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Prehab. Return to site actions for keeping your workforce well

Employers need to assess COVID-19 risks at the individual employee level and provide targeted "prehab" support to increase the resilience of the most vulnerable as they return to the workplace.

1. What changed on August 1st?

Like many people, our attention was drawn to Boris’ announcement of changes introduced on 1st August, including:

  • Relaxation of shielding.
  • Extension of the job retention (furlough) scheme.
  • Re-opening of premises such as beauty salons and wedding receptions.
  • A call to employees to return to their workplace if it is safe to do so.

2. What does the return to workplace change mean for employers?

2.1.  The law hasn’t actually changed.

Regulation1 continues to make it an offence for a person to go to work if that work can reasonably be done from home.   So legally, workplaces are still in lockdown.  But if the Government says employees are free to return to work then let’s continue.

2.2.  Exceed your minimum obligations to avoid issues further down the line.

It is unlikely that workplace transmission risk can be reduced to zero and there is little case law to help define what level of risk is acceptable, so we see lawyers advising employers to play it safe and exceed your minimum obligations including:

  • Ensuring employee health, safety and welfare (Health and Safety at Work etc Act 1974).
  • Maintaining workplace hygiene (Workplaces (Health, Safety and Welfare) Regulations 1992).
  • Providing PPE (Use of The Personal Protective Equipment at Work Regulations 1992).
  • Completing health and safety risk assessments (Management of Health and Safety at Work Regulations 1999).
  • Making reasonable adjustments (Equality Act 2010).
  • Following COVID Secure guidance from Government2 and the Health and Safety Executive3.

2.3. You may be faced with some unfamiliar return to workplace issues.

Such issues could include:

  • Employees refusing reasonable instruction to return. They may be caring for, or shielding, a vulnerable family member.  They may be one of the “worried well”.
  • Employees who’s workplace transmission risk cannot be adequately controlled but who want to return to the workplace because:
    • It may restore depleted mental and physical health associated with months of homeworking. How do you balance actual health, safety and welfare issues caused by homeworking against potential risks associated with a return to the workplace?
    • It may reduce worries about job security and losing influence compared to workbased colleagues.
  • Employees who have had the disease, are risk free but continue to struggle with ‘long-COVID’ symptoms including: chronic fatigue, muscle weakness and concentration difficulties.  Over 10% may struggle for more than a month, 5% for two months and 2% for more than 3 months4.

What this means for employers can be summed up by:

  • An employment law specialist who stated: “Now is the time to understand what’s going on with each employee”.
  • A Personnel Today article5 concluding that employers need to get more targeted by assessing COVID risks for individual employees and offer prehab* support where needed as they return to the workplace.

* Prehab is a term borrowed from medical practice, where it refers to a programme of diet, exercise and counselling to improve a patient’s resilience prior to stressful events such as chemotherapy or surgery.  Medical practitioners observe how even a single episode of exercise confers immediate results in terms of lowered blood pressure, improved sleep, reduced anxiety, improved insulin sensitivity and mental function.

3. How to identify employees in need of prehab support.

In combination, three calculators are available for identifying individual employees who have a high risk of developing severe COVID-19 symptoms or who have depleted mental health.

3.1. COVID-Age Calculator.

COVID-Age has been developed by the Association of Local Authority Medical Advisors (ALAMA)6.

COVID-Age works on the basis that the risk of severe COVID-19 symptoms increases with age.  COVID-Age is your employee’s actual age with years added on or subtracted based upon their risk profile.  For example:

  • If severely obese then add 10 years to their actual age to calculate their COVID-Age.
  • If they have Type 2 Diabetes then add 9 years to their actual age.
  • If they have high blood pressure then add 4 years for a 62-64 year old, steadily increasing up to 12 years for a 20-26 year old.
  • If they are female then subtract 8 years.

Their COVID-Age then places them into a risk category; a COVID-Age of less than 50 is Low risk and 50 to 70 is Moderate Risk.  ALAMA suggested workplace considerations for each risk category include:

  • Moderate Risk. They can return to work if your COVID-Security (having followed guidance from the Government, HSE, et al.) leaves them at a similar or lower risk of infection than they would be exposed to in the local supermarket, streets, parks and countryside.
  • Low Risk. They can return to work even if your COVID-Security leaves them at a higher risk than other environments.

COVID-Age is a judgemental calculation in that clinicians have used their expertise to select the risk factors and associated year adjustments based upon book reviews of published studies.  Publication of significant new studies can be quickly incorporated to produce a more refined COVID-Age calculation.  ALAMA advise that COVID-Age:

  • Does not provide an exact measure.
  • Is intended for use as part of an occupational health assessment of fitness for work and not as a basis for prescribing clinical treatment.
  • Should support and not replace the clinical judgement of a suitably qualified Occupational Health Specialist Practitioner.

3.2 Heart Age calculator.

Heart Age uses the QRISK-2 calculation originally developed by Pfizer but now used freely throughout the world.  QRISK-2 works in a similar way to COVID-Age, it shares many of the same risk factors and is correlated with the risk of developing severe COVID-19 symptoms.  But there are some important differences:

  • QRISK-2 is based upon the statistical analysis of individual level case data rather than expert judgement, so should be more accurate.
  • It is recommended for use by the National Institute for Health and Care Excellence (NICE) and widely used across the NHS as a basis for prescribing clinical treatment.
  • Its ability to recalculate Heart Age based upon changes to diet and exercise supports a powerful conversation about positive lifestyle changes.

3.3 Mood and Mental Health calculator.

Two mood and mental health calculators are endorsed by the National Institute for Health and Care Excellence for use in primary care situations (e.g., during GP consultations).

  • Anxiety.  GAD-7 assesses the four most common anxiety disorders; Generalised Anxiety Disorder, Panic Disorder, Social Phobia and Post Traumatic Stress Disorder.
  • Depression.  PHQ-9 assesses the severity of depressive symptoms, not explained by substance use or another medical or psychiatric condition.

In the hands of a clinician, such as an experienced Occupational Health Specialist Practitioner, these calculators can provide accurate health risk assessments, place both COVID specific and general health risks into context and help allay any fears.  On the other hand, they can identify elevated risks, get to the root cause of what’s causing them, help address them, recommend adjustments to better control them and also signpost to self-help resources or refer on to other practitioners for more specialist treatments. 

Work Wellness use all 3 calculators in its Health and Lifestyle Assessments where they help establish an objective starting point for a conversation about lifestyle choices, mood and stressors which many describe as a therapy in itself.

 

Work Wellness employee health assessmentsVital Signs Physical Health & COVID Vulnerability Assessments incorporating COVID-Age and Heart Age take an hour per employee and are conducted at your site according to your (and our) COVID-Secure Policy, turning a private meeting room into a clinic for the day.

Work Wellness employee mental health assessmentMind Matters Mental Health Assessments incorporating GAD-7 and PHQ-9 take between 30 to 45 minutes per employee and are conducted at your site or remotely by video conference or telephone.

4. Possible prehab adjustments

The objectivity of these calculators in the hands of an impartial clinician helps you to address concerns from some employees that you are exposing them to risks whilst other employees benefiting from targeted adjustments are being treated more favourably.  Such adjustments could include:

  • Allowing high risk employees to avoid tasks which by their nature, are likely to compromise social distancing, hygiene or PPE usage policy.
  • Flexible working hours to enable commuting when public transport is less crowded and the risk of transmission is lower.
  • Continued working from home. Be aware that all the normal health and safety legislation continues to apply when your employee is homeworking.  Google for example, announced in May that it is giving their homeworkers a $1,000 allowance for costs associated with upgrading their home workspace and DSE-Workstation equipment.
  • Stress / anxiety counselling.

5. Keeping high risk employees in the workplace

A May 2020 article published by the Society of Occupational Medicine7 argues that Prehab doesn’t end on return to work.  It’s worth conducting at least one follow-up review of high risk employees after they have returned to the workplace, both to review their risk level and whether targeted adjustments are adequate or still necessary.

For further information about Work Wellness Health & Lifestyle Assessments and our Prehab service, tailored to keeping your workforce well, please contact us here.

Sources:
  1. The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020.  26 March 2020.[]
  2. working safely during coronavirous[]
  3. Coronavirus (COVID-19): latest information and advice[]
  4. One in 20 develop ‘long Covid’, with older women most at risk. Personnel Today. 26 October 2020.[]
  5. Coronavirus: lockdown ‘phase two’ may bring added headaches for occupational health.  Personnel Today.  17 July 2020.[]
  6. Covid-19-medical-risk-assessment. ALAMA. Updated regularly.[]
  7. ‘Prehab’ for workers who have been shielding.  Society of Occupational Medicine.  22 May 2020.[]

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