Year : 2020  |  Volume : 24  |  Issue : 3  |  Page : 133--136

COVID-19—Practicing prevention in the workplace


Bobby Joseph, Nancy G Angeline, Sakthi Arasu 
 Division of Occupational Health Services, Department of Community Health, St. John's Medical College, Bangalore, Karnataka, India

Correspondence Address:
Prof. Bobby Joseph
Division of Occupational Health Services, Department of Community Health, St. John's Medical College, Bangalore - 560 034, Karnataka
India




How to cite this article:
Joseph B, Angeline NG, Arasu S. COVID-19—Practicing prevention in the workplace.Indian J Occup Environ Med 2020;24:133-136


How to cite this URL:
Joseph B, Angeline NG, Arasu S. COVID-19—Practicing prevention in the workplace. Indian J Occup Environ Med [serial online] 2020 [cited 2021 Jan 16 ];24:133-136
Available from: https://www.ijoem.com/text.asp?2020/24/3/133/302825


Full Text



 Introduction



Globalization, travel, and trade accelerates pandemics illustrating the interconnectedness of the world, and in turn pandemic affects international trade[1] which affects the workforce behind it. Due to the COVID-19 pandemic along with the resultant lockdown, the economy is affected globally and work trends changed drastically. Most organized sectors have moved on to work from home options and semi- and unorganized sectors faced multiple issues such as losing employment, cessation or reduction of salary, compulsory leave/loss of pay, overtime work with less workers, and increased physical and mental stress. Many industries which depend on migrant workforce were left with a handicap when reverse migration happened in the post lockdown period. There are no legislations[2] to protect these migrant workers during an economic shut down. Currently, workplaces are returning back to normalcy in a stepwise fashion and it is imperative to tackle COVID-19 among the workers and ensure safety and health.[3]

 Challenges in COVID-19 Prevention at Workplaces



A range of challenges are faced when COVID-19 prevention measures are to be followed at the workplace. Most of the sectors demand people to work in close proximity and many a time the management does not have contingency measures to tackle such a crisis.[4] Combined with this, the non-flexible nature of supply chain sector, lack of incentives, inconsistent government support, fragile trust between retailers and consumers, poor infrastructure, safety of staff and materials, and reduced manpower adds more difficulties to prevention of COVID-19 in workplaces.[5] The following are the common challenges faced:

Presence of machines and goods reduces the place for the workers and heavier or fixed machines makes it almost impossible to follow physical distancing.Wearing masks is a new normal for everyone and people are still struggling to get used to this measure. When this is combined with physically strenuous work, ill-fitting masks and masks which are not as per WHO guidelines, difficulty in breathing can make workers feel dyspnoeic and giddy.For every scientifically proven research result, there are a lot of rumours and false information which makes it difficult to implement preventive measures at the individual level.Workplaces cannot afford to give breaks every half hour for the workers to wash their hands and most of the workers find the hand sanitizer as a luxury they can live without.Return of a worker who contacted the disease and has been cured comes with the price of strained relationships, anxiety, stigma, and reduced work tolerance.[6]

 Preventing COVID-19 in Workplace



The responsibility of COVID-19 prevention in the workplace lies with the employers. Apart from the Government of India, organizations like the Centers for Disease Control and Prevention (CDC), Occupational Health and Safety Association[7] (OSHA), World Health Organization (WHO),[8] and National Centre for Disease Control (NCDC)[9],[10] have given their set of guidelines and Standard Operating Procedures for preventing COVID-19 at different types of workplaces. The mitigation strategies suggested can be classified based on the level of prevention they are part of. Since primordial prevention is not applicable in a pandemic, primary prevention is the most important strategy. Health education is given through mass media, social media, emergency broadcasts, and also through telecom service providers.

Primary prevention

Face masks reduce the risk of transmission of COVID-19 from 17.4% to 3.1% and physical distancing lowers the risk from 12.8% to 2.6%.[11] Facial shield or eye protection reduces risk from 16% to 5.5%. Masks are proven to bring down the mortality risks associated with COVID-19[12] and mandatory mask wearing regulations[13] and universal masking[14] are proven preventive measures against COVID-19 averting more than 200,000 cases by May in Washington DC.[15] Mask usage alone keeps the R0 < 1 and saving thousands of dollars spent per person.[16] Even though the N95 masks are considered the gold standard[17] in efficacy and protection, a well-designed, three layer and tightly fit mask is sufficient to protect the community (30-90% particle removal efficacy) from COVID-19.[18]

Social distancing was proven to reduce the disease transmission during previous epidemics of SARS and MERS.[19] WHO recommends a social distancing of 1 m,[20] whereas CDC[21] and Indian Government[22] advise 2 m. Many countries adopted national lockdowns to promote social distancing because the risk is high in places of work, education, entertainment, and commerce.[23]

Hand hygiene is a universal preventive and protective measure for multiple diseases and COVID-19 was added to that list. Hand washing reduces incidence of an infection, becomes more effective when correctly practised and should be coupled with educating the people on correct usage of soap and sanitizers.[24] Since COVID-19 is proven to spread through droplet infection, hand-washing definitely reduces its spread.[25]

Behavior change in wearing masks, physical distancing, and hand hygiene can be advocated at workplaces through health education activities. These and other methods that could be adopted at workplaces could include:

Installation of hands-free hand-washing points, hand sanitizer pointsFree distribution of three-layer breathable cloth mask to workersNutrition, physical activity, mental health promotionBehavior change communicationVaccination—once trials have proved their valuePeer-to-peer health educationAdvising all symptomatic workers to avail sick leaveFacilitating leaves during periods of quarantine

Secondary prevention

This involves early diagnosis and treatment. COVID-19 has a wide spectrum of presentation with 80% having mild symptoms, 15% with moderate, and 5% with severe illness.[26] Till date, there is no vaccine or curative medicine available and research trials are happening around the globe—most of the treatment focuses on slowing viral replication, reducing lung damage, and preventing complications. The diagnosis of COVID-19 through Rapid Antigen Test (RAT) and Polymerase Chain Reaction (PCR) tests are streamlined currently and made free or capped to affordable prices through the efforts of the Government. Factories should be equipped to screen at-risk individuals and facilitate their testing procedures. This early diagnosis reduces the risk of transmission to others. There is widespread research on COVID-19 treatment with numerous trials in progress around the world.[27],[28],[29],[30],[31] Since no specific cure is available yet,[32] factories should rely on their partnerships with hospitals or Employee’s Insurance schemes to make sure they get appropriate treatment.

Secondary preventive measures for COVID-19 in workplaces are as follows:

Mandatory thermal screeningReferral of symptomatic/close contact workers to network hospitals for screeningAccess to health insurance in case of hospital admissionsEducating isolated workers on guidelines for home isolationFacilitating sick leave during periods of home isolation or hospital admissionAddressing stigma at workplace by clearly educating about periods of transmission of the virusProviding care to individuals at high risk for COVID-19 such as older employees, pregnant women and workers with co-morbidities

Measuring the oxygen saturation has proven to be an effective measure in assessing the severity of COVID-19 and also the need for hospitalisation [33] but the feasibility to measure SpO2 for every worker on a daily basis can be challenging.

Tertiary prevention

Tertiary prevention measures will benefit the workers who test positive for COVID-19, undergo the mandated 14 days isolation and then return back to work. Ideal workplace rehabilitation comprises early return to work, workplace modifications when necessary and ergonomic measures to reduce pain and disability.[34] Organizational restructuring comes with its own burden of making every employee to adapt to the changes in the work environment.[35] It is better to focus on developing routines, improving work relations for the smooth integration of returning employees.[36] COVID-19 coupled with loss of work and/or loss of pay lead to lot of stress, mental exhaustion and depression[37],[38] among the employees. Mental health of the employees should not be ignored as the access to mental health services are also disrupted in the pandemic.[39]

COVID-19 is proven to cause long-term complications in some people with myocardial infarctions[40] and cerebro-vascular accidents[41] being documented. Factory management and the medical team should be oriented to manage treated COVID-19 affected workers returning to work and look out for danger signs of a delayed event. Workplaces have an important role in:

Facilitating the access to best of care to the worker through correct referralFacilitating follow-up visits to a physician after discharge from hospital admission/home isolationFacilitating comfortable return to work after discharge from hospital/home isolation.

 Best Practices in Workplace



A important concern to workplace management is that of testing,[42] before smooth inclusion of returning migrant workers. The shop floor employees depend on their management to interpret the policies and make interventions and it is up to the managerial stakeholders to bring about changes suitable to that workplace context.[6] The managerial readiness to accept and adopt measures for the betterment of employees goes a long way in increasing the trust of the workforce.[43] We have collated important practices from formal and informal interactions with different stakeholders of multiple industries. These measures are followed because of the proactive nature of the factory management who are concerned about the wellbeing of their employees. These practices are mostly beneficial or non-harmful even though there is no robust research data available—hence this editorial does not categorically endorse any of the following practices.

Some of these measures are:

Shifting from fingerprint attendance to touch-free face recognition entry and exitDistribution of locally available immunity boostersTimed breaks with alarms for hand-wash/sanitiser useProvision of soap for individual employees and addition of new wash stationsReorganisation of shopfloor layout and spacing of machines to follow distancingDesignated staff to oversee preventive measuresPlaying recorded COVID-19 messages on preventionProvision of factory-made masks to all employeesNot using pick up buses and if used, spray cleaning of seats after every tripBringing in a medical person to give awareness trainings to the employeesSpecial training for factory nurses by a doctor to pick up/refer a person with symptomsProviding hostels for quarantine on return from hometownStaggered eating schedules in factory and hostel canteensProtective gear for end line quality control staff.Workplace counselling services for COVID-19 related stress and anxiety.Pulse oximeter being used in nursing stationFacilitating optional testing for every employee

Until the arrival and widespread availability of an effective vaccine, these modalities if used singly or in combination are likely to ensure better prevention of infections in general in the workplace.

It is pertinent to mention here that the Employee State Insurance (ESI) Corporation has seen a sharp increase in registered members after March 2020. The “Atal Bimit Vyakti Kalyan Yojana”[44] which pays a token sum to registered members during the period of unemployment has relaxed its rules during COVID-19 times. It has increased the minimum amount to be paid from 25% to 50% of the wages; payable after 30 days of unemployment rather than 90 days. Many ESI Hospitals were converted into dedicated COVID-19 hospitals with 3,597 isolation beds, 555 ICU beds, and 213 ventilators.[45]

COVID-19 will be a part of human life and life has to be lived around it. This applies to the workplace also and many of these measures, whether mandated or innovated are essential to keep up not just the health of the employees but also their morale in general. The feeling that employer is taking measures to take care of them makes the employee less worried about the pandemic’s consequences.

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