I am writing on behalf of the Occupational Health and Safety Section of the American Public Health Association (APHA).  APHA is a diverse community of public health professionals that champions the health of all people and all communities. We speak out for public health issues and policies backed by science. We are the only organization that combines a nearly 150-year perspective, a broad-based membership and the ability to influence policy to improve the public’s health.

APHA’s mission is to improve the health of the public and achieve equity in health status. Our vision is to create the healthiest nation in one generation. As the executive director of APHA, Georges Benjamin, MD, noted recently, COVID-19 is disproportionately impacting some populations, in particular, African Americans and Hispanics. This alarming health disparity is due in part to the greater degree of exposure to SARS-CoV-2 in their jobs. A higher percentage of African Americans and Hispanics having public-facing jobs (i.e., they do not have jobs that can be performed at home.) 

We support the Virginia Occupational Safety and Health Program’s (VOSH) proposal to adopt a standard that would require employers to control, prevent, and mitigate the spread of COVID-19 to and among employees.  We agree with VOSH that the standard should apply to all industries and occupations.  We appreciate that VOSH is taking a leadership role to adopt a standard that sets a high bar for other states to protect the nation’s workforce.  Our specific comments on the VOSH proposal are as follows:

(1) ADOPT occupational protections from COVID-19 in the form of a STANDARD (i.e., not a regulation).  This will ensure the protections are permanent and enforceable.

(2) Page 6, paragraph G.  DELETE the provision that would allow employers to forego compliance with a VOSH standard on COVID-19 with “requirements in CDC publications to mitigate SARS-CoV-2…” 

The proposal refers to the CDC guidelines as “requirements,” but they are not “requirements.” They are merely guidelines.  Page 6, Paragraph G would undermine a VOSH standard and not provide necessary protections for workers.  The CDC guidelines do not place any responsibility on employers to take action. The phrases “if feasible” and “if possible” are used more than a dozen times in the CDC guidelines.  Retaining this provision of the proposed standard would be giving employers in Virginia a ludicrous option: comply with a VOSH standard or ignore it if you want to.  We urge the Safety and Health Codes Board (Board) to DELETE this provision.

(3) ADD reporting and recordkeeping requirements when an employee has a confirmed case of COVID-19.   We suggest the following: When an employer is notified or learns that an employee has a confirmed case of COVID-19, the employer is required, within 24 hours, to notify the appropriate state or local health department, as  well as any co-workers, contractors, or suppliers who may have come into contact with the person with a confirmed case of COVID-19. 

(4) EMPHASIZE the hierarchy of controls.  The standard must be consistent with the hierarchy of controls. The proposal correctly recognizes the primacy of engineering controls. It should more firmly stipulate that administrative controls take precedence over personal protective equipment.  (See Page 21, (F))

(5)  MAJOR AMENDMENT NEEDED:  Page 4, Paragraph D, refers to the "Exposure Risk Level" and lists factors to be used by employers to determine the risk level (see D(1), D(2)a and D(2)b).  This suggests a requirement for employers to conduct a hazard assessment.  However, beginning on Page 9, the proposed standard lists specific occupations and industries that fall into one of four exposure risk categories.

The list beginning on Page 9 confounds the provisions in D(1), D(2)(a) and D(2)(b).  Notably, some of the industries classified in the proposed standard as “Medium” risk level (page 11), such as poultry, meat, and seafood operations, and correctional facilities, have been the site of significant work-related outbreaks.  Using the hazard assessment approach, in contrast, responsible employers in these industries would have recognized that their inability (or unwillingness) to implement physical distancing increased the risk of exposure in their establishments. 

The proposed standard should be AMENDED to more explicitly state an employer’s duty to regularly conduct a hazard assessment of their establishment, and institute control measures to address those hazards using the hierarchy of controls.  The standard could additionally include a list of specific tasks (e.g., intubation, some dental procedures) that would automatically be classified as “Very High” risk.         

(6) AMEND Page 5, Provision 10(D)(2)(b): The description should refer to “airborne transmission” as a route of exposure.  Airborne transmission is broader than the risk of droplets-containing SARS-CoV-2 and includes aerosols containing SARS-CoV-2.  

(7) Page 7: CORRECT “CDC” to read: Centers for Disease Control and Prevention

(8) Page 20, DELETE the word “paid” in Provision C.  Not all breaks are paid.   

(9) Page 23, Provision 8, AMEND “water” to “running water”

(10) Page 33, Section 80:  AMEND:  All employers should be required to provide training to their employees with respect to COVID-19.  A basic level of training should be provided to all employees (e.g., the topics listed in Section 80(B)1-7)).   As the public health community and the public at large has witnessed, a workplace classified as “low risk” could easily become higher risk.  These situations are compounded because no hazard awareness training was provided by the employer.

Additional mandatory topics, such as the employer’s Infectious Disease Preparedness and Response Plan” should be included when hazards or job tasks are classified in the “Medium,” “High,” and “Very High” exposure risk levels.  

(11) Page 35, Section 90: We support the proposed provision on protecting employees from exercising their safety and health rights.  We recommend the provision be STRENGTHENED with explicit language to include discrimination protections for employees who have tested positive and those who have been exposed to COVID-19.

(12) We recommend the standard INCLUDE explicit language on employee involvement, such as in hazard identification, evaluation of controls and training, and revision of policies and  procedures.

(13) We note that hazardous, biological, and medical waste is not mentioned in the proposed standard, and appropriate requirements for containerization, safe disposal and labeling.

We appreciate that VOSH is taking a leadership role to adopt occupational health protections for COVID-19.  We are encouraged that the Commonwealth of Virginia will be setting a high bar for other states to protect the nation’s workforce.

Sincerely,

Celeste Monforton, DrPH, MPH

Co-Chair, Policy Committee

Occupational Health & Safety Section

American Public Health Association