Advocacy

 
James S. Frederick
Acting Assistant Secretary of Labor for Occupational Safety and Health
U.S. Department of Labor
200 Constitution Avenue, NW
Washington, DC 20210
 
Re: Docket No. OSHA–2020–0004
 
Dear Secretary Frederick:
 
The American College of Occupational and Environmental Medicine (ACOEM) welcomes the opportunity to provide comments on the Emergency Temporary Standard (ETS) for Occupational Exposure to COVID-19.
 
We support the need for the ETS to protect health care and health care support service workers from occupational exposure to COVID-19 in settings where people with COVID-19 are reasonably expected to be present and offer the following recommendations. Our recommendations reflect the comments we have received from our members who practice in medical center occupational settings.
 
Physical Barriers
Physical barriers are problematic in large health system institutions, which typically have many reception desks and shared workrooms. The scientific evidence has not established that physical barriers are effective. Efficient ventilation systems, work practice controls such as screening visitors and patients, and PPE provide more effective layers of protection; any additional benefit of physical barriers is speculative at this time. Barriers will require frequent cleaning which will unnecessarily strain resources, and their installation may actually impede the efficient function of ventilation systems that are a more effective engineering control to reduce spread of infectious particles. Individuals may physically circumvent the barriers to facilitate communication, bringing them into closer proximity than necessary. Barriers may also create a false sense of security and cause people not to observe physical distancing when it would otherwise be possible. ACOEM suggests facilities use appropriate PPE as an alternative especially when physical distancing cannot be maintained.
 
Medical Removal
The current version of the ETS requires medical removal of unvaccinated individuals who were not wearing a “respirator and other PPE” when in contact with an infected source. This is inconsistent with CDC guidance for health care workers (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html). Instead, the medical removal of unvaccinated employees with a significant risk exposure should be encouraged. Universal surgical facemask uses in health care settings limits exposure risk both from patients and coworkers. When both the source individual and the exposed healthcare worker are properly masked, the exposure is generally assessed as a low-risk exposure even without use of a respirator, unless an aerosol generating procedure is performed. Quarantining asymptomatic health care workers after low-risk exposures is not recommended by the CDC, and their medical removal simply due to not wearing a respirator, as outlined in the ETS, would create further staffing shortages, and provide opportunity for the indirect and unnecessary disclosure of individual vaccination status to management.
 
We recommend that the ETS direct facilities to conduct exposure risk assessments and implement postexposure work removal following current CDC guidance. Given the prominent role of asymptomatic spread in the pandemic, we further recommend the ETS encourage universal source control to minimize risk to staff and mitigate subsequent health care shortages, until community rates are acceptably low.
 
Contact Tracing
ACOEM appreciates OSHA’s intent to protect the privacy of the infected individual when conducting an exposure investigation and contact tracing. However, limited information sharing including the source employee’s identity and infectious period is often necessary to determine what PPE was worn by contacts and conduct an exposure assessment. Many infected employees do not recall which coworkers they took breaks with on a given day, and are sometimes unable to identify coworkers by name, especially if they are new to the work unit. We recommend allowing facilities to appropriately share the infected employee’s identity in limited ways when necessary to conduct exposure risk assessments. Without the ability to identify the source, entire clinical workgroups could be removed from work due to a possible significant exposure, shutting down services and limiting access to care, when in fact only one or two individuals might have sustained a significant risk exposure.
 
ACOEM further recommends removal of the provision requiring posting of general notices in work areas disclosing the presence of a COVID+ employee. Posting such a notice without the source’s identity would not allow individuals to self-identify if they had sustained a significant exposure and including the identity of the source in this venue would constitute an unnecessary and inappropriate breach of privacy. Such general nonspecific notices are likely to create anxiety without benefit. Over time, workers are likely to become inured to repeated postings of this type.
 
COVID-19 Log
Most facilities will be challenged to exclude remote workers from the COVID-19 log. The designation “remote worker” is quite porous and imperfect and may not be identifiable through any HR system. Rather we suggest excluding employees who pose no risk of exposure to coworkers due to not physically being present at the worksite during their communicable period.
 
General recommendations:
Over time we anticipate that SARS-CoV-2 will become but one of many endemic respiratory infectious diseases to which health care workers are exposed. We recommend consideration of aligning the requirements driven by objective data such as community incidence rates and facility vaccination rates. This could have the added benefit of incentivizing facilities to implement effective strategies to optimize vaccination rates. After the pandemic it would be prudent to consider the transition to a permanent standard that would ensure protection from other respiratory infectious diseases.
 
We urge that OSHA strongly support employer programs that either require or incentivize universal vaccination among healthcare employees, and we encourage OSHA to consider an ETS that would afford protections to other occupational groups outside health care.
 
Thank you for your consideration of our comments. Please do not hesitate to contact Patrick O’Connor, ACOEM’s Director of Government Affairs, at 703-351-6222 with any questions.
Sincerely,

Robert M. Bourgeois, MD, MPH, FACOEM
President, ACOEM