The current Ebola outbreak is a public health challenge, and global concern regarding the spread of the disease is understandable. It is important for businesses to keep the risks associated with this disease in perspective by staying informed regarding the evolving situation, and taking this opportunity to better prepare themselves.
- The World Health Organization (WHO) considers Ebola virus disease (EVD) a severe illness in humans, and reports an average 50% fatality rate in infected populations.
- Ebola is transmitted ONLY through direct contact with the blood or bodily fluids of an infected, symptomatic person, or through contact with objects such as needles, bedding, and discarded clothing that have been contaminated with infected secretions. The virus is NOT airborne nor is it spread through food or water. Ebola's rapid onset and high mortality levels are alarming, but other diseases, such as influenza, occur much more frequently and with greater impact.
- The current complexity and rapid spread of Ebola in West Africa is a result of limited health care and infrastructure resources. While the chances of a major Ebola outbreak occurring in an industrialized nation are minimal, the diagnosis of several cases of Ebola virus in travelers arriving into the United States and Canada has raised concern.
- The Centers for Disease Control (CDC) in the United States and Canada consider the risk of the spread of Ebola in those countries to be very low. However, awareness of the disease should serve as a reminder that employers-especially those who have workers traveling to foreign countries- should have procedures in place to control the spread of infectious diseases in the workplace.
Potential Employment Issues:
Employers are paying close attention to how the Ebola outbreak might affect work spaces given the high profile response from the Centers for Disease Control (CDC). Some news reports indicate that CDC officials have requested changes in the US quarantine laws in order to gain easier access to airline and ship passenger lists, provide patients with a clearer appeals process when subjected to quarantines, and give health officials explicit authority to offer vaccinations and medical treatment to those quarantined. Given these developments, what should be the response of employers to the Ebola incident and to workplace health concerns in general?
Some observers suggest employers may have a legal obligation under the Occupational Safety and Health Act (OSHA) in the United States or the Canada Labour Code to take steps to protect the health of employees traveling to Ebola risk areas on business. Although regulations offer only limited guidance about Ebola (e.g., record-keeping requirements, mandatory protective equipment rules and other generalized duties), employers are required to provide a workplace "free from recognized hazards that are causing or are likely to cause death or serious physical harm." While providing a workplace absolutely free of all recognized hazards may be difficult, employers should provide employees with travel safety training.
When travel to high-risk areas cannot be postponed, employees should be trained about the risks of exposure to, and the protocols for reducing the incidence of, infection. In addition to ensuring vaccinations are up-to-date before departing, travelers should be advised to assemble a health kit containing basic first-aid and medical supplies. Travelers should also review their health plans for medical evacuation coverage, and identify health care resources available in their destination country prior to departure.
After returning home, travelers should carefully monitor their health and report their recent travel and any symptoms to their healthcare provider. Employers should also encourage workers to stay home if they are sick so that they will not infect others.
Potential Legal Implications:
Employers need to be aware of conditions created by their unique operations, work environment and geographic locations that may impact their ability to maintain a workplace free of recognized hazards.
Employers must use caution to avoid violating federal and state employment laws, particularly those governing the use of employee medical information and prohibiting discrimination on the basis of a perceived disability.
An employer may require workers who are at a higher risk for Ebola, or who may exhibit symptoms, to obtain medical certification before returning to work in order to ensure the safety of other employees in the workplace. Wage and hour laws may present challenges for employers who prohibit employees from returning to work after traveling to Ebola-affected areas - particularly in cases where workers are being asked to stay home. When affected employees are represented by a union, an employer may have a duty to consult with the union before implementing Ebola-related measures.
Should employers encounter a situation that demands immediate action, workers should be given time off with pay if they are required to stay home due to Ebola concerns. Above all, the employer should fully document the basis for its decisions and use reasonable care to ensure that workers are treated fairly and that their privacy rights are respected.
How Organizations Should Prepare:
Although Ebola is not likely to become a pandemic, business leaders should leverage their employees' increased attention to the issue to enhance organizational preparedness. Some useful tips include:
- Promote the practice of careful hygiene; encourage healthy employees to come to work and ill employees to stay home.
- Minimize disruptions by identifying critical processes and functions that must continue for the business to remain viable, ensuring redundancy in key roles.
- Determine minimum staffing levels needed to sustain operations. Consider stockpiling inventories in case supply chains are interrupted.
- Evaluate critical suppliers and customers, and develop operational contingency plans should they become unavailable.
- Allow employees to telecommute if their jobs permit it, or stagger work hours in order to limit the spread of disease.
- Develop strategies for communicating with employees, customers, consumers, and the media.
- Consider expanding online business opportunities.
- Promote awareness of disease control protocols.
- Review sick and disability leave protocols, as well as any government-mandated leave policies.
- Consider travel restrictions for employees to high-risk areas, and ensure evacuation plans are in place for those employees who must travel to these zones.
- Should an employee or visitor become ill while on premises, Make sure they receive prompt medical attention. Cleaning staff should use EPA suggested disinfectants and cleaning methods.
Special Consideration for Healthcare Organizations:
Exposure prevention measures for healthcare workers potentially exposed to the Ebola virus are outlined by the US Occupational Safety and Health Administration (OSHA) and US Centers for Disease Control and Prevention (CDC); and by the Public Health Agency of Canada (PHAC).
Healthcare workers who risk exposure to the virus should be equipped with appropriate personal protective equipment (PPE), including masks, gloves, gown and eye covering. Proper infection control, sterilization measures and patient isolation protocols must be followed.
In a healthcare setting:
- Information on the Ebola threat and appropriate protective measures to be taken should be communicated to all potentially exposed staff and any employee, vendor or contractor that may have potential patient contact. Additionally, staff should be retrained on skills for infection prevention and control, including the appropriate use of PPE.
- Frontline healthcare workers (especially ER, intake and primary care workers) should be fully aware of the symptoms of Ebola and prepared to implement universal precautions as warranted. Staff should inquire about travel or recent contact with travelers when evaluating patients.
- Universal precautions should be used for all patients with fever, nausea, muscle pain, etc. - even prior to further examination or laboratory testing. Both patients and staff should be using surgical type masks for droplet protection, and practicing good personal hygiene (especially hand washing).
- If Ebola is suspected, patient isolation procedures should be implemented and staff should follow contact precautions as recommended by the CDC guidance referenced later in this document.
- Exposure of staff and family members to patients with suspected or confirmed cases should be controlled.
- Maximum biological containment procedures should be followed for laboratory samples and laboratory testing of samples from patients, as these samples are an extreme biohazard risk.
- Housekeeping and cleaning staff should follow the CDC guidance in handling any soiled laundry or equipment/surfaces that may have contacted with potentially infected body fluids. Standard disinfection protocols for highly infectious materials should be strictly followed. Heavily soiled laundry, bedding, clothing should be incinerated.
- Deceased Ebola patients are still a risk and should be handled with the same level of precautions as those infected, and should be placed in body bags and sealed caskets as soon as practical.
Considerations for Travelers:
Given the CDC's travel advisory, businesses should seriously consider postponing business related travel to the areas of West Africa where the Ebola outbreak is occurring. That being said, exposure to Ebola in the general business environment should be less than that in the healthcare industry. But in any case, adequate precautions/preparations should be taken to minimize exposure:
- Employees traveling to Western Africa should consult with their physician regarding appropriate vaccinations and other inoculations before the trip.
- If travel to affected areas is necessary, the WHO and CDC suggest:
- Individuals planning to work/meet in a healthcare setting should carefully follow standard precautions and infection control.
- Travelers should avoid contact with animals (alive or dead) and assure that any milk consumed is pasteurized and meat is cooked thoroughly. Also, facilities that prepare meats (such as slaughter houses) should be avoided.
- Avoid close, unprotected contact with sick people.
- Ensure good personal hygiene (particularly thorough hand washing).
- Some countries in West Africa have instituted screening protocols at airports and border crossings to identify individuals with high fever and other illness.
- Upon return, employees or visitors who have traveled to the West Africa should monitor themselves for symptoms for 21 days. If these employees or visitors develop symptoms, they should stay home from work and seek medical attention immediately. They should provide the healthcare facility with advance notice of the potential of Ebola exposure so that isolation precautions can be taken upon arrival. Individuals (e.g., passengers or crew members) who have been exposed to Ebola should not travel on commercial airplanes until they have been monitored for symptoms for 21 days and cleared by a physician.
- If employees traveling in Western Africa note symptoms, they should seek medical care locally before returning home. This helps minimize the chances of disease spread during passage. If possible, they should visit healthcare facilities with a good track record of infection control/treatment. Travel protection services, if engaged prior to departure, may assist in identifying appropriate medical providers and in providing other support to the traveler.
- Based on CDC guidance, crew members on a flight where a passenger or colleague becomes ill with fever, jaundice or bleeding should separate the sick person as much as possible from others; provide a surgical mask to prevent droplet spread; and use impermeable gloves during direct contact with blood, bodily fluids or items contaminated with blood (e.g., syringes). Crew members should practice good personal hygiene (particularly hand washing). Airlines may wish to provide Universal Precaution Kits for crews.
- The captain of an aircraft bound for the United States or Canada is required to report ill travelers onboard to the CDC prior to arrival.
For More Information:
The following websites are excellent resources for further information and updates: