EVAN FLOYD, PhD, CIH, is an assistant professor in the Department of Occupational and Environmental Health at the University of Oklahoma Hudson College of Public Health and chair of the AIHA Sampling and Laboratory Analysis Committee.
K. A. N. AITHINNE, PhD, GSP, CPH, is assistant professor of Research in the Department of Occupational and Environmental Health at the University of Oklahoma Hudson College of Public Health.
Editor’s note: The opinions expressed in this article are the authors’ and do not necessarily reflect those of AIHA® or The Synergist®.
Send feedback to The Synergist.
COVID-19 and the Art of Anticipation
Evidence-based science takes us many places and should never be abandoned. But its reductionist tendencies and statistical nature often keep us focused on the past, analyzing data instead of building our professional judgment and looking ahead.
Professional judgment is the intuition that forms after years of practice; it is the art that complements the science of industrial hygiene. With knowledge, experience, and judgment, we can anticipate threats and hazards long before we encounter them. Anticipation, the first principle of IH, allows us to envision the types of events likely to occur and how they will pan out.
This article identifies several aspects of the COVID-19 pandemic in the United States that our profession should have anticipated. Our intent is not to criticize or look back with 20/20 hindsight; rather, we are calling on IH and OEHS professionals to be confident in their skills and to act within their spheres of influence—in effect, to revive the art of anticipation.
1. Warnings about a COVID-19/influenza super-season were alarmist and misguided. On the contrary, we should have anticipated that this flu season would be one of the mildest in the past decade as long as large sectors of the population continued exercising COVID-19 transmission precautions. These precautions (physical distancing, limiting contacts, masking, and frequent hand washing and sanitization) are the same measures needed to prevent the spread of influenza and other communicable diseases. As of Jan. 16, rates of outpatient healthcare visits for influenza-like illness (ILI) were nearly half (1.4 percent) of baseline (2.6 percent), and CDC’s indicator of ILI activity was dramatically lower than any other in the past decade. Heat maps available in CDC’s Flu Weekly Index show all 50 states in the “minimal” and “low” levels. At the same time last season, only 8 states were at “minimal” or “low” status.
2. Increases in influenza and COVID-19 will result if we relax or abandon COVID-19 transmission precautions during the vaccine rollout. COVID-19 has completely eclipsed the morbidity, mortality, and economic impact of any other seasonal flu or communicable disease in the past century, and it is vitally important that we aggressively seek to eradicate this disease through widespread vaccination. However, any measure that reduces the perceived threat of COVID-19 is likely to lead to relaxation of policies and less personal adherence to transmission precautions. Therefore, it is likely that as vaccination campaigns begin to reach maturity, the rates of ILI will increase and COVID-19 will decrease more slowly than current models predict.
3. Old (and new) air purification and control technologies would see a resurgence of interest. During 2020 we saw huge demand for indoor air quality control measures such as HEPA filtration; ion generation; biocidal misting, fogging, and vaporizing; ultraviolet germicidal irradiation (UVGI); and upper-air UVGI. Sales for these types of devices boomed, and there were shortages for in-room HEPA units and UVGI products into late 2020.
4. Work patterns would shift from in-person to remote wherever possible. Virtual platforms that facilitated this shift would soar in popularity, but with this spike in utilization many services would experience capacity problems, service would be sub-optimal, and upgrades would be implemented by contract or gig workers. Zoom, Microsoft Teams, GoToMeeting, and WebEx used to be meeting platforms that only businesspeople knew about; now even elementary school kids know how to join a Zoom call, and many families have held Zoom holidays.
5. Occupational adaptability to virtual work would exacerbate disparities in the impact of the pandemic. In general, workers in higher-paying occupations were better able to shift to virtual work than those in lower-paying service and production occupations where physical presence is necessary. Midwestern meat packing plants experienced shutdowns due to high employee infection and transmission, which caused issues in the supply chain with farmers, distributors, and consumers sharing the pain. Transmission precautions caused job losses to soar in service sectors (such as retail sales, restaurant services, entertainment venues, and tourism). Meanwhile, those able to telecommute were actually more productive.
6. Disparities in child educational attainment will emerge based on family occupational adaptability to virtual work. Families unable to telework are experiencing more wage loss, reduced access to healthcare, and less availability of parents to assist in remote education. Rural and low-income communities have been disproportionately affected by lack of internet access, poor connectivity, and dearth of electronic devices, further limiting the ability of families in these areas to participate effectively in virtual learning platforms.
7. Increasing the demand for protective masks was likely to result in scarcity, hoarding, price hikes, and panic in some communities. Early announcements in the U.S. that face coverings were ineffective for personal protection led to a rush on N95 supplies. The country needed consistent communication, in the form of consensus statements, from all branches of government about what types of masks were sufficient for different situations and a clear explanation of why the public does not need N95s, but does need to mask for source control. These actions could have reduced the demand for N95s and eased shortages. 8. Shortages of N95 respirators would lead to importing of filtering facepiece respirators (FFRs). We could also have anticipated that masks designed to serve a predominantly East Asian population would not be ideal to fit the diverse U.S. population due to differences in facial anthropometries. Although some KN95s were unable to meet claimed performance (at least 95 percent filtration efficiency), what was more important was the generally poor fit provided by most of these products, largely due to differences in mask designs. Ear loops, a feature of KN95s, cannot provide as much face seal pressure as the head straps on N95s and are uncomfortable to wear long term. In addition, the vast majority of KN95s have vertical flat-fold designs that tend to crease the nose bridge and create a leak point; N95s, with their cup or horizontal flat-fold design, lack this crease. Finally, KN95s usually come in one size and are unable to accommodate a diverse population. In contrast, N95s come in two or three sizes. 9. The respirator testing capacity of the NIOSH National Personal Protection Technology Laboratory would be overwhelmed with demand. The process of conducting FFR testing is relatively slow. With such a tremendous increase in demand among newly imported FFRs, truncated testing and external assistance would be necessary to provide testing services in a timely manner. We understand and support the insistence that certification of any respirator remain within the jurisdiction of NIOSH. However, having guidance on truncated testing by partner labs of emergency-use imported masks could have allowed NIOSH to remain the central point of contact and data dissemination while utilizing the skill and expertise of scientists across the country. For example, in early April 2020, our department set up a truncated FFR testing program to meet the demands of our local emergency response office. Our methodology was based on the NIOSH NPPTL methods, but we would have welcomed collaboration with NIOSH to ensure our adaptations met their approval. We would have also gladly shared or reported our results to NIOSH to be added to their master list. Effective anticipation won’t eliminate all barriers to action, which could include a lack of resources, influence, know-how, and maybe even courage. But reviving the art of anticipation can reduce unnecessary surprises. We encourage OEHS professionals to use the lessons learned from 2020 to prepare for the next challenge—because if hindsight is 2020, then we’re keeping our eyes on the future!
CDC: “Weekly U.S. Influenza Surveillance Report.”