Exposure to biological agents in the workplace is associated with numerous health problems, including infectious diseases and allergies and awareness in this area has particularly become pertinent given the current Coronavirus disease of 2019 (COVID-19) pandemic. From an occupational health point of view, some of the thematic areas involved in dealing with COVID-19 are discussed here:
1. Reducing Exposure to COVID-19 at the workplace
Infection prevention and control of COVID-19 in the workplace should take a risk-based approach. The first step is to conduct a baseline risk assessment in an effort to characterise the current and potential risks around a workplace and this will form the basis for the organisation emergency preparedness for the Pandemic. Organisations have a variety of different approaches they could take to do this. Large complex organisations may choose more formal processes like bow-tie analysis, but other simpler methods still exist and will serve many organisations very well. A risk assessment reduces the possibility of missing important areas in the organisation that need attention. Assessment of existing and proposed controls needs to be cognizant of the hierarchy of control which ensures that collective measures are given priority over individual measures like use of Personal Protective Equipment (PPE)
The hierarchy of infection prevention and control of COVID-19 in the workplace involves
(i) Elimination refers to total removal of a risk and at the current level of the pandemic this is not yet a feasible option. While the Botswana Government has put in place commendable effort towards containment of COVID-19 cases, recent events and have shown that elimination is truly a mammoth task.
(ii) Substitution involves reducing risk by using safer alternative processes and an example of this is use of telemedicine as opposed to the traditional visiting of the doctors’ rooms. It is always important to ensure that the new reportedly safer method does not introduce a different set of risks and in the current example, misdiagnosis of patient conditions due to lack of physical examination.
(iii) Engineering Controls in the workplace include installing of transparent glass or hard plastic screens protecting employees from direct contact with clients as well as simple foot-operated sanitizer dispensers we have seen in recent times. More sophisticated equipment that increases ventilation and extraction of contaminated air also falls under this category.
(iv) Administrative Controls approach risk control from an organisational change in work practices and includes putting in place policies and procedures that are fully shared with all employees, creating a work environment that fosters safe work practises and regular checks to ensure adherence. Administrative controls also include arranging work places foster maintenance of the recommended 1-2 meters social distancing, registration and temperature checks of employees and visitors, regular sanitization of surfaces and hand washing
(v) Personal Protective Equipment is the least effective but most commonly used control. It is very much reliant on the individual to make themselves safer and peer review can be used to improve adherence. Examples of PPE include masks, gloves, face shields, aprons etc. and these are used to varying degrees depending on the risk level of specific workplaces. It remains the employer’s responsibility to ensure that employees are provided with appropriate and adequate PPE.
An action plan with deliverables, assigned responsibility, completion dates and resources required should be derived from the risk assessment and forms the basis of ensuring workplaces are ready to minimise risk of Covid-19 spread. Critical controls and legal requirements do not have to wait for the risk assessment and must be implemented immediately. The entire organisational COVID-19 infection prevention and control program should be monitored through a suitable performance monitoring process, looking at leading, current and lagging indicators. Scheduled management reviews of the organisational COVID-19 infection prevention and control plan should be conducted with clear outcomes.
2.Occupational Health Considerations in Case Management
As the COVID-19 pandemic escalates, it may be unfortunate but inevitable that employees will get infected by the novel Coronavirus. While the clinical management of the disease itself remains the responsibility of medical team at the designated healthcare facilities, clear processes should guide how the case is managed from an occupational health point of view. The employer needs to have a clear line of communication with the affected employee as well as the rest of the organisation. The process and nature of supporting the employee, their families and any other affected co-workers should also be clearly articulated and/or written. There is a need to have policies around workplace recovery and restoration that include rehabilitation of contaminated workspaces. A decision also needs to be made on whether this is an occupational acquired disease or not. This will require a proper assessment of whether the disease arose out of and in the course of the employee performing his duties. In cases where the COVID-19 case is a confirmed Occupational Disease, processes around filing for a compensation claim for the employee need to completed. Supporting the affected employee on their return to work is a critical aspect in employee health and wellness and this needs to be managed adequately and appropriately.
3.Employee Mental Health Considerations
As workplaces reopen to new ways of work after the global lockdowns, employers need to gear themselves to addressing issues of employee wellbeing and mental health as well as ensure that workplace cultures and environment do not compound already existing such issues. Besides personal sources poor mental health including pre-existing metal diseases, worry over self and loved ones contracting disease, lifestyle changes imposed by the lockdown including substance abuses, the workplace is associated with its own risks for poor mental health. These include fear of increased risk of contracting the disease at the workplace, financial stress from salary cuts or looming job losses and feeling of isolation and poor social interaction imposed by use of masks and adherence to social distancing protocol. This may be worsened by implementation of working remotely. Employers can adopt the following to ensure the impact of mental health in the workplace is reduced:
- Proactively boosting employee wellness activities through Employee Assistance Programme (EAPs). It may be necessary to nominate a small group of to lead the workplace mental health efforts.
- Ensure regular, timely and accurate communication with employees providing information about mental health, reducing stigma, encouraging help-seeking behaviours and increasing awareness of available mental health resources. Furnishing employees with recommended sources of information about the pandemic also helps to allay anxiety from misinformation.
- Update and share workplace policies that have been modified because of the pandemic. Written protocols on steps to be taken in the unfortunate event of an employee being infected also helps reduce anxiety around the workplace.
- Where working remotely has been adopted, provide clear guidelines and expectations. Setting clear plans with key deliverables, sharing calendars, use of electronic timesheets and well-spaced virtual meetings are some of the ways of keeping employees engaged while working from home.
4. Ethical Considerations
Underpinning the entire management of COVID-19 are critical ethical considerations. Important issues of public vs individual interests, disclosure, confidentiality, consent need to be thought through carefully.
Thabo Mosipi Occupational Health Nurse and Dr Mogwera Mogalakwe Occupational Health Practitioner, CEO Storkfort Health