COVID-19: how the UK's contractor workforce can stay safe from coronavirus

As Britain’s hospitals brace for the full impact of COVID-19, it is time for all of us – contractors and consultants included, to sit up and take coronavirus seriously.

COVID-19 is not simply just like a seasonal influenza epidemic -- it will cause a seismic surge in those needing to be treated in the UK’s hospitals and will unfortunately, for some, cause loved ones to be lost before their time.

Independent contractors: at greater risk?

Whatever our age, and whether we’re in a low risk group or not, there are actions which people should consider and take, if not simply for our own health, then also for the health of our families, parents, and communities.

As self-employed workers, contractors find themselves in a uniquely vulnerable situation here. Their independent way of life involves shouldering some very significant risks (whether HMRC chooses to acknowledge this or not). And at times like this, we find ourselves more at the mercy of such events than our full-time counterparts.

Here, exclusively for ContractorUK, the secretary-general of the Independent Health Professionals Association and chair of the Self-Employed Alliance, Dr. Iain Campbell offers general advice to contractors in these challenging times on behalf of both organisations. These represent these organisations' current views, rather than the views of the government.


Isn’t Coronavirus/COVID19/SARS-CoV-2, just like a seasonal influenza epidemic?

While it might cause similar symptoms, there are a number of features of COVID19 which are causing it to overwhelm healthcare systems in the manner we have seen in Italy. Ironically, one of the problems is that the disease is mild in many people and, worse, tends to have a protracted (on average 14 days) period, in which one is relatively asymptomatic but very able to spread the infection to others.

Both the milder course seen in some, and this asymptomatic but infective window contribute to the disease being very easily passed on to others without realising one has it, and it can therefore spread rapidly.

The statistics we are seeing are varying by region but roughly:

  • 80% of cases do not require oxygen and are classed as ‘mild’;
  • 15% require oxygen, and
  • 5% require an intensive care admission/ventilation

Mortality is often quoted in the region of 0.5% to 5%. It can be even higher where healthcare systems are overwhelmed. Additionally, the effect of massive influxes of inpatients in hospitals is that even people with very treatable other conditions may struggle to have their needs met during the peak of the crisis -- as our Italian colleagues report was occurring there.

While it is true that younger age groups have lower mortalities, this should not cause complacency as on average, every infected person passes it on to 2 to 3 other people - meaning that although one’s personal risk can be low, the risk one poses to others can be significant. In addition, although it is happening to a small percentage, we are still seeing many people in younger age groups badly affected.

So this is not just another seasonal flu epidemic and we must take it seriously. We should obviously do our utmost to avoid catching and spreading the infection.

How can I protect myself from coronavirus as a contractor?

Some simple measures really help. The virus can be removed from your skin and destroyed by washing your hands with soap and water -- or using alcohol hand sanitiser (if you can still obtain this).

But a cautionary note with hand sanitiser. Avoid rubbing or washing your hands until they’re red raw, with breaks in your skin. The last thing you want during this outbreak is to develop a skin infection, especially with so much pressure on the health service.

Wash your hands regularly and always before eating. Thorough hand-washing should take 30 seconds, and you may wish to watch this video to learn the NHS’s recommended ‘six-point handwashing technique.’ This technique will massively increase the efficiency of your hand washing. 

What about Social Distancing; does that really help?

The government has correctly identified this as an additionally important strategy to combating the virus.

In practical terms, attempt to maintain 2 metres (circa 6 feet) between yourself and other people where possible, and at least 1 metre. This is to shelter you from viral particles which are present in spittle which may come out of people’s mouths when talking, coughing or sneezing. There is some indication that faeces may also represent a potential route of infection, so heed the ‘wash your hands’ advice outlined above.  

While some medical procedures can aerosolise the virus, it does not appear to spread by air-based transmission in the general community (although if you are a patient with a home nebuliser take note -- this could represent a potential transmission risk to your family, it is wise for them not to be in the immediate vicinity when you are using such a machine if possible. Also note -- the same is potentially true for those with sleep apnea who have BIPAP machines at home).

Currently, social gatherings should ideally be avoided and unnecessary social contacts eliminated. And resist touching your face as much as possible.

Plus, be aware that viral particles can persist on surfaces for 24 hours. Initial evidence suggests hard surfaces are worse for this. As a note of caution, there is some indication that the virus may survive longer on plastic -- up to 3 days -- so it may be worth washing plastic packaging before opening it. Take care too around door handles, and lift buttons. Always wash your hands as soon as practical after touching either.

As a contractor should I continue to work if I feel unwell?

We contractors do have a reputation for soldiering on through almost any infection! There’s nothing like not getting paid where one doesn’t turn up for one’s work ethic. However, contractors must abandon this attitude during a pandemic, even though many of us wear it as a badge of pride.

If you have a new sustained cough or a fever, then you are putting the lives of others at risk if you do not follow quarantine advice.

My two organisations are extremely sympathetic to the financial ramifications of this and appreciate that the government’s vague suggestion of allowing the self-employed to claim statutory sick pay may be vastly inadequate here, especially if nothing comes of it.

Nevertheless, remember that because each infected person tends to pass the infection on to 2 to 3 others, there is a real risk to the lives of other contractors and individuals in your workplace, where this advice is ignored -- even if you personally are in a low risk group.

As a contractor, should I continue to work if I feel well?

For locum healthcare workers in ContractorUK’s audience, the needs of the communities we serve may well take precedence despite our heightened personal risk of exposure to the virus. What of those who are not healthcare workers, however?

This question is a more difficult one. There are personal and societal consequences to consider. The safest answer may well be to self-isolate until this is over (but that could be for four months). Such self-isolation is impractical for many and the decision may depend upon personal finances, whether you have other health conditions, and risk tolerance.

But if you live with elderly relatives or those with asthma, diabetes or chronic kidney disease -- which are high risk groups -- this ought to strongly bias your decision in favour of not working. So down tools totally if you can manage it, as such individuals in your household are in very high-risk groups. Else, you should make sure you have a full shower before coming into contact with your family on your return home.

Where you are minded to continue working out your contract, it is worth considering options like off-site working. This option may really help you to financially weather this storm.

Many clients can accommodate this, and indeed often they are even considering remote or home-working for their regular workforce, so definitely have a conversation with the most relevant client representative.

If working remotely is not an option, but if it’s not financially viable for you not to work or you feel that the benefit to the community merits the personal risk, try to take precautions (outlined above). I am full of admiration for those who decide that the needs of society are greater than their personal safety. However, this really should be a calculated personal decision, mindful of the risk to both yourselves and to others.

I am contractor aged 70+ (or approaching 70), should I continue to work?

The guidance given in the previous question was largely geared towards protecting those in this age demographic through the actions of those in other demographics.

While the mortality appears to be around 0.2% up until the age of 39; it starts to climb thereafter. Those in their 70s have an 8% risk of death should they catch COVID19 and thus my strong recommendation is that any person in (or approaching) this 70-years-old age group should very much consider stopping work altogether until after the outbreak and self-isolate at home. This too is the government’s official advice during the peak period of the outbreak.

My contractor business and I need to meet with and speak to a client face-to-face, what precautions should I take?

It is important when out of the house to wash your hands regularly, and be mindful of surfaces which may have viral particles on them such as door handles and elevator buttons. Don’t touch these where it’s not necessary.  

When speaking to clients in person try at all times to maintain social distancing. Most people will understand if you politely explain why you do not wish to shake hands -- and should be grateful. Remember, you are protecting them as much as yourself.

What are other high risk areas, such as in the typical contractor’s workplace?

Work keyboards are another potential repository of infection and washing these with isopropyl alcohol-based products prior to each use may be a useful intervention if you have no option but to use these. (N.B. Do beware rubbing the letters off the keys when doing this - don’t bring down the wrath of your client!).

For commuting as a contractor or meetings, is there any benefit to using a face mask?

There are two things to consider with face masks -- whether wearing a mask will protect others and whether it will protect yourself.

1. Protecting Others

Almost any mask will reduce the risk of spreading by essentially catching droplets of spittle which could otherwise affect others.

2. Protecting Yourself

Most masks are largely useless at this. This is because when you breath in, the seal is not very good and air comes around the mask more than through it. More positively, they can serve as a reminder not to touch one’s mouth. But this isn’t true of all masks. Some masks with a tight fit can help reduce your risk, although you’ll need to remove any beard first.

Still rather get masked-up? Then look for N95 or FFP respirator masks, assuming you want a mask which will actually reduce your risk. Consider though that when taking off the mask, you can contaminate your hands so always ensure you wash your hands after removing the mask.

If I become febrile at the client’s workplace what should I do?

It is wise to inform the client representative and head home to isolate yourself immediately.

If you feel well enough, and the client can accommodate it, there’s no reason not to work from home during this period. However, it is important to attempt to avoid passing on the infection. Do continue to observe all the same measures intended to stop you acquiring the infection, to reduce the risk of passing it on to others.

Due to lockdown fears, do I need to stockpile toilet paper?

Provided logistics hold up, there should be no supply problems here -- there’s plenty of stock in warehouses. Those isolating for a few months may need stock of toilet paper.

That said, it is not impossible to cautiously go out to replete your reserves even during such a period provided you are careful. If you’re an older person, having younger helpers undertake such tasks for you may be preferable to doing so yourself. Remember -- the virus can survive on goods purchased for 1 to 3 days, (three days for plastics).

Are there any further tips to reduce my risk of contracting coronavirus?

Avoid public transport hubs, social venues, big crowds and gatherings. Walking to work or taking your own car can be safer than using public transport or using taxis. Aim to have at least 1 metre (preferably 2 metres) between you and other people.

Other than that, do what contractors do best -- think outside the box! For example, if you have a nearby 24-hour supermarket do you need to shop at the busiest time of day? A trip to the supermarket at 1am may have slightly less selection (or more, as sometimes shelves are stocked at that time). But it has far less risk associated with it. Also note, I said ‘24-hour’ supermarket, because some supermarkets are operating reduced or dedicated customer hours (in addition to shoppers being restricted to a fixed, low number of items per customer).

Additionally, keep fit and healthy! Don’t sit around doing nothing if you do self-isolate -- the last thing you want is to be admitted with a deep vein thrombosis. 

What can I do to improve the financial situation of contractors affected by this?

There are two things we’d recommend. Firstly, contact your local MP and voice your concerns. This makes a real difference. Secondly, join SEA if you’re a contractor or IHPA if you’re in the health sector, and we will continue to lobby for your interests during this difficult time.

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Written by Iain Campbell

Dr. Iain Campbell is the former secretary general of the Independent Health Professionals Association: a trade association for independent healthcare workers which has undertaken significant litigation against blanket stances by public bodies.
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