CIEH EHN June 2020

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CONTACT TRACING The plan of action

THE MAGAZINE FOR CIEH MEMBERS

www.cieh.org June 2020 Volume 35 Issue 5

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COVID RESPONSE IN US STATE

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05 UP D A T E

News Fear for food standards in US trade talks; dramatic reduction in air pollution since lockdown; environmental lessons from COVID-19; contact tracing; membership news; CIEH postpones AGM and Excellence Awards.

EVER Y ISSU E 32 TALES FROM THE FRONT LINE EHP Ndinelago Landi Moses on her role in keeping coronavirus in check in Namibia.

GO ONLINE Find your next job at www.ehn-jobs.com, and see how to further your career at www.cieh.org

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FEATU R E S 10 THE BIG INTERVIEW US EHP Tim Hatch explains why EH is at the heart of Alabama’s response to the pandemic.

12 HOPELESS WITH HYGIENE With handwashing so crucial in reducing disease transmission, why aren’t we doing it properly?

19 L EG A L BR IEF ING Opinion The problems of legislating in a crisis.

Prosecutions Three successful EH cases.

2 3 Y OU R C A R EER Tips on … Stress-free working from home.

Webinars Highlights of COVID conversations.

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These images, using satellite data, show NO2 concentrations from 13 March to 13 April this year compared with the same period in 2019

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A learning opportunity IKE EVERY OTHER

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EHP, at the beginning of this crisis my head was down and the adrenalin was flowing. I had to work out how to juggle childcare while still trying to do a day job that was presenting the biggest challenges of my career, daily.

Now,almost three months into lockdown, I’m taking stock. I’m proud of the work I’ve done. And as a profession we are really coming into our own. Look at what our local authority colleagues have been doing around contact tracing and working with local businesses. Look at how our private sector colleagues have been safeguarding food supplies and helping their businesses get ready for reopening, safely.

I also realise burnout is a real possibility and it’s important we acknowledge that.

JULIE BARRATT “[Coronavirus] laws have had to be put together quickly and that has not been without consequences”

NDINELAGO LANDI MOSES “It is fulfilling to know that the work I do is contributing to the improvement of public health in my country”

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I’m trying to avoid it by taking some time out. I try to fit in a bit of exercise, an act of altruism or a little guilty pleasure every day – that’s not for everyone but I find it helps.

This is a one-time event. It’s not forever and as well as tragedy there are new positives that will come from it: new work relationships, new ways of working, innovation. I know that some of what I’ve achieved in the past few weeks will make things work better in the future.

This crisis has made us refocus on what’s important.

What a massive learning opportunity we’ve got. Let’s not forget to take it.

DAWN WELHAM, PRESIDENT JUNE 2020 / ENVIRONMENTAL HEALTH NEWS3

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News, 1

NEWS YOU CAN USE JUNE 2020 Follow us on Twitter

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Campaigners are worried that a US trade deal could weaken food rules, and CIEH is urging MPs not to rush negotiations and undercut standards

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LEAVERS SUPPORT EU RULES

US trade talks must slow ‘to allow scrutiny’ CIEH concerned that food standards are at risk while COVID-19 dominates politics

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food standards would be unwise and unpopular and the government should heed the warning, say experts.

An opportunity – in the form of an amendment to the AgricultureBill – to ensure food and drink, environmental and animal welfare standards are maintained in post-Brexit trade deals was lost on 13 May. Neil Parish, chair of the Environment, Food and Rural Affairs Committee (EFRA), proposed the amendment but WWW.CIEH.ORG

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it was defeated by 277 votes to 328. Ministers said standards can still be protected in the Trade Bill, but CIEH has pointed out that the bill doesn’t “make appropriate mention” of this issue.

Deeply uneasy about the lost opportunity,CIEH is lobbying MPs and peers, urging that trade talks with the US be slowed down to ensure they receive the required level of scrutiny and attention. Improvements in food-related public health outcomes, environmental and welfare standards across the UK

are being put at risk, unless there is political and public pressure to prevent this.

Particular concern focused on the weakening of rules on chlorinated chicken, livestock intensification and food labelling. CIEH described clear food labelling as a cornerstone of the UK’s current public health strategy.

CIEH wrote: “Although we recognise that the government is anxious to negotiate and conclude new trade deals with countries outside of the European Union, the

Most Conservative and Labour Leave voters support EU regulations, including those on food safety and the environment – and many want them strengthened – according to a survey of 22-48-year-old Leave voters

by Ipsos MORI for the Unchecked UK campaign.

78%

of respondents say regulation is necessary to ensure fair behaviour

84%

support increasing (47%) or maintaining (37%) food safety regulations

81%

support increasing (60%) or maintaining (21%) environmental regulations

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timing of the talks with the United States is questionable as many of the relevant stakeholders and food organisations are busy helping their communities get through the COVID-19 crisis. There is a great deal at stake if negotiations are rushed and deliver a deal that undercuts hard-won British food standards.”

Erik Millstone, professor of science policy at the University of Sussex, and part of the Food Research Collaboration, was “pleasantly surprised” at the EFRA chair’s strong stance but disappointed at the small number of Conservative MPs willing to stand up to the whips.

He added: “This is a warning to the government, reminding them that allowing the import of foods that don’t meet UK current standards will be hugely unpopular and they would pay a very high political price for doing so. But that doesn’t guarantee they won’t do anything stupid.”

As EHN went to press the government admitted there would be Brexit checks on animals and food products entering Northern Ireland from the rest of the UK, from January.

Climate lessons from COVID-19 Environmentalists call for radical shift from status quo

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OVID-19 HAS

shown us that society can transform itself with extraordinary speed when motivated to do so, environmentalists have argued. Yet radical change is needed to halt the climate crisis, which is a life and death scenario, and will be a much bigger catastrophe if we don’t act.

“You can’t self-isolate from climate crisis,” said Siån Sutherland, co-founder of environmental campaign A Plastic Planet.

“If you had said nine weeks ago ‘oh by the way we are going to put half the world’s population into lockdown for eight weeks’ we’d have all said ‘you’re bonkers, that’s absolutely not possible’. And look what’s happened.”

Sutherland added: “So I think we’ve proved to ourselves that extraordinary, seismic, dramatic change is possible and where there is

change there is opportunity.”

Sutherland said she is optimistic that we have learned about the connectedness of our different systems – environmental, societal and economic – through this crisis.

It might also be the case that the pandemic brings the climate change risk and loss more tangibly to richer countries.

“These kind of crisis situations happen to other people,” said Sutherland, “perhaps to some of the less prosperous nations. And they have to suffer the impact, particularly with climate crisis.

They are the ones that will suffer the impact much more than the rich west.

“What’s been very interestingis that the rich west are taking a huge brunt of the impact of COVID-19 economically and in every way.

That’s big learning for us.”

Already we have seen improvementsin air quality,

DATA

Environmental gains? 75% Environmental consultancy Ricardo Energy and Environment measured levels of N02 reduction, across 29 UK sites, between 23 March and early May. Oxford City Council (named by climate

charity ClientEarth as the number one UK local authority for tackling air pollution and which launched its own Charter for Cleaner Air in 2018) has had the highest reduction in N02 since lockdown.

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of its N02 comes from transport

34% AVERAGE FALL IN N02 ACROSS 29 SITES 55% Glasgow

59%

54% Leeds

N02 reduction since lockdown

54% York

Despite Oxford’s work on air pollution it took 10 years (to 2019) to reduce N02 by 36.8%.

47% Edinburgh 46% Manchester

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With fewer vehicles on the road air quality has improved dramatically, as the satellite images above show

However, its lead author noted that to tackle all of our environmental problems will need a “broader perspective” than just dealing with carbon emissions.

Diana Ivanova said the pandemic and climate change are “not really that disconnected” and this could be a wake-up call. She added: “As we see climate change happen, there will be an increase in pandemics – and this is quite well studied.

“Climate change is making the whole system much more vulnerable. And the thing that the pandemic now is maybe showing, in a bit less abstract terms, is what that would be like [in a climate crisis].”

Ivanova said what we really need, as well as short-term changes, are longer-lasting infrastructure and political changes. “It’s not just about individual people making small life changes. It’s really about completely rethinking and redesigning the way we live.

“That’s probably why I’ve referred to it as radical because radical actually comes from root. So it’s really about changing the root, the core of our life, because the status quo is just not desirable any more.”

with Nature Climate Change journal finding global carbon emissions down by 26%, and on our streets harmful N02 emissions are also down in some places by more than 50% (see Environmental Gains?).

Appetite for change is also strong in the UK with a Royal Society of Arts survey finding that the majority of people want to keep some of the changes that have occurred during lockdown – better air quality, increase in wildlife, improved social connections.

Just 9% want the world to return to exactly where it was pre-lockdown.

Another study from Leeds University, due to be published in the journal Environmental Research Letters, has listed 10 changes everyone can do to tackle climate change, from going car free to using renewable-based heating.

MEMBER NEWS

CLOSURE OF EHRB (EXTENSION) The CIEH Board of Trustees has reviewed the decision to close the Environmental Health Registration Board at the end of June. Doing this has been the intention since March 2018, but the Board realises that some candidates have not been able to complete their learning portfolios or assessments in the planned timeframe because of circumstances including the COVID-19 lockdown.

So the Board has agreed a short extension to allow people

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to complete these elements.

CIEH will allow, at its discretion, initial registrations with EHRB to continue until 30 September 2020. This is intended only for people who have almost completed their learning portfolios (PPP, ELP, etc) CIEH will also work with the remaining candidates who have completed their initial EHRB registration. This will be on a case-by-case basis and will include clear and final timeframes for completion where this is possible.

If you are unable to complete the required elements before the

end of June, contact education@ cieh.org with an indication of extenuating circumstances as soon as possible. (Candidates who are awaiting the result of a submitted learning portfolio or professional interview do not need to do this.)

AGM POSTPONED The Board of Trustees has postponed this year’s AGM until 17 September in order to comply with government advice, to protect attendees and to allow us to explore options for attendance online. Further details will be given soon.

RECENT EHRB CERTIFICATE OF REGISTRATION AWARDS Amanda Andrews, Sarah Azopardi, Craig Birkett, Diana Bryant, Kathleen Dalton, James Dhliwayo, Betelihem Hagos, Ruth Hamilton, Catherine Harris, Kelli Havill, Lucia Ifelebuegu, Aniqa Islam, Michaela Jones, Markus Leczek, Sheila McAlinden, Geraldine Mallon, Aaron Montgomery, Corina Mosu, Avril Nightingale, Awungfack Nkeng, Karen Olver, Giancarlo Quaroni, Annie Rawlings, Anne Marie Read, Christopher Segovia, Edward Snow, Vanessa Stephens, Alice Sarah Tomasevic, Leona Waites

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Government gives councils cash for contact tracing Local authorities’ work will run alongside a national test and trace service

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by Whitehall to fund local government contact tracing across England, with a further £29m going to the Scottish government, £18m to Wales, and £10m to Northern Ireland.

Local plans will focus on identifying and containing outbreaks in workplaces, housing complexes, care homes and schools. They will work alongside the test and trace service, local NHS and other organisations. Eleven English local authorities across rural and urban areas will help lead localised planning, and share lessons learned.

Tom Riordan, national test and trace adviser and chief executive of Leeds City Council, said: “It is essential that communities and local authorities are at the heart of plans to roll out test and trace.

Their work to respond to the virus has been exemplary.”

This is a fast-moving situation, so for up-to-date news sign up for the EHN Extra newsletter via MyCIEH, visit cieh.org/ehn-extra, and follow us on social media #EHNExtra.

C A SE STU D Y

Using EH skills ‘to give back’ Former EHP Jane Tait has signed up as a contact tracer to “give back” while also gaining a little income as her business – a bed and breakfast on the Hadrian’s Wall Path – has temporarily closed.

She said: “This was what I loved about being an EH officer, you always felt like you were doing something useful.”

Although excited to be part of a team making a difference, Tait was initially frustrated about the process. While she was impressed with the thoroughness of the ID process – copies of driving licence, passport, and utility bills were double-checked on a video call in real time – there were initial teething problems. She said time was wasted trying to log in to the system. She also raised some concerns about possible duplication of subjects across platforms.

However, after a few days her outlook changed. More information came through, and the software and training fell into place.

“They have covered all eventualities. It’s just a case of getting on with it now” Tait will be a tier 2 contact tracer, calling people who have tested positive for the virus.

She believes tier 1 staff will come from local authorities and Public Health England and deal with the more complicated cases, such as those involving care homes. Tier 3 will be the call centres, and they will be getting in touch with the contacts of contacts who have been exposed.

“The training is pretty comprehensive. It’s taken it

back to the bones in the detail that it goes into. They have covered all eventualities and I am fairly satisfied the information is helpful. It’s just a case of getting on with it now,” said Tait.

“The bottom line is, I can use my skills and qualifications to give back. We spend our whole lives trying to prevent ill health. It’s being able to give back and use our knowledge in a helpful way for community and society at large – to enable everybody to get back to their lives in the best way that they can.

“I am really hopeful about this. It has been rolled out too late – that goes without saying – but it should work.”

CIEH postpones Excellence Awards Conference and events manager Nikki Pearson said: “Our profession is at the forefront of this pandemic as key workers assisting in keeping us all safe. For this reason we need to allow our members to

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carry out this work, unhindered by entry deadlines and the like.”

Entries that have already been received will be included and judged for the 2021 awards. The new deadline for entries is 31 May 2021.

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The big interview VERSION

HE VIDEO CALL with American EHP Tim Hatch was one of the few that EHN has conducted in recent weeks that didn’t have a backdrop of a back bedroom or kitchen cupboards. Tim was speaking to EHN from his office in Montgomery, Alabama, where he has been more or less living since the beginning of the COVID-19 pandemic in the US. “I’ve been here since 3 March,” he says.

“I’ve had three days off but we’re working 7am-7pm most days because of the great needs of our Unified Command. The President declared a national disaster on 13 March, followed that same day by our state’s state of emergency. We’re nine weeks into it and just last Friday we got an extension of 60 days. So at least through 13 July [we’ll still have] our emergency orders.”

Alabama’s Unified Command is a team of agencies – in all, about 700 staff – brought together to tackle the coronavirus. It includes the Alabama Department of Public Health, where Tim is the deputy director for emergency preparedness and response. In non-COVID times he helps to co-ordinate the state’s response to hurricanes, oil spills, disease

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outbreaks and other disasters. Tim recalls Hurricane Katrina in 2005, and the ‘Tuscaloosa tornadoes’ in 2011, when Alabama experienced 63 tornadoes in one day and 250 people were killed.

When not dealing directly with an extreme event, Tim and his team are preparing. “One of the things we do is stockpile supplies and equipment for when the big one hits,” he says. And that, of course, is what has just happened. When we speak in mid-May, he says Alabama has had 10,000 confirmed cases of COVID-19, and 428 deaths. The number of deaths is still increasing, but the curve is flattening.

He says Alabama was better stocked with PPE than other states for the start of the pandemic, thanks in part to having been granted permission by the federal Food and Drug Administration to extend the use of some expired equipment. The state was also allocated its share of a national stockpile.

Despite being well prepared however, PPE quickly became one of Tim’s main

challenges. “Per capita we had more PPE to send out. However, it was not enough for the demand,” he says. “And our strategic national stockpile was meant to be for 72 to 96 hours of surge. After that time the normal procurement process should pick back up, but the problem was that we had 49 other states that were after this same amount of PPE. So here we are, nine weeks-plus into this disaster and we’re struggling to meet demand.”

He adds: “One of the things we’ve found in America is our reliance on foreign products, where everybody wants to pay as little as possible. But when the majority of our PPE has come from China, even then with the amount of capacity they have they still could not fill global need.”

This problem will sound very familiar to UK readers. And in fact the discussions that Alabama is having about lockdown, social distancing and testing and tracing are very similar to the ones we’re having here – right down to the role of EH. “I’ve been doing this for 25 years and I can honestly say, number one, I’m proud to be an EHP, I’m proud of EH staff across the globe because we’re a very dynamic body of professionals,” Tim says.

But Tim has had the same difficulties in getting decision-makers to understand just

‘ THERE’S A TREMENDOUS AMOUNT OF EH INFLUENCE ON THIS DISASTER’ A deputy director in Alabama’s public health department, Tim Hatch tells EHN how environmental health is at the heart of the US state’s response to COVID-19 WORDS BY SARAH CAMPBELL ILLUSTRATION BY TOM HUMBERSTONE 10 ENVIRONMENTAL HEALTH NEWS / JUNE 2020

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US EHP, 1

how vital EH is to an emergency response as in the UK, where CIEH and other bodies have been pushing hard to have local government EH placed at the heart of the national contact tracing effort, for example.

“In disasters EH removes the regulator hat and becomes more of a community support role,” he says. “When restaurants were closed here, immediately the term ‘non-essential’ came out the mouths of some management: ‘Since restaurants are closed, EH is non-essential.’ We said, ‘Wait a minute, people are still purchasing and buying food to take out.’ Yes we may not actually be in there doing normal inspections but we should offer that advice on food safety.

“Our schools closed, and one of the biggest things – especially here in the south – is that some children rely on school lunches for their nutrition for the day. So we had to set up temporary feeding sites and EH were extremely important.

Then you look at the amount of PPE being used, that increases the amount of waste we have. Who better than an EHP to help hospitals and communities manage that waste? So there’s US EHP Tim Hatch a tremendous amount of EH “If I see an increase influence on this disaster.” in the number of deaths and new Other than a good night’s cases as we start to sleep, what are his priorities reopen there would for the coming days and be some concern” weeks? Tim believes the state is about 60% of the way through the disaster response – “that’s just Tim’s estimation, no one else’s,” he qualifies. “Nursing homes are still a very big concern for us. We have to make sure we’re attending to those folks. We had a real big spike and problem with our nursing homes and we’re trying to get them tested and then of course the facilities cleaned and decontaminated.”

Otherwise, his thoughts are turning to long-term planning. Alabama has had Hazel Gowland today and, inset below right, leaving its share of protesters demanding the end home at the age of 18 of lockdown but Tim is fairly sanguine about that. “From my window I can see our state capitol and there have been some protests,” he says. “But if the government says there’s free chocolate cake, there’ll be somebody complaining that it’s not vanilla cake. For the most part people are managing very well with this unprecedented disaster. But from a health standpoint if I see an increase in the number of deaths and new cases as we start to reopen there would be some concern. We have cracked the door for reopening business – but we haven’t opened the door yet.”

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NOW WASH YOUR HANDS. PLEASE!

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Handwashing is one of the most effective ways of preventing disease transmission. So why are we so bad at it?

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aware of it, but the 498 people who visited two public lavatories in Belfast city centre between 10 and 20 March this year have made history. As they went about their ablutions, users of both the ladies and gents were filmed using thermal cameras. Blurry footage of their behaviour around the basins and hand dryers is part of a ground-breaking research study that is shedding some much-needed light on the nation’s handwashing habits.

In the absence of a vaccine, social distancing and hand hygiene offer the only defence against coronavirus infection.

Yet despite the pandemic – and intense public health messaging – the Belfast study found that more than 80% of us still do not wash our hands effectively.

“We know that most communicable diseases are spread by a lack of

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handwashing, but when it comes to compliance most of the research has taken place in healthcare settings. We really don’t know much about the habits of the general public,” says Aaron Lawson, research associate and lecturer in environmental health at Ulster University. “Coronavirus has made that very pertinent.”

Given the significance of good hand hygiene to disease transmission, Lawson admits he was surprised by the lack of evidence on the subject. “Previous outbreaks of MERS, SARS and Ebola generated lots of information about hygiene in community settings, but only in developing countries,” he says. “Our study is the first of its kind to evaluate the hand hygiene behaviour and compliance of the general population in the UK.” Having worked with Ireland’s food standards agency, Safefood, researching handwashing practices across the Republic, Lawson was well placed to set up the Belfast study as the COVID-19

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17% WHY ARE ONLY A MINORITY OF PEOPLE CAPABLE OF WASHING THEIR HANDS PROPERLY AFTER GOING TO THE LOO?

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pandemic unfolded, capturing a real-time behavioural snapshot.

“Ethical approval was quite extensive, given we were proposing to install cameras in public loos,” he says. “But the thermal images we capture aren’t recognisable, and signage at the entrance made it clear that the toilets were under observation for research purposes, so using them would represent consent. No one objected.”

Examination of the film footage divided handwashing into four categories: adequate (washing hands for 20 seconds using soap and water, and drying for 15 seconds using a hand dryer); basic (washing hands using soap and water, and drying using a hand dryer but not for the adequate length of time); poor (any other combination not fitting the above two); and none (did not wash or dry hands).

Almost two-thirds of people fell into the basic category, attempting to follow best practice but failing. Thirteen per cent made poor efforts, and just over 7% left the toilets without washing at all. Of the non-washers, there were twice as many men as women.

DATA

17%

of the general population wash their hands adequately

63%

show intent to wash their hands but this is still in an inadequate fashion

7%

of the overall general population do not wash or dry their hands at all, and this is more predominant among males

31%

WHO WASHES WELL?

of the general population do not wash their hands adequately, despite the coverage in the media highlighting the importance of adequate hand hygiene in minimising the transmission of novel coronavirus (COVID-19)

Ulster University’s Aaron Lawson (above right) used thermal cameras in two public toilets in Belfast city centre to research the handwashing habits of the public

The mean length of time spent washing hands for adults was 17.17 seconds and for children it was 32.51 seconds

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It was children who scored highest, with 83% ranking as adequate or basic when it came to hand hygiene. “Young people are the role models,” says Lawson. “They want to do the right thing and have a lot to show the rest of us about doing it well.”

As well as washing, the study looked at hand drying – a critical part of the decontamination process. More than 80% of the people observed used air hand dryers, 6% used toilet paper, 2% their clothes and 9% nothing at all.

“There’s widespread ignorance about the best way to wash and dry your hands,” says Lawson. “Doing it wrong means germs can still be passed on. The public health messages have not been effective.”

At Birmingham University’s department of economics, the advent of COVID-19 prompted Professor Ganna Pogrebna and her team to chart global attitudes to handwashing following a visit to the toilet (see page 17). Literature searches provided the information to rank 63 countries: the best, Saudia Arabia, shows 97% compliance and the worst, China, just 23%. The UK ranks towards the middle of the table, with 75% of people reckoned to be washing their hands to some extent after visiting the toilet. The data was then plotted against the real-time advance of the coronavirus around the globe.

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“We concluded that the initial pandemic spread was extremely correlated with handwashing culture,” says Pogrebna.

“The hardest hit countries were those that also registered the lowest rates of handwashing.”

A specialist in data science and behavioural design, Pogrebnaargues we need to know more about cultural factors and population groupings to understand how to communicate the hand hygiene message better. “Some cultures protect their personal space and avoid touching, while others such as Italy, France and Spain are kissing cultures,” she says. “I have a hunch that different perceptions of proximity to other people have a bearing. If you’re used to being crowded together perhaps you are less cautious. Or more fatalistic.”

Pogrebnabelieves much more work is required to understand behaviours before public health policies are developed and messages disseminated. “This type of marketing research takes money, and handwashinghasn’t traditionally been seen as all that exciting by funders. Who’d have

“The cool thing about handwashing is that you can be in total control of how well you do it”

thought it would be one of the most significant areas of research you could be involved in right now?”

Part of the problem may be the sophisticated marketing of pseudoscientific hand sanitisers that can be less effective against germs than soap and water. If a sanitiser is not at least 62% alcohol it won’t work, and there are concerns about antimicrobial-resistant germ strains emerging because of overuse.

“We all want to be in control of our situation, and the cool thing about handwashing is that you can be in total control of how well you do it,” says Pogrebna. “We must get that message across.”

HOW FREQUENT IS FREQUENT? Chartered EHP Lisa Ackerley agrees there has to be better public information about handwashing.“Simply telling people to wash their hands frequently isn’t very helpful. After all, how frequently is frequent?” she says. “I wash mine at significant moments – when I arrive somewhere,before I cook anything, before I eat anything and after I’ve been to the loo.

“And let’s have good evidence about the length of time it really takes to wash your hands properly, as well as the essential steps involved in that. We need to know much more about how handwashing works if we are to persuade people to change their ways.”

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From the Birmingham University study: percentage of people who do not automatically wash hands after going to the toilet

80%

OF PEOPLE IN THE BELFAST STUDY

SAUDI ARABIA 3%

USED AIR HAND DRYERS

BOSNIA 4% SUBS

ALGERIA 6% LEBANON 6% P N GUINEA 6% TURKEY 6% COLOMBIA 7% SOUTH AFRICA 7% VIETNAM 7% PANAMA 8%

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GEORGIA 9% FIJI 10% GREECE 15% KOSOVO 15%

“Different air dryers may harbour germs or spatter them back into the atmosphere at high speed”

PORTUGAL 15% ARMENIA 16% ROMANIA 16% PRODUCTION

BANGLADESH 17% SERBIA 17% MACEDONIA 18% PERU 18% PHILIPPINES 18% ARGENTINA 20% NIGERIA 20% KAZAKHSTAN 21%

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MOROCCO 21% GERMANY 22% ICELAND 22% SWEDEN 22% UNITED STATES 23% CANADA 24% ECUADOR 24% FINLAND 24% UK 25% IRELAND 26% BRAZIL 27% SWITZERLAND 27% BULGARIA 28% AFGHANISTAN 29% CZECH REPUBLIC 29% PALESTINE 29% UKRAINE 29% MEXICO 32% POLAND 32% AUSTRALIA 33% AUSTRIA 35% LATVIA 35% PAKISTAN 35% RUSSIA 37% FRANCE 38% INDONESIA 38% SPAIN 39% BELGIUM 40% INDIA 40% HONG KONG 42% MALAYSIA 42% ITALY 43% KENYA 48% THAILAND 48% NETHERLANDS 50% SOUTH KOREA 61% JAPAN 70% CHINA 77%

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According to the food safety consultant, who runs the Hygiene Doctor website, the public also needs easy access to handwashing facilities in the community. “EHPs have a role in making that happen,” she says. “As practitioners we know that handwashing is the single most effective way of reducing the risk of infectious diseases; after all, that is our whole raison d’être. Achieving a change of culture about handwashing would be the modern-day equivalent of identifying the Broad Street Pump.”

When physician John Snow traced a deadly outbreak of cholera in London’s Soho to one water pump in Broad Street in 1854, it not only stopped the disease in its tracks locally but led to sanitation improvements nationally. Boosting handwashingcompliance could have a similar effect on slowing the progress of COVID-19 and other infectious diseases.

NUDGE THEORY “We have to make wash hand basins and sanitiser dispensers much more accessible and apply nudge theory to encourage healthy behaviour,” says Ackerley. “In the workplace we will need risk assessment and monitoring, and far greater vigilance.

Technologies and design can assist and there are great examples in some industries already.”

The food industry is an exemplar when it comes to good hygiene, says Cheshire-based food safety consultant Russ Green.

“Food producers have a lot to teach other industries about maintaining standards,” he says. “My rule of thumb is

that handwashing facilities should not just be located in the toilets – food handlers shouldn’t have to walk through a door from their workplace to reach a wash hand basin. A similar protocol should be introduced in all workplaces.”

Green, a former EH inspector, anticipates future inspections in the workplace focusing on handwashing and drying facilities, and the promotion of far greater awareness of hand hygiene.

“This would involve guidance and a more strict interpretation of ‘suitable and sufficient provision of washing facilities at readily accessible places’ than is the current norm,” he says.

According to Aaron Lawson, the hand hygiene message has to be simple and clear.

“People need to know that if you don’t wash and dry your hands properly, you risk the germs growing again because of the moisture and temperature,” he says.

“Differentair dryers may harbour germs or spatter them back into the atmosphere at high speed, and 20% of females prefer to use toilet paper which can be contaminated with faecal pathogens. Paper towels are by far the most effective method.”

Lawson intends to stay on the research case, pursuing deeper understanding of public practice of hand hygiene.

“We want to continue to monitor compliance, which may decline as people get used to living with the threat of COVID-19,” says the 29-year-old researcher. “And we have to prepare for the possibility of the next pandemic – it may never come, but we must learn what we can from this one and ask ourselves what we might do differently next time around.”

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The four governments of the UK are taking different approaches to reopening schools after lockdown

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Legislating in a crisis Why rushing through laws on coronavirus has led to a lack of clarity and divergence among administrations

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LISA MALTBY SHUTTERSTOCK,

Written by JULIE BARRATT

N THE NORMAL

course of events legislation emerges slowly and cautiously onto the statute book. It goes through a process of consultation, detailed consideration, amendment and further amendment until it is the finished product, refined and fit for purpose.

The coronavirus legislation with which we are currently working has had a much swifter evolution, made by government without consultation or parliamentary consideration. And because the pandemic is a health issue, and power to deal with health issues is devolved, the four national governments of the UK have legislated independently but

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pretty much simultaneously to address the emergency. The necessary laws have had to be put together quickly and that has not been without consequences.

The legislation is prohibitive.

It limits what people can do. By way of example certain types of shops were required to close and the public were told they could only shop for essential items. What was conspicuously missing from the earliest versions was definitions. ‘Essential’ in the context of shopping was not defined, neither was what constituted exercise. Ministers added refinement during daily briefings – shopping should be done once a week where possible, exercise meant jogging, walking

and cycling, and social distancing required people to keep 2 metres away from others. However, that might have been ministers’ expressed intention, but it appeared nowhere in the legislation.

Guidance was issued to explain the intention of the legislation, but did not itself form part of that legislation.

With events moving quickly and legislation running to catch up, confusion was inevitable. However, that does not help those required to enforce the legislation as it is handed down, not as it was in the minds of ministers. Most recently the actions of a special advisor to the Prime Minister and the comments made by ministers and the attorney JUNE 2020 / ENVIRONMENTAL HEALTH NEWS19

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general in support of his definition of what constituted reasonable behaviour have added to the confusion.

Unusually the public on the whole has complied with not only the legislation but also the guidance.

Given the seriousness of coronavirus and its potential impact, this is not surprising. Criminal behaviour is a choice, being infected by a virus is not.

Self-interest and personal risk assessments have made most individuals comply, many going beyond the required limitations to protect themselves.

The legislation continues to evolve with the pandemic.

It has also begun to diverge.

In Wales, but not elsewhere, the 2 metre distancing requirement became law for workplaces. England moved faster than the other three countries in loosening the lockdown, causing uncertainty around the internal borders, and there are marked differences in the approaches to reopening schools and retail premises.

It is reasonable to expect this divergence to continue as the pandemic plays out, but it is also to be hoped that the legislation that emerges will be more refined in its requirements and more specific in its definitions.

Unless it is public confusion will lead to disenchantment and non-compliance, with potentially catastrophic consequences. The need for clear, unequivocal and understandable legislation has never been more urgent or more important.

Julie Barratt is an EHP, barrister, trainer (owner of JB Legal Training) and author 20 ENVIRONMENTAL HEALTH NEWS / JUNE 2020

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PRO SECUT SECUTIONS IONS This month’s selection of interesting cases and the lessons learned Cockroach adds crunch to cookie dough gelato

No gelato joke as punter gets more than they paid for at unclean ice-cream parlour AUTHORITY: Portsmouth City Council DEFENDANTS: Sprinkles Gelato OUTCOME: £5,000 fine; £1,571.59 costs; £170 victim surcharge; £100 compensation to victim OFFENCES UNDER: Food Safety and Hygiene (England) Regulations 2013

HAD A SUCCESSFUL PROSECUTION? Please tell us about it: email editor@cieh.org

THE STORY An unsuspecting customer was revolted to find a live cockroach on the side of her cookie dough ice cream during a visit to Sprinkles Gelato in February 2019. The unwelcome discovery prompted a visit from Portsmouth City Council, when inspectors discovered food at risk of contamination, poor cleanliness of equipment, refrigerators and freezers, failure to maintain handwashing facilities and no evidence that the business had an effective food safety management system.

While not being the worst case of pest infestation the EH team had seen, what concerned them the most was the apparent ineffectiveness of treatment over several months and the poor hygiene practices at hand.

HOW IT PLAYED OUT In court, the store’s parent company, Sprinkles Gelato 3 Limited, admitted to five

charges. Council inspectors visited again in May last year and found that the shop had resolved many of its problems.

LESSONS LEARNED Chris Larkin, the EH officer who led the case, says: “Our policy is to assist food businesses and give advice to ensure they trade safely. When problems are found during reactive visits it is important that prompt and proportionate action is taken depending on the risks identified.

“I am satisfied that this was done in this case. I am also pleased that I was able to use memory recall techniques during the interview with the complainant to obtain her statement and improve the quality of her evidence submitted at the trial.”

Food contamination risk at Sprinkles WWW.CIEH.ORG

AUTHORITY: Dacorum Borough Council DEFENDANTS: Hemel Foods Ltd and Ishrat Nasar OUTCOME: £14,800 fine OFFENCES UNDER: Food Safety and Hygiene (England) Regulations 2013; Animal Welfare Act 2006

THE STORY Mice aren’t often considered the victims in cases involving infestations. But the glue traps that Hemel Foods was using were most definitely not an appropriate way to get rid of the rodents. EHPs from Dacorum Borough Council visited the premises after receiving a complaint regarding poor food hygiene conditions and pests and saw a number of contraventions, including evidence of mice droppings and no documented food safety procedures. They also decided that the improper use of glue traps was resulting in the unnecessary suffering of mice.

HOW IT PLAYED OUT The team advised the owner of the work that needed to be carried out to comply with the law but further contraventions were witnessed on

Pests and poor hygiene at Hemel Foods

four more visits. A total of six visits were made within about two months – and while there were improvements in the control of pest and cleanliness, it was slow.

LESSONS LEARNED The council commended the dedication of EH officers Monica Vitorino and Rebecca Connolly, and the work of the legal teams. Julie Banks, the council’s portfolio holder for community and regulatory

services, says: “We will always take action where we deem it necessary to protect the public. This case sends out an important message, highlighting the need for businesses to comply with food safety and hygiene laws and to take appropriate measures in their business.”

Final straw as former landlord ignores repeated warnings over poor hygiene at pub AUTHORITY: Fenland District Council DEFENDANTS: Nigel Marsh OUTCOME: £2,000 fine; £170 victim surcharge; £1,000 costs OFFENCES UNDER: Food Safety and Hygiene (England) Regulations 2013

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THE STORY You can cajole and support, advise and serve notices only for only so long. In the case of George’s, a pub formerly run by Nigel Marsh, the messages obviously weren’t getting through. The final straw for the Fenland District Council EH team was a visit in February 2019, when they discovered serious food hygiene breaches relating to poor cleanliness, poor structure, poor temperature control, inadequate staff training and a lack of food safety management procedures.

Enforcement notices had been served previously and EH officers had offered advice and guidance on past visits, as well as in letters to Marsh. However, the February visit revealed standards had

Filthy fryers just one of the concerns at George’s

deteriorated again. Given the severity of the breaches and the poor history of compliance, the council decided to prosecute.

HOW IT PLAYED OUT In court, the magistrates found that Marsh had a high level of culpability due to his poor food safety record and considered the offences serious.

In mitigation, they noted that he had pleaded guilty at the earliest opportunity, had accepted ultimate responsibility and had no relevant previous convictions.

LESSONS LEARNED “These were serious offences and the defendant has a history of poor compliance with food safety and hygiene laws. It is only by chance that there was no food poisoning outbreak linked to the premises,” says Samantha Hoy, the council’s portfolio holder for housing. “The council does not take decisions to prosecute lightly but sometimes it is necessary to protect the public and reassure compliant food businesses that poor food hygiene and safety standards will not be tolerated.”

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Not mice business as glue traps used to rid restaurant of rodents deemed cruel

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Careers, 1

YOUR VERSION

CAREER

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6 WAYS TO …

WHAT CAN EMPLOYERS DO TO HELP WORK-LIFE BALANCE?

WFH can easily spill over into evenings and weekends. How can you restore boundaries?

W

ORKING FROM HOME

works really well for some people. But many EHPs – used to being in offices and spending time out and about in their local areas – have been thrust into it with little warning or time for preparation. When you’re not used to it, home-working can start to dominate your whole life. So how can you switch off, if you’re always on? Fortunately, it is possible to build in behaviours that will save your sanity.

Written by ROBERT SANDERS

1. IT’S NOT ABOUT CLOCK-WATCHING SHUTTERSTOCK, LISA MALTBY

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Switch off when working from home

We are so used to seeing our time as the asset for which our employer pays us, but it’s our knowledge, skills and experience that make the difference.

Without the day-to-day distractions of office life, you can often achieve far more when working from home. Try to

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set yourself three key outcomes for each day that lead to your weekly goals.

If you can achieve most of these then you are doing a good job, regardless of the hours you put in.

2. SET CLEAR BOUNDARIES Agree with your partner, your children and yourself what your core working hours will be. Set a schedule that works for you and stick to it. Some days will be more productive than others (just as they are in the workplace). Concentrate on maintaining the habit so it becomes second nature.

3. MAKE APPOINTMENTS WITH YOURSELF AND YOUR LOVED ONES If you are having a meeting with colleagues, you book an appointment in your diary, and know you won’t be working at that time. So why

1. SET AN EXAMPLE Make sure you are not eating into staff’s time with phone calls and emails sent out of hours. Respect their time (and your own).

2. OFFER TECHNICAL ADVICE AND TRAINING Make sure staff know how to use ‘auto-replies’, ‘out of office’ and other notifications. Or provide ‘work-only’ equipment so that it is easier to shut it out at the end of the day.

3. GIVE CLEAR EXPECTATIONS Make your expectations clear in relation to time and quality of work so staff don’t feel they are on a treadmill.

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How to switch off when WFH

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not schedule time for non-work things too?

Quality time with others is extremely important, but easy to put off. Arrange a film night, book in a call with your family, or schedule a Zoom quiz with friends. If it’s in the diary, it happens.

4. LITERALLY UNPLUG

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Whether you have a daily nine-to-five, or need to work around family or children, you need to prevent yourself being dragged back into the work world. If your mind is on your work, even briefly, you are not giving yourself recovery time. So, take advantage of technology.

Turn off notifications, redirect calls and set up auto-replies.

This will help to avoid the temptation to solve every little problem out of hours.

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5. TALK LIKE YOU MEAN IT When you communicate with others, throw in phrases like ‘at close of play’, ‘when I finish today’ and ‘until I switch everything off’. Say these sorts of things in your own mind when you are managing your activities. It will help to programme your mind – and that of others – to recognise that there is a time in each day when work stops.

6. BELIEVE IN MIRACLES If you find that work bleeds into the evenings, it can be productive to book in ‘me-time’ for things like self-development, mindfulness and exercise before the working day starts. In his book The Miracle Morning, author Hal Elrod recommends using the first hour of the day – getting up earlier if necessary – for vital activities such as exercise, reading and writing.

Robert Sanders is a therapist and coach in West Sussex. www.robertsanders.me.uk 24 ENVIRONMENTAL HEALTH NEWS / JUNE 2020

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COVID conversations CIEH has been hosting a series of webinars on the impacts of the coronavirus across environmental health. Steve Smethurst picks out a few highlights

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Not mice business PESTS WE MAY FACE AN EXPONENTIAL RISE IN PESTS “Where there have been closed premises there’s high risk if there’s been food, water, harbourage and no human activity. There are signs there’s been an increase in populations.

If a restaurant had 10 fertile female cockroaches on the premises at the time of closure, then two months on there could be another 600. If you left a pregnant mouse on its

FACTOR IN THE FEAR FACTOR “Some people will have a terror of letting anybody into their houses. If you’re shielding, the last thing you need is somebody coming in to deal with a cockroach, for example, but it may mean so many people are just putting up with a problem, which will only get worse.”

PUBLIC HEALTH ELIMINATE RISK USING TIME “When you’re talking about PPE in relation to EHOs, you can eliminate the risk by using time.

For example, 72 hours elapsing would allow you to put distance between you and the source of infection.”

MESSAGE FATIGUE “You can only say the same message for so long before the way in which it’s delivered has to change. I work with a company that monitored soap use in toilets against footfall – it found only 50% of workers in large office blocks wash their hands after going to the toilet. It improved when people were made aware of the monitor, and when they made it a competition between the floors they got it to more than 90%.

There’s a system in Denmark that screams at you if you don’t wash your hands, which is, you know, quite fun.”

FRUSTRATIONS BUILD “People with mental health problems are often isolated, living in poor areas in poor accommodation. If they’re stuck in their flats for weeks, it will not help. There’ll be plenty of people who may not have had mental health problems before the lockdown. Distressingly, there’s a lot of issues around increased violence and domestic abuse.”

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HOUSING

own for 12 weeks, you could end up with 65 mice by the time you returned.”

NOISE AND NUISANCE COMPLAINTS ARE CHANGING “Most noise complaints now relate to antisocial behaviour issues. Statutory nuisance gives us certain pathways but it seems people are drinking more and there are increased stresses and strains within homes and relationships. This stuff is quite difficult to deal with within the statutory nuisance approach.”

A ROLE FOR EHPs “EHPs are central. At the moment there are no formal and systemic arrangements for catching noise and noise pollution data on a UK-wide basis. If we can harness that information and get it fed into a central point, it will put us in a powerful position to petition government about measures that need to be taken.”

UPDATE YOUR ENFORCEMENT POLICIES “It’s important to update any enforcement policies so people can understand how the local authority is going to deal with disrepair, complaints or HMO licensing, for example, and making sure that that information is disseminated to the right people. There are always landlords and tenants who don’t necessarily communicate effectively with the local authority and it’s important that we get the message out.”

PRIORITISE COMPLAINTS AND ADAPT YOUR COMPLAINTS PROCESS “We’re adapting our processes for dealing with complaints. We want tenants to provide photographs or video evidence so that we can do a desktop risk assessment before we decide whether it’s appropriate to visit. We’re also considering the use of suspending notices and considering de-prioritising Category 2 hazards, so not actually dealing with the less serious housing matters.”

HEALTH AND SAFETY WHEN TO REPORT COVID-19 UNDER RIDDOR IN HEALTH AND SOCIAL CARE “You only have to report under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) if an unintended accident at work has led to someone’s possible or actual exposure; if a worker has been diagnosed as having COVID-19, and there’s reasonable evidence that it was caused by exposure to work; and if a worker dies as a result of occupational exposure.”

TAKE SIMPLE PRECAUTIONS “Large organisations have

access to guidance and support from their insurer, but some councils are writing to all clubs – golf, rugby, football, cricket and gyms – and specifically suggesting that they flush their systems and clean shower heads before they use them again, which is good practical advice.”

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TO WATCH THE WEBINARS, VISIT: WWW.CIEH.ORG/POLICY/CORONAVIRUS-COVID-19/WEBINARS

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DO YOU HAVE A TALE TO SHARE? Email editor@cieh.org

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POSITIVITY IS KEY Although the work at 1 the checkpoint is repetitive, I approach every shift with great positivity and allow little to no room for errors.

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At a checkpoint east of Windhoek, Landi Moses helps screen drivers for COVID-19

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TALES FROM THE FRONT LINE

‘On a busy shift we screen around 150 individuals’ Namibia has reported only 22 cases of COVID-19 and no deaths*. EHP Ndinelago Landi Moses is helping to ensure it stays that way

I“

LIVE IN THE CAPITAL

of Namibia, Windhoek.

I’ve recently qualified as an EHP and have been assigned to Hosea Kutako International Airport, about 40km east of the city, as a port health officer.

However, most airport activities have been halted to prevent further spread of COVID-19 so most of my work is at a roadside checkpoint 17km from the airport in the Seeis area.

“The checkpoint is made of tents. We have teams of police officers, military police, traffic officers, immigration officials and port health officials. All these teams perform different tasks with the main goal of ensuring lockdown measures are effective.

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“Using a thermometer gun, we take the temperatures of all individuals that pass through the checkpoint. [We record] their full name, vehicle registration number, contact details, residential address and identity number and the temperature on the thermo-gun. All these details are deemed necessary for case and contact tracing should any of these travellers present positive with COVID-19 if tested.

“On a busy eight-hour shift, we screen approximately 150 individuals. As the roadblock operates 24 hours a day, screening is also expected to occur 24 hours Ndinelago Landi Moses

ADAPT TO RAPID CHANGES IN OPERATIONS With new research 2 findings and subsequent WHO guidelines and recommendations, tasks change often and work operations are changed as a result.

CONSTANT READING IS EXTREMELY IMPORTANT There is no such 3 thing as knowing too much on a certain topic and to improve your knowledge, one has to read, research and ask questions when needed.

a day. I work in a team of three on an eight-hour shift. Fortunately, the ministry has provided us with cars.

Team members that have driving authorisation are responsible for the pick-up of other colleagues.

“A truck driver that I screened at the checkpoint once said: ‘We’re not essential workers, we are the suicide squad.’ Although this statement was followed by laughter, there is some truth in it. I did not imagine I would be working as a front-line worker in the midst of a global pandemic so early in my career.

“Due to my humanistic values I believe that each individual should aim to use his or her expertise to make a difference in the lives of many. It is very fulfilling to know that the work I do is contributing to keeping people healthy and to the improvement of public health in my country.

Being an EHP is a purposeful career.” * Correct at the time of going to press

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