Clinically Vulnerable and Pregnant Employees: Lockdown Guidance

National restrictions will be imposed across England from Thursday 5th November. To help contain the virus, the government have advised that everyone who can work effectively from home must do so. Where people cannot do so – including but not limited to – people who work in national infrastructure, construction and manufacturing – they should continue to travel to their workplace. Public sector employees working in essential services, including health, childcare or education, should also continue to go into work. The risk of transmission is substantially reduced provided COVID-19 secure work guidelines are followed closely.

This morning, guidance has been published defining clinically extremely vulnerable groupsGuidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19.

Clinically extremely vulnerable groups are those individuals likely to require hospitalisation and be at serious risk of death or long-term health complications as a consequence of COVID-19 infection. It is employees who fall into this category who are advised to work only from home. If they cannot work from home, they may be eligible for Statutory Sick Pay or Employment Support Allowance if their normal salary is not continued. The government has indicated they will write to everybody who is clinically extremely vulnerable to set out detailed advice confirming they fall into this category in the coming days.

Same Household: People living in the same household as someone defined as clinically extremely vulnerable, but who are not clinically extremely vulnerable themselves, can still attend work.

Clinically extremely vulnerable children of employees: The government state ‘evidence has shown there is a very low risk of children becoming very unwell from COVID-19, most children originally on the shielded patient list no longer need to be and therefore can still attend school. If they are unsure, parents should contact their child’s usual GP or hospital clinician to check whether they should still be considered clinically extremely vulnerable. If a GP or clinician has advised that a child should remain on the shielded patient list, they are advised not to attend school. Children who live with someone who is clinically extremely vulnerable, but aren’t themselves, should still attend school’.

For clinically vulnerable employees, there is a higher risk of severe illness from COVID-19, but less so than in the group of clinically extremely vulnerable individuals. These employees should be especially careful with hand hygiene, minimise contact with others and be careful to follow strict 2 m distancing in the workplace. Provided these new national restrictions are met, the employee may continue to attend work in a COVID-secure environment. If they cannot be met, even with adjustments to the usual employed role, the employee should work from home on health grounds.

Currently published government guidance is ambiguous in defining clinically vulnerable people. It makes reference to age 60 or over. But within the same document it states:

  • Aged 70 or over (regardless of medical conditions)
  • Under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds):
    • Chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
    • Chronic heart disease, such as heart failure
    • Chronic kidney disease
    • Chronic liver disease, such as hepatitis
    • Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS) or cerebral palsy
    • Diabetes
    • A weakened immune system as the result of certain conditions or medicines they are taking (such as steroid tablets)
    • Being seriously overweight (a body mass index (BMI) of 40 or above)
    • Pregnant.

Our belief is there is an error in the document that will be revised, so watch out for updates. For now, we recommend you implement an age threshold of 60 rather than 70 in the guidance above.

Pregnant employees should be considered as clinically vulnerable, unless they have also been diagnosed with a cardiac disorder or other medical condition that falls within the clinically extremely vulnerable category. These employees may continue to work at least until 28 weeks of pregnancy in a COVID-secure environment. At 28 weeks pregnancy, an occupational health assessment should be considered to stratify their overall clinical risks and to confirm the appropriateness of continuing to attend work. It is not an absolute requirement for all pregnant employees to work from home from Thursday 5th November .

Where Medwyn Occupational Health has already provided a health risk assessment of your employee the grading of moderate or high risk is unlikely to have changed. Please refer to the original risk certificate to confirm if the employee is fit to attend work, requires role adjustments, or should only work from home. There is no need to undertake a new risk assessment unless health status has changed in the last 8 months.

Anxiety and uncertainty around individual health risks is likely to present amongst those employees required to attend work. If these individuals have not already had an occupational health risk assessment you may wish to consider referring to Medwyn Occupational Health for further advice.

Please don’t hesitate to contact the team on 01306 873936, or email admin@medwynoh.co.uk for further support.

COVID-19 Testing & Symptom Checker

Flu and COVID-19 are both contagious respiratory illnesses but they are caused by different viruses. COVID-19 is caused by infection with a new coronavirus (called SARS-CoV-2) and flu is caused by infection with influenza viruses. Some of the symptoms of flu and COVID-19 are virtually indistinguishable based on symptoms alone and a PCR test may be needed to help confirm a diagnosis.

Both COVID-19 and flu can spread from person-to-person, between people who are in close contact with one another (within approximately 2 metres). Both are spread mainly by droplets made when people with the illness (COVID-19 or flu) cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

It may be possible that a person can get infected by physical human contact, such as shaking hands, or by touching a surface or object that has virus on it and then touching their own mouth, nose, or possibly their eyes.

The flu virus and the virus that causes COVID-19 may be spread to others by people before they begin showing symptoms, with very mild symptoms or who never developed symptoms (asymptomatic).

If a person has COVID-19, it could take them longer to develop symptoms than if they had flu.  Typically, a person develops COVID-19 symptoms 5 days after being infected but symptoms can appear as early as 2 days after infection or as late as 14 days after infection.

Flu and COVID-19 share many characteristics but there are some key differences between the two. While both illnesses can cause a cough, a COVID-19 cough can be particularly severe. It is also unusual for flu to have long-lasting symptoms, while many people experience a slow recovery from COVID-19.

If you are experiencing symptoms of a cold, such as coughing, sneezing, a high temperature or a runny nose it is important to stay at home as COVID-19 can be transmitted by coughing and sneezing – droplet transmission. It is essential to get tested as soon as possible, as you will need to self-isolate for at least ten days if you have a positive COVID-19 test.

Due to many of the symptoms of COVID-19, flu and colds being so similar, the only way to confidently know for certain whether you have COVID-19 is by taking a PCR test. An increase in demand for free NHS COVID-19 tests has led to local shortages. Medwyn Occupational Health is now able to offer a home testing kit at a cost of £125. Lab results are usually available within 48 hours of the lab receiving the sample.

To download the symptom & flu checker as an A4 PDF, click on this here

Returning to the Workplace – Latest updates

Shielding Guidance for People at High risk of Coronavirus (Clinically Extremely Vulnerable)

The government has announced that from 1st August, shielding employees can return to the workplace. The government has made this decision because infection rates in the community are falling. One in 1,700 people are estimated to have the virus now, down from 1 in 500 four weeks ago.

What changes from 1st August?

Extremely vulnerable people who are most at risk from becoming ill with coronavirus will no longer need to shield.

This means that employees can return to work, if they cannot work from home, as long as the workplace is COVID secure. Employees will no longer be eligible for statutory sick pay – unless they develop coronavirus symptoms, or someone they know develops symptoms and they are told to self-isolate and cannot work from home.

Inevitably, some employees may feel uncertain about returning to work. The government is asking employers to ease the transition for their clinically vulnerable employees by ensuring robust support measures are put in place. Employees should be advised about specific policies in relation to COVID-19, agree a plan for returning to work and any adjustments that may be needed before they return. 

If it is not possible to strictly adhere to your COVID secure business requirements for employees  identified as shielding before the employee returns to the workplace, we would recommend referring your employee to Medwyn Occupational Health for guidance on adjustments to ensure their safety and to manage health risks.  

What happens if there us a second wave?

The government will continue to monitor the evidence closely and adjust any advice accordingly. Should shielding need to resume, it is not necessarily the case that everyone who has been shielding over the past three months will have to do so again.

What does One Meter plus Guidance mean for workers?

The move to one metre plus is not currently consistent with published COVID secure guidance for each business sector, so this will inevitably cause some confusion for employers. Where possible, two metre distancing between employees should be maintained – but where this is not possible – it allows alternative working practices to be considered, with additional measures such as perspex screens and other PPE. Guidance on how to implement this in context of employee health risks has not been published, so until further scientific evidence is available, Medwyn recommends the following approach for employees who have returned to work sites:

Standard/Low Health Risk Employees – To maintain standard two metre distancing, but where this is not feasible, one metre plus distancing can be adopted in line with government advice on risk management.

Medium & High Health Risk Employees – To continue maintaining stringent two metre distancing.

HSE Guidance on Health Surveillance

The Health and Safety Executive (HSE) has advised that statutory health surveillance should continue where employees are working on-site and exposed to hazards. Occupational health providers have been asked to offer a tiered approach to health surveillance.

Medwyn Occupational Health will be providing online symptom questionnaires which can be completed remotely and submitted by the employee. Where symptoms or health concerns are identified, a telephone or video consultation will be organised.  If a face-to-face examination is required following the initial remote consultation, this will be undertaken with appropriate safeguards recommended by Public Health England (PHE).

Hand-Arm Vibration at Work

Hand arm vibration (HAVS) online questionnaires can be sent to employees who continue to work with vibratory tools. For any individuals identified with potential HAVS symptoms, a clinical assessment will be performed by video and a decision made if a face-to-face examination is justified.

Control of noise at Work and Respiratory Health Hazards

Hearing and respiratory health hazards will be assessed with an online questionnaire to identify any individuals at risk of associated health problems. Providing the employee does not identify any relevant problems, audiometry or spirometry will be deferred for up to 6 months.

Safety Critical Medicals

Medwyn Occupational Health will perform a task analysis to ascertain if it is appropriate to undertake assessments remotely by telephone or video consultation and defer a face-to-face examination. If the assessment is conducted remotely, a ‘fitness to work certificate’ may be restricted by duration until the employee has been seen for a face-to-face consultation.

Safety Critical Medicals will be provided to employees where the risks to themselves or others outweigh the risk of exposure to COVID-19 for our clinical team and the individual. PPE will be worn if a face-to-face medical is required.

We are aware that clients have employees now due health surveillance. We will contact those we believe are due over the next two weeks to discuss next steps. If you have not used Medwyn for health surveillance in the past and your COVID work risk assessments have identified exposure to noise, vibration or respiratory hazards please contact us to discuss your requirements.