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.
