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Reopening Your Small Business: Advice From Epidemiologist Dr. Kavita Trivedi

Reopening Your Small Business: Advice From Epidemiologist Dr. Kavita Trivedi

Update: 2020-09-01
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As many restaurants and offices prepare to reopen their doors, it can be very tempting to simply resume “business as usual.” However, while the number of COVID-19 cases are certainly in decline, this health threat is still far from over and business owners need to continue enforcing the proper safety protocols if they want to protect their employees and customers. In this episode, Jon Aidukonis and Gene Marks along with special guest and epidemiologist, Dr. Kavita Trivedi, examine which precautionary measures you need to implement before you reopen your small business.



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Executive Summary


0:46 —Today’s Topic: How Do I Keep My Small Business Safe Once We Reopen?


2:23 —The most effective masks are those which you can comfortably wear throughout the entire day without moving them.


5:23 —Small business owners need to carefully consider the logistics of their building or operational facilities. Having a clear understanding of your building’s sanitation, ventilation and screening practices will make it easier to develop a set of appropriate safety guidelines.


6:58 —You also need to make sure that your office layout is equipped with internal barriers to further prevent the spread of any possible contagions.


7:57 —In order to maintain your current client base, your customers need to see your staff actively demonstrating proper safety measures, such as wearing masks and maintaining social distancing.


11:09 —Prior to their return, employees should practice all the new safety strategies at home so that they can implement them at work.


13:28 —Your employees also need to be comfortable enforcing all these new protocols when they are with their fellow coworkers and clients, even if they are met with resistance.


15:09 —Face coverings will not only help protect you, but also all the people you interact with.


20:01 —If you decide to purchase face masks for your employees, it helps to offer a variety of masks so that they can use one that is most comfortable for them. In addition, you should require employees to have a minimum of three masks that they clean and can rotate throughout each week.


26:38 —For liability purposes, business owners should reach out to professional safety consultants to ensure that their facilities are as safe as possible.


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Transcript


Gene: Hey, everybody. This is Gene Marks. Welcome back, and welcome to The Hartford Small Biz Ahead podcast. I’m here, of course, with my cohost, John Aidukonis. John, hello to you.


Jon: Hey, Gene. How’s it going?


Gene: We’re doing well. We’ve got a full, packed segment here that we want to talk about. Obviously, this is very, very relevant stuff. We have Kavita Trivedi joining us. First of all, is it Dr. Trivedi?


Kavita: Yes, it is.


Gene: Okay. Well, I’m going to call you Kavita if that’s okay with you, but just want to be official that it’s Dr. Trivedi. Kavita is the president of Trivedi Consults, her own consulting firm. She’s an attending physician at San Francisco Veteran’s Hospital and a consultant for World Health Organization. Kavita is an epidemiologist, which I think seems to be a position very much in demand in 2020. Kavita, thank you very, very much for joining us. If I can ask you, just how long have you been practicing?


Kavita: Yeah, so I’ve been practicing as a physician for 17 years and I have been in public health for the last 13 years, and my consulting business has existed for the past six years. I have a quite a bit of experience in both public health as well as epidemiology and certainly infection control, which is of course the topic of the day at the moment.


Gene: Yes, it is. Here’s my second question. You wear a mask, right?


Kavita: Absolutely. Yes, I do.


Gene: Before we actually get to the particulars of running a small business, I’ve just got to ask you a question about the masks. What are your recommendations? My wife and I have been through like 15 different types of masks, the cloth ones, the disposable ones. So far, my favorite one is made by the Hanes corporation. I feel kind of weird wearing a mask that’s made by the same company that makes my underwear. Do you have any recommendations for people when they’re buying masks?


Kavita: Let me just explain the science here for a second too. You know, we recommend face coverings. I call them face coverings and not masks, just because the community is wearing them and they can look very different from one another. They can wrap around your ears as opposed to have straps all the way on the back of your head.


What we’re trying to do with the face coverings is we are trying to decrease the amount of virus in the environment. What happens with this virus and many other viruses is that people cough or they talk, and the virus travels in droplets, respiratory droplets, both in your mouth and out of your nose. Then when they get into the environment, they can evaporate. When they evaporate, they become smaller. When they’re smaller, they stay in the environment for longer. Whereas if they’re on these larger droplets, they drop.


That’s the reason we ask people to wear your face coverings. I think early on in this pandemic, we asked people to really just wear them indoors, but now we are also recommending them outdoors just for this exact reason, because you’re trying to decrease the amount of virus in the environment that people are in.


Then in terms of which face mask or which face covering, honestly, it really is whatever face covering you can keep on for the duration that you are outside or inside a small space. It doesn’t really matter what type of mask you’re wearing, as long as you’re covering your nose and your mouth. It’s not helpful to keep moving the mask around your face. We have a lot of people that move it down off their chin. I do think that there’s some difficulties when we talk about eating and drinking, because you obviously have to move the face covering for that.


Generally, you really shouldn’t be touching the mask. You don’t want to be touching the mask at all. Really, whatever face covering is good for your face. Everyone’s ears and head shapes and the distance between their mouth and their chin is different. I would recommend people buying a few different ones and seeing which one they can keep on their face for the longest period of time without touching it, is the mask that I recommend for each person.


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Gene: Okay. Let’s turn to business now, right? Kavita, so our audience are small business owners. People are trying to reopen their businesses. People already have businesses that are open, but they’re trying to operate them safely. As you know, the information out there sometimes is inconsistent. Sometimes we’re hearing conflicting information, and both John and I wanted to give you the opportunity to talk as an epidemiologist, somebody who does this for a living. Put yourself in the shoes of a small business owner. Tell us everything we need to do to run our businesses as safely and healthfully as possible.


Kavita: Sure. I’m going to cover three different topics that are important for people to consider and think about. One is the buildings that these small businesses are in. I have a lot of clients whose businesses are in buildings where there are multiple businesses or there are landlords, and it’s important to understand the facility in which your business is operating.


You want to understand what the screening protocol is for coming into the building. You want to understand what the ventilation and filtration or the HVAC system is in the building, what precautions the building, the landlords, are taking in terms of ensuring, for example, that in the bathrooms, windows are left open and trash cans are in the right place, that hand sanitizers are all over the building and that are adequate and that are filled.


Then, of course, you want to learn about cleaning and disinfection. You want to understand what cleaning and disinfection products are being used, are they active against the coronavirus, and how frequently the building is being cleaned and disinfected. I think there are a lot of questions to sit down and talk with the landlords about, about infection prevention and cleaning and disinfection and ventilation.


The other thing in terms of buildings that we are advocating for is making sure that our office layouts are appropriate for this new normal that we’re in right now. I mentioned already that face covering is very, very important in any indoor environment, but then the other thing we talk about are barrier controls.


We’re talking about plexiglass and face shields, so a way that, if it is in the environment, a way that the virus doesn’t move around the environment. Talking with your landlord about if that is a possibility, to insert plexiglass in specific areas of a small business, I think that’s really important. Yeah, the first topic I would address, or not just the first, but one of the topics I think that is important to address, is the issue of building maintenance and cleaning and disinfection.


The second topic I would say it’s important for small business owners to consider is how they can make customers, clients, visitors feel safe, right? When I go to a small business, any business in my community, I really like that they are saying that they are adhering to safety protocols and policies, and that I see their employees wearing face coverings and maintaining distance and all of those things. I think it’s important for us to show our clients that we understand the virus and that we are humbled by the virus, and we are doing the best we can in terms of keeping them safe and our visitors safe.


The kinds of things I’m talking about here are screening protocols, right? You really don’t want your employees or your staff or clients and visitors to come into your business if they are having any symptoms consistent with COVID-19. That is important. I think making sure that everybody understands that, that this is not going to penalize them from coming into work or from coming and having an interaction with you face to face.


Then, considering how much of this can be done virtually is certainly a new era that we’re all in, and whether or not we should continue that and whether or not you can continue that I think is something to also consider. Really thinking through how to make your clients, customers, employees, staff, feel safe in this environment I think is extremely important, and really believing in your sick leave policy and believing in your screening protocols, so that people are not exposed to one another in the workplace.


I’ll emphasize you do not want to be the small business and the story in your local newspaper about an outbreak of COVID-19, right? We don’t want that to happen, but even more importantly, you really want your staff and your employees to know that you’re looking out for their best interests and their family’s best interests.


I will note that just because you are interacting with others in the workplace doesn’t mean that you’re just exposed to them. You’re actually exposed to everyone else they are exposed to. This concept of us and who is us in this context is really broad, right? It’s not just the people that you interact with in the workplace and just the say 10 of you. It is actually all the family members and all the households of all those 10 people that are being exposed to one another.


The growth of this virus is not linear. It’s exponential. One person can potentially infect multiple people. Out of those people, many people may be okay with the virus, but there may be one elderly individual, one person with an underlying health condition who has a bad outcome, and that’s what we’re trying to prevent.


Kavita: Okay. First thing we talked about is facilities. Second was clients and really employees, and the third thing is implementation. We can have all the safety policies and all the protocols we want. When people actually wear the mask or the face covering, they put it on their chin, or when they get into the office, they don’t wash their hands. Or when you’re having lunch with someone, you’d like to interact the way you did before coronavirus, and so you sit close to each other and you don’t have these coverings on, right? Implementation is extremely, extremely important.


It’s an area that I focus on with my clients. How do you get people to do the right thing, right? I mean, the classic case for us in epidemiology is handwashing. We’ve been talking about handwashing since the 1930s, right? We’ve been talking to people about, “Please wash your hands after interaction on public transportation or after interaction with other people.” Just now, you’re really seeing people start washing their hands.


I traveled back from Geneva early in March, right when this started in the U.S. and I was really impressed to see people in the airport washing their hands so diligently. I’d never ever seen that. I’m always looking for it, because I am an epidemiologist and we try to get people to be conscious of their hand hygiene.


I do believe people are conscious of this sort of thing right now. It’s the problem of trying to get them to continue to do it, right? Trying to get them to continue to do it, continue to be diligent, continue to wash their hands effectively, continue to wear their face covering. It’s trying to get people to continue to do these things long-term, because unfortunately, I do think we were probably going to end up with these behavior changes for the longer term.


In terms of implementation, I recommend things like before you decide to reopen and you’re coming back to the office, have a day where everybody at home wears a face covering all day, and they conduct their business with a face covering on and they practice to see what that’s like. Maybe they realize after a few hours they don’t like that face covering. Maybe they realize that they’re not wearing it the way that is most effective for them. Those types of exercises before they come to the office, where the stakes are of course higher, are highly recommended in terms of implementation.


Also I recommend telling employees and staff, and of course visitors and customers, what you expect of them before they come to the office or before they come to the business, right? You want your employees and staff to understand. “This is what we are recommending. These are the policies we’d like you to implement, and this is what we expect.” Then also, having somebody in the office feel comfortable saying, “Hey, you’re not wearing your face mask. You need to make sure to wear it,” and have that be openly known that that will happen in order for everyone to feel safe.


Because I do feel as though we all have to understand that we’re in this together as a community, as a workplace, as all these households, and we’re simply trying to protect one another. Yeah, so facilities, client interaction, customer interaction, and then finally implementation.


Gene: That’s great. Kavita, we had a problem with the recording. Can you start on this from the very beginning? I’m just kidding. We got it all. We didn’t have any problems. It was a great explanation and really, really great content. John, I know you’ve got some questions. Go ahead.


Jon: Yeah. Kavita, I think it starts with the notion of a mask, right? I think that there’s so many people who look at the mask or the face covering as a symbol of themselves, but just to validate it with someone who knows this, it’s really so we’re protecting others, right? Wearing a face covering isn’t about me, John. It’s about me, John, not giving the virus to you, Kavita, or limiting the amount of spread I could contribute to potentially giving it to you.


Kavita: Right. As you know, the public health messaging around face covering has really changed during the pandemic, which it has changed because the science is changing, right? In the beginning, you heard, “No one wear a face mask, leave them for the healthcare providers.” Then as we moved along, we, “Oh, no, wait, everyone needs to wear a face mask, especially indoors.” Then we had the politicization around it, right?


Now, currently, the thought has evolved even further, where in the middle of the pandemic, we definitely said wear the face mask to protect other people from your droplets if you are sick, and remember, with this virus you could be asymptomatic, right? You can have the virus, not know you have the virus, and when you talk, when you cough, clear your throat, you’re actually emitting droplets into the environment. Yes, that is a reason to wear the face mask.


However, now we are finding that if you wear a face mask, you, John, wear a face mask and you do not have the virus, right, and other people around you are not wearing a face mask and they have the virus, you will potentially have a less-severe course of disease if you are exposed to the virus. People that wear face coverings themselves have a lower inoculum of virus, a lower viral load. Therefore if they get the virus, it most likely will be asymptomatic or just a very mild case.


There actually are two reasons now to wear the mask. You want to protect others from your droplets, but you also want to help alleviate symptoms in yourself if you are exposed to virus from somebody else.


Jon: That’s really interesting, because I do remember in the very beginning of when it became really pandemic status in the U.S., right, so back in March where they were seeing some of those instances where healthcare workers were more likely to have more severe cases. There is a correlation between the amount of exposure and the severity of the case, it sounds like, or potentially.


Anything any of us can do to not eliminate but to mitigate, it could potentially result in either a more positive outcome for us as an individual or our communities, which if we can get ourselves there, is ultimately the best thing for the economy, because then people can be a little bit more comfortable in, one, the right things to do, but also engage in commerce because they have the right protocols in place. It’s not really this A or B, do we focus on health or economic challenge. We kind of have to address both together to get through this.


Kavita: Right. If I may, since I’m a doctor, I like to talk about we talk about sex. One of the things that we talk about is when HIV started, when we started seeing HIV, we weren’t telling people, “Stop having sex.” We were saying, “Just use a condom,” right? This is very similar, actually, where we’re saying we’re not telling you not to interact.


We’re actually not telling people to do that. We’re not telling people to stop working. We’re not telling people to stop engaging in their livelihoods. We’re just asking them, “Can you do it with a face covering?” Which certainly is different from last year, right, certainly different from the way we interacted in 2019, but it is a very low-budget thing for people to do that can get everyone back to work and feeling safe around one another.


Again, you’re protecting that one person in your larger group who happens to have an underlying health condition, who takes care of an elderly parent. I mean, those are the people that we’re most concerned about. I’m not saying that young people can’t get this as well, they can, but we are very, very concerned about those people in our circles, and wearing the face covering is a very cheap way for us to get back to work and help protect one another at the same time.


Gene: Kavita, I have just a two-part question for you. The first is that, listen, you’re an epidemiologist. You studied this for years. I’m sure you’ve studied. You’ve studied the history of pandemics like this, and clearly there have been many in the past. I mean, back in 1918, people were wearing face masks. You said that the science was kind of slow. We’ve been through different iterations since the coronavirus has been spreading.


Question number one is why do you think it took so long for the medical community to tell us what to do with face masks? Why wasn’t it just, from day one, “Guys, here’s the playbook, everybody’s got to be wearing a face best right away, because we’ve got thousands of years of history that tells us that”? Then my second part of the question is actually more relevant to business owners now, which is if I’m a business owner and I want to buy a face mask for my employees or help them procure them, what specific face mask? What are the do’s and the don’ts of face masks? N95s, handkerchiefs? Anyway, let me ask you to just tackle the first part first.


Kavita: Yeah. I mean, I think early on in the pandemic, we were very concerned about our healthcare workers. When there are aerosol-generating procedures, that is where an extreme amount of viral load is in the environment. Still our healthcare workers are the ones that are at most risk, even to this day. I think early on, because the supply was limited, that’s why we heard don’t wear face masks in the community.


I think that was different from 1918, because we didn’t have N95s back then. I think the concern was, if everybody wears an N95 in the community, then we’re not going to have enough for our healthcare workers, who are the ones that need to be wearing those N95s, right? I think that was what was the concern early on.


Then I think science is science, where things are changing. What’s relevant three months ago, or certainly what’s relevant in a different country, is not necessarily relevant here in the United States in 2020. We need to see cases and case studies of what works in our situation, so it’s relevant to our current practices. We have seen that now, and we can say that people are protected when they wear the face mask. We also can say that you’re protecting your community when you wear a face covering.


My favorite story thus far is … I’m sure you all read this in the paper about a month ago, about the two hairstylists in Missouri. The two hairstylists in Missouri, who actually did have COVID and didn’t know it yet, were cutting people’s hair. They ended up cutting 140 clients’ hair. As you all know, when you cut someone’s hair, you are obviously in close contact with them. However, in this situation, the hairstylists all wore face coverings, and they asked all of their customers to wear face coverings as well.


In this situation, everybody was wearing a face covering, right? Nobody got the virus, of any of those clients. My understanding from the paper that was published just a couple of weeks ago is that everyone was within this close contact, obviously less than six feet of distance, for greater than 30 minutes. What’s interesting about that is none of those 140 cases, people, got the virus, but in one of the homes of the hairstylists where the hairstylist did not wear a face covering, the whole family got it.


These studies are just showing us that if we adhere to face coverings now, in this age with this particular virus, we can limit the spread. I think those situations, Gene, are really, really helpful with us promoting the use of face coverings, because obviously it’s not part of our current culture. I think once those cases were more elucidated, I think people felt more comfortable saying, “Hey, we really know that this is protecting you and protecting others, so we really, really recommend you all wearing face coverings.”


Unfortunately for many people, the science is going to continue to change, so our recommendations will continue to change. Then in terms of your second question, wait. It was about business, right?


Gene: Yeah. Really I got the message that we should be wearing face coverings. Obviously that makes sense. Just bottom line, what should we buy? What do we get for our employees and for ourselves?


Kavita: Yeah. I’m not a big fan of the bandanas, only because I don’t think that they actually can stay on your face for very long. There are a number of companies out there that have various two-ply cloth face coverings. I would say if I were a small business, I would ask … and I guess I am a small business, I just am all remote … but I would recommend that people buy various face coverings, and offer their employees a number of different face coverings to see which one works the best for them.


Then I also would suggest having three face coverings, I think at the minimum. We are recommending folks wear them all day and then launder them at night. If you have three, you can rotate through. That’s an easy way to just do laundry every couple of days. At least three face coverings per individual. We even have some small businesses that have a face covering for every day of the week, so there’s a separate one.


I do not like any face coverings with exhalation valves. I do not recommend the N95s for community mass wearers. I don’t think that we actually need that. It’s actually really kind of uncomfortable to wear the N95s for a long period of time. I just don’t think those are very effective in this situation. Any face coverings that go around your ears that are relatively comfortable to talk in, but that are fitted, that go around your chin, that are flush with your face, those are the kind of face coverings that I would recommend.


Jon: I think this is all really great information. I could go on for hours, because I have questions on things like testing and how often should you get tested if you have the means to, because I do think, Kavita, you’ve made a really good point that you’re saying the science is changing. What I want the listeners to get too is that doesn’t mean it’s inaccurate. I think that what we need to be really clear on is that science and statistics are a numbers game, so you really need the volume and the information to have that final authority on this is what works. I try and explain it almost is evolving as we learn more.


Yeah, I think this has been great. I think, as confusing and complicated as the past couple months have been, it goes back to a couple key things, which I think is keep it clean, right? Wash your hands. If you’re going to use gloves, use them properly. Wear face coverings. Respect the distance and try and limit any unnecessary physical interactions. I don’t know, maybe we could do a follow-up conversation in a couple of weeks when things start to change again, but it’s been great hearing from you and just reaffirming some things that are out there, and giving a little bit of color as to why they work or why we should do our best to adhere.


Kavita: Right. I would say, just in closing, John, that I would recommend people find the help of an expert, an epidemiologist or someone else who understands this, because the direction coming from our public health departments and various government entities can be confusing. There are various guidelines. It’s hard to know what to focus on. I would just say try to reach out to somebody that you trust, that you know understands this material, to help guide you if you have questions, because I do think you don’t want to shoot from the hip with this. You want to make sure that what you’re doing, especially in a small business, is sound and makes sense for the moment.


Absolutely the science will change. It will continue to change, because there are 4,000 papers published on COVID-19 every week. The science is continually changing, and it should change as we learn more about the virus. People have to understand too that there should be some amount of flexibility with understanding that the science will change. What we’re doing now may be drastically different in a few months, but I still think the pillars of prevention, as you already highlighted, John, are face coverings, physical distancing, hand hygiene, and cleaning and disinfection. Those are really our pillars of prevention, and will likely be that case even six months down the line.


Gene: Kavita, before we let you go, though, your consulting firm, which is trivediconsults.com … and it’s consults with an S … that is what you do, I’m assuming, correct? I mean, so you are, I’m assuming, one of a number of growing small consulting firms that are advising businesses big and small on best practices for having a healthy environment. Is that correct?


Kavita: Yes. Yeah. My focus is on antibiotic stewardship and infection control, and of course the infection control piece has become quite popular in the last three or four months. Yeah, so we are helping businesses, organizations, law firms, agencies, youth community centers, and we’ve had so many different groups reach out and ask for guidance on best practices. Yes, that’s what me and my team are currently doing and guiding folks on right now, yeah.


Gene: Just as a final word, if you’re a small business owner listening to this and you have those concerns, hiring a firm like Trivedi Consults seems like a very prudent thing to do nowadays, not only just because it’s a best practice and the right thing to do, but from a liability standpoint, I think it’s very helpful to document what you’re doing and have outside experts. Some people might say, “Well, it might be cost prohibitive,” but I would imagine that you can be joining up with other people in your community, other business owners in your association or in your chamber of commerce, and sharing the costs of sharing the knowledge of an expert or an expert firm to come in and do that kind of consulting.


Kavita, thank you. It’s Kavita Trivedi at Trivedi Consults, T-R-I-V-E-D-I consults.com. Great information. I do agree with you, John. We should definitely have Kavita back. Thank you so much, Kavita, for spending your time. For more tips and advice on running your small business, please visit us at www.smallbizahead.com. Great conversation we’ve had. Lots of more good information coming on the way. Thanks for listening.


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Reopening Your Small Business: Advice From Epidemiologist Dr. Kavita Trivedi

Reopening Your Small Business: Advice From Epidemiologist Dr. Kavita Trivedi

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