Returning to Work Safely in Michigan and across the US

Neitzel: As Michigan starts up its economy again, we're gonna see lots of changes at work places all over the place. Some of them we've already seen. So if you go to a grocery store now, you're probably noticing plexiglass barriers between you and the cashier, places clearly marked out for you to stand so we can maintain social distancing. Stores like groceries that are critical infrastructure have had to implement this during the pandemic. Now, as other businesses start to re-open though, we're gonna see those same types of approaches to mitigate the risk of exposure to the coronavirus. And so we're gonna start to see things like perhaps temperature screenings and symptom diaries that people might complete on the way into the workplace. We're gonna see much more emphasis on social distancing, on the installation of barriers where they are feasible to separate people physically, changes maybe to the ventilation systems, lots more emphasis on sanitation and hand washing. So all of these things are gonna be approaches that are implemented in a wide variety of workplaces all around Michigan, and indeed around the world.

Speaker 1: Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast, focusing on the ongoing coronavirus pandemic. Disease prevention and economic security are both public health concerns. Until there's a vaccine to stop COVID-19, social distancing is our best defense. But our health depends on financial resources as well to pay for basic needs, insurance, and other costs to support our physical and mental well-being. So that means getting back to work as safely as possible.

Rick Neitzel is an associate professor of Environmental Health Sciences at the University of Michigan School of Public Health. With his expertise in occupational health we asked Neitzel how businesses of all shapes and sizes, across all sectors can reopen while keeping workers and customers safe and secure. 

Neitzel: From an occupational health perspective, we have pretty set ways that we approach problems like this. We have a whole suite of tools available to us. Again, things like physical separation, social distancing, controlling ventilation, limiting access to facilities. Again drawing on this suite, we're able to recommend for different types of workplaces approaches to reduce risk that would be particularly appropriate for those workplaces. So we always have to recognize that different kinds of workplaces have different needs, different configurations. So what we recommend for a grocery store is gonna be different than what we recommend for an office or for a manufacturing facility. And the key here is it's not one size fits all. We need to give these workplaces some flexibility to implement these risk mitigation measures as effectively as possible given whatever constraints they have again for that particular workplace.

When we think about keeping people safe in the workplace from any hazard, it could be in radiation, it could be a dangerous chemical, it could be this novel coronavirus, with all of these things we want to approach the mitigation of that risk in a sort of in-depth fashion. And so we'll basically stack different layers of protection to make sure we're not relying on just one single aspect of risk mitigation to keep us safe.

So a great analogy here is the analogy to keeping people safe on the road while they're driving. We can think about safety measures there at a number of different levels. The highest level or so most broad-level would be public health interventions around driving safety. So we could think for example about trying to eliminate risks on the road wherever possible. This is why, for example, if you have a driving under the influence charge there's a chance your license may be taken from you. We wanna eliminate the risk of you potentially driving drunk and putting others at risk. So that's always the first step. Can we eliminate this hazard in some way?

Now, with the COVID-19 pandemic here, really the only way we're gonna get to elimination is through a vaccine or through herd immunity, and both of those things are unfortunately quite a ways out in time.

We could also then think about, well, how can we engineer the roadways and the way we drive to make driving more safe. And so we very purposely have designed our roads to be as safe as possible. We put in traffic lights and stop signs to safely moderate the flow of traffic. We put in guard rails on sharp curves. All of these things are designed to make the roadways inherently as safe as possible for people. We can think about the same kind of engineering control when it comes to controlling risk to exposure to this novel coronavirus. So engineering controls in the workplace for viral protection would include things like physical barriers implementing changes to the ventilation system to make sure we have more fresh air. We could also think about controlling access to workplaces. So maybe the public is not allowed - we're not accepting visitors right now. That all of these things again are kind of physical changes to the workplace to make it safer.

Below that we could start to think about more as we say administrative controls, things we do to change behaviors or to make behavior safer. So, nobody driving on the road in the United States legally doesn't have a driver's license. So, that licensing process is one way that we can ensure that people meet bare minimum safety requirements to safely operate a motor vehicle. We've even changed that process since I got my license, way back when, to where now we have graduated driver's licenses. So when you first get the ability to drive, you don't have unlimited rights to drive under any circumstances. We gradually increase your access to different driving circumstances. Again, to give you some experience and make you a safer driver before we let you drive in the middle of the night with a bunch of friends in their car.

We could also think about speed limits that we sat on roadways. Those are designed to keep people safe and in the event of a crash, make sure that crash isn’t exceptionally dangerous. Administrative controls when it comes to COVID-19, would include things like social distancing, making sure that people know to stay at least six feet away from others. It could also include things like changing the way the work is scheduled. So, maybe we move to multiple shifts, so we don't have so many people in a workplace at any one given time. We might also move to things like alternating work days where I only work every other day again to keep the head count down.

So these behavioral controls are designed to protect us essentially from coming into contact with other people who might be infected. Finally, we come to the lowest level here, which is what we would consider to be personal protection. And in this case when we talk about driving and that analogy, personal protection might include wearing your seat belt, for example, or making sure that you are not driving under the influence. So those are things you can do to change your own behavior for the better. Using your turn signals, something that many American drivers are totally unaware of, that are actually designed to be safe.

On the virus front, we could think about wearing a face cover, wearing gloves, certainly washing your hands regularly throughout the day. And I will say here sanitation is key. We know that washing your hands with soap and water is better or more effective than simply putting on hand sanitizer. But both of them are definitely better than nothing.

So you can see, we basically try to stack all of these different levels: the public health interventions, the engineering controls, the administrative controls, and this personal protective equipment. We stack all of those things together to give us multiple layers of defense and the more layers we have, the less our risk of becoming affected.

Speaker 1: And not every industry, type of business or workplace has the same level of risk. If you're thinking that a logger working by themselves in the middle of the forest, has a different risk of getting infected than a grocery worker who interacts with hundreds of customers every day, you'd be right.

Neitzel: Which of these almost infinite number of workplaces in Michigan are higher risk or a medium risk or lower risk, and how do we basically quantify that risk? We started to examine, well, what are the factors or the features of different workplaces and types of work that might put people at more or less risk of getting exposed to a potentially infected person? And so we kinda distilled this down to eight different factors that we think really dictate what your particular risk of exposure might be. And so this would include things like: Do you interact with the general public? Do you have close interactions or direct physical contact with your coworkers? Are you sharing tools or machinery or office equipment? Are you having to travel to many different sites over the course of your job? Do you work in an area where there's a high density of workers? In other words, each worker doesn't have very much space basically to themselves. Are you working indoors or outdoors? Are you working in a building that has pretty good ventilation or outside, or are you trapped in a space that doesn't have much air movement? And finally, how much access do you have to sanitation facilities, hand washing stations or hand sanitizer stations?

Once we break it down to those individual factors in the workplace, we can start to talk about, well, what workplaces might have better access to sanitation? What workplaces have more interaction with the public? And we can start to come up with some gradations there and we could say, for example, if we look at a range of workplaces, we could talk about workplaces that have very high or regular interaction with the public, workplaces that have less interaction with the public, or maybe workplaces that have no interaction with the public. And so we can really start to come up with some gradations of risk there for each of those eight characteristics. And then we've actually come up with an algorithm that let's us combine all of these things and consider how each of those factors might be more or less important relative to the others. In doing that we can come up with a quantitative risk score. And using that score, we can basically bucket different industries into low or medium or high risk of infection.

Now, the low-risk workers, these would be again people working at outdoors, it might also include the residential construction for example, those low-risk workplaces don't need so much in the way of risk mitigation interventions. But the medium and especially the high risk workplaces are gonna need more work. We need to stack even more layers of defense for those workplaces to make sure that workers can return to work safely and with minimal risk of infection.

Speaker 1: Based on their level of risk and using the stacked best practices, business owners and managers can formulate and implement layers of protection for their employees. From construction sites, to office buildings, to food service settings, these changes will need to look different.

Neitzel: There's lots of different ways that risk can be managed here. So for example, construction workers might have some regular contact with their colleagues, but to the extent we can implement social distancing between those workers. We can reduce their contacts. That's a good thing. We could also make recommendations or even prohibit the sharing of tools. In a lot of workplaces, the more complicated, more expensive tools are often shared. So by either cutting down on sharing between workers or making sure that those tools are thoroughly cleaned between use, we can make sure that people aren't transferring the virus by sharing their tools.

The same would work in an office setting. For anybody who's seen the movie Office Space, you know, that sharing staplers is kind of a no, no. It's a social no, no, and now it's a no-no in terms of reducing virus transmission, as well.

We could also think about a much different setting, restaurants as a workplace. We need to ensure that not only other restaurant workers are protected, but the customers coming to the restaurant are protected as well, and there's a number of ways we can do that. So we could think about limiting seating. So maybe we only have every other table in the restaurant being served to make sure that there's physical separation between these different tables. We might have physical barriers in the waiting area to make sure that the customers are separate and that they're separate from the host or hostess who's trying to get them seated.

We might move more towards reservations to make sure that we don't have too many folks in a restaurant at the same time. We could also do things like moving away from the traditional sort of plastic covered menus to maybe an electronic menu or a disposable single use menu. Now, of course, there's sustainability issues there, but our first priority here is to get people back to work and then we'll figure out how to make sure that this is a sustainable approach as well.

So, the key here is flexibility and creativity and innovation. Again, there's no one-size-fits-all approach here and every different kind of workplace is gonna have to consider different factors. But the good news is, we've got a lot of creative and the innovative people working on these solutions, both on the academic side, but also in the industry to make sure that when our businesses reopened they're protecting the workers, and they're also protecting their clients and customers.

Every state in the United States and Michigan is no exception, is a very diverse state with lots of different economic sectors and also different geographical regions. Michigan actually might be more complicated than most because we're comprised of two giant peninsulas and we're also quite a large state. And so what we need to recognize here is what's happening in the Upper Peninsula in terms of infection risk and workers getting back to work, is gonna be much different than what's happening, for example, in Southeast Michigan and in Detroit. We need to design approaches that can handle that diversity, geographically and occupational.

And one of the concepts that's come up is something called a labor shed, which is kind of analogous to a watershed. This is basically for a given area, for example Detroit, what larger geographic region are workers traveling from to get into Detroit to do their work and of course back out to go back home. And it turns out in Michigan there's some quite complicated movements every day of workers from one region to another. Now, that's a good thing. People have jobs to get to, so they're traveling to get to those jobs. The thing we need to be mindful about is, we don't necessarily want people coming from a region that has a very high infection prevalence and traveling to go to work to a region that has a low infection prevalence. So we've gone about this in a very organized and systematic way, so we can truly compare apples to apples and look at very different industries and rate them using a systematic scale and determine what is their risk level and as a result of that, what are the interventions they need to do to go back to work safely?