INTELLIGENCE UPDATE Coronavirus Outbreak – March 10, 2020
TABLE OF CONTENTS CURRENT SITUATION │3 Travel and Health Advisory │3 Infections and Deaths by Territory and Country │4 U.S. Government Measures │7 Work Cancellations│7 Medical Services│7 Travel Restrictions│7 States of Emergency│7
Global and Special Territory Measures │8 Travel Restrictions│8
Virus Factsheet │8
BUSINESS RISKS │9 Business Continuity│9 Security Response Benchmarking │9
RECOMMENDATIONS FOR TRAVELERS │10 RECOMMENDATIONS FOR BUSINESSES │10 EMERGENCY CONTACTS │12
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CURRENT SITUATION As of March 10, 2020, the COVID-19 epidemic continues to show signs of slowing in mainland China, but infections are escalating in several other countries including South Korea, Japan, Iran, Italy and others. On March 7, the global number of confirmed cases of coronavirus passed a milestone of 100,000. The World Health Organization (WHO) said on Monday, March 9, that the COVID-19 outbreak is “very close” to becoming a pandemic. A “public health emergency of international concern” (PHEIC) remains in effect. In the United States, there are now 755 confirmed cases in at least 37 states, including the District of Columbia. The CDC has warned that sustained person-to-person infections are likely to continue to occur in the United States. Highlights: ▪
As of 9 a.m. ET on Tuesday March 10, there were 115,829 confirmed cases and 4,087 deaths. Italy (9,172), Iran (8,042) and South Korea (7,513) have experienced a surge in infections.
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114 countries, areas or territories have confirmed cases of infection. Some of the most recent have included Bulgaria, Costa Rica, Faroe Islands, French Guiana, Maldives, Malta, Martinique and the Republic of Moldova.
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On March 7, Italy recorded a dramatic 1,247 spike in new cases of infection. As the worst affected country in Europe, Italy has recorded 9,172 cases of infection and 463 deaths, the largest number of fatalities outside of mainland China.
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International travel restrictions are multiplying, with an increasing number of countries barring visitors from the worst affected countries, such as China, Italy, Iran, Japan and South Korea, as well as mandating quarantines for returning citizens.
Travel and Health Advisory U.S. government agencies maintain strict travel advisories for high-risk countries. ▪
The U.S. Department of State advisory remains at Level 4, Do Not Travel, for all of China. On Feb. 26, the Department of State also issued a Level 4, Do Not Travel, advisory for Iran. It advises that those currently in either country attempt to depart using commercial means, if possible. For those who stay, it advises following CDC guidelines and stocking up on food to limit movement outside the home. The CDC has issued a Level 3 alert, recommending the avoidance of all non-essential travel to China, Iran, Italy and South Korea.
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On Feb. 29, the U.S. Department of State announced Level 3, Reconsider Travel, advisories for South Korea and Italy. On March 6, Level 3 advisories were subsequently announced for Azerbaijan and Turkmenistan. A Level 3 advisory is also in effect for Mongolia.
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According to the WHO, at least 72 state parties have implemented restrictions on foreign nationals with travel history in China, South Korea, Japan, Iran and/or Italy. Many airlines have limited or suspended services to and from these countries.
The WHO risk assessment in Situation Report 48 published March 8 is as follows: China: Very High; Regionally: Very High; Globally: Very High.
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Infections and Deaths by Territory and Country The table below shows the latest number of confirmed cases of infection and death tied to the coronavirus by country, area and territory. Figure – Table of Infections and Deaths by Country, Area and Territory Coronavirus Outbreak Infection Numbers – 9:00 a.m. March 10 ET Total Confirmed Infections: 115,829 Deaths: 4,087 Recovered: 64,046 Total Countries, Areas and Territories with Confirmed Infections: 114 Country/Area/Territory
Infected/Deaths
Country/Area/Territory
Infected/Deaths
China
80, 756; 3,136 dead
Estonia
12; 0 dead
Italy
9,172; 463 dead
Albania
10; 0 dead
Iran
8,042; 291 dead
Macau
10; 0 dead
South Korea
7,513; 54 dead
Azerbaijan
9; 0 dead
Spain
1,500; 35 dead
Peru
9; 0 dead
France
1,412; 30 dead
Costa Rica
9; 0 dead
Germany
1,281; 2 dead
Hungary
9; 0 dead
United States
755; 26 dead
Latvia
8; 0 dead
Japan
530; 9 dead
North Macedonia
3; 0 dead
Switzerland
374; 3 dead
Slovakia
7; 0 dead
Netherlands
321; 4 dead
South Africa
7; 0 dead
UK
321; 5 dead
Mexico
7; 0 dead
Belgium
267; 0 dead
Maldives
6; 0 dead
Sweden
264; 0 dead
Belarus
6; 0 dead
Norway
227; 0 dead
Bosnia Herzegovina
5; 0 dead
Singapore
160; 0 dead
French Guiana
5; 0 dead
Austria
157; 0 dead
New Zealand
5; 0 dead
Hong Kong
118; 3 dead
Afghanistan
5; 0 dead
Malaysia
117; 0 dead
Dominican Republic
5; 0 dead
Denmark
113; 0 dead
Luxembourg
5; 0 dead
Bahrain
109; 0 dead
Tunisia
5; 0 dead
Australia
91; 4 dead
Bulgaria
4; 0 dead
Greece
89; 0 dead
Malta
4; 0 dead
Canada
77; 1 dead
Senegal
4; 0 dead
UAE
74; 0 dead
Serbia
4; 0 dead
Iraq
71; 7 dead
Bangladesh
3; 0 dead
Kuwait
69; 0 dead
Colombia
3; 0 dead
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Iceland
69; 0 dead
Cambodia
2; 0 dead
Egypt
59; 1 dead
Cameroon
2; 0 dead
Israel
58; 0 dead
Saint Martin
2; 0 dead
India
56; 0 dead
Faroe Islands
2; 0 dead
Thailand
53; 1 dead
Nigeria
2; 0 dead
San Marino
51; 2 dead
Morocco
2; 0 dead
Taiwan
47; 1 dead
Cyprus
2; 0 dead
Portugal
41; 0 dead
Martinique
2; 0 dead
Lebanon
41; 1 dead
Lithuania
1; 0 dead
Finland
40; 0 dead
Burkina Faso
1; 0 dead
Czech Republic
40; 0 dead
Channel Islands
1; 0 dead
Philippines
33; 1 dead
Saint Barthelemy
1; 0 dead
Vietnam
31; 0 dead
Monaco
1; 0 dead
Brazil
30; 0 dead
Mongolia
1; 0 dead
Indonesia
27; 0 dead
Togo
1; 0 dead
Palestine
25; 0 dead
Armenia
1; 0 dead
Slovenia
25; 0 dead
Ukraine
1; 0 dead
Ireland
24; 0 dead
Vatican City
1; 0 dead
Saudi Arabia
20; 0 dead
Liechtenstein
1; 0 dead
Russia
20; 0 dead
Panama
1; 0 dead
Algeria
20; 0 dead
Andorra
1; 0 dead
Oman
18; 0 dead
Gibraltar
1; 0 dead
Qatar
18; 0 dead
Brunei
1; 0 dead
Argentina
17; 1 dead
Moldova
1; 0 dead
Romania
17; 0 dead
Bhutan
1; 0 dead
Poland
17; 0 dead
Nepal
1; 0 dead
Pakistan
16; 0 dead
Jordan
1; 0 dead
Ecuador
15; 0 dead
Paraguay
1; 0 dead
Georgia
15; 0 dead
Sri Lanka
1; 0 dead
Chile
13; 0 dead
Croatia
13; 0 dead
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The map and chart below show the location of confirmed cases of infection and death tied to the coronavirus. Figure – Map and Chart of Confirmed Global Cases of Coronavirus
Source: Johns Hopkins Center for Systems Science and Engineering (CSSE)
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U.S. Government Measures On March 6, the U.S. government announced the allocation of $8.3 billion to combat the epidemic and preventive measures are continuing to escalate. Most state and local health departments are in the mitigation phase of responding to the outbreak, which includes conducting investigations into possible infections, establishing isolation orders and trying to disrupt chains of transmission. The state of epidemic response varies greatly from state to state. Clients are advised to research their own areas of operation and residence to ascertain the most accurate and up-to-date information. Work Cancellations ▪
Adjustments and cancellations to normal work and school schedules are growing throughout the United States. As with other epidemic countermeasures, these may vary significantly from place to place, and clients are advised to research their own locations.
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Schools and colleges in some areas, including the University of Washington and Stanford, have announced that the remainder of the semester will be taught online. Several other schools and campuses are expected to announce similar closures in the coming weeks.
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A growing number of employers have urged employees to work from home, including Microsoft, Google, Facebook, Amazon and Twitter, among others.
Medical Services ▪
Medical services are currently operating normally with no signs of strained capacity.
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Many hospitals are starting to adjust their epidemic preparedness and response plans to take into account a potential heightened need for specialized equipment and the possibility of outsourcing patient services to off-site facilities, among other measures.
Travel Restrictions ▪
The U.S. Department of State advisory remains at Level 4, Do Not Travel, for all of China. On Feb. 26, the Department of State also issued a Level 4, Do Not Travel, advisory for Iran. It advises that those currently in either country attempt to depart using commercial means, if possible. For those who stay, it advises following CDC guidelines and stocking up on food to limit movement outside the home. The CDC has issued a Level 3 alert recommending the avoidance of all non-essential travel to China, Iran, Italy and South Korea.
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On Feb. 29, the U.S. Department of State announced Level 3, Reconsider Travel, advisories for South Korea and Italy. On Mar. 6, Level 3 advisories were subsequently announced for Azerbaijan and Turkmenistan. A Level 3 advisory is also in effect for Mongolia.
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Beyond mandatory and voluntary quarantine measures in certain areas and cases, there are no government restrictions in effect for internal travel within the United States.
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A growing number of U.S. companies have cancelled all international business travel for their employees.
States of Emergency ▪
As of the evening of March 9, at least 10 states have declared a state of emergency, including California, Florida, Illinois, Maryland, New Jersey, New York, Ohio, Oregon, Rhode Island and Washington.
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Global and Special Territory Measures Preventive measures taken by the international community also continue to escalate. Travel Restrictions ▪
Airports across the world have introduced enhanced screening measures to prevent the further international spread of the disease. According to a report by the WHO, at least 72 state parties have implemented travel restrictions on foreign nationals who have been in China, Italy, Iran, South Korea and Japan. Although specific regulations may vary, foreign nationals are typically barred entry if they have been to these countries within the past 14 days upon arrival at customs. At least 43 airlines around the world have suspended flights to China, Italy, Iran, South Korea and/or Japan. The WHO is working on recommendations for resuming flights.
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There are travel and public transit restrictions of various degrees throughout China. If traveling, clients are advised to research their route and destination to ascertain up-to-date information. In addition, travel has been limited between the mainland and other Chinese territories. Hong Kong and Macau have announced temporary bans on travelers coming from Wuhan or Hubei. Authorities in Hong Kong have announced the temporary closure of 10 of its 14 border crossings with China and a halt to the issuing of travel permits for mainland Chinese. There is a mandatory quarantine on anyone arriving from mainland China, Italy, South Korea and Iran for 14 days, and flights to the mainland are greatly reduced.
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Italy, the worst hit country in Europe, on March 9 extended travel restrictions from the northern region to encompass the entire country, limiting the free movement of approximately 60 million people. Police are enforcing quarantine restrictions and imposing fines on anyone who attempts to violate of evade the measures. Residents are required to have special passes if they wish to travel internally within the country.
Virus Factsheet Key aspects of the Wuhan coronavirus, or “2019nCoV,” are still relatively poorly understood. The following information is derived from WHO Situation Reports and other sources: ▪
Incubation Period: 1-14 days, but generally 3-7 days. Recent research by a Chinese team found that the incubation period could be as long as 24 days. The Hubei government has said the incubation period could be as long as 27 days, based on data from one case. According to the WHO, the median incubation period has been further refined to 5-6 days.
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Severity: Most people display relatively mild symptoms. Current estimates suggest that about 15% progress to severe disease with 3% becoming critical, including pneumonia and respiratory failure. The mortality rate for confirmed infections is about 2%, with some experts expecting this number to fall as milder cases are found. However, these preliminary estimations should be treated with caution. The mortality rate of seasonal flu is below 0.1%. According to a WHO statement on March 9, more than 70% of coronavirus cases in China have recovered.
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Transmissibility: The virus is human transmissible. Recent research by Chinese scientists supports asymptomatic spread and concludes that the virus behaves similarly to the flu, suggesting that it may spread more easily than previously thought. Chinese researchers have documented the case of a woman who spread the virus to five family members without showing symptoms herself. In Chengdu, a recovered patient was readmitted to hospital after once again testing positive for the virus (an earlier test may have been a false negative). On Feb. 22, Wuhan subsequently mandated a 14 day quarantine for all patients cured of the virus. The reproduction number of the virus, expressed as “R0” (R-naught), which indicates how many additional infections will result from each infection, remains uncertain. In a disease with a value R-naught = 1 each infection would be
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expected to cause one additional infection; the WHO published an estimated R-naught of 1.4 to 2.5, although some teams have placed this number higher. o
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Routes of transmission are believed to include respiratory droplets and close physical contact. It is also likely that the disease is transmissible via contact with contaminated surfaces, where the virus may survive for some time. There is little evidence of transmission via the fecal-oral route. There has been some misinformation that the virus may be able to spread long distances through the air. This is false.
Treatment: The only proven available treatment for the disease is standard supportive care. There is anecdotal evidence that anti-viral and AIDS drugs may be useful in treating patients, but these treatments have not yet been validated.
BUSINESS RISKS Business Continuity The coronavirus outbreak presents a heightened business risk environment for multinational corporations and others operating in China, Iran, Italy, South Korea, Japan and elsewhere. The introduction of quarantine measures and travel restrictions present a significant business continuity challenge for businesses dependent on person-to-person services and transactions, such as those operating in the tourism, hospitality, retail, retail-based financial services and banking sectors, among others. In addition, the closure of production facilities and travel bans are creating supply-chain challenges and logistical problems for the transfer of goods, equipment and the ability for employees to reach their places of work. Clients are advised to remain up to date with national and local regulations related to the crisis, and to note that measures adopted by national and local governments may not be uniform. On a broader level, the coronavirus outbreak continues to take a toll on global markets. Amid market jitters caused by the outbreak, on March 9 the Dow experienced its worst day of trading since 2008. The global oil market also crashed, recording its worst loss in approximately 30 years and wiping billions from the market value of some the largest multinational oil and gas corporations. Whether planning to mitigate the heightened medical or business risk environment, companies — especially, but not limited to, those with a footprint in the worst-hit countries — should prepare for the crisis and its potential negative effects to be felt for months rather than weeks.
Security Response Benchmarking Multinational firms have begun adopting various policies in response to the outbreak, including the following: ▪
Restricting all non-essential international travel to China and other badly affected countries, or altogether.
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Allowing flexible working arrangements, including working from home.
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For employees returning from China and other badly affected countries, mandatory work from home for a set period, for example 14 days, to mitigate the risk of passing infection to other employees.
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Mandating that employees presenting flu-like symptoms obtain a diagnosis before returning to work.
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Some companies in badly affected European and Asian countries have introduced controls at work, including carrying out fever checks on employees at entrances and restricting guest access to company premises.
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A large number of major multinational corporations have closed their offices or suspended operations in mainland China and Hong Kong. In certain cases, these measures are also gradually being implemented in Italy, Japan and South Korea.
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In Germany, BMW mandated that 150 employees from its Munich, Germany, plant self-quarantine after an employee tested positive for the coronavirus.
RECOMMENDATIONS FOR TRAVELERS According to the CDC, travelers should avoid all non-essential travel to China, Iran, Italy and South Korea, and reconsider travel to Japan. If traveling to any of these countries, you are recommended to: ▪
Avoid contact with sick people.
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Discuss travel to with your health care provider. Older adults and travelers with underlying health issues may be at risk for more severe disease.
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Avoid animals (alive or dead), animal markets and products that come from animals (such as uncooked meat).
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Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
Those who have become ill during a 14-day period following travel to these countries should: ▪
Seek medical care right away. Before you go to a doctor’s office or emergency room, call ahead and tell them about your recent travel and your symptoms.
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Avoid contact with others.
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Do not travel while sick.
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Cover your mouth and nose while sneezing with a sleeve or tissue, not with the hands.
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Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
RECOMMENDATIONS FOR BUSINESSES According to the CDC, businesses are recommended to: Actively encourage sick employees to stay home ▪
Employees who have symptoms of acute respiratory illness should be recommended to stay home and not come to work until they are free of fever (100.4° F [37.8° C] or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants). Employees should notify their supervisor and stay home if they are sick.
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Ensure that company sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
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If your company uses vendors/businesses who provide contract or temporary employees, talk with them about the importance of sick employees staying home and encourage them to develop nonpunitive leave policies.
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Do not require a healthcare provider’s note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way.
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Employers should maintain flexible policies that permit employees to stay home to care for a sick family member. Employers should be aware that more employees may need to stay at home to care for sick children or other sick family members than is usual.
Separate sick employees ▪
Employees who appear to have acute respiratory illness symptoms (i.e. cough, shortness of breath) upon arrival to work or become sick during the day should be separated from other employees and be sent home immediately. Sick employees should be instructed to cover their noses and mouths with a tissue when coughing or sneezing (or an elbow or shoulder if no tissue is available).
Emphasize staying home when sick, respiratory etiquette and hand hygiene by all employees ▪
Place posters that encourage staying home when sick, cough and sneeze etiquette, and hand hygiene at the entrance to your workplace and in other workplace areas where they are likely to be seen.
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Provide tissues and no-touch disposal receptacles for use by employees.
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Instruct employees to clean their hands often with an alcohol-based hand sanitizer that contains at least 60-95% alcohol, or wash their hands with soap and water for at least 20 seconds. Soap and water should be used preferentially if hands are visibly dirty.
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Provide soap and water and alcohol-based hand rubs in the workplace. Ensure that adequate supplies are maintained. Place hand rubs in multiple locations or in conference rooms to encourage hand hygiene.
Perform routine environmental cleaning ▪
Routinely clean all frequently touched surfaces in the workplace, such as workstations, countertops and doorknobs. Use the cleaning agents that are usually used in these areas and follow the directions on the label.
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No additional disinfection beyond routine cleaning is recommended at this time.
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Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls and desks) can be wiped down by employees before each use.
Advise employees before traveling to take certain steps ▪
Check the CDC’s Traveler’s Health Notices for the latest guidance and recommendations for each country to which you will travel. Specific travel information for travelers going to and returning from China, and information for aircrew, can be found on the CDC website.
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Advise employees to check themselves for symptoms of acute respiratory illness before starting travel and notify their supervisor and stay home if they are sick.
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Ensure employees who become sick while traveling or on temporary assignment understand that they should notify their supervisor and should promptly call a healthcare provider for advice if needed.
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If outside the United States, sick employees should follow your company’s policy for obtaining medical care or contact a healthcare provider or overseas medical assistance company to assist them with finding an appropriate healthcare provider in that country. A U.S. consular officer can help locate healthcare services. However, U.S. embassies, consulates and military facilities do not have the legal authority, capability and resources to evacuate or give medicines, vaccines or medical care to private U.S. citizens overseas.
Additional measures in response to currently occurring sporadic importations of COVID-19 ▪
Employees who are well but who have a sick family member at home with COVID-19 should notify their supervisor and refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
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If an employee is confirmed to have COVID-19, employers should inform fellow employees of their possible exposure to COVID-19 in the workplace but maintain confidentiality as required by the Americans with Disabilities Act (ADA). Employees exposed to a co-worker with confirmed COVID19 should refer to CDC guidance for how to conduct a risk assessment of their potential exposure.
In addition to these recommendations, the CDC advises businesses to create an Infectious Disease Outbreak Response Plan. Guidance and considerations for creating a plan can be found here.
EMERGENCY CONTACTS G4S Risk Operations Center For questions regarding this report or for immediate assistance, please call: ▪
G4S Risk Operations Center: (866) 604-1226
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Alternate Phone: (866) 943-8892
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