How prepared are workers’ compensation systems for COVID-19?

Regardless of the workers’ compensation model (private insurance, competitive state fund, exclusive state fund), every insurer has to prepare for the unexpected. Afterall, insurance is the transfers the financial risk of rare but costly events from the insured to the insurer.  As noted in my last post, the COVID-19 event most certainly is a rare event and just as assuredly will result in accepted workers’ compensation claims.  How each workers’ compensation insurer will fair in this reality depends greatly on past actions to:

• Understand the risk
• Plan for the financial consequences, and
• Prepare for the operational impact

Like all large business, workers’ compensation insurers identify their risks through environmental scanning, SWOT analysis, and risk ranking exercises.  Then comes the hard part:  putting in place the financial and operational contingency plans to ensure the resilience of the organization at a time it is needed most.  Low probability but high impact events like the COVID-19 pandemic may be identified but what happens next depends on the leadership.   

Corporate planning exercises are internal to the organization and not necessarily subject to public scrutiny making it hard to know how many workers’ compensation insurers saw COVID-19 coming and what, if anything, they did to prepare. Identifying past events and their impacts—how well we have learned from past events- is critical to such preparations.

The “Unknown” occupational disease risk in workers’ compensation

When workers’ compensation systems started a century ago, the focus was “industrial accidents” .  Few “industrial diseases” were included in early legislation and typically by industry or process ( things like lead poisoning in smelting or sulfur poisoning in coal mining) and not diseases.   The “Spanish Flu” pandemic of 1918 provided ample proof that a pandemic virus was a real risk to workers particularly in healthcare centres. 

The formulation of workers’ compensation legislation in most jurisdictions prevented workers’ compensation systems from accepting claims for previously unknown or scheduled diseases.  This limitation was noted at the time.  For example, one jurisdiction’s annual report noted:

As an example of the limitations of the Act, it may be mentioned that during the severe epidemic of Spanish influenza in the fall of 1918, many inquiries, telephonic and otherwise, were made as to whether the influenza was covered by the Act, some of the inquirers claiming that it was due to their daily work. There could, of course, be only one answer to these inquiries, that the influenza, though a great misfortune, could not by any stretch of imagination be considered as an accident arising out of employment.
[Source: Second Annual Report of the Workmen’s Compensation Board of the
Province of British Columbia For The Year Ending December 31^st 1918, Page U11]

As the tone of the passage suggests, the worker’s compensation authority saw the lack of coverage as a gap in the legislation.  The then chairman wrote:

In the closing months of the last year we have been compelled to reject a number of claims arising out of the influenza epidemic, in which mothers with small children made application for pensions. One case was particularly painful. When informed that we must reject her claim, the mother of eight small children asked us in desperation: "What am I to do?" We were unable to answer. She withdrew from the Board room accompanied by two of her frightened children clinging to her skirts, and one in her arms, to answer the question as best she could. These experiences also compel us, at the risk of being censured for going outside of our sphere, to call attention to the enormous wastage of life, health, and happiness through failure or inability to obtain medical attention.
[Source:  1918 Annual report ibid., page U47]

Over time, most workers’ compensation systems adapted to include coverage for occupational diseases.  The Spanish flu killed 675,000 in the US (population in 1918 was 103 million) and an estimated 40 million worldwide (when the population was about 1.8 billion).

From a workers’ compensation perspective, the possibility of a new disease suddenly emerging to injure and kill workers in the course of their employment was no longer an unknown risk.

“Known unknowns”

The idea that a new work-related disease could emerge was proven out when in other serious outbreaks less deadly than the Spanish influenza pandemic.   The 1957-58 “Asian flu”, for example,  infected 20% to 40% of the population but the death rate was much lower (excess deaths estimated at 66,000 in the US).  Other influenza viruses have spread quickly around the world, often resulting in harm to workers particularly those in the medical field where close contact lead to transmission and illness.  These include the “Hong Kong flu” of 1968, various strains of “Avian flu” and “Swine flu”.
[I've included a list of notable pandemics from Madhav N, Oppenheim B, Gallivan M, et al. Pandemics: Risks, Impacts, and Mitigation. In: Jamison DT, Gelband H, Horton S, et al., editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 27. -Table 17.1, Chapter 17] 

Serious illness from pandemic virus became a serious topic in “business continuity” and “disaster management” in the corporate and government world in the late 1990s.  Concern over Y2K, increasingly serious natural disasters such as hurricanes, and disruptions through terrorism such as the September 11^th attacks pushed the evaluation of risk from the academic classroom and actuarial backrooms to corporate boardrooms.  Annual reviews of risks and business continuity plan testing became part of the corporate culture.  In hospitals and government offices, contingency plans were developed for many risks but one epidemic helped spur some workers’ compensation systems to take specific action to prepare for the “know unknown”:  the emergence Severe acute respiratory syndrome (SARS).

The 2003 SARS outbreaks in Ontario and British Columbia in particular provide hard lessons on the human and financial cost of work-related disease.  I attended a policy conference a few years later where one presenter noted that more than 400 claims were received by the WSIB for SARS exposure,  more than 160 for SARS illness, and two fatalities.  In a reflection of the risks associated with working at the front lines of medicine,  98% of accepted claims were from women in healthcare.  If you are unfamiliar with what happened during the SARS outbreak, you may find the following reference informative:

Low DE. SARS: LESSONS FROM TORONTO. In: Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors. Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington (DC): National Academies Press (US); 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92467/

Anticipating the next pandemic

Workers’ compensation insurers were certainly aware of the risk of pandemics.  The risk was publicly acknowledged and actively planned for.  One annual report noted:

In 2003, Canadians saw Severe Acute Respiratory Syndrome (SARS) strike with devastating human economic costs. In 2004, the avian influenza virus put workers at risk and resulted in millions of birds being destroyed. In both cases, the original source of human infection was an animal. The potential threat posed by diseases crossing over from animals has been identified as a serious risk to humans by the World Health Organization. These “zoonotic” diseases have had very limited health impact on B.C.workers to date; however, in the event of an outbreak of a highly contagious disease, front-line caregivers may be at increased risk. These diseases are within the scope of coverage by the Workers Compensation Act if the worker contracts the disease in the course of, and arising out of, duties related to his or her employment.
WorkSafeBC,  2004 Annual Report and 2005-2007 Service Plan

In corporate planning and business continuity departments, pandemic planning was on the agenda.  Those charged with these tasks amplified the messages from experts.  The many public appearances and analysis of Michael T. Osterholm over the last twenty years, the assessments of the World Health Organization, and the rankings of the World Economic Forum may not have been on everyone’s reading list but business continuity planners and disaster management professionals certainly understood the risk.   “Team sites” were prepared, operational impacts and costs were estimated in some workers’ compensation systems.  Risk ranking exercises in finance departments often included the pandemic risks and actions were taken in many workers’ compensation insurers to operationally and financially manage (or at least buffer) the impact of the known pandemic risk with an unknown arrival date. 

A Current Risk

To be clear, pandemic risk has been on the agenda for years.  Researchers have raised the alarms but not every government or insurer was listening.  In hindsight, these warnings seem eerily prescient.  For example, this top finding from the Global Health Security Index [October 24, 2019] was alarming—at least to those who read them:

Countries are not prepared for a globally catastrophic biological event, including those that could be caused by the international spread of a new or emerging pathogen or by the deliberate or accidental release of a dangerous or engineered agent or organism

The World Economic Forum noted the risk of pandemic in many of its reports over the last fifteen years. Most recently, its Global Risk Report 2020 placed infectious diseases among the top ten impacts and noted:

Global health security risks. Considerable progress has been made since the Ebola epidemic in West Africa in 2014–2016, but health systems worldwide are still under-prepared for significant outbreaks of other emerging infectious diseases, such as SARS, Zika and MERS. [P. 76]

Major reinsurers like MunichRe  and SwissRe identified the risks and set up their own units or plans for pandemics and cooperated with the World Bank to launch the Pandemic Emergency Funding Facility in 2016.  Other large reinsurers certainly identified the risk.  The consequences of higher death rates across all demographics during a largescale pandemic on life insurance underwriters and government social insurance as well as on workers’ compensation insurers. Reinsurers and large insurers often provided tools and assessments to help insurers identify the risk and make plans accordingly.  [see Aon’s  https://www.aon.com/InfectiousDiseaseResponse/default.jsp for example].

For any insurer, these assessments made the risk clear.  How each prepared in light of this information will determine how well they will weather the consequences during of the current pandemic. 

Preparing for the inevitable…

Operational contingency plans often included building system access and redundancies.  If one office or headquarters was quarantined or significant numbers of staff were disabled in a particular centre, operations could continue elsewhere.  The ability of workers’ compensation insurers to shift to work-from-home models were developed and tested.  These operational contingencies were not necessarily in anticipation of pandemic or local outbreak but based on more generally on the availability of staff and facilities after or as a disruptive event unfolds.  Scenario planning included a variety of possible disruptions from earthquakes to an outbreak and even scenarios that may have sounded farfetched at the time:

Due to the cruise ship, cargo and air traffic through Vancouver, it is possible that emerging diseases will be identified here in BC and that workers in health care, transport and hospitality will develop compensable disease.
[WCB of BC,  “Future Risks: Issue specific environmental scan” 1998].

As with most insurers, workers’ compensation insurers create “reserves” for risks like these.  Occupational disease reserves and disaster reserves are commonly developed and funded.  The robust market returns and extended economic growth cycle since the Great recession (2007-2009) have allowed reserves to be built up for many insurers.  Whether present reserves will be sufficient is an open question.  No one yet knows the extent to which work-related COVID-19 will result in workers’ compensation claims but injury, illness and fatality claims arising from this pandemic are already entering workers’ compensation systems world wide.

Aside from reserves, funding strategies may include reinsurance. Reinsurance is a way for a firm or insurer to share the financial risk of large losses.  You can think about it as insurance for insurers.  As a strategy, it may insulate any one insurer but that assurance comes at a cost.  Premiums and deductibles may be high.  Just how each insurer manages its pandemic risk will vary.  Whether to establish reserve, reinsure, do both… or neither, is a choice for any risk.  Now that this particular eventuality risk has become manifest, the consequences of those choices will begin to be reflected in financial statements. 

Enter the Pandemic and the need to adapt

The COVID-19 pandemic is still unfolding and its impact on the economy and insurers is uncertain at best.  The impact on workers battling the pandemic, supporting the ill, and keeping the essentials of society running is unknown. 

In this pandemic, quarantine is becoming a bigger issue.  The lag in disease development and the potential for asymptomatic and pre-symptomatic individuals make quarantine and isolation a priority especially for first responder, healthcare workers and others providing direct care to those who are ill or vulnerable particularly the elderly.  Large numbers of first responders and healthcare workers are being sidelined because of work exposures.  Quarantine is for the well exposed but not infected.  The period of quarantine may mean lost wages and psychological pressure on workers and their families. 

As I noted in my last post, quarantine is not typically compensated by workers’ compensation legislation.  This may be changing. Washington state “is taking steps to ensure Workers’ Compensation protections for health care workers and first responders who are on the front lines of the COVID-19 (coronavirus) outbreak.”  The news release states:

L&I [Washington State’s Department of Labor and Industries is immediately changing its policy around workers’ compensation coverage for health care workers and first responders who are quarantined by a physician or public health officer. Under the clarified policy, L&I will provide benefits to these workers during the time they’re quarantined after being exposed to COVID-19 on the job.https://www.governor.wa.gov/news-media/inslee-announces-workers-compensation-coverage-include-quarantined-health-workersfirst 

Workers’ compensation systems have expanded their coverage over the last century to include more occupational disease.  Science has led us to better understand the work-relatedness of occupational illnesses and workers’ compensation systems have adapted to the benefit of both workers and employers.  Their varying degrees of preparedness for this pandemic will be revealed over time but workers and employers will undoubtedly be relying on workers’ compensation systems well after the pandemic peaks. Any shortcomings in their preparation should not jeopardize the benefits and supports promised by workers’ compensation laws. Those with work-related illness and first responders forced into quarantine by medical order need to be supported financially regardless of past decisions or policies.   

Will there be a significant cost?  Of course. Medically ordered quarantine, however, is necessary to protect others on the front line and the rest of us.  These workers and their families are already sacrificing so much; they should not have to suffer lost wages, use vacation time or consume sick leave because of their dedication in spite of the risk.  It is not as if they can quit their jobs and be free of the quarantine.  They are, for all intents and purposes, totally disabled from work by virtue of their exposure and the medical risk that carries for everyone.

Workers’ compensation has evolved its coverage in the past.  Perhaps now is the time for a further evolution along the lines proposed in Washington state.

Can a worker claim workers’ compensation for COVID-19 exposure, illness or quarantine?

[The following is a general response to questions from students in workers’ compensation, disability management, and workplace insurance courses.  The law and policy will vary by specific jurisdiction].

The emergence of the novel coronavirus (COVID-19), has prompted concerns around the world.  While prevention, control, and treatment questions top the list, workers’ compensation questions are being raised.  The most common question: Can a worker with a confirmed case of COVID-19 illness successfully claim workers’ compensation?  The short answer is “Yes”.  Getting to that short answer, however, takes some explanation, beginning with the determination of the work-relatedness of the disease.   

Work-relatedness of disease

For COVID-19 or any other disease-causing virus, the possibility of a workers’ compensation claim depends on the wording of law and policy in the jurisdiction.  Many diseases are scheduled as “occupational diseases” in workers’ compensation law or defined in policy.  Occupational, work-process, or industrial exposure to known, biologically-active agents including viruses may be defined as the presumed cause of specific disease (lead poisoning in smelter workers, chicken pox contracted by a teacher from a student in their care, for example).  The presence of disease and the history of exposure in the occupation or industry defined typically establishes a presumptive (although rebuttable) work-related cause, opening the door to workers’ compensation claims for medical costs, rehabilitation, financial compensation, survivor benefits, and death benefits. 

A novel disease will not have been previously scheduled as an occupational disease in legislation or listed in policy. In such cases, it must be determined whether the disease is work.  If the nexus between work and resulting health impact can be shown, then the basis for a workers’ compensation claim can be established.

The test to establish work-relatedness, or causation, of a disease varies across jurisdictions. For example, in British Columbia, the test for work-relatedness is “causative significance”, meaning the worker’s employment must have been of causative significance in producing the disease. To satisfy the causative significance test, the worker’s employment must have been more than a trivial or insignificant aspect.

A few workers’ compensation jurisdictions have a more stringent test, often referred to as “predominant” or “major contributing cause”.  In Oregon, the condition that stems from the injury or disease rather than on-the-job injury or exposure is the basis making a claim; work has to be a “a major contributing cause” of a condition, defined as a cause contributing more than 50 percent to an injured worker's disability or need for treatment. 

COVID-19 appears to spread most easily to those who come into “close contact” with the virus.  The US CDC defines close contact for healthcare workers as follows (see footnote 2 in CDC’s FAQs for  Coronavirus Disease 2019 (COVID-19):

a) being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time; close contact can occur while caring for, living with, visiting, or sharing a health care waiting area or room with a COVID-19 case, or

b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)

  

For healthcare workers, ambulance drivers, physicians treating COVID-19 patients, the applicable work-relatedness test may be more easily established given the increased likelihood of exposure

Less obvious but still likely to meet the work-relatedness test, are bus drivers transporting quarantined travelers, cleaners brought in to disinfect facilities, or morticians dealing with the fatalities of the disease.  Beyond occupations and industries that make the likelihood of exposure and infection higher than that of the general public, establishing work-relatedness may be difficult once the virus is not traceable from person to person. 

Standard of proof

Workers’ compensation jurisdictions vary regarding the standard of proof necessary to establish the issues in question, such as causation.  Unlike criminal law where the standard of proof is “beyond a reasonable doubt”, most workers’ compensation statutes rely on a “balance of probabilities” standard:  if it is more likely than not that the disease is work-related, then the claim is accepted for workers’ compensation purposes.

Some workers’ compensation jurisdictions, like British Columbia, have a slightly lower “evenly weighted” standard: if the evidence on an issue is evenly weighted, the finding must favour the worker. This means that a claim is accepted if it is at least as likely as not that the disease is work-related.

Establishing work-relatedness of disease

Note that evidence a worker has the disease is not evidence the disease is work-related.  A valid, accurate lab test may well confirm the presence of COVID-19 but not it’s work-relatedness.

In the early stages of epidemiological investigation, the connection between work and the diagnosis may be established by public health officials and epidemiologists tracing the source of the infection and those who came in contact with the disease.  In the case of a public health worker contracting the virus after exposure to infected individuals, that work-related connection is pretty obvious in the early stages of an outbreak.  On the face of it, the public health authority’s epidemiological reports would likely be sufficient evidence for satisfying the work-relatedness test.  Scheduled occupational disease provisions or statements in policy may allow the presumption of work-relatedness in the absence of information to the contrary without need for detailed investigation in every single instance. 

The challenge for many workers outside scheduled or policy-defined industries or occupations is to establish that work-relatedness.  Once the disease is more generally spread in the community, establishing the work-relatedness may be much harder to do.  Is the worker ill with an infection confirmed as COVID-19?  Did the exposure resulting to the infection arise in the course of employment and out of the duties associated with that work, or was the exposure from the use a surface on public transit, an unshielded cough of passerby on a street, or from another vector of disease (including our own children)? 

The adjudicative decision for a workers’ compensation claim will become more complex as the risk differential between work and non-work exposures equalize. The onus of proof in inquiry-based workers’ compensation systems (such as British Columbia and Ontario) remains with the insurer; in adversarial systems (most US jurisdictions), the onus may fall more heavily on the worker.  In either case, the complexity of determining the work-relatedness question can mean extensive investigation, cost and delay in reaching a decision.

Exposure is not disease…  Or disability

All of us are exposed to agents of illness and disease in our lives and work but exposure does not necessary lead to disease.   A healthcare worker attending patients with an active case of COVID-19 disease, for example, may be in close contact for varying durations of exposure but never develop the disease.   Personal protective equipment (PPE), training, and adherence to protocols are specifically designed to counter the increased risk in clinical settings where healthcare workers are exposed to severely ill patients.  

Not all those exposed to the COVID-19, even in close contact such as a quarantined residence, will not necessarily become infected with the COVID-19 virus.  Reportedly, a couple confined to the same cruise ship cabin, one partner can test positive for the disease while the other does not.  For COVID-19, as for many other agents of illness and disease, exposure alone does not guarantee disease and/or disability.   

Even in cases where exposure results in a positive test for COVID-19, not everyone develops disabling symptoms. It is not clear yet why some people who test positive seem unaffected by COVID-19.  Children and some adults have tested positive for COVID-19 but show no signs of illness or disease.  In others, the symptoms may be mild and dismissed as a minor cold.

From a workers’ compensation perspective, this is an important point:  exposure is not disability.  Exposure may lead to disease and disease may be disabling.  Where exposure is not followed by disease, and or disability, a claim for any workers’ compensation because of COVID-19 exposure would unlikely succeed; no medical treatment would be required and there is no impairment that makes the worker incapable of work.  Documentation of the exposure is always important but unless the disease develops, it is unlikely any claim filed would be accepted by the workers’ compensation insurer. 

At this point, testing for COVID-19 is a public health issue.  At some point, credible diagnostic tests may be offered through medical labs.  Diagnostic tests are generally not considered as medical expenses under a workers’ compensation claim.  At present, there is no vaccine against this disease.  When one is available, the cost would not normally be covered by workers’ compensation. 

What about asymptomatic disease cases?

A case of COVID-19 may be detected in an asymptomatic person.  The person may or may or may not develop symptoms but may be able spread the disease to others.  A confirmed case in an asymptomatic person may be subject to quarantine or isolation. 

Let’s clarify those terms:  Quarantine restricts the movement of well persons who may have been exposed to a communicable disease.  Isolation separates an ill person from those who are healthy. 

In a confirmed work-related COVID-19 exposure where the worker tests positive for the virus, the worker would likely be isolated and monitored in isolation.  Once the virus is no longer detected, the individual is no longer infectious.  Barring any necessary recovery time, the worker can safely return to work.

In this case, all the necessary elements of a claim may be present: the person is a worker, the exposure is work-related, and disease is confirmed.  Work is causative of harm.  The body reacts but at a level that is asymptomatic.  But for the infectious nature of the disease, there is no impairment.  With no symptoms, there are no medical expenses.  There is no treatment for COVID-19, so no medical treatment expenses are incurred.  

Assuming there is no work the worker could do while in isolation, the period where the worker is unable to earn because of the illness (continued detection of the virus) may result in earnings loss.  A workers’ compensation claim for lost earnings may be defensible for an asymptomatic worker with work-related COVID-19.

Suppose a treatment is developed that hastens the ability of the body to fight off the virus and shorten the course of illness.  If such a treatment existed, its cost might be accepted as a medical expense in an accepted workers’ compensation claim made by a worker with test-confirmed COVID-19 but no symptoms.   

Accepted COVID-19 workers’ compensation claim:  what is covered?

An accepted workers’ compensation claim opens the door to payment for medical expenses, hospital costs, prescriptions, rehabilitation and compensation for lost wages. In some cases, recovery will be protracted.  It is not clear if permanent disability results but past experience with SARS would suggest that permanent disability may occur and compensation may be payable.

If the disease is work-related and COVID-19 results in death, workers’ compensation may provide payments to survivors and dependents as well as funeral or burial costs.

What about quarantine?

According to news coverage, some workers have been quarantined due to exposure to COVID-19 in the course of their employment.  Some workers caught in a quarantine of a ship, hotel, or other facility may continue in their employment duties and receive wages for their work; others such as the flight crew of an evacuation mission may be quarantined with their passengers for the duration of the quarantine period.  Can quarantined workers claim workers’ compensation for their lost wages?

Workers’ compensation claims are generally based on disability not exposure.  In most cases, lost wages due to quarantine would not be considered compensable under a workers’ compensation claim.  Employer HR policies or collective agreements may have provisions to use sick leave or vacation time for quarantine cases.  Employers may also continue to pay workers either on the basis that adhering to the quarantine is an implicit work-related assignment or in recognition of on-line work they may be able to do during the quarantine.

Quarantine duration periods imposed for COVID-19 are typically around the 14-day time frame.  Quarantines may be recommended or imposed on persons with exposure.  Given the possibility of spreading the disease while asymptomatic, the 14-day time frame following exposure is intended to contain the disease.  Not every employer offers sick leave and even if sick leave is a provision, not all employees will have sufficient sick leave to cover a 14-day absence.  Even if the quarantine is work-related, there is no typically no basis for a workers’ compensation claim.

Psychological impacts?

Think of the dedicated health care workers coping with the onslaught of sick patients or the field workers in public health visiting the ill or dying in the community during a pandemic.  Consider a crew member responsible for serving quarantined guests, some of whom eventually test positive for COVID-19 and are removed to a hospital for treatment.  The psychological impact might be significant even if these workers do not contract the particular virus themselves.  It is conceivable that workers may file claims related to COVID-19 based on mental injuries despite the absence of the disease itself. 

Jurisdictions vary in how mental injuries are adjudicated within the workers’ compensation framework. Most accept mental injury that is the sequelae or consequence of a compensable work-related injury or disease.  Workers’ compensation jurisdictions may also accept a claim for a work-related mental injury as the primary condition, provided certain requirements set out in each jurisdictions’ law and policy has been met.

Mental injury may arise independent of direct physical harm and may take months to develop and be diagnosed.  The stress of being confined with others particularly if others in the group develop the disease may contribute to anxiety and depression of others in quarantine.  The longer-term impacts may include Post Traumatic Stress Disorder (PTSD).  A recent review found quarantine could have negative consequences [see Samantha KBrooks, Rebecca K Webster, Louise E Smith, Lisa Woodland, Simon Wessely, NeilGreenberg’ Gideon James Rubin, “The psychological impact of quarantine and howto reduce it: rapid review of the evidence”, The Lancet, OnLine First,February 26, 202].   To date, there are no published reports of workers’ compensation claims for mental injury being accepted.

Employer responsibilities

Employers are responsible for the health and safety of their workers.  That general duty does not diminish in the event of an outbreak or pandemic.  The duty to plan for and protect workers is not limited to the healthcare system.  Retail, factories, banks, arenas, restaurants and offices need procedures and plans in place.  Supplying a box of face masks and a container of disinfecting wipes may be appropriate but are insufficient in most cases to discharge an employer’s duty.

Employers need to ask fundamental questions about what will happen in the event of an infectious disease outbreak.  Will workers be able to work from home?  If certain workers are quarantined, who will do their necessary work?  Have they been trained?  Is their safety likely to be at risk?  These questions are just as valid for small businesses as they are for large ones.  The prospects of a widening prevalence in the community increases the urgency to plan, acquire protective equipment, establish procedures, and prepare.   

So, in addition to “wash your hands, wash your hands” and “don’t touch your face”, take the time to think about the implications an infectious disease like COVID-19 might have in your workplace.  If you are an employer,  work in human resources, or serve on a joint health and safety committee, look at your plans, update your policies, check with your workers’ compensation and disability insurance providers—they will likely have resources to help you plan and prepare.  Whether COVID-19 or a future virus spawns a pandemic, your preparation will be worth it.

Term	Practical Definition for Workers’ Compensation COVID-19 Claims Purposes
Asymptomatic	Not having or showing signs of illness
Case	An instance of COVID-19 infection (not the person)
Exposure	Direct or close contact with an infectious agent (such as bodily fluids from a person with active viral disease)
Isolation	Separation of an ill person or persons with a communicable disease from those who are healthy with the purpose of limiting the spread of the disease
Quarantine	Separation and restriction of movement of a well person or persons who may have been exposed to a communicable disease with the purpose of limiting the spread of the disease (and detect if illness develops).
Symptomatic	Having or showing signs of illness