Current COVID-19 impact on Industry and best practice prevention strategies
As of April 1, 2020, over 4000 US residents have have died due to Covid-19. It’s a number that has more than tripled in five days, and now exceeds the number of people known to have died in mainland China, where the pandemic started in December. If the current trend continues, in another week, the number will push to over 10,000 US deaths. The future is uncertain.
It’s a fact that US industry relies heavily upon Chinese suppliers. Anyone sourcing Chinese products knows that every year, the Chinese New Year creates a supply chain headache. It’s China’s most important holiday, and every factory in the country shuts down for 2-4 weeks. To offset the traditional holiday interruption, US based companies who rely on Chinese goods place advance, larger orders to make sure they have ample buffer stock. Unfortunately, this year, the outbreak of Covid-19 fell at the same time as the holiday.
An estimated 380 million Chinese residents were off work and traveling during the holiday, and the virus spread like a wildfire. To combat, the Chinese government mandated extended factory shutdowns. So, a holiday that typically lasts 2-4 weeks, lasted 5+ weeks, and after that, thousands of workers were unable to work due to illness, and the government enacted additional shutdowns and quarantines. China has not fully rebounded.
The China “scenario” is repeating itself across the globe. It moves into a country, takes a foothold, and slams the economy, leaving a trail of tragedy and sorrow in its wake. The USA is still in the early phases, and in the end, the financial and human toll here will likely be far worse than what China experienced.
Long term growth will be delayed. For the time being, US companies just have ride things out. Overall consumer demand for manufactured goods, which contribute strongly to economic growth, has been stagnating. Restaurants, recreational centers, non-essential retail outlets, travel agencies, and other non-essential services are seeing very heavy cash flow pressure. The steep reduction in sales (or the complete elimination thereof), while many fixed costs remain, has put a great number of companies in a very precarious economic situation. Unfortunately, some businesses will not survive.
The impact on industry is suspected to continue to worsen as the spread of the virus impacts the US. As we’ve all seen, New York and California are being hammered right now, and experts believe that the impact across the US will be severe through May, and has good potential to roll into June/July. Things are going to get far worse, before they get better.
Once we’re able to get past the virus, manufacturing sectors will rebound strongly. Companies will simply have to push hard to recoup the losses as best they can.
Steps Employers Can Take to Reduce Workers’ Risk of Exposure
Companies should have an Infectious Disease Preparedness and Response Plan. Stay abreast of guidance from federal, state, local health agencies, and consider how to incorporate the recommendations into workplace-specific plans. Plans should consider the level(s) of risk associated with various worksites and assigned jobs. Considerations may include:
- a) where, how, and to what sources of Covid-19 might workers be exposed, including: The general public, customers, and coworkers; and sick individuals or those at particularly high risk of infection (e.g., international travelers who have visited locations with widespread sustained COVID-19 transmission, healthcare workers who have had unprotected exposures to people known to have, or suspected of having, COVID-19).
- b) workers’ individual risk factors (e.g., older age; presence of chronic medical conditions, including immunocompromising conditions; pregnancy).
Follow federal, state, and local recommendations regarding development of contingency plans, and keep in mind:
■ Increased absenteeism.
■ Social distancing, staggered work shifts, downsizing, delivering services remotely, and other exposure-reducing measures.
■ Options for conducting essential operations with a reduced workforce, including cross-training workers across different jobs in order to continue operations or deliver surge services.
■ Interrupted supply chains or delayed deliveries. Plans should also consider and address the other steps that employers can take to reduce the risk of worker exposure in their workplace, described in the sections below.
Implement Basic Infection Prevention Measures and Controls
Protecting workers will depend on emphasizing basic infection prevention measures.
■ As appropriate, all employers should implement and enforce good hygiene and infection control practices, including:
■ Promote frequent and thorough hand washing, including by providing workers, customers, and worksite visitors with a place to wash their hands. If soap and running water are not immediately available, provide alcohol-based hand rubs containing at least 60% alcohol.
■ Encourage workers to stay home if they are sick.
■ Encourage respiratory etiquette, including covering coughs and sneezes.
■ Provide customers and the public with tissues and trash receptacles.
■ Employers should explore whether they can establish policies and practices, such as flexible worksites (e.g., telecommuting) and flexible work hours (e.g., staggered shifts), to increase the physical distance among employees and between employees and others if state and local health authorities recommend the use of social distancing strategies.
■ Discourage workers from using other workers’ phones, desks, offices, or other work tools and equipment, when possible.
■ Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the work environment. When choosing cleaning chemicals, employers should consult information on Environmental Protection Agency (EPA)-approved disinfectant labels with claims against emerging viral pathogens. Products with EPA-approved emerging viral pathogens claims are expected to be effective against the virus based on data for harder to kill viruses. Follow the manufacturer’s instructions for use of all cleaning and disinfection products (e.g., concentration, application method and contact time, PPE).
■ Develop Policies and Procedures for Prompt Identification and Isolation of Sick People, if Appropriate
■ Prompt identification and isolation of potentially infectious individuals is a critical step in protecting workers, customers, visitors, and others at a worksite.
■ Employers should inform and encourage employees to self-monitor for signs and symptoms of COVID-19 if they suspect possible exposure.
■ Employers should develop policies and procedures for employees to report when they are sick or experiencing symptoms of COVID-19.
■ Where appropriate, employers should develop policies and procedures for immediately isolating people who have signs and/or symptoms of COVID-19, and train workers to implement them. Move potentially infectious people to a location away from workers, customers, and other visitors. Although most worksites do not have specific isolation rooms, designated areas with closable doors may serve as isolation rooms until potentially sick people can be removed from the worksite.
■ Take steps to limit spread of the respiratory secretions of a person who may have COVID-19. Provide a face mask, if feasible and available, and ask the person to wear it, if tolerated. Note: A face mask (also called a surgical mask, procedure mask, or other similar terms) on a patient or other sick person should not be confused with PPE for a worker; the mask acts to contain potentially infectious respiratory secretions at the source (i.e. the person’s nose and mouth).
■ If possible, isolate people suspected of having COVID-19 separately from those with confirmed cases of the virus to prevent further transmission—particularly in worksites where medical screening, triage, or healthcare activities occur, using either permanent (e.g., wall/different room) or temporary barrier (e.g., plastic sheeting).
■ Restrict the number of personnel entering isolation areas.
■ Protect workers in close contact with (i.e. within 6 feet of) a sick person or who have prolonged/repeated contact with such persons by using additional engineering and administrative controls, safe work practices, and PPE. Workers whose activities involve close or prolonged/ repeated contact with sick people are addressed further in later sections covering workplaces classified at medium and very high or high exposure risk.
■ Actively encourage sick employees to stay home.
■ Ensure that sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
■ Talk with companies that provide your business with contract or temporary employees about the importance of sick employees staying home and encourage them to develop non-punitive leave policies.
■ Do not require a healthcare provider’s note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way.
■ Maintain flexible policies that permit employees to stay home to care for a sick family member. Employers should be aware that more employees may need to stay at home to care for sick children or other sick family members than is usual.
■ Recognize that workers with ill family members may need to stay home to care for them.
■ Be aware of workers’ concerns about pay, leave, safety, health, and other issues that may arise during infectious disease outbreaks. Provide adequate, usable, and appropriate training, education, and informational material about business-essential job functions and worker health and safety, including proper hygiene practices and the use of any workplace controls (including PPE). Informed workers who feel safe at work are less likely to be unnecessarily absent.
■ Work with insurance companies (e.g. those providing health benefits) and state and local health agencies to provide information to workers and customers about medical care in the event of a COVID-19 outbreak. Implement Workplace Controls. OSHA professionals use a framework called the “hierarchy of controls” to select ways of controlling workplace hazards. In other words, the best way to control a hazard is to systematically remove it from the workplace, rather than relying on workers to reduce their exposure.
■ During a COVID-19 outbreak, while it may not be possible to eliminate the hazard, the most effective protection measures are (listed from most effective to least effective): engineering controls, administrative controls (including safe work practices), and PPE. There are advantages and disadvantages to each type of control measure when considering the ease of implementation, effectiveness, and cost. In most cases, a combination of control measures will be necessary to protect workers from exposure to SARS-CoV-2. In addition to the types of workplace controls discussed below, CDC guidance for businesses provides employers and workers with recommended prevention strategies to implement in workplaces:
Engineering controls involve isolating employees from work related hazards. In workplaces where they are appropriate, these types of controls reduce exposure to hazards without relying on worker behavior and can be the most cost-effective solution to implement. Engineering controls for SARS-CoV-2 include:
■ Installing high-efficiency air filters.
■ Increasing ventilation rates in the work environment.
■ Installing physical barriers, such as clear plastic sneeze guards.
■ Installing a drive-through window for customer service.
■ Specialized negative pressure ventilation in some settings, such as for aerosol generating procedures (e.g., airborne infection isolation rooms in healthcare settings and specialized autopsy suites in mortuary settings).
Administrative controls require action by the worker or employer. Typically, administrative controls are changes in work policy or procedures to reduce or minimize exposure to a hazard. Examples of administrative controls for SARS-CoV-2 include:
■ Encouraging sick workers to stay at home.
■ Minimizing contact among workers, clients, and customers by replacing face-to-face meetings with virtual communications and implementing telework if feasible.
■ Establishing alternating days or extra shifts that reduce the total number of employees in a facility at a given time, allowing them to maintain distance from one another while maintaining a full onsite work week.
■ Discontinuing nonessential travel to locations with ongoing COVID-19 outbreaks. Regularly check CDC travel warning levels at: www.cdc.gov/coronavirus/2019-ncov/travelers.
■ Developing emergency communications plans, including a forum for answering workers’ concerns and internet-based communications, if feasible.
■ Providing workers with up-to-date education and training on COVID-19 risk factors and protective behaviors (e.g., cough etiquette and care of PPE).
■ Training workers who need to use protecting clothing and equipment how to put it on, use/wear it, and take it off correctly, including in the context of their current and potential duties. Training material should be easy to understand and available in the appropriate language and literacy level for all workers.
OSHA Safe Work Practices
OSHA Safe Work Practices are types of administrative controls that include procedures for safe and proper work used to reduce the duration, frequency, or intensity of exposure to a hazard. Examples of safe work practices for SARS-CoV-2 include:
■ Providing resources and a work environment that promotes personal hygiene. For example, provide tissues, no-touch trash cans, hand soap, alcohol-based hand rubs containing at least 60 percent alcohol, disinfectants, and disposable towels for workers to clean their work surfaces.
■ Requiring regular hand washing or using of alcohol-based hand rubs. Workers should always wash hands when they are visibly soiled and after removing any PPE.
■ Post handwashing signs in restrooms.
■ 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. While correctly using PPE can help prevent some exposures, it should not take the place of other prevention strategies. Examples of PPE include gloves, goggles, face shields, face masks, and respiratory protection, when appropriate. During an outbreak of an infectious disease, such as COVID-19, recommendations for PPE specific to occupations or job tasks may change depending on geographic location, updated risk assessments for workers, and information on PPE effectiveness in preventing the spread of COVID-19. Employers should check the OSHA and CDC websites regularly for updates about recommended PPE. All types of PPE must be:
■ Selected based upon the hazard to the worker.
■ Properly fitted and periodically refitted, as applicable (e.g., respirators).
■ Consistently and properly worn when required.
■ Regularly inspected, maintained, and replaced, as necessary.
■ Properly removed, cleaned, and stored or disposed of, as applicable, to avoid contamination of self, others, or the environment. Employers are obligated to provide their workers with PPE needed to keep them safe while performing their jobs. The types of PPE required during a COVID-19 outbreak will be based on the risk of being infected while performing job tasks that may lead to exposure. Workers, including those who work within 6 feet of patients known to be, or suspected of being, infected and those performing aerosol-generating procedures, need to use respirators:
■ National Institute for Occupational Safety and Health (NIOSH)-approved, N95 filtering facepiece respirators or better must be used in the context of a comprehensive, written respiratory protection program that includes fit-testing, training, and medical exams.
■ When disposable N95 filtering facepiece respirators are not available, consider using other respirators that provide greater protection and improve worker comfort. Other types of acceptable respirators include: a R/P95, N/R/P99, or N/R/P100 filtering facepiece respirator; an air-purifying elastomeric (e.g., half-face or full-face) respirator with appropriate filters or cartridges; powered air purifying respirator (PAPR) with high-efficiency particulate arrestance (HEPA) filter; or supplied air respirator (SAR).
■ Consider using PAPRs or SARs, which are more protective than filtering facepiece respirators, for any work operations or procedures likely to generate aerosols (e.g., cough induction procedures, some dental procedures, invasive specimen collection, blowing out pipettes, shaking or vortexing tubes, filling a syringe, centrifugation).
■ Use a surgical N95 respirator when both respiratory protection and resistance to blood and body fluids is needed.
■ Face shields may also be worn on top of a respirator to prevent bulk contamination of the respirator. Certain respirator designs with forward protrusions (duckbill style) may be difficult to properly wear under a face shield. Ensure that the face shield does not prevent airflow through the respirator.
■ Consider factors such as function, fit, ability to decontaminate, disposal, and cost. OSHA’s Respiratory Protection eTool provides basic information on respirators such as medical requirements, maintenance and care, fit testing, written respiratory protection programs, and voluntary use of respirators, which employers may also find beneficial in training workers at: www.osha.gov/SLTC/etools/respiratory.
■ Respirator training should address selection, use (including donning and doffing), proper disposal or disinfection, inspection for damage, maintenance, and the limitations of respiratory protection equipment.
■ The appropriate form of respirator will depend on the type of exposure and on the transmission pattern of COVID-19. See the NIOSH “Respirator Selection Logic”
■ Follow Existing OSHA Standards; standards may apply to protecting workers from exposure to and infection.
■ OSHA’s Personal Protective Equipment (PPE) standards, which require using gloves, eye and face protection, and respiratory protection. When respirators are necessary to protect workers or where employers require respirator use, employers must implement a comprehensive respiratory protection program in accordance with the Respiratory Protection standard (29 CFR 1910.134).
■ The General Duty Clause, Section 5(a)(1) of the Occupational Safety and Health (OSH) Act of 1970, 29 USC 654(a)(1), which requires employers to furnish to each worker “employment and a place of employment, which are free from recognized hazards that are causing or are likely to cause death or serious physical harm.”
■ OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) applies to occupational exposure to human blood and other potentially infectious materials that typically do not include respiratory secretions that may transmit SARS-CoV-2. However, the provisions of the standard offer a framework that may help control some sources of the virus, including exposures to body fluids (e.g., respiratory secretions) not covered by the standard.
The level of risk depends in part on the industry type, need for contact within 6 feet of people known to be, or suspected of being infected, or requirement for repeated or extended contact with persons known to be, or suspected of being, infected.
To help employers determine appropriate precautions, OSHA has divided job tasks into four risk exposure levels: very high, high, medium, and lower risk. The Occupational Risk Pyramid shows the four exposure risk levels in the shape of a pyramid to represent probable distribution of risk. Most American workers will likely fall in the lower exposure risk (caution) or medium exposure risk levels.
Very High / High Risk
Very high exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem, or laboratory procedures. Workers in this category include:
■ Healthcare workers (e.g., doctors, nurses, dentists, paramedics, emergency medical technicians) performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and exams, or invasive specimen collection) on known or suspected COVID-19 patients.
■ Healthcare or laboratory personnel collecting or handling specimens from known or suspected COVID-19 patients (e.g., manipulating cultures from known or suspected COVID-19 patients).
■ Morgue workers performing autopsies, which generally involve aerosol-generating procedures, on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death. High Exposure Risk High exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19. Workers in this category include:
■ Healthcare delivery and support staff (e.g., doctors, nurses, and other hospital staff who must enter patients’ rooms) exposed to known or suspected COVID-19 patients. (Note: when such workers perform aerosol-generating procedures, their exposure risk level becomes very high.)
■ Medical transport workers (e.g., ambulance vehicle operators) moving known or suspected COVID-19 patients in enclosed vehicles.
■ Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death.
Medium exposure risk jobs include those that require frequent and/or 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 who may return from international 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 (i.e. schools, high-population-density work environments, some high-volume retail settings).
Low Risk (Caution)
Lower exposure risk (caution) jobs are those that do not require 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 coworkers.
We hope this information has been helpful to you. More importantly, we hope that you and your family are safe. Money is important, but at times like this, we are reminded that those we love are far more important. Be safe, be smart, and do everything you can to stay healthy!!
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