Although COVID cases in the U.S. have eased of late, companies still need to have a plan for additional flare-ups. But many don’t.

Ask any mid-sized business leader, and you’ll likely hear about operating in one of the most challenging risk environments in recent history, particularly the direct and indirect effects of COVID-19 over the past two years.

Although COVID cases in the U.S. have eased of late, companies still need to have a plan for additional flare-ups. But many don’t.

QBE North America’s recently released Mid-Sized Company Risk Report showed that while COVID is on business leaders’ minds as an important risk, fewer than half (46%) of companies surveyed have a mitigation strategy for pandemic-associated risks.

Produced in partnership with the Association for Corporate Growth, the survey found that pandemic risks declined overall as a concern from the 2020 study, falling to the fourth highest “macro” risk.

This is a serious concern considering the potential for new, highly contagious COVID variants.

Research shows that the probability of novel disease outbreaks will increase three-fold over the next few decades and that there is a two percent probability of a pandemic with a similar impact to COVID occurring in any year.

With this reality in mind, it’s imperative that companies have business continuity plans and mitigation strategies in place when, not if, the next global health crisis occurs. Doing so can not only save the vitality of a business should an event occur, it can also be a competitive advantage.

What You Should Review for Your Future Pandemic Plans

1) One of the biggest concerns for a company in a pandemic is the health and safety of its people.

Bobby Steinsdoerfer, senior vice president, property & casualty, QBE North America

Organizations should note which employees are considered essential in-office workers and strategize ways to protect them while on the job. This can include providing personal protective equipment, setting up contact tracing protocols and quarantine procedures that meet or exceed government suggestions, and establishing designated workspaces for each person when applicable, as well as reorganizing the office space and improving indoor air quality.

2) Ensuring that customers and clients are also healthy is another major part of the mitigation strategy.

Businesses should implement cleaning strategies that ensure public spaces are kept clean as well as follow any masking and social distancing guidelines from authorities. Businesses can also provide customers and visitors to their buildings with masks, as well as have hand sanitizer stations set up throughout the workplace.

3) Cybersecurity related to remote work is another a top concern for mid-sized businesses when it comes to future pandemic worries.

Remote employees leave companies open to cyber risks, emphasizing the need for airtight cybersecurity measures, even when workers aren’t virtual.

Businesses should ensure they have a cybersecurity team in place to monitor exposures, as well as training modules and workshops to teach employees how to be cyber safe both in the office and at home.

It’s best for these practices to be implemented in tandem with cybersecurity standards and other measures such as virtual private networks and two-factor authentication. Organizations should also consider whether they approve of employees using their personal devices for work or if they prefer employees to use company devices.

Businesses should also establish transition procedures such as a system for how employees can collect their in-office equipment or get it shipped to their home, and protocols for transferring, moving and storing company data that is needed to work at home.

4) A review of the supply chain can never hurt for future risk mitigation efforts.

As we have seen over the last two years, a pandemic can disrupt the supply chain for businesses and greatly hinder operations. Therefore, a pandemic risk mitigation plan should consider supply chain vulnerability.

The strategy could include using multiple, geo-graphically dispersed suppliers instead of just one. Multi-sourcing allows businesses to keep operating if their main supplier is unable to meet demands and mitigates potential supply chain bottlenecks.

5) A pandemic could force changes to a company’s business model to stay solvent.

Jennifer Clough, assistant vice president, risk solutions, QBE North America.

For instance, many restaurants added delivery of prepared meals during the pandemic. This change added a new set of hired and non-owned auto exposures that businesses needed to consider. A robust mitigation plan would include practices to minimize and insure against potential exposures related to operational shifts.

6) Finally, even if most or all employees cannot come to the workplace, it’s critical that companies still maintain the physical location.

Many risks increase due to vacancy, including break-ins, burst pipes, fires, gas leaks, icy sidewalks, falling ice, to name a few.

Staff turnover or layoffs could degrade the effectiveness of Fire Protection Impairment programs for vacant or idle buildings.

Businesses should have maintenance and security plans that include keeping heating and air conditioning on, regularly checking the property, and a recurring inspection schedule to ensure the building remains safe and ready for workers to return.

Staying Vigilant

Though cases in the U.S. are easing, the pandemic continues. It’s easy to let our guard down as we ease back into our old ways. But it doesn’t mean another flareup can’t and won’t occur.

Staying vigilant in processes and planning can make all the difference for businesses should any major interruption come their way. &

Bobby Steinsdoerfer is the Senior Vice President, Property & Casualty at QBE North America. Jennifer Clough is the Assistant Vice President, Risk Solutions for QBE North America.

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With cannabis products legalized to some degree in all but four U.S. states1, the growth of the cannabis industry—production, processing, distribution, and retail sales—translates to increased demand for commercial space and support services. The commercial real estate (CRE) community faces a continuous learning curve as regulations continue to evolve, not only in terms of cannabis sales, but cannabis industry safety. Among other safety considerations, indoor air quality for cannabis-related businesses is a key concern for business owners and landlords, who must protect themselves from liability while offering safe, acceptable conditions for tenants, employees, and customers.

No longer confined to backyard operations or shady rental houses, most commercial cannabis production and processing takes place in high-tech, indoor facilities where temperature, light, and humidity can be controlled for ideal growing conditions that ensure high quality and yield. For workers in these indoor grow facilities, conditions can be less than ideal, with exposure to CO/CO2, high relative humidity, ozone, cleaning chemicals, and biological hazards presenting health risks. Dispensaries and cafes present their own hazards for employees and customers: inhalation exposure (marijuana smoke may contain over 50 known carcinogens) and absorption exposure (due to settled chemicals from smoke and/or preparation surfaces).

To address these hazards, owners of cannabis businesses and/or their landlords must maintain indoor air quality with adequate ventilation. There are four key factors to an effective ventilation system:

Proper Filtration. Indoor cannabis cultivation facilities may contain hundreds or thousands of plants along with soil or grow media to support them, and fans to circulate air. This creates a dusty environment with high particulate loads that must be addressed by adequate filters.

Air disinfection. The warm, damp environment in which cannabis grows can also play host to mold, mildew, bacteria, and viruses that can harm workers as well as crops. UV-C disinfection can be an effective method to eliminate these harmful microorganisms from the air.

Odor control. The distinctive and pervasive odor from cannabis can trigger complaints from neighboring businesses and may violate local odor ordinances, as well as put others at risk. Numerous options for odor control are available, including activated charcoal filters, biofiltration, and commercially produced neutralizing oils. Depending on which option is selected, odor control can be integrated into existing HVAC or purification systems or applied independently.

Exhaust location. Proper ventilation systems appropriately direct exhaust away from neighboring tenants, parking areas, and pedestrian walkways. Securing the proper permits is often required when setting up a commercial exhaust system.

While it is still a federally controlled substance, a growing majority of Americans favor widespread legalization of marijuana2, and related legislation has been introduced in Congress by both parties. Legal sales of marijuana in the U.S. are expected to exceed $33 Billion in 20223.  As the cannabis industry continues to grow, it will present increased opportunities for CRE owners, investors, and operators to capitalize on the demand for space. Despite the evolving legal landscape of the industry, there is no question that OSHA regulations apply to cannabis workers. Savvy CRE players will protect themselves and their tenants by addressing cannabis-related health and safety concerns, including indoor air quality, with the help of a qualified health and safety professional who is experienced in consulting for cannabis businesses and the landlords who rent to them.

1. https://disa.com/map-of-marijuana-legality-by-state
2. https://www.pewresearch.org/fact-tank/2019/11/14/americans-support-marijuana-legalization/
3. https://fortune.com/2022/04/11/legal-marijuana-sales-33-billion-2022/

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KARACHI: Some 20 per cent kitchens studied in district Central were found to have higher concentrations of carbon monoxide (CO), an odourless and colourless gas that can kill, says a study recently published in Pakistan Journal of Science.

The study “Carbon monoxide concentrations in kitchens of gas-fired burners, Karachi, Pakistan” was conducted by Prof Zafar Iqbal Shams and his team at the Institute of Environmental Studies, Karachi University (KU).

The study investigated the carbon monoxide concentrations in kitchens of middle-income inhabitants residing in 54 bungalows and 25 apartments in district Central

“While the study does highlight an issue of public health importance, the results may not be reflective of what’s happening at a larger scale in society,” explained Prof Shams, adding that the team could not widen its scope to lower income areas due to funds’ shortage.

28,000 deaths, 40m respiratory disease cases are reported annually due to indoor air pollutants in country

People living in small congested places, he said, were likely to be more at a risk of hazardous indoor pollution.

“Undetected or unsuspected carbon monoxide exposure can result in accidental deaths. It’s one of the leading causes of poisoning morbidity and mortality in the western world,” he said.

Citing the Murree tragedy that took scores of lives early this year, Prof Shams said people died of carbon monoxide poisoning when they stayed in cars with turned on heaters and fell asleep. “In the USA, more than half of accidental carbon monoxide poisoning deaths are caused by motor vehicle exhaust followed by domestic gas appliances.”

Study’s findings

The investigation showed that over 80 per cent of kitchens of the bungalows and apartments met the World Health Organisation (WHO) guidelines on carbon monoxide for maximum-time weighted permissible limit for one, eight and 24 hours’ of human exposure.

“However, carbon monoxide concentrations in some kitchens were substantially higher in both the housing categories for all the time-weighted categories.

“The higher carbon monoxide levels in some kitchens may be because of their inadequate ventilation or outdoor contaminated air,” the study says.

It also points out that the kitchens of the apartments demonstrated the highest eight-hour carbon monoxide concentration during evening hours, which may be due to greater fossil-fuel related business activities within and around the apartments such as roadside catering and higher vehicular traffic emissions.

“Appropriate ventilation of kitchens may reduce their CO concentrations to meet the guidelines for getting out of any health-related risk. The outdoor CO concentrations can be reduced by decreasing the vehicular traffic jam and catering activities around the apartments,” the study suggests.

It cites the World Bank 2006 report according to which 28,000 deaths and 40 million cases of respiratory diseases are reported annually due to indoor air pollutants in Pakistan.

It refers to a 2008 study on indoor carbon monoxide and PM 2.5 (particulate matter of 2.5 micrometres or smaller) concentrations conducted in Rehri Goth, which demonstrated that women involved in cooking with biomass were potentially vulnerable to exposure to high concentrations of CO and PM2.5.

Carbon monoxide is found in fumes produced any time when people burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges, or furnaces. It can build up indoors and poison people and animals who breathe it.

According to experts, elevated ambient air concentrations of CO are hazardous because inhaled CO enters the bloodstream and reduces the amount of oxygen that the blood can deliver to the body’s organs (like the heart and brain) and tissues. At extremely high levels, the CO can cause death.

The most common symptoms of CO poisoning are headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion.

People who are sleeping or drunk can die from CO poisoning before they have symptoms.

Published in Dawn, April 20th, 2022

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As COVID cases declined across the U.S. in recent months and mask mandates were lifted, more people returned to restaurants, concert halls and offices maskless. But the novel coronavirus’s Omicron subvariant BA.2—which caused another wave in Europe and China—and related variants threaten to reverse that progress here. Earlier this month dozens of attendees (including high-ranking government officials) tested positive for COVID after attending a dinner in Washington, D.C. The safest option, of course, is to continue avoiding crowded indoor activities. But there remains a lot of interest in safely enjoying bars, cafes and other higher-risk venues that offer the benefits of social interaction.

Scientific American asked experts in epidemiology, medicine, risk assessment and aerosol transmission for advice on how to decide which risks we are willing to take. These decisions are based on assessments of personal risk, community risk and exposure risk—and the steps one can take to take to mitigate them. Personal risk refers to the danger of contracting COVID faced by an individual and the members of their household. Community risk is the current likelihood of encountering COVID among members of one’s community. And exposure risk accounts for the increased chances of catching COVID at a particular venue based on airflow characteristics of the space itself and other people’s behavior.

Here is what experts say about managing these risks while maintaining some of the benefits of public life.

How should a person factor personal risk for severe COVID into their decisions?

The number-one predictor of having a severe case of the disease is age, followed by the presence of comorbidities and immunocompromised status, according to Katelyn Jetelina, an epidemiologist who studies COVID risks at the University of Texas Health Science Center at Houston. Using data from the U.S. Centers for Disease Control and Prevention, she estimates that even vaccine-boosted people ages 50 to 64 are more than 10 times more likely to die from a severe breakthrough case than 18- to 49-year-olds with the same vaccination status. Donald Milton, a physician and clinical researcher who studies respiratory viruses at the University of Maryland, highlights recent research showing that, in households with a person who was infected with the Omicron variant (B.1.1.529) of the COVID-causing virus SARS-CoV-2, 43 to 64 percent of people became infected as well, depending on whether the initially infected person was boosted, fully vaccinated or unvaccinated. Jetelina cautions that we also need to account for the personal risks of the people with whom we live in our own risk assessments.

In general, people should discuss personal COVID risk with their doctor; it depends, in part, on which medications they take. Ethan Craig, a rheumatologist at the University of Pennsylvania, cares for patients who are immunosuppressed because of disease or medication and studies COVID risks in that population. One such immunosuppressive drug, rituximab, “knocks out your ability to make antibodies against new viral exposures and impairs your ability to make a response to a vaccine,” he says. Craig adds that such patients usually take precautions of their own accord, such as wearing high-filtration N95 masks, and “if anything, I end up having to talk people down sometimes and be like ‘Look, it’s okay to go to the grocery store.’” For some people, however, even this amount of exposure could be considered an unacceptable risk.

How does the risk of dying from COVID compare to the risk of dying from other causes linked to common activities?

Jetelina estimates that, for people between the ages of 18 and 49 who are boosted, the risk of dying from COVID is roughly equal to the risk of dying when someone drives about 10,000 miles. COVID risk goes up substantially with age and with being unboosted or unvaccinated. Thanks to vaccines, infection-induced immunity, therapeutics, better care and other factors, the relative risk of dying from COVID if you catch it is now, broadly speaking, comparable to that of seasonal flu, Jetelina says—but importantly, because you are more likely to catch COVID than flu, the absolute risk remains much greater. Jetelina recommends COViD-Taser’s Relative Risk Tool, a resource funded by the National Science Foundation, that she helped to develop. It compares one’s risk of death from the disease to such risk posed by other activities, including driving. Although it is a research tool, Jetelina says she can “really trust the science and mathematics behind it.”

But Baruch Fischhoff, a professor of engineering and public policy at Carnegie Mellon University and an authority on how to communicate health risks, cautions against using risk-risk comparisons to make choices without fully considering benefits or unquantified risks. Employers may also misuse such comparisons to compel employees to accept certain risks on the job, which is not exactly a choice. Currently, risk calculators provide estimates based on retrospective data and may be unable to reliably weigh long-term complications of COVID.

How should one assess community risk?

There is no perfect way to measure community risk because it would take repeated random testing, so experts use other estimates: daily cases per 100,000 residents, test positivity rates and growth rates. Jetelina recommends using the New York Times’ tracker to look up community transmission for your county. She considers community risk high when there are more than 50 weekly cases per 100,000 residents. When the risk is lower than that, Jetelina—a healthy, young boosted person—feels comfortable taking off her mask indoors. “I will say it’s taken a lot of time for me to be comfortable with that,” she says. “Once transmission rates of those indicators start increasing a bit, I’m putting my mask back on.” Others suggest a slightly higher risk threshold of 10 daily (or 70 weekly) cases per 100,000 residents.*

Daily city or county case counts are often an undercount because not everyone is getting tested and home test results are not always reported. As a work-around, health authorities use the “test positivity rate,” or “percent positive”—the percentage of COVID tests reported to public health authorities that were positive. If that number exceeds 5 percent, it is widely considered high risk for community transmission (provided the amount of testing in that area is adequate). But the community sample used to measure test positivity likely includes many people who seek out testing because they are currently experiencing COVID symptoms. So test positivity is typically higher than the infection rates among the people you might encounter in a cafe or grocery store, most of whom do not have any symptoms but could still be infectious.

Still, Robert M. Wachter, a professor and chair of the department of medicine at the University of California, San Francisco, says there is no test positivity threshold that separates “safe” from “not safe” because it also depends on other factors, such as whether the benefit outweighs the risk to you, personally, the number of people you will be exposed to, and the closeness and duration of exposure.

Because of these large uncertainties in test coverage, Gerardo Chowell, a professor of mathematical epidemiology at Georgia State University, prefers to look at the general trend in daily COVID cases, hospitalizations and deaths, or percent positive. “When the trend is going up, you’re seeing the transmission chains expand,” Chowell says. “That means that the reproduction number”—the expected number of secondary infections from each infected person—“must be greater than one. If it is increasing, that’s probably the time when [one has the] highest risk of acquiring COVID in a social setting without a mask,” he says.” Wachter points out that, where available, wastewater surveillance may also give an early indication of COVID trends.

What is known about exposure risk in different settings, such as bars or movie theaters?

Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and one of the world’s leading experts on airborne transmission of viruses, says COVID risk in indoor spaces exists on a continuum. It is believed that reducing the amount of virus inhaled (i.e., the inhalation dose) makes infections less likely or illness less likely to be severe. Marr says one of the riskiest settings is an aerobic exercise studio: if somebody is infected, they are going to be exhaling more virus, and everyone else will be inhaling at a faster rate, too. Breathing heavily produces up to 10 times more aerosol particles that carry viruses than breathing normally, according to Richard Corsi, an expert on indoor air quality and dean of the College of Engineering at the University of California, Davis.

Marr says that talking in bars expels a similar number of respiratory particles as coughing, “so it’s like everyone’s in there coughing together.” Craig uses smoking as an analogy for aerosols exhaled during breathing and talking. In other words, “if a person was smoking in this place, would I be able to smell it?” he says. In movie theaters, there is risk of exposure from those seated immediately around you, but because of limited talking and, typically, a high ceiling, there is a lot more dilution of the air. So such a theater may be less risky than other crowded indoor venues. By that reasoning, museums, big-box retailers and grocery stores with high ceilings tend to be relatively safer as well.

Places with rapid rates of ventilation and filtration—such as some subways—are also much lower risk. The Bay Area Rapid Transport (BART) system in San Francisco Bay, for example, filters the air more than 50 times an hour with “virus-trapping MERV-14 air filters” inside each car. An Italian study of schools found that classrooms with ventilation systems that exchanged air six times per hour reduced infections by more than 80 percent, but many classrooms in the U.S. fail to meet this standard. Corsi characterized current public health recommendations of four to six air exchanges per hour as “a little bit anemic … we can do better.” He recommends owners or managers of crowded indoor spaces, such as classrooms, offices and bars, aim to filter or ventilate with fresh air at rates approaching 12 air exchanges per hour to reduce risks down to the level of an airborne isolation room in a hospital. Not all venues have the resources to do this, but the benefits increase with greater filtration rates, so the closer to this ideal, the better. In places with inadequate ventilation, consider bringing a portable high-efficiency particulate air (HEPA) purifier—or building your own using box fans and high-quality HVAC (heating, ventilating and air-conditioning) filters—to run nearby.

Although the virus is thought to be transmitted primarily through the air, there have been a few documented cases of surface transmission, so it remains a good idea to wash your hands frequently, Marr says.

How can one further reduce the risk of getting COVID from everyday activities?

Getting vaccinated and boosted protects against death, hospitalization and, to a lesser extent, catching and spreading the virus. To avoid infection, Wachter recommends wearing an N95 mask. He has observed that the risk of U.C.S.F. health care workers—himself included—getting infected from their patients while wearing a well-fitting N95 is extraordinarily low. These respirators get close to filtering all of the virus, but they do not filter 100 percent. And if an N95 does not form an airtight seal with your face, it may allow unfiltered air into your lungs. So it is essential to try out and select N95 models that fit and seal to your face without gaps.

What is the risk of taking your mask off in a restaurant or bar to take a sip or bite?

In the 1990s medical researcher Stanley Wiener, then at the University of Illinois College of Medicine, proposed that a person could use respirators to survive aerosolized biological attacks, taking it off briefly to consume food and drink. During the pandemic, many places have allowed masks (or N95 respirators) to be removed while actively eating and drinking. Removing an N95 momentarily for a bite or sip carries “some risk, but I think it’s pretty tiny if you’re exposed for three seconds,” Corsi says, unless an infected person is “right in your face … and shedding a lot [of virus].” Provided community risk is low or trending downward, Chowell, too, feels comfortable briefly removing his respirator to eat or drink at a party.

What do we know so far about the risk of “long COVID”?

Ranu Dhillon, a physician at Brigham and Women’s Hospital in Boston, who advises governments on infectious disease outbreaks, says he is seeing some patients with “a constellation of different types of symptoms after acute COVID infection,” including young, boosted and relatively healthy people. Wachter cautions that some fraction of vaccinated individuals who get infected—which one study estimates to be around 5 percent and possibly higher—may continue to feel short of breath or fatigued or think less clearly than before. COVID may increase the risks of heart attack, stroke, brain abnormalities or the onset of diabetes. While there have been preliminary studies of the rates of long COVID, including risks of developing cardiovascular complications, Wachter says many of these involved unvaccinated people or infections with variants prior to Omicron. Provisionally, he likens these risks to 20 years of untreated high blood pressure or smoking and points out that one cannot know the risk of long COVID among vaccinated and boosted individuals until long-term studies have concluded, which will take years.

How can we balance these risks with the benefits of socializing and being with others?

According to Wachter, one of the most important factors in overall COVID risk is whether “the person next to me has it.” He acknowledges that if someone is both vaccinated and boosted, it is not irrational for that person to decide that the mental energy and angst of calculating risks and taking precautions is high enough—and the risks of getting sick or dying from COVID are low enough—that they will go back to “living like it’s 2019”—as people in many parts of the country already have. He still worries about the risk of long COVID, though. Milton says that many people “don’t want to wear masks forever” and that we should work to make our built environments better at stopping aerosol transmission. He says people also have to decide whether to wear a high-quality mask when they are around those at higher risk, such as the elderly or immunocompromised, or around other people in general, such as at a party. When community transmission is low, Chowell says he may feel comfortable removing his N95 at parties in some situations, such as to have a drink. “Then you find a way to still interact with people, and they smile back once in a while,” he adds.

*Editor’s Note (4/19/22): This paragraph was edited after posting to correct the description of the threshold of COVID transmission that Katelyn Jetelina considers a high community risk.

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A person at San Ysidro High School has been diagnosed with tuberculosis and may have exposed students and school staff, the San Diego County Health and Human Services Agency announced Tuesday.

The dates of exposure were from Jan. 11 to March 18 of this year. HHSA is working with San Ysidro High School officials to notify those who were potentially exposed.

Meanwhile, the county’s TB Control Program is testing, at no-cost, all identified students and staff members.

“Testing is recommended for people who were exposed to assure they are not infected, since initial infection usually has no symptoms,” said Dr. Wilma J. Wooten, county public health officer. “For any infected individuals, early diagnosis and prompt treatment can prevent the infectious form of the disease.”

A negative test result usually indicates that the person is not infected with the TB bacteria. However, it may take eight to 10 weeks after exposure for a test to be positive, officials said. San Ysidro High School students and staff who were exposed to the infected individual and receive a negative test result from their first TB test in April, will require a follow- up test next month.

Tuberculosis is transmitted from person to person through indoor air during prolonged contact with an infected person. Most people who are exposed do not become infected.

Symptoms of infectious tuberculosis include persistent cough, fever, night sweats and unexplained weight loss. People with symptoms of TB, or who are immune-compromised and may not show obvious symptoms, should consult their medical provider. Tuberculosis can be cured with an extended course of specific antibiotics.

According to the HHSA, tuberculosis is not uncommon in the San Diego region and, although decreasing since the early 1990s, case counts have stabilized in recent years. In 2021, 201 cases were reported in San Diego County. To date, 23 cases of tuberculosis have been reported in 2022.

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