The economy is reopening, with the government introducing new regulations aimed at preventing the spread of the Covid-19 coronavirus. To protect the health of employees and customers while restoring the financial well-being of business, regulations by themselves may be insufficient.
We need a “whole system” approach to the problem, rapid learning and a positive workplace culture. Successful methods come to us from “improvement science” in health care and other fields.
They suggest that we need clear, measurable aims, including, no worker infected on the job, no customer becomes ill, low absenteeism rates and a shared understanding of the major system “drivers” — behaviours or interventions — linked to those aims.
This will enable us to better organise our activity in the new Covid-19 workplace, introducing necessary changes including, but not limited to, those required by regulations.
• Prevention of disease transmission in the workplace
• Preserving the physical, mental and financial health of workers,
• Effective leadership and management, and
• Successful continuation of business operations
From the health standpoint, the critical issue in the workplace and more broadly, is to understand the relative risk of harm, and therefore need for protection, of different individuals and groups. Protecting those most at risk, while allowing others to get back to work activity not only limits loss of life, it helps avoid another lockdown and additional economic damage.
In some industries, including health care, there are unique considerations including that the business is essential, and the situations are hazardous (for example: known infected patients undergoing surgical procedures) but still controllable.
In all industries, owners, managers and workers need to assess personal risk profiles that contribute to the chances of severe illness in workers, which relate primarily to age (such as individuals under 20 have a one in 900 risk of hospitalisation compared to one in five for people over 70) and coexisting medical conditions (e.g. obesity, diabetes, chronic heart, kidney and lung disease, untreated HIV, active TB), the extent to which each workplace creates risk, and how risk can be controlled.
Each worker should have their personal risk level assessed. Those in most danger of severe Covid-19 disease should ideally work from home or if this is impossible be excused from work.
Though much about Covid-19 is poorly understood, effective methods for protecting against exposure and disease transmission are known, cheap, and accessible. Focus on the basics!
Everyone with a workplace contact needs a constantly worn, properly applied face covering (cloth or other mask over mouth and nose, with or without a shield or visor), frequent hand hygiene, physical distancing (1.5m or more) where possible, and regularly disinfected surfaces (every two hours or between contact in high-touch areas).
The discovery that approximately 40% of people who get Covid-19 have no symptoms yet are infectious is a great concern. It means that a single, apparently healthy individual can be in the workplace for days spreading the disease to fellow workers or customers.
This is a compelling reason for universal mask wearing - it not only protects the mask wearer but everyone around them, including vulnerable groups.
Simple and effective actions to prevent Covid-19 are now well known, but reliable implementation of the basics is still difficult and less common than it should be.
The encouraging thing is that even in workplaces where Covid-19 is present, such as hospitals treating the disease, worker infections are rare when the basics are done well.
High reliability on the basics is unlikely to be achieved by blind implementation of regulations; it requires planning, input from frontline workers, testing changes, and following scientific evidence where it exists and as it changes.
Let’s take just one element of the system – safe journeys to and from work. Public transport (taxis, trains, buses) appears unsafe for the Covid-19 era, with overcrowding in vehicles and at waiting points, and in its current state is probably a significant factor in disease transmission.
Commuters can play their part in infection prevention by wearing masks, doing hand hygiene upon entry and exit, keeping windows open where possible, and distancing at waiting points.
Other interventions should be tested. With government support, business and the transport industry can expand capacity and decrease passenger density, such as passenger limits in taxis, ride sharing, staff shuttles, repurposing of unused vehicles and greater use of bicycles or motorbikes.
Some regulations are aimed at preventing infected persons from entering the workplace, requiring require daily symptom screening.
We have learned however that in Covid-19 fever and other common symptoms can be absent and the illness can start with gastrointestinal complaints (e.g. diarrhoea, abdominal pain), unusual fatigue, loss of smell or taste, confusion or disorientation.
Efficiency of screening can be improved with technology e.g. smartphone apps but with frequent repetition even the best intentioned can lose interest.
Two potentially helpful strategies are to provide responses directly to a supervisor or a colleague, or to place highly visible reminders at the entrance to a workplace. Employees who begin to feel unwell should be encouraged to report this and go home, rather than stick it out until the end of the day.
Level 4 lockdown restrictions on outdoor activities may have created a false impression of risk in that setting, and a distraction from the major environmental risk factors – the 3 Cs: closed spaces, crowded places and close contact.
At many work sites, including hospitals, Covid-19 has spread mainly from worker to worker in poorly ventilated indoor spaces in which workers congregate at predetermined times such as at lunch or in shared work transport.
Physical separation, ventilation, and staggering of meal and other meeting times can help reduce risk. Business entry or exit points are high-risk areas where queueing occurs. Fingerprint ID technologies are an undesirable common touch point, literally, that should be removed, unless sanitised after each use.
Where work at close quarters is impossible to avoid, employee “pods” (groups) can be created so that if an infection does occur, spread may be limited to a smaller number of people. Another tactic is to have fewer workers but additional shifts at night so that spacing is achieved.
Employees who have recovered from Covid-19 and no longer infectious can return to work and become a safety asset. They can be placed among unexposed employees in such a way as to reduce contact between susceptible individuals. Antibody tests, not yet available in SA, are a signal of immunity and should aid in risk assessment, task allocation and placement.
Workplace leadership and culture may be the strongest determinants of employee and customer protection. It creates an environment in which learning can occur, while generating trust, confidence and mutual care. Creating this positive environment is the job of leaders at all levels in the organisation.
In hospitals, it is achieved when senior doctors and managers are visible in the workplace, wearing the same personal protective equipment as everyone else and adhering to the same protocols and protections. It is enhanced by frequent and honest engagement with employees.
The same approach should work in other industries.
South African business needs to be back in action, paying taxes and salaries, restoring the nation’s livelihood, and government’s role is critical, not only in terms of regulations but also through financial support to businesses, workers and families.
Government can also lead the way setting up safer systems in its own workplaces, and by enabling and educating South Africans to do the same.
In the re-opening economy, we must protect the whole population, especially vulnerable individuals. An emphasis on the whole system, with a focus on the basics (mask wearing, distancing, hand hygiene) should help limit both the health and economic impact of the coronavirus pandemic.
Investment by business in these interventions has huge economic and humanitarian value.
Without them Covid-19 will severely disrupt business continuity, result in large costs and loss of life.
Kantor is an independent health care consultant at Insight Actuaries & Consultants.
He is a key contributor to Business For South Africa’s efforts to help promote the safe return to work of all South Africans.