Coronavirus guidelines for city workers

Clinical Question

What are the guidelines for city workers through 2020 (including police, medical first responders, pressurized and open sewer workers, and undertakers)?

Key Findings

  • The virus that causes COVID-19 has been found in untreated wastewater, though researchers do not believe that exposure to untreated wastewater or sewer systems can cause disease.
  • For wastewater workers, standard practices associated with wastewater treatment plant operations should be sufficient protection from COVID-19 transmission, including engineering and administrative controls, hygiene precautions, specific safe work practices, and PPE normally required. No additional COVID-19–specific protections are recommended at this time.
  • Municipalities and local EMS authorities should coordinate with state and local public health, PSAPs, and other emergency call centers to determine need for modified caller queries, including questioning callers to determine the possibility that the individual of concern has COVID-19 symptoms.
  • EMS clinicians and first responders caring for a patient with possible COVID-19 infection or who will be in the compartment with the patient should use CDC-recommended PPE, including N-95 or higher-level facemask, eye protection, and disposable gloves.
  • Law enforcement who may contact individuals confirmed or suspected to have COVID-19 should follow CDC’s Interim Guidance for EMS and otherwise avoid close contact with the public during an apprehension.
  • CDC guidance recommends funeral home workers use routine infection prevention and control precautions when handling a decedent who died of COVID-19. When transferring bodies and embalming, workers should follow standard precautions, including the use of additional PPE to protect from splashing fluids.
  • There is no known risk associated with being at a funeral or visitation service with the body of a deceased COVID-19 patient.

Summary of information

Wastewater and Sanitation Workers

The CDC recommends wastewater and sanitation workers use standard practices associated with wastewater treatment plant operations to protect against COVID-19 transmission and does not recommend any additional COVID-19–specific protections at this time.[1] While persistence in water is possible, there is no evidence that the COVID-19 virus has been transmitted via sewerage systems with or without wastewater treatment. Further, there is no evidence that sewage or wastewater treatment workers contracted the severe acute respiratory syndrome (SARS) in 2003.[2] Workers at sanitation treatment facilities should wear appropriate PPE, perform hand hygiene frequently, and avoid touching eyes, nose, and mouth with unwashed hands.

First Responders

Medical first responders should follow all general OSHA-recommended steps to avoid acquiring COVID-19, including isolating suspected cases, conducting routine cleaning and disinfection, training workers, identifying workers with increased susceptibility, and using and optimizing PPE.[3] All EMS units should implement robust infection control procedures, including protocols for safely using PPE. When COVID-19 is suspected in a patient needing emergency transport, first responders should notify healthcare facilities in advance that they may be caring for, transporting, or receiving a patient with suspected COVID-19 infection.[4]

EMS clinicians should exercise appropriate precautions when responding to any patient with signs or symptoms of a respiratory infection, including beginning assessments from a distance of 6 feet if possible and minimizing patient contact until patients are equipped with a face mask. If COVID-19 is suspected, all PPE as described below should be used. If COVID-19 is not suspected, EMS clinicians should follow standard procedures and use appropriate PPE for evaluating a patient with a potential respiratory infection. During transport, EMS clinicians should limit the number providers in the patient compartment to essential personnel only.[4]

Police Officers

Law enforcement officials should maintain a distance of 6 feet if possible when interacting with the public and ensure only trained EMS workers assess and transport anyone with suspected COVID-19 infection. If contact with individuals with suspected COVID-19 infection is required, law enforcement should follow CDC’s Interim Guidance for EMS, including the use of all recommended PPE. If close contact occurs during apprehension, officials should properly clean and disinfect gear prior to reuse using a household cleaning spray, follow standard operating procedures for disposing used PPE, and follow standard procedures for laundering clothes.[5]

Undertakers/Morticians

Standard precautions and routine infection control procedures are currently recommended for undertakers and funeral home workers handling the body of a deceased COVID-19 patient.[6] Specifically, the Minnesota Department of Health recommends morticians use standard PPE, including protection of eyes, nose, and mouth, when preparing the body or embalming.[7] CDC guidance state that embalming, burial, and cremation are permitted, though workers should check for additional state and local requirements that may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.

The CDC confirms there is no known risk associated with being in the same room at a funeral with the body of a deceased COVID-19 patient. However, funeral home workers should advise individuals to avoid touching the body and follow CDC guidance, including social distancing and hand hygiene.[6]

Gaps in Knowledge

The risk of COVID-19 transmission via untreated wastewater remains unclear. While the virus that causes COVID-19 has been found in the feces of some patients, scientists expect the risk of such spread is low.

Author Information

Authors: Emily Plumley, MPH, Yale School of Public Health
Completed on: May 6, 2020
Last revised on: May 6, 2020

Reviewed by: Marsha-Gail Davis MD
Reviewed on: May 14, 2020

This summary was written as part of the CoRESPOND Earth 2.0 COVID-19 Rapid Response at UC San Diego. For more information about the project, please visit http://earth2-covid.ucsd.edu

References

  1. CDC. Water and COVID-19 FAQs. cdc.gov. https://www.cdc.gov/coronavirus/2019-ncov/php/water.html. Updated April 23, 2020. Accessed May 2, 2020.
  2. WHO. Water, sanitation, hygiene and waste management for COVID-19. WHO Technical Brief. Published March 19, 2020. Accessed May 1, 2020.
  3. OSHA. COVID-19 Control and Prevention. Osha.gov. https://www.osha.gov/SLTC/covid-19/controlprevention.html. Accessed May 2, 2020.
  4. CDC. Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States. cdc.gov. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html. Updated March 10, 2020. Accessed April 30, 2020.
  5. CDC. What Law Enforcement Personnel Need to Know about Coronavirus Disease 2019 (COVID-19). cdc.gov https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-law-enforceme.... Updated March 14, 2020. Accessed April 30, 2020.
  6. CDC. COVID-19 and Funerals. cdc.gov. https://www.cdc.gov/coronavirus/2019-ncov/faq.html#COVID-19-and-Funerals. Updated April 22, 2020. Accessed May 2, 2020.
  7. Minnesota Department of Health. COVID-19 Funeral and Mortuary Science Guidance. Health.state.mn.us. https://www.health.state.mn.us/diseases/coronavirus/guidefuneral.pdf. Updated March 19, 2020. Accessed May 2, 2020.