Challenges of "Return to Work" in an Ongoing Pandemic (N Engl J Med. 2020.06.08)

"Low-Tech" Prevention Measures in Daily Operations
Throughout the country, many industries, services, and offices that are deemed to represent "essential operations" under relevant federal guidance and state public health orders have remained open, including hospitals and some clinics, in which the services provided require personal attendance and close contact. Use of personal protective equipment and environmental and sanitation controls in these settings have limited the acquisition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by these workers. Indeed, there are multiple low-tech solutions to prevent transmission, including deferral from attending work or public venues by those who feel unwell, frequent hand washing, use of masks of appropriate design and manufacture, and practices of avoiding as far as possible close physical contact with others (Table 1). These measures are labor-intensive, requiring that individual workers and customers take protective actions in real time, and proper adherence requires active monitoring of workplace or public behavior. To ensure adherence, imposition of corrective actions may be warranted, such as employee discipline or exclusion of nonadherent persons from a physical facility. Furthermore, to encourage hourly workers to defer from attending work when ill, employers have found it necessary to offer or extend sick-leave benefits. Although not legally required, this represents ethical employer behavior to accommodate illness and thus prevent transmission.
In commercial and other public settings, operational considerations and concerns for transmission risk are broad and encompass areas traditionally not within management's ken or responsibility. Resumption of day care and school operations is a crucial factor, because many employees are simply unable, given family circumstances, to return to work if education and day care for children and elderly or disabled family members remain closed. In revising public health orders, state and local governments therefore must coordinate reopening of industry with resumption of schools, day care, and day treatment. Transmission concerns include conditions of transportation (e.g., mass transit) to and from work, as well as social, religious, and leisure activities of workers outside of work hours, in which failure to maintain personal protective measures can put the person at risk for infection. Transmission risk from outside of the workplace or institution is then transferred into it when the person returns on subsequent days for work or study. To assess these risks, many essential-workplace employers that have continued operations throughout the pandemic have administered daily health questionnaires, with review of symptoms suggestive of Covid-19 (Table 2) and inquiries about household and social contacts with a recent diagnosis of infection or presumed infection. Some employers and institutions have adopted pre-entry temperature screening with the use of equipment that scans foreheads or measures body temperatures with ease of use that prevents undue delays and entry bottlenecks. Positive responses on daily questionnaires, or an elevated body temperature indicated by electronic scanning, lead to detailed analysis of whether the employee, visitor, or student presents a risk to others meriting exclusion from entry and referral to testing and an at-home quarantine period. In residential settings, such as residential colleges or schools, quarantine may require that the institution itself provide facilities for this purpose, unless the person can be safely referred or transferred to a personal home setting.

進行中のパンデミックにおける「職場復帰」の課題 (N Engl J Med. 2020.06.08)






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