Special Article

Year: 2020│Volume:8│Issue-2

Occupational Health and Safety Practices at workplace during COVID-19 Pandemic

Ankit Viramgami1, Avinash Pagdhune2, Kamalesh Sarkar3, Rakesh Balachandar4,

1Scientist B Clinical Epidemiology Division, Division of Clinical Epidemiology,
2Scientist B Division of Poison Information Center,
3Director & Scientist G,
4Scientist D, ICMR-National Institute of Occupational Health



Corresponding Author:

Dr. Rakesh Balachandar
ICMR-National Institute of Occupational Health
Meghaninagar, Ahmedabad
Gujarat – 380016, India
E mail ID: balachandar.rakesh@gmail.com




Abstract:

Coronavirus Disease 2019 (COVID-19) a highly contagious viral respiratory disease has been declared as pandemic due to its global spread across most countries. Social isolation (i.e. physical distancing) and strict embracement of personal hygiene are few demonstrated preventive methods of COVID-19 transmission. All countries, based on the recommendations of World Health Organization (WHO), have adopted lockdown strategy (promoting physical distancing) to prevent COVID-19 transmission in the community including workplaces. In the interest of economic sustenance, many countries have partially relaxed the lockdown policies, to resume selective functioning of factories / organizations / institutes / workplaces. However, in the absence of appropriate occupational health and safety policies, workplaces are a potential threat for COVID-19 transmission & outbreak. The following document reviews the conventional hierarchy of occupational safety and health control measures (i.e. engineering controls, administrative controls and PPE), necessary to prevent COVID-19 outbreaks at workplace, based on the current scientific evidences on COVID-19.

Key words: COVID-19, Occupational safety and health, Hierarchy of occupational controls

COVID - 19:

Coronavirus Disease 2019 (COVID-19) is primarily a respiratory disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus strain 2). Ever since the declaration of COVID-19 as global pandemic on March 12, 2020,[1] countries globally have resorted to multiple preventive measures to mitigate the transmission of this highly contagious SARS-CoV-2. Lockdown is one such major measure adopted to minimize the inter-human social / physical contact in addition to buy time for better management of the illness (develop vaccines, identify effective molecules to treat COVID-19).[2] This has minimized travel, trade, production, tourism, food supplies, and financial markets [2]. The lockdown in addition to reducing COVID-19 mortality and healthcare demand is perhaps an interim resort to slow transmission of COVID-19, and conceive definite plans to control the contagion.[3]) Reopening the lockdown could be a potential threat for resurgence of the epidemic, particularly at the workplace.[2]) Hence, it is essential to strictly consider the occupational safety measures to prevent COVID-19 outbreak / transmission at workplaces.

The occupational safety and health practices should be customized to prevent / reduce the transmission / outbreaks (of COVID-19) at the workplaces. The employer should seriously consider the specific exposure risks, sources of exposure, routes of transmission, and other unique characteristics of SARS-CoV-2, while adopting the preventive measures. Precarious resumption of work without appropriate planning and measures can result in a cascade of failures / catastrophe.[2],[4] Hence the employer should attempt to address the challenges of COVID-19 with sufficient resources and trained workers to optimally perform during this pandemic situation. The current article discusses the COVID-19 planning for occupational health and safety of workers, based on current understanding of COVID-19 transmission and conventional infection preventive industrial hygiene practices.

Epidemiology of COVID-19

All individuals irrespective of age, sex and socio-economic status are vulnerable to COVID-19 infection. However, only a proportion of them exhibit flu-like symptoms, ranging from fever, upper respiratory tract infection and lower respiratory tract infection, gastro-intestinal symptoms with varying severity etc. Individuals with comorbidities such as immunocompromised state, uncontrolled diabetes, persons with malignancy, subnormal renal function etc. are highly susceptible and exhibit high fatality rate.[5] Further, susceptible individuals on acquiring infection are likely to develop symptoms within the longest incubation period (i.e. 2 weeks from the day of contracting the infection, 95% confidence interval 9.2 – 18 days)[6]. Hence, the COVID-19 suspected individuals are quarantined or (observed) during the incubation period to confirm the status of illness (negative / positive) of the individual. While a substantial proportion of infected individuals remain asymptomatic / recover uneventfully[7].

Environmental factors such as temperature, humidity, contact surface and many others could potentially influence the survival and transmission of SARS-CoV-2.[8] A unit degree Celsius rise in temperature and unit percentage increase in relative humidity would reduce the reproduction number (R0) of SARS-CoV-2 by 0.0225 & 0.0158 respectively.[9] No virus could be detected after 5 minutes at 950Celsius temperatures. The SARS-CoV-2, under controlled conditions (220 Celsius & 65% humidity) has been demonstrated on plastic and steel surfaces even after 72 hours, although the number of viral particles substantially reduced after 4 hours, while particles are undetected on cardboard and copper surfaces after 4 & 24 hours respectively. [10, 11] Further the virus were undetected respectively after 3 hours, 4 days, 7 days on printing / tissues papers, glass / currency notes and stainless steel /plastic surfaces under controlled conditions (220 Celsius & 65% humidity).[12] Hence the ambient conditions should be considered in the occupational safety and health of the workers.

Disinfectants such as 1% & 2% household bleach (hypochlorite solution), 70% ethanol / isopropanol were effective virucidal agents, as no virus were detected after 5 minutes of virus inoculation under controlled conditions (220Celsius & 65% humidity). Other disinfectants with similar potency are 7.5% Povidone iodine, 0.05% chloroxylenol, 0.05% chlorhexidine, 0.5% hydrogen peroxide & 0.1% Benzalkonium Chloride. [12, 13]

Transmission of COVID -19

The basic reproduction number (R0) for COVID-19 ranges from 2 - 4, i.e. an infected individual is directly responsible to generate (on an average) 2 -4 new cases.[8] COVID-19 is commonly transmitted by closely contacting (2 meters or less) an infected individual. Further, the risk increases with the duration of time spent in close contact with the infected individual.

Aerosols produced by the cough / sneeze of an infected individual, by far is the common source of transmission[2]. Though SARS-Cov-2 virus is reported in other biological fluids such as blood, stool and lacrimal secretions, the transmission via these fluids is rarely reported.[14]

There are two main known routes COVID-19 transmission:

Implementation of workplace controls

The “Hierarchy of controls” adopted by the occupational safety and health professionals to control workplace hazards may as well be customized and adopted to control COVID-19 transmission at workplaces.[15] The efficient way to control an occupational hazard is to systematically remove (eliminate) it from the workplace. However, an occupational hazard (such as COVID-19), where elimination is impossible, the most effective protection measures are (listed in the hierarchy of effectiveness): engineering controls, administrative controls (including safe work practices), and personal protective equipment (PPE).[15] Each of these control measures has its merits and limitations when considering the ease of implementation, effectiveness and cost.[15] As in controlling other occupational hazards, a combination of control measures is necessary to protect workers from SARS-CoV-2.

Engineering Controls

Engineering controls involve isolating employees from work related hazards; specific engineering controls for SARS-CoV-2 include:

Administrative Controls

Administrative controls require action by the worker or employer. The administrative controls for SARS-CoV-2 are listed below (but not restricted to). The listed administrative control measures may be customized as per the requirement of workplace:




Safe Work Practices

Safe work practices are types of administrative controls that include to reduce the duration, frequency, or intensity of exposure to a hazard. Examples of safe work practices for SARS-CoV-2 include:




Routine environmental cleaning:


Policies for suspected / confirmed COVID-19 positive worker

The employer should draft policies and procedures for prompt identification and isolation of sick people at the workplace,

Special considerations



Personal Protective Equipment (PPE)

While engineering and administrative controls are considered more effective in minimizing exposure to SARS-CoV-2, PPE may also be needed to prevent certain exposures. Examples of PPE include: gloves, goggles, face shields, face masks, and respiratory protection, when appropriate. The best way to reduce any risk of infection is good hygiene and avoiding close contact (closer than 2 meters) with any potentially infected person.

Guidance on facemasks

Face masks may be considered when working in closed spaces with other persons / co-workers. Face masks should only be considered as a complementary measure and not a replacement for established preventive practices, such as physical distancing, cough and respiratory etiquette and personal hygiene. Following guidelines should be noted while wearing face masks


Classifying of the occupational (SARS-CoV-2) risk [28]

Occupational Safety and Health Administration (OSHA) has classified the occupational risk of contracting SARS-CoV-2 virus at the workplace during an outbreak, as “very high”, “high”, “medium”, or “lower” (caution). The classification of risk is based on the need to contact the COVID-19 confirmed / suspected person within a distance of 2 meters and for extended duration (or multiple contacts). Majority of the workplaces commonly encountered by general public would qualify between lower (caution) to medium exposure risk.

Very high risk jobs: The workers have very high potential for close exposure (< 2m) to known or suspected sources / cases of COVID-19. Workers in this category include:


High risk jobs: The workers have high potential for exposure to known or suspected sources of COVID-19. Workers in this category include:



Medium exposure risk: Workers frequently and/ or in close contact with (i.e., within 6 feet of) people who may be infected with SARS-CoV-2, but who are not known or suspected COVID-19 patients. In areas without ongoing community transmission, workers in this risk group may have frequent contact with travelers returning from locations with widespread COVID-19 transmission. In areas where there is ongoing community transmission, workers in this category may have contact with the general public (e.g., schools, high-population-density work environments, some high-volume retail settings).

Lower exposure risk (caution): Workers involved with machinery tools / computers and do not come in contact with people known to be, or suspected of being, infected with SARS-CoV-2 nor frequent close contact with (i.e., within 6 feet of) the general public. Workers in this category have minimal occupational contact with the public and other co-workers.

Conclusion:

In the absence of a suitable vaccine or effective molecules (drugs) against COVID 19, adherence to the preventive strategies is the best option to avoid/reduce the transmission. Further, until effective vaccines and treatment molecules are available, workers being in constant contact with co-workers and non-workers are at risk transmitting / acquiring COVID-19 at workplace. Therefore, occupational safety and preventive health strategies should be strictly adhered at workplaces to prevent COVID-19 outbreaks.

Conflict of Interest: None

Funding: Nil

Acknowledgment: Nil

References:

  1. WHO. WHO announces COVID-19 outbreak a pandemic. 2020; Available from: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic.

  2. The, L., India under COVID-19 lockdown. The Lancet, 2020. 395(10233): p. 1315.

  3. Neil, M.F., L. Daniel, N.-G. Gemma, I. Natsuko, A. Kylie, B. Marc, et al., Report 9 - Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand, in Coronavirus (COVID-19) updates. 2020, Imperial College London. p. 20.

  4. Fan-Yun, L., W. Chih-Fu, H. Yu-Tien, C.C. David, and N.K. Stefanos, Work-related Covid-19 transmission. 2020, BMJ Yale: MedRxiv. p. 22.

  5. Bi, Q., Y. Wu, S. Mei, C. Ye, X. Zou, Z. Zhang, et al., Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. The Lancet Infectious Diseases.

  6. Cascella, M., M. Rajnik, A. Cuomo, C.S. Dulebohn, and R. Di Napoli, Features, Evaluation and Treatment Coronavirus (COVID-19). 2020, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;.

  7. Sakurai, A., T. Sasaki, S. Kato, M. Hayashi, S.I. Tsuzuki, T. Ishihara, et al., Natural History of Asymptomatic SARS-CoV-2 Infection. N Engl J Med, 2020.

  8. Bar-On, Y.M., A. Flamholz, R. Phillips, and R. Milo, SARS-CoV-2 (COVID-19) by the numbers. eLife, 2020. 9: p. e57309.

  9. Jingyuan, W., T. Ke, F. Kai, and L. Weifeng, High Temperature and High Humidity Reduce the Transmission of COVID-19. 2020, Cornell Universoty: ArXiv. p. 26.

  10. van Doremalen, N., T. Bushmaker, D.H. Morris, M.G. Holbrook, A. Gamble, B.N. Williamson, et al., Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med, 2020. 382(16): p. 1564-1567.

  11. Alessio, N., Temperature dependence of COVID-19 transmission. 2020, BMJ Yale: medRxiv.

  12. Chin, A.W.H., J.T.S. Chu, M.R.A. Perera, K.P.Y. Hui, H.-L. Yen, M.C.W. Chan, et al., Stability of SARS-CoV-2 in different environmental conditions. The Lancet Microbe, 2020. 1(1): p. e10.

  13. Kampf, G., Potential role of inanimate surfaces for the spread of coronaviruses and their inactivation with disinfectant agents. Infection Prevention in Practice, 2020. 2(2): p. 100044.

  14. Lescure, F.-X., L. Bouadma, D. Nguyen, M. Parisey, P.-H. Wicky, S. Behillil, et al., Clinical and virological data of the first cases of COVID-19 in Europe: a case series. The Lancet Infectious Diseases.

  15. NIOSH, Hierarchy of controls, N.I.o.O.S.a. Health, Editor. 2015.

  16. Boldog, P., T. Tekeli, Z. Vizi, A. Denes, F.A. Bartha, and G. Rost, Risk Assessment of Novel Coronavirus COVID-19 Outbreaks Outside China. J Clin Med, 2020. 9(2).

  17. Donnelly, C.A., A.C. Ghani, G.M. Leung, A.J. Hedley, C. Fraser, S. Riley, et al., Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet, 2003. 361(9371): p. 1761-6.

  18. Booth, T.F., B. Kournikakis, N. Bastien, J. Ho, D. Kobasa, L. Stadnyk, et al., Detection of airborne severe acute respiratory syndrome (SARS) coronavirus and environmental contamination in SARS outbreak units. J Infect Dis, 2005. 191(9): p. 1472-7.

  19. Ijaz, M.K., A.H. Brunner, S.A. Sattar, R.C. Nair, and C.M. Johnson-Lussenburg, Survival characteristics of airborne human coronavirus 229E. J Gen Virol, 1985. 66 ( Pt 12): p. 2743-8.

  20. Mangen, M.J., M. Nielen, and A.M. Burrell, Simulated effect of pig-population density on epidemic size and choice of control strategy for classical swine fever epidemics in The Netherlands. Prev Vet Med, 2002. 56(2): p. 141-63.

  21. Hoehl, S., H. Rabenau, A. Berger, M. Kortenbusch, J. Cinatl, D. Bojkova, et al., Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med, 2020. 382(13): p. 1278-1280.

  22. Gilbert, M., G. Pullano, F. Pinotti, E. Valdano, C. Poletto, P.Y. Boelle, et al., Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet, 2020. 395(10227): p. 871-877.

  23. EPA. List N: Disinfectants for Use Against SARS-CoV-2. 2020 [cited 2020 15/05/2020]; Available from: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2.

  24. Lubna, A.A.-A., A.B. Ghada, B. Elaine, C. Justin, C. John, D.M. Chris, et al., Physical interventions to interrupt or reduce the spread of respiratory viruses. Part 2 - Hand hygiene and other hygiene measures: systematic review and meta-analysis. 2020, BMJ Yale: medRxiv. p. 84.

  25. Semple, S., Dermal exposure to chemicals in the workplace: just how important is skin absorption? Occupational and Environmental Medicine, 2004. 61(4): p. 376-382.

  26. Chemical Agents that Cause Occupational Diseases, in The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society.

  27. Yamagishi, T., Environmental sampling for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a coronavirus disease (COVID-19) outbreak aboard a commercial cruise ship. medRxiv, 2020: p. 2020.05.02.20088567.

  28. Occupational Safety and Health Administration, Guidance on preparing workplaces for COVID-19, U.s.o.A. Department of Labor, Editor. 2020, Occupational Safety and Health Administration. p. 35.

How to cite this article:

Viramgami A, Pagdhune A, Sarkar K, Balachandar R. Occupational Health and Safety Practices at workplace during COVID-19 Pandemic. J Comprehensive Health 2020;8(2):