Saturday, November 14, 2020

What keeps workers safe from COVID-19?

 

Workplaces address  COVID-19 infection risks by highlighting the hazards and implementing a hierarchy of controls.   Observing the strategies and tactics workplaces are actually using  can provide valuable insights and examples.





Science informs workplace safety and health.  Proven measures in the fight against COVID-19 include: physical distancing,

  • frequent hand washing,
  • not touching your face,
  • wearing a mask,
  • avoiding crowds, and
  • sticking to your immediate “bubble”.


The point of these measures is to keep concentrations of virus out of your airways where the disease takes hold.  


Everyone wants this COVID-19 infection threat to go away.   Until this hazard is eliminated, employers are required (by occupational safety and health authorities, public health orders, and the moral imperative) to protect workers and other persons in the workplace.  In the context of the COVID-19 pandemic, that means active measures to eliminate the workplace hazard or mitigate exposure and infection risk.


The Common Objective

Workplaces share a common objective in this pandemic: 

Prevent workers from contracting COVID-19 virus. 


Workers and other persons in the workplace are at increased risk when they occupy the same workspace, are in close proximity to others, or have contact with contaminated surfaces. 


“Close proximity” is a general term and not the same as the “close contact” term used by public health officials.  Just because you have been in close proximity to others does not make you a “close contact”.


Health Canada, for example, defines close contact for COVID-19 this way:

Close contact: Breathing in someone's respiratory droplets after they cough, sneeze, laugh or sing. [see Health Canada, Coronavirus disease (COVID-19): Prevention and risk] 

For contact-tracing purposes, the CDC uses the following definition of close contacts:

Someone who was within 6 feet of an infected person for a cumulative total of 15 minutes or more over a 24-hour period starting from 2 days before illness onset (or, for asymptomatic patients, 2 days prior to test specimen collection) until the time the patient is isolated. [See CDC, Contact Tracing Plan, Appendix A]


Close-proximity encounters may not meet the formal definition of “Close-contact” but being near enough to someone to potentially breath in their respiratory droplets does create a pathway for transmission.  Interrupting those transmission pathways is the priority. 


From research, experience, and incident investigations, we know this virus is most often transferred person-to-person by respiratory droplets (generated when we speak, sneeze, cough, sing, shout, laugh or talk); surface-to-person transfer of the virus occurs to a lesser degree and effectively controlled with sanitation and hygiene. Reported contact-tracing results have focused on person-to-person chains of transmission as the most common pathway.  Most workplace COVID-19 safety plan strategies and tactics are focused on this priority.   

 

Common Strategies

Workplaces are following eight main observed strategies:

       Keep workers FAR from hazard

       Distance workers and others from each other

       Reduce potential viral presence in workspace

       Eliminate close spatial contact

       Stop droplet exposure risk (non-medical settings)

       Stop droplet and viral particle transmission (medical and similar settings)

       Control close-proximity encounters

       Actively limit chains of transmission


This is not an exhaustive list and few organizations rely on just one strategy.  That said, each strategy has its own rationale, and each workplace develops or selects tactics that work best for that workplace. 


Observing the tactics—and how well they are implemented—illustrates what can be done to minimize workplace risks amid this pandemic. 


Strategy 1:  Keep workers FAR from hazard

If you live alone on an island, you have no direct risk of exposure to the virus.  Life is generally not like that; however, creating islands or “bubbles” that keep occupants far from the virus is a valid strategy that has been implemented with some success.


Work-from-home policies are now commonplace.  Working and living in your own bubble far away from potential sources of infection works well.  The recent National Hockey League (NHL) and National Basketball Association (NBA) playoffs demonstrated that large bubbles can also work.  On a smaller scale, the Villanova Nursing home is a great illustration of how bubbles in the healthcare sector.


The Vilanova nursing home - How workers and staff avoided the first wave

As the first wave of the virus swept across Europe, a nursing home in France locked down.  Over the next 47 days, 29 of the staff of 50 stayed with the residents day and night, sleeping on mattresses on the floor.  Other staff who came from the outside to assist were kept separate from the sequestered staff and residents; they also wore PPE.  In the beginning, residents were confined to their rooms while staff did a deep clean of the facility.  After that, the staff and residents mixed freely, maintaining morale and the mental health of all concerned.  [See The Associated Press, “How a nursing home in France stopped coronavirus from killing elderly in its care”, May 04, 2020 available at https://www.cbc.ca/news/world/france-vilanova-nursing-home-1.5554296 ]


Broken Bubbles:  The Melbourne Outbreak

Bubbles can work both ways:  to keep uninfected people in and to keep infected people from contacting others. Victoria, Australia is currently experiencing a second wave centred in and around Melbourne, the state’s largest city.  Beginning in May 2020, foreign visitors were required to quarantine in specific hotels for two weeks.  The mandatory quarantine was enforced by contracted private security guards.  The bubble in this case was for quarantined individuals. Within weeks, COVID-19 had spread in these locations among guests and the staff and guards charged with maintaining the quarantine.  Gene sequencing of the virus that has now spread widely in the state traces the origin back to the quarantine hotels.  The exact exposures that resulted in infection have not been formally reported but lack of training, lack of PPE, inadequate hygiene, breaches in protocols have been mentioned as probable contributing factors.  The premier of the state cited the sharing of a lighter among security guards and certain “carpooling” arrangements as examples that contributed to the outbreak, although more fundamental issues such as work insecurity and lack of clear lines of responsibility likely contributed.  [See   Ben Schneiders, “How hotel quarantine let COVID-19 out of the bag in Victoria,” The Age, July 3, 2020 at https://www.theage.com.au/national/victoria/how-hotel-quarantine-let-covid-19-out-of-the-bag-in-victoria-20200703-p558og.html]. 


[Note:  Australia clamped down hard on this outbreak.  As of this writing, no or very few positive COVID-19 tests are being recorded]


Like all the strategies for keeping workers safe, success is dependent on how well the supporting tactics are implemented and maintained. Maintaining bubbles is hard.  Staying home or working from home is hard.  Necessities such as groceries and medical attention may be sought remotely; realistically, most of us need to physically leave our homes for many purposes. Each time the bubble is breached, the risk of infection goes up.  That applies to everyone in the bubble.  Keeping bubbles small makes them more manageable but each time anyone in the bubble interacts outside the bubble, everyone in the bubble has increased risk.


Working-from-home policies do not fully insulate employers from workers’ compensation liability.  Work-related risks may still exist for every worker carrying out work, including COVID-19 infection risks and other risks associated with working from home, (e.g., workers’ compensation claim  by a worker who was injured while carrying personally acquired office furniture upstairs at home for employer approved work-from-home setup was allowed [State of New York Supreme Court, Appellate Division, Third Judicial Department,  530530, October 22, 2020].  Each time I open the door to sign for a courier delivery or leave my home to get work supplies, I am also opening the door to an interaction that carries risk.


Strategy 2:  Distance workers and others from each other

Keeping workers far from the virus is not a practical strategy for many workplaces.  Despite voluntary and ordered closures in many communities, enterprises deemed “essential” have remained open. Fire fighters, healthcare workers and police officers are universally accepted as essential. In my community, the list of essential businesses includes local hardware, drug, and grocery stores.  Many non-essential businesses including construction and retail have continued to operate during the pandemic (albeit with some restrictions). 


The main strategy implemented to keep workers safe in these environments are designed to distance staff and patrons.  In the local hardware store, the counters were widened overnight with improvised plywood sheets to ensure patrons and service staff had a six-foot or two-meter distance between them.  Monitors were in place at the grocery store to ensure capacity never exceeded the allowed set number.  Tape on sidewalks and markers on floors guided customers to maintain distances.  Directional arrows ensured aisles would not become congested (at least not with people facing each other and forced to pass within the required distance). 


Capacity limits may be mandated by public health.  Many restaurants and retail spaces are small and capacity limits are needed to allow for spacing between staff and patrons. 


Again, this strategy and associated tactics require active monitoring to be effective.  Coupled with other strategies and tactics, the risk of infection can be reduced.  The more space between workplace participants, the greater the protective effect.


Strategy 3:  Reduce potential virus presence in the workspace

Even with distancing methods in place, staff and other persons in the workplace may still be infected with Covid-19 and shedding the virus (often unknowingly while asymptomatic or pre-symptomatic). One observed tactic now in many workplaces is the presence (or increased presence) of sanitation stations.  At one roadside construction site, I saw a sink had been installed to a fire hydrant so workers could wash with soap and water more readily.  Several retailers have put hand-sanitizing stations throughout their stores.  The number of staff performing spot cleaning and sanitation duties is observably higher than ever.  In several large retailers, frequent public address system announcements to staff direct them to specific tasks like sanitizing their workstations or breaking to wash their hands.


The added costs of these measures are minor compared to the costs of lockdowns.  When outbreaks do occur, “deep cleaning” and sanitation of the workplace are implemented to further reduce the potential for any further infection even if surfaces were not the obvious or immediately identified source of infection.  In our community, the few incidents observed have resulted in short closures and a resumption of activities within a day. 


Visible signs of increased sanitation efforts and well stocked sanitation stations for customers certainly increases my willingness to visit certain businesses during the pandemic. That said, this strategy focuses on things, not people; it only works with other preventative efforts including distancing. 


Strategy 4:  Eliminate close spatial contact

Wider counters and capacity control tactics can distance workers from others in the workplace but much of service, sales and administration involves in-person contact.  A key strategy is to reduce the close spatial “pinch points” and hand-offs that are often required.  Home delivery and curbside pickup are common tactics that has been implemented to eliminate spatial contact.  Orders are placed online or over the phone and payment pre-arranged; patrons arrive and pick up orders already at or orders are delivered to the curb or doorstep. Restaurants, office supply houses, and petfood stores are among the stores in my neighborhood who have implemented these tactics. 


Our local library has implemented another similar tactic: choreography.  each patron approaches an outside window and holds their library card to the glass; a staff member scans the barcode from inside the library, retrieves the books and DVDs requested online.  Next, the patron steps back and the staff member places the order outside the door on a table then returns inside, allowing the patron to then come forward to retrieve the items being loaned.  This dance may be inefficient in terms of time but completely effective in eliminating close spatial contact. By the way, the staff member (wearing mask and face shield and sitting behind plexiglass) manning the door also asks each patron wanting to enter the library a set of COVID-19 questions, ensures mask use, and directs hand sanitization upon entry to the library.     


Eliminating close spatial contact works well for transactional operations.  When UPS recently delivered our new tablet, they skipped the signature requirement in order to eliminate the close spatial contact needed to sign the electronic delivery tracker.   Process design changes like these are likely to continue.  There may be some loss of service opportunities, queuing issues and time efficiencies of in-person close spatial contacts as a result of these tactics.


Strategy 5: Stop droplet exposure risk (non-medical settings)

The Covid-19 virus is primarily spread in respiratory droplets.  Well-fitting, non-surgical masks covering mouth and nose have been proven to reduce droplet transmission from the wearer and there is some evidence that they limit droplets from being inhaled by the wearer.  [see, “Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2”, CDC, Updated Nov. 10, 2020].


Facial shields prevent droplet splashes or projections from a cough or sneeze from reaching the wearer’s face (eyes, nose and mouth in particular).  Plexiglass and suspended plastic shields have a similar effect, and their height and width add distance between the point of droplet generation and possible exposure.  This does not remove the risk entirely. 


We know indoor spaces and spaces with poor ventilation allow droplets to travel further and remain afloat in the air longer than in outdoor spaces.  Increasing the ventilation by opening a window or changing external air mix in HVAC systems may be options (although more costly particularly in the winter season).  The US Environmental Protection Agency notes:


By themselves, portable air cleaners and HVAC filters are not enough to protect people from the virus that causes COVID-19. When used along with other best practices recommended by CDC and others, filtration can be part of a plan to protect people indoors. [see Air Cleaners, HVAC Filters, and Coronavirus (COVID-19), EPA webpage]

 

Tactics that rely on physical barriers degrade communications often required between workers or workers and others in the workplace.  In my community, I have seen both customers and employees bypass the barrier and work around the edge to speak with each other, thus defeating the purpose of the barrier.   


Again, this strategy does not work on its own.  Sanitation of barriers, capacity limits, and other measures are important. 


Strategy 6: Stop droplet and particle exposure risk (medical and similar settings)

Testing for Covid-19, transporting patients with the virus, and caring for them in hospitals and intensive care units are obvious examples of situations with elevated risk of infection.  In an environment with high potential for viral infection, more protections are needed.  Nurses, respiratory technicians, physicians, cleaners, and care aides put themselves in these high hazard environments every day. 


In a sea of known COVID-19 virus, stopping droplets and particles is hard.  The PPE, safe work procedures, supervision and training are among the most effective safeguards, barriers and defenses for keeping healthcare workers safe.  It is not just an N95 mask or a facial shield that achieves the objective; protection is achieved by multiple layers.  Each layer of protection has value but is not perfect. James Reason’s classic “Swiss Cheese” model provides an accessible, memorable metaphor for understanding how multiple layers work.  Active and latent defects occur in every barrier, but the multiple layers reduce the probability of these gaps aligning in such a way as to allow the virus to infect the worker. 


Just because there is a pandemic doesn’t mean that the rest of life stops.  People need blood tests, dental work, physiotherapy, and a range of medical and similar services that can only be given in close-contact care.  The risk in each situation must be assessed.  In many cases, several items of PPE may be required.  Achieving a safe work situation requires more than the provision of PPE.  The right PPE, supervision, training and safe work procedures are essential in these medical and similar workplaces.


The CDC includes consideration of increased ventilation and filtration in its guidelines for healthcare:

Optimize air-handling systems (ensuring appropriate directionality, filtration, exchange rate, proper installation, and up to date maintenance)....Consider the addition of portable solutions (e.g., portable HEPA filtration units) to augment air quality in areas when permanent air-handling systems are not a feasible option.

[Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic, CDC Updated July 15, 2020].


This strategy, like the others, has its limits.  It cannot stop workers from being exposed outside the work environment.  Reported cases of workers infecting each other in breakrooms and social events among their peers illustrate some of these risks. 

 

Strategy 7: Control close-proximity encounters

Close-proximity encounters with customers and co-workers are often unavoidable.  Passing people in a corridor, cooperating in a lift of a heavy object, or handing a receipt to customer involves close- proximity interactions.   Most such interactions are fleeting; risk increases with increased duration and closer positioning. 


Despite rules, procedures, and efforts to prevent them, close-proximity situations arise.  This is particularly true in manufacturing, construction, fabrication, personal services, and processing tasks where multiple workers must work closely for periods of time. 


After considering and implementing PPE and procedures, some companies are implementing technologies to help lessen the number and duration of close-proximity contacts.  Proximity sensors and apps on cellphones can alert workers when they are in close proximity to others.  Several sensors are in the form of wearable disks or tokens that provide light and/or sound cues when workers are within defined distances.  Enhanced versions can also track the identities of the participants and even their locations during encounters—factors that could be useful should the need for contact tracing arise. 


Several token-based products are directed more at industrial applications such as food processing and equipment manufacturing.  Safeteams technology implementation requires each employee to be issued a wearable fob.  The fob emits a light cue if a worker is near another worker.  “Beacons” installed in the workplace periodically communicate via Bluetooth allowing for mapping and contact tracing.   [See Mary George, Contact Tracing, Social Distancing Monitoring, and Other Technologies for Keeping Workers Safe, Food Industry Executive, 22 July 2020 at https://foodindustryexecutive.com/2020/07/contact-tracing-social-distancing-monitoring-and-other-technologies-for-keeping-workers-safe/ ]

 

Again, tokens or other monitors (including human observers) are not a complete solution.  A sensor chip is into a shield.  Like any protection, it has its limitations including how well users actually attend to the warnings emitted.  Other strategies and tactics including active supervision to ensure safe work procedures are followed are needed.   


Strategy 8: Actively limit chains of transmission

This strategy relies on frequent, wide or universal testing within the workplace, rapid results and rapid, thorough contact tracing with effective support for quarantine and isolation. Quickly identifying a workplace exposure to Covid-19 and stopping the transmission of the virus in a workplace is essential to safe work.  Procedures for rapid reporting and contact tracing within workplaces are essential to limiting chains of transmission.


This strategy is particularly applicable in natural resource and construction camps where accommodations are often closely spaced and food services are provided en masse.  Camps often operate in a sort of bubble but with rotating members.  The possibility of an infected worker entering the camp and unknowing spreading the virus puts all personnel at risk. 


To better manage this risk, New Gold Mining in Northern Ontario is now testing every employee for COVID-19.  New Gold has 150 workers in 14 day rotations entering the camp.  The company uses Precision Biomonitoring test kits at its River operations.  The battery-operated analysis device is about the size of a toaster and contains the necessary reagents and technology to analyze nine samples at a time and deliver results to a smartphone app in about an hour. Rapid identification of anyone carrying the virus allows containment of virus and protect other workers.  [see Sarah Bridge, Ioanna Roumeliotis, “Ontario mining company 1st to try new mobile test that diagnoses COVID-19 in as little as an hour,” CBC News, 11 August 2020 available at https://www.cbc.ca/news/canada/rapid-onsite-covid-test-1.5680526 ]


Rapid testing with rapid results is essential to limiting chains of transmission in the community.  That is why many jurisdictions place such an emphasis on contact tracing.  While smartphone-based contact-tracing apps are being implemented in many countries and some firms, not everyone has a cellphone and many who do have older ones that may not be compatible with the contact tracing app. 


Singapore was among the first to roll out a contact tracing app but privacy concerns and low uptake from the general population limited its use. Although migrant workers were required to download the app, large gaps in coverage made the app less effective.  Now Singapore is handing out small TraceTogether “tokens” to those without phones or reluctant to use GPS based technologies.  The battery-operated token is worn or carried in a purse or pocket.  It interacts with other tokens and smartphones with the enabled TraceTogether app.  In the event of a positive COVID-19 test result, the token can be turned over to public health contact tracers.  Close-proximity Bluetooth contacts over the previous 25 days stored on the device facilitate contact tracing.  [See Saira Asher, “Coronavirus: Why Singapore turned to wearable contact-tracing tech”, BBC Singapore, 5 July 2020 at https://www.bbc.com/news/technology-53146360 ]


Testing poses lots of questions: who to test, how often, how quickly can results be obtained, how reliable are the results, how are results communicated and to whom… Equally important is what happens next.  Without rapid isolation of positive cases and quarantine of close contacts, testing does not effectively break the chains of transmission. 


Many other strategies and tactics

This set of observed strategies and tactics illustrate what steps are being taken to protect workers, but these observations are illustrations not a comprehensive examination.  Organizations are innovating and implementing many other ideas to achieve the objective of keeping workers and others in the workplace safe from Covid-19 infection.  As our understanding of the virus, the sources of transmission and the means of prevention improve, strategies and tactics must evolve.


Most techniques rely on more than awareness of the hazard.  Managing this risk relies on training, supervision, and support.  Implementing broad use of PPE, for example, requires more than putting a box of masks and gloves on the breakroom table or a bottle of hand sanitizer in the lobby.


Strategies and tactics may be fine in the abstract but meaningless if not fully implemented. If the COVID-19 safety plan posted in most businesses is not being followed, everyone who engages in that workplace is at increased risk—a risk that they may unknowingly carry with them to their families and community. 


Almost all effective safety plans rely on more than one strategy and associated tactics.  Even in isolated bubbles, handwashing, testing, monitoring, and PPE are needed.  Multiple strategies may overlap but never think of that overlap as wasteful.  Safeguards, controls, and defenses are always subject to defects—latent or active deficiencies that can permeate allow the hazard a pathway.  Each additional layer of protection decreases the risk of harm. 


As you traverse your communities, engage in your workplaces, and patronize businesses observe the actual COVID-19 prevention actions being taken.  Think about the underlying strategies and how well the implemented tactics contribute to achieving the prevention objective.      


Final comment

All the signage, plexiglass, and PPE in the world will make a difference in the trajectory of this pandemic if there is no buy-in from workplace participants.  As a consumer, I now where a three-layer non-surgical mask inside all inside workplaces I visit.  I have walked out of businesses that are obviously exceeding their allowed capacity.  I have gone out of my way to engage in businesses visibly following and enforcing their own workplace COVID-19 safety plans.


The best strategies and most effective tactics will not work if they are not followed.  Complacency and failures to prioritize safety are the biggest threats to the success of any safety plan.  As a worker, supervisor, consumer or other person in the workplace, this is not just a matter of following the plan but helping others to maintain vigilance and compliance every day.  COVID-19 will be a risk in the workplace for months and months to come.  Despite the natural tendency toward fatigue, making the strategies and tactics in every COVID-19 safety plan part of the culture is the only effective way forward. 

 

 

 

Tuesday, August 4, 2020

Do employers need a workplace Contact Tracing plan or app?

If you are an employer, you have a positive duty to protect workers from harm.  Industry-specific guidelines on how to do that in the COVID-19 environment are now published by occupational safety and health organizations (such as  CDC, SafeWorkAustralia, and WorkSafeBC). The physical barriers, personal protective equipment, physical distancing, cleaning guidance and safe-work protocols required to discharge this duty are essential preventative measures. 


Prevention is rarely perfect.  The safeguards, barriers and defenses put in place to protect workers from harm may be subject to inadvertent active or latent defects;  despite multiple layers of precautions, when gaps or defects in prevention align, workers in your workplace may well be exposed to harms including the COVID-19 virus. 


Every jurisdiction has specifically emphasized employer responsibilities during this pandemic.  For example, consider this guidance to employers in Ontario:


The employer is required to take every reasonable precaution in the circumstance to protect the health and safety of workers, and do a risk assessment to determine what parts of the jobsite and what other workers the affected worker would have had contact with.


Based on this risk assessment, the employer may be required to:

  • send co-workers who were exposed to the worker home for two weeks. Ask them to self isolate and self monitor and report any COVID-like illness to their employer
  • shut down the job site while the affected workplace area and equipment are disinfected

[See Government of Ontario, COVID-19 (coronavirus) and workplace health and safety]


No employer wants any worker to be exposed to or infected by this virus; nor does anyone want to see operations shut down or healthy employees quarantined.  Yet, close contact exposures may occur in your workplace; planning for them can mitigate the impact on your employees and operations. 


Just the facts


The science around COVID-19 is still developing but there are four very important facts to keep in mind:

  1. COVID-19 is a respiratory illness contracted when virus particles are either directly inhaled from droplets expelled by an infectious person or indirectly transferred from contaminated surfaces to face, eyes, mouth or nose. 
  2. After unprotected close contact with an infectious person or contaminated surface, an exposed person’s symptoms may develop during an incubation period of 14 days, however, up to a quarter of those infected are asymptomatic. 
  3. An infected person is infectious to others during a communicability period; that period for those with mild symptoms begins two days before the onset of symptoms.  Infected persons are considered infectious until 10 days after onset of illness, as long as they are fever free and have improved. Those with more severe cases may be infectious until two consecutive negative laboratory test results, at least 24 hours apart, which could take weeks to establish.
  4. Just because a person is no longer infectious does not mean they are fully recovered.  Lingering symptoms including fatigue, cough, respiratory and neurological issues may persist. 


Exposure and Close Contact


Unless you are in the healthcare sector, you or your employees may not know when, where, or exactly how an exposure to COVID-19 has occurred.  It is very unlikely a customer will produce a sudden, uncovered cough or sneeze then announce, “I’m positive of COVID-19”.  (If that every happens, your response as an employer would have to be immediate).   More likely, an employee or public health contact tracer will report a close contact exposure, an illness suspected to be caused by the coronavirus, or a positive test result.  The actions you take next are critical to stopping the spread of the disease in your enterprise and the broader community.   


COVID-19 is a respiratory illness.  Your employee breathing in a quantity of droplets from an infectious person, for example, is certainly an exposure that may lead to the development of the disease.  The now ubiquitous plexiglass shields erected in workplaces prevent some of that, but surfaces, tools, and containers may become inadvertently sources allowing a worker to transfer virus particles to their hands then to their eyes, nose or mouth.  Just because a barrier is in place does not mean all potential contact in the workplace has been eliminated; nor do the precautions you take eliminate the possible introduction of the virus into the workplace by other routes. 


Workers may also be exposed to the virus outside the workplace and not realize they have been exposed. Crowded spaces like transit, house parties, and shopping venues have been identified as places where the virus easily spreads.  An employee may be exposed in any of these settings, become infectious, and expose others at work. 


You employees may be exposed at work or in the course of their employment.  It is not uncommon for a worker, customer, or other person in the workplace (such as a delivery person, courier, student, service technician, inspector) to begin to feel symptoms while at work.  Infectious persons (possibly asymptomatic or pre-symptomatic) in “close contact” with workers or customers may inadvertently and unknowingly expose others in the workplace. Definitions of “close contact” vary but if you work within two meters (6 feet) of another worker, customer, or other person in the workplace for fifteen minutes or more, you would likely meet the definition in most jurisdictions. 


Not all exposures or close contacts with a person who is infectious will result in illness. With the knowledge that some people are asymptomatic or pre-symptomatic but infectious, we now know that exposures to this virus may be more common and less obvious than in the above example.   In many cases, the first sign that one of your workers was exposed will be when they report being ill.  Where they were infected may not be obvious.  Their safety and health are paramount but beyond that, investigating the source of the exposure and protecting workers and others in the workplace must be your priority.


A Workplace Scenario


As an employer, you are likely to encounter a case of COVID-19 in your workplace at some point.  Whether or not an employee becomes infected in the course or employment, you are going to have to determine who came in close contact with a source of the infection (an infectious customer or co-worker, contaminated surfaces or discarded tissues used by an infectious person) , which employees should be quarantined, and when the diagnosed and quarantined employees can return to work.  Acting quickly is critical to stopping the spread of the virus and limiting the impact on operations.


Consider this scenario:


Anna and her two other team members worked in close proximity Monday to Thursday.  They did their best to keep physically distanced, but the nature of their work meant working side by side for periods of time.  On Friday morning, Anna woke with a dry cough, headache and fever.  She called her manager’s line and left a message regarding her symptoms; she then called her doctor who told her to self-isolate and immediately referred her to testing.  On the following Monday morning her test results were received:  positive for COVID-19.  After receiving the diagnosis and instructions from her physician, she called her manager with the news.


As Anna’s employer, you will be concerned for her.  You will also have concerns for your other staff and your production.  While it may not be clear if Anna contracted the disease at work, you have a duty of care for your other employees who were in close contact with her and others who may have been exposed through the immediate operational space.


When can my employee return to work?


In the above scenario, Anna will be told to isolate and will not be returning to work for at least 10 days from symptom onset. Isolation prevents sick persons from spreading the disease to others, including family members.  Isolation means not going out for food or entertainment and definitely not to the workplace.


If Anna is well enough and can work from home while isolated, that may be an option; she can’t end her isolation until she is no longer infectious.  The infectious period begins two days before the onset of symptoms and extends for at least 10 days even if symptoms subside.  Beyond the 10 days, isolation is required until the worker is fever free for three days and all other symptoms are resolving. 


Even though the isolation period may have ended, workers like Anna may need more time to recover from other symptoms to return to work. For some occupations, another test may be necessary to confirm a worker is no longer infectious.  Although no longer infectious, many who recover from COVID-19 experience fatigue and other symptoms that may delay a full, safe, and durable return to work.  Your “duty to accommodate” a worker extends to such cases. 


What about close contacts?


Remember, Anna was likely infectious for the two days prior to symptom onset.  It is likely her team members were in close contact with her during that time.  Cleaners, supervisors and others who visited Anna’s work area may have been exposed.  Perhaps she met with her manager or another team concerning the next project.  None of those employees may report being ill (or ill yet). 


The sooner well employees are informed of their exposure, the better the chances of arresting the spread of the disease.  As a precaution, workers with close contact should be told to self-quarantine for fourteen days from the date of exposure.  Quarantine is a means of restricting the contact and movement of a person who has been exposed; it prevents the spread of disease to others.  The following concisely describes what Anna’s close contacts will be expected to do 14 days from last contact with her:


  • stay at home and monitor yourself for symptoms, even just one mild symptom
  • avoid contact with other people to help prevent transmission of the virus prior to developing symptoms or at the earliest stage of illness
  • do your part to prevent the spread of disease by practicing physical distancing in your home

[see How to quarantine (self-isolate) at home when you may have been exposed to COVID-19 and have no symptoms, https://www.canada.ca/en/public-health/services/publications/diseases-conditions/coronavirus-disease-covid-19-how-to-self-isolate-home-exposed-no-symptoms.html]


Exactly how your enterprise will handle COVID-19 absence for those who must isolate or quarantine is up to you.  It may require amended sick-leave policies, new procedures for initiating quarantine, and even supports to enable quarantine to be effective.  Your quick action can prevent cascading exposures to other workers, their family members, and the broader community.  If Anna’s test results are negative for the COVID-19 virus, then her continued self-isolation and quarantine of her close contacts would not be necessary.


If informing employees waits until there is a positive test result, the implications may be more profound. The well employees may have returned to work on Monday morning but once Anna (or a public health contact tracer) makes you aware of the positive COVID-19 test, all employees having had close contact with Anna must quarantine for fourteen days following the last close contact.  The potential length of the quarantine does not change but the delay in starting their self-isolation raises the potential for Anna’s close contacts to unknowingly become infectious and infect others at work, home or in their community.    


In the scenario above, Anna experienced the first symptoms on Friday morning and got her test results on Monday.  That may be close to the ideal case.  Had she come to work ill, the potential for a wider exposure would expand.  The fact she stayed home and got her test result so quickly means she had limited contacts and the virus had limited opportunities to spread.  Co-workers with close contact would count their quarantined period from their last close contact.  Team member that worked with Anna on Wednesday or Thursday would count their quarantine date from their last close contact with Anna.  Hopefully, quarantined employees will not get sick but if they do, they will not spread the disease further.  Quarantined workers can return to work once the quarantine period expires if they are otherwise healthy and symptom free.


Can I leave identifying close contacts up to public health contact tracers?


Public health contact tracers have special training and knowledge to do their jobs but you, as an employer, have a duty to protect your workers.  As an employer, you have important information for contact tracers. You know your workplace and are in the best position rapidly identify close contacts.  Your attendance records, work schedules, employee contact information, building entry logs, and meeting minutes can help you rapidly identify close contacts and prevent wider exposure.


It may be that you as an employer will be contacted by public health with information that an infectious customer, technician or other person was at your workplace, raising the possibility of close contact exposure.   Your records of who was working with or serving that customer will be important to the contact tracer but also to your ability to fulfill your duty of care for your employees.  Remember, the faster exposures are identified, the sooner the spread of the virus can be halted; the impacts on your workers’ health and your operation’s production are limited the sooner you act.


Isn’t there an app for that?


Many countries and some employers are mandating or recommending smartphone apps or other technologies to facilitate contact tracing.  Korea, Singapore, the UK, Iceland, Norway and others have implemented programs with varying degrees of success.  The apps generally use Bluetooth technology to register either location and/or proximity to others with the app or tracking “token”.  If a person is identified as infected with COVID-19, the app can quickly identify others who may have had close contact during the infectious period. [see Ryan Brown, Why coronavirus contact-tracing apps aren’t yet the ‘game changer’ authorities hoped they’d be, CNBC, July 3, 2020].


These apps are not without controversy.  They only work well if widely enabled on many devices, so public acceptance (or government mandate) are required.  In Singapore, for example, temporary foreign workers are required to carry a tracking token and that interacts with the nationally mandated smartphone app (voluntary for citizens).  [see Saira Asher, Coronavirus: Why Singapore turned to wearable contact-tracing tech, BBC News, Singapore, 5 July 2020].  Not all smartphones are capable of handling contact tracing apps and those with greatest vulnerability such as lower income citizens and older individuals may not have access to the latest technology.          


Corporate apps are also available.  These may be adopted and mandate by a firm for employees but there are both privacy and efficacy issues.  Not everyone is OK with 24 hour a day GPS tracking by an employee or a government.  Questions about how data will be collected and used are often raised. 


Privacy issues aside, efficacy issues include the false positives of proximity.  Even if the app only measures proximity to another smartphone for a given period (say, 15 minutes), that may not mean any exposure has taken place.  Just because the agent renewing your insurance or the Uber driver were taking you to your appointment were close enough to register contact in a tracing app, the presence of a plexiglass shield  or divider will not be registered;  if either you or the other person is identified as infectious, the close contact warning would be a false positive.  The converse is also true; a missed close contact is like a false negative.  If an infectious person does not have the app or token (or the device is out of power or app not enabled), no close contact can be recorded.  Tracing apps cannot record proximity to environmental exposures and may yield a false sense of security.   These technologies cannot detect the virus; they only detect proximity (or location, in some cases).  


Take action now


Before COVID-19 hits your workplace, put your plans in place.  Besides doing what is necessary to comply with OSHA and public health orders or guidance, you need to have a plan for what to do when an employee or public health identifies a COVID-19 exposure or transmission. Your plan may include containment and decontamination teams, but you will need to address policy issues like when and how to isolate, deep clean and disinfect the area concerned.  Your personnel plan for containment, informing close contacts, supporting quarantine, isolation and return-to-work is even more important.  The speed and thoroughness of your actions to stop the chain of transmission is essential to the safety and health of your employees and others in your workplace.  With that in mind: 

  1. Prepare:  develop policies and procedures so staff know what to do if they feel ill and particularly if they are diagnosed with COVID-19.  Privacy laws and policies will vary so keep those in mind as you prepare.  Confidentiality is important and safeguards should be built into your policies and procedures. Involve staff and union representatives in your plan development. Consultation, addressing concerns, developing policies, and then training staff will challenging in the COVID-19 era but critical to your planning and preparation.   
  2. Update and keep current:  Where people work, seating floor plans, travel records and entry/exit logs need to be accurate and immediately available when required.  Meetings may not always have minutes, but every meeting should have a record of attendees, location and times. Update employee contact information for home, mobile phone numbers, and email.
  3. Operationalize your plan:  Assign specific resources to manage suspected or known COVID-19 exposures.  Delays in identifying close contacts can result in wider spread within your operations and beyond.  Having key resources familiar with operations and records, knowledgeable of your policies and equipped with the commensurate authority to act will be necessary.  Be sure to build redundancy into your plan. Your plan needs to operate even if the specific resources become ill or unavailable.
  4. Consult, train, build awareness:  Your operations depend on people.   The very steps necessary to limit the spread of COVID-19 and facilitate contact tracing need to be understood and concerns addressed in advance of any need.  Activity logs, attendance at meetings, entry and exit logs are necessary but concerns over why they are needed, how long they will be kept, who has access and the purposes allowed for that access need to be clear and understood.  Build awareness of your plans and why the procedures are needed to protect workers and others in the workplace.
  5. Build resilience:  For the near to medium term, COVID-19 is part of our reality.  Anticipating the consequences of exposures and close contacts in your workplace can mitigate against the greatest impacts and accelerate your ability to keep workers safe and restore operations.  Having your plans and resources in place, assigning and cross-training personnel, and testing your plans are essential to restoring and maintaining the health and safety of your employees and the success of your operations.

COVID-19 will be in our workplaces for some time—likely measured in years rather than months.  Whether this or some other infectious disease, workplaces must adapt in ways to protect workers and others in the workplace.  


Wednesday, June 3, 2020

Are workers getting workers’ compensation for work-related COVID-19 illness?

Workers contracting the COVID-19 virus in the course of their employment are claiming workers’ compensation.  Just how many workers’ compensation claims for work-related coronavirus disability have been filed to date is not reported in most jurisdictions but a few recent reports provide some insight into what may be a significant class of ongoing workers’ compensation claims.

Health care workers are filing and receiving workers’ compensation claims

It is no surprise that those on the front lines of treating those infected with the COVID-19 virus will be at elevated risk of contracting this disease.  Some doctors, nurses, healthcare attendants and personal care aides as well as cleaners and other personnel working in close contact with the sick are contracting COVID-19 despite administrative controls and personal protective equipment (PPE).

Washington state was hit early and hard with COVID-19.  Acute care centres and long-term care homes became the epicenter of serious and fatal outbreaks of the virus. Work-related COVID-19 claims followed.  Reported data from Washington state’s exclusive state fund shows Washington State’s Department of Labor and Industries (L&I):
“ … began taking COVID-19-related [workers’ compensation] claims on March 1, …. Since then, 1,074 total claims were filed statewide by May 20, and 931 of them were accepted, according to the data…Nearly 85% of workers’ compensation claims related to COVID-19 filed from Whatcom and Skagit counties were from healthcare workers…” [Denver Pratt, “Healthcare workers make up majority of COVID-19 workers’ comp claims in Whatcom, Skagit”, Bellingham Harold, May 27, 2020 ].

Claims are being filed beyond the healthcare sector

Just north of Washington State, the Canadian province of British Columbia was similarly hit early with cases of coronavirus.  Again, acute care and long-term care centres have experienced dozens of outbreaks resulting in infections and deaths of both residents and staff in these congregate settings.  Work-related COVID-19 infections also spread in settings outside of health care.   As in many other jurisdictions, prisons and food processing plants have also experienced significant COVID-19 outbreaks in BC.

The exclusive workers’ compensation insurer in the province, WorkSafeBC reports: 
Ind. classification unitIndustry subsectorClaims registered
Acute CareHealth Care and Social Services173
Long-Term CareHealth Care and Social Services64
Ornamental Nursery or Floral Field ProductionAgriculture23
Residential Social
Service Facility
Health Care and Social Services15
Pre-hospital Emergency Health CareHealth Care and Social Services14
Local Government and Related OperationsPublic Administration12
Daycare Centre,
Preschool, or Playschool
Other Services (nes)12
Community Health Support ServicesHealth Care and Social Services10
Physician Professional ServicesHealth Care and Social Services9
Pulp and Paper MillWood and Paper Products7
SupermarketRetail7
Law EnforcementPublic Administration7
Outdoor Sport TourAccommodation, Food, and Leisure Services7
Retirement Home or Seniors' Home (accommodation only)Health Care and Social Services7
Commercial Cleaning
or Janitorial Services
Other Services (nes)5
Security or Patrol
Services
Other Services (nes)5
[WorkSafeBC, COVID-19 claims data by industry, (as of May 27, 2020)]

These data reflect a much broader range of industries where workers have filed claims.  These may still be early days and the table above only reflects classification units with 5 or more claims registered.  The table illustrates that workers in a broad range of industrial and occupational situations are contracting this disease and becoming disabled.

Not all claims accepted … or accepted yet

Before a workers’ compensation claim for COVID-19, the workers’ compensation insurer must receive a claim.  Although reporting the injury or illness to the employer directly may be a requirement, most jurisdictions allow a year or more for a claim to be registered with the workers’ compensation insurer.  The one-year timeframe is common but there are both shorter and longer windows for filing a workers’ compensation claim.   Nevada allows just 90 days from the discovery of an occupational illness; Pennsylvania allows 300 weeks from the last exposure.  These early reports from Washington and British Columbia, therefore, should not be reflective of all the cases that might eventually result in workers’ compensation claims.

Once a claim is registered, the workers’ compensation adjudication process kicks in. Among the questions that must be determined are the following:
  • Is this claim from a “worker” as defined by legislation or policy?
  • Is the claim work-related?

Focusing only on medically established cases of COVID-19 infection, not every claim registered with the workers’ compensation claim will result in an accepted workers’ compensation claim.  If the person filing the claim is not covered by the workers’ compensation legislation or policy, the workers’ compensation insurer has no jurisdiction and the claim will be rejected.  If the worker is covered, but the COVID-19 infection was not work-related, then the claim may be denied (or “disallowed” in some jurisdictions).  This determination is often lengthy and may involve the weighing of evidence concerning the work-relatedness of the disease.
Some jurisdictions have put in place “presumptions” regarding COVID-19; if a worker is in an essential occupation and contracts COVID-19, the infection will be considered work-related unless the presumption is rebutted by other evidence.  Presumptions serve several purposes.  They simplify and often shorten the adjudicative process for the workers’ compensation insurer. Presumptive clauses may improve consistency of decision making and reduce the administrative time and effort at determining work-relatedness on every claim.  That is not to say individual claims adjudication won’t arrive at the same conclusion; a presumption may obviate the need to gather and weigh scientific and medical evidence repeatedly. Presumptions may also shift the onus of proof away from the worker.  The announcement of a presumption also raises awareness of the risk and possibility of claiming workers’ compensation.  The downside of presumptions, however, may result in the acceptance of some claims that are not truly work related.  The converse is also true:  the lack of a presumption may result in workers actually disabled or killed by the work-related COVID-19 will not result in an accepted workers’ compensation claim.

When will we know the true extent of work-related COVID-19 workers’ compensation claims?

These are early days of a pandemic.  It will be years before all of the cases of work-related COVID-19 that have occurred to date are filed, adjudicated and accepted.  That said, the early data provides some evidence of just how many workers may have entitlement to worker’ compensation for their work-related COVID-19 illness, disability or death.

WorkSafeBC reports far fewer claim filings to date than Washington state.  Of the 514 claims filed as of May 27, 2020, 186 have been allowed.  Two-thirds of these allowed claims arose from the healthcare sector. About a third of claims have been disallowed or rejected with about the same proportion either pending or suspended, often awaiting additional information.

The differences in reported and accepted claims between two jurisdictions of similar size, economic structure, and geography are likely not relevant at this time.  The development of the pandemic in these two jurisdictions has been very different.  The sectors impacted overlap but are not the same.  That said, data from both jurisdictions can highlight the risks workers are facing during this pandemic.

Is a coronavirus COVID-19 infection reportable

It should be noted that Washington State and British Columbia have exclusive workers’ compensation agencies.  Both the Department of Labor and Industries in Washington State and WorkSafeBC are also the principal occupational health and safety agency for their respective jurisdictions.  It may be that incidences of work-related COVID-19 are more likely to be reported than in jurisdictions where workers’ compensation is a separate authority.  Regardless of the agency responsible for occupational safety and health, there is a general requirement for work-related COVID-19 cases to be recorded or reported.

In the US, the Occupational Safety and Health Administration (OSHA) reporting standards would require a COVID-19 illness be recorded in OSHA 300 logs.  In a May 19 Enforcement Memo, OSHA [see Revised Enforcement Guidance for Recording Cases of Coronavirus Disease 2019 (COVID-19)]  revised its reporting requirements specifically for COVID-19, noting:
Accordingly, until further notice, OSHA will enforce the recordkeeping requirements of 29 CFR 1904 for employee COVID-19 illnesses for all employers according to the guidelines below. Recording a COVID-19 illness does not, of itself, mean that the employer has violated any OSHA standard.

The standard does not apply to employers with 10 or fewer employees and certain employers in low hazard industries.  That said, all employers have a duty to investigate reported injuries and illnesses regardless of any reporting requirement.  As noted in my previous post, contact tracing is going to be an important factor in determining work-relatedness [see Should workplace health and safety go back to “normal”?].  All jurisdictions require an employer to consider an injury or illness to be work-related if an event or exposure in the workplace either caused or contributed to the resulting condition.  COVID-19 falls clearly in this category.

Employers may fear reporting a work-related injury or disease because of possible detection of a safety or health violation. Employers may also be unaware of their obligations or the protections offered by workers’ compensation.  Workers are typically obligated to report work-related injuries or diseases to the employer but may not always file a claim for a variety of reasons including fear of reprisals from the employer, a lack of understanding of their rights, and the loss of earnings not covered by workers’ compensation.

Removing barriers to filing a claim for work-related COVID-19

Many workers and employers are not fully aware of the potential for a workers’ compensation claim related to COVID-19.  This barrier is addressed to some degree by agency promotion and open source reporting illustrating accepted workers’ compensation claims.

There are many barriers to receiving workers’ compensation [see  Why aren’t all time-loss work injuries compensated?].  Some barriers relate to misperceptions.  Workers may fear filing a claim will hurt their employer at a time when businesses are suffering. Employers may similarly worry about the impact COVID-19 claims will have on their premiums.  To address this barrier, some workers’ compensation boards have differed premiums, exempted payroll protection or emergency wage benefits from premiums, or addressed the experience rating of premiums.  Nova Scotia’s Workers’ Compensation Board announced that, “Employers who have front-line workers contract COVID-19 due to their work will not have the costs of those workplace injury insurance claims impact their industry rate or individual experience rating…”.  Instead of the COVID-19 claim costs being included in calculation of experience rating, the costs will be pooled across the overall employer base.  [see Nova Scotia, Workers’ Compensation Board , “WCB Nova Scotia announces further support for employers during COVID-19”, NS WCB News,  (May 29/20)].

Employers and workers may also be unaware of the exclusive remedy workers’ compensation provides.  In almost all jurisdictions in North America, workers’ compensation protects employers from being sued by workers harmed in the course of and out of the duties related to their employment.  The few exceptions relate to employer actions that amount to deliberate or egregious disregard for a worker’s heath or safety.  Although certain states do not permit such actions (Alabama, Georgia, Indiana, Maine, Nebraska, New Hampshire, Pennsylvania, Rhode Island, Virginia, and Wyoming), the threshold of proof in those that do is extremely high.  Workers’ compensation is a no-fault system and effectively shields the employer (and other workers) from being sued by workers with work-related injury or disease.

More data needed

Accepted workers’ compensation claims are a trailing indicator at best.  The timeliness and transparency of workers’ compensation claims data for COVID-19 claims are important.  While it may take years to fully assess the impact of this disease on workers and workplaces, the knowledge of the occupations and sectors at risk can better inform prevention activities and awareness of hazards.  Data on claims reported, accepted and denied inform workers, employers and policy makers.  Just as important are process times; knowing how long it takes for cases to be reported, claims registered, determinations made and payments issued are essential to policy makers, employers, workers and their families.