Helping Small Employers Reopen Safely

Alan Fleeger was watching Fox News the night of April 22 when an exchange between entrepreneur Mark Cuban and host Laura Ingraham caught his attention. Ingraham asked Cuban for his thoughts on Texas Governor Greg Abbott’s plans to ease restrictions on businesses put in place to protect the public from exposure to SARS-CoV-2. Cuban responded that more specific guidelines were necessary for businesses to reopen safely. “The state and the federal government need to put together protocols that define what’s necessary to protect not only the customers coming in but the employees as well,” Cuban said. He mentioned a few examples: if a customer tries on clothes at a retail store but doesn’t buy them, how should the clothes be handled? Does a mask left behind at a restaurant need to be treated as hazardous material? How can employees protect themselves when cleaning high-traffic areas such as bathrooms? Fleeger, a past president of both AIHA and the Product Stewardship Society, found himself yelling the answers to Cuban’s questions at his TV. When the interview ended, Fleeger decided he would reach out to Cuban. He discovered an email address that Cuban was reported to respond to and sent him a message explaining that AIHA’s members were experts in the kinds of issues Cuban had raised. “What I told him was that I think if we collaborate, not only can we help protect his employees, but we can also help prevent the spread of the virus,” Fleeger recalls. It was 11:30 at night. Not twenty minutes later, Cuban replied. Put some guidelines together and send them to me, he said.  “ABSOLUTELY PERFECT” The next day, Fleeger, exhilarated by Cuban’s interest, contacted AIHA CEO Larry Sloan, then-AIHA President Kathy Murphy, and then-Vice President Lindsay Cook to discuss how to respond. The group understood that Cuban’s request could involve significant resources. But AIHA had an opportunity to help the country meet an urgent need for practical workplace health guidance in the midst of a crisis unlike any since the 1918 flu pandemic. And if AIHA was successful, Cuban’s support could potentially draw significant attention to occupational health and safety and highlight how industrial hygienists are best suited to respond to this type of crisis. Not only was Cuban a celebrity from his appearances on the NBC show Shark Tank and his ownership of the National Basketball Association’s Dallas Mavericks, he was also a member of President Trump’s recently created advisory council for reopening the American economy.  The group agreed that the guidelines should focus on practical steps that employers, employees, and the public could take to prevent the spread of COVID-19. Fleeger communicated this proposed format to Cuban. “And Mark wrote back, ‘Absolutely perfect. This is what’s needed,’” Fleeger recalls. Eventually, Cuban promised that if he liked what AIHA sent him, he would promote it to his 8 million Twitter followers and pass it on to the White House advisory group. Quickly, Fleeger and AIHA leaders identified volunteers among the AIHA membership who were available to help immediately. These volunteers eventually came to be known as AIHA’s COVID-19 Re-Open America Guidelines Task Force.  On April 28, Fleeger sent Cuban the task force’s first guidelines, for restaurants, which contained eight pages of practical advice for employers, workers, and customers on how to protect themselves and others from exposure to the coronavirus. The guidelines go well beyond physical distancing and face coverings. They address, in plain language, the handling of waste and laundry, enhanced cleaning practices, and ventilation issues. They answer the questions Cuban asked on Ingraham’s show (for example, “any items left by customers should be placed in sealed bags and the bag should be disinfected and isolated until the customer returns”). And they reflect the detailed perspectives of OHS professionals trained in hazard evaluation.  Cuban not only loved the restaurant guidelines and wanted to see more, he also asked AIHA to put together a website to disseminate them. That website,, launched on May 1 with links to guidelines for gyms, general office settings, at-home-service providers, construction, retail establishments, hair and nail salons, and rideshare/taxi services. The focus on smaller and medium-sized enterprises reflected a consensus on which businesses needed the most help, according to task force member John Henshaw. “Our thinking was, the larger enterprises had resources or access to resources,” says Henshaw, who served as OSHA administrator from 2001 through 2004 and is currently a consultant based in Florida. “We wanted to try to make sure [smaller businesses] had the right information, recognizing that that’s the majority of workplaces in this country.”
AIHA Task Force Generates Industry-Specific COVID-19 Guidance
“EVERYTHING WE CAN” When launched on May 1, there were approximately 800,000 total cases of COVID-19 in the U.S., including 30,000 new cases. Nearly 40,000 Americans had died of the disease. The imminent reopening of businesses in many areas added urgency to the task force’s work. “States are reopening, like it or not,” Fleeger says, describing the task force’s perspective. “It didn’t matter where your politics are. The states are reopening, and there is a need for guidance. And that’s what we do. We protect worker health. We do everything we can to minimize the spread of the virus.” AIHA promoted to national media and OHS industry publications. Articles about the guidelines appeared in Business Insider, USA Today, Bloomberg Law, and other publications. On May 5, Cuban kept his promise, tweeting, “Before you go back to work, this is one site you should review. The @AIHA, an organization that specializes in corporate and industrial hygiene has put together an amazing safety guide for almost every type of business.” Traffic to the site skyrocketed more than 900 percent, from just under 1,900 pageviews on May 4 to nearly 17,500 the day Cuban posted his tweet. Cuban also brought the guidelines to the attention of the White House advisory group, which followed up with Fleeger. As this article was being written, the White House was reviewing guidelines AIHA’s task force had developed for schools.  ONE MILLION DOWNLOADS Initially, the task force held weekly calls to discuss the development of new guidelines. As the process became familiar, the calls changed to biweekly, according to Shannon Gaffney, another task force member. Smaller groups held additional calls to discuss specific industries. “We considered what safety measures each industry would need to implement, how they can do so in the most efficient way possible, what type of communication would be needed, and many other questions,” Gaffney says. “In many cases, task force members consulted with members of these industry sectors.” Some documents were more difficult to develop than others. Guidelines for establishments that draw large crowds, Henshaw says, such as lodgings and houses of worship, required the authors to think extensively about potential points of contact between people, exposure controls, and reducing transmission through education. “It’s one thing to educate a worker, where you have some control” over training, Henshaw says. “But it’s not so easy when you have a patron of a restaurant or a weekly visitor in a house of worship or somebody who’s coming with their family for a vacation rental.” “Industries where physical distancing is hard, if not impossible, such as dentistry, are much more difficult” to develop guidelines for, Gaffney says. “Some organizations, like summer camps, are geared toward children and young adults, so getting those groups to comply with new standards presents its own challenges.”  To reach the intended audience, the documents’ authors tried not to make the guidelines too technical while ensuring that they align with current science and CDC guidelines. The documents will be updated as the science progresses. “Everything we’ve done is based on current science,” Fleeger said. “We didn’t want to put out a really detailed white paper on coronavirus, because if I hand that to a nail salon [owner], they’re going to [say], ‘I don’t know what to do with this. Tell me what I need to do.’” By late July, the number of documents on had grown to twenty-five. As this issue of The Synergist went to press, unique downloads of the guidelines neared 1 million. Spanish translations were available for several documents, and posters that share best practices for preventing transmission of SARS-CoV-2 had recently been added. “AN AMAZING EFFORT” Since restrictions on businesses were lifted, the pandemic has seen a resurgence. On Aug. 5, total cases of COVID-19 in the U.S. were over 4.6 million, and more than 155,000 total deaths were attributed to the disease. But task force members agree that the guidelines are helping employers and workers deal with the unavoidable complications of operating a business in a pandemic. “The purpose of our guidelines is to help businesses that are essential or need to open to protect their workers and their patrons,” Gaffney says.
Fleeger, whose shot-in-the-dark email to Cuban got the effort underway, takes satisfaction from the task force’s role in helping AIHA achieve its mission. He also brims with admiration when he thinks of the many members who contributed generously on such short notice.

“Just above and beyond the call of duty,” Fleeger says of the task force members. “It was just an amazing effort. We’ve done the right thing to get the protective measures out there to help people, and to help employers, so they can open their doors, and do it as safely as possible.”

ED RUTKOWSKI is editor-in-chief of The Synergist.
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AIHA’s COVID-19 Re-Open America Guidelines Task Force
Hamid Arabzadeh, CIH, CSP, CHMM, FAIHA David Beatty, MPH, CSP, CCEP Corey Boles, PhD Elizabeth Bussman, CIH Mark Drozdov, MS, SSM, FSM, BSI, RSO, CAI, CMA, GPRO Carter Ficklen, CIH, CSP Alan Fleeger, CIH, CSP, FAIHA Bernard L. Fontaine, Jr., CIH, CSP, FAIHA Shannon Gaffney, PhD, MHS, CIH Thomas G. Grumbles, CIH, FAIHA John Henshaw, MPH, CIH, FAIHA Dana Hollins, MPH, CIH Catherine Hovde, CIH, CSP Neva Jacobs, MSPH, CIH Perry Logan, PhD, CIH Heather Lynch, MPH Eric Miller, MPH, CIH Amber Hogan Mitchell, DrPH, MPH, CPH Melanie D. Nembhard, MSPH, CIH Justine Parker, CIH, CSP, CHMM, CPH Jennifer S. Pierce, MS, PhD Aaron Schoemaker, CSP Jack Springston, CIH, CSP, FAIHA Ken Unice, MS Rachel Zisook, MS, CIH Matt Zock, CIH