Four pillars of safety for starting back to work

My 18, 2020

We will be rolling out carefully designed plans in Sunrise Step 1 to start back to work safely soon. Our work is guided by the four pillars of safety:

  1. hygiene
  2. screening
  3. distancing
  4. masks

But is there evidence that these four pillars actually work to prevent the spread of COVID-19?

In a Medical Dispatch in the New Yorker entitled “Amid the Coronavirus Crisis, a Regimen for Reentry” the good doctor and writer Atul Gawande  answers a similar question-“ Is there any place that has figured out a way to open and have employees work safely, with each other and with their customers?

Well, yes: in health care.

The Boston area is a COVID-19 hotspot with a hospital system with 50,000  employees working on site in the month of April. While workplace transmissions were not zero, they were few, so Dr. Gawande writes that there are lessons to be learned to bring people back to work from places that never locked down.

safety icons

What are those lessons? Dr. Gawande draws parallels to the combination therapy of several drugs we use to treat HIV infections. Here the preventive measures are:

  1. hygiene
  2. screening
  3. distancing
  4. masks
  5. all used TOGETHER
hand wash icon



We know the importance of washing our hands, but frequency makes a difference. Research during the 2002 SARS Coronavirus outbreak found that washing hands more than  10 times a day reduced infections by more than forty five percent. But, handwashing and disinfecting high-touch surfaces at least daily by themselves are unlikely to have much impact since environmental transmission may account for as little as six percent of COVID-19 infections.

That’s because SARS-CoV-2 is mainly spread by respiratory droplets and aerosols.



Daily screening can help in these scenarios:

  • New Fever?
  • Symptoms? Cough; sore throat; shortness of breath; loss of taste or smell; nasal congestion or a runny nose.
  • None of the above? OK to work.
  • Any of the above? Get testing ASAP.
    • If positive, contacts can be identified and tested and all positive individuals quarantined.
    • If negative, return to work with the proviso, because of false negative tests, of being afebrile and without symptoms for seventy-two hours.
social distancing


Because COVID-19 is spread by aerosol transmission, physical distancing is vital and the 6 foot rule is key. We can prevent workplace infections by:

  • spacing workers farther apart
  • limiting the number of people on elevators or shared workspaces
  • and working and meeting remotely whenever possible

However, Dr. Gawande points out that distancing is no guarantee against getting infected. Sneezing and prolonged contact in confined spaces like airplanes create conditions for multiple transmissions well beyond 6 feet.  Even with these measures, Dr. Gawande cites the example of a single infected member of a choir who had cold-like symptoms for three days infecting fifty-two of the sixty other choir members in ninety minutes of choir practice in a crowded church.

So, it is important to keep physical distancing, limit contact time to a minimum, and stay away from crowded places.



Masks combined with distancing are important to at least partially block the spread of respiratory droplets from a person with an active but unrecognized infection-infectivity starts before symptoms and peaks at a time when symptoms start.

Surgical masks are three times better than cloth masks, but, if at least sixty per cent of the population wore well-fitting two-layer cotton masks, the epidemic could be stopped.

That said, Dr. Gawande writes that masks are “designed to safeguard others, not the wearer. The basic logic is: I protect you; you protect me.”

Dr. Gawande cites strong evidence that this  four-part combination strategy is working:

  • Most health care workers in the Boston hospital system who become infected acquired their infection in the community, usually from family.  
  • No correlation between infection and high-risk hospital assignments.

The conclusion of this article is on the fifth element of success:


  • People living and working together every day
  • Never wanting  to be the one to make someone else sick
  • Sticking to the four pillars combination of prevention

We know these tenets work. Let’s model a safe return to the workplace for our community by continuing to lift up these 5 elements of success.

Credit: Dr. Ashley Haase, MD-  Regents’ Professor and Head, Department of Microbiology and Immunology, Professor of Medicine- Infectious Diseases and Internal Medicine