As the mining sector is gearing up to restart operations after the COVID -19 lockdown, mining firms should be careful not to reinvent the wheel, but to apply the valuable lessons learnt from other epidemics such as HIV/AIDS and tuberculosis to keep its workforce healthy and safe.
There is no doubt that the local mining industry is vulnerable to the virus.
Since the early 1990s, mining has been the sector most impacted by HIV, AIDS, tuberculosis and silicosis.
With HIV, silica dust exposure and silicosis increasing the risk of tuberculosis, the industry has had to respond in a decisive and unprecedented manner by applying multi-pronged, multidisciplinary and novel approaches to tackle the burden of disease, in addition to the concomitant stigma, discrimination and labour relations challenges that accompany these diseases.
The mining industry would do well to identify the leading practices that contained the HIV and tuberculosis epidemics, and to enhance and adopt these practices to contain and mitigate the impact of coronavirus on the industry.
Similar principles to IDENTIFY, PREVENT, TRACE, TEST, TREAT and for the early diagnosis, early treatment, rehabilitation and eradication of COVID-19, whilst maintaining mineworkers’ dignity, play a major role in keeping mine workers healthy and safe.
There is no time for complacency.
While the true extent of current coronavirus community transmission is unknown, mines have to be extremely vigilant of the rapidly evolving epidemic, and be attuned to the community patterns of disease, as well as the environmental and human risk mitigation factors.
In flattening the curve, mines should urgently develop COVID-19 workplace policy, plan for local outbreaks and identify high risk employees.
The innate nature of the mining environment lends itself to dense occupancy in accommodations, in commuting to the workplaces, in travelling to the stopes either in a vehicle or on foot.
In addition, specific mining processes involve teams working in close proximity to each other; all of which are potentially hazardous COVID-19 transmission points.
In these specific mining scenarios, it will be a challenge to comply with the precautionary measures recommended to the general public, such as keeping a ‘social or physical distance’ of one metre, and appropriate hand washing.
In contrast however, surface mining operations and mechanised mining do provide ample opportunities to enforce these hygiene behavioural practices.
As the pandemic progresses, we are learning more about the behaviour of the SARS-CoV-2, the virus responsible for COVID-19. It is important to note that unlike tuberculosis, the COVID-19 is NOT caused by airborne transmission.
While there are still many unknowns regarding COVID-19 virus viability, both in air and on surfaces, under various environmental conditions, the transmission pathways are generally well described. The two main pathways can be categorised as direct and indirect.
The direct route involves the inhalation of droplets expired by an infected person, through speech, coughing or sneezing. As a rule of thumb, at very close distances of less than one metre, large droplets may reach the breathing zone of another person.
Smaller droplets can adhere to dust particles or be captured by air movement; they may remain airborne and be inhaled by receptor-person(s) further away from the index-person..
The indirect route is the surface-hand-mouth-nose mucosal contact. Droplets may have been deposited on surfaces and the virus may survive on the surface for hours or days.
The survival time varies hugely, from a few hours on porous surfaces (tissues) to days on smooth, non-porous surfaces (stainless steel). Usually the survival time on the skin is much shorter than that on non-animate surfaces.
The Minerals Industry Risk Management Process should be applied in developing mine specific COVID-19 risk management strategy.
An appropriate analysis of the exposure pathway, starting with source identification (identifying index-persons) and understanding the epidemiology of COVID-19 in the peri-mining community, is imperative for optimal containment of the disease,
Controlling the spread of COVID-19 should be done by systematically applying a hierarchy of controls, comprised of the following mechanisms:
Screening, not only for HIV, tuberculosis and the chronic diseases of lifestyle, has become the norm in the South African mining industry. To this, we should add screening for COVID-19.
Symptom- and fever-screening at work and at home, to identify suspected cases and contacts early, should be given priority. Contacts should be actively and promptly traced, tested and treated.
Infected mineworkers should be placed in isolation immediately. Contacts and mineworkers with flu-like symptoms should remain self-quarantined at home or in mining accommodation, as applicable.
It may become necessary for mines to institute specific COVID-19 quarantine facilities for its employees who are unable to self-isolate in their usual accommodations.
Administrative controls carry significant weight in preventing COVID-19 on the mines.
Customised COVID-19 workplace policies and procedures must be integrated into the strategic risk management frameworks and core business practices, and be endorsed by top leadership and employees alike. In addition, mines should develop specific community outbreak intervention strategies.
These policies must be clear about who is entitled to sick leave or quarantine sick leave, and explicit about how this should be implemented.
Occupational medicine practitioners should prepare in advance and ascertain how the Department of Mineral Resources and Energy (DMRE) guidelines on the minimum standards of fitness to perform work on the mines and medical incapacity policies should be applied in suspected, infected and recovering COVID-19 cases.
Existing peer educator platforms, and health and safety committees, should be used effectively to educate and raise awareness on COVID-19.
General health promotion materials, illustrating good cough hygiene, hand washing, respiratory etiquette, COVID-19 symptoms, quarantine/isolation methods, and information on available healthcare facilities, must be freely available, using multiple communication channels.
Health response teams must be well prepared regarding the COVID-19 case definition, and be equipped with the correct protective equipment, medical supplies and referral pathways.
There must also be consistent monitoring, evaluation and reporting of COVID-19 cases to inform epidemiological trending and further research.
As part of the risk management process, high risk COVID-19 categories amongst the workforce, should be actively identified and appropriately managed, namely:
- employees with pre-existing occupational lung diseases such as asthma, obstructive airways diseases, active/chronic/past tuberculosis, and pneumoconiosis e.g. silicosis;
- employees with comorbid risk factors and pre-existing diseases such as cardiorespiratory disease, diabetes, hypertension, auto-immune disorders and cancers;
- HIV-infected employees with low CD4 counts; and,
- smokers, who are at higher risk of contracting SARS-CoV-2.
These workers should be fast-tracked to receive prophylaxis for the seasonal influenza (flu vaccine), pneumococcal pneumonia (pneumococcal vaccine) and tuberculosis (isoniazid preventive therapy), as advised by their doctors.
Engineering and environmental controls
The COVID-19 crisis presents us with an opportunity to expand and strengthen what has already been achieved with dust control measures such as improved ventilation, wetting methods accompanied by robust leadership, and behavioural strategies.
These dust control mechanisms indirectly control COVID-19, tuberculosis and other airborne infectious diseases, which is a win for public health, employers and the economy.
Behavioural risk communication controls
As the mines prepare for re-entry into the workplace post lockdown, companies would do well to understand their employees’ knowledge base, attitudes, and perceptions that drive employees’ responses to the COVID-19 pandemic.
Information needs must guide risk communication strategies to address myths and target specific behaviour modifications that prevent COVID-19.
Some preventive, ongoing non-pharmaceutical interventions comprise good hand hygiene, cough etiquette and physical distancing, and must be emphasised.
Where physical distancing is impossible, a cloth mask can prevent transmission from an asymptomatic carrier to the rest of the workforce.
Personal protective equipment
The mining environment is confined and cramped with poorly ventilated spaces; mineworkers will find it almost impossible to escape COVID-19.
Physical distancing is unrealistic in some instances and may go against standard safety measures. While mine workers are equipped with personal protective equipment such as face masks and respirators, these are for dust prevention only and not specifically for COVID-19 prevention.
However, specific protocols and training can be developed to make use of the available respirators / masks in particular ‘hot spot’ transmission scenarios such as densely populated working spaces and mines that operate in areas of high community transmission.
Surgical / medical masks are recommended for suspected or infected persons and for healthcare workers on the frontlines. However, employers should strongly prohibit, suspected or infected COVID-19 employees from being on site.
Other support mechanisms
The mining industry would do well to engage with the service providers of their employee assistance programmes to provide advice, stress management and psychosocial support to their workers 24/7.
A COVID-19 hotline, managed by the mines’ occupational health staff, could assist with triaging mineworkers. This would take a substantial burden off the public health systems and hotlines managed by the National Institute for Communicable Diseases.
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The mining industry has well-organised and well-functioning occupational health and medical facilities. Guided by the Minerals Industry Risk Management Process, adopting the Minerals Council’s COVID-19 Ten Point Plan of Action, and using the recent guidelines from the DMRE, it is well-positioned to develop customised COVID-19 prevention strategies for its workforce, extending to the peri-mining communities.
The industry, together with its tripartite stakeholders, needs to think carefully, weigh risks in context, implement policies commensurate with the magnitude of this threat, and be decisive, relentless and tenacious in its fight against the impact of COVID-19.
Professor Derk Brouwer is the Chair in Occupational Hygiene in the Occupational Health Division, School of Public Health at the University of the Witwatersrand and an A2 National Research Foundation (NRF) rated exposure scientist.
Dr Vanessa Govender is a lecturer and the academic coordinator of the Post Graduate Diploma in Occupational Health programme in the Occupational Health Division, School of Public Health at the University of the Witwatersrand, and is a mining occupational medicine specialist.