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Covid-19: Less haste, more safety

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3258 (Published 20 August 2020) Cite this as: BMJ 2020;370:m3258

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Rapid Response:

Let's stop talking about COVID-safe and COVID -secure -- it's COVID-mitigated

Dear Editor

We have been in countless meetings of different organisations where there have been important discussions about making the workplace COVID-secure or COVID-safe (and in one unfortunate malapropism, COVID-friendly!). This language is problematic as it suggests that we can make places 100% safe for staff, which will never be possible. The language can also drive irrational behaviour; the term COVID-secure suggests a very high degree of certainty requiring extreme procedures.

Thus, COVID-secure transport to hospital required patients not to use taxis, public transport or even walk – they had to find someone who had self-isolated for 2 weeks to drive them.

A more useful way we should think about workplaces (and indeed other public and private spaces and activities) during the pandemic is to describe them as COVID-mitigated. This follows standard risk assessment approaches; the risk of a person entering a space or taking part in an activity should be risk assessed and categorised. Factors that need to be considered include the estimated prevalence of infection in that space, contact time and distance and other factors such as the degree of aerosolization.

Once the risk has been categorised there needs to be a judgement as to whether it is a reasonable risk. Where possible steps should be taken to reduce the risk and the risk reassessed. Then, depending on the level of the risk, appropriate mitigation should be undertaken. This could include appropriate PPE or physical barriers to reduce the risk to the individual.

The term COVID-mitigated emphasises that there is always a residual risk, and that steps should be taken to reduce that risk. Even in a situation where there is a low incidence of infection and good social distancing then it is necessary to mitigate the risk, for example, by good handwashing.

This approach also emphasises the dynamic nature of risk. As things changes (especially prevalence) then the risk changes and so may the necessary mitigations. It also discourages people and organisations taking extreme steps in an attempt to eliminate negligible risks.

It also gets people to think about their own safety in a considered way. Every activity or place where there is more than one person will carry some risk of COVID-19 infection, but that risk can be so small that most people may choose to accept it.

While the risk of infection is broadly the same for everyone in the workplace, the consequences of infection are different depending on age, ethnicity and co-morbidities. This now becomes a familiar two-axes risk assessment, and further mitigations will be needed as the potential severity of infection will be higher for people in these groups. This is important for safety and ensuring equity of opportunity and access for all.

COVID-mitigation is a less misleading way of describing how we should approach preparing to start activities and open places following the lockdown. We would suggest that a simple algorithm to help assess the risk and plan the appropriate mitigations would be helpful.

Professor Catherine Urch
Professor Andrew George

Competing interests: No competing interests

25 August 2020
Catherine E URCH
Consultant Palliative Medicine and divisional director Surgery and Cancer
Andrew J T GEORGE
Imperial College Healthpartners
catherine.urch@nhs.net