This post is meant to help businesses design and implement protocols to keep employees, customers, and the greater public safe from Covid-19 during business operation. The federal government (executive branch, Centers for Disease Control (CDC), and FDA), local government (governor's office, health departments), and The World Health Organization (WHO) have released numerous amounts of information on this subject. We encourage all businesses to read and learn as much as they can. However, these guidelines are not specific to your unique business. Additionally, they have often been unclear, contradictory, and/or unrealistic. Unfortunately, thinking and targeted strategies will be required to find the ideal strategy for your unique enterprise.
Wonder Medicine is here to help businesses find unique strategies to allow them to operate safely. Please email us about your business at info@wondermedicine.com. Let us know what strategies you have been using. If you are local (Boise, Idaho), we will set up a time to meet you at your business. If you are not local we will call you. This service is completely free.
Goals of a Covid-19 Safety Protocol
Allow businesses to operate in a financially viable way.
Protect employees from potential infection (remember, your employees are your number 1 resource).
Protect customers from potential infection.
Disseminate valuable information and contribute to community infection control, thereby protecting the greater public.
Set an example, be rational, and realistic!
Remember, SARs CoV-2 (Covid-19) is just one of many risks faced by workers and the general public everyday. In the last few months, the risks have been considerable, to the tune of almost 100,000 deaths in the United States. However, as case numbers fall, other potential risks may become more important considerations. For instance influenza causes between 12,000 and 61,000 thousand deaths annually in the United States alone. But yet, most of us have not worn face masks during past flu seasons and businesses have not shut down, at least since 1918. Approximately 40,000 people die every year in the United States from automobile accidents. But yet, most of us still drive. Risks are everywhere; we always accept them and continue to live our lives. Covid-19 will likely eventually take its place among all the other risks we face everyday.
As time passes and Covid-19 cases fall, businesses should start removing protocols and policies. Active Covid-19 cases in your community, general risk tolerance, local laws, and clientele will likely be the main considerations for removal. If your workers or customers are typically older with health issues, consider more rigorous protocol strategies and prolonged implementation. Some policies and protocols implemented may be beneficial indefinitely. Learn from Covid-19, and carry it’s lessons with you into the future.
Make sure any strategy you implement does not cause more harm than good. For instance, masks (particularly N95 masks) make it harder to breathe and impair our body’s ability to cool down. Outdoor work crews that distance more than 6 feet have very little chance of contracting or spreading Covid-19. However, they have a very real risk of overheating and exhaustion. As such, the risks of putting a mask on your outdoor workers greatly outweighs the benefits. What is important is having your outdoor workers wear masks when traveling together in a confined vehicle. Ideally workers would drive their own cars to the job site. Your business needs to think about every part of your protocol. Make sure to think about the risks and repercussions of any actions. Staying at home is great for infection control, but puts victims of domestic violence at a very heightened risk. Think, every action has consequences!
General Safety Principles
Engineering controls are the most important strategy as they take human factors out of the equation. Set up, or move to an environment that reduces the chances of infection.
Human distancing works. Keep people apart, 6 feet is a reasonable goal.
Limit the things your employees and customers touch. Pay specific attention to checkout procedures. Wash your hands frequently.
Encourage employees and customers to wear masks and gloves in the right settings.
Engineering Controls
Modifications to a given environment will always lead to better results than modifications that rely in any way on humans and learned behavior. This is one of the hallmarks of occupational health. Engineering controls should be any businesses first consideration with regard to keeping humans safe. It will be your most effective means of protecting employees, customers, and the general population.
If some of your business can be conducted outside, do so. Air moves constantly outside and is constantly recycled. If working inside, provide sufficient airflow. Exhaust fans or even a well-placed fan next to an open window can help. Small rooms with still air are not ideal places for business during the pandemic.
Recently airlines have begun installing HEPA filters to clean the recycled air in their pressurized cabins. I was sad to hear that for previous years, we were breathing fart-laden air! Thank you for this and many additional new improvements Covid!
Space out the furniture and materials in your operating areas to allow people to pass each other while maintaining adequate distance. Space out tables, chairs, and workstations as needed as well.
Clean all surfaces frequently that are contacted regularly. A virucidal solution (chemical that kills coronavirus) is the gold standard. However, this will often not be possible with the short supply of cleaning supplies and price surges going on. Also, remember that chemicals harm people. Make sure your cleaning supplies are not harming your customers. A good scrub with soap and water goes a long way, and should be utilized. Soap and water is better than nothing, and it is known to be safe. Never ingest or inject cleaning materials or chemicals into your body. This will potentially kill you long before Covid-19 has a chance to do so. Think about everything you are doing, even when your leaders and governments appear thoughtless.
Remove universally contacted hardware and surfaces from operation. For instance, use automatic doors or leave your front door open, so that all-comers do not need to touch the door handle or push-bar. When charging patients, have them insert or swipe their own credit card. Do not require employees to touch customer credit cards. Have employees touch all screens and keypads for your customers. Do not require customers to touch screens or keypads. The end goal is simple. Remove items that everyone must touch from your business equation entirely. Do not have customers and employees passing items between each other.
Consider putting your younger, healthier employees in areas where exposures could occur. Keep individuals with chronic medical issues or advanced age (usually > 65 years, definitely > 75 years) at home or in discrete locations where exposure risk is limited. Nowhere is this more important than in healthcare settings, where Covid-19 infected individuals are contacted by necessity.
Human Distancing
The best way to stop the spread of communicable (infectious) diseases is to keep people apart from each other. How many times have you heard that in the last few months? Covid-19 is spread by respiratory droplets and direct contact. A cough, sneeze, or even just exhaling can spew trillions of viral particles. Thank goodness these particles disperse rapidly. At 6 feet, in well circulated areas, most all particles should have scattered. Encourage employees and customers to distance. Politely ask individuals standing too close to others to take a step back. Distance yourself and avoid touching things unnecessarily. This will benefit you, your employees, and your customers much more than masks or gloves.
Limit the number of people in a given environment to only those necessary. For instance, Wonder Medicine only allows patients within our building for the time being. No guests, visitors, or dependents are currently allowed entrance. This may seem harsh, but is key for infection control.
Limit the Things People Touch
Encourage your employees and customers to only touch items when absolutely necessary. Do not check every piece of fruit by hand at the grocery store. Pick one visually, grab it, and be done. Covid-19 can remain viable for days on some surfaces.
Personal Protective Equipment
Remember when we were told not to wear masks and then later told to always wear masks? Confused? All of us are. All masks are not created equal. Cotton t-shirts, polyester, surgical masks, N95s, powered respirators, and numerous other solutions are all being utilized. Do masks help? The short answer is, yes, they do. We have been using them in healthcare for years for this very purpose.
At this time we would recommend having all of your employees wear a mask if they are unable to maintain at least a 6 foot distance from other people in an enclosed environment. We would also encourage customers to wear masks if they are unable to distance themselves.
If your employees need to pass things back and forth between customers or other employees, consider having them wear gloves. Remember that if you are wearing gloves, then touch your exposed face, the gloves are then a useless intervention. If you are going to wear gloves, do not touch other parts of your body, the contents of your purse, your car door handle, or anything else that you would subsequently touch with an ungloved hand.
Masks and gloves are almost never removed properly. As such, their utility is limited on a population level. If you touch your gloves or mask with your bare hands while removing them, you have undermined the utility of these items. Masks and gloves are only effective when worn and removed properly.
Bottom line, consider masks and gloves as a third line measure after environmental controls and distancing measures have been put in place. Make sure all individuals know how to put on and remove masks and gloves properly. As even health care workers struggle with removing protective equipment properly, I have limited hope for the general public.
Washing hands immediately with soap and water after contacting a shared surface and prior to touching one's face, are probably the best recommendations of all. Always do this at a minimum.
Discussion
Covid-19 has taken the world by storm. As it is so new, we have not had time to study it in detail. Many well-intentioned individuals, entities, and bureaucratic agencies have put out information to try and keep us safe. However, they have often been wrong. In fact, everybody who has spoken about Covid-19 has most likely been wrong at some point. Unfortunately, even this article may become wrong or incorrect in the near future. The most important thing to do for any entity providing information on Covid-19, is to quickly admit they were wrong when new information becomes available, provide new information in a clear and concise manner, reflect on what they could have done better, and move forward. What’s better than science? Newer, better science. Actively thinking and reflecting is how we will become a better society in general, but especially with regard to Covid-19.
Please stop writing “we are closely monitoring the Covid-19 pandemic and have been following advice from the CDC and WHO. Your safety is important to us…..”at the top of your businesses Covid-19 policy. Instead, start with actionable items that you would like your employees and customers to follow. Put actionable items under bold headings. People have limited attention, make sure the most important parts of your policy are most emphasized and at the top. At the bottom of your policy, consider adding links to other resources, such as the CDC and WHO recommendations.
You can take a look at Wonder Medicine’s Covid-19 policy/information on our website under COVID-19 INFO. We tried to make our policy actionable, clear, and concise. We recommend that this be your company’s goal as well.
It is really difficult to know if we are overdoing all of this Covid-19 stuff. In areas where surges have occurred, it probably seems like we are not. But in the rural communities I work in, where case numbers have been low, it seems like we have been overdoing it. The reality is that most young and healthy people are very unlikely to have a serious complication from Covid-19. Older individuals and those with health problems are really the reason we have shut down large sectors of the economy and our businesses. In many ways we have prioritized the safety of older and high-risk individuals over the needs younger, healthier society members. Additionally, we have prioritized medical concerns over financial well-being, with serious secondary effects (we always do this in the United States by the way). A balance between these difficult equations is needed. This balance is well beyond the scope of this article, but it is important to consider these important concepts for policymaking.
The general public is more unhealthy and overweight than ever. Keeping oneself healthy, is an important part of survival even in the modern world. This has become readily apparent during Covid-19. Maybe more than ever, it is time for us to reflect on our own health habits and attempt to improve them. Exercise more, eat healthy, and avoid harmful substances.
Wonder Medicine’s Longevity and Performance Program improves your lifespan and healthspan with a research-driven proactive program that focuses on the big picture of your health so you can perform at your highest potential.
Author
William Brandenburg, MD, owner of Wonder Medicine clinic and full time rural hospitalist.
Editor
Karlee Brandenburg, RN-BSN, owner of Wonder Medicine.
Conflict of Interest
This article promotes Wonder Medicine clinic, which the author and editor own.
Disclaimer
This article was written for educational purposes only. It is not intended to serve as legal or medical advice for your business. Use this article as a starting point for drafting Covid-19 protocols for your business, but please do your own homework. Consider speaking with a public health consultant to review your specific business policy.
References
Feng et al. Rational Use of Face Masks during the Covid-19 Pandemic. Lancet. 2020
CDC: Identify Strategies to Reduce the Spread of Covid-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/strategies-to-reduce-spread.html. Accessed on May 20, 2020.
WHO: Coronavirus Disease (Covid-19) Pandemic. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=CjwKCAjwqpP2BRBTEiwAfpiD-37ITyLBb1M3Jk-yntmxrJzESN9NtO9s2K5i7I-9F4bIyLwOkIZUsBoCfTAQAvD_BwE. Accessed on May 20, 2020