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To the Editor:
The number of small and medium-sized enterprises (SME) far exceeds that of large companies, and much more people are employed.1 SMEs are more flexible in adapting to some economic changes, however, due to the smaller size, once an employee was diagnosed with COVID-19, the damage of SEM may be failed to recovery from the plague.
Up to May 11, 2020, there have been over confirmed 4,006,257 cases of coronavirus disease 2019 (COVID-19) infection and 278,892 resultant deaths.2 The confirmed case in Taiwan were almost have traveling history of aboard or intra-family infection.3 Workplace breakout has not been reported. As physicians of occupational medicine, and occupational health service experts, we have confronted many tasks and dilemmas in the face of the COVID-19 outbreak.
Government of Taiwan revised the labor-related law, Occupational Safety and Health Act and Labor Health Protection Rules. The main revision is that occupational health services should be provided in enterprises which contain 200 to 299 employee since July 1, 2018, and which contain 100 to 199 employee since January 1, 2020. For the endemic, Kaohsiung Medical University broadly provides occupational health services for more than 50 enterprises and SMEs in Kaohsiung City and no enterprises have COVID-2019 pandemic breakout. We propose the following policy suggestions on top of existing protocols4,5:
First, providing extra occupational health services. Besides regular occupational health service, we should consider increase the frequency of occupational health service according to the rapid change of COVID-19 breakout. The strategy not only provides more information of COVID-19, but also let companies and employees feel more at ease. If possible, enterprises even should consider hiring a full-time occupational health service nurse or medical physician. Consider making a good communication between occupational medicine experts and enterprises by means of communication software if the local regulations permit. The occupational health experts could update the epidemic situation and propose effective anti-epidemic steps in time.
Second, work pattern adjustment. To keeping social distance and avoid employees gathering, dividing into a smaller group divisional shift is important, such as taking turns to rest during mealtimes, even in vacation to reduce employee contact with each other. Smaller groups of the fixed employees keep the SMEs maintaining production, reduce the possibility of cross infection, and give employees enough time to prepare for the epidemic. SMEs should also make quarantine at the entrance, provide alcohol disinfection, and strengthen environmental cleanliness.
Third, uses of automatic technologies and artificial intelligence. Short of face masks and information about health as well as manpower were frequently happened in SME. We suggested SMEs to use the name-based rationing system for face masks (launched on February 6, 2020), each person with Taiwan National Health Insurance Card (NHI card) or Resident Certificate can buy limited but enough face masks with lower price. Also, SMEs can use internet system to connect the Central Epidemic Command Center (CECC), even various smart phones APP to get information such as face mask stock. By means of communication software for online operations is also a way to reduce person-to-person contact. Through simulation exercises, employees can adapt to the software communication process in response to the pandemic.
Fourth, supporting and maintaining workplace mental health. We provided interviews even telephone or online interviews for mental health support and short questionnaire such as Checklist Individual Strength Questionnaire,6 Copenhagen Burnout Inventory,7 etc to screen and transfer high risk employees to psychiatrics or psychological service. Use psychological strategies to manage stress and stay positive is good for both employees and SMEs.
Prevention is better than treatment. Aggressively investigating potential therapies of COVID-19 is crucial, we also should prevent catastrophe of breakout or provide strategy for return to work after pandemic in SMEs. We followed the comments from Occupational Safety and Health Administration (OSHA): (1) workplace risk levels; (2) complaints, referrals, and rapid response investigations (RRIs); (3) inspection scope, scheduling, and procedures. Furthermore, we recommend above advices with the principle of hazard evaluation and prevention: Engineering Controls, Administrative Controls, Personal Protective Equipment, and Training and Information.5 We hope that in facing the COVID-19 pandemic, all enterprise should harmonize the implementation of their health care system and occupational health service experts to fulfill an efficient order of health care in workplace and overcome the COVID-19 pandemic.
1. Total Employment of Small and Medium Enterprises by Industry in 2018. Taiwan:Small and Medium Enterprise Administration, Ministry of Economic Affairs; 2019.
2. Coronavirus Disease 2019 (COVID-19) Situation Report-112. Geneva:World Health Organization; 2020.
3. COVID-19 (SARS-CoV-2 Infection)- Taiwan. Taiwan:Taiwan Centers for Disease Control; 2020.
4. Interim Guidance for Businesses and Employers to Plan and Respond to Coronavirus Disease 2019 (COVID-19). Atlanta:Centers for Disease Control and Prevention; 2020.
5. Kapust PJ. Interim Enforcement Response Plan for Coronavirus Disease 2019 (COVID-19); 2020.
6. Wang C-L, Huang J-J, Yang C-Y, Chuang H-Y. The evaluation of validity and reliability for the Chinese Version of Checklist Individual Strength Questionnaire. Taiwan J Fam Med
7. Yeh W-Y, Cheng Y, Chen C-J, Hu P-Y, Kristensen T. Psychometric properties of the Chinese version of Copenhagen Burnout Inventory among employees in two companies in Taiwan. Int J Behav Med