key: cord-0857741-e7k5r5cs authors: Roberts, Morgan; Thygerson, Steven M.; Beard, John D.; Clark, Camille; Montague, Emma title: Occupational safety and health guidelines in relation to COVID‐19 risk, death risk, and case‐fatality proportion: An international, ecological study date: 2022-03-14 journal: Health Sci Rep DOI: 10.1002/hsr2.539 sha: ae72813ea3096670f9c4c91b905666eeb962952d doc_id: 857741 cord_uid: e7k5r5cs BACKGROUND: Coronavirus disease 2019 (COVID‐19) began in 2019 with several unknown factors. The World Health Organization (WHO) subsequently developed COVID‐19 occupational safety and health (OSH) guidelines to reduce occupational COVID‐19 transmission. Many countries also developed their own COVID‐19 OSH guidelines, but whether these guidelines included WHO's guidelines and whether including WHO's guidelines in countries' COVID‐19 OSH guidelines reduced COVID‐19 transmission is unknown. OBJECTIVES: The objectives of our study were to (1) compare the COVID‐19 OSH guidelines of several countries to WHO's OSH guidelines, (2) estimate associations between characteristics of countries and their OSH guidelines and the number of WHO's OSH guidelines included in countries' OSH guidelines, and (3) estimate associations between WHO's OSH guidelines included in countries' OSH guidelines and COVID‐19 risk, death risk, and case‐fatality proportion. METHODS: This study represents international, ecological research of 36 countries from all six world health regions. Countries' COVID‐19 OSH guidelines were compared with WHO's OSH guidelines. Linear regression models adjusted for potential confounders were used to estimate associations of interest. RESULTS: The median number of WHO's 15 COVID‐19 OSH guidelines included in countries' COVID‐19 OSH guidelines was eight. Countries' COVID‐19 OSH guidelines focused on workers included significantly more of WHO's COVID‐19 OSH guidelines than countries' COVID‐19 OSH guidelines focused on general populations. Including “provide personal protective equipment for workers” and “create workplace policy for wearing personal protective equipment” in countries' COVID‐19 OSH guidelines were significantly related to decreased COVID‐19 risk, death risk, and/or case‐fatality proportion. CONCLUSIONS: Countries' COVID‐19 OSH guidelines should include WHO's guidelines, focus on workers, and include “provide personal protective equipment for workers” and “create workplace policy for wearing personal protective equipment.” or other government entities. Therefore, information from other sources, such as from legal websites that cited government guidelines, was used as needed. The following country's guidance documents were translated to English: Argentina, Estonia, and Luxembourg. A content analysis was conducted by comparing the 36 countries' COVID-19 OSH guidelines to WHO's OSH guidelines. WHO's COVID-19 OSH guidelines were considered as the gold standard comparison because of our study's international focus. These guidelines apply to workers in nonhealthcare settings. Fifteen specific guidelines in WHO's COVID-19 OSH guidelines were identified: 1. Determine workplace level of risk (through a risk assessment). 2. Decide on the ability to reopen according to risks. 3 . Encourage regular handwashing. 4 . Provide handwashing or sanitation stations in the workplace. 5 . Provide personal protective equipment (PPE) for all workers. 6 . Create a workplace policy for wearing PPE at work. 7 . Require 1 m of physical distancing. 8 . Rearrange the workplace to include physical barriers to promote physical distancing (such as glass, queue management, etc.). 9 . Stagger shifts or have employees telework when possible. 10 . Cancel/postpone work travel. 11 . Disinfect workplace regularly (especially high-touch surfaces). 12 . Create an environment with continuous COVID-19 education in the workplace. 13 . Require sick/symptomatic workers to stay home and quarantine, as well as implement protocols, to limit their exposure as they leave the workplace if symptoms onset during work hours. 14. Increase ventilation rate by natural or artificial means (avoid recirculation, especially for medium-high risk workplaces). 15 . Create a workplace plan of action for the prevention of COVID- 19. 5 Two raters were trained to review each countries' COVID-19 OSH guidelines and determine whether (i.e., "yes" or "no") they included WHO's 15 COVID-19 OSH guidelines. If the two reviewers disagreed, then a third trained rater review the discrepant guidelines and make the tiebreaking decision. SAS version 9.4 (SAS Institute Inc.) was used to conduct all statistical analyses, and the country was used as the unit of analysis. Percent agreement and κ, and 95% confidence intervals (CI) for κ, were calculated to estimate the agreement between the two raters' determinations of whether countries' COVID-19 OSH guidelines included WHO's OSH guidelines. 5 The US Census Bureau's information on the age of population for each country was available as the number of people in 5-year age categories: 0-4, 5-9,…, 90-94, 95-99, >99. 7 To calculate the average age of population for each country, the midpoints of each age category were multiplied by the number of people in that age category, the products were summed, and the sums were divided by the total population. COVID-19 risk per 1,000,000 people, COVID-19 death risk per 1,000,000 people, and COVID-19 case-fatality proportion were calculated for each country using WHO's information on COVID-19 cases and deaths, the US Census Bureau's information on population, and the following formulas 7 Provide personal protective equipment for workers 16 44 Create workplace policy for wearing personal protective equipment 23 64 One meter of physical distancing required 23 64 Rearrange workplace to include physical barriers to promote physical distancing 16 44 Stagger shifts/telework when possible 20 56 Cancel/postpone work travel 16 44 Disinfect workplace regularly (especially high-touch surfaces) 27 75 Continuous COVID-19 education in the workplace 18 50 Sick/symptomatic workers stay home and quarantine (limited exposure as leaving workplace) Increase ventilation rate by natural or artificial means (avoid recirculation), especially for medium-high risk workplaces 12 33 Create a workplace plan of action for the prevention of COVID-19 17 47 Number Handwashing is the best practice for stopping the spread of infectious diseases because people often touch their faces, eyes, and mouths. Germs on the hands can carry infectious diseases such as, but not limited to, salmonella, E. Coli O157, and norovirus. In addition, the US CDC found that 20%-30% of diarrheal sicknesses and respiratory infections can be prevented by regular handwashing. 59 A meta-analysis found that handwashing is effective for mitigating the spread of gastrointestinal illness. 60 Two other studies found the combined effect of hand hygiene (i.e., using alcohol-based hand sanitizer) and face mask wearing reduced incidence of influenza. 61 found "Noncompliance was strongly associated with weaker feelings of moral obligation and low trust in authorities, but also with characteristics related to antisocial potential." 65 Culture or inadequate policy may also play a role in noncompliance with COVID-19 OSH guidelines. For example, in Nepal, a motorcycle driver will wear a helmet because doing so is required by the law, but he or she will not put a helmet on his or her motorcycle passengers, such as a spouse, child, or baby, because there is no law that requires helmet use by passengers. 66 The connection between the COVID-19 OSH guidelines and deaths is maybe not direct as a majority of COVID-19 deaths is among retired elderly people. However, the percentage of elderly or retirement people in many countries who still work full-or part-time is increasing. 67 The authors declare no conflicts of interest. Surveying the Covid-19 Pandemic and its Implications Biological, clinical and epidemiological features of COVID-19, SARS and MERS and AutoDock simulation of ACE2 Infodemic and the spread of fake news in the COVID-19-era Cleaning and disinfection of environmental surfaces in the context of COVID-19 Considerations for public health and social measures in the workplace in the context of COVID-19 World Health Organization International Programs, International Data Base. International Data BaseUnited States of America Census Bureau, International Programs. International Data Base World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. 2020. Accessed Vaccine BNT162b2: conditions of authorization under Regulation 174 GDP per capita (current US$) Covid-19 workplace response protocol. FDRE Ministry of Labour and Social Affairs Website New coronavirus COVID-19. Argentina Ministry of Health Website Australian Government Department of Health. Coronavirus (COVID-19) advice for the health and aged care sector. Australian Government Department of Health Website COVID-19: guidance for employers in Italy COVID-19: guidance for employers in France. Bird & Bird Website Press statement on covid-19 and additional preventive and control measures introduced by the government of the republic of Zambia. Zambia National Public Health Institute Website Vietnam covid-19 outbreak-maintaining a safe workplace. Vietnam Business Law Website Ten most important things to know about the coronavirus and its prevention The new normal-Indonesian health minister issues COVID-19 workplace guidelines. SSEK Indonesian Legan Consultants. Website. 2020. Accessed Government of India Ministry of Health & Family Welfare Directorate General of Health Services. Guidelines on preventive measures to contain spread of COVID-19 in workplace settings. Government of India Ministry of Health & Family Welfare Directorate General of Health Services Website Public safety advice -COVID-19 news. Greece National Public Health Organization Website The Hashemite Kingdom of Jordan. Guide for companies and workplaces. Jordan Ministry of Health Website COVID-19 in Germany: back to business after the lockdown-guidance for employers. Mayer Brown Website Guideline on workplace safety during COVID-19. Ministry of Health. Health Protection Agency Website UK guidance on returning to the workplace: managing health and safety issues during the COVID-19 pandemic. The National Law Review Website Public health inspection checklist for workplaces, public facilities/spaces-COVID-1 Ministry of Health New Zealand. Guidelines for businesses and services. Ministry of Health New Zealand Website Tighter measures to minimize further spread of COVID-19 Ministry of National Health Services, Regulations, and conditions. Health & safety of building & construction workers during COVID-19 outbreak. Government of Pakistan Website FAQs for Kenyan employers on the Covid-19 (coronavirus) Ministry of Health and Wellness. Infection prevention and control measures in workplaces guide Ministry of Public Health. Recommendations for businesses and workplaces in the case of finding COVID-19 patients. Department of Disease Control Website Covid-19 safety measures at work. Website. 2020 Mexico institutes measures to prevent the spread of COVID-19 in the workplace. The National Law Review Website Protect yourself and others. Uganda Ministry of Health Website United Arab Emirates Ministry of Health and Prevention. Covid-19 information awareness Covid-19 Nepal: preparedness and response plan (NPRP). WHO Website Guidance on preparing workplaces for National Health Commission of the People's Republic of China. Getting your workplace ready for COVID-19. National Health Commission of the People's Republic of China Website World Health Organization. Regional Office for the Eastern Mediterranean Region. Afghanistan COVID-19 response guidelines. WHO Website World Health Organization. COVID-19 technical guidance names, origin & modes of transmission. WHO Website Getting your workplace ready for COVID-19. WHO Website A new look at the statistical model identification Splines for trend analysis and continuous confounder control Outcome modelling strategies in epidemiology: traditional methods and basic alternatives Occupational Safety and Health Administration -United States. OSHA's Bloodborne Pathogens Standard's Fact Sheet Absence of apparent transmission of SARS-CoV-2 from two stylists after exposure at a hair salon with a universal face covering policy Covid-19: important potential side effects of wearing face masks that we should bear in mind Headaches and the N95 face-mask amongst healthcare providers Covid-19: should the public wear face masks? Surgical mask placement over N95 filtering facepiece respirators:physiological effects on healthcare workers Face Masks for the General Public Show me the science-why wash your hands? Centers for Disease Control and Prevention Web site US Centers for Disease Control and Prevention. Your Guide to Masks Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis Mask use, hand hygiene, and seasonal influenza-like illness among young adults: a randomized intervention trial Facemasks, hand hygiene, and influenza among young adults: a randomized intervention trial Risk assessment at work and prevention strategies on COVID-19 in Italy Assessing and managing the risks of COVID-19 in the workplace: applying industrial hygiene (IH)/occupational and environmental health and safety (OEHS) frameworks Non-compliance with COVID-19-related public health measures among young adults in Switzerland: insights from a longitudinal cohort study Prevalence of motorcycle helmet use in Kathmandu, Nepal: an observational study A global view on the effects of work on health in later life Ecologic studies