“The world of work will never be the same again….In a post COVID-19 world, work not only has to be safe, it has to be “clean and assured.”  - Larry Pearlman, Marsh Risk Consulting
 

“The science is decades old on all the benefits that come from healthy buildings, including infectious disease reduction…But these strategies have not been fully deployed in buildings.”  -Joseph Allen, Director of the Healthy Buildings program, Harvard T.H. Chan School of Public Health

The COVID-19 pandemic has raised general awareness about our health at work, including the importance of the buildings themselves.  Given that we spend an average of approximately 90% of our lives indoors and a third of that in an office setting, it makes sense that we should pay more attention to our health and safety in these spaces.  Healthy building experts and public health officials have already been making steady progress in understanding what makes a building healthier and what steps must be taken.  Top pandemic-related topics include air quality and ventilation, moisture, temperature, water quality, and even physical aspects of our spaces most people have never thought much about previously.  The current crisis has drastically increased the interest in this research, as well as in healthy building certifications such as the WELL Building Standard and fitwel.  Clearly, most companies will not be returning to business as usual given the risk of COVID-19 transmission and heightened uncertainty, and new rules may also be a matter of law, but what will the office of the future look like, and how will we operate? 

In her piece for “Working Knowledge,” Kristen Senz gets to the heart of the matter by asking questions most of us can instantly identify with:

• "Will you ever again step onto a crowded elevator without hesitation? 
• Reach for a doorknob without concern (or gloves)?"

We can all likely add to her list pretty easily:

• Touch the button in the above-mentioned elevator?
• Shake the hands of someone you are meeting, especially if they just flew in from out of town? Or worse, if they just coughed or sneezed?
• Will you ever not notice again when someone near you sneezes? (We should have extra sympathy for allergy sufferers right now)
• What are your conditions for giving a hug?  
• How close are you comfortable sitting next to a coworker?
• When are in-person meetings really needed?
• How healthy and safe is your building, and how do you know?
• How comfortable are you with the idea of business travel in the near future?
• Are you ready to use the office bathroom, or any public bathroom?

Put in another light, one can ask how healthy and safe is your building, and how do you know?  It stands to reason that employees will be asking these questions, and that when companies can answer them confidently and clearly, there’s a greater chance more people can get back to the office.  

One major change that has already occurred is that more people are and will be working remotely.  The technology exists and has worked brilliantly, the work by and large seems to be getting done and likely better in many cases without commutes, and there could even be a savings in the future from resulting reductions in office space.  As reported by Jane Margolies of the New York Times  Kate Lister of Global Workplace Analytics predicts that more than 25% of employees will continue to work from home regularly more than one day per week, an increase from the prior estimate of 25%.  An MIT study estimates that over 34% of respondents have switched from commenting to working at home, and these numbers are higher in some areas.  

But as Ben Tranel of Gensler Design puts it, “Humans are social animals. We value human connection, and we want to join our colleagues at work again.”  The Gensler Research Institute’s 2020 Workplace Survey of over 5,000 office workers indicates that people overwhelmingly prefer working at the office as opposed to working from home, their local coffee shop, or a coworking space.  But this research was conducted before the Coronavirus pandemic.  So the question is what are the required changes and communication required to provide that needed confidence so that people can work together safely again - and so that they will in fact do so.  

Although questions of our health at work and in buildings generally may seem new to many, these concerns are not at all new to the scientists, researchers, doctors and policy experts who study and work in health, public health (including infectious diseases), occupational health, and those who study and work to improve building health. After all, buildings and cities have changed dramatically before, in response to previous pandemics and disease outbreaks such as cholera, tuberculosis, and the 1918-1920 flu.  The current pandemic is just making what these experts already knew we needed to do more likely, or at least more rapidly adopted. 

According to Joseph Allen, the Director of the Healthy Buildings program at the Harvard T.H. Chan School of Public Health, some good news is that the procedures and many of the tools we need to make buildings safer for people and less welcoming to pathogens already exist. Mr. Allen and his colleague Dr. Macomber, a senior lecturer at Harvard Business School, recently published their book which now seems like a must read: Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.  According to Mr. Allen, 9 top  Foundations of a Healthy Building have been identified, partly through over 40 years of research at the Harvard Healthy Building Lab: ventilation, air quality, thermal health, moisture, dusts and pests, safety and security, water quality, noise, and lighting and views.

Mr. Allen and Dr. Macomber report that we take up to 2 million breaths in workspaces in a typical year.  So the potential impacts of making these spaces healthier and more disease-resistant are highly significant.  And now that we’re more aware of the importance of buildings to our health, expect those shopping for apartments, homes, and office spaces to start asking questions and to demand healthier spaces as well as better information.  Prospective employees will also likely start asking about building health as well. 

Solutions to make buildings healthier will vary of course in size, complexity, and in the time required for implementation.  Those planning new buildings will of course have an advantage in that they can design for safer spaces, while that leaves most existing building operators to scramble really to see what can be retrofitted and when.  Fortunately, answers are emerging.  

While we can not reduce our disease transmission risk to zero, there are clear ways in an order of priority that we can work to reduce this risk.  One of the most important concepts for understanding and reducing disease and other hazard risk in buildings is known as the Hierarchy of Controls.  Introduced by the Prevention through Design Program at the National Institute for Occupational Safety and Health, the Hierarchy of Controls is a widely accepted system of safety measures often illustrated as an inverted pyramid where more effective solutions are at the top and less effective solutions are at the bottom.  The Hierarchy is not only a tool and really a lens through which employees and employers can evaluate strategies for preventing and addressing risks, but the system also importantly provides designer and planners a means to think about better design for future spaces. 

In order of decreasing effectiveness, the 5 hazard controls in the hierarchy are: Eliminations, Substitution, Engineering Controls, Administrative Controls and Personal Protective Equipment (PPE). 

In reviewing and applying these principles, we can start to think through what kinds of changes we are likely to see from employers and building managers as well as how much employees are going to be asked to do differently going forward.

Image: https://www.cdc.gov/niosh/topics/hierarchy/default.html

• Elimination - Elimination means physically removing a hazard.  For example, the only way for employees to do this in an office space is to literally not be there, in the space.  Elimination is considered the most effective strategy and should be implemented in an emergency and/or before all other strategies if effectiveness is the topmost goal, explaining why it has been the expectation to date in the pandemic that all employees who can work from home should indeed do so.  Elimination may not always be possible, but it should always be considered even just as a part of a thorough understanding of hard reduction possibilities.  To practice this strategy, companies and employees need to ask at the highest level, “Who really needs to be in the office?” At least in the short term, those who do not need to be in the office to do their jobs optimally will likely be staying home and working remotely. 

• Substitution - Substitution means replacing one hazard or process with another that may be less risky.  Substitution in the Coronavirus context might mean staggering shifts so that key employees are on site at the same time, or isolating teams from each other so that the risk to each team is reduced.  In this way, teams are more likely able to substitute for each other and the whole organization is less likely to face a shut down.  Substitution is also relatively simple in theory if not always in practice.

• Engineering Controls - Engineering controls are designed to catch a hazard before it reaches an employee, at or as close to the source as possible.  The idea is to isolate the employee from the work hazard in a way that involved changing the space or something about how the space operates.  These controls also tend to be independent of worker action, meaning that the human element is removed to some extent.  Another way to think about Engineering strategies is adding technologies or engineering tools to the building itself to protect against disease.  

Engineering Controls are where we are likely to see the most visible change and expenditures, but they also vary widely. 

Immediately implementable and simpler Engineering Controls might consist specifically of:

• Increased cleaning and disinfecting - and cleaning verification. Companies are going to need to set new procedures and processes and then convey these to employees and possibly to regulators or verifiers.
  • Frequency and rigor of cleaning and disinfecting will increase
  • High touch surfaces will receive more attention
  • PPE may be required for cleaning
  • Cleaning confirmation will need to be posted and likely audited
• HVAC (see also more complex Engineering solutions)
  • Increase ventilation/circulation to the extent possible
  • Increase filtration if possible (within system limits)
  • Add air purification
• Changes in office furnishings, possibly temporary, which might include:
  • Moving desks further apart, and reducing the number of desks per area
  • Marking distances on floors so that people know and can also conveniently see the required distance to keep from desks or stations, or even how far to stay apart (and how many people can distance safely) in an elevator
  • Decrease or elimination of "hot desking” where employees do not have designated spaces
  • Adding barriers between employee spaces, such as partitions or reintroducing parts of the cubicle concept
  • Removing chairs or other furnishing to physically prevent employees from gathering closer than Administrative Controls permit
  • Closing smaller spaces where social distancing might not be possible, such as conference rooms
  • Adding screens and other equipment to facilitate more people joining gatherings that do take place in person without adding to the density of the space
• Application of touchless technology wherever possible (particularly important in restrooms)
  • Faucets and toilets
  • Doors (particularly bathroom doors, if possible.) Removing doors is also an option, though this may be a more complex solution.  
  • Trash cans
  • Automated shades
  • Elevator floor selecting
• Restroom modifications
  • Closing some stalls, to keep people further apart
  • Closing some sinks, also to maintain distance
  • Eliminating air hand dryers for the time being
• Cafeterias may be closed or may operate in a reduced capacity or with separate precautions for some time

More complex Engineering Control steps may include:

• Building Condition Assessment & Recommissioning for air and water quality. (particularly urgent where buildings may have been vacant for some time) Commissioning is basically an auditing step to verify if a building is performing in reality the way it is designed. 
• Water Treatment (specific to reopening after closure, above and beyond existing procedures)
  • Pipes must be flushed and properly sanitized 
  • Legionnaire’s disease in particular is a risk with stagnant water, if a building has been closed for over three weeks. 
• HVAC Improvements
  • Increase air circulation/ventilation to a minimum of 30 cubic feet per minute / person
  • Improve air filtering (less complex, as long as the system is sized appropriately for the upgraded filter) to PM2.5
  • Maintain 50 to 60% humidity if possible
  • Run air handlers whenever the building is occupied
  • Increase operable windows
• More significant floor plan modifications
  • Modifications may have to be made to the popular open office concept
  • Bathrooms may need significant retrofitting
    • Urinal partitions
    • Complete redesigns and/or additional facilities
  • Hand washing stations outside of bathrooms should also be considered
• Increased outdoor space
• Increased biophilic design, including more plants and other natural design elements
• Materials changes
  • Smoother surfaces which are easier to wipe, and non porous
  • A possible increase in antimicrobial materials, and in materials where the virus does not seem to thrive as much

• Administrative Controls - As one moves down the Hierarchy of Controls, this strategy comes into place for risks that are less well controlled and where the individual employee will be a key player in determining effectiveness.  Administrative controls might involve changes to policies that require trust for successful implementation, such as asking employees who are ill to stay home.  Dedensifying buildings (fewer people on site) and tactics such as alternating shifts or isolating workers or terms are sometimes considered administrative controls and at other times are considered substitution, perhaps depending on the level of supervision.  Rules about conducting meetings remotely or lowering travel are considered administrative controls, as are training and educational programs.  Safe work practices such as providing communications, signage and supplies for proper hygiene are also considered administrative controls, as they only work with compliance (but it could be argued that the supplies themselves are a form of PPE).  

Administrative Controls cover a wide range of tactics, from communication strategies to changes in behavior employees will be asked to undertake:

• A top request/requirement of all employees going forward will be that ill employees simply stay home (temperature tests and other checks may remove some of the autonomous dimension here, if they are determined not to violate privacy)
• Key employees may be asked to come in at different times than others who can perform the same critical function, or they may be isolated t different parts of an office or building
• Shifts and hours may be staggered to lower building density, and also to prevent bottlenecks as fewer people will be using entrances, elevators and/or stairs at the same times
• Employees will be required to stay as separate as is reasonably possible and advisable
  • Employees will be asked to social distance at 6 feet apart or greater
  • Desks and chairs not intended to be used may be marked (as opposed to removed, which is an engineering solution)
  • In-person meetings will likely be limited to only when essential, and these meetings should be limited to ten people or less if at all possible
  • Limits will likely be set as to the number of people:
    • In the building
    • On a particular floor
    • In a given room or meeting, if in-person
    • In the elevator at any given time
  • Guests may not be permitted or may be permitted only in certain areas, and they will have to follow a set protocol
• New procedures will have to be designed, implemented and monitored for how materials and/or supplies enter buildings, including any measures needed further down the supply chain
• Business travel will likely be significantly decreased for some time
• It’s pretty clear that no one should be shaking hands in the near future
• Traffic patterns in hallways, stairwells and in other spaces may be altered with signage, such as making some spaces or entrances one-way (administrative as compliance can not be physically required)
• Employees will be asked not to share supplies and technology
• Employees will likely bring food from home instead of using common spaces and equipment to store or serve food. Cleaning supplies will be provided for any equipment that is shared, for wiping buttons and handles.
• Hand sanitizer, wipes, tissues and related supplies will be widely available
• Communications will increase through distributed written policies, group and individual meetings (likely increasingly virtual), emails, and increased signage in public spaces both in the office and building generally (lobbies, elevators) to communicate and create public awareness regarding:
  • To communicate policies regarding hygiene, PPE, and other health related requirements
  • To provide transparency about building health measurements and conditions
  • To provide check ins and other support to employees to determine their needs and concerns
• Leadership and enforcement will also grow in healthier buildings moving forward
  • Management will need to promulgate sensible policies, provide sufficient training, and set examples following sensible policies employees can understand and respect.  Sufficient training and communication means sharing and repeating key policies consistently, repeatedly. 
  • Employees who do not follow reasonable policies will need to be disciplined appropriately
• Additional Human Resources support will likely be necessary for some time, including the establishment of a position to coordinate COVID-19 issues and their workplace impact (per the CDC).  Employees are going to need more support to understand and adjust to change, but it will take greater effort to promulgate, implement, and oversee the significant amount of related policies and changes, which might include:
  • • All businesses need to have or develop an Infectious Disease Preparedness and Response Plan 
    • Stay apprised of all guidance from federal, state, local, tribal, and/or territorial health agencies, which will likely keep evolving as conditions change
    • Implement flexible sick leave and relate supportive policies and practices
• Additional Health Support, including mental health services, will also likely be necessary for some time.  It’s critical to understand that team members are a company’s biggest asset, and that well informed, confident and supported employees will more likely show up for work and give their best effort.

The need for strong and consistent employee support and communications can not be overstated.  As many have already said, there is likely no “going back to normal,” and this uncertainty can create a great deal of anxiety.  Employees face an uncertain future right now, and they have increased concerns about pay, leave, and of course their health. They may be trying to figure out how to parent, teach, and work at the same time.  They may even be dealing with the illness of family members or friends.  Companies that provide great leadership and honest and transparent communications are likely to come out ahead in the transition back to the office and back to future operations, as keeping people going is absolutely keeping a business going.  These companies should see strong performance in productivity, retention and even employee attraction when new normals are ultimately established.  

• Personal Protective Equipment - Personal Protective Equipment, or PPE, comes into play when the equipment itself is needed to protect employees from a possible, likely, or known risk that may be in the environment.  Where other controls do not achieve the safety level required, PPE can be thought of as effective but also a last line of defense.  Examples of PPE include masks, shields, gloves, goggles, and respiratory protection.  PPE requirements vary by the site, hazard, and risk.  Employers and employees need to keep in mind that PPE only works when properly worn, maintained and disposed.  Proper and consistent PPE training is therefore essential.  PPE varies, but it’s pretty clear that people should be wearing masks at least to travel to buildings and as they move through common areas. 
   

PPE requirements and participation will vary greatly by what is required by law, what is recommended, and what is completely voluntary.  These factors will also vary by the risk level in a given state, city, or even office, the risk associated with a given task or role, and also whether illnesses/exposures have been reported.  The shifting nature of this and other threats is one reason we will all have to remain alert and adaptable as this disease and other known health risks evolve. 

In trying to understand the issues we must address to get back to offices safely and how offices might change in the future, it’s not too difficult to process available, though evolving, information and to try to build a sensible looking list.  This is an important step for all stakeholders, but it is important to note all key questions have not been addressed.  Before we fully process what we think we understand, we also need to keep in mind some top issues that currently seem more intractable than others:

• Public Restrooms – Even with social distancing and cool new technologies to make restrooms safer, this is clearly a place where people come together.  Restrooms remain an unsolved current and critical challenge.
• Public Transportation – How do we transport people to and from work more safely, even as more people start to use public transportation again?  PPE is one solution, but transportation remains a bottleneck to preventing disease transmission.
• Elevators – Limiting people in elevators sounds like a good idea, but what about larger buildings where the tightest limits just don’t make practical sense?
• Schools – Schools present their own host of problems.  How much can we ask of kids not to ouch their faces, to don PPE, and not to mix?  Until we resolve school challenges, kids may likely be home more – and this means caregivers can’t also get to work.
• Handwashing Note:  Related to restrooms and schools, how do we get adults and young people to truly understand they have to wash their hands with soap for 20 seconds? It sounds simple to ask everyone to wash properly, but this is more challenging in practice. Studies document that many people do not wash their hands, do not use soap if they do wash their hands, or perhaps just don’t wash long enough to achieve the desired result.  As reported by Henry Grabar at Slate, the average office worker flushes between 2 and 3.5 times per day.  Half the people who visit restaurants use the bathroom.  And these numbers actually sound low. 

This list serves as a warning: If we can not resolve these top challenges, we very likely lessen the effectiveness many of the other efforts. These issues also illustrate precisely why our strategies must be “all of the above” in nature, and why efforts and training and others communication must remain constant.   

One way to build confidence and to confirm aspects of building health and safety would be to achieve a healthy building certification, such as the WELL Building Standard or fitwel.  Where earlier and other green building certifications focus more on energy, water, and materials in an effort to lower the impact of the built environment, attention has increased in recent years to making sure spaces also support greater health and wellbeing.  WELL Building was created by the International WELL Building Institute and Delos Living in 2014, and fitwel was created by the Center for Disease Control, the U.S. General Services Administration, and the Center for Active Design in 2017.  A key difference between the two standards is that WELL requires onsite performance testing by an approved WELL Assessor.  Fitwel may be less expensive, less complex and more widely applicable for existing buildings and across a portfolio, but these factors can result in fitwel appearing to be a less impactful standard. 

These standards are growing in popularity with good reason, as health and well being have been directly linked to healthy and profitable businesses in recent years.  Some examples presented by Mr. Allen and Dr. Macomber in a recent Harvard Business Review article include:

• Doubling outdoor air in an office was shown to improve worker performance 1.7%
• A study of 3000 workers found that 57% of sick leave could be related to poor ventilation

A 2017 study found that if a company spent in between $14 to $40 per person annually on improving the indoor air environment, each employee’s productivity could increase by $6,500 per year. Lawrence Berkley National Laboratory reports that occupants of office buildings with above-average ventilation rates up to 40 cfm (20 L/s) per person have 10% to 80% fewer sick building syndrome (SBS) symptoms at work.  Berkeley researchers also estimated as far back as 2011 that improving office air quality alone could result in adding $20 billion to the US economy annually.  This is a significant statistic, as employees represent a company’s greatest asset- and also one of its greatest expenses. Speaking about the study’s release, John Mandyck, Chief Sustainability Officer of United Technologies Corporation, asserted, “The payback for improved indoor environmental quality far outweighs the investment, considering that more than 90 percent of the costs associated with a building are related to the people who work within it once construction is completed." People are indeed a core asset, and their trust and confidence will play a significant role in when and how operations can resume smoothly

Making offices and all buildings healthier is now clearly a global imperative.  There are one-time adjustments and steps companies must take in the nearer term and in a time of uncertainty where some of these actions feel like guesswork. Among many other changes, furniture will be moved further apart, sanitation supplies will be increased, and we will be asking workers to follow a host of new policies and procedures.  We will also keep working away at the challenges we literally don’t have current best answers for, including how to encourage certain critical behavioral changes.  Now that it is clear how critical healthy buildings are to human health and business profitability, longer term investments and shifts will also take place.  The shape of existing buildings may change significantly, and new buildings will of course be designed differently.  A question is how well this evolving system will work, and whether the near term changes will create the confidence needed for people to go back to the office and feel safe so they can do their jobs to their best ability. 

For further reading:  

https://hbr.org/2020/04/what-makes-an-office-building-healthy

https://9foundations.forhealth.org/

https://www.bergmeyer.com/posts/navigating-the-workplace-in-our-post-covid-reality/

https://www.nytimes.com/2020/04/07/business/workplace-telecommuting-coronavirus.html

https://hbswk.hbs.edu/item/why-covid-19-raises-the-stakes-for-building-health

https://www.gensler.com/research-insight/blog/designing-office-building-lobbies-to-respond-to-coronavirus

https://www.gensler.com/research-insight/blog/how-should-office-buildings-change-in-a-post-pandemic-world

https://www.theverge.com/2020/5/7/21249496/building-ventilation-design-health-humidity-cost

https://www.marsh.com/us/insights/research/reopening-for-business-in-a-post-coronavirus-world.html

https://www.wsj.com/articles/reopening-the-coronavirus-era-office-one-person-elevators-no-cafeterias-11589189402 (Paywall)

Related Rate It Green Discussions and Articles:

https://www.rateitgreen.com/green-building-articles/protecting-workers-on-the-jobsite-emerging-ideas-on-communication-safety-procedures-ppe/141

https://www.rateitgreen.com/green-building-community/discussions//studies-high-ventilation-rates-are-associated-with-lower-rate-of-illness-and-absences/3145

https://www.rateitgreen.com/green-building-community/discussions//summary-of-recent-40-years-of-research-why-is-green-building-necessary/3073

https://www.rateitgreen.com/green-building-community/discussions//study-a-summarization-of-the-top-green-building-features/2913

https://www.rateitgreen.com/green-building-articles/new-research-shows-intelligent-green-design-linked-to-multiple-health-benefits/51?utm_content=bufferfc259&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

https://www.rateitgreen.com/green-building-articles/healthy-design-a-key-factor-in-green-building-moving-forward/97

https://www.rateitgreen.com/green-building-articles/investing-in-green-building-can-lead-to-better-health-and-productivity/74?utm_content=buffer43817&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

https://www.rateitgreen.com/green-building-community/discussions/sustainable-building-communities/9-keys-to-avoiding-sick-building-syndrome-study/3820#sickbuildingsyndrome

Resources:

https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/businesses-employers.html

https://www.epa.gov/indoor-air-quality-iaq/office-building-occupants-guide-indoor-air-quality

https://www.ashrae.org/technical-resources/bookstore/indoor-air-quality-guide

https://www.osha.gov/Publications/OSHA3990.pdf

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https://www.hon.com/sites/hon.com/files/hon-healthy-workplace-product-solutions-guide.pdf

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