On behalf of our public employee clients, we are actively monitoring developments relating to the spread of Coronavirus disease 2019 (COVID-19). One of a labor union's primary responsibilities is to protect its members and ensure that they have the best and safest working conditions - especially when a pandemic threatens.

Northern California has become an epicenter of the virus's spread due to the area's economic importance and its status as a popular tourist destination. Today, California declared a State of Emergency. Further spread of the virus throughout the state and nationally is inevitable. Below is a summary of how COVID-19 can be spread, the symptoms, best practices and the steps your employer should be taking to protect its employees.

Symptoms

Fever, cough and shortness of breath, which may appear 2-14 days after exposure. Reported illnesses have ranged from mild symptoms to severe illness.

How the virus is spread

According to the Centers for Disease Control and Prevention (CDC), the current understanding of this new disease is that it spreads mainly from person-to-person through respiratory droplets. These are produced when an infected person coughs or sneezes and can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. These droplets also land on surfaces or objects, which may spread the disease on contact.

People are thought to be most contagious when they are at their sickest (i.e., showing the most symptoms). However, some spread might be possible before people show symptoms. There have been reports of this occurring with COVID-19, but this is not thought to be the main way the virus spreads.

Best practices to protect against its spread

It is recommend that you do the following to keep yourself safe:

-The best course of action for public safety employees during this evolving crisis is to maintain vigilant hand hygiene. This includes washing your hands often with soap and hot water. If soap and water are not available, use an alcohol-based hand rub. (Look at the ingredient list to be sure it is more than 60% alcohol-based.) You should also use nitrile gloves.

-Avoid customary handshaking.

-Stay up-to-date on all required immunizations, including the flu shot. Although the flu shot will not protect you from COVID-19, it will help prevent the flu which has similar symptoms to this Coronavirus.

-Cover your nose and mouth when you sneeze or cough with a tissue or flexed elbow.

-After using a tissue, throw it in the trash and wash your hands.

-Avoid touching your eyes, nose, and mouth. Germs spread this way.

-Clean and disinfect surfaces and objects that may be contaminated.

-Avoid close contact with anyone with cold or flu-like symptoms.

-If you feel sick-stay home! Limit contact with others as much as possible to keep from infecting them.

-If you have flu-like symptoms, the CDC recommends that you stay home for at least 24 hours after your fever is gone, except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine.) Immediately contact your healthcare provider if conditions and symptoms get worse.

-If prescribed antiviral medication, complete the entire treatment regimen.

-Use personal protective equipment whenever there is an expectation of possible exposure and maintain proper procedures to handle and clean equipment after such exposure. More details below.

-Stay up-to-date on information about the COVID-19 outbreak, which can be obtained from the CDC's website. Local and state public health departments are also excellent sources of information concerning this epidemic.

CDC Recommendations for making contact with individuals infected with COVID-19

Emergency Medical Services Personnel

In addition to the above recommendations, we summarize below the CDC's recommendations for Emergency Medical Services (EMS) personnel making contact with individuals confirmed or suspected to have COVID-19, which are found on its website.

These recommendations are as follows:

-If a patient is suspected of having COVID-19, EMS clinicians should put on appropriate Personnel Protective Equipment (PPE) before entering the scene. EMS clinicians should consider the signs, symptoms, and risk factors of COVID-19.

-If information about potential for COVID-19 has not been provided by the 911 Public Safety Answering Points (PSAPs), EMS clinicians should exercise appropriate precautions when responding to any patient with signs or symptoms of a respiratory infection. Initial assessment should begin from a distance of at least 6 feet from the patient, if possible. Patient contact should be minimized to the extent possible until a facemask is on the patient. If COVID-19 is suspected, all PPE as described below should be used. If COVID-19 is not suspected, EMS clinicians should follow standard procedures and use appropriate PPE for evaluating a patient with a potential respiratory infection.

-Recommended PPE.

-A single pair of disposable patient examination gloves. Change gloves if they become torn or heavily contaminated.

-Disposable isolation gown.

-Respiratory protection (i.e., N-95 or higher-level respirator).

-Eye protection (i.e., goggles or disposable face shield that fully covers the front and sides of the face).

-A facemask should be worn by the patient for source control. If a nasal cannula is in place, a facemask should be worn over the nasal cannula. Alternatively, an oxygen mask can be used if clinically indicated. If the patient requires intubation, special procedures should be followed.

-During transport, limit the number of providers in the patient compartment to essential personnel to minimize possible exposures.

-EMS clinicians who will directly care for a patient with possible COVID-19 infection or who will be in the compartment with the patient should follow Standard, Contact, and Airborne Precautions, including the use of eye protection.

-Drivers, if they provide direct patient care (e.g., moving patients onto stretchers), should wear all recommended PPE. After completing patient care and before entering an isolated driver's compartment, the driver should remove and dispose of PPE and perform hand hygiene to avoid soiling the compartment.

-If the transport vehicle does not have an isolated driver's compartment, the driver should remove the face shield or goggles, gown and gloves and perform hand hygiene. A respirator should continue to be used during transport.

-All personnel should avoid touching their face while working.

-On arrival, after the patient is released to the facility, EMS personnel who came into contact with the patient should do the following:

-Remove and discard PPE and perform hand hygiene. Used PPE should be discarded in accordance with routine procedures.

-Properly handle, clean, and disinfect individual care equipment, instruments, and devices. Any items that are not disposable and come into contact with an individual who potentially may be infected must be cleaned and disinfected. Items that are disposable must be disposed of properly.

-Handle textiles, uniforms, and laundry carefully. Avoid shaking the clothes. Bag or otherwise contain contaminated textiles for proper care and cleaning. Be sure to follow fabric-care instructions and special laundering requirements of all textiles or clothing according to agency policy. Package, transport, and store clean textiles or uniforms so they are protected during transport and unloading so they are clean for future usage.

-EMS personnel who have been exposed to a patient with suspected or confirmed COVID-19 should notify their chain of command to ensure appropriate follow-up.

-Any unprotected exposure (e.g., not wearing recommended PPE) should be reported to occupational health services, a supervisor, or a designated infection control officer for evaluation.

-EMS clinicians should be alert for fever or respiratory symptoms (e.g., cough, shortness of breath, sore throat). If symptoms develop, they should self-isolate and notify occupational health services and/or their public health authority to arrange for appropriate evaluation.

-Documentation of patient care should be done after EMS clinicians have completed transport, removed their PPE, and performed hand hygiene. The documentation should include a listing of EMS clinicians and public safety providers involved in the response and level of contact with the patient (for example, no contact with patient, provided direct patient care). This documentation may need to be shared with local public health authorities.

-Special guidelines should be followed to clear EMS Transport Vehicles after transporting a patient with confirmed COVID-19.

Law Enforcement

The CDC also provides recommendations for law enforcement officers making contact with individuals confirmed or suspected to have COVID-19.

-Law enforcement officers should keep a distance of 6 feet from the individual who is confirmed to have or is suspected of having COVID-19.

-Officers should have a trained Emergency Medical Service/Emergency Medical Technician assess and transport anyone they think might have COVID-19 to a healthcare facility.

-If the officers must make contact with individuals confirmed or suspected to have COVID-19, they should follow the above procedures for EMS.

-If close contact occurred during apprehension, the officers should follow the above procedures for EMS with respect to cleaning their duty belt and other gear, containing and disposing of PPE, and containing and laundering clothes.

California regulations concerning protections against aerosol transmissible diseases at the workplace may be applicable:

Given the disease's likely ability to infect persons in this manner, we believe that the provisions of Section 5199 of Title 8 of the California Code of Regulations, entitled "Aerosol Transmissible Diseases," apply to protect, minimally, law enforcement and fire employees. We encourage you to make sure that your department is aware of its responsibilities under this regulation. To summarize, Section 5199 mandates the following:

-Written Procedures and Safeguards: Your employer shall establish written infection procedures to control the risk of transmission of COVID-19, which incorporate State of California guidelines, including the screening and referral of cases and/or suspected cases of COVID-19 and an exposure control plan.

-Protective Equipment: The employer shall provide all safeguards required by Section 5199, including provision of personal protective equipment, respirators, training, and medical services, at no cost to you or other employees, at a reasonable time and place for you and other employees, and during working hours.

-Respirators:

-Where respirator use is required, your employer shall provide at no cost to you a respirator that is at least as effective as an N95 filtering facepiece respirator, unless the employer's evaluation of respiratory hazards determines that a more protective respirator is necessary. Your employer shall also provide medical evaluations of employees required to use respirators; fit testing procedures for tight-fitting respirators; procedures for proper use of respirators in routine and reasonably foreseeable emergency situations; procedures for cleaning, storing, inspecting, repairing, and discarding respirators.

Keep in mind that the CDC has not indicated (as of March 3, 2020) that public employees should wear protective masks during the course of their regular duties unless they must make contact with individuals confirmed or suspected of having COVID-19.

-Where respirator use is not required, your employer may provide respirators at your request or permit you to use your own respirator, if the employer determines that such respirator use will not in itself create a hazard. Your employer must establish and implement procedures to ensure that any employee using a respirator voluntarily is medically able to use that respirator, and that the respirator is cleaned, stored, and maintained so that its use does not present a health hazard to the user.

-Medical services: Your employer shall provide to any employee with occupational exposure the necessary medical services for COVID-19, in accordance with applicable public health guidelines.

-Training: Your employer shall ensure that all employees with occupational exposure participate in a training program. Where respirator-use is required, your employer shall train employees in the respiratory hazards to which they are potentially exposed during routine and emergency situations.

-Employee contact with individuals infected by COVID-19: In cases involving individuals who are identified as having COVID-19, these individuals shall be provided with disposable tissues and hand hygiene materials and masked or placed in such a manner that contact with employees who are not wearing respiratory protection is eliminated or minimized until transfer can be accomplished. Your employer shall ensure that this placement or transfer is effected in a timely manner.

-Recordkeeping: Your employer shall establish and maintain an accurate medical record for each employee with occupational exposure. The employer shall ensure that all employee medical records required by this section are kept confidential.

Other steps your employer should take

In addition to the above Section 5199 requirements, we recommend that your employer do the following:

-Provide additional hand sanitizers and surface wipes.

-Increase wipe down of counters and workstations.

-Increase posted literature on proper health precautions.

-Identify meetings that can be accomplished on-line.

-Message employees and the public on effective protective measures.

-Ensure timely and consistent communication internally with employees and externally with the community.

-Protect and prioritize the safety and wellbeing of its workforce, including putting in place hygiene protocols beyond Section 5199 and social distancing strategies such as telecommuting/work from home accommodations, alternate work schedules, modifying workplace behavior to reduce person-to-person contact that can mitigate transmission of illness by increasing physical distance or reducing frequency of congregation in socially dense community settings, such as schools or workplaces.

THE SPREAD OF COVID-2019 IS A SERIOUS ISSUE. WE URGE YOU TO CONTACT YOUR EMPLOYER ON BEHALF OF YOUR MEMBERS TO LEARN MORE ABOUT ITS RESPONSE PLANS AND THE TYPES OF EQUIPMENT IT HAS AVAILABLE TO PROTECT YOU AND YOUR MEMBERS.

If you have any questions about this alert, please contact Gregg Adam or Matthew Taylor.