The failure of the paycheck protection program underscores the issues and barriers that prevent federal programs and regulations from benefiting the local small businesses that these programs are initially developed to target.
These barriers are not new to those of us that work in occupational health. Although it has been almost 50 years since OSHA was created to guarantee workers the right to a safe job, occupational disease is still one of the leading causes of death in the US. There is a disproportionate impact on communities of color and the lowest paid workers. Those who have the least access to health insurance and medical care.
Although workplace-associated diseases, including asthma and cancer, are preventable the difficulty in reducing the impact of occupational hazards on American workers is in part due to lack of enforcement and awareness of policies and guidance among those workers most at risk. The current pandemic has also demonstrated how difficult it is for workers to protect themselves if they do not have access to the necessary personal protective equipment (PPE) and supplies.
Prior to being hit by the pandemic, small businesses posed a particular risk. They often use hazardous chemicals but have little access to occupational health guidance. In the US there are more than 5.4 million businesses that employ less than 20 workers. OSHA provides free consultations to small businesses. However, with their current funding rate it would take them over 200 years to reach all businesses with <20 employees.
While out of economic necessary many small businesses are opening as social distancing policies are being relaxed. They will be needing to develop new cleaning and disinfection procedures to protect their workers and their clients without much occupational health guidance. While it is essential to properly clean and disinfect public spaces as we open up America, it is important for everyone to know that the use of “more” chemicals is not necessarily better and will not necessarily better protect you, your workers or your clients and may cause unintended consequences.
Even prior to the President suggesting injection of disinfectants, the CDC had already reported a rise of poisonings in the US from cleaning and disinfection products. These poisonings range from people mixing chemicals that produced a toxic gas, using too high concentrations of bleach to disinfect their groceries, and children overdosing on hand sanitizers. Furthermore, long-term exposures to many of these chemicals can increase the chance of chronic diseases, such as COPD, asthma, or diabetes, that are risk factors for complications with COVID-19.
As small businesses, especially those that serve the public, reopen they should absolutely focus on reducing coronavirus transmission while also minimizing exposure to chemicals.
The federal government has a well-established hierarchy of controls for occupational exposures, that is an excellent framework for considering these issues. Preference is given to systems-based controls that reduce exposures as close as possible to the source and place less responsibility on individual workers.
First in the hierarchy is the emphasis on elimination of the exposure or substitution for less hazardous products or procedures. Social distancing policies and closure of non-essential businesses was an attempt to eliminate as many unnecessary exposures as possible. Now as these businesses open up, they should focus on using cleaning and disinfection products with less hazardous side effects. The EPA has put together a list of disinfectants effective against SARS-CoV-2, the virus that causes COVID-19. You can also focus on methods that reduce exposures. For example, using wiping procedures and minimizing spraying disinfectant will reduce potential inhalation risks.
Next in the hierarchy of controls are engineering solutions. Is it possible to increase ventilation in the space? Add fans or open doors and windows? Clear plastic barriers or “sneeze guards” at cash registrars are another example of an engineering control that can minimize exposure to virus-containing droplets.
It is always important to consider administrative controls. This includes standardized protocols for cleaning and disinfections procedures and documented worker training on those protocols. Other examples of administrative protocols may be checklists to document when cleaning has occurred or policies on how many people can be in the business at one time.
Finally, as a last resort is the consideration of PPE. This can include gloves, glasses, uniforms, respirators and face masks. However, PPE should not be the only control used. Those higher up in the hierarchy, that place less responsibility on the worker using it correctly each and every time, will be more effective at keeping workers and clients safe.
While only N-95s and other types of certified respirators are effective at protecting the individual from airborne viruses, face masks have become an interesting tool in our war on coronavirus. They are most effective at preventing infected individuals (especially those who do not yet know that they are infectious) from reducing the spread of the disease by providing a barrier as close as possible to the primary source of exposure (infected people).
OSHA has issued specific guidance to prepare workplaces for COVID-19 and NIOSH has additional recommendations for small businesses. Trade organizations and large corporations are beginning to develop industry specific guidelines or advice such as these for auto repair and beauty salons.
It is important to emphasize that chemicals used for cleaning and disinfection are crucial for reducing infectious diseases. After all, it was widespread chlorination of drinking water that led to the largest gains in American life expectancy in the 20th century, ahead of antibiotics and vaccines.
The uncertainty of these current times is wearing on all of us, as we continue to assess competing risks for minimizing coronavirus transmission while trying to restart our economy. It is however, very important that we develop policies and practices to minimize our use of hazardous chemicals in small businesses, especially those that could make these already vulnerable workers at increased risk for COVID-19 complications. While it is essential that cleaning and disinfection be conducted in these public spaces, it is important to remember that “more is not necessarily better…”