Let’s talk about comorbidities. A comorbidity is the simultaneous presence of two chronic diseases or conditions in a patient. In the case of COVID-19, certain comorbidities are known to increase one’s risk for a more severe illness.
According to the CDC, people with any of the following underlying medical conditions are at increased risk for severe illness from COVID-19:
Cancer
Chronic kidney disease
COPD (chronic obstructive pulmonary disease)
Immunocompromised state (weakened immune system) from solid organ transplant
Obesity (body mass index [BMI] of 30 or higher)
Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
Sickle cell disease
Type 2 diabetes mellitus
Additionally, people with any the following might be at an increased risk for severe illness from COVID-19:
Asthma (moderate-to-severe)
Cerebrovascular disease (affects blood vessels and blood supply to the brain)
Cystic fibrosis
Hypertension or high blood pressure
Immunocompromised state (weakened immune system) from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, or use of other immune weakening medicines
Neurologic conditions, such as dementia
Liver disease
Pregnancy
Pulmonary fibrosis (having damaged or scarred lung tissues)
Thalassemia (a type of blood disorder)
Type 1 diabetes mellitus
What does this mean for you and your employees? It means that for the duration of this pandemic, you likely need to maintain two sets of work rules—one for employees with comorbidities and one for those without. Employees with one of the listed underlying disabilities (or pregnant employees) might need an exception in an in-person work requirement or attendance policy, a separate work area, or more frequent breaks to remove a mask.
It does not, mean, however, that you can force or mandate a separate set of rules on disabled or pregnant employees who do not request them. The law does not allow employers to impose paternalist policies on these employees. In fact, the workplace discrimination hate paternalism. Good intentions do not excuse discrimination. An employer acting from a place of good intentions to protect disabled or pregnant workers from a potentially deadly exposure of COVID-19 is still discriminating if that’s not the employee’s choice. Only the employee can make that choice.
There is increasingly a greater understanding that one’s work life impacts their personal life and vice versa. The two do not exist in separate bubbles.
Adverse childhood experiences — potentially traumatic events that occur in childhood — can impact how people cope with stress, how their brains develop and how much risk they have toward certain health issues, according to the Centers for Disease Control and Prevention. ACEs include violence, abuse and growing up in a family with mental health or substance use problems. While 61 percent of adults in the U.S. have at least one ACE, 16 percent have at least four.
Even though ACEs occur long before people enter the workforce, they’re still relevant to a person in adulthood. And employers can take certain steps to create a “trauma-informed workplace,” said Kate Daugherty, community impact director at Hopeworks. Education management company Hopeworks has been trauma-informed since 2012, and Daugherty leads the Youth Healing Team, which trains other organizations in how to have this culture.
The Youth Healing Team has led training for schools, health care organizations and nonprofits, but this type of knowledge is useful for people in any industry, Daugherty said.
The Youth Healing Team provided training for the city of Baltimore, which is now a trauma-informed city. Photo credit: Hopeworks.
The City of Baltimore had the team provide training on the weekend of Feb. 8-9, when Mayor Jack Young signed the Elijah Cummings Healing Act, officially making Baltimore a trauma-informed city. The bill requires the city to train employees on trauma-responsive and trauma-informed care and services.
City Councilmember Zeke Cohen sponsored the bill. Cohen, who is also Chairman of The Education & Youth Committee, recounted a mass shooting in his district, the First District, in which four people were shot and two people were critically injured. The mass shooting took place at 3:45 in the afternoon, when two different schools were dismissing. Many children witnessed the mayhem.
“The thing that was perhaps most disturbing to me is when I went to visit one of the schools the next day, there was no additional support. No clinicians, no crisis response team. It just happened,” he said. “And what we know about trauma and the brain is that unless treated, that exposure to violence can have an indelible impact on the long term health outcomes and well-being of young people.”
On another occasion, a group of high school students whose school recently had a school shooting approached the education committee and challenged them to work more on reducing trauma, Cohen said. The committee worked with the students on the bill to make Baltimore a trauma-responsive city.
Interestingly, Cohen said, one type of business helped create a groundswell of support for this bill: Barbers and beauticians. In some Baltimore communities, people of color distrust getting psychiatric care in the hospital or health care setting because of mental health stigma, Cohen said, and barbers have become the unofficial clinicians of these communities. They cut the hair of and have conversations with people who may be the victims or shooters in mass shootings.
The support of businesses like barbers and beauticians was important to the cause, Cohen said.
“Even if the bill is great, if we don’t have a groundswell of people and organizations standing with it, we’ll miss an opportunity,” he said.
Part of the training which Hopeworks provides organizations and the city of Baltimore is learning about buffering factors, Daugherty said
People with ACEs may develop coping skills that got them through traumatic times in the past, but those skills aren’t appropriate for a professional setting, she said. And employers shouldn’t demonize employees for their coping skills.
She gave the example of a Youth Healing Team employee who was a smoker. Upon talking to him, they found out that he liked having that opportunity to stop and breathe. The Youth Healing Team suggested that, when he was stressed, he try standing still and taking 10 deep breaths. Then, he could reassess how he was feeling and decide if he still felt like he needed to smoke.
“Sometimes it worked and sometimes it didn’t, but slowly over time we started to see that he needed to use that adverse coping skill less and less often,” Daugherty said.
Cohen stressed the importance of continued support of individuals, nonprofits and businesses if this bill that encourages Baltimore to train its employees to be trauma-responsive is to remain durable. Different organizations and nonprofits tend to operate in silos.
“What’s been gratifying to me about this work has been to have all these organizations working collectively. It’s been exciting,” he said. “It’s hard for a number of reasons for organizations to think about collective impact outside their own institutional needs.”
Long-distance trips may be something to boast about, with wanderlust-driven influencers posting perfectly filtered photos on their social media accounts. Work-sponsored road trips also may sound glamorous but workers should recognize the potential negative impacts of business travel on their health.
Frequent business travel is associated with poorer health outcomes, according to “Business Travel and Behavioral and Mental Health,” a 2018 article from the Journal of Occupational and Environmental Medicine. The analysis found that people who traveled more often for work were more likely to smoke, have trouble sleeping and show higher levels of anxiety and depression symptoms. The study concluded that “employers should provide programs to help employees manage stress and maintain health while traveling for work.”
Hal F. Rosenbluth, chairman and CEO of New Ocean Health Solutions, at one point hit the road every other week for work. Rosenbluth knows the challenges of regular business travel within the U.S. and abroad. For people who travel overseas, there’s “always the possibility of sickness or geopolitical events that require immediate attention and sometimes evacuation,” he said.
Medical and travel security services firm International SOS and medical insurance provider Geo Blue are among the options for these travelers. “I typically use it if I’m traveling to countries where medical care isn’t terrific or I’m out of the city somewhere where there isn’t a lot of care. If something goes wrong, I know I can have a plane or a helicopter get me to where I need to go,” Rosenbluth said.
Lengthy international trips may “cause a person to lack focus after arrival” and Rosenbluth recommends travelers delay meetings for 24 hours to recover from the flight and adapt to time changes.
Whether someone is traveling domestically or abroad, work-life balance may take a hit. Especially for people with young families, the partner who remains at home with the children may feel overwhelmed, Rosenbluth said, and that communication is important.
Business professionals informally polled on LinkedIn by Workforce had several suggestions to stay healthy while traveling for work and how employers can help.
Find quick, healthy grab-and-go options near the hotel to resist the urge to eat fast food.
Join a gym with multiple locations to use the membership while traveling.
Employers can maintain a company culture that stresses positive health behaviors like getting enough sleep and allowing people time to eat.
Reimburse reasonable wellness expenses for fitness classes in travel destinations.
Rosenbluth suggests that travelers exercise, which may be difficult if there’s no fitness center or if the destination poses a safety hazard for walks offsite. Business travelers also should be careful about what they eat and should carefully consider food safety.
The importance of good eye health is often underappreciated in the working environment. Many conditions or diseases of the eye — such as cataracts, disorders affecting the retina, dry eyes and uncorrected refractive conditions — can have a substantial impact on employee productivity and well-being. Fortunately, there is much that employers can do to maintain an eye-friendly working environment and promote eye health among their employees.
Most problems with the eyes occur gradually over time — so gradually, in fact, that people may not even attribute their problems to failing vision. Cataracts are a good example of this. The leading cause of vision loss for people over the age of 40, cataracts occur when the lens of the eye, normally clear, very gradually starts to become cloudy. Another condition associated with aging is presbyopia, which also develops slowly as the lens of the eye becomes thicker and less flexible, losing its ability to focus light onto the retina. The retina itself can break down over time, such as with a condition known as age-related macular degeneration, or AMD. AMD is another leading cause of blindness in older people.
Dry eye disease can also affect work performance. This occurs when there are not enough quality tears to properly lubricate the eye. As a result, eyes can become itchy, painful and irritated. Vision may become blurry or eyes may water excessively. Left untreated, dry eye disease can lead to damage of the cornea.
The effect of conditions such as these on work performance can be subtle at first. Employees may experience difficulty seeing and reading in reduced lighting. Driving in poorly lit areas can become increasingly challenging. They may find themselves unable to look at computer screens, read documents or do close work for as long as they used to without experiencing problems such as headaches or eyestrain. Glare from sunlight, overhead lighting or headlights may bother them more than before. The added effort and strain can make them feel sleepy or irritable.
Certain work environments can contribute to the development of eye disease. For instance, exposure to blue light from the screens of electronic devices or from prolonged exposure to sunlight from working outdoors without proper eye protection can contribute to the development of cataracts or AMD. Environments with diminished ambient humidity or prolonged computer use can contribute to symptoms of dry eyes. Overhead lighting or indirect sunlight shining on the work surface can also cause symptoms of dry eyes or eyestrain.
When doing their jobs, or simply being on the job site, causes increasing discomfort, employees may avoid work, or take more and longer breaks. They may not even realize their discomfort is due to eye issues. Many may attribute these changes to other health problems, such as depression or poor sleep, or they may chalk it up to losing interest in their work or simply getting older. If these issues are left unchecked for long enough, failing vision can lead to serious workplace accidents and permanent damage to the eyes may occur.
Addressing environmental contributors to eye disease and discomfort can help minimize the eye problems that affect work performance. Ensure that indoor air is clean and properly humidified. Evaluate lighting and determine what changes can be made to minimize glare on surfaces. Computers and other light-emitting screens can be fitted with filters that block blue light. Employees who work outdoors should be provided with proper eye protection, such as sunglasses that effectively block UV radiation.
But the most effective way of maintaining good eye health is by encouraging employees to undergo a comprehensive annual eye exam. This will identify problems early so that employees maintain a high level of job performance, the risk of accidents due to vision impairment is reduced, and eye conditions are treated promptly, possibly staving off permanent vision loss. An annual comprehensive eye examination may also catch conditions such as diabetic retinopathy, hypertension and vascular problems that can impact both eye and overall health long before the condition causes a vision symptom. People are three times more likely to get an annual eye exam than an annual physical, making the eye exam an even more important touchpoint between employees and preventive health care.
To encourage employees to undergo an annual eye exam, make sure that vision care coverage is included in their health benefits package. It can also be helpful to hold eye health awareness seminars or other events to teach employees about the importance of taking care of their eyes.
