31st March 2020
I’m not sure if the health and safety of humans, organizations, and our economy have ever been so transparently and clearly linked, or globally connected.
In B.C we had 970 confirmed cases as of yesterday (March 30th) and are on the verge of seeing the flattening of the curve, or ongoing increases. In this article I look at some numbers for B.C, some potential consequences for human health, and some key considerations for businesses and their obligations during this challenging situation.
Whatever the outcome, we all need to stay home, and continue social distancing for the immediate future. Yes, this will be tough, but it’s necessary.
Organizations across BC have a very clear role, and mandate to support these efforts. Some considerations:
Here’s some considerations for organizations in relation to health, safety, and the critical need to continue efforts to flatten the curve as we enter this critical juncture of COVID-19 management as a province.
Traditionally health and safety has dealt with systems to keep the majority of the workplace safe, and in most cases with reasonable interventions, barriers, and controls it is the minority who are at risk of suffering ill health at work, and your organization will work with a few key resources to manage risk.
Some workplace hazards have had significant health issues beyond individual workplaces such as hazardous substances with significant exposures to workers, their families, and the wider communities that went undetected, or were ignored. Lead, asbestos, silica or benzene are a few examples that led to significant exposure and impacts within industries, or communities over time.
While the COVID-19 outbreak poses low risk to the majority of the workplace, and might not be truly considered a workplace hazard, it is an interesting outlier in relation to workplace health and safety.
COVID-19 has singlehandedly influenced the majority of workplaces in the world, more or less at the same time, forcing restrictions or outright shutdowns of the workplace in ways that human exposure to lead, asbestos etc. did not.
In serious cases coronavirus infections, including COVID-19 can develop into pneumonia leading to fatalities in extreme cases.
The intensity and impact of the COVID-19 pandemic is also having significant impacts on human mental health for many employees.
Uncontrolled COVID-19 is a low risk hazard for the general population locally in the workplace, however it poses extraordinarily high risk if uncontrolled in the wider community. It is a hazard based on its capacity for exponential growth, mass infection, and potential for fatalities.
The likelihood of contracting the COVID-19 virus, without any precautions or controls is incredibly high. The virus has a number of factors that make it highly contagious and its transmission a concern:
This all creates the potential for it to spread exponentially ramping up exposures dramatically.
Later in this article we see that BC goes from 103 cases to 970 in 2 weeks, and consider what that may look like in another 2 weeks and you start to appreciate the potential likelihood for exposure.
The majority of us can work with COVID-19 infections and feel no worse than if we had a common cold, the likelihood of severe and critical infections or fatalities for the majority of the workforce is low.
As of March 28th the WHO broke down the infections into the following severities for cases that have been documented, and provides evidence that the risk of significant complications from infection are low for most of us:
|Percentage of Infections||Infections Per 100||Severity of Infection|
|80%||8/100||Mild or Asymptomatic|
|5%||5/100||Critical Infections Requiring Ventilation|
|3-4% of all infections||3-4/100||Deaths Divided By The Reported Cases|
The probability (mathematical odds) of the average worker dying from the infection appear to be low, however in some cases it can be fatal for those with poor general health and/or underlying conditions.
Establishing exact percentages for risk of fatality is extremely difficult, but currently data indicates Canada is sitting at roughly a 1% of Case Fatality Rate (the percentage of confirmed cases which have died), while BC is higher at 1.75% (17 ÷ 970), and globally it’s closer to 3.5%.
This scenario would create alarm in most workplaces, a virus that is easily transmitted, and that has a reasonable degree of probability for fatalities. You certainly would consider the risk, and appropriate controls.
A greater concern, is the impact the virus can have outside your workplace in larger populations if it is not contained. The more people infected, the greater the potential for severe, and critical infections, and fatalities in susceptible individuals (elderly, underlying conditions, immune deficiencies).
The virus’s potential for exponential growth has demonstrated the potential to cripple health care systems, and infrastructure when uncontrolled.
The consequences of COVID-19 infections range from inconsequential to staggering, and correlate directly to the context, and scale of exposure and control. What if workplaces don’t control the virus well?
In a small corner store with 5 employees the health impacts would very likely be inconsequential, with limited health issues. It may not even be classified as a work related health issue.
In a government office or university with 1500 people, an aging demographic (many employees may be baby boomers) and higher staff numbers there is potential for more sever risk and consequences.
Consider hypothetically that with no precautions in place 1000 of those employees were exposed. Using the WHO data there is a statistical probability of 150 severe infections with employees off work, 50 hospitalized employees and 1-3 fatal outcomes.
While purely a hypothetical exercise, I believe that would reasonably rival most other workplace hazards for significance. What organization would risk losing 20% of its workforce over a 2-3 week period with potential for fatalities?
The key here is that it’s numbers related. The larger the group that is exposed, the higher the risk of serious consequences, and conversely, the lower the group exposed, the lower the consequences.
This significant increase in the number infections and deaths outside the work environment, and in the wider community, unchecked and growing exponentially, can become even more catastrophic as we’ve seen, health care facilities overwhelmed, and in a worst case scenario collapsing.
While the small corner store is not suffering any operational or health and safety impacts, consider what happened in BC tracking one confirmed case leading up to 970 confirmed cases as of March 30 2020.
Look at the exponential growth of cases in British Columbia. It must be noted there are no numbers at this point indicating how many unconfirmed or potential cases existed on or prior to January 28th.
In British Columbia the known exposures went from generally small numerical and percentage increases, to significant increases, until nearly 90% of all known cases came in weeks 8 (369) and 9 (498). 90% of cases in just two weeks.
To understand how deadly this can become when uncontrolled, in a single day, New York saw 250 deaths, while Italy saw more extreme consequences of this exponential growth with 475 deaths in a day.
Table 1: BC Actual Case Progression New and Cumulative Cases
|Week||New Cases||Deaths||Cumulative Cases||Case Increase|
|1st Week (Jan 28th)||1||0||1||0%|
|9th Week (Mar 28th)||498||4||970||106%|
Chart 1: BC Actual Case Progression New and Cumulative Cases
Taking the cases known to March 30th and projecting at a conservative 100% increase in cases each week, might representative of what growth looks like with the provincial precautions working.
With only a 100% increase in cases we still escalate exponentially from the current 970 cases, to just short of 7760, in 3 weeks (additional weeks highlighted in red).
Table 2: Projected Case Progression New and Cumulative Cases
|Week||New Cases||Deaths||Cumulative Cases||Case Increase|
|1st Week Jan 28th||1||0||1||0%|
|9th Week Mar 30th||498||4||970||206%|
Chart 2: Projected Case Progression New and Cumulative Cases
When we look at the known data for infections in BC up to March 30th we can expect varying increases from anywhere between 114% to over 400% based on historical cases in BC to this point.
Depending on the volume of new cases over the next three weeks, BC could see organizations and communities succeed in flattening the curve, and begin to rebound starting to recover with a decrease in new cases, or fail in flattening the curve and have an explosion of significant increases in new cases.
Hypothetically, based on WHO infection analysis, BC might look something like this in 3 weeks with varying percentage increases from a week to week.
This is has been simplified to demonstrate a repeat of 100% increases for 3 weeks, then 200% increases, and finally 400% increases. The reality is an unpredictable mix of percentage increases within that range is feasible.
Note the 2% death rate is merely an estimate based on average case rates in BC. As numerous variables influence the rate of death (case ratio vs. infection ratio) this number may increase or decrease significantly.
Table 3: BC Projected Cases by Week 12
|% of Weekly Increases||Projected BC Cases||Mild or Asymptomatic (80%)||Severe Infection (15%)||Critical Infections Requiring Ventilation (5%)||2% of Cases Result in Death|
If organizations continue to support social distancing, isolation, and applying precautions as instructed there is a reasonable chance we may be able to flatten the curve.
This is why it is so critical for workplaces, and communities to focus on flattening the curve.
With incredibly high numbers of infection, and limited health care resources, services are strained, and critical and non-critical services are impacted due to overwhelmed hospitals with COVID-19 cases.
Critical surgeries, treatment, and support for life threatening injuries and illnesses such as work related injuries, car accidents, high risk pulmonary and cancer patients must all compete for the limited resources available.
Less immediately critical health issues such as cancer surgeries, orthopedic (musculoskeletal), gynecological, and obstetrical (childbirth) surgeries and health issues also are impacted as they fall down the priority list which can potentially influence long term impacts on population health.
A key consideration is also the quality of medical care from a mentally, and physically exhausted medical care team? What mistakes will they make without the proper mental, emotional, and physical conditions and resources available to them? How long will it take for burnt-out physicians, nurses, and other key medical staff to recover?
Your workplace has the capacity to influence this pandemic directly and indirectly.
What your organization chooses to do can have significant impacts towards succeeding in flattening the curve, or failing to flatten the curve. Examples in New York and Italy provide worst case scenarios for failure.
The workplace is a concerning areas for the spread of this virus because of the length of time, and number of people that are potentially spreading the pathogen in the environment they work in. So it’s up to your organization to eliminate the workplace as a source of potential spread.
For businesses that are still open, or wen we are able to start easing off the social distancing and isolation, with returns to work, you should presume COVID-19 is in your workplace.
Below are some hypothetical timelines, and some potential considerations as we consider working alongside this unpleasant co-worker.
Over the next few months as the world focuses on controlling the outbreak, many workplaces will remain closed, operate in reduced capacity, or operate under strict health requirements. They will have strict requirements to continue to manage exposure to the COVID-19 virus while waiting for immunization of the general population. This may include:
Table 4: Potential Risk Reduction Measures
Just brainstorming some ideas for a mid-term response, which may be a still sensitive time as infections go through natural peaks and valleys as the wider population is gradually reintroduced to social norms, and social distancing is relaxed.Mid Term (January to June 2021?)
There are a number of scenarios that have been suggested that may take place economically. Business will not be “as usual” and precautions will still be critical to prevent a secondary wave.
During this stage, I would imagine exposure to the virus, and a developed vaccine both begin to immunize some of the population, with some workers reintegrating into the workplace, and a reduction in stress on human health, health care systems, and organizations.
This would likely be a planned, and gradual return to work with the vaccine being cascaded down the list of essential BC services over time allowing a gradual shift from only isolated, low risk, and essential workers working, to the gradual reintroduction of the rest of the workforce within communities.
From a health and safety perspective, workplaces should be considering the implementation of an exposure control plan to identify:
Over the last few years a number of organizations, and individuals (including Bill Gates in 2018) recognized the world was not prepared to effectively manage pandemics.
Workplaces should consider that this COVID-19 outbreak is not an isolated case, and that outbreaks such as this may increase is likelihood, and severity. Long term considerations should be:
The COVID-19 outbreak was predictable, but not anticipated by most businesses, communities, or governments. It poses an economic, and health hazard to workers, businesses, communities, and governments.
Interestingly not a significant work related hazard directly, but a hazard that can influence health and safety in the workplace all the same, with devastating consequences for society as a whole.
Organizations are now focusing on the short term priority of flattening the curve, and doing what they can to maintain operations. The key is to do so without further exasperating the number of cases, and exponential growth of infections, and further handicapping and delaying the rebound of human and economic health.
Most organizations have a better understanding of the critical role they play in the management of pandemics, and leadership must continue to make decisions with the long term benefit of a flattened curve taking precedent over short term difficulties.
Organizations must also give consideration to what they would do differently when the next epidemic, or pandemic breaks out. Fast reactions are essential to minimizing long term impacts on human health and the economy, delays can be costly as we are observing in multiple cases around the world.
Contact Carbon Safety Solutions if you would like to discuss measures to help manage the spread of COVID-19 in relation to your workplace.
Phone: 250 734 1373
Posted in: Safety Blog