As a professor of Human Science and of Family Medicine at Georgetown University and as former chief medical officer for OSHA and Associate Director for Science at NIOSH/CDC, I would like to thank the Commonwealth of Virginia’s Department of Labor and Industry for extraordinary leadership in proposing the Emergency Temporary Standard, “Infectious Disease Prevention:  SARS-CoV-2 Virus That Causes COVID-19”, and urge the Safety and Health Codes Board to approve it. This standard represents an extremely important advance in occupational safety and health that would benefit virtually every worker in the Commonwealth.

The following suggestions are meant to clarify language and to strengthen the standard:

Clarify droplet and airborne transmission definitions:

While SARS CoV2 is transmitted primarily by direct contact and droplet spread, it is also transmitted through airborne droplet nuclei, requiring both droplet protection and respiratory protection depending on the worker’s anticipated exposure level. It is helpful to clarify the distinction between large droplet spread and airborne droplet nuclei spread to avoid confusion about different PPE use. 

On page 5, section 2.b., the phrase “respiratory droplets in the air” should be changed to read “droplets or airborne droplet nuclei” to clarify that both methods of transmission are being addressed. 

Similarly, on page 12, under the definition of “face shield”, the phrase “airborne particles” should be replaced with “droplets or splashes” to clarify that face shields are excellent protection from droplets but are not respirators.

This distinction should be carried through in the paragraph at the top of page 28, which states, in part, “employees classified as “very high” or “high” exposure risk shall be provided with and wear gloves, a gown, a face shield or goggles, and either a surgical/medical procedure mask or a respirator when in contact with or inside six feet of patients or other persons known to be, or suspected of being, infected with SARSCoV-2.” (emphasis added).  Elsewhere in the document the distinction between surgical/medical procedure masks, which may be helpful to protect the wearer from droplet transmission (if worn with face shields or goggles) and respirators, which provide respiratory protection from airborne exposures, is clearly and accurately explained.  In the situation described here, the words “and either a surgical/medical procedure mask or” should be deleted. 

Reference the spectrum of COVID19 effects:

The proposed standard accurately describes the most common symptoms of COVID19.  However, cases of conjunctivitis as well as pulmonary embolism and stroke, among other presentations, have been reported. It may be useful to recognize this in the text.

On page 8, for the definition of COVID19, insert the word “primarily” before “a respiratory disease” to clarify that some presentations of the disease may be primarily gastrointestinal or neurologic, or other.

On page 15, the definition of “Symptomatic” should be extended by changing the ending of the first sentence to read “nausea. vomiting, diarrhea, or other symptoms found to be associated with COVID19”.

Clarify that this standard would fill an existing gap in worker safety and health that CDC has not been able to address:

While CDC guidance is important for overall public health, it frequently fails to address worker safety and health issues adequately, and its guidance is voluntary and not required.  Current CDC guidance that would allow bandanas to be used for respiratory protection in certain circumstances and guidance that would permit critical infrastructure workers to return to work if infected but asymptomatic, even in circumstances where appropriate distancing is not feasible, are wholly inadequate to protect workers. Previous shortcomings in guidance for worker protection occurred during the anthrax contamination of the U.S. mail and with initially inadequate guidance to protect workers from H1N1 and from ebola virus disease.  The proposed standard provides much more protection from COVID 19 for the workers of Virginia and should not be preempted by CDC guidance under any circumstance.

On the top of page 6, paragraph G should be removed.

Severity Classification:

The proposed standard clearly distinguishes between “Medium” and “High” risk categories based on the likelihood that workers encounter others who are infected or who might be infected.  However, it would be helpful to clarify how that determination is made.

              At the top of page 11, insert a new sentence,“ For this designation to apply, local jurisdiction public      health testing should confirm the absence of asymptomatic disease carriers by conducting PCR testing at least one percent of the general population, or employers should offer PCR testing among workers on request.” before the sentence that starts with  “Medium exposure risk hazards…”

Minor comments:

          On page 7, the CDC is the “Centers for Disease Control and Prevention” (add “and Prevention”)

          On page 34, change the first letter in 6.c. from “W” to “H” (typographical error).

Once again, thank you for this important contribution to worker safety and health.