatever issues you may be facing:

• Obesity and reduced fitness
• Issues of musculoskeletal health
• Employee fears
• PASC symptoms
• Presenteeism

Occupational health providers have the solutions you need to help restore the levels of workforce health and safety you have worked so hard to maintain over the years.

Occupational Health Solutions Summary

28:56-30:54

Now, I am going to summarize how occupational health can help you. During today’s presentation, we’ve mentioned several solutions from occupational health that can facilitate a safe and healthy return to work for your employees who have been laboring in alternative arrangements, working from home, or furloughed since the start of the pandemic.

Here is a quick recap. We covered:

• Guidance on COVID recommendations from the Centers for Disease Control and Prevention (CDC)
• Physical exams at Concentra medical centers to diagnose and provide ongoing monitoring and treatment of persistent COVID symptoms after the virus has cleared
• Onsite programs – available in a wide range of models for all needs and budgets – to help ease employee fears about returning to work and giving them easy access to a knowledgeable medical expert
• An athletic trainer – as a standalone service or as part of an onsite program to address risks of musculoskeletal injuries before they occur
• Return-to-work and fitness-for-duty physical exams to assess health status where appropriate and legally permissible – some great options as you return your workforce
• Informational campaigns to employees to encourage physical activity, good nutrition, and wellness
• Encouragement of phased exercise programs and inter- or intra-shift exercise programs
• Telemedicine, to provide employees support for their health without losing undue productivity and
• A host of employer-based health support, including:
  • Pre-employment functional testing
  • Musculoskeletal screening
  • Early reporting programs

As you can see, occupational health is ready and able to support you and your employees as we all get back to the high levels of business activity we enjoy and need.

Thank you for your attention, and now we have time for a few questions.