Dear Employers,

We know these are scary times. The nation moved to lockdown Level 3 on Monday, which means more than eight million people have returned to work. You are responsible for keeping them safe at work – no doubt a daunting task amid a highly infectious respiratory pandemic.

I work as a doctor in one of Cape Town’s busy community health centres. Every day we see upwards of 50 suspected Covid-19 patients, and the numbers are rising. During this surge of frighteningly sick patients – acutely hypoxic patients, for example, stumble in requiring immediate oxygen – we have also been inundated by those who would do better staying at home.

Businesses have taken to sending streams of healthy employees to us for medical clearance if there is an outbreak or for individual risk assessments. This is where you, the employer, comes in.

Public hospitals do not have the capacity to evaluate healthy employees every time there is a single case in a workplace. Nor do we have the capacity to write sick certificates for every employee that has a sore throat. We need to save our energies for the sick Covid-19 patients that need hospital-level care.

So let me help you help us. You can keep your employees safe without unnecessarily overburdening your local primary healthcare centre. To do so, implement a few basic Covid-19 rules.

• Sick policy. Covid-19 causes an acute onset of fever, cough, headache, sore throat, loss of taste and smell, shortness of breath, and body aches. All employees should be screened for these symptoms before entering the workplace, and encouraged to stay home if they are sick. If your employee has any of these symptoms, tell them to stay home for 14 days. If they are severely ill – mainly if they feel short of breath or have high fevers above 38⁰C for more than three days – they should be evaluated by a medical professional. Likewise, if they are at high risk for developing severe disease – if they are older than 50, have chronic hypertension, diabetes, severe obesity, chronic lung disease, or uncontrolled HIV – please send them to hospital for a thorough evaluation of their symptoms.
  However, if your employee is younger than 50, otherwise healthy and mildly ill – maybe just a sore throat and loss of smell but no other symptoms – please tell them to stay home and self-isolate for two weeks from the onset of symptoms. Even if they had a mild case of Covid-19, after 14 days they are no longer infectious and can safely return to work.
  Please do not send your employees with mild symptoms to the day hospital just for a sick certificate. We WILL issue a 14-day sick certificate on those symptoms alone. If they can lie to you – claiming to have these symptoms – they can lie to us too. Please trust that your employee is calling in sick in good faith and let them stay home, on paid sick leave, with no questions asked. Community spread of Covid-19 is real and accelerating. Quarantining all South Africans with Covid-19, no matter how mild, is how we stop the spread together.

• Test results. Initially we were testing every patient with Covid-19 symptoms, no matter how mild. However, due to a global shortage of test kits and reagents, this testing strategy is no longer viable. Our primary healthcare patients are currently waiting two to three weeks for results. As stated above, even if a patient is Covid-19 positive, after 14 days they are no longer infectious and safe to return to work. This means that we are safely sending your employees back to work often without their test results. Please do not give your employees a hard time. Do not send them back to the day hospital, repeatedly asking for proof that they are negative. After 14 days, even if they were positive, they are NOW negative. If they are well, they are cured. Covid-19 is an acute infection. That means it goes away. Let them come back to work without a printout of test results, which we cannot provide.

• Outbreak control. Covid-19 is firmly established in South Africa’s communities and spreading rapidly in the hot spots. Patients are infectious 48 hours prior to the onset of symptoms. Many people will accidentally come to work in the few days before they get sick. This means that no matter how good your infection control policies, you will have workplace cases of Covid-19. Please do not send your entire workforce to the day hospital every time you have a case. That wastes our time and unnecessarily exposes your healthy workforce to other patients who might have Covid-19. If you have a workplace outbreak, contact the public health department to assist with outbreak control. The patient’s workspace should be disinfected, not the entire facility. Most importantly, a workplace contact list must be developed. A close contact is defined as an employee who was within two meters of the Covid-19 positive employee for more than 15 minutes, starting 48 hours before the patient had symptoms. Employees who wore a mask and were always spaced more than two meters away, are not high-risk contacts. Fleeting contact in the passageway does not count. Once you have identified a list of close contacts, those contacts must quarantine at home for 14 days. If they are asymptomatic, they DO NOT need to go to the day hospital for a test. After 14 days, if they are symptom-free, they may safely return to work without medical evaluation. If they are low-risk employees – under 50 with no chronic medical conditions – and develop mild symptoms consistent with Covid-19, then they should stay at home for 14 days from the onset of symptoms. If they are high-risk employees – over 50 or any employee with chronic medical conditions – please send them to hospital for evaluation, because they are at risk of developing severe disease. Likewise, if they are short of breath or severely ill, we want them to come to hospital. But if you send all your employees for evaluation for every Covid-19 case, you WILL crush us.
• Infection control policies. The crux to preventing Covid-19 from running wild in your workplace can be summarised by three actions: physical distancing, universal masks, and hand washing. Make sure your employees are always spaced more than two meters apart, even during lunch and tea breaks. Staggered breaks are essential to preserving distancing. All employees should wear a cloth mask to prevent direct droplet spread of Covid-19. That mask should fit snugly over their nose and mouth. Do not pull it down to speak; that’s when it matters the most. Face shields and Perspex dividers between close workspaces provide additional barrier protection. Finally, sanitiser or soap and water should be provided, and employees encouraged to wash their hands frequently. Workspaces and high-contact shared surfaces should be routinely cleaned throughout the day.

Nobody wants to go to work during Covid-19, but we don’t have a choice. We must work, and as an employer you must make it as safe as possible to help South Africa stop the spread of this virus. Following these few basic rules will help protect your employees without unduly overburdening the public healthcare system that is already struggling to cope.

Please, help us help you. If you’re sick, go to hospital. If you are exposed to a Covid-19 case but feel well, stay home. And if you go to work, mask-up and stay safe.

Sincerely,

Your friendly but tired primary healthcare doctors and nurses. DM

Andrea Mendelsohn is a Senior Medical Officer at a public community health centre in Cape Town. She writes in her personal capacity.