Managing Infection Risk in High Social Connectivity Occupations and Settings, Schemes and Mind Maps of Behavioural Science

Download Managing Infection Risk in High Social Connectivity Occupations and Settings and more Schemes and Mind Maps Behavioural Science in PDF only on Docsity! 1 Managing infection risk in high contact occupations Summary 1. Raising awareness of the problem of high social connectivity • There is emerging evidence that some occupations and situations pose particularly high risk of infection due to high levels of social connection. This higher risk is linked to increased mortality in some occupations and sectors of the population, including lower income and BAME communities1. • People in occupations involving numerous social contacts of longer duration and close proximity may be at increased risk of both contracting and spreading Covid-19. Examples of potentially higher risk occupations may include: bus and taxi drivers, social care and healthcare workers and people working in some retail, catering, security, and manufacturing settings. • Other situations involving numerous social contacts of longer duration and close proximity also carry a higher risk of spreading Covid-19. Examples include: using public transport; large family gatherings; religious and cultural events; pubs, restaurants and cafes. • As risk levels reduce in the general population, it is vital that all members of the public, employers, employees and self-employed people are aware of which situations will continue to pose higher risk and of what actions need to be taken by everyone to reduce the risks in these situations. 2. Communicating two key principles for managing higher infection risk due to social connectivity 2.1. People who have large numbers of contacts with different people are at higher risk of infection and transmission. Those in high contact or high disease exposure occupations should therefore pay particularly close attention to the social distancing and hygiene recommendations that are also recommended for the rest of the population. This is especially important when mixing with those at high risk of severe consequences of infection, such as older people or those at high risk from infection due to health conditions. It is vital that the responsibility for managing infection risk due to multiple contacts is shared between the people at risk, their employers and all the people they meet. A Covid-secure risk assessment must be undertaken to ensure that risks are minimised. Wherever possible, changes to the structuring of workplace activities and enironments should be prioritised. Taking extra care to manage infection risk may also involve everyone concerned undertaking additional actions such as handwashing at appropriate times, avoiding touching face or surfaces, cleaning all shared surfaces, changing/washing clothes, using and disposing of tissues, ventilating shared spaces, social distancing, wearing a face covering when close to others if social distancing is not possible. The EMG paper on Transmission of SARS-CoV-2 and Mitigating Measures (04/06/2012) sets out how to select appropriate measures. 2.2. People with different social networks should try to avoid meeting (especially close, prolonged, indoor contact) or sharing the same spaces For example: • people who share a workspace (e.g. office, section, floor) should try to avoid meeting or sharing spaces (e.g. kitchens, toilets) with people who share a different workspace 2 • contact should be avoided between teachers and pupils from different classes and especially different schools • sports teams from different areas should avoid sharing facilities and enclosed spaces. 3. Developing practical solutions to reduce social connectivity The steps listed below are based on co-design principles previously described by SPI-B2,3,4 for successfully developing, communicating, implementing and regulating guidance for reducing infection transmission, in order to maximise adherence. Note that all the steps listed below need to be taken, and it is vital to involve everyone in these occupations and communities in working together to find practical and acceptable solutions. 3.1 Carry out an extensive education campaign for employers, employees, self-employed people and the general public, working with diverse members of the target workforce/user groups and multidisciplinary experts in supporting behaviour change to provide toolkits suitable for different user audiences, with clear and convincing explanations, detailed guidance and effective behaviour change techniques 3.2 Co-create guidance and positive solutions with input from diverse members of all the different target workforce/user groups and their representatives (both organisational and community leads, employees and community members, including members of BAME communities) to identify opportunities, concerns, barriers and solutions. Positive solutions must be equitable, reassuring and supportive, should maintain social cohesion and support, and should promote a shared sense of responsibility for infection control. 3.3 Redesign shared activities and spaces to minimise contacts, for example, by adopting new shift patterns or patterns of workspace use, setting up teams or “buddies” to ensure that contact is limited to small groups of people, restricting access to communal spaces or allocating spaces to particular groups at particular times with ventilation and cleaning between use. This should be part of the Covid-safe risk assessment process described in 3.4 below. 3.4 Use existing organisational structures and processes for implementation, for example Health and Safety regulations and enforcement processes, including personal and workplace risk assessments to identify, apply and monitor appropriate control measures which reduce infection spread 3.5 Monitor and feedback to all concerned to check and reassure that infection control is being implemented effectively. All guidance developed must be extensively and iteratively tested and optimised through real-world implementation and feedback, taking particular care to consider and minimise the possible burden or anxiety that this may place on individuals and to ensure that new working practices do not result in discrimination, stigmatisation or interpersonal conflict. 5 Because death from COVID-19 in working age adults is relatively rare, confidence intervals around SMRs for many occupations remain wide. This is particularly true for women, who are generally at lower risk of death than men (although whether this gender difference applies to all ethnic groups has not yet been investigated). Associations may also be due to differences in age structures (with the available data it was only possible to control for this at the above and below 55 years cut-off). Similarly, the analysis was not able to control for other confounders such as differing levels of chronic disease in different occupations. Despite these limitations, the work reinforces the need for effective risk assessments to be made for all workplaces to prevent COVID-19 transmission and associated mortality. Such assessments should consider the risks from all routes of transmission (air, person-to-person, and surfaces), and are most effective if they are developed jointly by employers and the individuals performing the various work activities which comprise any job. It is encouraging in this regard to note that mortality was not elevated in healthcare workers, despite their close proximity to infection in many roles, which suggests that effective protection can be afforded by good infection control protocols and procedures. Because BAME workers are over-represented in higher risk occupations, it is likely that their occupational risk may be contributing to the higher rates of infection and mortality noted in some ethnic minority communities11. Since BAME workers are a stigmatised group and many of the high risk occupations are also stigmatised, managing this risk poses important specific challenges in terms of ensuring that risk management is improved but does not result in further stigmatisation, discrimination or ostracisation12,13. In addition, management of this risk must, especially in the public sector, comply with equality duties in the Equality Act 2010. To avoid stigmatisation, It is vital that people from BAME communities have a high level of involvement in the creation and implementation of measures to reduce risk. This would also improve trust in official messages in these communities. Section 3 of this paper therefore highlights the need for co-creation of tailored solutions and educational materials in collaboration with BAME people in the workforce and the community. Further collection of occupational data in all key surveys and in the Track, Trace, Isolate programme (both index cases and contacts) will help to improve the certainty of these early statistical findings. However, surveillance of high proximity workplace settings is also needed to identify outbreaks and monitor resurgence. 2. Communicating two key principles for managing higher infection risk due to social connectivity Previous health promotion campaigns have successfully raised awareness that infection transmission can be reduced by hand and surface hygiene and maintaining 2 metres distance from others, and the principles for reducing environmental transmission have been communicated in a series of papers from SAGE EMG. There is less awareness and understanding by the general public of how transmission can be reduced by limiting the size and connectivity of social networks in higher risk occupational and other settings. Limiting the size and connectivity of social networks corresponds to the ‘Elimination’ or ‘Substitution’ principles within the hierarchy of control for reducing transmission, which are generally more effective than mitigation through ‘Engineering’, ‘Administrative’ or ‘Personal Protective Equipment’ approaches such as social distancing, hygiene measures and face coverings. Conveying the transmission risk whilst providing clear and simple guidance on how it can be mitigated by an individual’s actions is critical in successfully embedding behaviour change. Future 6 health campaigns could therefore usefully promote awareness of the risk created by wide transmission through social networks combined with the following two key principles for how to reduce transmission between social networks: 2.1. People who have large numbers of contacts with different people are at higher risk of infection and transmission. Some occupational roles and situations require higher levels of contact with networks or groups of people, such as clients, customers, staff, community members or fellow passengers on public transport or planes. People whose work involves close, prolonged contact with many different people (e.g. hairdressers, care home workers) or going into multiple homes (e.g. carers, cleaners, plumbers) may have a higher risk of infection and transmission. People who come into contact with a very high volume of people (i.e. many contacts with clients/customers at work, even if these are brief – for example, retail workers) also have a higher risk of infection and transmission. Those in higher contact or higher disease exposure occupations should therefore pay particularly close attention to the social distancing and hygiene recommendations that are also recommended for the rest of the population. This is especially important when mixing with those at high risk of severe consequences of infection, such as older people or those at high risk from infection due to health conditions. People in high contact roles (e.g. serving the public, providing support across a large organisation or community) and everyone they meet will need to take extra care to protect each other by reducing the risk of catching and spreading infection. Taking extra care will involve a range of measures including handwashing at appropriate times, avoiding touching face or surfaces, cleaning all shared surfaces, changing/washing clothes, using and disposing of tissues, ventilating shared spaces, keeping 2 metres apart and wearing a face covering if closer than this. This will be especially important when sharing spaces (e.g. toilets, dining rooms, entrances, lifts). There is evidence that these measures can be effective in reducing risk when carried out carefully and thoroughly. Measures for reducing risk of transmission can also be used within the home, and may be especially helpful if a family member is symptomatic, has been in contact with a confirmed case, or if someone in the household is at high risk from Covid-195. As outlined in the EMG paper on Transmission of SARS-CoV-2 and Mitigating Measures (04/06/2012), it is important that people taking these measures consider all the routes of transmission and that the measures are taken together to provide the best protection. Where feasible, working one week with contact/one week without contact (e.g. home working, not working, working alone) will minimise risk of spreading any asymptomatic infection caught during the week working with contact, since this will become non-infectious to others by the end of the week without contact. 2.2. People with different social networks should avoid meeting or sharing the same spaces People with different workplace or other social networks should try to avoid meeting or sharing the same spaces, to reduce transmission between the networks (even if the networks are not large). This means that in workplaces without public facing contact but where workers need to come to work and interact with each other (e.g. factories, offices) people should form teams and as far as possible only have contact with people in those teams. For example: 7 • people who share an office (which is a team/network of workers) should avoid meeting or sharing space with people who share a different office (which is a different team/network of workers); • people who work on different shifts or days should form a team and avoid meeting other teams working on different shifts or days. Small groups of workers could be “buddied” together to create teams who always work together; • contact should be avoided between teachers and pupils from different classes, since a teacher and their class is a small network/team; • people who make contact with clients or customers from a particular area (e.g. of the city or country) or a particular group (e.g. an organisation or client group) should avoid meeting or sharing spaces with people who work with clients or customers from a different area or client group. Where feasible, alternate team working, with teams working one week with contact/one week without contact (e.g. home working, not working, working alone) will minimise risk of spreading any asymptomatic infection within and between teams. Note that people providing supervision (e.g. management) or support (e.g. IT, maintenance, catering) to many different colleagues in an organisation have potential to spread infection across groups/networks and so also need to pay particular attention to social distancing, hygiene and wearing face-coverings if appropriate. 3. Developing practical solutions to reduce social connectivity The principles previously articulated by SPI-B for providing guidance2,3,4 are relevant to successfully communicating, implementing and regulating these behaviours. These principles are well aligned with the theoretical framework used to inform CPNI’s COVID-19 Workplace Actions messaging campaign14 which aims to help organisations successfully embed good health behaviours in the workplace in line with UK Government guidelines. Note that all the steps listed below need to be taken, and it is vital to involve everyone in these occupations and communities in working together to find practical and acceptable solutions. Provide a credible rationale and precise and detailed guidance In order to control social network contacts effectively everyone must understand how this will reduce transmission, why this is important, and exactly what they need to do to help reduce transmission between networks. There are several important target audiences, including individual employees at all levels, so they can readily identify and apply the principles in their day-to-day work and organisations/business leaders who will need to design and implement practices, processes and policies to facilitate and manage social network contacts. In addition, self-employed people and their customers (i.e. the general public) as well as members of the community encountering high risk situations in public places (e.g. gatherings, public transport) need to understand and apply the principles of social network control where needed. These principles cannot be conveyed by simple, short messages and will require an extensive campaign with clear, consistent, detailed, positive messaging linked to effective behaviour change techniques (such as training to improve skills, goal setting and self-monitoring). Leadership teams will need to both understand how to apply these principles within their organisations themselves via their own practices and policies and how to effectively support required behaviours in their 10 1PHE. Disparities in the risk and outcomes for COVID-19. Published 2020 June 2. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment data/file /889195/disparities review.pdf 2SPI-B: Behavioural principles for updating guidance to minimise population transmission (April 2020) 3SPI-B: Theory and evidence base for initial SPI-B recommendations for phased changes in activity restrictions (April 2020) 4Interdisciplinary Task and Finish Group on the Role of Children in Transmission: Modelling and behavioural science responses to scenarios for relaxing school closures (May 2020) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment data/file /886994/s0257-sage-sub-group-modelling-behavioural-science-relaxing-school-closures-sage30.pdf 5Little P et al. Reducing the risks from coronavirus transmission in the home – the role of viral load. BMJ 2020;369:m1728 6Hua Qian, Te Miao, Li LIU, Xiaohong Zheng, Danting Luo, Yuguo Li. Infoor transmission of SARS-CoV- 2 [published online ahead of print, 2020 April 7]. medRxiv 2020.04.04.20053058; DOI: https://doi.org/10.1101/2020.04.04.20053058. 7Hayward AC, Beale S, Johnson AM et al. Public activities preceding the onset of acute respiratory infection syndromes in adults in England - implications for the use of social distancing to control pandemic respiratory infections. [version 1; peer review: 2 approved]. Wellcome Open Res 2020, 5:54. DOI: https://doi.org/10.12688/wellcomeopenres.15795.1 8Leclerc QJ, Fuller NM, Knight LE et al. What settings have been linked to SARS-CoV-2 transmission clusters? [version 1; peer review: 1 approved with reservations]. Wellcome Open Res 2020, 5:83. DOI: https://doi.org/10.12688/wellcomeopenres.15889.1 9ONS. Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered up to and including 20 April 2020. Published 2020 May 11. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/bulle tins/coronaviruscovid19relateddeathsbyoccupationenglandandwales/deathsregistereduptoandinclu ding20april2020 10ONS. Which occupations have the highest potential exposure to the coronavirus (COVID-19)? Published 2020 May 11. https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetyp es/articles/whichoccupationshavethehighestpotentialexposuretothecoronaviruscovid19/2020-05-11 11 Ethnicity and COVID-19 – 2nd June preliminary meeting for SAGE. Note by SAGE Secretariat (June 2020. 12 Solanke, I. Discrimination As Stigma (Hart, 2017). 13Löfstrand CH et al. Doing ‘dirty work’: Stigma and esteem in the private security industry”, European Journal of Criminology, Vol 13, Issue 3, 2016. DOI: 10.1177/1477370815615624 11 14CPNI. COVID-19 workplace actions campaign: Guidance for organisations. https://www.cpni.gov.uk/system/files/documents/ec/04/CV- 19%20Workplace%20Actions%20Campaign%20Guidance%20v1.0.pdf 15Riddle, L., Rogers, M. B., Amlôt, R., Cudworth, R., and Ulrich, S., (2015). Willing and Able: Building a crisis resilient workforce. https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/risk/deloitte-uk-crisis-resilient- workforce.pdf 16Pearce JM, Parker D, Lindekilde L, Bouhana N & Rogers BM (2019) Encouraging public reporting of suspicious behaviour on rail networks, Policing and Society. DOI: 10.1080/10439463.2019.1607340 17Bonell C, Michie S, Reicher S, et al. Harnessing behavioural science in public health campaigns to maintain 'social distancing' in response to the COVID-19 pandemic: key principles [published online ahead of print, 2020 May 8]. J Epidemiol Community Health. 2020;jech-2020-214290. DOI: 10.1136/jech-2020-214290 Appendix Age-standardised mortality rates of death involving the coronavirus (COVID-19) in England and Wales, by major occupational group, deaths registered up to, and including, 20 April 2020 Rate among men aged 20 to 64 in ERW, with confidence intervals Managers, directors and senior officials Professional occupations Associate professional and technical ‘occupations ‘Administrative and secretarial ‘occupations Skilled trades occupations Caring, leisure and other service ‘occupations Sales and customer service occupations Pracess, plant and machine operatives Low skilled elementary occupations 5 10 15 20 25 ‘Age standardised mortality rates of death invalving COVID-19 (per 100,000) Age-standardised mortality rates of death involving the coronavirus (COVID-19) in England and Wales, deaths registered up to, and including, 20 April 2020 Rate among men aged 20 to 64 in E&W, with confidence intervals Elementary Construction Occupations Elementary Process Plant Occupations Elementary Cleaning Occupations Elementary Security Occupations Elementary Storage Occupations Other Elementary Services Occupations o 10 20 30 40 50 Age standardised mortality rates of death involving COVID-19 (per 100,000) Source: Office for National Statistics 12  15 In order to explore the relationship between occupational proximity to others, degree of exposure to disease and pay the datasets from the above two ONS studies were merged. Occupations were divided into quintiles according to hourly wage and proximity to others at work. The population in each of these quintiles was summed and the % Female was applied to calculate the number of men and women in each quintile. These population totals were used as denominators to calculate population mortality rates per 100,000 population. We also summed the numbers of deaths in males and females in each occupation to provide the numerator for these mortality rates. 95% confidence around rates were calculated using Stata. For specific occupations age standardised mortality ratios were calculated using ONS data on the proportion of COVID-19 deaths in adults aged 20-64 who were aged 55 or over for males and females separately, applied to the total number of COVID deaths in the occupational dataset. This gave the estimated total number of deaths in those aged <55 and those aged 55 or over in the occupational dataset. These deaths were then assigned according to the proportion of the population in each occupational category to give the expected number of deaths in males and females aged <55 and those aged 55 or over in the occupational dataset. Deaths were then totalled to give the total number of expected deaths in males and females. The standardised mortality ratio was calculated as observed deaths/expected deaths for each occupation. 95% confidence intervals were calculated using the formula SMR +/- 1.96* Square root (Observed/Expected). Occupational SMRS were plotted for occupations where SMRS were > 1.4 Results There are very strong associations between male COVID mortality and low pay, high proximity occupations and high disease exposure occupations. For each level of proximity and disease exposure mortality rates tended to be highest in the lowest paid occupations. The relationship between proximity and mortality was strongest in high disease exposure groups and was also apparent in the lowest disease exposure groups. COVID-19 Mortality according to work proximity quintile of occupation. Males vs Females 20 8 8 15 S 10 i Zs i 2) Me i a a a a = 1 (lowest 5 (highest 5 proximity) proximity) 2 mMale m Female COVID-19 Mortality according to disease exposure quintile of occupation. Males vs Females 16 14 12 8 10 5 2 oe. okt [ a = :: it a a a = 1 fowest 5 (highest disease disease exposure} exposure) Male @ Female COVID-19 Mortality according to pay quintile of occupation. Males vs Females g 5 = I li | A i i 5 (highest pay) 1 flowest pay} mMale mFemale 16 Interaction between pay, degree of work proximity and mortality os hf & & Mortality per 100,000 uw aml all il hill ul 1 dowest work 4 5 -highest work proximity proximity mhighest pay m4 m3 miowest pay Male - Occupational exposure to disease, pay and mortality from COVID alt nell HL tli ul lowest disease 2nd quintile © 3rdquintile —4thquintile highest disease exposure exposure quintile quintile y S - th Mortality per 100,000 uw Mhighest pay quintile math quintile m 3rd quintile m2nd quintile mlowest pay quintile Male - Occupational exposure to disease, proximity and mortality from COVID w S 5 .. s = 10 a eo otal ME alld ¢, Mill = Jowest disease 2ndquintile 3rdquintile —Athquintile highest disease exposure exposure quintile quintite lowest proximity quintile = 4thquintile m ardquintile wand quiraile highest proximity quintile 17