What should employers and building owners/managers be doing to protect employees and other stakeholders from COVID-19?

The first thing to do is to be aware of the U.S. Centers for Disease Control (CDC) guidance. The CDC has specific guidance for businesses and retirement/independent living properties, and other facilities.

Secondly, you want to have a written infection prevention plan in place that goes along with the CDC guidance. There are three major fundamentals of prevention that we look for:

1. Activity/work modification.
   1. Eliminate in-person contact
   2. Use barriers or other “engineered” controls to separate people
   3. Modify behaviors to incorporate physical distancing, increased hand washing/hygiene, frequent cleaning/disinfection
   4. Use personal protective equipment, gloves, respirators (N95s), masks
2. Medical screening & monitoring.
   1. Keep people with symptoms out of the workplace/community space
   2. Increase protection measures for persons at risk, such as older adults and those with underlying medical conditions
   3. Have protocols in place for addressing HR/legal aspects (e.g., doctor clearances, restriction of work, restriction of access to common areas). Screening/monitoring generally relies upon self-reporting, although some entities are taking temperatures and using questionnaires.
3. Communication
   1. Inform and remind/reinforce. We are trying to break old habits and create new habits (physical distancing, hand-hygiene, etc.)
   2. Maintain a campaign of regular training, townhalls, signs, posters, flyers, and exercises
   3. Reduce anxieties by putting the focus on preventative actions

What do you do if you have a case present in the workplace or at a property?

The CDC website has specific guidance on the cleaning/disinfection of your home and workplaces/community facilities. Your infection prevention plan should also have a protocol for incident response when you have a case. The fundamentals of incident response when you have a case are to:

• Assess the event – what was impacted and who was exposed?
• Stay out of any areas that were occupied by the infected individual for 24 hours or as long as possible. Small droplets that are exhaled may stay airborne in closed quarters for some time.
• Inform the affected parties (i.e., those who may have interacted with the infected individual). If they were following proper prevention protocols before the incident, then they should have been protected even if they interacted with the person that has the illness.
• Clean and disinfect the surfaces and areas that the person interfaced with as determined during the initial assessment.
• Increase or reinforce prevention measures (e.g., cleaning frequency, activity modifications).

How do you properly clean/disinfect?

Refer to the CDC technical guidance for cleaning and disinfection. There are a few important definitions for terms we’re hearing regularly that we need to keep in mind:

• Cleaning = removing dirt or debris
• Disinfection = killing the germs

It’s important to remember that these go hand-in hand. In order to allow the disinfectants to work, it’s important for the surface to be clean and free of debris.

What types of disinfectant should be used?

When it comes to disinfectants, the CDC has recommended three basic disinfectant types:

1. Bleach-based solution
2. Alcohol-based solution
3. EPA-registered disinfectant for SARS-CoV-2

When using disinfectants, it’s critical that you read the label and follow the manufacturer’s directions for disinfection. When following the directions, keep these critical points in mind:

1. Contact time – how long the surface is wetted with disinfectant for it to work properly
2. Physical removal – cleaning, wiping, scrubbing helps with disinfection
3. Safety precautions – always follow them per the label (e.g., ventilation, gloves, eye protection)

What is all the discussion around “masking” about? What are the pro’s and con’s?

There’s a lot of talk about masks in the media right now. Stay up to date with guidelines from the CDC, which have been changing in the course of this pandemic. Different types of “masks” are being discussed, often interchangeably. However, there are important differences to be aware of:

• Respirators – Respirators refer to devices that are tested and certified to be effective by an organization called NIOSH. (An example of one of these certified & tested respirators is the N95.) These respirators are designed to protect the wearer, however they can provide some degree of protection for people around the wearer as they reduce the number of particles released into the air when exhaling. To ensure the effectiveness of a respirator, they need to be fit-tested to the person. With regards to an N95, these masks are really designed for a single use, but in the current situation, we may be forced to reuse them. There are various discussions underway on how to disinfect them best for reuse, but there is no definitive guidance at this time.
• Surgical Masks – These are engineered masks designed to cover the mouth/nose to reduce the amount of droplets from that persons mouth/nose. They’re primarily designed to protect people from the person wearing the mask – they do very little to provide protection to the wearer.
• Cloth Masks – These are made from common materials to cover the mouth/nose to reduce the amount of droplets becoming airborne from that persons mouth/nose. These are also primarily designed to protect people from the person wearing the mask. These masks are not well-studied, and they are not expected to be as protective as surgical masks or a respirator. Regardless of that, the CDC and local health departments are currently recommending their use.

There are two main concerns regarding wearing a mask or respirator:

1. Poor hygiene can spread germs from masks/respirators exposed to infectious droplets (e.g. sharing equipment, reusing without cleaning first, contamination of hands when removing).
2. False sense of security which leads to more risky behavior (e.g., more relaxed physical distancing)

The key takeaways to remember: 1) properly fitted & certified respirators are best, but surgical or cloth masks should also help reduce risk in the community to some degree if used properly, and 2) even if wearing a mask, it is still of critical importance to practice good hand hygiene and physical distancing.

Any other advice or perspectives to share?

The situation we’re in is very dynamic and it’s likely to be with us for a long time in some form until a vaccine or game-changing treatment is available. By some reports, this could last for at least a year and even as long as two years.

It’s important to think about what you will do and how you will manage your facilities when these current isolation restrictions ease up, but the virus is still out there. Make sure your infection prevention plan is flexible and incorporates a scalable series of measures based on an “infection alert level”. This would start at normal conditions, move up to seasonal flu, and move even higher for outbreak events, eventually progressing to shelter in place orders.

Don’t be surprised if this outbreak fades away and then returns later this fall. Have your plan together and be ready to respond.