Thanks to the COVID-19 pandemic, the health risks within the built environment have never been more concerning. The pathogen’s highly infectious nature has fully opened building operators’ eyes to the importance of indoor environmental quality (IEQ) inside America’s buildings.
As more and more states around the nation consider re-opening buildings that have sat stagnant for the last eight weeks or more, facility managers and consulting and specifying engineers are often left with more questions than answers.
Jim Kendzel, MPH, CAE, director of codes and standards, American Supply Association (ASA), recently moderated a webinar, “COVID-19 and Safety in the Workplace – Getting Back to Work,” designed to provide guidance and best practices for individuals responsible for opening up these recently silenced structures. The webinar examined ways to keep the workplace safe and how returning occupants can endure the threat of COVID-19 as well ward off the threat of additional potential IEQ-related contaminants.
Kendzel: What are the considerations companies should take when deciding whether to reopen?
Dr. David Krause: One of the first things people need to consider is what are the public health and regulatory guidelines for your specific area? While one state may have a release, others may not. Companies may have employees who reside in one state but travel to another. So, look at the current public health guidance and regulatory requirements for your operations where you're at.
As an owner, manager, or operator have to ask yourself: Is it worth it? If you're going to open up a store, though you see your competitors are having three people a day coming into that retail establishment, maybe it's just not worth it. You may open, but nobody may show up. Beyond that, you really need to look at your staff and customers and perform a risk assessment. That can be a back-of-the envelope assessment, or it can be a more formalized event. Look at what you can do to minimize and manage the risk of exposure and infection of your staff.
Beyond the infection related to COVID-19, are the water systems at your facility, building, or campus ready? They’ve likely sat stagnant for a while, which could pose a hazard for lead, waterborne pathogens, sediment debris, etc. Look at your fire suppression systems, electrical systems, and life safety systems that were suppressed during the shutdown. Make sure you’re not messing up the easy stuff because you’re so hyper-focused on the [COVID-19] pathogens.
Dave Bush: From my standpoint, the threshold of consideration would be, “Am I ready to reopen? Should I reopen now?” Once you get legally approved to do so by the governor of your state, are you prepared to open immediately? Obviously, it makes perfect sense from a commercial standpoint to want to get right to it. But, bear in mind, in my job, I have to look at all the potential issues that may occur down the line. I have to consider the problems, and then we invent problems in our minds to help advise our clients. One of the questions we're going to ask is, “Well, if you open today, even though it's legally permissible, are you exposing yourself to potential liability if one of your employees or customers comes in and has become exposed? Are you then subject to liability for that?”
You're always going to run into somebody who argues, “Oh, well, you’re putting profits ahead of safety.” You do have a threshold argument to say, “Well, if the government has approved our reopening, then I have, at the very least, a legal basis to do that.” Do what you can to secure as much information from whatever sources are available — the CDC, OSHA, whatever — as to the recommended policies and practices. Have a plan in place, don't just open your doors and play it by ear. Be prepared to address a lot of these additional questions right off the bat, and then you can tailor your situation to the circumstances as they develop.
Kendzel: Can you talk to us about any additional risk that exists beyond being exposed to COVID-19 or the coronavirus when you open up and restart your building systems?
Tim Keane: Absolutely. And to follow up with what David said, all three of us have a lot of legal experience. Dave Bush is an actual lawyer. And David Krause and I are involved in litigations and have served as expert witnesses.
One case comes to mind that correlates with Dave Bush’s warning that you have to have plans and be prepared. In this case, a document was uncovered — a memo of a meeting — after a Legionnaires disease outbreak at a hospital. The hospital was required by code to have a risk management plan. The meeting notes said the manager went to Google to find out what the facility should do. That's not a good position to be in.
The risk for serious outbreaks occurs when buildings that have been stagnant are opened and the water in the system has been sitting there with potential to corrode the lead and cause higher lead levels, and also the potential for bacteria growth.
I’ve written two documents that are on my website. The first one is titled, “COVID-19 and Legionella – Preparations to consider for Municipal and Building Potable Water Systems.” This paper addresses what you can do now to a stagnant building water system to reduce the risk for bacterial growth. It might be stagnant, and the municipality might need to do some flushing.
The other document is titled, “Chapter 3 Developing a Building Potable Water System Flushing System,” which focuses on developing and building a potable water system flushing program. It details what you need to do to be compliant with ASHRAE 188, what you should do to flush the building out, etc. For instance if you’re managing a small building with a home hot water heat heating system and no circulation, all you need to do is turn up the temperature and flush with high-temperature water. There is a minimal risk there. If you’re operating a large building with a large complex plumbing system, the document goes through step by step on how to flush the mains coming in and how to flush your equipment and any type of potable or non-potable equipment. So those two documents are pretty much at the ground-zero level detailed how-to guidance for a maintenance person or contractor.
Bush: And while it’s great to go out and get this information, you can't just sit on it. Once you’ve got the information, you've got to do something. Ignorance of the law is no defense, but neither is having the knowledge and not doing anything with it. Very often, that's even more problematic. You may say, this information doesn't apply to me for X, Y, or Z reasons. You may be right, but that isn't necessarily going to defend you or immunize you from liability. And it certainly isn't going to immunize you from somebody making an accusation.
Kendzel: The OSHA [Occupational Safety and Health Administration] and CDC [Centers for Disease Control and Prevention] guidelines have come out, and they talk about risk levels and the types of steps you should be taking. Can you talk a little bit about these guidelines and provide an understanding of the different risk levels?
Krause: I think you need to understand the context of what’s being put out there. One, they're trying to give a framework, some rudimentary guidance, to employers. This is like guidance from my mother-in-law. She hasn't been there and doesn't know what I do. This guidance is from well-intended academics, though these regulators have never done what you do. So, you know, this is a floor and not the ceiling. Beyond that, the risk levels are very qualitative — trying to establish which people in your organization fall into those risk levels. It's well-intended, though it is very likely to change. When we get into these legal cases, and they’re trying to determine what was the standard of care, we have to look back and determine what day it occurred on? Things are moving so fast. In this situation, it's a day-to-day kind of thing. With Legionnaires, it’s determined by what year it was? The standards have been changing rapidly from year to year or every three to four years.
But this is happening so fast, and I don't think you can look at anything and say, “That was the definitive standard of care,” because we don't even know that any standard of care that is being put out there is going to work. Six feet? Well, I saw something the other night that said 12 feet. Even with 12 feet, you really couldn't be in most buildings. So, regarding the risk levels, I wouldn't put a whole lot of weight on them.
I would like to make people aware of something has just recently come out from the American Industrial Hygiene Association (AIHA). It's a website called backtoworksafely.org that offers resources that have been developed for specific areas, such as retail, hair and nail salons, gyms, construction, home service providers, and others. This is a resource to keep an eye on.
Kendzel: You brought up the concept of documenting earlier. And one of the questions we asked in a survey, and I’d like to ask here, was, “Do you recommend to document your actions along the way?”
Bush: In many instances, it is the best approach. You need a paper trail in law; it is really, in many ways, one of the most compelling avenues of proof. Remember Watergate? The missing 18 minutes of audio within the Nixon tapes?
If you've got documentation, it has to be comprehensive. If you've got gaps, you've got problems. If your documentation is spotty — if you implement a policy that you're taking temperatures at this time, that you provided masks and gloves, and that you’re implementing a send-home policy on these items, your policy has to be accurate and consistent. Also, never, ever falsify documents. If you forget to write something down, don’t add it in an hour or two hours later, never do that. Also, never have somebody sign your name for you when you didn't. Documentation can be a blessing and a curse.
Kendzel: What should you do when you find an employee has an illness or notice an employee is showing symptoms?
Keane: I’ve been in some hospitals with some significant rates of COVID in those cities that have implemented a policy where they tested employees at every entrance to the building. And these were big buildings, probably around six different entrances, and the employees doing the testing were not trained nurses. They were regular staff equipped with forehead infrared thermometers who tested everybody. Everybody got a sticker saying they had been tested that day. So, you could see people walking around and know they had been tested. When this first started, I had anxiety. I mean, I'm sleeping at this hospital, I'm working there — paranoia crept in. It was a panacea, maybe, but getting my temperature checked every morning and knowing I was good made me feel a little bit better. I think for the visitors, the people coming in, and the employees, it gave everyone a sense of wellbeing. The hospitals were being aggressive — as aggressive as they could be. I felt really comfortable and very good that they were taking temperatures. They did not keep a log of everybody's temperature they took, but they did keep a log of those who failed, and those individuals that were sent home.
Krause: Not having a fever doesn't mean you don't have COVID-19. Having a temperature certainly doesn't mean you have COVID-19. You could have any number of other things. Allergies can induce a temperature in some folks. So, it's a general test. It might capture 1% to 2% of those who are potentially infectious with this disease. So, you know, I wouldn't take this one to the mat.
I think it [taking temperatures] would be appropriate for a lot of facilities, especially if you've got people working shoulder to shoulder, to help rule out if somebody has a fever. If they do, they’ve got to go home.
We, as a society and country, are ill-prepared to carry out any real testing with any real urgency. And, you know, getting a doctor's note — you’re probably more exposed by going to the doctor’s office. Also, the doctor is most likely not going to be able to give you a test that says, “You don't have it.” After you get that test, the next person you run into may be exposed, and he or she could give it to you. So, the guidance that I give to my clients is, yes, take temperatures if it's feasible and you're able to track people. But, really, you should just assume everybody has it. Maintain the mindset that every person you encounter, every employee, customer, and vendor that walks through the door, is infectious. It’s up to you to implement the procedures that will minimize the risk of those individuals spreading the infection.
Kendzel: Should we require masks? Should masks be optional? Should customers wear masks?
Krause: As an industrial hygienist, we separate respirators from other types of PPE, and, in no way shape or form, even though they're often completely misused and conflated and just lumped in the same bag, are surgical masks, cloth masks, and dust masks respirators. Period.
We’ve been discussing N95 masks as if they are the be-all, end-all. And, in the world of industrial hygiene and respiratory protection, the N95 is the bottom of the barrel. That is the lowest-rated protection you can offer anybody. And now that is the coin of the realm. Face coverings and masks really fall into the same realm as boot covers, booties, or shoe covers. You put them on so you don't track dirt inside your customers’ houses. Masks are not protecting the wearer, they’re protecting the environment from the wearer.
Once we start reopening, you're going to see increases in cases. It is unavoidable. It is a forced reintroduction of people. We do not have a vaccine, a treatment, or a rapid test. You will see increases in disease rates around the country as we reopen. It’s unavoidable. Yes, one layer of protection can be wearing a mask. And I think masks are, whether we like it or not, part of it. They’re not personal protective equipment; they’re really environmental protective equipment, protecting the environment or the office space or the factory floor from the workers. They’re low intensity and have little impact on people.
One of my clients has a retail store where they're selling pharmaceuticals. And two or three of their employees said, “No, we can't wear masks because we have PTSD.” As a policy, my clients went with the direction of this is part of the new uniform. If you can't wear this, you can't work here.
Kendzel: Can you legally require employees to wear masks?
Bush: Absolutely. And it makes perfect sense in the sense that you are not protecting the wearer, but you're protecting the rest of the world from the wearer. It makes even more sense that we can do that as we can require you to wear a mask to prevent you from infecting your coworkers in the event that you have the disease. And, interestingly, from the employer standpoint, they can implement a policy that requires that if employees don't wear this, they cannot come to work.
I've defended cases in that sense where construction workers refused to wear safety harnesses or a tie off. There is a legitimate defense there, but, as an employer, you need to have a policy in place, and it has to be consistently applied. I actually won a case where the defendant plaintiffs, or the employer, was using that as a defense. We were able to show that the employer never really enforced the policy. It was a paper policy. If you're going to document something — if you're going to put something on paper — it has to be real. You just can’t put it on paper to make it effective. But, regarding the masks, yes, I think they make perfect sense.
Kendzel: Give your thoughts and guidance as it relates to cleaning and sanitizing. When should it be done, and how should it be done?
Krause: AIHA has put out a fact sheet on considerations you should think about as a building owner on their COVID-19 website, so that's one place to start. That document is at the 30,000-foot level — it's a very high-level document — and includes some things you should do and some things you should avoid.
One of those things, pardon the pun, is the Chinese fire drill. You're informed that you have an employee or a customer who was diagnosed a week ago and was in your shop two weeks before that. All of a sudden you're dropping $50,000-$75,000 to have your facility deep cleaned. The damage has been done.
What we're advising, as an association, is that we establish a higher level of ongoing cleaning and disinfection throughout the day, throughout the occupied spaces, throughout the workspaces, and throughout the customer and common areas. We must clean at a high level of what is normally seen in hospitals. We're moving those principles, practices, and procedures into the normal workplace to try to control pathogens. Rather than bringing in the team of super cleaners in hazmat suits, how about we have two or three folks who are trained, equipped, evaluated, and supervised to clean and then disinfect, using appropriate disinfectants that have been at least listed by the EPA. We think that's going to be more effective and useful. The fogging, the blow-and-go, and the bug bombs are all dangerous. I've seen them cause more problems than they solve.
The problem is, as soon as you’re done cleaning and you bring in the next person, you’ve potentially reintroduced the pathogen.
Kendzel: If attendees could walk away with one thing out of this discussion, what should it be?
Keane: As buildings open, more people are going to get sick. That's a given. And I've been in situations where building owners were devastated by outbreaks. We went through one where the building owner was crying after being deposed because an outbreak killed two people and hospitalized 10. So, our goal is not to prevent illness. We can't do that; it's going to happen. We want to prevent outbreaks, massive illness, and failures due to inaction. And that can be done.
Bush: I go by the old Sun Tzu philosophy: The general who makes the most calculations is most likely to win. The folks attending this webinar — it shows that they're concerned and interested in gleaning whatever information they can.
Be prepared to implement policies that you can change in ways to address this situation, which might be difficult. Approach the situation using reasonable and commonsense approaches in terms of sanitizing and call-out policies.
If you’re going to document, do it carefully and thoroughly. If you do it wrong, or you do it improperly, it's going to be problematic. Gather the necessary information, have a game plan, and follow as much news as you can. There's no way you're going to absolutely prevent the illness. But, if you're showing good faith and reasonable efforts, that is a sort of protection. And you may benefit from that, at least legally.
Krause: I'm going to reiterate what Dave Bush said: have a plan. Sit down and think your way through this. Number two, be skeptical. You will be presented with lots options and everyone will be telling you, “Here's the one thing you need to do, here's the magic bean you need to plant, here's the one device you need, and here's the one chemical you need to buy.” This pandemic has not changed human nature. There are shysters, snake oil salesmen, and miracle workers out there in droves right now. Ask for guarantees, references, registration numbers, and data. If it sounds like it’s too good to be true, you can assure yourself it’s too good to be true. Have a plan, develop your defenses in depth, and be ready to adjust on the fly.