Friday, August 21, 2020

HVAC Systems and COVID-19

 HVAC Systems and COVID-19

Do we need to protect employees from our building’s air conditioners?

 

Cause for concern?

In one study, available online as a preprint and has not undergone scientific review, researchers in Oregon collected samples from various places inside a hospital’s HVAC system and found genetic material from the virus that causes COVID-19. This demonstrates that it may be possible for the virus to be transmitted through HVAC systems.

The research started late; the final evidence is not in yet

However, researchers did not assess if the genetic material they found was able to cause infection, and they noted there were no confirmed COVID-19 cases associated with the samples found in the ventilation systems.

There is currently no conclusive evidence documenting the possibility of COVID-19 transmission through an air conditioning unit.

The known risk is non-circulation indoors

The known risk is that hot weather outside makes people seek air-conditioned comfort indoors. And indoors, there is less ventilation and more opportunity to spread disease. The risk to healthcare workers is that we are indoors and, on occasion, not socially distancing and rebreathing the air that people have just exhaled.

When we shut the doors and windows to keep the hot air outside, we are essentially eliminating the flow of fresh air, so everyone in the room is breathing and rebreathing the same air. If someone in the room is infected with COVID-19, then they are breathing out the virus, which can linger in airborne droplets and be inhaled by another person, potentially causing infection.

By comparison, if you were outside and near an infected person who breathed out some viral particles, there is a much larger volume of air flowing to disperse and dilute those particles quickly, reducing the risk of spread to another person nearby. That is why infectious disease experts consider outdoor gatherings and activities less risky than indoor ones (though not completely risk-free).

Another suspected risk of air conditioning

The other significant risk is that air conditioning units, fans, or even an open window can create strong enough air currents to move virus-containing droplets around a room. This happened in January at a restaurant in Guangzhou, China, where a person with COVID-19 infected five other people sitting at neighboring tables from 3 to 6 feet away, according to a study by scientists from the Chinese Center for Disease Control and Prevention. After examining video footage of the diners who were infected and simulating the transmission of the virus, scientists concluded that the small outbreak was caused by strong air currents from the air conditioning unit above the diners, which was blowing virus-containing aerosols from an infected person to those nearby. The restaurant also had no windows — and thus no ventilation bringing in fresh air and diluting virus particles in the air.

A clue: Flu particles can travel 30 feet in the air

The fact that aerosolized viral droplets can move in air currents in this way means that if you are in a room with an infected person and fresh air is not circulating, even if you are socially distancing to keep 6 feet apart at a minimum, you may not be safe.  Although there are currently no published studies that have examined precisely how far airborne COVID-19 particles can travel, previous research on influenza found that viral particles may travel upward of 30 feet in the air.

To be clear, this is only a concern in shared public places. At home, the risk of contracting COVID-19 through air currents or air conditioning units is no more likely than spreading the virus through close contact or touching contaminated surfaces.

CDC Engineering recommendations for protecting employees right now:

  • Modify or adjust seats, furniture, and workstations to maintain social distancing of 6 feet between employees, where possible.

o   Install transparent shields or other physical barriers where possible to separate employees and visitors where social distancing is not an option.

o   Arrange chairs in reception or other communal seating areas by turning, draping (covering the chair with tape or fabric so seats cannot be used), spacing, or removing chairs to maintain social distancing.

  • Use methods to physically separate employees in all areas of the building, including work areas and other areas such as meeting rooms, break rooms, parking lots, entrance and exit areas, and locker rooms.

o   Use signs, tape marks, or other visual cues such as decals or colored tape on the floor, placed 6 feet apart, to show where to stand when physical barriers are not possible.

o   Replace high-touch communal items, such as coffee pots and bulk snacks, with alternatives such as pre-packaged, single-serving items. Encourage staff to bring their own water to minimize the use and touching of water fountains or consider installing no-touch activation methods for water fountains.

o   Consider taking steps to improve ventilation in the building, in consultation with an HVAC professional, based on local environmental conditions (temperature/humidity) and ongoing community transmission in the area:

o   Increase the percentage of outdoor air (e.g., using economizer modes of HVAC operations) potentially as high as 100% (first, verify compatibility with HVAC system capabilities for both temperature and humidity control as well as compatibility with outdoor/indoor air quality considerations).

o   Increase total airflow supply to occupied spaces, if possible.

o   Disable demand-control ventilation (DCV) controls that reduce air supply based on temperature or occupancy.

o   Consider using natural ventilation (i.e., opening windows if possible and safe to do so) to increase outdoor air dilution of indoor air when environmental conditions and building requirements allow.

o   Improve central air filtration:

      •  Increase air filtration to as high as possible without significantly diminishing design airflow.
      •   Inspect filter housing and racks to ensure appropriate filter fit and check for ways to minimize filter bypass.

o   Consider running the HVAC system at maximum outside airflow for 2 hours before and after occupied times, in accordance with industry standards.

o   Generate clean-to-less-clean air movements by re-evaluating the positioning of supply and exhaust air diffusers and/or dampers and adjusting zone supply and exhaust flow rates to establish measurable pressure differentials. Have staff work in “clean” ventilation zones that do not include higher-risk areas such as visitor reception or exercise facilities (if open).

  • Consider using portable high-efficiency particulate air (HEPA) fan/filtration systems to help enhance air cleaning (especially in higher-risk areas).
  • Ensure exhaust fans in restroom facilities are functional and operating at full capacity when the building is occupied.
  • Consider using ultraviolet germicidal irradiation (UVGI) as a supplemental technique to inactivate potential airborne virus in the upper-room air of common occupied spaces, in accordance with industry guidelines.

CDC References and links for these recommendations are found here: https://www.cdc.gov/coronavirus/2019-ncov/community/office-buildings.html


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Thursday, August 13, 2020

Dangerous Hand Sanitizers


The FDA's list of dangerous hand sanitizers is now at 100+

On August 7, 2020, the FDA issued updated guidance to provide additional clarification on testing of alcohol used in hand sanitizers manufactured under FDA’s temporary policies to help ensure that harmful levels of methanol are not present in these products. This testing will help ensure widespread access to alcohol-based hand sanitizers that are free of contamination.

The FDA updated their guidance to provide clarification that companies must test each lot of the active ingredient (ethanol or isopropyl alcohol (IPA)) for methanol if the ethanol or IPA is obtained from another source. The FDA recommended using the test methods described in the USP monograph for alcohol (ethanol) and conducting the testing in a laboratory that has been previously inspected by the FDA and is compliant with current good manufacturing practices (CGMP).

Additionally, any alcohol (ethanol) or IPA found to contain more than 630 ppm methanol does not fall within the policies described in the temporary guidance and as a result, may be considered evidence of substitution or contamination, or both. Alcohol-based hand sanitizers that are contaminated with methanol are subject to adulteration charges under the FD&C Act. The alcohol (ethanol) or IPA should be destroyed following guidelines for hazardous waste, and the manufacturer or compounder should contact the FDA regarding the test results and the alcohol’s source.

Pharmacy list also updated

The temporary guidance has also been updated to provide adverse event reporting guidelines for state-licensed pharmacies and outsourcing facilities.

The agency also included an additional denaturant formula in the temporary guidance. Denaturing alcohol in hand sanitizers is critical to deterring children from unintentional ingestion. The FDA has said that consumer and health care professional safety is a top priority for FDA, and an important part of the FDA’s mission is to protect the public from harm, especially as they seek to help increase hand sanitizer supply.

For questions, email the FDA here:  COVID-19-Hand-Sanitizers@fda.hhs.gov 

The list of dangerous hand sanitizers

For the latest list of dangerous hand sanitizers as of August 10, 2020, and a list of products on their dangerous hand sanitizer list, go here (scroll down to see the list).

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Thursday, August 6, 2020

What if Schools Don't Reopen or Partially Open?

What if Schools Don't Reopen or Partially Open?

What leave will employees be entitled to receive?

In the early months of 2020, everyone assumed that we would just need to take care of our children at home for a few weeks, maybe through spring break, and we would be fine. Then it was "just make it to summer." Now summer is winding down, and many kids are not going back to school full-time (at least not in person) any time soon. This creates tremendous challenges for families as well as employers.
It's not pretty out there right now

The United States averaged more than 1,000 new coronavirus-related deaths for the tenth day in a row on Wednesday, August 5th, as fatalities remain high following a peak in new cases. States are scrambling to find a way to open schools – and the temptation is to model our school openings after European and other countries. This is impractical because, as of August 8, 2020, the US has failed to curb the virus substantially. Contrary to some overly positive "cherry-picked" reports, we all need to understand that 180 countries are doing better than the US in terms of what counts most; the death rate caused by COVID-19. The U.S. rate is currently 485 deaths per 1 million citizens. For instance, Canada stands at 237 per million citizens; Germany 110 per million, Russia 99 per million, Norway 47 per million, Japan 8 per million, and South Korea has only 6 Coronavirus deaths for every million citizens.  This is not political—if we're not aware of this information, we can't properly prepare.
 
Let's hope our death rate gets better. Still, with the continued rise in U.S. coronavirus cases and uncertainty regarding whether and in what manner schools will reopen in the fall, it is critical for providers, clinics, hospitals, and other businesses to understand the developing leave rights under federal, state and local law.
 
The Emergency Paid Sick Leave Act (EPSLA)

Who is eligible - generally:
  1. Generally, if you employ fewer than 500 employees, you are a covered employer that must provide paid sick leave and expanded family and medical leave 
  2. Certain employers with fewer than 50 employees may be exempt from the Act's requirements to provide specific paid sick leave and expanded family and medical leave.
  3. Certain public employers are also covered under the Act and must provide paid sick leave and expanded family and medical leave.
Be sure to know your situation, check first

For Specific additional information, you can determine your FFCRA Eligibility as an Employer or Employee here: https://www.dol.gov/agencies/whd/ffcra/benefits-eligibility-webtool/employee

A few highlights:

Under the federal Families First Coronavirus Response Act [FFCRA]: https://ogletree.com/insights/the-families-first-coronavirus-response-act-faqs-the-fmla-amendments-and-paid-sick-leave-requirements-of-the-new-law/ there are two major provisions: the Emergency Paid Sick Leave Act (EPSLA) and the Emergency Family and Medical Leave Expansion Act (EFMLEA).

Under the EPSLA, employers with fewer than 500 employees and certain public employers must pay sick leave of up to 80 hours, or roughly 10 days, to full-time employees who are:
  • Subject to a federal, state, or local quarantine or isolation order related to COVID-19.
  • Advised by a health care provider to self-quarantine due to concerns related to COVID-19.
  • Experiencing symptoms of COVID-19 and seeking a medical diagnosis.
  • Caring for an individual subject to a quarantine or isolation order by the government or a health care provider.
  • Caring for a child whose school or place of care is closed or whose child care provider is unavailable because of COVID-19. This may not sound like sick leave, but it's one of the EPSLA's six grounds for such leave.
  • Experiencing any other substantially similar condition specified by the secretary of health and human services in consultation with the secretary of the treasury and the secretary of labor.
The Emergency Family and Medical Leave Expansion Act (EFMLEA)

For employers of fewer than 500 employees, an additional 10 weeks of family leave at two-thirds of regular wages is potentially available under the EFMLEA to care for a child whose school or place of care is closed or whose child care provider is unavailable because of COVID-19. The FFCRA does not have requirements for private-sector employers with 500 or more employees. 

There are two other options available for school or place-of-care closures or child care unavailability related to COVID-19: emergency paid sick leave and expanded family and medical leave. An employee can use both buckets for this type of leave, but only for up to a total of 12 weeks of leave. To be eligible for this leave, another "suitable individual," such as a co-parent, co-guardian, or the "usual child care provider," must not be available to provide the care the child needs.

Last Spring vs. Now

The U.S. Department of Labor (DOL) has indicated that an employee's ability to use FFCRA leave last spring will not necessarily affect whether the employee can use FFCRA leave this fall. For example, an employee may be able to use leave under the FFCRA in the coming months, even if the employee was able to work (in person or remotely) when schools were closed last spring. An employer should not assume that the same schedule/arrangement would work for an employee moving forward. The DOL has acknowledged that circumstances may change, including employees realizing they are not able to provide childcare and work remotely at the same time effectively. Parents may also conclude that because remote learning may be here to stay indefinitely, they need to devote more time and attention to it this fall. Similarly, some employees may need to use leave because a co-parent, who may have used FFCRA leave in the spring to care for the child, has now exhausted the maximum 12 weeks of leave.
New questions and issues with school reopening

Some school reopening plans are generating new questions. For example, if a school opens for in-person instruction, but an employee voluntarily chooses the remote learning option for his or her child, is FFCRA leave available? Generally speaking, the answer is no. To be eligible for FFCRA leave, the physical location where the child receives instruction or care must be closed. If, however, the school is operating at reduced capacity to comply with social-distancing guidelines, such that the employee's child has no choice but to receive remote learning, or if the school uses a hybrid model where in-person instruction is only provided on certain days of the week, FFCRA may be available.

The DOL also clarified that if a childcare provider or school is open to some students, but not to the employee's student (due to capacity or other COVID-related limitations), the school or childcare provider is still considered "closed" to that student who is unable to attend. This means that employees may be eligible to use FFCRA leave when needed to care for children at home due to a "hybrid" model under which students physically go to school a few days each week and attend virtual school the other days.

State and Local Laws

While employers with 500 or more employees are not governed by a federal law that would require them to provide leave to employees to care for children out of school, some states and municipalities have passed paid sick leave laws that are triggered by a COVID-19-related event or absence and do not have a maximum employee threshold.
 
For example, several cities in California, as well as Colorado, New Jersey, Oregon (currently expiring on September 13, 2020), and the District of Colombia have extended some or all of the benefits of the FFCRA to employers with 500 or more employees. Other states and municipalities have more limited leave laws that apply to school closures and/or public health emergencies. As with the FFCRA, if employees have not already exhausted these leave benefits; they may be entitled to job-protected leave to care for a child whose school is closed.
 
Again, employers might need to consult with their attorneys and plan ahead—have discussions with employees to learn how school reopening plans may impact their work schedules, whether remote work is or remains an option; and whether any added flexibility to their schedules. For instance, working around the school day or taking intermittent leave may provide adequate solutions. Good communication before deadlines can go a long way toward reducing anxiety and finding creative solutions that enable employees to remain productive while taking on the added role of at-home educator. 

And keep on keeping up on these things because:

A New York Court Order Struck down Portions of DOL's FFCRA Regulations just this week.
However, the district court's decision does not make clear whether its decision to vacate portions of the final rule applies only to the state of New York or on a broader, nationwide basis. Given this, employers should consult legal counsel before making any decision as to whether or not to provide paid FFCRA leave.

Yes, this is changing daily and it is a challenge. Keep on checking with your HR organizations, your State Laws and Google the latest once in a while. 
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