The Interministerial Ordinance MTP/MS 14, published on January 25, amends Annex I of the Joint Ordinance 20/20, and updates the measures to be observed to prevent, control and mitigate the risks of transmission of covid-19 in work environments.

Among the main changes, the following stand out:

  • updating the concepts of confirmed and contacting cases;
  • reduction of the period of leave of workers;
  • exclusion from sorting at the entrance of establishments;
  • recommendations on remote work;
  • ventilation in the work environment;
  • mandatory supply of PFF2 masks to risk groups; and
  • increase from three to four hours of mask change time.

In the comparative table, we indicate the main changes:

THEME AS IT WAS AS IT IS
  • Confirmed cases - Concept                                                                                                                                                                                                   
The worker with: a) laboratory test results, confirming covid-19, is considered confirmed, according to the guidelines of the Ministry of Health; or
b) influenza syndrome or Severe Acute Respiratory Syndrome - SRAG, for which specific laboratory investigation was not possible, and which has a history of contact with laboratory-confirmed case for covid-19 in the last seven days before the onset of symptoms in the worker.
The worker is considered confirmed in the following situations: a) Influenza Syndrome - SG or Severe Acute Respiratory Syndrome - SRAG, as defined by the Ministry of Health, associated with anosmia (olfactory dysfunction) or acute ageusia (gustatory dysfunction) without another previous cause, and for which it was not possible to confirm covid-19 by another criterion;
b) SG or SRAG with a history of close or household contact of a confirmed case of covid-19, in the 14 days prior to the onset of signs and symptoms;
c) SG or SRAG with laboratory test result that confirms covid-19, according to the guidelines of the Ministry of Health;
d) asymptomatic individual with laboratory test result that confirms covid-19, according to the guidelines of the Ministry of Health; or
e) SG or SRAG or death by SRAG for which it was not possible to confirm covid-19 by laboratory criterion, but which presents alterations in lung imaging tests suggestive of covid-19, according to the guidelines of the Ministry of Health.
  • Suspected cases - Concept
It is considered a suspected case of the worker who presents acute respiratory condition with one or more of the following symptoms: fever, cough, sore throat, runny nose and shortness of breath, and other symptoms may also be present, such as muscle pain, tiredness or fatigue, nasal congestion, loss of smell or taste and diarrhea.

It is considered a suspect case of every worker who presents a condition compatible with SG or SRAG, as defined by the Ministry of Health.

The worker with at least two of the following signs and symptoms is considered a worker with a picture of SG: I – fever (even if reported); II - cough; III - respiratory distress; IV - olfactory and gustatory disorders; V - chills; VI - sore throat and headache; VII - runny nose; or VIII - diarrhoea.

It is considered a worker with SRAG, who, in addition to SG, presents: I - dyspnea and/or respiratory distress or persistent chest pressure or pain; or II – oxygen saturation less than 95% in ambient air or bluish coloration (cyanosis) of the lips or face.
  • Confirmed case contactants - Concept
The asymptomatic worker who had contact with the confirmed case of covid-19 between two days before and 14 days after the onset of signs or symptoms or laboratory confirmation is considered to be a confirmed case contactant of covid 19, between two days before and 14 days after the onset of signs or symptoms or laboratory confirmation, in one of the following situations:
a) have contact for more than 15 minutes less than one meter away; b) stay less than one meter away during transportation c) share the same home environment; or
d) be a health professional or other person who directly handles a covid-19 case, or laboratory worker who manipulates samples from a covid-19 case without the recommended protection.
The asymptomatic worker who was close to a confirmed case of covid-19, between two days before and ten days after the onset of signs or symptoms or the date of collection of the laboratory confirmation examination (confirmed asymptomatic case ) of the case, is considered to be a close confirmed case contactant of covid-19, in one of the following situations: a) had contact for more than 15 minutes less than one meter away,  with a confirmed case, without both using a face mask or using them incorrectly;
b) had direct physical contact, such as handshake, hugs or other types of contact with a person with confirmed case;
c) remained less than one meter away during transport for more than 15 minutes; or d) shared the same home environment with a confirmed case, including dormitories and lodgings.
  • Suspected case contactants - Concept
The asymptomatic worker who had contact with a suspected case of covid-19 between two days before and 14 days after the onset of symptoms of the case is considered to be a suspectedcase contactants in one of the following situations: a) having contact for more than 15 minutes less than one meter away b) remaining less than one meter away during transport; c) share the same home environment; or d) be a health professional or another person who directly handles a case of covid-19, or laboratory worker who manipulates samples of a case of covid-19 without the recommended protection. The asymptomatic worker who had contact with a suspected case of covid-19, between two days before and ten days after the onset of symptoms of the case, is considered to be a close suspected case contactantof covid-19, in one of the following situations: a) had contact for more than 15 minutes less than one meter away without both using a face mask or using incorrectly; b) had direct physical contact with a person with a suspected case; or c) shared home environment with a suspected case, including dormitories and lodgings.
  •  Work removal of confirmed cases

The organization should immediately remove workers from face-to-face work activities for 14 days in the following situations: a) confirmed cases of covid-19; b) suspected cases of covid-19; or c) contactants of confirmed cases of covid-19.

The period of removal of contactants from a confirmed case of covid-19 must be counted from the last day of contact between the contactors and the confirmed case.

Away workers considered suspected cases may return to their face-to-face work activities before the specified period of leave when:
a) laboratory examination rules out covid-19, according to the guidelines of the Ministry of Health; and b) are asymptomatic for more than 72 hours.

Contactants who reside with a confirmed case of covid-19 must be removed from their face-to-face activities for 14 days, and a supporting document must be presented.
 The organization should remove from face-to-face work activities, for ten days, workers considered confirmed cases of covid-19.

The organization can reduce the removal of these workers from face-to-face work activities to seven days as long as they have been without fever for 24 hours, without the use of anti-thermal medication, and with remission of respiratory signs and symptoms.

The organization should consider as the first day of confirmed case isolation the day following the onset of symptoms or molecular method test collection (RT-PCR or RT-LAMP) or antigen test.
  •  Removal from work of close contactants
 The organization should immediately remove workers from face-to-face work activities for 14 days in the following situations: a) confirmed cases of covid-19; b) suspected cases of covid-19; or c) contactants of confirmed cases of covid-19.

The period of removal of contactants from a confirmed case of covid-19 must be counted from the last day of contact between the contactors and the confirmed case.

Away workers considered suspected cases may return to their face-to-face work activities before the specified period of leave when:
a) laboratory examination rules out covid-19, according to the guidelines of the Ministry of Health; and b) are asymptomatic for more than 72 hours.

Contactants who reside with a confirmed case of covid-19 must be removed from their face-to-face activities for 14 days, and a confirmation document must be presented.
 The organization should remove workers considered contacting close to confirmed cases of covid-19 from face-to-face work activities for ten days.

The period of removal of contacts close to confirmed case of covid-19 should be considered from the last day of contact between the nearby contacts and the confirmed case.

The organization can reduce the removal of these workers from face-to-face work activities to seven days as long as molecular method testing (RT-PCR or RT-LAMP) or antigen test has been performed from the fifth day after contact, if the test result is negative.

Close contact-ins residing with a confirmed case of covid-19 must present a document proving the disease of the confirmed case.
  • Removal from work from suspected cases
 The organization should immediately remove workers from face-to-face work activities for 14 days in the following situations: a) confirmed cases of covid-19; b) suspected cases of covid-19; or c) contactants of confirmed cases of covid-19.

The period of removal of contactants from a confirmed case of covid-19 must be counted from the last day of contact between the contactors and the confirmed case.

Away workers considered suspected cases may return to their face-to-face work activities before the specified period of leave when:
a) laboratory examination rules out covid-19, according to the guidelines of the Ministry of Health; and b) are asymptomatic for more than 72 hours.

Contactants who reside with a confirmed case of covid-19 must be removed from their face-to-face activities for 14 days, and a confirmation document must be presented.
 The organization should remove workers from face-to-face work activities for ten days, considered suspected cases of covid-19.

The organization can reduce the removal of these workers from face-to-face work activities to seven days as long as they have been without fever for 24 hours, without the use of anti-thermal medication, and with remission of respiratory signs and symptoms.

The organization should consider as the first day of isolation of suspected case the day following the onset of symptoms.
  • Procedures for identifying suspected cases
The organisation shall establish procedures for identifying suspected cases, including:

a) channels for communication with workers regarding the appearance of signs or symptoms compatible with covid-19, as well as contact with confirmed or suspectedcase of covid-19, and polls may be conducted, through physical or electronic means, telephone contact or electronic service channels; and

b) screening at the entrance of the establishment in all work shifts, and may use body temperature measurement by infrared or equivalent, before workers start their activities, including outsourced.
The organization should establish procedures for identifying suspected cases, including channels for communication with workers about the appearance of signs or symptoms compatible with covid-19, and contact with confirmed or suspected case of covid-19, admitted polls, by physical or electronic means, telephone contact or electronic service channels. 
  • Remote work

The organization should promote telework or remote work when possible.

Face-to-face meetings should be avoided and, when indispensable, the distance provided for in Annex I of the ordinance should be maintained.
Telework or remote work may be adopted at the employer's discretion, in line with the guidelines of health authorities.
  • Ventilation
  When split-type air conditioning system is used, it is recommended that doors and windows be kept open or that an air renewal system be added, in view of technical or operational feasibility. The exhaust systems installed must be kept in operation during office hours.
  • Risk group workers - Telework
Workers aged 60 years or older or presenting clinical conditions at risk for the development of complications of covid-19, according to sub-item 2.11.1, should receive special attention, prioritizing their stay in the residence in telework or remote work or, in activity or place that reduces contact with other workers and the public,  when possible. Workers aged 60 years or older or presenting clinical conditions of risk for the development of complications of covid-19, according to sub-item 2.12.1, should receive special attention, and telework or remote work may be adopted at the employer's discretion.
  • Risk group workers - Measures and supply of masks
For the workers of the risk group, if it is not possible to stay in the residence or remote work, work should be prioritized in an airy and sanitized place at the end of each work shift, in view of the other measures provided for in the Annex to the ordinance. The organization shall provide these workers with surgical masks or masks of type PFF2 (N95), or equivalent, when not adopted telework or remote work.
  • Mask change time
Surgical or tissue masks should be replaced at least every three hours of use or when they are dirty or moist. Surgical or tissue masks should be replaced at least every four hours of use or when they are dirty or damp.

 

The other measures remain in force and must be fully observed by companies in order to minimize the risks of transmission and contagion among workers. We highlight below the main measures provided for by the ordinance:

 

Guidance measures

 

— Mandatory to disseminate informative guidelines or protocols to workers, indicating the necessary measures for the prevention, control and mitigation of the risks of transmission of covid-19. The guidelines should include:

  • prevention measures in work environments, in common areas, such as in cafeterias, bathrooms, changing rooms, rest areas and in the transportation of workers, when provided by the employer;
  • actions for early identification and removal of workers with signs and symptoms compatible with covid-19;
  • procedures for workers to communicate, including remotely, signs or symptoms compatible with covid-19 or possible contact with confirmed case of covid-19;
  • instructions on hand hygiene and respiratory label; and
  • forms of contagion, signs, symptoms and care needed to reduce transmission in the workplace and in the community.

The organization should extend this information to outsourced workers and other organizations that enter the facility.

Instructions to workers can be transmitted during training or through security dialogues, physical or electronic documents, posters and internal regulations, avoiding the use of pamphlets.

 

Conduct that should be adopted in confirmed, suspected and contacting cases

 

— Immediately remove workers with confirmed cases, suspected cases and contacting cases close to cases confirmed for covid-19 from face-to-face work activities for a period of ten days.

For the purposes of the period of removal:

  • in confirmed cases, the day following the onset of symptoms or molecular method test collection (RT-PCR or RT-LAMP) or antigen test should be considered;
  • in suspected cases, the day following the onset of symptoms should be considered; and
  • in cases of close contactants, it should be considered from the last day of contact with the confirmed case.

The period of leave may be reduced to seven days in the following cases:

  • confirmed – provided they have been without fever for 24 hours, without the use of anti-thermal medication, and with remission of respiratory signs and symptoms;
  • close contactants – provided molecular method test (RT-PCR or RT-LAMP) or antigen is performed from the fifth day after contact, if the test result is negative; and
  • suspected – provided they have been without fever for 24 hours, without the use of anti-thermal medicine, and with remission of respiratory signs and symptoms.

— Guide workers away on the need to remain in their residence, maintaining remuneration during the period of leave.

— Establish procedures for identifying suspected cases, including communication channels for workers to report the appearance of compatible signs or symptoms and contact with confirmed or suspected case of covid-19.

— Collect information on contactants, activities, the workplace and common areas frequented by the suspected or confirmed worker of covid-19.

— Guide contactants close to suspected cases of covid-19 about contact and the need to report immediately to the company the emergence of any signs or symptoms related to the disease.

— Keep record up to date with the following information:

  • workers by age group;
  • workers with clinical conditions at risk for the development of complications related to more severe conditions of covid-19 (no specification of the disease, preserving confidentiality). Clinical conditions at risk for the development of complications of covid-19 are considered: severe or decompensated heart diseases (heart failure, infarcted, revascularized, patients with arrhythmias, decompensated systemic arterial hypertension); severe or decompensated pneumopathy (oxygen-dependent, moderate/severe asthma patients, Chronic Obstructive Pulmonary Disease – COPD); immunosuppressed; advanced-stage chronic renal patients (grades 3, 4 and 5); diabetics, according to clinical judgment, and high-risk pregnant women;
  • suspected and confirmed cases;
  • close contactants on/who were on leave; and
  • measures taken to adapt working environments to prevent covid-19.

— Forward suspected cases to the organization's medical outpatient clinic, when available, in order to carry out appropriate evaluation and follow-up. The care of symptomatic workers should always occur separately from the other workers, providing masks to all those present in the outpatient clinic.

— When the activities of a given sector or of the establishment itself are stopped as a result of covid-19, the following procedures shall be adopted before the return of activities:

  • ensure the adoption of the preventive measures provided for in the annex to the Ordinance and the correction of situations that may have favoured the contamination of workers in the working environments;
  • sanitize and disinfect the workplace, common areas and vehicles used;
  • strengthen communication to workers; and
  • strengthen the monitoring of workers to ensure the removal of confirmed, suspectedand contacting cases close to confirmed cases of covid-19.

 

Hygiene and cleanliness of the environments

 

— Sanitize and disinfect workplaces frequently, by cleaning the surfaces of tables, countertops and chairs in the interval between shifts or whenever there is the designation of one worker to occupy the job of another. The cleaning and disinfection of keyboards, handrails, door handles, payment terminals, elevator buttonens, tables and chairs should also be cleaned and disinfected.

 

Hand hygiene and respiratory label

 

— Guide employees to frequent hand hygiene, with the provision of resources for this purpose close to workplaces, including water, liquid soap, disposable paper towel and trash can (with manual contact-free opening) or hand-appropriate sanitizer, such as 70% alcohol.

— Advise on not sharing towels and personal products.

— Procedures should be adopted to ensure that, as far as possible, workers avoid touching surfaces with high frequency of contact, such as lift buttons, door handles and handrails.

— Workers should be instructed to avoid touching the mouth, nose, eyes and face with their hands and to practice respiratory label, including wearing disposable handkerchief for nasal hygiene, covering the nose and mouth when sneezing or coughing and sanitizing their hands after sneezing or coughing.

— Specialized Services in Safety Engineering and Occupational Medicine (SESMT) and the Internal Commission for Accident Prevention (Cipa) should participate in the prevention actions implemented by the organization.

 

Social distancing

 

— Adopt measures to increase distance and reduce personal contact between workers and between them and the external public, with guidelines to avoid close contacts such as hugs, handshakes and unnecessary conversations.

— Establish a minimum distance of one metre between workers and between workers and the public. If the physical distance of at least one meter cannot be implemented to reduce the risk of transmission between workers, customers, users, contractors and visitors, it should be:

  • for activities carried out in fixed work posts, maintain the use of surgical mask or fabric and adopt waterproof partitions or provide facial protection of the type plastic visor (face shield) or goggles; and
  • for other activities, maintain the use of surgical mask or tissue.

— Adopt measures to limit the occupancy of elevators, stairs and restricted environments, including sanitary facilities and changing rooms.

— Demarcatise and rearrange the places and spaces for queues and waits at least one meter away between people.

— Take measures to avoid agglomerations in working environments.

 

Personal Protective Equipment (PPE) and other protective equipment

 

— Create and review procedures for the use, hygiene, packaging and disposal of PPEs and other protective equipment used, and employees are oriented on the use, cleaning, disposal and replacement of masks, hand hygiene before and after their use and even limitations of their protection against covid-19.

— Provide surgical or tissue masks for all workers, with required use in shared environments or in those where there is contact with other workers or the public (it is mandatory to use the masks and replace them every four hours or when they have been dirty or damp).

— Professionals of the medical service of the organization, when any, should receive PPE or other protective equipment, according to the risks, including respiratory protection mask type PFF2 (N95), in accordance with the guidelines and regulations of the Ministry of Labor and Welfare and the Ministry of Health.

 

Ventilation of workplaces and common areas

 

— Natural ventilation in workplaces or measures should be taken to increase the number of air exchanges in the enclosures as much as possible, bringing clean air from outside and avoiding the recirculation of air conditioning.

— When split-type air conditioning system is used, it is recommended that doors and windows be kept open or that an air renewal system be added, in view of technical or operational feasibility.

— The exhaust systems installed must be kept in operation during office hours.

 

Risk groups

 

— Workers aged 60 years or older or presenting clinical conditions at risk for the development of complications of covid-19 should receive special attention, and telework or remote work may be adopted at the employer's discretion.

— Surgical masks or masks of type PFF2 (N95) or equivalent shall be provided when not adopted telework or remote work.

 

Common areas of the company

 

For the common areas, the published Ordinance updated the obligations and recommendations to be followed by employers, ranging from cafeterias to the transportation offered to workers.

 

Lunchrooms

 

— The sharing of glasses, plates and cutlery without sanitization is sealed.

— Self-service should be avoided or, where it cannot be avoided, control measures such as:

  • hand hygiene before serving or supplying disposable gloves;
  • hygiene or frequent exchange of kitchen utensils for shared use, such as shells, handles and spoons;
  • installation of salivary protector on self-service structures; and
  • use of masks and guidelines to avoid conversations during the service.

— Provide frequent cleaning and disinfection of the surfaces of tables, countertops and chairs, as well as adopt in the cafeterias minimum spacing of one meter between people in line and on the tables, guiding compliance with respiratory etiquette recommendations and the need to avoid conversations. When the frontal or transverse distance is not observed, a physical barrier should be used on the tables with a height of at least one and a half meters in relation to the ground.

— Distribute workers at different times at the places of meal.

— Deliver set of sanitized utensils, packed individually.

— Inclined jet drinkers should be adapted so that water consumption can only be used with the use of a disposable cup or individually used container.

 

Locker rooms

 

— Avoid crowding of workers at the entrance, exit and during use of the dressing room.

— Guide workers to keep the distance of one metre from each other during their use.

— Guide workers on the order of deparamentation of clothing and equipment, so that the last protective equipment to be removed is the mask.

— Provide a sink with water and liquid soap, as well as disposable towel or hand-appropriate sanitizer dispensers, such as 70% alcohol, at the entrance and exit of the changing rooms.

 

Transportation offered by the employer

 

— Implement procedures for communication, identification and removal of workers with symptoms before boarding, thus preventing the entry of symptomatic or contacting patients close to confirmed cases of covid-19 in the vehicle.

— Lay down the obligation to wear protective masks when boarding workers in the vehicle and use throughout the stay.

— Guide workers to avoid crowding in the boarding and disembarkation of transport, with the implementation of measures to ensure minimum distance of one meter between each person.

— Comply with the maximum capacity of passengers, limited to the number of seats of the vehicle.

— Maintain natural ventilation inside vehicles and, where the use of the air conditioning system is necessary, air recirculation should be avoided.

— Seats and other vehicle surfaces most often touched by workers should be sanitized regularly.

— Drivers should frequently sanitize their hands and their workstation, including the steering wheel and surfaces most often touched.

— Keep a record of workers using transport, listed by vehicle and travel.