According to the World Health Organization, protecting health-care workers from the coronavirus infection should be every country’s first priority. When these workers get sick, they can no longer help stem the epidemic or treat the infected, and sick workers who continue working can further spread the virus. The first case of COVID-19, the disease caused by the coronavirus, in a U.S. health-care worker has already been diagnosed, and many more will undoubtedly follow.
To prevent health-care workers and other essential employees from getting sick, the Trump administration should make use of a basic policy tool: regulation and enforcement by the Occupational Safety and Health Administration.
As the assistant secretary of labor for occupational safety and health, I led OSHA from 2009 to 2017. Unique among federal agencies, OSHA can issue rules that require employers to take steps to reduce or eliminate hazards that threaten worker safety or health. The Centers for Disease Control and Prevention, for example, issues infection-control guidelines to hospitals, but cannot require a facility to follow them.
However, OSHA’s hands are tied in this crisis because it does not currently have a regulation covering airborne infectious agents. OSHA could help limit the impact of a global epidemic in the United States by issuing an emergency temporary standard, quickly protecting health-care workers and others from exposure to COVID-19.
In the early 1990s, at the height of the HIV/AIDS epidemic, OSHA issued a bloodborne-pathogen standard that required establishments where workers could be exposed to contaminated blood or other bodily fluids to implement protective measures. This standard is the reason why every hospital room has a container for sharps disposal, and why every hospital offers its employees free hepatitis-B vaccination.
OSHA’s efforts in this area were opposed at the time by many in the health-care community. Dentists, for example, complained that if they had to wear masks and gloves, they would not be able to practice dentistry. But once the standard was issued, the industry found that its provisions were effective and relatively easy to implement. The results have been enormously positive. The rate of needlesticks among health-care workers has decreased dramatically and the number of hospital workers who develop work-related hepatitis B has decreased: Cases dropped from about 12,000 annually to a mere handful each year.
The continued value of the OSHA bloodborne-pathogen standard was demonstrated again in 2014, when several U.S. health-care workers were infected with the Ebola virus. Since the standard covered Ebola exposure, OSHA officials were able to ensure that hospitals that might receive Ebola patients followed required safety precautions.
Creating a standard that would protect workers exposed to airborne infectious diseases has long been an OSHA priority. In 2010, following the H1N1 influenza pandemic, the agency started working on a rule that would apply to health-care facilities and other establishments where workers might be exposed to the flu, tuberculosis, or other airborne diseases, as well as other dangerous hospital-transmitted infections such as methicillin-resistant Staphylococcus aureus (MRSA). The standard would require employers to develop and implement an infection-control plan to protect health-care and related workers with occupational exposure. It would include provisions for worker training and distribution of masks and other personal protective equipment.
Rules that require employers to plan for an epidemic may seem like common sense, and many employers voluntarily already do everything they would be required to do. But many is not enough. An OSHA standard would provide much-needed guidance, and the prospect of inspections and civil penalties would no doubt motivate some employers to do the right thing. Such a standard would, in essence, make following CDC guidance an enforceable requirement.
Health-care workers aren’t the only people who need protection, of course, and employers must also begin planning to continue operating under pandemic conditions. There are large numbers of workers whose activities are vital to society’s function, especially during a disease outbreak. What would happen if bus drivers were too sick to drive, or pharmacists stopped coming to work? These workers are at increased risk of infection because they have regular contact with the public. They need to be trained and prepared to control their exposure, but for the most part their employers have little experience in addressing these issues. There are other workers, such as truck drivers and utility workers, who may not be at elevated risk, but whose functions are vital to the economy. How will we make sure they remain healthy and able to do their jobs?
OSHA made significant progress developing the infectious-disease standard during the Obama administration, and completed a draft when Donald Trump took office, in January 2017. But among the early actions of the new administration was a comprehensive deregulatory initiative. OSHA’s work on the standard was halted.
When Congress enacted the OSHA law almost exactly 50 years ago, it anticipated a situation like the one we now face. In response to an emerging hazard like COVID-19, OSHA can quickly issue an emergency temporary standard (ETS) that would stay in effect for six months.
Last month, Democratic Representatives Bobby Scott and Alma Adams wrote to Secretary of Labor Eugene Scalia asking him to prepare to issue an ETS should conditions in the United States deteriorate.
If we are to control the epidemic, all essential workers must be trained and equipped to respond. There is still time—perhaps not much—for this planning and preparation to occur. President Trump must abandon his anti-regulatory fervor and use OSHA to help protect us all.