COVID-19 requires a strategy through the use of the hierarchy of controls. Having a vaccine is the best method to eliminate the virus.
History Repeats Itself With COVID-19 After 100 Years
Today’s breaking news shows increasing numbers represent the coronavirus (Covid-19). COVID-19 influences our nation and isn’t the first virus that has caused a pandemic and likely not the last. According to Kessler (2018), history repeated itself after 100 years. In October 1918, the United States had been an active participant in World War I for more than a year. While the declared enemy was overseas, there was a disease working in our nation. The pandemic enthralled cities with fear as schools canceled and theaters, churches, and other public gathering places closed. In one month, 195,000 Americans perished, making it the deadliest month in American history. The killer was none other than influenza (Kessler, 2018).
This article lists the controls used throughout the past pandemics to determine what worked and what did not. The information highlights that a vaccine will eliminate the virus while other controls will reduce the virus's spread.
Today, the pandemic has disrupted our nation that affected the economy, workforce production, and mindset. This present-day problem is complex and requires a few controls to protect people from harm. Solutions exist, although implementing a plan remains Non-standardized across the nation. Having a strategy requires focus to reduce the likelihood and severity of the hazard. The use of the hierarchy of controls developed by the Occupational Safety and Health Administration (OSHA) will aid in developing an effective standardized protection plan to accomplish this task.
Control of Hazards
Control involves the elimination or reduction of identified hazards
— Fuller, 2015
Hierarchy of Controls
The pandemic is a challenge, and many are unsure about how long before the virus subsides. To protect the nation, the purpose of the hierarchy of controls presents a path to move reduce risk and present less danger. Using the hierarchy of controls provides a systematic approach to reduce or eliminate risk by using personal protective equipment (PPE), administrative, engineering, substitution, and elimination controls (Goetsch, 2019). The most effective control of removing a hazard is eliminating the hazard, and the least effective mitigation control is PPE.
History presents a few options for reduced exposure. Comparing controls used with previous pandemics may shed light on what worked, did not, and how we may help ourselves with the global illness. Figure 1 presents the hierarchy of controls used to eliminate the hazard or reduce the level of risk.
Figure 1, Hierarchy of Controls
Controls Used to Protect During a Pandemic
Pandemics cause health-related issues for people throughout the world. Examples include the Influenza of 1918, 1957, and 2003. Each pandemic presented complications for people during each episode. With the rapid spread of influenza, the slow implementation of adequate controls expanded the fatality rate. Reviewing each pandemic lists what controls they put in place and how effective they were.
Each control falls under a rank order from least to most useful (Goetsch, 2019). The least effective control used during the pandemics includes PPE. Protective equipment includes a face mask and administrative procedures associated with social distancing, quarantine, personal hygiene, and the closure of public places. Next, engineering controls are more effective and include disinfectants, while the elimination control identifies the vaccine. Table 1 presents a list of controls used throughout several pandemics. The list represents controls used then, today, and future options.
Table 1, Controls Used During Each Pandemic
Elimination (Most Effective)
Isolation / Quarantine
PPE (least Effective)
Pandemics throughout history identify health vulnerabilities as a result of a lack of vaccines and treatments. Several pandemics existed in 1918, 1957, 2003, and 2020. According to the Centers for Disease Control and Prevention (CDC) (2018), the 1918 pandemic influenza created a significant public health crisis that caused 50 million fatalities in the states. Outbreaks with flu-like symptoms detected at Camp Funston in Fort Riley, Kansas, resulted from troops deployed for World War I. Public health officials started education programs and announced the dangers of coughing, sneezing, and influenza spread. Public health officials encouraged staggered employment hours and less public transportation use to prevent overcrowding and the spread of the flu.
During the pandemic of 1918, the Spanish Flu strengthened without a means for medical treatment. A vaccine was not available, and protection required non-pharmaceutical interventions such as quarantine, personal hygiene, disinfectants, and limited social gatherings (CDC, n.d.). Schools and businesses closed, travel restrictions occurred, and masks became the mitigation strategy for this pandemic (NAS, 2007). Because of the increased illness rate, the development of better disease surveillance and containment strategy became apparent.
In 1957, the Asian flu emerged and spread throughout the world. This pandemic was the second major influenza event to occur following the 1918 outbreak. About two million deaths occurred worldwide and were considered the least severe pandemics in the 20th century (Britannica, n.d.). The short lived pandemic existed in 1933, and the nation was quick to get to work. The pandemic caught the eye of Dr. Maurice Hilleman, Chief of Respiratory Diseases at Walter Reed Army Institute of Research in Washington D.C. Dr. Hillemann concern about the outbreak of the flu in Hong Kong pushed to development of a vaccine by the time school began in the fall (Little, 2020). Announcing the flu presented some resistance. When the flu arrived in the states, a vaccine was ready.
Because medicine was available, the disease ended after that. Besides the vaccine, authorities implemented recommendations to include reducing public gatherings and closing public places. Having each of the controls reduced the spread of the virus (CDC, 2013).
The spread of Severe Acute Respiratory Syndrome (SARS) began in China and spread throughout 29 countries. SARS become a concern in 2003, causing a global epidemic. The infection progressed without a vaccine. They placed a majority in the hospital and isolated to prevent the virus's spread (ALA, n.d.). Over 8,000 cases existed, with 774 deaths. Long-term effects included shortness of breath, chronic lung and kidney disease, although most recovered from the illness (ALA, n.d.). The disease ceased to spread in 2004 due to containment quarantine measures for persons infected.
COVID-19 remains one of the worst hazards that has influenced our nation. Reviewing the hierarchy of controls suggests that elimination is the best choice, while PPE and administrative controls reduce the illness's spread.
PPE exists when processes are under development and hazards are not likely under control. Here, PPE use is inexpensive to set up. Face masks, protective clothing, and gloves represent the best barrier to protect against the hazard. Next, administrative controls involve changing the way people work. a change in policy or procedures to reduce the likelihood of exposure. For example, administration controls include isolation when sick, telework, social distance, and the six-foot separation presents a quick means to carry out a change to protect people.
Engineering controls include physical barriers such as a plastic transaction window used in grocery and bank institutions. Ventilation systems upgrades offer protection from exposure and need time to carry out. Therefore, PPE and administrative controls are useful supplements. Next, substitution shows replacing the COVID-19 with a less-lethal dose in the body. They still must research to find the correct drug and may take time to produce (American Society of Safety Professionals, n.d.).
Elimination is the most effective control within the hierarchy. The control involves removing the hazard. Here, a vaccine is necessary to end the virus. It is important to note that a vaccine is not 100% effective (ASSP, n.d.). A vaccine is available, and other controls are necessary to reduce the risk of exposure.
Control of Hazards
Perhaps the most challenging aspect is creating a control to reduce the identified hazard and risk
— Fuller, 2015
The hierarchy of controls presents the best option to beat or delay a pandemic. The vaccine is the most effective control of removing the hazard, while PPE, administrative, and engineering controls reduce the virus's spread. A vaccine is necessary to stop the pandemic instead of slowing the infection rate. For example, once the 1918 flu crisis was over, they put a minor effort to protect the public from the next episode. In 1933 they developed a flu vaccine with the forethought of another wave spike. The 1957 pandemic remained short-lived because of the 1933 vaccine. Waiting for the pandemic to arrive creates a slow response time to prepare and beat the threat. A proactive approach is necessary to prepare for the danger ahead.
History has presented two observations. The hierarchy of controls provides a layered approach to reduce risk and eliminate the hazard. Risk reduction requires the use of PPE, administrative, and engineering controls. Next, the best method to eradicate a virus involves an effective vaccine. While not 100% effective, history has shown the length of a pandemic predicates whether a vaccine is available.
A pandemic demands a mitigation strategy to prevent mass illness. Using the hierarchy of controls holds concerning the level of effectiveness each layer provides. Medication is our best option, and the other controls provide quick relief from the disease's spread. Developing a vaccine presents the best option to shorten the pandemic and allow our nation to get back on track. Until an ample supply of medication arrives, we will have to continue to social distance, isolate, wash hands, and wear a mask.
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