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