Refining the layers of prevention: adding masks, customizing toolboxes

An infectious disease specialist explains why masks are only part of the COVID-19 response

By Dr. Robyn Harrison

However diverse the experiences, every business and industry has been impacted in some way by the COVID-19 pandemic. Its corona has spared no one. Despite this, Canadians are coming together in novel ways, across specialties and disciplines, and industries are ready to meet this challenge.

In light of today’s rapid global information sharing, this is a moment for leaders to ask themselves how they might choose to hit media headlines in the event that this should occur. Certainly no one strives to be portrayed as an industry plagued by outbreak, but some may see opportunity to be portrayed as the business driving the tailored layers of prevention.

Businesses ready to excel and adapt through the pandemic as leaders in prevention will, of course, stand to gain more than just favourable publicity and good health. Exposure to a single COVID-19 case (even without further outbreak), can lead to a significant number of quarantines (by law) and operational and financial impacts, affecting both individuals
and businesses.

It has become evident through science that people infected with SARS-CoV-2 (the virus that causes COVID-19) are most contagious in the first few days of their sickness or even just before they recognize symptoms from COVID-19. Furthermore, while COVID-19 can be astonishingly mild for some, it can be deadly for others. Therefore, tailored-to-setting prevention measures are certainly high yield. 

How should it be done?

The key is to work in layers by combining practical and specific on-site knowledge (think floor plans, work or production schedules, break room spaces, etc.) with the more general expert guidance being issued by Canadian and provincial public health officials.

A tour of published outbreaks from around the world reveals trends, illuminates areas of risk, and confirms one thing unequivocally: this virus has not gone away.

SARS-CoV-2 resurfaces when a guard is let down. Knowledge of this, combined with analysis of the virus and its spread, help to hone present day public health and infection prevention messages. This also underscores why no single prevention measure stands alone. 

Frontline and management teams are advised to avoid what global experts have dubbed the ‘Three Cs’: crowded spaces, confined spaces, and close person-to-person contacts. This applies when on the job, at break times, and in the community.

Translated, this means that risk of the disease spreading from one person to another is lower:

• outdoors;

• when hand washing is routinely and correctly done (20 seconds with alcohol-based hand rubs or soap and water will work)

• when people are spaced two metres apart (physical distancing);

• when fewer individuals mix in-person (virtual is the way to go when possible);

• when anyone sick is supported to speak honestly and stay home from work (preventing importation of infection into the workplace); and

• when those ill have access to COVID-19 testing and tracing (so that others can be placed on quarantine when applicable to prevent outbreak); and

• when masks are worn by everyone.

The new kid on the block in the prevention toolkit is ‘masking for all.’ Wearing a three-layer (ideally with a polypropylene layer) cloth mask
is recommended.

Personal protective equipment such as a mask is certainly not new to industry, but its placement in break room settings or at business meetings or during travel is novel to some. 

Why does adding masks to existing measures make sense?

Masks work in part by containing the wearer’s respiratory droplets. Droplets carrying virus can emerge from speaking, shouting, or singing. Physical distancing (spacing two metres apart from others at meetings, during breaks or mealtimes, or in work areas) can also help minimize the spread of a person’s droplets.

With key points about how the virus spreads in mind, it is easier to understand how an ‘everyone in’ approach to masking and physical distancing can protect. 

Some have implied that ‘masking for all’ as a lone prevention measure will suffice. Not so. No single prevention measure stands alone at this stage.

Masking is simply an addition to the prevention pyramid – the ‘hierarchy of controls. Analogous to a mask itself, industry needs layers of protection for the frontline. The hazard – in this case a virus – has not gone away.

How far can the current layers of prevention and protection take us?

This is the time to shine a spotlight on how each business is optimally tailoring the bundle of measures to their setting. Bringing industries across the Prairies back up to full speed involves refining the layers of protection for the frontline.

This is not a ‘one mask solves all’ scenario, rather a time to place the masks as ‘cherry on top.’ Accomplishing this will pave secure paths forward. 

Dr. Robyn Harrison is an Infectious Disease Specialist who works in Edmonton, Alberta and a Clinical Professor at the University of Alberta. She is also a Communicable Disease Consultant for the province-wide Alberta Health Services Workplace Health and
Safety Program.