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The past few months have seen organisations focusing on a whole new area of risk assessment related to infection control. Andrew McNeil CMIOSH, Simon Rider PgDip(Law) and Dr Dawn Pope CMIOSH offer evidence of published cases of local outbreaks relating to facilities and businesses and consider how COVID-19 risk assessments can be informed.
Risk assessments are often the first document that health and safety inspectors ask to see on an inspection or after an incident. They are a focal point for any civil claim or any prosecution. COVID-19 risk assessments have become a key strand in the UK government's response to providing a healthy and safe workplace in the pandemic.
In July the UK Health and Safety Executive (HSE) helpfully produced a template to address the risk assessment process. It provides a good basis for cross-referencing other relevant guidance, though it would be wise to check all government guidance relevant to your industry.
For many, risks such as Legionella, asbestos or manual handling are well known and categorised from years of analysis. This is not the case with COVID-19. We are still learning about this virus, how it is transmitted and how to treat it.
Outbreak incidents
The Centers for Disease Control and Prevention recently published reports of outbreak incidents that highlight potential risks in workplaces.
Case study 1: Infection through a lift trip in Heilongjiang
Newspaper headlines said: 'Coronavirus: woman infects 71 people after one lift trip'. The unwitting super-spreader returned home to the Chinese province of Heilongjiang on 19 March following a trip to the US, according to the report published by the Centers for Disease Control and Prevention.
Prior to her arrival, the region had reported no new coronavirus cases for eight days. She had no direct contact with any other people in her building and had not taken the lift with anyone else. However, on 26 March, her neighbour invited her mother and her boyfriend to stay the night. Three days later, they went to a party with another group of people. Then, on 2 April, a member of the party suffered a stroke and was taken to hospital, accompanied by his sons. On 7 April, the mother’s boyfriend began showing COVID-19 symptoms.
Researchers concluded that the traveller must have contaminated the elevator, prompting a mass spread of infections. It then transpired that they had infected 28 people in a first hospital – including five nurses and a doctor – followed by another 20 in a second hospital.
Case study 2: a call centre in Seoul
Another informative and thorough study was an outbreak in a call centre in early March in Seoul, South Korea. A single infected employee worked on the 11th floor of a building; that floor had 216 employees. Employees did not generally move between floors, and they did not have an in-house restaurant for meals.
Over the period of a week, 94 of those people became infected (43.5%). Three other people on different floors were also infected. Note how one side of the office was mainly infected, but there were others at some distance away on the other side, who also became infected.
While the number of people infected by different routes such as respiratory droplets, aerosol or fomite transmission (door handles, shared water coolers, elevator buttons etc) is unknown, this shows that being in an enclosed space, in a crowded office environment and sharing the same air for a prolonged period is very high risk for exposure and infection.
Communication with health and safety law firms indicates that employees are already approaching lawyers with a view to claims from workplaces including meat processing plants, agricultural processing operations, warehouses and manufacturing operations. Of course, unless there are several cases in quick succession, like the cases described, it might be difficult to prove a person was infected from their workplace.
More recent information about these circumstances was published in a letter by a field epidemiologist who is also an occupational physician and was involved in investigating that incident. He added: 'The work environment of the call centre was an important reason for the high attack rate on the 11th floor. The width of the desks was 1.2m, and most employees had worked without face masks despite the high risk … [and] enclosed space … In addition, presenteeism also affected the high attack rate. At least 10 employees continued to work despite having symptoms.'
Case study 3: a restaurant in Guangzhou
A report of an outbreak of COVID-19 in a restaurant in Guangzhou in late January and early February also demonstrates likely aerosol spread, from a single asymptomatic carrier in a restaurant environment.
The infected person had dinner with nine friends. During the meal, which lasted about an hour, the asymptomatic carrier released low levels of virus into the air from breathing.
Airflow, from various airflow vents, was from right to left. The tables were about a metre apart. About half the people at the infected person's table became sick over the next seven days. 75% of the people on the adjacent downwind table became infected. Two of the seven people on the upwind table were infected (probably by turbulent airflow).
No one at tables out of the main airflow from the air conditioning on the right to the exhaust fan on the left of the room became infected.
Incidentally, this outbreak demonstrates quite clearly that sitting back-to-back in an indoor environment does not offer protection from infection. Direction of airflow is important as it can defeat measures such as sitting back to back, and even make distancing less effective.
Get everyone involved
With the COVID-19 risk assessment getting to the root of what an organisation can and should be doing to protect against infection, it is important to involve the workforce. The HSE produced a separate guide about involving the workforce in the health and safety COVID-19 risk assessment, 'Talking with your workers about preventing coronavirus'. This guide helps employers to structure the dialogue that should take place between management and workforce. Only by engaging all experiences and perspectives will an effective risk assessment with maximum engagement be achieved.
Who is up to speed?
The wealth of documentation through which an organisation must plough in order to consider all the factors that should go into a risk assessment is considerable. The government has been producing hundreds of pages of guidance. For example in the care sector, Vic Raynor, executive director of the National Care Forum was quoted on the National Care Forum website as saying: 'Government guidance has come to the sector in stops and starts – with organisations grappling with over 100 pieces of additional guidance in the same number of days, much of which was not accompanied by an understanding of the operational implications of operating care services.' And the guidance has been changing rapidly.
In mid-July, Dr Dawn Pope, director of SEL Group, reviewed the websites of the top 10 FTSE companies to see if they had complied with the HSE’s recommendation that they display their risk assessment on their website (see our Linkedin Live discussion here). At the time of the survey, SEL Group did not locate the COVID-19 Secure Notice or the published risk assessment for any of the companies reviewed.
Searching the web for COVID-19 risk assessments in general does not bring up as many results as one would expect if every organisation were doing this. If organisations have failed to comply with this key reporting requirement from the HSE, what other aspects of their COVID-19 risk assessment will they have failed to give adequate attention to?
Another indicator of compliance is the number of companies that have supplied or displayed the COVID-19 Secure poster prominently on their premises or on their website. In the experience of the authors, this is a vanishingly small percentage of organisations.
Control measures
Much of the HSE’s COVID-19 risk assessment template focuses on additional control measures. There is a column to identify any additional control measures, and a further two columns to identify the person responsible, and the date by which this work should be carried out. Employers should have important control measures are already in place before employees return to work.
If any control measures are left as future actions perhaps because of, for example, PPE supply problems or other factors, and employees can trace an outbreak of COVID-19 to the workplace, the COVID-19 risk assessment can be a key document in civil and criminal proceedings. It may leave the employer open to allegations of not having done all that it reasonably could to ensure the health of its employees as though there were control measures, there weren't yet in place.
Face masks
The UK has been relatively slow to adopt face masks. This is not necessarily negative. It is, in fact, in line with World Health Organization and UK government guidance. There is no increasing emphasis on face masks, but this raises the question of whether they can be viewed as too much of a solution in a risk assessment.
Of course, wearing face masks properly is very much down to good training. The World Health Organization has produced a video explaining how face masks should be handled and worn to maximise their effectiveness. This video is a good reference for any employer training.
Revising the risk assessment
The risk assessment should be regularly reviewed in the light of changing government guidance. In view of the frequency of this, it should be reviewed each time relevant guidance is announced as having been updated. Sometimes changes occur without public announcements and it is therefore prudent to keep all the documentation and the control measures in risk assessments under review.
COVID-19 risk assessments are a crucial tool in addressing risk and communicating it to employees and others affected by the operation. We would make the following observations:
- It is important to complete the risk assessments involving all in the organisation. Ensure that control measures are not left open especially if assigned to individuals.
- In any risk assessment and important consideration is whether it is possible to avoid bringing people together. Allowing employees to work from home and communicate with customers using online or telecommunications tools rather than visits where possible.
- Following the control measures suggested in government guidance help control potential outbreaks such as those described here by addressing people who are unwell coming to work, ensuring that those at work are adequately distanced, and providing numerous reminders on good practise to avoid virus spread.
- Risk assessments should be kept up to date with current medical knowledge, government guidance and changes in operational procedures.
- Risk assessments should be displayed on websites of organisations with more than 50 employees and the COVID-19 compliance poster should be placed on websites and displayed in premises.
With everyone's desire to get back to work as soon as possible, and changes to the work from home guidance made from 1 August 2020, the question of whether the work can be done from the employee’s home may not be being given enough attention.
According to the UK government’s guidance: ‘Employers should consult with their employees to determine who, from the 1 August 2020, can come into the workplace safely – taking into account a person’s journey, caring responsibilities, protected characteristics, and other individual circumstances. Extra consideration should be given to those people at higher risk.’
Risk assessment and consultation are powerful tools to support the decision-making about how COVID-19 risk can best be mitigated in your business. However, the real challenge is not producing a document or having a discussion, it is employees and managers acting to modify behaviours and implement controls effectively. It is not about being risk averse, but making reasonable decisions to identify controls that balances the needs of the business with the safety and health of the individual.
This article was written by Andrew McNeil CMIOSH, managing director of McNeil Collective; Simon Rider, senior consultant at McNeil Collective; and Dr Dawn Pope CMIOSH, consultant at SEL Group