OSHA has ranked worker risk of occupational exposure to the coronavirus on a low (caution), medium, high and very high scale. The level of risk depends on several factors:
- 1. Industry type
- 2. Need for contact within 6 feet of people known to be, suspecting of being, or actually infected
The image below shows the four exposure risk levels representing the probability distribution of risk. Most American workers fall in the lower or medium exposure risk levels.
FIGURE: Occupational Risk Pyramid for COVID-19
Very High Exposure Risk
Very high exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19 during specific medical, postmortem, or laboratory procedures. Workers in this category include:
- + EXAMPLES: Healthcare workers (E.g. doctors, nurses, dentists, paramedics, emergency medical technicians) performing aerosol-generating procedures (e.g., intubation, cough induction procedures, bronchoscopies, some dental procedures and examples, or invasive specimen collection) on known or suspected COVID-19 patients.
- + Healthcare or laboratory personnel collecting or handling specimens from known or suspected COVID-19 patients (e.g. manipulating cultures from known or suspected COVID-19 patients).
- + Morgue workers performing autopsies, which generally involve aerosol-generating procedures, on the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death.
High Exposure Risk
High exposure risk jobs are those with high potential for exposure to known or suspected sources of COVID-19. Workers in this category include:
- + EXAMPLES - Healthcare delivery and support staff (e.g., doctors, nurses, and other hospital staff who must enter patients’ rooms) exposed to known or suspected COVID-19 patients. (Note: when such workers perform aerosol-generating procedures, their exposure risk level becomes very high.)
- + Medical transport workers (e.g., ambulance vehicle operators) moving known or suspected COVID-19 patients in enclosed vehicles.
- + Mortuary workers involved in preparing (e.g., for burial or cremation) the bodies of people who are known to have, or suspected of having, COVID-19 at the time of their death.
Medium Exposure Risk
Medium exposure risk jobs include those that require frequent and/or close contact with (i.e., within 6 feet of) people who may be infected, but who are not known or suspected COVID-19 patients. In areas without ongoing community transmission, workers in this risk group may have frequent contact with travelers who may return from international locations with widespread COVID-19 transmission. In areas where there is ongoing community transmission, workers in this category may have contact with the general public (e.g., schools, high-population-density work environments, some high-volume retail settings).
Lower Exposure Risk (Caution)
Lower exposure risk (caution) jobs are those that do not require:
- 1. contact with people known to be, or suspected of being, infected; nor
- 2. frequent close contact with (i.e., within 6 feet of) the general public.
Workers in this category have minimal occupational contact with the public and other coworkers.
What to do to protect workers
|Low Risk (Caution)||Medium Risk||High and Very High Risk|
|General Guidance||Follow steps all employers can take.||Follow steps all employers can take.||Follow steps all employers can take.|
|Engineering Controls||+ Additional engineering controls not recommended.
+ Ensure current engineering controls function as intended.
|+ Physical barriers such as clear plastic sneeze guards, where feasible.||+ Air-handling systems for healthcare facilities.
+ Patients with known/suspected COVID-19 should be placed in airborne infection isolation room (AIIR), if available.
+ Use isolation rooms when available when performing aerosol-generating procedures on patients with known/suspected COVID-19.
+ Use special precautions associated with Biosafety Level 3 when handling specimens from known/suspected COVID-19 patients.
|Administrative Controls||+ Monitor public health communications about COVID-19 recommendations.
+ Determine effective communication strategies with workers.
|+ Consider offering face masks to ill employees and customers until they are able to leave workplace.
+ Keep customers informed about symptoms and ask sick customers to minimize contact with workers.
+ Where appropriate, limit worksite access.
+ Consider strategies to minimize face-to-face contact.
+ Communicate availability of screening and other health resources.
|+ If working in healthcare facility, follow existing guidelines for identifying/isolating infected individuals.
+ Consider cohorting (grouping) COVID-19 patients when single rooms are not available.
+ Post signs requesting patients and family members to immediately report symptoms of respiratory illness on arrival and use disposable face masks.
+ Consider enhanced medical monitoring of workers
+ Provide all workers job-specific education and training on preventing transmission of COVID-19.
+ Ensure psychological and behavioral support is available.
|Personal Protective Equipment||+ Additional PPE not recommended.
+ Continue using ordinarily-used PPE.
|+ Consider combination of gloves, gown, face mask/shield or goggles.
+ PPE will vary by work tasks, result of employer determination, and types of exposure.
|+ Likely need gloves, a gown, face shield or goggles, and either a face mask or respirator depending on job tasks and exposure risks.
+ Those who work in contact or within 6 feet of patients known, suspected, or infected should wear respirators.
+ Laboratory/morgue workers may need additional PPE against blood, bodily fluids, chemicals, and other materials.
+ Workers who dispose of PPE and other infectious waste must also be trained and provided appropriate PPE.
|Safe Work Practices||NA.||NA||+ Provide emergency responders and other essential personnel working away from fixed facilities with alcohol-based hand rubs containing at least 60% alcohol.|
For more information
With the situation evolving day-by-day, government directives and recommendations are also changing frequently. It can be overwhelming to keep up with all the information and difficult to know where to look for the right steps to take. We’ve designated this area of our blog to post important updates and share key resources and guidelines you need to best protect your employees and yourselves.
In addition to checking this area of our blog, follow us on social media to receive notifications when we share important information.
Ultimately, federal, state, and local government agencies are the best source of information in the event of an infectious disease outbreak. Check out the resources below for the latest developments and guidance. Also be sure to check your state medical, dental or veterinary boards (as applicable) for guidance on things like seeing patients, practice closure directives, and more.
- + Centers for Disease Control and Prevention COVID-19 webpage: www. cdc.gov/coronavirus/2019-ncov
- + OSHA COVID-19 webpage: www.osha.gov/covid-19
- + OSHA Guidance on Preparing Workplaces for COVID-19: OSHA Publication OSHA 3990-03 2020
- + National Institute for Occupational Safety and Health COVID-19 webpage: https://www.cdc.gov/niosh/emres/2019_ncov.html