Tehran creates a decision-making tool to guide the city's COVID-19 response.
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Physical distancing is considered as one of the efficient and essential policies for decreasing exposure and breaking transmission cycle in COVID-19 outbreak. Workers in different jobs are exposed and at risk of contracting COVID-19 infection and workplaces are considered as potential places for crowing and accumulated risk of infection transmission, depends on different factors applied to the nature of the jobs. In the other hand saving and securing health of workforce is one of the top priorities in all communities. In addition to applying occupational health regulations, physical distancing, adapted to the level of risk (prevalence of infections) and degree of necessity of the activities (production or service), is considered as one of the mandatory and efficient policies to respond COVID-19 epidemics by controlling exposures and transmission cycles. Most of service and production activities of countries are vital for them then it is mandatory to take into consideration economic, social and security issues in physical distancing policy making and implementation. Necessity of the activity (production or service) and level of the risk (prevalence of infection in the region or clusters in the target activity/job environment) were considered as the main two factors in Iranian decision-making model. The first step is to identify necessity of the economic activities (production or service) in country based on economic and social considerations and classify them based on International Standard Industrial Classification (ISIC) categories (table1).
Table1: Example of identified necessity of activities classified based on ISIC
The second step is classifying the whole country based on level of the risk in the province, district or industrial zone and the activity type/unit (table2). Table2: Level of the risk for geographical location and activity type/unit
The third step is decision making matrix (table3) based on risk level and code of necessity. Table3: Decision making matrix
Forth step is identifying level of authorized activity for the production and service activities according to the matrix of risk level and necessity coding (table3). Requirements in table4 are based on regulations explained in table2. Table4: Table of authorized level of activity
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The initiative aims to create a dynamic and risk-based decision-making tool for policy making on physical distancing for service providers and industries in COVID-19 response.
Efficiency and effectiveness of this model is monitored and supported by the Health Surveillance System. Monitoring is carried out by registering the status of the activity and the industry’s QR Code at a website (https://eoh.behdasht.gov.ir/login). Evaluation is carried out through questions and feedback by employees and customers of the service regarding how the target industry has complied with core regulations of the occupational health guidelines. The monitoring system is implemented by 7000 qualified occupational and environment health inspectors all around the country.
It is inevitable that the decision-making process will be influenced by some other factors out of the context of the matrix, resulted from social and economic pressure due to closing of some activities.
In addition to response activities to control the COVID-19 epidemic within the country. There has been no reported cluster of cases in workplaces frequently, except in only one industry.
Reduced number of referred cases has allowed rehabilitation in the healthcare workers and has resulted in more resilience of the health system during the epidemic.
All industrial and service activities within the country are now active under controlled conditions. Moreover, social, and economic impacts of the epidemic such as cost implications or unemployment have been restrained to a reasonable extent.