Guidelines to minimise COVID-19 infection risk

James Kon

The Ministry of Health (MoH) recently issued comprehensive guidelines for the vulnerable population during the COVID-19 pandemic to minimise the risk of infection.

In a statement, the ministry said that current epidemiological evidence suggests that the SARS-CoV-2 virus responsible for COVID-19 disease is transmitted readily through respiratory droplets and contact. This has implications to workplace/business settings where transmission is likely to occur either directly via close contact or indirectly via contaminated surfaces and/or objects (fomites). This risk could be greater if employees/clients share workstations (communal computers, electronic devices, for example).

Cases encountered thus far have shown that it is possible for infected persons to transmit the virus in the early phase of their illness, when their symptoms are non-specific or mild. Although evidence has shown that the majority of infected cases (80 per cent) have mild disease, a smaller proportion of cases go on to develop severe pneumonia, with some dying from the infection.

The vulnerable population at high risk for COVID-19 infection include people who are aged 70 or older (regardless of medical conditions) as well as people who are under 70 with an underlying health condition. These include chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), emphysema or bronchitis, uncontrolled or severe asthma; heart disease such as heart failure, hypertension, stroke, diabetes mellitus, chronic kidney disease; chronic liver disease such as hepatitis; chronic neurological conditions such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy; and splenic disorders such as sickle cell disease or removal of spleen, weakened immune system as a result of conditions such as HIV and AIDS, or on long term steroid medication or chemotherapy, being heavily obese ie with a body mass index (BMI) of 40 or above, and pregnant women.

Additionally, there are some clinical conditions which put people at even higher risk of severe illness from COVID-19. Those who may be at particular risk due to complex health problems include: individuals who have received an organ transplant and remain on ongoing immunosuppression medication; people diagnosed with cancer and are undergoing active chemotherapy or radiotherapy; people with cancers of the blood or bone marrow such as leukemia who are at any stage of treatment; people with severe lung conditions such as cystic fibrosis or severe asthma (requiring frequent hospital admissions or courses of steroid tablets); people with severe diseases of body systems, such as severe chronic kidney disease (on dialysis); and pregnant women who have a serious heart condition.

File photo of people adhering to social distancing at a shopping centre. PHOTO: RAHWANI ZAHARI

For the vulnerable population, work arrangements can be considered by employers when reviewing the suitability of vulnerable workers’ placement at the workplace. These, however, are not to replace the need for social distancing, hygiene measures as well as other infection control and transmission reduction measures.

One of the measures is temporary work redeployment where vulnerable employees can be temporarily redeployed to another role or work environment within the organisation where there is minimal exposure to COVID-19 infection or contact with the public.

This includes groups such as pregnant women and individuals with health conditions such as those listed as Vulnerable Populations at High Risk for COVID-19 Infection.

Other arrangements include reducing the need for and duration of physical interactions where employers must minimise the need for physical meetings by, for example, using tele-conferencing facilities. If there is a critical need for physical meetings to proceed, the number of attendees should be limited and the duration shortened. Meetings should be conducted in open, well-ventilated spaces.

Vulnerable employees may be redeployed to other roles or work processes where there is minimal interaction with the public. Alternatively, employers may want to consider reviewing work processes to reduce physical interaction with the public and, for example, consider use of online transactions and drive-through services.

There is also a need to ensure clear physical spacing of at least one metre apart, where employers must provide for wider physical spacing (of at least one metre apart) for work stations (for example, clearly demarcating the work stations that can be used to achieve the one metre spacing).

Available seats in meeting rooms should also be spaced at least one metre apart and clearly marked. The same safe distancing measures should apply to common spaces, such as entrances/exits, lifts and pantries/canteens, where congregation or queuing of employees or visitors/clients might occur. Employers should also remind employees to maintain the one metre physical spacing during informal discussions amongst employees.

Employers should implement staggered working hours to reduce possible congregation of employees at common spaces such as entrances/exits. The staggered working hours must be implemented over at least three one-hourly blocks, with not more than half of the employees reporting to work within each one-hour block. For example, if the normal working hours are from 8am to 5pm, employers could stagger employees’ reporting times at one-hour intervals between 7.30am and 10.30am (eg 7.30am to 8.30am, 8.30am to 9.30am and 9.30am to 10.30am), with corresponding staggered timings for end of work. Timings of lunch and other breaks must also be staggered.

Where possible, reporting and ending times should not coincide with peak-hour travel, especially if employees require the use of public transport. Employers may consider staggering and reducing number of employees entitled to work breaks at any one time so as to reduce congregating at pantries/canteens/break areas.

Employers must defer or cancel all group events or activities which involve close and prolonged contact amongst participants. These include conferences, seminars, training and exhibitions. Social gatherings at the workplace, such as the celebration of birthdays, should be kept to no more than 10 persons at any one time, with safe distancing measures in place.

Shift or split team arrangements should also be implemented or enhanced for suitable workplace settings, such as the manufacturing industry. Employers can consider having employees work in shifts and extending operational hours to maintain production output. Alternatively, employers should look into split team arrangements where employees are assigned to work under alternate teams and be deployed according to different work schedules or at different work sites. Employers should consider clear separation of employees on different shifts or split teams, such as implementing human traffic management measures and stepping up cleaning of common areas during shift or split team changeovers.

In addition, discourage workers from using other workers’ phones, desks, offices, or other work tools and equipment, when possible. Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the work environment in line with MoH Guidance on Disinfection
of Workplaces. In the usage of personal protective equipment (PPE), ensure vulnerable workers who need to use PPE are properly trained on how to put on, use/wear and take off correctly, including in the context of their current and potential duties. Ensure PPE is disposed of correctly.

In terms of preparing to institute flexible workplace and leave policies, and reporting of illness, employers should ensure that sick leave policies are flexible and consistent with public health guidance, and that employees are aware of and understand these policies.

Employers should also implement flexible policies that allow employees to stay home if they are sick, in self-isolation, or caring for family members. Additionally, employers should develop policies and procedures for employees to report and declare when they are sick or experiencing symptoms of COVID-19 while at work which is a critical step in protecting other workers, customers, and visitors.

Employers should inform and encourage employees to self-monitor for signs and symptoms of COVID-19 if they suspect possible exposure.

It is also the responsibility of employees to always take the necessary preventive actions when they are at work such as adhering to the recommended social distancing measures, avoiding physical greetings or handshakes, wearing a mask where applicable, frequently washing hands or use of hand sanitiser, adopting respiratory etiquette, etc.

In cases where measures to make the workplaces safer in reducing infection transmission such as temporary redeployment or making other work arrangements have been undertaken but has been further assessed by the employer that they may still pose an increased risk to the vulnerable worker, then, wherever possible, the employer may consider for vulnerable employees to work by telecommunicating from home, provided that there are means of monitoring work hours, work output, remote access and connectivity to workplace and colleagues.

These must also be in line with the organisation’s human resource and work processes policies. Consider retaining employees with critical functions only to remain in the workplace setting, to reduce crowding and close contact. Additional measures could include reviewing work processes and providing the necessary IT equipment/facilities for employees.