Coronaviruses are an extremely common cause of colds and other upper respiratory infections.
COVID-19, short for “coronavirus disease 2019,” is the official name given by the World Health Organization to the disease caused by this newly identified coronavirus.
Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43 and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002. On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19).
The numbers are changing rapidly.
The most up-to-date information is available from the World Health Organization, the US Centers for Disease Control and Prevention (CDC), and Johns Hopkins University.
It has spread so rapidly and to so many countries that the World Health Organization has declared it a pandemic (a term indicating that it has affected a large population, region, country, or continent).
Currently, patients are being suspected of having coronavirus if they fulfil the following criteria and contact their health care provider who will then decide if testing is necessary. The criteria are found at http://www.nicd.ac.za/diseases-a-z-index/covid-19/,
Currently this includes:
Persons with acute respiratory illness with sudden onset of at least one of the following: cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective)] irrespective of admission status AND
In the 14 days prior to onset of symptoms, met at least one of the following epidemiological criteria:
- Were in close contact 1) with a confirmed 2) or probable 3) case of SARS-CoV-2 infection;
- History of travel to areas with presumed ongoing community transmission of SARS-CoV-2
- Worked in, or attended a health care facility where patients with SARS-CoV-2 infections were being treated
- Admitted with severe pneumonia of unknown aetiology.
Please watch for updates as this might change.
NASO/OROPHARYNGEAL SWABS and respiratory samples are used to identify the corona virus. Full details of specimens and how to collect and transport are found at http://www.nicd.ac.za/wp-content/uploads/2020/03/COVID-19-Quick-reference-v7-10.03.2020-Final-clean.pdf
These are currently being processed at the national Institute for Communicable diseases
Evidence in peer-reviewed literature does not support the use of thermal scanning as an efficient measure for detecting fever in travellers or individuals requiring access to workplaces (1-4).
Studies have shown that many travellers that have passed the temperature- based screening had subsequently tested positive for COVID-19 using the reverse transcription polymerase chain reaction (RT-PCR) (5-7). A study by Quilty et al., (2020) demonstrated that approximately 46% of travellers would not be detected by airport thermal scanners (8).
The reasons for this include:
- The individual may not have symptoms as yet i.e. they are still in the incubation period.
- The individual may be on antipyretic medication to suppress a fever.
- It may yield a false positive result (fever due to another cause).
The accuracy of the thermal scanner is variable and requires close up face imaging (<50cm) which leads to an unnecessary risk for droplet spread of COVID-19.
The NIOH recommends that a broader strategy be used to identify possible COVID -19 cases. This includes a brief screening questionnaire assessing the risk of exposure either from travel within the last 14 days or a close contact with a positive COVID-19 patient and a symptom checklist.
A screening questionnaire can be found at https://www.nioh.ac.za/wp-content/uploads/2020/03/self-declaration-questionnaire.pdf
A specific job risk assessment needs to be conducted to determine which PPE are required.
Surgical masks are not tight fitting respirators. Therefore, if the concern is exposure to COVID-19, then a tight fitting respirator such as FFP2 or N95 should be considered since the use of the surgical mask may allow droplets to n enter through the sides, top and bottom of the mask.
Due to the shortage of stock, unnecessary use of PPE should be discouraged. In general, masks should only be usedor if you have symptoms such as sneezing or coughing. You need to know how to use it and dispose of it properly.
Gloves require frequent changing. Thus every time one touches a potential contaminated surface, their nose, mouth and eyes, the gloves need to be changed. If not changed, this may result in cross contamination. This is not feasible with the current stock shortages.
There is currently a worldwide shortage of N95 respirators, thus they need to be supplied to workers that are at high risk of exposure such as health workers in contact with COVID-19. Workers who are required to wear respirators should be to be fit tested to confirm fit prior to use.
PPE includes gloves, surgical masks, goggles or face shield, gowns, aprons and in specific circumstances respirators such as N95 or FFP2 standard or equivalent.
But it must be emphasised that the use of PPE should be minimised.
The decision for employees to wear PPE should be based on the outcome of the risk assessment. These employees should include those are likely to be exposed to suspected cases, symptomatic and those likely to perform aerosol generating procedures.
These workers include:
- Airline operations (e.g. airline cabin crew, aircraft cleaners, mechanics)
- Boarder control (e.g. security officials, and other boarder officials)
- Health care (e.g. paramedics, nurses, doctors, other medical staff)
- Laboratories (e.g. medical technologists, scientists, laboratory aids and researchers)
- Pathology and funeral services (e.g. mortuary attendants, autopsy technicians and funeral directors)
- Solid waste and wastewater management (e.g. waste pickers, water treatment plant
In addition, if a person/ worker is symptomatic they need to wear a surgical mask to prevent transmission.
For more information on use of PPE please see https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf
Employers should consider applying the hierarchy of controls in terms of implementing the controls prior to using the of PPE. Appropriate use of PPE involves proper selection and training and information on how to put on, remove and dispose of it.
As of 16 March, 2020, face masks are not recommended for the general public or workers that are not directly exposed.
If you have respiratory symptoms like coughing or sneezing, experts recommend wearing a surgical mask to protect others. This may help contain droplets containing any type of virus, including the flu, and protect anyone within three to six feet of the infected person.
Guidance for dentist practitioners.
Contact with people should be limited, because one cannot reliably identify patients who are asymptomatically infected. Many dental procedures produce aerosols, known to increase exposure potential if patients are infected and because PPE is in such short supplier, aerosol generating procedures should be limited. The SA Dental Association as well as the ADA recommended only emergency treatment be done at this time. If you must treat, CDC advises that you ask screening questions and if patients fall into risk categories perhaps consider referring to a medical centre that would be appropriately equipped. If there is potential for aerosols even when performing the urgent procedures, then appropriate administrative and engineering controls should be in place followed by appropriate PPE as informed by your risk assessment.
Yes, and the employer must provide the permits to an employee which should meet the requirement of the level 4 regulatory conditions in accordance with regulation “permit to perform an essential or permitted service” in terms of regulations issued in the Disasters Management Act. A law enforcement agent may request this permit at any time.
The threat or hazard is SARS-CoV-2, however different jobs may have different activities and possibly multiple exposures, and thus have different risk profiles for each hazard. Therefore, the risk assessment must assess each activity and exposure as it may have a multiplicative or additive effect on the health of workers.
In addition, some tasks may involve more touching of surfaces and may increase breathing rates putting workers at additional risk.
Please note that no control measure reduces risk 100%, therefore when determining which control measure to implement it is important to weigh the advantages and disadvantages, maintenance and technical data sheets. https://www.nioh.ac.za/covid19-guidelines/
A household is still a workplace for some individuals, so a risk assessment, even if it is very basic, would have to be in place. As long as it identifies all the hazards the employee is exposed to and lists the control measures which have been implemented, that should be fine. It should not only include domestic workers inside the house, but outside the house as well, such as gardeners. The OHS Act does not differentiate between informal and formal work, as long as there is an employer/employee relationship and they meet the definition of the two.
There is limited scientific evidence available on this matter and neither has it been recommended by NDOH or WHO. However, the main concern is that this may affect the worker’s respiratory symptoms as the chemicals used may be allergenic or irritant in nature. The contact time and coverage on all surfaces is also questionable. Currently workers are advised to maintain respiratory and hand hygiene as control measures and surface disinfection of potential contaminated objects is recommended.
It is important to procure good quality masks made of cotton material which is less irritating. It is unlikely that several workers in one workplace will have an allergic type reaction to the cloth mask. However, irritant reactions are possible thus it is important to obtain good quality masks. If the worker has a history of allergies which should be in their medical file, this will be another clue of whether the condition is new or was existing before. Surgical masks can be used if cloth mask are a problem.
The use of either one or both depends on the protection desired as informed by the risk assessment which looked at various activities within the workplace. The shield is to protect the worker from droplets and splatter and also protects the eyes, however a surgical mask is designed to contain inhaled droplets from being expelled into the environment by the wearer/user. A cloth mask is not considered as a PPE as it does not have a protective factor and merely aids in reducing droplet spread.
Screening has been recommended at workplaces and the occupational health services can screen workers and NHLS mobiles can be contacted to take the samples (depending on logistics, workforce numbers and availability) or other laboratory services. Please contact the NIOH hotline 0800 212175 for further information on the mobile service for workplaces.
Yes, this is regulated, as stipulated by the Department of Employment and Labour, but workers should be trained and informed first so that they understand the regulatory and safety requirements, company policies and their responsibilities.
The regulation state per employer, so if sites are part of one employer, a combined report should be submitted, however, sites may differ and it would be more practical to submit for each site to the provincial inspectors. The signed off risk assessment should be submitted to the Department of Employment and Labour Provincial Chief Inspector or the Occupational Health Specialist. It is mandatory for companies that have >500 employees to submit. Those with 10 – 500 employees do not have to submit although it is good practice. Those with <10 employees do not have to submit however should have the risk assessment available as it will be requested if inspected.
|Province||Provincial Chief Inspector||OHS Specialist|
|Gauteng||Michael Msiza||Lesibe Raphela|
|KwaZulu-Natal||Edward Khambula||Sandile Kubheka|
|Eastern Cape||Lucky Mkhonto||Kulungile Nkanjeni|
|Western Cape||David Esau||Fezeka Ngalo|
|Northern Cape||Ivan Vass||Isaac Mohapi|
|North West||Boikie Mampuru||Lucia Ramusi|
|Limpopo||Phaswane Tladi||Carol Mthethwa|
|Free State||Manelisi Luxande||Makalo Khoele|
All surfaces should be disinfected. The chemical used will depend on the type of surfaces in the area. In general, 0,1% bleach or 70% ethanol can be used.
The frequency depends on the risk profile and varies for different workplaces (e.g. activities, density or population, frequent use etc.) and will be informed by the risk assessment. Have cleaning protocol in place. Examples: before the shift, midday and at the end of a shift, or every 4 hours. Have hand wash facilities or sanitizers accessible for frequent hand cleaning to prevent further contamination during the day and ensure staff are trained on proper use of facilities. Doors that can be kept open, leave them open to avoid frequent touching or frequent cleaning.
The World Health Organisation recommends more than 60%, hence 70% is widely used as being more effective and generally used for disinfection. 60% may be more gently for human use and 70% for surfaces.
They should be referred to the Occupational health practitioner or Occ. Health specialist or contracted dermatologist who will recommend possible alternative cleaning products.
It has been proven effective for surface decontamination to easily kill viruses but the devices should be installed properly, number of devices per room should be determined, irradiance must be measured and fixtures must be maintained.
Fogging is usually done for massive spaces, especially where some surfaces cannot be reached by hand and there is no manpower to do the disinfection. Regular wiping still applies, as long as the biocide is targeted for Coronavirus as well (please review your products to confirm efficacy) and the correct concentration is prepared. Note that cleaning (remove dirt) and decontamination (kills virus and is done after cleaning) are two separate processes.
Employers that are not complying can be reported to the Department of Employment and Labour. The Department in a recent briefing stated that non-compliant companies will be shut down and employers face criminal charges. Telephone: (012) 309 4000
Yes, HBA RA is done every 2 years as per regulation and when there is any change (structure, procedure, technique, incident etc.) that happens before the 2 years have elapsed. With the COVID-19 situation, the risk assessment may be reviewed several times during the risk adjusted 5 alert stages of lock down depending on the company, as more workers return to work at different stages and as different controls are implemented at different times. The risk assessment is an ongoing process.
The use of public transport is a risk factor in addition to many other risk factors like, age, comorbidities. The employee is at high risk and thus should be provided with a cloth mask to mitigate the risk of exposure when using public transport.
If one has a small business, like a consulting business, where one works from the home, but sees clients both inside the home and outside the home randomly, is a risk assessment still mandatory for the business? How would this be affected with the presence of other family members in the home as well? Can we get guidance on this please?
Yes. The HBA regulation require all employers including self-employed persons to conduct risk assessments even if work is done at home. Family members must be included as well as visitors, as they all have the potential of either contracting or spreading the infection. Follow the same process risk assessment process. Identify potential source (clients, family, contaminated surface or objects etc.); how can the host (you as worker, family members in the surrounding, clients) be affected and what preventive measures you have in places (social distancing, masks, sanitizers, cleaning and disinfection of surfaces, online meetings rather than face-to-face meetings, screening of persons entering your premises as it is your workplace etc.). https://www.nioh.ac.za/covid19-guidelines/ ; https://www.nioh.ac.za/covid-19-presentations/