FedEE Employer Q&A on COVID-19

Q: What should happen if an employee contracts a high temperature at work, or shows other signs of infection – such as a dry cough and difficulty in breathing?

A: It is critical that employers deal with suspected COVID-19 in a responsible way and put a priority on the welfare of employees as a whole. The existence of a high temperature could indicate a wide range of conditions – including high blood pressure, alcohol abuse and other causes of infection. In all instances, the priority should be to isolate the individual concerned, give them plenty of drinking water and call for medical help. Contrary to advice given in the UK and several other countries, the first step should not be to send the employee home – as they could be very vulnerable if the infection develops quickly and they could further infect their family.

Once the employee has been treated and taken into the care of health professionals the priority should be to discreetly investigate who the employee has been in touch with at theworkplace over the last 2-3 days and advise the employees and other company contacts concerned to seek a virus check-up or self-isolate. Premises should also be treated with an effective disinfectant and no-one allowed to work in potentially infected workspaces.

Finally, it is critical to avoid alarm amongst employees and to avoid, where possible, the identity of the person (s) who has/have shown signs of being unwell. It is important also to stress that nothing has been confirmed and that it is very likely that it is just a false alarm.

Q: As a big company operating in several countries we are probably going to have instances of COVID-19 in our workforce. When talking to our occupational physicians what should I bear in mind?

A: Although the general advice about handwashing is an important defence against disease transmission, there are some very effective ways that employees can be protected from the worst consequences if infection strikes. Back in the last pandemic, 100 years ago, 95% of those dying from “Spanish flu” did so due to secondary infections. It would appear that this remains a similar threat with COVID-19. Furthermore, there is an important data protection issue facing employers during the present crisis and we have seperately advised our member firms how to deal with this.  This should, however, not prevent employers from trying particularly to protect those who are most vulnerable – such as people nearing retirement age, those with heart conditions or diabetes.
In addition to seasonal flu vaccinations, employees should be given pneumococcal vaccine PPV to protect them against 23 strains of the bacterium that gives rise to pneumonia. This is 50-70% effective and usually reserved for those aged 65+ – however, it is perfectively effective for those below that age, although it still leaves space for human respiratory viruses that directly cause pneumonia. It is also important for those being treated for the virus to receive antibiotics. This will not touch the virus itself, but will fend off secondary infections. Doctors are often averse to using antibiotics because of building up bacterial resistance in the population – but its use could save numerous lives.

Finally, as COVID-19 is primarily a respiratory disease it is going to particularly affect regular smokers. If ever there was a time to quit it is therefore now. Any notion that gargling with ethyl alcohol (neat vodka) is a defence against the virus is a pure fallacy. For alcohol to kill the virus it would have to be over 60% proof (a strength that would burn the mouth lining and internal organs of anyone trying to gargle with it or drink it) and stay in contact with the virus for up to an hour. Moreover, other types of alcohol (methyl alcohol and isopropanol) are entirely poisonous for humans

Q: It is clear that the virus is highly contagious, but what else do we know about it?

A: There has now been enough time since the pandemic began for scientific assessments to be made about its transmission.

The virus remains in the air, at room temperature, for up to three hours. When it settles, it remains active on copper for four hours, cardboard for up to 24 hours and plastic and stainless steel for up to three days. Once infection takes place, the average period for it to become evident is 5.5 days and 97% of infections are evident by 11.5 days. The most common test is undertaken by a throat swab and painful deep nostril sampling process and a result will normally be available in 2-3 days (although some tests work much faster).
Q: Can we believe the official figures?
A: We know from the findings in Iceland – the country with the most comprehensive testing exercise in the World and with a government of relatively high integrity – that half of all sufferers of the disease do not show any symptoms whatsoever. This is dangerous because they are the people most likely to spread the disease. Moreover, in many countries with poor health systems, ineffective governments and high levels of poverty the incidence of the disease in the population will be confined to figures about a small proportion of more affluent residents. On top of this, are political regimes, like Turkey, Iran and Russia, that deliberately suppress the data and also where testing methods are suspect. Moreover, the classification of the disease as COVID-19 will often be confused with other diseases. Even the WHO and CDC have a category of “flu-like” diseases. Although COVID-19 has symptoms generally unlike flu it can easily be confused by hard pressed health professionals. Finally, unless a person is identified as at risk, or traced because they have been in contact with someone known to be infected, the statistics rely on self-reporting. Because the majority of people who do have symptoms experience them in a mild form – and because the prospect of being visited in a dramatic way by authoritarian medics is so frightening – many people simply will not report the symptoms they have. For this reason we should multiply the official global number of people who have been infected with the disease by at least five. It remains highly uncertain how this translates into deaths from COVID-19 – but the multiplier for this may be somewhat lower – at 3x.  It should be noted too that a substantial proportion of those infected – whether detected or not – have now recovered from the disease, although no figures at all exist for the numbers of people who have been reinfected due to contraction of a subseqntly mutated form of the disease.

Q: So what are the official mortality rates for COVID-19? Are they the same all over the world?

A: Taking as read the answer given above. There is some evidence to believe that there are at least two major strains of the disease present in the World. One that originated in Wuhan (or possibly Maryland in the USA) and another in Iran. It is certainly mutating over time and new, distinct strains could evolve at any time.  Early indications from China suggested that the mortality rate was officially around 2%, but this has risen now globally to just over 4%. Differences in mortality are likely to arise because of the age structure of a country (Italy having one of the oldest populations in the World), gender (men are more vulnerable), and also because of the incidence of smoking. It is undoubtedly also connected with the quality of health services, the way that infected patients are treated and how effective authorities are in detecting the incidence of infection.

In Italy the mortality rate is currently 8.6%, in Iran 7.3%, Spain 5%, France 3.6% and Switzerland 3.6% Germany 1.0%. Overall, across the World, it is 4.9%.

Q: What every employer needs to know is how long will the present crisis continue?

A: Things have quickly peaked in China and it could now be just a matter of weeks before things are back almost to normal. However, in the rest of the world estimates differ.

The Spanish Emergency Coordination and Alerts Centre suggests two months, the UK food and clothing Chain, Marks and Spencer has predicted it will be four months, whilst Donald Trump has optimistically suggested until July or August. Least optimistic is the Robert Koch Institute in Germany, that advises the German Government. They estimate that it could last up to two years. From Chinese experience, we can expect the cases to peak by May and then fall away. However, on the evidence of the Spanish Flu – that killed 50 million over 100 years ago – there could be a second surge after a few months of improvement.

So much will depend on the discovery, and human trials of, an effective vaccine – and the earliest that could happen is September this year. It will then take months to get the vaccine into full production and the world’s population immunized. Our best bet therefore is the end of this year.

Q: Are face masks and respirators effective defences for employees?

A: There appears some uncertainty, especially in Western Europe, about the effectiveness of face masks and respirators against viral infections. Much of the misinformation is unfortunately originating from the medical profession who support their use by healthcare professionals, but ironically (and irresponsibly) not the public. Moreover, in some countries, such as France, it remains unlawful to wear a protective mask in public. The facts are that, properly chosen and warn, masks and respirators do offer a significant measure of protection. This is recommended, for instance, by the OSHA for those in medium to high risk jobs. Devices produced for protection from dust or made from a woven fabric offer little or no protection. The best standard is a respirator class FFP2/3 (N,R or P in USA). Many people also wrongly wear a mask exposing the nasal area, or bring the mask down when they are talking.

Masks are effective against tiny droplets from the mouth containing the virus, but not purely airborne virus particles that are extremely small. Droplets are ejected up to two metres when someone speaks or breaths. The fabric used must be the non-woven sort found in surgical masks. Wearing these in two layers and regularly changing the outer mask is an inexpensive way to protect the wearer – although this still leaves the eyes, and other vulnerable areas, unprotected.

There is no full protection that can be practically worn – but “keeping ones distance” (up to two metres), not shaking hands and washing hands regularly are essential first lines of defence. The face mask/respirator is the next essential step and should, where possible, be issued to all employees, with a change made every few hours.

Q: Everyone is warned about minimising contact, but what should companies do about meetings?

A: Companies are being faced with some dilemmas about the holding of physical, formal meetings and gatherings in the light of the current health crisis. These include scheduled works council and health and safety meetings, union-management negotiations, training and conferences (internal and external), AGMs, company canteen facilities, charity and sporting events and meetings with clients or potential clients.

In some countries gatherings above certain threshold levels are banned. For instance, in Denmark workplace meetings must not now exceed ten people, whilst in Serbia all gatherings of 5 or more are unlawful. Such limits will pose particular challenges for the holding of AGMs, as these are regulated by company law and individual company articles of association.

In all circumstances involving employees there is a “duty of care” obligation and no company wishes to run the risk of enforced closure, disruption or raised anxieties because of a viral outbreak. It is therefore essential to review all points of physical contact involving employees, visitors and stakeholders and develop a contingency policy to regulate them in some way. This will then need to be agreed and those affected notified in a non-alarmist way. This is not a measure that should be left to the heavy-handed approach of security personnel, but very much an HR accountability.
Q: Are there any data protection implications about COVID-19 policies or actions in companies – especially in Europe?
A: Yes. There are a number of data protection concerns that should be addressed by employers relating to the exceptional handling of health data in the context of the current pandemic. These mainly require a common sense approach within the framework of the GDPR.
Health data is a special data category under Article 9 (2) of the regulation, but there are exceptions under 9.2 (i) in respect to handling such data with explicit employee consent, or in the public interest “in the area of public health”. A further exception exists for the protection of employee health and safety (9.2(b)). However, employers should put a policy in place setting out limits to “the right to know”, staff training, data retention limits, security and informing employees responsibly and proportionately about risks that arise. Procedures will need to be carefully devised about whether, and how, to collect “risk data” concerning visitors and employees (countries recently visited, contact with infected people etc). Moreover,the company will not only need to know what it will do if a high risk situation is detected, but also how it can protect sensitive personal data in respect to immediate colleagues when identities could readily be surmised.
Q: Is COVID-19 the only serious threat faced by employees right now?

A: No, there continues to be a serious global danger from Influenza, with new potentially devastating strains appearing every 10-20 years. Flu kills around 300,000 to 650,000 people globally each year, although employers can reduce its threat by asking employees to be immunized each year for the most commonly circulating strains of the virus.

In some parts of the world TB remains a huge threat – with up to 1.5 million deaths each year. Measles is potentially fatal and continues to crop up in urban areas from time-to-time and the rate of infection is growing – in spite of available immunization. Dengue is also a major threat in tropical countries and is spreading gradually to countries in temperate climates. 40% of the world is now at risk of dengue fever, and there are around 390 million infections a year. The fatality rate is 20% of those suffering this disease in its severe form.  However, a growing potential danger also comes from the West Nile Virus (WNV)

Employers should be aware that the mosquito-borne disease originating from WNV is now present in all countries around the world – except Antarctica. To date, there is no known direct human-to-human transmission, although it would be possible through untested blood from a donor, or by mosquitos biting individuals in succession. In the southern hemisphere, the risk of it begins in April and in the Northern hemisphere the peak is October/November. Like COVID-19, it has an incubation period of up to 14 days and most sufferers experience mild symptoms. These include fever, fatigue, headache, myalgia (muscle pain) and a maculopapular rash. However acute West Nile Encephalitis (WNE) can result in facial nerve palsy, paralysis, severe depression and neuromuscular respiratory failure. There is no specific treatment for it and no vaccine available to head off its risk. In the US alone there are around 2,500 cases of WNV infection a year, with a fatality rate of 6.3% – 50% higher than for COVID-19. However, in some years the incidence has doubled.
Q: What is the worst case scenario for the COVID-19 virus?
A:What no governmental body will tell you is how many lives could be lost to COVID-19, although some political leaders have given huge estimates about many of their population are likely to contract the disease. The mortality rate originally reported in China was around 2%, but now it is close to 5%. This still looks a low figure until we notice that even a rise from 4% to 5% constitutes a 25% increase in the number of deaths. Even if we take a modest 20% estimate of the global population contracting the infection and assume it spreads to everywhere in the world then the total deaths from it will be 75 Million people – making it equivalent to the Spanish flu pandemic of 1918/19. This means 3.27 million deaths in the USA, 660,000 in the UK and 10,000 per one million population elsewhere. The majority of lives will be those aged 65+ or with serious underlying conditions, but employers should brace for the loss of maybe 2% (20 in every thousand) staff. This is worst case and hopefully we will not even get close to a million deaths worldwide.
Q: Is chloroquine an effective treatment for COVID-19?

A: The US FDA has given limited approval the drug chloroquine for use against COVID-19. This drug has been used for many years to treat Malaria and Arthritis, but it has now been banned in many African states. There have been no extensive clinical trials into its effectiveness against any type of coronavirus and its use can be very dangerous if taken in the wrong quantities. However, a small scale research exercise in France has found that it assists patients recover from the virus more quickly. A combination of azithromycin and hydroxychloroquine or chloroquine are now freely available under the state health system to coronavirus patients in Cyprus.
Last Updated: April 2020.
Copyright: FedEE Internal Inc.
The Federation of International Employers (FedEE)