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Workplace Roles In Flattening The Curve

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:

  • COVID-19 has provided a glimpse that in extreme circumstances, the failure of one, can contribute to the failure of the many
  • British Columbia is critically poised to determine over the next week if the precautions in place have been effective at mitigating the spread of COVID-19
  • The intent is to reduce the risk of exponential and catastrophic impact on our general health as a province, and also our health care systems, services, and our economy
  • The short term impact on our economy by shutting down social and business interactions is critical in fighting the COVID-19 outbreak, and aiding both health and economic recovery
  • Your organization, your workplace, your leadership’s choices, compliance, and commitment are key to our provinces success in successfully flattening the curve

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.

COVID-19 As a Workplace Risk

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.

Significant Exposure

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.

Impact On Workers

Coronaviruses such as COVID-19 and other Severe Acute Respiratory Syndrome (SARS) related viruses predominantly influence respiratory systems.

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.

COVID-19 Likelihood and Severity

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.

High Likelihood

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:

  • The virus appears to have up to a 14 day incubation period
  • Those exposed may be infected, and potentially contagious prior to (or without) exhibiting symptoms
  • It is transmitted by close contact (6 feet) with infected people
  • Respiratory droplets produced by infected people coughing or sneezing can be inhaled by others
  • Some reports indicate it may be suspended airborne for up to 3 hours (inconclusively)
  • It has the capacity to exist on multiple surfaces from hours to days

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.

Low Severity

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
15% 15/100 Severe Infection
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.

COVID-19 At Work

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?

Workplace Dynamics

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.

Infections in Numbers

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.

BC Known Case Growth (Actual)

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%
2nd Week 3 0 4 300%
3rd Week 1 0 5 25%
4th Week 2 0 7 40%
5th Week 1 0 8 14%
6th Week 24 1 32 300%
7th Week 71 3 103 222%
8th Week 369 9 472 358%
9th Week (Mar 28th) 498 4 970 106%

Chart 1: BC Actual Case Progression New and Cumulative Cases

BC Known Cases (Projected)

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%
2nd Week 3 0 4 400%
3rd Week 1 0 5 125%
4th Week 2 0 7 140%
5th Week 1 0 8 114%
6th Week 24 1 32 400%
7th Week 71 3 103 322%
8th Week 369 9 472 458%
9th Week Mar 30th 498 4 970 206%
10th Week 970 19.4 1940 100%
11th Week 1940 38.8 3880 100%
12th Week 3880 77.6 7760 100%

Chart 2: Projected Case Progression New and Cumulative Cases

Variable Percentages

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
100 7760 6208 1164 388 124
200 26190 20952 3929 1310 524
400 121250 97000 18188 6063 2425

Potential to Flatten The Curve

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.

COVID-19 Health Care Consequences

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?

COVID-19 Your New Co-Worker

Your Impact On The Working Community

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.

Short Term (April to December 2020?)

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

 

Mid Term (January to June 2021?)

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:

  • Lessons learned, and areas to improve
  • Those who are less likely to be infected (immunized through infection, or vaccination)
  • Those who may still be at risk of infection
  • Potential for a 2nd wave (and mutation), and secondary exposure and infection (based on medical expertise)
  • Review and consider tasks and activities that may be at higher risk to those not immunized:
    • Travel to other countries still working on containing the virus
    • Exposure to internationals that may be travelling from other countries still working on containing the virus
    • Exposure to local individuals that may be infected
    • Exposure to surfaces, materials, or areas that may have been infected
  • Modifications using interventions, barriers, and controls in table 4, and other measures to adapt the workforce to working with reduced exposure
  • Develop strict policies for any workers showing symptoms of COVID-19 during the recovery mid-term recovery period

Long Term (July 2021 onwards?)

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:

  • Post-incident review, what did the organization do well, what needs to be improved?
  • Prepare a business continuity plan for short term reduced operating capacity, or complete shut down
  • Develop a business continuity team for larger organizations
  • Develop company isolation, shut down, and remote working policies, procedures and training
  • Monitor and assess infectious diseases with rapid growth potential and brief business continuity teams
  • Develop an exposure control plan for future outbreaks to identify and manage potential hazards, and provide training as required prior to potential exponential growth of cases
  • Large or complex organizations may wish to consider the potential impacts should a large natural disaster or terrorist type event coincide with a pandemic outbreak

Conclusion

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.

Email: info@carbonsafety.ca

Phone: 250 734 1373


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