16VAC25-220-30. Definitions

"Medium” exposure risk hazards or job tasks are those not otherwise classified as very high or high exposure risk in places of employment that require more than minimal occupational contact inside six feet with other employees” 

Define ‘more than minimal’. This should mirror the CDC definition of ‘close contact’.  Per revised CDC guidance, a person trained and fitted to an appropriate respirator may not be deemed to be a ‘close contact’, so an exception should be provided. Also, per CDC, “Several COVID-19 investigations recently highlighted by CDC provide convincing data adding to the evidence for the prevention effectiveness of masking for individuals with high risk exposures”, which reinforces that face coverings alone, or even respirators that have not been fitted, provide a high level of protection for both the wearer and other persons in proximity. See https://www.vdh.virginia.gov/coronavirus/frequently-asked-questions/disease-prevention/

"Lower” exposure risk hazards, (…) “through the implementation of engineering, administrative and work practice controls, such as, but not limited to:  1.  Installation of floor to ceiling physical barriers constructed of impermeable material and not subject to unintentional displacement (e.g., such as clear plastic walls at convenience stores behind which only one employee is working at any one time);

What is the scientific basis for this requirement? In many stores and other venues, ceiling heights are 10’ to as much as 30’ or more above the floor, which would make this impractical and would serve no valid purpose. Also, installation of such large barriers may impede air circulation and actually create pocket of stagnation that would elevate the exposure risk. Further, in any sprinkled building this would likely obstruct sprinkler flow, which would be a violation of the Fire Code. If the barrier prevents the direct transmission of droplets between one person and another, would this emulate the protection provided by a face covering and physical distancing, which would mean a smaller barrier may well be sufficient?

“Employee use of face coverings for contact inside six feet of coworkers, customers, or other persons is   not an acceptable administrative or work practice control to achieve minimal occupational contact.”

The CDC definition of ‘close contact’ should be considered in defining ‘minimal occupational contact’. Also, CDC guidance indicates that coverings can protect both the wearer and those in proximity from the spread of SARS-CoV-2. As noted here, https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html, “Cloth masks not only effectively block most large droplets (i.e., 20-30 microns and larger) but they can also block the exhalation of fine droplets and particles (also often referred to as aerosols) smaller than 10 microns which increase in number with the volume of speech and specific types of phonation. Multi-layer cloth masks can both block up to 50-70% of these fine droplets and particles and limit the forward spread of those that are not captured.  Upwards of 80% blockage has been achieved in human experiments that have measured blocking of all respiratory droplets, with cloth masks in some studies performing on par with surgical masks as barriers for source control.” Also, per CDC, “Several COVID-19 investigations recently highlighted by CDC provide convincing data adding to the evidence for the prevention effectiveness of masking for individuals with high risk exposures”, which reinforces that face coverings alone, or even respirators that have not been fitted, provide a high level of protection for both the wearer and other persons in proximity. See https://www.vdh.virginia.gov/coronavirus/frequently-asked-questions/disease-prevention/ See also https://doi.org/10.1016/j.eml.2020.100924 as well as http://jv.colostate.edu/masktesting/.

"Face  covering” (…) A face covering is (…) not considered a form of personal protective equipment or respiratory protection equipment under VOSH laws, rules, regulations, and standards.”

CDC guidance indicates that coverings can protect both the wearer and those in proximity from the spread of SARS-CoV-2. As noted here, https://www.cdc.gov/coronavirus/2019-ncov/more/masking-science-sars-cov2.html, “Cloth masks not only effectively block most large droplets (i.e., 20-30 microns and larger) but they can also block the exhalation of fine droplets and particles (also often referred to as aerosols) smaller than 10 microns ; which increase in number with the volume of speech and specific types of phonation. Multi-layer cloth masks can both block up to 50-70% of these fine droplets and particles  and limit the forward spread of those that are not captured. Upwards of 80% blockage has been achieved in human experiments that have measured blocking of all respiratory droplets, with cloth masks in some studies performing on par with surgical masks as barriers for source control.” See also https://doi.org/10.1016/j.eml.2020.100924 as well as http://jv.colostate.edu/masktesting/.

While there is limited evidence that infection can occur from exposure to infectious aerosols under very specific circumstances, the overwhelming evidence is that the main route of infection is from virus-laden droplets, likely because droplets contain a higher number of viable SARS-CoV-2 virus than aerosols. According to Taylor Engineering, “Masks have been shown by experimental and modeling studies (Leung et al, Hao et al, Aydin et al, Booth et el, Davies et al, Goyle et al) and by epidemiological studies (Howard et al, Gupta) to be the most effective measure and also the only measure that appears to be necessary to control the outbreak.” Face coverings are not respirators, but there should be a greater recognition of the benefits wearing a face covering alone provides in mitigating risk, including when people are working in closer proximity.

“Minimal occupational contact” means no or very limited, brief, and infrequent contact  (…)”

Definitions should align with the CDC definition of ‘close contact’, since that is the guiding principle for when a person is at risk for infection based on exposure to an infected person.

"Physical distancing” Physical separation of an employee from other employees or persons by a permanent, solid floor to ceiling wall constitutes one form physical distancing from an employee or other person stationed on the other side of the wall, provided that six feet of physical distance is maintained from others

If, as demonstrated by research, the primary risk of exposure is through droplets and not aerosols, if the barrier is sufficiently large to interrupt the transmission of infectious droplets from one person into the breathing zone of another, would this not be sufficient to assure ‘physical distancing’?  Why would a cubicle wall not be sufficient, provided face coverings were worn when standing if ones’ face would be above the cubicle wall?

16VAC25-220-40. Mandatory requirements for all employers.

Subsection B(8)e, “The Virginia Department of Labor and Industry within 24 hours of the discovery of three or more of its own employees present at the place of employment within a 14-day period testing positive for SARS-CoV-2 virus during that 14-day time period.”

For employers with large numbers of employees, this could result in imposing a requirement that VDLI be notified every two weeks or even more frequently, which is incredibly burdensome. What is the value of serial reporting by an employer to VDLI, especially when B(8)d requires reporting to VDH when the worksite has had two or more confirmed cases of COVID-19?  VDH would the responsible agency for responding to and investigating any outbreaks that have occurred, not VDLI. Recommend requiring only an initial report to VDLI, not on-going reporting.

Subsections F and G state, “until adequate supplies of respiratory protection and/or personal protective equipment become readily available for non-medical and non-first responder employers and employees, employers shall provide and employees shall wear face coverings.”

As outlined above, there is ample research, and community-based evidence, which demonstrate that simple face coverings are effective in limiting the spread of SAR-CoV-2 virus even when physical distances cannot be maintained at all times.  In combination with ventilation (F2), is it reasonable to stipulate that respirators be provided when available when this introduces all of the other requirements of 29 CFR 1910.134 (e.g., medical clearance, fit testing, establishment of a respiratory protection program) and where there are no established exposure limits for SARS-CoV-2?

Subsection L(4), Sanitation and disinfecting, states, “Areas  in  the  place  of  employment  where known or suspected to be infected with the SARS-CoV-2 virus employees or other persons accessed or worked shall be cleaned and disinfected prior to allowing other employees access to the areas.

The presumption should be that ‘suspected to be infected’ persons are present in the workplace every day, and there will be a time interval between when the person is either diagnosed or becomes symptomatic and during which they were present in the workplace. Imposing a requirement to disinfect now that the employee ‘knows’ of a case is disingenuous at best and provides no tangible benefit—employees have already been exposed to potential fomites. Subsection E(1)c imposes a requirement that employees clean and disinfect the immediate area in which they were located prior to leaving. Section L(5) and L(6) impose requirements that high touch surfaces and shared tools and equipment be routinely cleaned and disinfected. Is this not sufficient?  Further, the CDC states, “It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads”. 

16VAC25-220-50. Requirements for hazards or job tasks classified as very high or high exposure risk and 16VAC-25-220-60. Requirements for hazards or job tasks classified as medium exposure risk.

Subsection B(1): The changes that are suggested in this section will require engineering evaluations be performed, require substantial work effort, may jeopardize the operation of the HVAC, increase operational costs, and provide little if any tangible benefit.  At best, this section should require the employee assure ventilation systems are working ‘optimally as designed’. Source control (e.g. the wearing of face coverings) should be the emphasis of this standard, not imposing expensive modifications to or evaluations of ventilation systems. See Taylor Engineering for a review of how ventilation systems are not an optimal choice for controlling exposure to SARS-CoV-2 virus.

Subsection B(1)(b)(i), “Increase total airflow supply to occupied spaces (…)”

What does ‘increase total airflow’ even mean? There is substantial evidence that source control (face coverings) should be the primary control for COVID-19, and research indicates that increasing ‘airflow’ may be provide little tangible benefit while greatly increasing operational costs.

Subsection B(1)(b)(iv),  “Increase air filtration to as high as possible”.

To my knowledge, there is very little evidence to-date of a COVID infection occurring as a result of the virus being transmitted as an aerosol through an air handling system. While this may seem like a good idea, what is the scientific basis for imposing this requirement?  Further, determining what level of filtration an HVAC system can accommodate requires an engineering evaluation, which imposes a substantial financial burden on the employee where there is little evidence that increasing ventilation rates and filtration are beneficial. Again, source control (masking) should be the primary emphasis. See Taylor Engineering.

Subsection B(1)(b)(v),  “Generate clean-to-less-clean air movements by re-evaluating the positioning of supply and exhaust air diffusers and/or dampers and adjusting zone supply and exhaust flow rates to establish measurable pressure differentials.

While this may seem like a good idea, there is limited evidence of infection by aerosols, which this subsection seeks to address at great cost to the employer. If the primary route of infection is through droplets, the emphasis should be on source control.

Subsection B(6) of 16VAC25-220-50

Please reconcile the language in this section to conform to the VDLI FAQ and related interpretation which indicates that certain tasks, including laboratory tests and specimen handling, may be conducted at BSL-2.

16VAC25-220-50. Requirements for hazards or job tasks classified as very high or high exposure risk and 16VAC-25-220-60. Requirements for hazards or job tasks classified as medium exposure risk.

Subsections D. Personal protective equipment (PPE). 1(a) “Employers shall assess the workplace to determine if SARS-CoV-2 virus or COVID-19 disease hazards or job tasks are present or are likely to be present that necessitate the use of personal protective equipment (PPE).”

General comment: There are situations (intubation and other aerosol-generating procedures, close contact with a known infected person, etc.) where the use of respiratory protection is an obvious, common sense precaution. In the absence of an occupational exposure limit for SARS-CoV-2 virus, however, and knowing that there are factors which increase ones’ risk of infection, serious disease or even death, it is difficult to quantify or perform a hazard assessment to determine when respiratory protection would be necessary. This draft standard states, “when engineering, work practice, and administrative controls are not feasible or do not provide sufficient protection, employers shall provide personal protective equipment to their employees”. “Do not provide sufficient protection’ is a very nebulous requirement when our understanding of this virus and ways to mitigate exposure are evolving. What level of risk of infection is acceptable? If ventilation and the use of face coverings theoretically reduce the risk to less than 1%, is that sufficient or would respiratory protection be required to reduce the risk even further?