Can technology speed the return to office post-COVID? Is contaminated office air conditioning a COVID culprit?

Most offices in the US are still not open or only ‘essential personnel’. As this Editor noted on 19 May, a number of companies, including startups, are focusing on working with employers on return-to-work strategies. There are a raft of approaches including on-site clinics, temperature screening checkpoints, and check-in/reporting apps from Verily (Alphabet) and Fitbit’s Ready to Work. These screeners generally monitor for self-reported symptoms, but some will advise and track you to testing if you demonstrate risk, such as UnitedHealth Group and Microsoft’s ‘ProtectWell’ with a closed loop of testing recommendations that are reported to the employer. Collective Go from Collective Health goes a bit further in emphasizing up-front (molecular [PCR]) testing and continuous employee monitoring into their protocols for, apparently, every worker. OneMedical, which works with 7,000 employers, adds to their on-site management and testing additional contact tracing. FierceHealthcare

Maybe it’s in the air-conditioned air you breathe? Office building air circulation may be a culprit in the spike in Florida, Arizona, and Texas cases. The uptick in cases in Southern states where the contagion rates were initially fairly light may be due to the mostly recirculated air in office air conditioning systems. Most modern buildings don’t have windows which open. Older buildings have their own problems like mold from leaky systems and ‘soot’ (from air pollution and when people used to smoke in offices, remember when?). Newer LEED buildings are so ‘tight’ and energy efficient that air tends to be stagnant. Few buildings have good ratios of air exchange with the outside plus use HEPA filtration throughout the HVAC system. The total picture is that any virus can make its way through offices–six feet of distancing, masks, sanitization, no cafeterias, and acrylic panel separators be d****d.  (Contrast your average office building with modern commercial aircraft where about 50 percent of air is recirculated at any one time, there’s a total change about every three minutes, and HEPA filters are used! AskThePilot, a great site for all things airline)

A return-to-work readiness strategy suggested here by a Harvard Medical epidemiologist whose main area is TB spread are germicidal UV lights high in the room to catch the viruses that go up, then down. UV light for sanitization and disinfection is a technology used for several years to disinfect patient care areas (PurpleSun is one). Far-UVC, versus near-UVC, and potential uses are outlined in this Nature article from February 2018Harvard Gazette

WOT with Proteus found equal to or better than DOT in TB medication adherence trial

Implications for administration of tuberculosis and other rigorous therapies. A test conducted by a California university team with tuberculosis (TB) patients comparing Wirelessly Observed Therapy (WOT) administered through Proteus Digital Health’s combination ingestible pill and sensor-based smartphone tracking, versus standard Directly Observed Therapy (DOT), found that WOT was equivalent to DOT in accuracy–and superior to DOT in supporting confirmed daily adherence to TB medications. It was also overwhelmingly preferred by participants. 

TB is a disease where treatment requires strict adherence to medication protocols over a lengthy treatment course and usually requires a period of direct observation of patient dosage. In the first part of the test examining accuracy under direct observation, the researchers reported a 99.3 percent rate of positive detection accuracy (95% CI, 98.1% to 100%) among 77 TB patients under treatment with IS-Rifamate. The second part of the study among 66 patients took place in a randomized control test. The Proteus WOT system was found superior to DOT in supporting confirmed daily adherence to TB medications during the continuation phase of TB treatment by 93 percent to 63 percent. The treatment course was as long as 29 weeks. Participants rated preference for a WOT system at 100 percent.

The study was performed by researchers from the University of California, San Diego, Stanford University, HHS and Orange County Health Care Agency and published in PLOS Medicine on 4 October. The team recommended that a WOT system like Proteus be used within high-burden TB settings in low and middle-income countries, especially as it can be monitored seven days a week versus a standard five days.  Mobihealthnews