Informing risk assessment for those employees who may be more vulnerable to COVID-19
Robin Cordell, Director, Council for Work and Health
Our experience as occupational health clinicians over this last few weeks has revealed understandable anxiety among employers, employees and their families over the risk to those employees considered to be more vulnerable if they were to contract COVID-19.
Towards the end of March it became clear in published Government policy (now updated as at 1 May) at:https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-othersthat among those considered more vulnerable, which is broadly similar to those who have a ‘flu’ jab under NHS arrangements due to specified health conditions, there are those who are considered to be extremely vulnerable.
People in this very high risk group, about 1.8 million people, have been advised by the Government to be “shielded”, as at: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
Therefore there are three groups of people identified by Government in terms of the level of risk of a serious outcome.
At the top end of the scale, those at very high risk, who have been told they must not leave home for 12 weeks (or longer if the Government advises this).
The largest group is those at the standard level of vulnerability for the population as a whole. The whole population are required to follow the enforceable measures introduced on 23 Mar 2020, as at: https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-others. These social distancing measures include working from home wherever possible.
There is a substantial group in the middle, who have conditions that make them more vulnerable, and so are at increased risk, but who do not have the health conditions that make them extremely vulnerable and at very high risk of a serious outcome if infected.
Employers will all know that (at: https://www.hse.gov.uk/workers/employers.htm#) they have a legal duty to protect the health of their employees, and other who may be affected by their activities. Employers must do whatever is reasonably practicable to achieve this.
Some employers have directed all employees who are more vulnerable to remain at home. This is an effective social distancing measure, and will enable organisational outputs to continue if these employees can work entirely from home.
However, many organisations are engaged in essential work that cannot be done from home. This includes healthcare and social care workers, those in local authorities, working with the most vulnerable people in society and providing essential services, and those in logistics. A risk management based approach has been undertaken by these clients. Occupational health clinicians can advise on the vulnerability of their employees, and to suggest how the increased risk in more vulnerable individuals might be mitigated. Government provides guidance to employers on social distancing in the workplace at: https://www.gov.uk/guidance/social-distancing-in-the-workplace-during-coronavirus-covid-19-sector-guidance
Following referral by clients, a short occupational health teleconsultations is undertaken with employees followed by a short report is sent (with consent) to the employer.
The outcome of these assessments is tailored advice, given the employee’s individual health conditions and work circumstances, in order to inform the employer’s risk assessment. We have found that “shading” the level of vulnerability within the more vulnerable group has been helpful, as our experience is that some in this middle group are more vulnerable than others. We now use a GREEN-YELLOW-AMBER-RED risk indicator.
The following risk management table is based on Government guidance on social distancing at,and professional consensus documents, including those provided by the Faculty of Occupational Medicine (FOM), the Royal College of Obstetricians and Gynaecologists (RCOG). Assessment of ethnicity as a risk factor is also included, in view of the observed disproportionate number of deaths among those of BAME ethnicity as at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30922-3/fulltext,.
|Level of risk of severe illness if contract COVID-19 as compared to the general population
|Risk Mitigation the employer is advised to put in place
|Those under 70, who may have underlying health conditions, but based on occupational health assessment do not have conditions defined in Government guidancethat would place them in the more vulnerable group if they were to contract COVID-19.
|Social distancing – the standardrisk mitigation advised by the Government for the population
|Those considered to be more vulnerable to serious illness if they contract COVID-19. These are people over 70, or those under 70 with the underlying health conditions listed. Occupational health clinicians will advise specifically on the vulnerability of those who are pregnant, depending on the environment where they work.
|Social distancing, stringently applied (as specific to each workplace)
|There will be some people the occupational health professional making the assessment considers highly vulnerable. These may be those more severely affected by one of the conditions the Government advises makes that person more vulnerable, or those who have a combination of conditions that further increases their vulnerability. This is co-morbidity. Occupational health clinicians will also advise on whether other factors might further increase vulnerability among the more vulnerable, including ethnicity, age and gender, and smoking.
|Social distancing, stringentlyapplied. Occupational health clinicians may provide further advice on controls on a case by case basis as needed.
|Those considered to be extremely vulnerable. People with conditions set out in Government guidance on shielding, and who will usually have had a letter from the NHS advising them of this.
|Shielding for 12 weeks, or longer period as advised by Government
Robin Cordell, Director, Council for Work and Health