Non-Pharmacological Interventions for Pandemic Mitigation: What you should know (Part 3)

In previous articles in this series, I have discussed the evidence for and against several Non-Pharmacological Interventions (NPIs) for mitigation of pandemic influenza. In the first article, I discussed the similarities and differences between pandemic influenza and SARS-CoV-2, and how we could learn from research into NPIs for mitigation of pandemic influenza to take considered decisions regarding mitigation of COVID-19.

This article will continue the discussion on NPIs, and will discuss workplace measures and closures.

Workplace measures and closures

Background information:

Workplace measures include:

  • Paid-leave policy
  • Telework from home
  • Staggered shifts (having different activity and meal times, and times of entry and exit from the workplace)
  • Reduced contact
  • Weekend extension

Telecommuting: Working from home using the internet or phone

Findings

A total of 19 studies were included in the systematic review, of which 12 were simulation studies.

The implementation of a workplace measure alone was associated with a median 23% reduction in cumulative incidence.

Simulation studies also showed a delay and reduction in peak influenza attack rate, but the effectiveness declined with

  • Higher basic reproductive number (R0)
  • Delay in implementation of the intervention

A quasi-cluster RCT from Japan showed that paid sick leave policy reduced the overall risk of influenza A (H1N1) by ~20% in one influenza season.

Workplace measures showed greater effectiveness when combined with other interventions (school closures, personal protective measures and antiviral drugs).

All six studies investigating the effectiveness of workplace closure were simulation studies.

Simulations suggested that workplace closures were less effective than other interventions.

One simulation study predicted that workplace closure alone would have little impact.

Large-scale workplace closures could delay epidemic peak for 5-10 days, and small-scale closures may have a modest impact on attack rate or peak number.

A study in the USA showed that 28% of employed respondents feared losing their jobs or businesses as a result of having to stay home from work for 7-10 days in the event of a pandemic influenza outbreak.

Workplace closure would cause less severe personal economic crises for those who received pay while they worked remotely. However, in many organizations/ institutions, the proportion of such individuals is likely to be small (In an educational institution, members of administration and most teachers may be able to work remotely, but employees from housekeeping, transport, maintenance, canteen/cafeteria, etc. won’t. If school closure has been mandated, these latter personnel risk loss of pay for the duration of closure. Ironically, the most vulnerable are often the most affected, as they do not have a buffer/ safety net. Contractual and daily wage workers will also be severely affected, especially if the economic impact of closures results in downsizing of workforce, and an economic recession.).

Telecommuting is feasible in very limited and selected settings only.

In developing countries the majority of economic activities depend on on-site presence. Even in high-income countries, transitioning most services/ jobs online will not be easy, and pose technological challenges in the short-term.

Several trades, services and industries are largely on-site (construction, hospitality, food, logistics, etc.).

Large-scale workplace closures are likely to be disruptive and have substantial economic consequences, creating an economic burden for governments.

The most costly strategy considered in a simulation study was that of continuous school closure with a continuous 50% workplace non-attendance. This scenario has the highest overall cost (US$ 103 million) and the highest cost per prevented case (US$ 9894 per case).

A survey in the USA found that self-employed individuals and those unable to work from home might be unable to comply with recommended workplace measures because of job insecurity and financial considerations.

Employees will accept workplace closures only if there is no anxiety regarding job security and income replacement.

Social equity concerns may be exacerbated by workplace closure due to the lack of income to pay for necessities in lower income families.

Self-employed and low-income families have a higher risk of suffering from financial problems as a result of workplace measures. Unless the government steps in with a substantial package to support such people, most will slip into heavy debt and severe financial/ personal crises. Low-income countries are therefore likely to avoid workplace measures and closures in an attempt to safeguard the economy. This will have other consequences for the spread of infection, and raise several ethical challenges.

Most stakeholders are unlikely to find workplace closures acceptable.

Telework, paid-leave policy and staggered shift measures are unlikely to be feasible in most circumstances.

Overall, mandated workplace closure is unlikely to be feasible.

Quality of evidence: There is very low quality of evidence that workplace measures and closures reduce influenza transmission.

Overall strength of recommendation: Conditionally recommended

The balance between the advantages and disadvantages of implementing workplace measures and closures is uncertain.

Workplace closures may only be warranted as an extreme social distancing measure in an extraordinarily severe pandemic.

Notes: The criteria for determining what constitutes an extraordinarily severe pandemic have not been defined.

The optimum timing and duration of workplace measures and closure have not been investigated adequately.

There is a need for studies investigating the potential impact of workplace measures and closures on families and public.

Useful Links:

Link to previous articles on Non-Pharmacological Interventions for Pandemic Mitigation:

https://communitymedicine4all.com/2020/08/05/non-pharmacological-interventions-for-pandemic-mitigation-what-you-should-know-part-1/

https://communitymedicine4all.com/2020/08/12/non-pharmacological-interventions-for-pandemic-mitigation-what-you-should-know-part-2/

Link to the related WHO document:

https://apps.who.int/iris/bitstream/handle/10665/329438/9789241516839-eng.pdf?ua=1

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