COVID-19 (COVID-19) Risk Mitigation Strategy for Construction Workers and Worksites
The following document represents an application of the best evidence available in the 111 medical and scientific communities as of October 22, 2020. The evidence-based recommendations contained in this document may change as new data become available. As such, updates to this report shall be provided monthly until the COVID-19 pandemic is under control. In addition to this document, insureds of Atlas General Insurance Services will now have access to our new COVID-19 website (www.nipitnow.com) which includes the NIPIT COVID-19 Daily Questionnaire screening tool and FAQs to help guide employers and employees toward better workplace practices. The purpose of this document is to assist business owners in mitigating the risk of COVID-19 transmission to prevent outbreaks at the workplace. No strategy is currently available that can completely eliminate all risk of COVID-19 at the workplace while allowing business to remain physically open.
The protocols contained in this document are recommended best practices. They are not intended to be fully comprehensive as each job site is a little different and may require its own special measures to prevent the transmission of COVID-19. These protocols are not meant to supersede orders, rules, regulations, or mandates issued by a jurisdictional authority. All contractors must continue to comply with all relevant rules and regulations concerning workplace safety and health. This document does not offer any legal advice.
COVID-19 is spread from person to person so businesses should endeavor to transition as many employees as possible to working from home. The construction industry requires most employees to work on-site, posing a higher level of transmission risk especially among those doing indoor construction work. The preponderance of evidence, as of October 22, 2020, suggests that COVID-19 is spread mostly through the air and therefore, reducing the risk of outbreaks at the workplace focuses primarily on three things: masking (and sometimes the addition of face shields), ventilation, and distancing.
Because outbreaks tend to occur during congregate activities (several people together in one place), especially in closed environments with a lot of forced-vocalization (loud talking or shouting), the secondary focus of a rational risk reduction strategy involves keeping the work environment as quiet as possible with the fewest possible number of workers physically together in one place (especially in an enclosed space at any given time). This represents significant challenges for the construction industry.
Finally, because COVID-19 can likely also be spread through touch, an additional element of the risk reduction strategy centers around physical contact with communal surfaces and objects.
General Information About the Novel Disease COVID-19
It takes, on average, 6-8 days from the time a person is exposed to (infected with) the virus that causes COVID-19, until they begin to feel sick. This is known as the incubation period. Once the incubation period is over and someone begins to feel sick, they may continue to have symptoms like cough, fatigue, and shortness of breath for several weeks but are typically only infectious to others for about one more week. People are most infectious during the two days before they begin to feel sick and on the day they become sick. About 75% of COVID-19 is spread during these three days. Catching COVID-19 early and separating those infected from their coworkers is the key to preventing outbreaks at the workplace.
Because some infected individuals may be able to shed the virus for a longer period of time, out of an abundance of caution we recommend that persons with COVID-19 be kept out of the workplace/job site for two weeks following the onset of symptoms or a positive test, whichever comes first.
A current estimated 45% of people who contract COVID-19 never develop any symptoms. These asymptomatic so-called ‘silent carriers’ are believed to be just as infectious as people who feel sick. When people don’t know they’re sick they go to work, hit the gym, socialize at barbecues and parties, attend religious services, and eat and drink at bars and restaurants where they are infectious to others. These are also typically environments in which people take off their masks and are the most common sites for community outbreaks. Applying this to the workplace, it is imperative that workers do not eat, drink, or socialize with one another unmasked until the pandemic is under control.
An estimated 15% of people who get a relatively mild case of acute illness following COVID-19 infection go on to have lingering effects from the disease. Bouts of extreme fatigue, body aches, sore throat, and cough may persist for many months after an infected person tests negative for the virus.
No work demographic is safe from COVID-19 but some industries are being hit harder than others. Businesses that can allow employees to work from home have been having minimal workplace outbreaks while businesses such as restaurants in which employees and customers spend protracted amounts of time in proximity to one another have the highest number of workplace outbreaks. Construction is another industry in which we are seeing high numbers of infections because of the amount of time workers spend in close proximity to one another, often without sufficient face protection.
This document is made up of two sections. The first contains a 19-point list of the specific science-based steps we recommend those in the construction industry take immediately. Many employers will not be able to implement all 19 measures but should do their best to comply with as many of them as possible. The second section has Questions and Answers designed to provide clarity and context for each of the recommended 19 strategic measures for lowering the risk of disease transmission at the workplace.
Throughout this document, links are provided to help employers and employees gain a better understanding of COVID-19 and obtain the right equipment and tools needed to protect them from infection and provide detailed instructions on how to use them effectively. This document overlaps with other NIPIT documents but is also specific to the construction industry. Other industry-specific documents may be requested at www.nipitnow.com.
The NIPIT COVID-19 Risk-Mitigation 19-Point Strategy
- Employers should seek to minimize the number of employees present in an enclosed space at any given time. It is common practice in this industry for multiple subcontractors and crew members to work together in the same space. During the COVID-19 pandemic, attempts should be made to minimize the number of workers in close proximity to one another, especially indoors when ventilation to the outside is not possible. This may impact construction timetables and costs (see below). When more than one worker must share an enclosed indoor space, extra measures must be taken to avoid an outbreak as follows:
- Masking is the most important risk mitigation tool that we have against COVID-19 in the workplace but in order for it to be effective, everyone must wear an effective mask. All employees as well as customers/clients/vendors (collectively visitors) must wear acceptable face coverings at all times while on the work premises. This will require forepersons and contractors to stock acceptable masks for employees and visitors and ensure that they are available at all times. Clean (unused) masks should be stored in a sealable plastic bag or other container and be available at the worksite for employees and visitors. Click here to watch an instructional video on how to properly fit and use a face mask. Workers performing jobs that require prolonged (more than 10 minutes, continuously) and/or shorter but repeated close range (less than six feet of interpersonal distance) interactions with other workers or visitors should also wear face shields during such times. It is important to remember that almost half all people who contract COVID-19 do not get any symptoms but can still spread the disease just like those who feel sick. “I feel fine” is not a reason to not wear a mask. A foreperson or other other designated employee should be tasked with keeping a list of workers on the job site and ensuring that everyone wears a proper face covering. Gaiters, masks made of stretchy fabrics, or loose-fitting cotton masks that do not make a tight seal against the face are not adequate face coverings for persons spending more than 10 minutes continuously or 15 minutes cumulatively in close proximity to others. Click here for more information about adequate face coverings.
- If possible, closed spaces shared by more than one worker (congregate spaces) should be equipped with a True HEPA air filtration unit (see 'C' in section two for specific recommendations regarding acceptable air filtration units and 'D' for how to properly use them for maximum effectiveness). Businesses that cannot equip shared work spaces with a True HEPA air filtration unit should endeavor to provide as much fresh air to the space as possible. Open doors and windows allow the air in a space to be refreshed, lowering the risk of COVID-19 transmission, and smaller rooms with windows and/or doors that
- Since worksite elevators and bathrooms do not typically have adequate ventilation, they should be used by only one person at a time. Avoid hoists or elevators if there is an option to use stairs instead. While using enclosed conveniences, workers and visitors must remain masked at all times. Portable toilets should have their doors left fully open after each use for a minimum of two minutes before the next person enters. This may require employers to increase the number of portable toilets at a worksite. For office or trailer bathroom facilities without an open window, HEPA filtration should be provided if possible.
- In shared work areas where there are neither windows nor doors to provide adequate ventilation of a closed space, a plastic sheet should be draped from wall-to-wall and floor-to-ceiling to create a barrier against disease transmission between workers, Workers should understand that such a barrier is an added layer of protection and is not a substitute for wearing a mask and face shield when more than one person is working in the same space.
- It is common for workers in the construction industry to share transportation to and from job sites. During the COVID-19 pandemic, this should be avoided as much as possible. Remember that the virus is spread mostly through the air in enclosed spaces when people are next to one another for a prolonged period–especially if one or more people are not properly masked and there is talking. If employees must share a vehicle to get to and from job sites, it is imperative that adequate masks be worn by everyone at all timeswhile in the vehicle. Conversation inside the vehicle should be avoided or kept to a minimum as talking increases the amount of aerosols that get emitted into the air, increasing the risk of disease transmission if someone is infected. Remember, just because you don’t feel sick does not mean that you do not have COVID-19 and most transmission of this disease takes place before a person knows they’re sick. All windows should be kept open at least three inches while the vehicle is in motion and fully open when parked or at a stop for more than one minute. During inclement weather when it may be impractical to keep windows down, workers should wear both masks and face shields inside the enclosed vehicle. The handles, armrests, seat-backs, and any other areas of the interior/exterior touched by passengers should be disinfected using an appropriate sanitizer whenever getting into and out of the vehicle.
- Signs should be posted widely at all worksites mandating the use of acceptable face coverings at all times (see 'F' in section two for recommendations regarding the type of signage to use, where to position signs in the workplace, and where you can get them). In an office setting, floor decals telling visitors where to stand should be placed three feet away from counters opposite employees’ work stations. Employees’ chairs within an office or worksite trailer should be positioned at least six feet apart from one another (see 'F' in section two for details regarding which type of floor decals to use and where to get them). Distancing of six feet lowers the risk of direct transmission of COVID-19 via larger droplets emitted from the mouth during talking, coughing, and sneezing but does not sufficiently protect against small viral aerosols that float on the air and can easily travel across a room further than six feet (see ‘B’ in section two for more information about direct transmission of COVID-19). For this reason, distancing is not a replacement for masking but offers an additional layer of protection against (direct) transmission. Note: tape may be used in place of floor decals for spacing/distancing for employees; however, tape is not recommended as a distancing aid for visitors. Whenever possible, trailer and office doors and windows should be left open for better ventilation. Even keeping doors and windows open 2-3 inches dramatically improves air exchange in an otherwise enclosed space, clearing out aerosols and lowering the risk of disease transmission. During colder weather, this may require the addition of space heaters to some rooms/work areas.
- Cough/sneeze guards should be installed in offices/trailers on counters across which employees interact with visitors (see 'G' in section two for specific recommendations regarding acceptable cough/sneeze guards, how to position them, and where to get them). This is especially important for employees who interact with visitors repeatedly throughout the day or occasionally but for prolonged periods of time (10 continuous minutes or more) such as cashiers, receptionists, and secretaries.
- Each office/administrative employee, whenever possible, should have their own exclusive-use work space. Employers should seek to minimize the sharing of equipment or materials as much as possible. In situations where this is impractical, a decontamination procedure should be undertaken before and after each employee engages with a common use object such as a desk, chair with arms, copy machine, or keyboard (see 'L' in section two for specific recommendations regarding decontamination of surfaces). Each employee should have their own personal-use hand sanitizer at their desk/ work station or on their person and should sanitize their hands after touching documents, equipment, or other items that may have been handled by others (see 'H' in section two for specific instructions regarding proper hand sanitization). Similarly, construction workers who share equipment such as nail guns, drills, and paintbrushes should sanitize the grip areas of common-use tools before and after sharing them with others. Workers wearing gloves should make certain to sanitize their hands thoroughly before putting on
and immediately after taking them off. Some of the best guidance for equipment sanitization especially for head and eye protective wear can be found in the MSA Cleaning Guide. Exclusive use tools and equipment do not need to be sanitized before or after each use.
10.Every employee and visitor must have their temperature taken before being allowed to enter the workplace/job site each workday. The office manager, site-supervisor, foreperson, contractor, or another designated employee (collectively, management) must log temperature data on each employee who reports to work each day as well as visitors to demonstrate compliance with this program. Any employee or visitor with a temperature of 100 F/37.8 C or higher should be prohibited from entering the workplace/ worksite and instructed to contact their primary physician for an evaluation for infection (see 'J' in section two for more information about how to use a non-touch thermometer and where to get one). This should be reported to management immediately. If an employee does not have a primary physician, they may be instructed to present to an urgent care clinic or to contact the county Department of Public Health for instructions on how and where to get tested. Anyone in the State of California can have a free COVID-19 test so cost should never be a barrier to testing (see ‘K’ in section two for more information about free testing). An employee with a negative COVID-19 test performed at the correct time (see 'K' in section two for information about the correct time to get tested and which test to take) may be permitted to return to the workplace provided they have a temperature below 100 F/37.8 C and do not have any symptoms (see 'L' in section two for a detailed list of COVID-19 symptoms). Remember that there are other contagious illnesses besides COVID-19 that can cause people to feel sick and even if an employee does not have COVID-19, it is unacceptable to have an infectiously ill person at the workplace.
11.Employees should be educated regarding the symptoms of COVID-19 and mandated to immediately leave or stay away from the workplace/worksite and report to management as soon as they develop any symptoms. Employees should be similarly mandated to report to management any exposure(s) they may have had to any person(s) known to have or strongly suspected of having COVID-19, including friends, coworkers, and household members. To demonstrate compliance with the NIPIT protocols, employees must take, sign, and submit the Nipit COVID-19 Daily Questionnaire to management each day prior to being admitted into the workplace/worksite, before having their temperature taken. By signing at the bottom, each employee attests to having answered every questions honestly and to the best of their knowledge. If an employee answers ‘YES’ to any of the questions in Section A of the Questionnaire, they should stay home and report this to management immediately. To promote compliance, it is recommended that employers assure employees that no penalties will accrue in terms of lost income as a result of time off work due to suspected COVID-19 symptoms, exposure, or testing.
12.Communal eating and drinking should not be permitted during the COVID-19 pandemic. Remember that COVID-19 is spread through the air. Since communal eating involves prolonged time spent in close proximity to others with masks removed, this is a particularly high risk activity for spreading the disease. Restaurant dining–including outdoor dining–is the most common source of community outbreaks. Workers should always wash/sanitize their hands thoroughly before eating.
13.Whenever possible, businesses should endeavor to set up strategies to minimize direct person-to-person interactions with customers and clients. Credit card purchases, whenever possible, should be made over the phone. Similarly, whenever possible, businesses should endeavor to replace face-to-face meetings with virtual meetings, including between and among employees. Virtual tours of worksites should be performed in place of physical tours whenever possible.
14.Waiting room areas should be limited to one person or family/couple at a time whenever possible. Construction offices with waiting room areas should institute a policy for visitors to call from their cars when they arrive and instruct them to wait in their cars or outside the office/worksite trailer until the time of their appointment. A True HEPA unit should be placed in the waiting area, if possible, and kept on high continuously during business hours. Waiting rooms which have open ventilation to outside air may allow more visitors provided each person or family/group is separated from each other by at least 6 feet and wearing appropriate face-coverings.
15. Employees should be trained how to use their PPE, keep their work areas safe, sanitize their hands and equipment, and follow all the recommended protocols contained in this document. It has been shown that workers are more apt to follow the rules when they understand clearly both what is expected of them and why their compliance is important. This document provides guidance for key protective behaviors but weekly team meetings with workers to reiterate safety protocols and/or update them on new protocols will provide reinforcement and the opportunity for employees to ask COVID-19-related questions. Understanding improves compliance. Employers will be provided with monthly updates and occasional bulletins as important new information informs our understanding of best practices. All employers and employees will also have access to the nipitnow.com website which contains regularly updated FAQs. The following workplace safety training video from GBCA, though not updated with a current scientific understanding of COVID-19, is helpful; employees should be encouraged to watch the video and take the COVID-19 Awareness Certification test which is available for free to GBCA and Trade Union members as well as members of partner associations.
16. Construction sites are often noisy environments. COVID-19 is spread mostly through the air via larger droplets that travel a few feet and then fall to the ground as well as
smaller droplets called aerosols that can float on the air and travel quite far (across a room or terrace). When the air is stagnant, tiny aerosols containing the virus can accumulate in a closed space, hanging in the air for up to three hours. When there is a steady directional breeze, aerosols emitting from an infectious person can travel downwind to coworkers or visitors. Breathing creates a small amount of aerosols but heavy breathing (such as during hard work) creates even more. Talking creates even more aerosols than heavy breathing, and shouting creates still more aerosols than talking. Loud worksites where people are breathing hard and shouting over the sound of machinery are particularly high-risk environments for the spread of COVID-19. When possible, workers should be led away from noisy areas to be given lengthy instructions or have conversations. Masks and face shields should remain in place, especially during close conversations.
17.Employers should institute flexible policies that permit employees to care for sick family/household members. During the pandemic, childcare may be limited or unavailable and employers should be supportive of employees who may need to stay at home to care for a sick child, parent, significant other, or household member. Remember that we are not living in normal circumstances. The CDC provides helpful guidelines for those who are forced to be temporarily out of work to care for someone who is sick.
18. Construction business owners, general contractors, and others who interact with customers/clients should work to manage their expectations with regard to both timetables and cost during the COVID-19 pandemic. Costs of construction may be higher and the time to completion may be longer when employers comply with the safety protocols in this document including such important measures as limiting the number of workers that can be in an enclosed environment together at any given time. Employers who do business in multiple geographic areas should take caution prior to sending employees on business-related travel by checking the CDC travel warning levels.
19. Employees should report to management as soon as they have a positive COVID-19 test (see ‘K’ in section two regarding testing) and employers in the State of California (per SB 1159) are required by law to report all positive COVID-19 viral tests to their Workers Compensation insurance carrier. This may be done by here.
Questions and Answers regarding COVID-19 and the Nipit COVID-19 Risk- Mitigation 19-Point Strategy
A) Terminology of COVID-19
Q: What is the difference between coronavirus, COVID-19, and SARS-CoV-2?
A: COVID-19 (sometimes referred to colloquially as just 'COVID') is the name of the pandemic disease caused by a novel (never seen before) virus called SARS-CoV-2 (sometimes referred to colloquially as just ‘the coronavirus’). SARS-CoV-2 is a member of a family of viruses, some of which can infect humans. Some human coronaviruses cause colds but only SARS-CoV-2 causes COVID-19. COVID-19 was named as a contraction of the following: COrona VIrus Disease-2019 .
B) Transmission Overview
Q: How do people catch COVID-19?
A: COVID-19 is a disease caused by a virus called SARS-CoV-2 that is spread from person-to-person, mostly through the air. When we breathe, tiny liquid particles that are too small to see, called respiratory aerosols, shoot out of our noses and mouths filling the air around us like a mist. If you've ever had a conversation outdoors on a cold winter day and noticed what looks like a vapor cloud coming from your nose and mouth as you speak, then you've seen evidence of respiratory aerosols.
These aerosols can float in stagnant air (think of an unventilated room with the door and windows closed) for hours. When a person who is infectious with COVID-19 breathes, their aerosols contain viral particles shed from their lungs, throat, and nose. Speaking creates significantly more aerosols than just breathing and the louder someone speaks, the more aerosols they generate. If they shout, cough, or sneeze, they create even more aerosols which fills the air around them with more virus. If an uninfected person inhales enough virus-containing aerosols, they can get COVID-19. This is referred to as airborne transmission.
In addition to airborne transmission, larger droplets are projected from the mouth and nose when people talk, shout, sing, cough, or sneeze. These larger droplets do not hang in the air the way aerosols do. They project from the mouth and/or nose for a few feet and then fall to the ground or land on some other surface (desktop, counter, chair arm, etc.). If a person is infectious, these larger droplets will contain higher amounts of the virus than aerosols do.
This is the reason for social distancing. Someone with active COVID-19 can transmit the disease by projecting virus-containing droplets directly into the nose, eyes, or mouth of a nearby uninfected person by coughing, sneezing, or talking if the right kind of mask and protective eyewear are not being worn. This is known as direct transmission. At normal speech levels, droplets are typically projected about 3-4 feet through the air before they fall to the ground. However, some studies have shown that forced expiration or vocalization (coughing, sneezing, shouting) can project droplets as far as 10-12 feet. Direct transmission can also occur when people kiss or touch one another’s faces. Have a look at this video showing droplets and aerosols from coughing, sneezing, and talking, taking special note of how long aerosols can hang in the air and how far they can travel without ventilation compared to when a window is opened to allow for ventilation.
Finally, COVID-19 can also be spread through touching common use objects. When someone with active infection rubs their eyes, nose, or mouth, they get virus on their fingers. If they then touch some communal surface like a doorknob, elevator button, or credit card, they contaminate those objects. If an uninfected person then turns the doorknob, presses the elevator button, or takes the credit card, they can get the virus on their own hands which they will then carry to their face when they rub their eyes, nose, or mouth, causing infection. The same thing can happen if infectious droplets land on a surface such as a counter or the arm of a chair and then someone else comes along and touches that surface. This kind of spread is referred to as fomite transmission and although it seems less common to spread COVID-19 this way compared to colds or flu (which are associated with a lot more sneezing, runny nose, congestion, and nose-blowing), it is still important to take precautions against fomite transmission such as hand washing and the use of hand sanitizers which will be discussed below in question ‘H'. Sharing food and drinks is another vector for famine transmission and should be avoided during the pandemic.
C) Airborne Transmission
Q: How can I avoid breathing in viral aerosols?
A: The simple rule is: Don't share your air. As much as possible, never inhale someone else's exhale or vice-versa. It's all about the right masks, ventilation, and to a lesser extent, distance.
Masks are likely the most important risk mitigation step a person (or a society) can take against COVID-19. For mask use to be effective, everyone must wear their mask while at work. The effectiveness of any particular mask is based on two factors that are equally important: the right fabric and the right fit.
Fabric : A good cloth mask should have one layer of tightly woven (600 thread count or more) cotton such as denim, duck cloth, canvas, or twill and a second layer of either natural
silk, a synthetic such as chiffon (polyester/spandex blend), or flannel (cotton/polyester blend). The tight cotton weave physically traps droplets and some of the aerosols while the silk or synthetic second layer traps some additional aerosols by electrostatic attraction. Such a mask is likely as effective as an N95 respirator (which, as of the creation of this document, is still recommended by the CDC for exclusive use among healthcare workers) if it is properly fit to the face. However, such masks can be hard to source or make and typically do not provide an ideally tight face-fit. A good alternative to the dual-layer cloth mask are the Korean-made masks that make us of nanofiber technology capable of trapping even very small particles the size of aerosols with an efficiency similar to that of an N95 respirator while providing a better fit than cloth masks or N95s. These masks are reusable, can be cleaned with 70% alcohol spray, are more comfortable, and are permitted for use by the general public. They can be purchased here for $5 each or $40 for a pack of ten and come with a reusable clip specially designed to help the mask fit better and reduce the need for adjusting its position.
Loose weave cotton fabrics like the material used to make bandanas and lightweight T-shirts are far less effective, and thin stretchy materials like those used for neck gaters may actually increase the risk of disease transmission as they not only fail to trap larger droplets but may turn droplets into smaller aerosols that can travel further, hang in the air longer, and be more easily inhaled deeply into the lungs to seed infection.
Fit : A well-fit mask should hug your face with as little gapping as possible. The idea is that all the air you breathe (both in and out) should be filtered. Mask gaps (spaces between the mask and face) allow unfiltered air to pass around the mask and can reduce a mask's filtration efficiency by as much as 50%. The size and shape of each person's face is unique so a mask that includes some adaptability of shape to provide a more snug and secure fit is preferable. Clipping the ear straps together at the back of the head usually provides a snugger and more secure fit than placing them around the ears. Masks with a bendable metal nose strip also help make the fit more snug and hold the mask in place better, reducing the need to reposition the mask while talking.
Take the Sunglasses Test: After ensuring that your mask is properly fit to your face, put on sunglasses and then walk up and down a flight of stairs, repeating until you start breathing heavily. If your sunglasses fog up quickly and significantly, the mask fit is unacceptable (too much gapping). If there is minimal or no fogging, the mask fit is acceptable for protection against aerosols. Helpful tip: if you have a good quality nanofiber or cloth mask which is fit well but still fails the Sunglasses Test, consider folding a tissue into a 1/2 inch strip and placing it beneath the mask at its upper border around the bridge of the nose and across the cheeks. Here is a video demonstrating this simple helpful technique.
Once in place, one should avoid touching the fabric of the mask while taking it off, putting it back on, or repositioning it during use. The virus-containing droplets and aerosols trapped by the mask can be transmitted to the fingers which then can cause the wearer to spread the disease to others by fomite transmission or to themselves if they rub their eyes, nose, or mouth without first sanitizing their hands. Here is a good instructional video demonstrating the proper way to put on, take off, and store your mask in between uses:
Ventilation is almost as important as masking for reducing the spread of COVID-19. Whenever possible, doors and windows should be propped open to allow air exchange and promote airflow. This reduces the accumulation of aerosols that can otherwise remain suspended in room air for up to 3 hours. Keeping the door of an interior room ajar by as little as 3 inches can substantially reduce the accumulation of viral aerosols within the room. Keeping both front and back entry doors of an office suite open creates airflow that can flush out aerosols.
Air filtration units containing True HEPA filters should ideally be placed in every room that’s in regular use (other than for storage) especially waiting rooms, break rooms, conference rooms, and bathrooms which are often occupied by several people at the same time. HEPA stands for High-Efficiency Particulate Air and is the US standard for air filtration. To meet True HEPA standards the filter must remove 99.97% or more of all particles which are 0.3 microns (micrometers) in diameter (about the size of an aerosol that could contain the virus). “HEPA-type” and “HEPA-like” filters fail the standard and should be avoided.
True HEPA filters come in grades from H10-H12 for non-medical use and H13 or higher for medical use. To best eliminate viral aerosols, HEPA H13 (medical grade) is recommended. For a typical 10' x 12' room, a small medical-grade H13 True HEPA unit such as this one can filter all the air in the room approximately every 15 minutes (see 'D' below for instructions regarding how to properly use and position an air filtration unit).
In addition to air filtration, air circulation is also important for reducing airborne transmission. Oscillating fans and fans designed to move air in a spiral pattern should be placed in hallways and larger communal spaces to help prevent the accumulation of aerosols in stagnant air. A unit such as this one may be positioned at desk height, near one end of a hallway or room to help reduce the risk of aerosol accumulation and airborne transmission.
D) True HEPA air filtration unit placement
Q: Where in the room should I place my True HEPA unit?
A: Aerosols can travel on breezes and float long distances on air currents. For this reason, air filtration units should be placed between people never behind them. Air filtration units draw a room's air toward them and then shoot the filtered air upward (or off to the sides). If there are viral aerosols floating in the room, having the unit behind you means those aerosols will be drawn toward you, increasing your risk. All air filtration units come with filters that must be replaced at regular intervals. Check the manufacturer's instructions and follow them carefully. Place a sticker on each unit noting the date of the last filter change and the date of the next required filter change. Management should keep a log of filter changes for attestation purposes. Air filtration units should be left on at the high setting at all times during business hours in regular or continuous use rooms. For rooms used only occasionally, it is okay to set the units on low or turn them off after the room has had sufficient time to be filtered. When a room is occupied by one person working quietly, the unit may be kept on the low or medium setting. If a room is used for phone calls or meetings (talking creates more aerosols) or if the room is shared by more than one person, the unit should be kept on the high setting. Units should be kept continuously running on the high setting in restrooms during business hours.
E. Face Shields
Q: Is a protective face shield still important if I’m already wearing a mask?
A: The infection process begins when the SARS-CoV-2 virus attaches to receptors on the surfaces of cells that line the respiratory tract. However, these receptors are found not only in the nose, throat, and lungs but in many internal organs, allowing the infection to spread within the body to the heart, kidneys, testes, and nervous system. These same receptors are also found in the eyes and reports of conjunctivitis (red, swollen, irritated eyes caused by infection) are becoming more common in COVID-19 suggesting that droplets or aerosols can cause infection through the eyes. Workers whose jobs require prolonged and/or repeated interpersonal contact with visitors such as receptionists, therapists, baggers, checkers, and cashiers, should wear a protective face shield in addition to a mask. The effectiveness of a protective face shield and a quality mask in combination to prevent infections is higher than using either measure alone. A face shield should not be thought of as a substitute for a quality face mask.
Q: What kind of signs and floor decals are appropriate?
A: Compliance with rules is improved when there exists the perception of official enforcement by those in authority. Posting signs at worksites mandating masking and social distancing have been shown to significantly increase compliance. It is recommended that signs clearly ordering masking be placed both outside and inside the workplace. There should be a sign posted at every portal of public entry to a place of business and interiorly on the doors of restrooms, conference rooms, communal work rooms, and break rooms. At construction sites, signs should be posted on portable toilets, any entry/exit points to the project, and in any area where congregate work activity is taking place (more than one worker in a designated area at a time. Such signs should be moved to follow the work taking place to ensure that a sign mandating masking is always in view of workers while they are conducting their work. Signs with an image in addition to a verbal order have been shown to be more effective than those that use words alone.
Floor Decals help people comply with physical distancing. Floor decals should be placed at least three feet from the edge of a transaction counter, opposite employees’ stations, in offices, trailers, and other administrative areas. Floor decals are not practical within construction worksites as workers are constantly in motion. However, workers should be reminded to maintain physical distancing from one another as much as possible. Decals, like signs, are more effective when they include an image in addition to a verbal order. Here is an example of an acceptable decal compelling physical distancing.
G) Cough/Sneeze Guards
Q: How high and wide does a cough/sneeze guard need to be in order to provide protection to employees performing interpersonal/transactional work across a counter?
A: In addition to tiny aerosols, larger droplets are also emitted when we speak, sing, shout, cough, or sneeze. Larger droplets contain more virus. But unlike aerosols that can float in the air for up to 3 hours and travel long distances on air currents, droplets only project a few feet then drop to the ground (or other room surfaces). We want to avoid inhaling aerosols or being hit in the face with droplets, so keeping six feet (or more) apart whenever we have to be in prolonged proximity to someone else makes sense and cough/sneeze shields are an important added layer of protection against droplets for those who work behind counters such as receptionists, tellers, and cashiers.
Cough/sneeze guards must be high enough to extend at least one foot overhead of the employee. If the employee sits 90% of the time or more while behind the counter (as do many receptionists, for example), that measurement may be taken from the seated position. If the employee stands more than 10% of the time behind the counter (as do many cashiers, for example), the measurement should be taken in the standing position. Cough/sneeze shields should be a minimum of three feet wide for each employee and employees should restrict themselves as much as possible to keeping directly behind the center of their shield during
interactions with visitors/customers/clients/vendors. Cough/sneeze guards are not meant to replace masks or face shields as they are only effective at blocking droplets, not aerosols (unless they extend from wall to wall and counter to ceiling). Here is an example of an acceptable cough/sneeze guard.
H) Hand Cleaning
Q: How do I keep my hands clean?
A: During the normal course of work it may not be possible for some workers to avoid touching anything that has not been touched by others. For this reason, hand washing with soap and water or the use of a hand sanitizer is important. SARS-CoV-2, the virus that causes COVID-19, has a fatty capsule around it that is destroyed by the detergents found in common soap. Destroying this capsule deactivates the virus. Working the soap through the hands to ensure that all areas of skin are well coated, including the backs, tips/fingernails, and webs of the fingers, is the first step. This should be followed by thorough rinsing for a minimum of 20 seconds. Humming the Happy Birthday song from beginning to end while rinsing is a good way to ensure this. Hand sanitizers should similarly be worked through the hands thoroughly and then allowed to air dry completely before touching anything. Remember: having the virus on your hands can cause you to become infected if you touch your face (eyes, nose, mouth). Learning to be aware of unconscious face touching takes time and practice but is important as we cannot always sanitize our hands immediately after touching a common-use object or surface.
There are many effective hand sanitizers. Those comprised of at least 70% alcohol (but not more than 90% alcohol) are effective against the SARS-CoV-2 virus. However, it is important to avoid touching one's face, especially the eyes, until the hands are completely dry after using hand sanitizers to avoid injury. The frequent use of hand sanitizers means exposing one's skin to detergents and other antimicrobial agents that can carry some risk and result in dry, painful skin. It is a good idea to sanitize, wait for your hands to dry, and then follow with a good hand moisturizer.
Note: there are some ineffective and even some dangerous hand sanitizers. This link can help guide you and avoid making a bad purchase.
Q: Can I just wear gloves instead of having to washing my hands?
A: The virus that causes COVID-19 can live on gloves and if someone with virus on their gloves rubs their eyes, nose, or mouth they can become infected just as if they had not been wearing gloves. Gloves are not disinfectants. However, they can be helpful in reducing the
amount of hand washing or hand sanitizing if the gloves are carefully removed before touching one's personal use surfaces or (especially) one's own face. For example, shopping with gloves which are then properly removed before touching one's car or face can eliminate the need for hand sanitization. To properly remove gloves, pinch one glove near the wrist and peel it off. Keeping the peeled-off glove in hand, take the index finger of the now gloveless hand and slide it under the wrist end of the other glove, folding it over and then peeling that glove off as well. Glove removal may be followed with hand washing or sanitizer as an extra precaution before touching personal use surfaces or one's face, but if done properly, this is not essential. Surgical and other disposable gloves should not be reused but they can be washed with soap and water just as you would wash your hands as a way of reducing the irritation of frequent hand washing.
J) Non-Touch Thermometer
Q: What is the best way to take someone's temperature?
A: Non-touch thermometers that use infrared technology to detect temperature are preferable to standard thermometers that are placed in the mouth when screening for COVID-19. Non- contact infrared thermometers can be placed in front of someone's forehead and the reading is done in just a couple of seconds. The person being tested should keep their mask on while the examiner extends their arm fully forward to take the reading. Once the examiner gets the reading, they should move away. Here is more information on how to use non-touch thermometers from the FDA and here is an example of a recommended reliable non-touch thermometer for purchase.
Q: What are the differences between the different COVID-19 tests and which one should I get?
A: There are three different kinds of tests for COVID-19. Two of them test whether someone currently has an infection and one tests whether someone has had it in the past.
The two tests that check for current infection are the PCR (also called the 'molecular' test) and the antigen test (also called the ‘rapid’ test). PCR tests have to be sent to a lab and typically take at least a couple of days to get results. Antigen tests may be performed in doctors' offices and typically provide results in less than 30 minutes. Both PCR and antigen tests may be performed by a nasal or oral swab.
The test that checks for past infection is called the antibody test. This test is administered at doctors' offices and labs by blood draw or a finger-prick to capture a few drops of blood and it is a rapid test, typically providing results in less than 30 minutes.
Q: When should a test for active illness be performed?
A: If an employee has a fever (at least 100 F/37.8 C) or any of the symptoms listed below in 'L', they should be asked to immediately leave the workplace and contact their doctor or the county public health department for testing. Anyone in the State of California can receive a test to see if they currently have COVID-19, free of charge. Check here for more information about free testing. If the employee seeks advice from their doctor, it is up to the healthcare professional to decide which test, if any, their patient should have. However, employers should be aware that tests for active disease will most likely be inaccurate unless performed 5 - 15 days following exposure or within 5 days of onset of symptoms for the antigen/rapid test, or within 7 days of onset of symptoms for the PCR/molecular test. The best day to have either the PCR or antigen test is day 7 post-exposure (the day before onset of symptoms). Not all healthcare professionals are aware of the correct timelines or windows for accurate testing and employees tested outside of the above described testing windows should not be allowed to return to the workplace until 2 weeks following the date of onset of symptoms and then only if the employee does not have an elevated temperature (at least 100 F/37.8 C) and is not experiencing a worsening or relapse of symptoms.
Q: I think I may have been recently exposed to COVID-19, what should I do?
A: An employee who believes they may have been recently exposed to someone with COVID-19 must report this to management before returning to work. If an employee reports having had a recent (within the last 4 days) exposure to someone known to have or strongly suspected of having COVID-19, they should be asked to stay out of the workplace until they have been tested for active disease. Again, in order to be accurate, that test should be performed 5 - 15 days following exposure with the ideal PCR or antigen test day being day 7 after exposure. Most primary care offices and urgent care facilities are now providing COVID-19 testing and anyone in California has access to free testing at the county public health department.
Q: What if an employee refuses to get tested?
A: If an employee with symptoms refuses to get tested they may be permitted to return to work two weeks following the date of symptom onset even if they continue to experience minor symptoms such as intermittent headaches and fatigue. However, if they are sick with ongoing cough, diarrhea, body aches, or fever they should remain out of the office for two weeks following the date of onset of symptoms. If an asymptomatic employee who reports suspected exposure to someone with COVID-19 refuses to get tested, they may be permitted to return to work 3 weeks following the date of suspected exposure.
Q: Can an employee who is tested outside the window for testing accuracy come back to work if they test negative?
A: If an employee with symptoms gets tested outside of the above window for accuracy, they may be permitted to return to work two weeks following the date of symptom onset even if they continue to experience minor symptoms such as intermittent headache and fatigue. However, if they are sick with ongoing cough, diarrhea, body aches, or fever they should remain out of the office. Remember that other infections such as cold and flu can produce similar symptoms and it is unacceptable to allow infectious persons to come to work.
Q: When should the antibody test be performed?
A: Antibodies to COVID-19 become detectible in the blood about 2 weeks after the onset of symptoms or 3 weeks after exposure. If an employee believes they had COVID-19 but did not get tested and it has been two or more weeks since their symptoms began, they do not require any testing to return to work provided they don’t have a fever or have ongoing cough, diarrhea, or body aches. If they would like to seek antibody testing to confirm that they did in fact have COVID-19, they should do so without involving their employer.
Q: What are the symptoms of COVID-19?
A: We are all familiar with reports of COVID-19-related pneumonia as these constitute the majority of cases that become critical and can lead to death. Such patients classically experience shortness of breath, dry cough, and fever. But COVID-19 can produce different clinical syndromes in adults (and at least one syndrome that is specific to children) that do not look like the classic respiratory illness. In fact, it is estimated that almost half of all people who get COVID-19 will have no symptoms at all. Such asymptomatic people can still transmit COVID-19 to others even though they feel fine.
The majority of people who do get physically sick from COVID-19 have at least 2-3 of the following:
● Loss of smell and/or taste
● Fatigue (often severe)
● Fever (100 F/37.8 C or higher) ● Body aches and chills
● Dry cough (little or no phlegm comes up with coughing)
● Shortness of breath (difficult and/or painful to take in a deep/full breath)
● Stomach cramps and/or diarrhea
● Difficulty concentrating/mental confusion
Of these, sudden loss of smell and/or taste is the one that is most specific to COVID-19 as it is not commonly seen in other respiratory diseases. Colds and flu typically produce a stuffy nose and that can impair smell/taste to a degree but in COVID-19 there is not typically a stuffy nose and the sense of smell is often not just diminished but lost entirely. An estimated 55% of people diagnosed with COVID-19 report loss of smell/taste without significant nasal congestion and there have been numerous case reports of patients with COVID-19 in which the sudden inability to smell their coffee or taste their food is their only symptom.
In addition to the above, many people with COVID-19 develop blood clots in their veins and arteries. Blood clots can cause pain in the legs, chest, or other body areas. They can also cause no immediate symptoms and there have been many case reports of patients with COVID-19 who were asymptomatic until one of the blood clots broke free and traveled to the lungs (pulmonary embolism) or brain (stroke). Severe respiratory illness seems to favor older people but blood clots have been identified among people in their 30's - 50's. Blood clots are the cause of more than 40% of COVID-19 deaths. Myocarditis (inflammation of the heart) is also commonly found including among young, otherwise healthy patients who have had COVID-19. This can be asymptomatic or can cause fatigue and chest pain.
M) Surface Decontamination
Q: How do I keep my work area from becoming contaminated?
A: At the beginning of this section of the document, you were instructed not to share your air. It is also important not to share your things during the pandemic. The best protection against fomite transmission (catching the disease by touching something contaminated and then rubbing your face) is for each employee to have their own workspace with their own exclusive use computer, chair, desk, pens, paper, printer, etc. However this is not possible in some cases and employees should be required to keep not only their own work area clean but to participate in general office sanitization of communal spaces.
The SARS CoV-2 virus that causes COVID-19 can live on hard, non-porous materials like glass, metal, or plastic for some time (2-3 days). Only EPA approved disinfectants should be used. There are numerous EPA-approved disinfectants that can be found here.
Each disinfectant has its own method of application (spray, wipe, etc.) and requires a certain amount of time to be on the surface to be effective. For example, 70% ethyl alcohol and Lysol disinfectant spray each requires 2 minutes of contact to sufficiently disinfect a surface while Clorox bleach requires 10 minutes. Whichever product you decide to use, be sure to follow the directions printed on the label carefully. Disinfectants use chemicals that can be harmful to the skin, eyes, and lungs. Using protective gloves, masks, and eyewear is strongly recommended when performing disinfection of surfaces. Many disinfectants can also be flammable. It is recommended that disinfectants be stored in a safe, cool, dry place such as a locked closet or cupboard. Here is a quick reference from the EPA which encapsulates these recommendations and should be posted in the workplace wherever it is necessary and appropriate.
N) The Nipit COVID-19 Daily Questionnaire
The Nipit COVID-19 Daily Questionnaire was designed as a screening tool to identify those who might be infected. Employees should be required to complete the questionnaire each day prior to leaving for work. If an employee answers ‘NO’ to every question in Part I, they should sign the questionnaire and come to work. Employees must present their signed questionnaire to management upon arrival prior to having their temperature taken. Employees may not enter the work premises without a signed questionnaire attesting to having answered ‘NO’ to every question in Part I.
If an employee answers ‘YES’ to any of the questions in Part I, they should not come to work. Instead, they should contact management to report that they had one or more ‘YES’ answers. Management should instruct the employee to contact their doctor or present to the local department of public health for testing.
An employee who presents at work without a signed questionnaire attesting to have all ‘NO’ answers to the questions in Part I should not have their temperature taken and should not be permitted to enter the work premises. They should be sent home with instructions to see their doctor or seek testing at the local public health department.
The Nipit COVID-19 Daily Questionnaire can be found here.