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A New Perspective: How the COVID-19 Pandemic Reshaped Our Understanding of Workplace Safety, Health and Wellness MAGGIE COOK-SHIMANEK, MD, MPH
SEPTEMBER 28, 2021
Objectives
1. Describe the central role of workplace safety, health and wellness in the COVID-19 pandemic conversation.
2. Articulate how the circumstances of the pandemic interacted with workers’ compensation.
3. Discuss the potential lasting effects of the pandemic on the workplace moving forward.
Describe the central role of workplace safety, health and wellness in the COVID-19 pandemic conversation.
OBJECTIVE 1
Source: https://sph.umich.edu/news/2020posts/returning-to-work-safely-in-michigan-and-the-us.html
Source: https://www.cdc.gov/niosh/topics/hierarchy/default.html
Source: https://dli.mt.gov/covid-19/town-halls/employer-town-halls
Elimination
Transition to remote work
Source: https://sph.umich.edu/news/2020posts/returning-to-work-safely-in-michigan-and-the-us.html; https://www.ncci.com/SecureDocuments/QEB/QEB_Q4_2020_RemoteWork.html
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349441/pdf/AJPH.2020.305738.pdf; https://deohs.washington.edu/hsm-blog/most-people-cant-work-home
Income and Ability to Work Remotely
Majority of workers couldn’t perform work from home
Work from home is possible
- 62% of workers with a bachelor’s degree or more
- 23% of those without a four-year college degree
Source: https://www.pewresearch.org/social-trends/2020/12/09/how-the-coronavirus-outbreak-has-and-hasnt-changed-the-way-americans-work/
Engineering controls
Separate from the source of exposure
Source: https://sph.umich.edu/news/2020posts/returning-to-work-safely-in-michigan-and-the-us.html
Administrative controls
Change the way people work
Source: https://sph.umich.edu/news/2020posts/returning-to-work-safely-in-michigan-and-the-us.html
Personal protective equipment
Protect the worker with PPE
“Any safety measures, including infection-control measures, work better when they are “stacked,” meaning each worker has layers of protection.”
Source: https://sph.umich.edu/news/2020posts/returning-to-work-safely-in-michigan-and-the-us.html
Layered Prevention Strategies
Source: https://www.who.int/publications/i/item/WHO-2019-nCoV-workplace-actions-policy-brief-2021-1
Source: https://www.osha.gov/bloodborne-pathogens/worker-protections
Bloodborne Pathogens BLOOD AND BODY FLUID PRECAUTIONS FOR ALL PATIENTS
VACCINATION REQUIREMENTS FOR EMPLOYEES
EXPOSURE CONTROL PLAN
HAND HYGIENE
SAFE INJECTION PRACTICES
SAFE SHARPS MANAGEMENT/ DISPOSAL
LABELS AND SIGNAGE
TRAININGS
PERSONAL PROTECTIVE EQUIPMENT
POST—EXPOSURE PROTOCOLS
Articulate how the circumstances of the pandemic interacted with workers’ compensation.
OBJECTIVE 2
Workers’ compensation interface
Causation
Telemedicine
Clinical care
Causation
COVID-19 – Occupational Disease
Source: https://www.cdc.gov/niosh/docs/96-115/diseas.html#Infectious%20Diseases
In comparison to other claims for occupational diseases where there is aunique workplace exposure, the same is not always true with infectious diseases.
Healthcare, social service, and corrections workers are at known risk for hepatitis B & C virus, HIV, and tuberculosis, but there is typically a distinct exposure event.
Elements of a Causation Analysis
1. Establish the diagnosis
2. Define the workplace exposures
3. Consider exposures outside of the workplace
4. Provide supporting evidence
5. Assign medical probability
Without the work-related exposure, is it medically probable that the patient would have the current
diagnosis and require treatment?
OSHA Workplace Exposure Risk
Very high - Healthcare workers, laboratory personnel, morgue workers
Source: https://www.osha.gov/Publications/OSHA3990.pdf; https://www.osha.gov/coronavirus/safework
High - Healthcare delivery and support staff, medical transport, and mortuary workers
Medium – Workers have frequent/close contact with people who may be infected with SARS-CoV-2
Lower - Workers have minimal occupational contact with the public and other coworkers.
Occupational Disease Determinations
Typically, workers have the burden of proving that an illness or injury arose out of and in the course of employment
Rebuttable presumptions shift the burden of proof to the party against which the presumption applies
Irrebuttable presumptions essentially establish a conclusion regardless of the evidence presented against work-relatedness
Source: AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition 2013
Source: https://www.ncsl.org/research/labor-and-employment/covid-19-workers-compensation.aspx; https://www.ncci.com/Articles/Pages/COVID-19.aspx; https://www.ncci.com/Articles/Documents/II_Covid-19-Presumptions-2021.pdf; https://www.iaiabc.org/covid-19
States with legislation, executive orders and other administrative policy action discussing workers’
compensation coverage of COVID-19 (09/07/21)
Enacted
Failed/expired
Pending
Application of Information
Series of studies using Bureau of Labor Statistics data to estimate the number of workers covered by COVID-19 executive orders and laws
1. Estimates of covered employment using industry/occupation
2. Assigned exposure risk factor to the industry/occupation per OSHA
Estimate of potentially exposed employees under policy language
Source: https://www.wcrinet.org/news/press-releases/wcri-estimates-number-of-workers-covered-by-state-covid-19-presumptions; https://www.wcrinet.org/images/uploads/files/wcri_presumption_coverage.pdf; https://www.wcrinet.org/images/uploads/files/wcri_summary_presumption_coverage.pdf
Summary of Information from WCRI data reports as of January 4, 2021
State Covered employees ActionRisk- adjusted
employee estimate
Minnesota
Total employment2,880,650
- Licensed peace officer- Firefighter- Paramedic or EMT- Nurse or health care worker, correctional officer or security counselor employed by
state or a political subdivision at a corrections, detention or secure treatment facility - Health care provider, nurse or assistive employee in health care, home care, or long-
term care setting with direct COVID-19 patient care or ancillary work in COVID-19 units - Worker required to care for children of first responders or health care workers
House File 4537
Rebuttable presumption
80,571
WCRI state example: Minnesota
Source: https://www.wcrinet.org/images/uploads/files/wcri_MN_presumption_coverage.pdf
Summary of Information from WCRI data reports as of January 4, 2021State Covered employees Action Risk- adjusted
employee estimate
Kentucky
Total employment 1,900,000
- Employees of a health care entity- Law enforcement, EMT, fire departments- Corrections officers - Domestic shelter workers - Child advocacy workers - Rape crisis center staff - Department for community-based services workers- Grocery workers- Child care center workers
Executive order 2020-227
75,763
WCRI state example: Kentucky
Source: https://www.wcrinet.org/images/uploads/files/wcri_KY_presumption_coverage.pdf
Implications of COVID-19 Work-Relatedness
Supports timely workplace contact tracing
Informs workplace safety and health efforts
Provides opportunities for surveillance/tracking
National data
National Council on Compensation Insurance (NCCI) -June 23, 2021
NCCI has observed $260 million of case-incurred COVID-19 workers’ compensation losses, excluding self-insureds
As of year-end 2020, private carriers and state funds reported 45,000 pandemic-related claims to NCCI
Average COVID-19 cost per claim of approximately $6,000 (claims with reported payment or reserve)
COVID-19 frequency of approximately 8 claims per 10,000 workers For comparison, historical non-COVID-19 related claim frequency including medical only,
have averaged more than 250 claims per 10,000 workers
NCCI estimates that COVID-19 claims, excluding self-insured, have the potential to result in WC losses exceeding $500 million over the entire duration of the pandemic
Source: https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-What-We-Know-Now.aspx; https://www.ncci.com/Articles/Documents/Insights-COVID-19-WCSeverityAssumptionsUpdate.pdf
NCCI White Paper – April 2020
Source: https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-Modeling-Potential-Impacts.pdf
NCCI - June 23, 2021, continued
Source: https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-What-We-Know-Now.aspx
Claims by industry sector and claim type
75% of all COVID-19 claims reported to NCCI
NCCI - June 23, 2021, continued By claim type
Source: https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-What-We-Know-Now.aspx
Historically, medical-only claims accounted for almost 75% of all workers’ compensation claims, but with COVID-19 the claim-type distribution is reversed.
Almost 75% of reported pandemic-related claims have an indemnity component.
NCCI - June 23, 2021, continued
Source: https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-What-We-Know-Now.aspx
By size of loss
NCCI - June 23, 2021, continued
Source: https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-What-We-Know-Now.aspx; https://www.ncci.com/Articles/Pages/Insights-COVID-19-WorkersComp-Modeling-Potential-Impacts.pdf; https://www.ncci.com/Articles/Documents/Insights-COVID-19-WCSeverityAssumptionsUpdate.pdf
Ultimate COVID-19 losses
Montana Data
Montana DLI Data
Source: https://erd.dli.mt.gov/data-dashboards/covid-related-wc-claims
Montana DLI Data, continued
Source: https://erd.dli.mt.gov/data-dashboards/covid-related-wc-claims
Source: https://erd.dli.mt.gov/data-dashboards/covid-related-wc-claims
Montana DLI Data, continued
Source: https://erd.dli.mt.gov/data-dashboards/covid-related-wc-claims
Montana DLI Data, continued
Source: https://erd.dli.mt.gov/data-dashboards/covid-related-wc-claims
8.2%3.2%
Montana DLI Data, continued
Clinical Care
Telemedicine
1135 CMS Waiver
Source: https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm
Expansion of Telehealth with 1135 Waiver, March 6, 2020
• Allowed beneficiaries from any geographic location to access services from their homes
• Waived enforcement for HIPAA violations against health care providers who serve patients in good faith through technologies such as FaceTime or Skype
Source: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-At-A-Glance.pdf
Telemedicine in workers’ compensation
Source: https://erd.dli.mt.gov/work-comp-claims/medical-regulations/
June of 2020 - Labor-Management Advisory
Council recommendation to explore telehealth in
workers’ compensation
September of 2020 – First telemedicine
workgroup
Created an inventory of relevant matters for workers’
compensation
Reconvened in May of 2021 to review legislative updates
Decision to create a FAQs document for
workers’ compensation
House Bill 43Passed April 19, 2021 and signed by Governor Gianforte
Effective date January 1, 2022
Summary of changes:
- Expands telehealth definition to include audio, video, or other telecommunications technology or media, including audio-only communication.
- Eliminates the rural/urban distinction for the use of telehealth services.
- Removes the requirement for an in-person patient and healthcare provider encounter prior to initiating telehealth.
Source: https://leg.mt.gov/bills/2021/sesslaws/ch0242.pdf
Product
DLI Employment Relations Division Medical Regulations
Source: https://erd.dli.mt.gov/_docs/work-comp-claims/medical-regs/Work-Comp-Telemedicine-FAQs.pdf
Telemedicine, continued
Source: https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/states-actions-expand-telemedicine-access-covid-19
Longer-term clinical implications
Post-COVID conditions – covered by Dr. Greg Vanichkachorn tomorrow
Source: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
Discuss the potential lasting effects of the pandemic on the workplace moving forward.
OBJECTIVE 3
Source: https://www.cdc.gov/coronavirus/2019-ncov/community/mental-health-non-healthcare.html
Mental Health and the Workplace
Concern for health of loved ones
Social isolation
Financial uncertainty
Job uncertainty
Work life balance
Workplace Mental Health
Poor mental health and stress impacts employee:
- Job performance and productivity
- Engagement in one’s work
- Communication with coworkers
- Physical capability and daily functioning
Source: https://www.cdc.gov/workplacehealthpromotion/tools-resources/workplace-health/mental-health/index.html
Mental Health and the Workplace, continued
National Institute for Occupational Safety and Health (NIOSH) defines Total Worker Health® (TWH)
Source: https://www.cdc.gov/niosh/twh/faq.html; https://www.cdc.gov/niosh/twh/priority.html
Source: http://hub.dli.mt.gov/safety-wellness/Pages/wellness.aspx
Mental Health and the Workplace, continued
Source: https://mhanational.org/mental-health-healthcare-workers-covid-19; https://www.ama-assn.org/delivering-care/public-health/managing-mental-health-during-covid-19
Mental Health and the Workplace, continued
Source: https://www.cdc.gov/mmwr/volumes/70/wr/mm7026e1.htm
Elements of Job Satisfaction Livable wages
Mobility and growth opportunities
Workplace flexibility and schedule control
Benefits
Working conditions and safety
Source: https://www.urban.org/urban-wire/five-elements-good-job
Telework
Productivity
Convenience
Recruitment/retention
Source: https://www.bbc.com/worklife/article/20201023-coronavirus-how-will-the-pandemic-change-the-way-we-work; Image credit: Emmanuel Lafont
Movement during the pandemic
Source: https://www.pewresearch.org/fact-tank/2020/07/06/about-a-fifth-of-u-s-adults-moved-due-to-covid-19-or-know-someone-who-did/
Physical Health and Safety
Occupational Safety and Health Administration
Source: https://www.osha.gov/coronavirus/ets; https://www.osha.gov/coronavirus/safework
Source: https://www.mckinsey.com/featured-insights/future-of-work/the-future-of-work-after-covid-19
Proximity, infection prevention, policies, etc.
Source: https://www.wsj.com/articles/dont-sneeze-office-etiquette-for-flu-season-1422392408
Amount of viable virus being shed and expelled
Type of contact the person has with others
Setting where the exposure occurs
Preventive measures in place
Proximity, infection prevention, policies, etc.
Social Determinants of Health
Source: https://www.mass.gov/info-details/covid-19-community-impact-survey#findings-
Changes in Employment Status Due to the Pandemic
The Following Groups were more likely to report:
Source: https://www.mass.gov/info-details/covid-19-community-impact-survey#findings-
Risk Mitigation: Focus on Work
Source: https://www.mass.gov/info-details/covid-19-community-impact-survey#findings-
Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity
Source: https://www.mass.gov/info-details/covid-19-community-impact-survey; https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html; https://covid.cdc.gov/covid-data-tracker/#demographics; https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html
“Our common humanity is more important than all the things that divide us.”
- Mairead Corrigan
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