This study evaluated trends in the implementation of workplace measures against COVID-19 by Japanese companies. We conducted a prospective cohort study, using data from December 2020 and December 2021, with 13,419 respondents participating in the follow-up survey. We evaluated nine workplace measures against COVID-19 (e.g., encouraging mask-wearing at work) and used the McNemar test and the Chi-square test for trend in the analysis. Small-sized companies (1–9 employees) exhibited a significant increase in the implementation of all the measures, with a rate of increase ranging from 8.4% to 16.1% (P-value: <0.001). Medium-sized companies (10–49 employees) also showed significant improvements in nearly all the measures (rate of increase: 3.5% to 10.5%, P-values: <0.001 to 0.004), except for one specific measure. Larger companies (more than 50 employees) displayed a mixed pattern, with some measures increasing and others decreasing. A persistent gap was observed between smaller (fewer than 50 employees) and larger companies in the implementation rates of these measures. The findings revealed a positive shift in workplace measures against COVID-19 among smaller companies in Japan over 1 year, although gaps between them and larger companies persisted.
Workplace measures against COVID-19 are critical to protecting the health of employees and customers, maintaining business operations, and controlling the spread of infection in the community. The workplace is a cluster-prone environment, and workplaces have established a combination of individual measures such as implementing hand hygiene, maintaining physical distancing, and using personal protective equipment, as well as workplace measures such as frequent ventilation and work shift changes. A meta-analysis indicated that combining multiple infection control measures in the workplace dramatically reduces workers’ risk of COVID-19 infection (0.2% vs. 24.0%) [1]. There are proven benefits to companies in investing in infection control measures, such as reduced employee illness and absence and enhancement of work engagement [2].
Many workplaces implemented infection control measures during the COVID-19 pandemic, but a certain number of workplaces could not implement effective measures. Small and medium-sized enterprises (SMEs) confronted various issues when implementing workplace COVID-19 infection control measures [3]. These issues included cost limitations, a lack of medical professionals, worker compliance problems, limited resources such as disinfectants, and the financial impact of outbreaks [4, 5]. These issues were especially apparent during the early stages of the COVID-19 pandemic globally as well as in Japan [6]. The Japanese government and local administrations have been assisting SMEs by supporting the cost of infection control measures and disclosing information about good practices in each company [7]. Owing to these combined initiatives, the implementation rate of workplace measures against COVID-19 among Japanese SMEs increased between the first emergency declaration (first wave, April 2020) and the end of that year (third wave, December 2020), but there was still a large gap between SMEs and large enterprises [8, 9].
Three COVID-19 outbreaks occurred in Japan from December 2020 to December 2021, comprising the third to the fifth waves. A state of emergency was declared in each wave, and the COVID-19 alert level was raised. The second state of emergency was declared in January 2021, followed by a third declared in April 2021 due to the spread of virus variants [10]. Workplace vaccination programs started in June 2021, after the start of vaccinations for older people and healthcare workers in February 2021[11]. As a result, most Japanese people had received their second dose of the COVID-19 vaccine by November 2021, and the infection rate temporarily decreased [12]. As public vaccination progressed in Japan, the restriction of behaviors such as public eating, drinking, and events, as well as traveling, were gradually relaxed [13]. We hypothesize that as the progression of vaccination relaxed the implementation of individual COVID-19 measures, the implementation of workplace measures also changed. It is not well known how these changes affected the implementation of infection control measures in the workplace. Therefore, the purpose of this study was to evaluate how the implementation of infection control measures by Japanese companies changed during the 1-year period from December 2020 to December 2021, according to company size.
Study design and setting
We conducted this study as part of the investigations conducted by the CORoNaWork (Collaborative Online Research on Novel Coronavirus and Work) project [14]. This prospective cohort study used data from a baseline survey conducted in December 2020 (T1) and a follow-up survey conducted in December 2021 (T2). The data from both the baseline and follow-up surveys were collected using self-administered questionnaires completed online. The baseline survey was conducted during the third wave of the pandemic in Japan when the number of COVID-19 cases and deaths was much higher than those during the first and second waves. The follow-up survey was conducted once the fifth wave of the COVID-19 pandemic had eased; by November 2021, the number of cases had decreased, partly because most Japanese people had received two doses of COVID-19 vaccination [15].
All participants involved in the study provided informed consent. This study was approved by the ethics committee of the University of Occupational and Environmental Health, Japan (references No. R2-079).
Participants
Fujino et al provided details of the baseline survey protocol [14]. We recruited individuals who were registered as full-time workers, temporary workers, contract workers, and self-employed workers. The baseline survey included 33,807 participants stratified by sex, region, and occupation. After excluding invalid responses, 27,036 respondents remained (Figure 1). After excluding 8,476 participants who had dropped out of the study and 5,141 who had retired or changed jobs during the 12-month follow-up period, 13,419 participants who completed the self-administered questionnaire were eligible for inclusion in the analysis.
Dependent variable
The outcome of this study was the implementation of workplace measures against COVID-19. First, we developed an initial list of workplace measures against COVID-19 by reviewing the academic literature and relevant guidelines [6, 16, 17] describing standard workplace measures against COVID-19 in Japan when the baseline study was conducted. Next, experts in workplace measures against COVID-19 extracted the measures based on the generalizability and effectiveness of these measures in SMEs. Finally, following consultation with a panel of experts, we drafted a list of measures and selected nine key measures (Table 1) that were approved by all of the authors [9]. The survey question designed to evaluate workplace measures against COVID-19 was: “Is your workplace currently implementing the following measures against COVID-19?” Study participants responded with a “yes” or “no” to each item.
| Measure | Description |
|---|---|
| Encouraging mask-wearing at work | Encourage employees to wear masks consistently in the office to help stop the spread of COVID-19 |
| Requesting employees to stay home when ill | Request employees to refrain from coming to work if they show symptoms of illness |
| Restricting work-related social gatherings and entertainment | Keep company events and social activities at a minimum to reduce close contact between employees |
| Enforcing temperature measurement | Check everyone’s temperature at the workplace entrance to identify anyone who might be sick and send them home |
| Installing partitions or changing the working environment | Installing physical barriers or rearranging the workplace layout to ensure physical distancing among employees (e.g., desk layout or flow lines) |
| Restricting face-to-face meetings | Reducing the frequency of in-person meetings and encouraging virtual meetings instead |
| Stopping business trips | Avoid or stop all business travel to lessen the chances of catching and spreading the virus |
| Conducting health screenings for visitors | Screen all visitors for health issues to ensure they are not bringing any risks into the workplace |
| Encouraging remote working | Support or arrange for employees to work from home, reducing the number of people in the office |
Independent variables
The exposure variable in our study was the size of the company. Companies were categorized into four groups according to size: fewer than 10 employees, 10–49 employees, 50–999 employees, and 1,000 or more employees.
Covariates
We obtained questionnaire data as the following covariates: sex, age, job type, and geographic region of workplace. We used participants’ postal codes to identify the location of each workplace.
Statistical analyses
We performed a descriptive analysis comparing the number and percentage of nine workplace measures against COVID-19 by company size. We applied the Chi-square test for trend to obtain P-values for trends in each workplace measure according to company size. We used the McNemar test to assess how the implementation rate of workplace measures against COVID-19 changed according to company size between the baseline and the follow-up surveys. We regarded a P-value of <0.05 as statistically significant. Stata SE 16.1 (StataCorp LLC, College Station, TX, USA) was used for all statistical analyses.
The characteristics of the participants are presented in Table 2. Approximately half of the 13,419 participants were men (57.1%). Most of the participants were aged 50–59 years (37.6%), followed by those aged 40–49 years (31.4%). Workplace locations were classified according to seven geographic regions: the leading three in proportion were (in order) Kanto (24.0%), Chubu (17.7%), and Kansai (12.3%). In terms of job type, desk work (51.8%) accounted for the largest proportion, followed by work involving communicating with people (24.5%) and manual work (23.6%).
| n | (%) | |
|---|---|---|
| Sex | ||
|
|
7,666 | (57.1) |
|
|
5,753 | (42.9) |
| Age (years) | ||
|
|
614 | (4.6) |
|
|
2,044 | (15.2) |
|
|
4,212 | (31.4) |
|
|
5,039 | (37.6) |
|
|
1,510 | (11.3) |
| Geographical region of workplace | ||
|
|
358 | (2.7) |
|
|
1,180 | (8.8) |
|
|
3,224 | (24.0) |
|
|
2,371 | (17.7) |
|
|
1,649 | (12.3) |
|
|
1,588 | (11.8) |
|
|
1,072 | (8.0) |
|
|
1,977 | (14.7) |
| Job type | ||
|
|
6,956 | (51.8) |
|
|
3,293 | (24.5) |
|
|
3,170 | (23.6) |
| Company size (number of employees) | ||
|
|
3,205 | (23.9) |
|
|
2,045 | (15.2) |
|
|
4,566 | (34.0) |
|
|
3,603 | (26.8) |
Table 3 shows trends and gaps in the implementation rates of workplace measures against COVID-19 by company size during the 1-year study period (from T1 to T2). Companies with 1–9 employees significantly increased their implementation of all nine workplace measures against COVID-19 from T1 to T2 (rate of increase: 8.4%–16.1%, all P-values: <0.001). In companies with 10–49 employees, nearly all of the measures showed statistically significant increases (increase rate: 3.5%–10.5%, P-values: <0.001 to 0.004), except for restricting work-related social gatherings and entertainment (increase rate: 1.3%, P-value=0.292). Some measures showed a significant increase from T1 to T2 in companies with 50–999 employees and in those with 1,000 or more employees (i.e., installing partitions or changing the working environment and encouraging remote work in companies with 50–999 employees [all P-values <0.001]; installing partitions and changing the working environment for companies with ≥1,000 employees [all P-values <0.001]).
|
Company size (number of employees) |
December 2020 n (%) |
December 2021 n (%) |
T2–T1 % |
P-value for difference (McNemar) |
|
|---|---|---|---|---|---|
| Encouraging mask-wearing at work | 1–9 | 1,671 (52.1) | 2,010 (62.7) | +10.6 | <0.001 |
| 10–49 | 1,510 (73.8) | 1,583 (77.4) | +3.6 | <0.001 | |
| 50–999 | 3,963 (86.8) | 4,026 (88.2) | +1.4 | 0.019 | |
| ≥1000 | 3,278 (91.0) | 3,305 (91.7) | +0.7 | 0.217 | |
| P-value for trend | <0.001 | <0.001 | |||
| Requesting that employees refrain from going to work when ill | 1–9 | 1,479 (46.1) | 1,888 (58.9) | +12.8 | <0.001 |
| 10–49 | 1,423 (69.6) | 1,503 (73.5) | +3.9 | <0.001 | |
| 50–999 | 3,802 (83.3) | 3,856 (84.5) | +1.2 | 0.061 | |
| ≥1000 | 3,263 (90.6) | 3,273 (90.8) | +0.2 | 0.664 | |
| P-value for trend | <0.001 | <0.001 | |||
| Restricting work-related social gatherings and entertainment | 1–9 | 1,377 (43.0) | 1,749 (54.6) | +11.6 | <0.001 |
| 10–49 | 1,311 (64.1) | 1,337 (65.4) | +1.3 | 0.292 | |
| 50–999 | 3,601 (78.9) | 3,533 (77.4) | –1.5 | 0.033 | |
| ≥1000 | 3,189 (88.5) | 3,086 (85.7) | –2.8 | <0.001 | |
| P-value for trend | <0.001 | <0.001 | |||
| Enforcing temperature measurement | 1–9 | 1,012 (31.6) | 1,291 (40.3) | +8.7 | <0.001 |
| 10–49 | 1,120 (54.8) | 1,219 (59.6) | +4.8 | <0.001 | |
| 50–999 | 3,392 (74.3) | 3,457 (75.7) | +1.4 | 0.038 | |
| ≥1000 | 2,828 (78.5) | 2,886 (80.1) | +1.6 | 0.033 | |
| P-value for trend | <0.001 | <0.001 | |||
| Installing partitions or changing the working environment | 1–9 | 926 (28.9) | 1,351 (42.2) | +13.3 | <0.001 |
| 10–49 | 953 (46.6) | 1,168 (57.1) | +10.5 | <0.001 | |
| 50–999 | 3,029 (66.3) | 3,427 (75.1) | +8.8 | <0.001 | |
| ≥1000 | 2,838 (78.8) | 3,035 (84.2) | +5.4 | <0.001 | |
| P-value for trend | <0.001 | <0.001 | |||
| Restricting face-to-face meetings | 1–9 | 877 (27.4) | 1,260 (39.3) | +11.9 | <0.001 |
| 10–49 | 816 (39.9) | 887 (43.4) | +3.5 | 0.004 | |
| 50–999 | 2,817 (61.7) | 2,772 (60.7) | –1.0 | 0.230 | |
| ≥1000 | 2,709 (75.2) | 2,606 (72.3) | –2.9 | 0.001 | |
| P-value for trend | <0.001 | <0.001 | |||
| Stopping business trips | 1–9 | 853 (26.6) | 1,367 (42.7) | +16.1 | <0.001 |
| 10–49 | 851 (41.6) | 1,007 (49.2) | +7.6 | <0.001 | |
| 50–999 | 2,869 (62.8) | 2,862 (62.7) | –0.1 | 0.870 | |
| ≥1000 | 2,710 (75.2) | 2,675 (74.2) | –1.0 | 0.259 | |
| P-value for trend | <0.001 | <0.001 | |||
| Conducting health screenings for visitors | 1–9 | 734 (22.9) | 1,177 (36.7) | +13.8 | <0.001 |
| 10–49 | 675 (33.0) | 830 (40.6) | +7.6 | <0.001 | |
| 50–999 | 2,449 (53.6) | 2,511 (55.0) | +1.4 | 0.098 | |
| ≥1000 | 2,173 (60.3) | 2,195 (60.9) | +0.6 | <0.517 | |
| P-value for trend | <0.001 | <0.001 | |||
| Encouraging remote working | 1–9 | 624 (19.5) | 895 (27.9) | +8.4 | <0.001 |
| 10–49 | 299 (14.6) | 406 (19.9) | +5.3 | <0.001 | |
| 50–999 | 1,251 (27.4) | 1,392 (30.5) | +3.1 | <0.001 | |
| ≥1000 | 1,802 (50.0) | 1,854 (51.5) | +1.5 | 0.071 | |
| P-value for trend | <0.001 | <0.001 |
The implementation rates in restricting work-related social gatherings and entertainment, restricting face-to-face meetings, and stopping business trips decreased in companies with 50–999 employees and ≥1,000 employees (rate of decrease: –0.1% to –2.9%). Decreases were also statistically significant for restricting work-related social gatherings and entertainment in companies with 50–999 employees (P-value=0.033) and for restricting work-related social gatherings and entertainment (P-value <0.001) and restricting face-to-face meetings (P-value=0.001) in companies with ≥1,000 employees.
The gap in the implementation rate of workplace measures between companies with more than 50 employees and those with fewer than 49 employees narrowed over the 1 year between T1 and T2 (differential rate: T1: 7.9%–49.9%; T2: 2.6%–42.0%). We identified a gap of at least 10% (the minimum gap rate was 10.8% between companies with 10–49 employees and those with 50-999 employees in terms of encouraging mask-wearing at work), except for encouraging remote work (the minimum gap rate was 2.6% between companies with 1–9 employees and those with 50–999 employees).
The implementation rate was lowest for encouraging remote work (range: 27.9%–51.5%) in comparison with the other eight workplace measures.
The present study provided insight into trends in the implementation rates of workplace countermeasures against COVID-19 in companies of various sizes in Japan during the 1-year period from December 2020 to December 2021. We found increases in the implementation rate of nearly all of the measures during this period. Especially in companies with 1-9 employees and 10-49 employees, the implementation rates increased for all nine workplace measures. In contrast, the implementation rates of some workplace measures decreased in companies with 50–999 employees and ≥1,000 employees. Another important finding is that a large gap remained between larger companies (more than 50 employees) and smaller companies (fewer than 50 employees), although the gap narrowed over time. We also found that encouraging remote work was not implemented as frequently as the other measures.
In this study, a statistically significant increase in the implementation rate of nearly all workplace measures was observed in companies with 49 or fewer employees during the 1-year study period. This trend is considered a result of the accumulation of evidence for the effectiveness of the prevention measures against COVID-19 since the third wave [18] and the Japanese government’s support policies for SMEs [7]. This trend is similar to those observed in a study that investigated trends in workplace measures by company size [8]. However, it may not be possible to maintain workplace measures sufficiently with prolonged duration of the COVID-19 pandemic. A study conducted in the United States reported that people’s adherence to nonpharmacological interventions decreased as the pandemic became more prolonged [19]. Another study investigating longitudinal changes in the implementation of workplace measures against COVID-19 from March to August 2020 in Japan found that workplace measures were well implemented during the early stages of the outbreak but diminished after the second wave [20]. Government-centered support is still important to ensure the continuous implementation of workplace measures against COVID-19, especially for SMEs, which are vulnerable to the economic burden caused by the ongoing COVID-19 pandemic [5].
This study showed that the gap between companies in the implementation rates of workplace measures against COVID-19 remained significant, although it did narrow. This implies that SMEs are struggling with promoting the implementation of these measures. This result is consistent with previous studies conducted around the time of the declaration of the first state of emergency and during the third wave [8, 9]. The implementation rate of workplace measures in SMEs has improved since the declaration of the first emergency, but the gap between the implementation rate in large companies has remained significant. In Japan, occupational health staffing requirements depend on the number of employees in a workplace; large companies with more than 1,000 employees (or more than 500 in the case of hazardous workplaces) must employ at least one full-time occupational physician, whereas companies with fewer than 50 employees are not obligated either to employ an occupational physician nor to organize a health committee [4]. The occupational health service center plays a role in supporting SMEs (especially those with fewer than 50 employees). It has been pointed out that it is difficult to provide systematic support for SMEs, which account for approximately 96% of all companies in Japan [21]. According to a survey report in Japan [22], SMEs in need of support had low recognition of the occupational health service center, with 48.8% to 61.9% of SMEs not even knowing the name of the center. SMEs need government-centered financial assistance and provision of information regarding the available services.
A further finding of this study was the relatively low implementation rate of encouraging remote work compared with that of the other workplace measures. Remote work implementation in this study had nearly the same tendency as that in studies conducted before and after the first emergency declaration and during the third wave [8, 9]. This could be due to several factors, including the nature of work, technological challenges, productivity concerns, employee preferences, compliance and security issues, and cultural factors. A cohort study investigating the effects of remote work on job stress suggested that job stress levels varied with the frequency of engaging in remote work. High-frequency remote workers may experience more job stress due to having less support from supervisors and coworkers and less social support than non-remote workers. Medium- and low-frequency remote workers may experience less job stress due to having more control over their work than non-remote workers [23]. Despite the proven effectiveness of remote work in reducing the spread of COVID-19 [24], the above problems highlight that remote work is not a uniformly implemented measure, and implementing remote work should be considered according to each company’s specific circumstances.
Our study has several limitations. First, we did not consider confounding factors such as occupation-specific factors or the feasibility of implementing specific measures in different work environments. It is possible that the implementation rate of workplace measures is more heavily influenced by job type or work environment than company size. Even if such a possibility exists, we believe it is also important to overview the rates of insufficient implementation of workplace measures in SMEs in situations involving these confounding factors.
Second, the participants in this study are not representative of Japanese companies because they were monitors of an Internet survey company. To deal with this limitation, we conducted cluster sampling, stratifying participants based on sex, geographic region, and job type.
Third, the study data were collected using a self-report questionnaire completed by employees, which may have yielded results that differ from the actual conditions of the included companies. It is also possible that the increase in implementation rates of workplace measures was a result of increased awareness of individual measures rather than of workplace measures, owing to participants experiencing repeated waves of the COVID-19 pandemic. In this regard, we consider that it is also important to review the implementation of workplace measures against COVID-19 based on employees’ actual responses.
Fourth, this study examined the implementation of COVID-19 prevention measures at two points within 1 year. As such, we could not capture short-term changes in COVID-19 infection rates or dynamic changes in workplace practices that may have been direct responses to specific administrative guidance. Future studies would benefit from more frequent data collection to more accurately assess the impact of these external factors on workplace safety practices.
This study revealed trends in the implementation rate of workplace measures against COVID-19 in Japan by company size during the year following the third wave of the pandemic. The results indicated that SMEs made progress in implementing workplace measures against COVID-19, but gaps remained between them and the implementation rates in larger companies. Larger companies should be encouraged to share good practices and to assist companies in their supply chains to effectively support workplace measures in SMEs. Additionally, policymakers should provide financial support to SMEs and occupational health service centers. It is suggested that government-centered financial assistance and provision of information regarding available services are necessary for SMEs to effectively implement workplace measures against COVID-19.
This work was supported and partly funded by research grants from the University of Occupational and Environmental Health, Japan (no grant number); the Japanese Ministry of Health, Labour and Welfare (H30-josei-ippan-002, H30-roudou-ippan-007, 19JA1004, 20JA1006, 210301-1, and 20HB1004); Anshin Zaidan (no grant number); the Collabo-Health Study Group (no grant number); Hitachi Systems, Ltd. (no grant number); and scholarship donations from Chugai Pharmaceutical Co., Ltd. (no grant number). The funders were not involved in the study design; the collection, analysis, and interpretation of data; the writing of this paper; or the decision to submit the paper for publication.
The current members of the CORoNaWork Project, in alphabetical order, are: Dr. Akira Ogami, Dr. Ayako Hino, Dr. Hajime Ando, Dr. Hisashi Eguchi, Dr. Keiji Muramatsu, Dr. Koji Mori, Dr. Kosuke Mafune, Dr. Makoto Okawara, Dr. Mami Kuwamura, Dr. Mayumi Tsuji, Dr. Ryutaro Matsugaki, Dr. Seiichiro Tateishi, Dr. Shinya Matsuda, Dr. Tomohiro Ishimaru, Dr. Tomohisa Nagata, Dr. Yoshihisa Fujino (present chairperson of the study group), and Dr. Yu Igarashi. All members are affiliated with the University of Occupational and Environmental Health, Japan.
None declared.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
