ABSTRACT

Objective

To collect the available evidence related to occupational health in the face of the introduction of the new SARS-CoV-2 coronavirus pandemic.

Methods

Scoping review developed from the Arksey and O'Malley framework. The search was performed in the databases PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science and Google Scholar. Documents on COVID-19 and its relationship with occupational health published in English, Portuguese and Spanish were included. The review, selection and characterization of the studies was carried out by five reviewers.

Results

The search and selection identified 43 documents published between December 2019 and April 2020. The topics covered include occupational exposure, protection measures, psychosocial affectations of workers, particularly health, as well as conditions of work organization that can influence contagion.

Conclusions

Health workers are the most exposed workforce. Accompaniment, coaching and training in relation to patient care and the use of personal protection equipment are essential to reduce contagion among health personnel. In other work activities, social distancing is the standard measure for the mitigation of transmission, as well as the continuous disinfection of workplaces.

Key Words:
COVID-19; occupational health; coronavirus; health personnel; occupational exposure (source: MeSH, NLM)

RESUMEN

Objetivo

Recopilar la evidencia disponible relacionada con la salud laboral frente a la introducción de la nueva pandemia por el coronavirus SARS-CoV-2.

Métodos

Revisión exploratoria desarrollada a partir del marco de Arksey y O'Malley. La búsqueda se realizó en las bases de datos PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science y Google Scholar. Se incluyeron documentos sobre COVID-19 y su relación con la salud ocupacional publicados en inglés, portugués y español. La revisión, selección y caracterización de los estudios fue desarrollada por cinco revisores.

Resultados

La búsqueda y selección identificó 43 documentos publicados entre diciembre de 2019 y abril de 2020. Las temáticas abordadas incluyen exposición ocupacional, medidas de protección, afectaciones psicosociales de los trabajadores, particularmente de la salud, así como condiciones de la organización del trabajo que pueden influir en el contagio.

Conclusiones

Los trabajadores de la salud son la fuerza laboral más expuesta. El acompañamiento, entrenamiento y la capacitación en relación con la atención de pacientes y el uso de elementos de protección personal son fundamentales para disminuir el contagio entre personal de salud. En otras actividades laborales el distanciamiento social es la medida estándar para la mitigación de la transmisión, así como la desinfección continua de los lugares de trabajo.

Palabras Clave:
Infecciones por coronavirus; salud laboral; síndrome respiratorio agudo grave; personal de salud; exposición profesional (fuente: DeCS, BIREME)

The SARS-CoV-2 pandemic poses significant challenges for public health in general and for occupational health in particular ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... . The most widely used measure to avoid a rapid spread is social distancing ²2. Hicks MJ, Faulk D, Devaraj S. Occupational Exposure to Social Distancing: A Preliminary Analysis using O*NET Data. Ball State University. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/ndxg7bz .
https://cutt.ly/ndxg7bz... , nonetheless, a wide range of jobs involve direct contact or physical proximity between people. Some occupations can be carried out at home, which significantly reduces the number of contacts ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... . Health workers who provide general health care to sick individuals in hospitals and clinics are at increased risk of exposure to SARS-CoV-2. However, not only health workers can be affected, estimates indicate that between 40% and 70% of the world population could be infected ³3. Baldwin R, Mauro BW (eds.). Economics in the Time of COVID-19. London. CEPR Press Centre for Economic Policy Research [Internet]. CEPR Press; 2020 [cited 2020 May 20]. Available from: Available from: https://bit.ly/3363PLZ .
https://bit.ly/3363PLZ... .

The international emergency caused by the coronavirus outbreak poses enormous challenges to the first res-ponders and health workers in the face of the pandemic ⁴4. Gallasch CH, da Cunha ML, de Souza Pereira LA, Silva-Junior JS. Prevenção relacionada à exposição ocupacional do profissional de saúde no cenário de COVID-19. Rev Enferm. UERJ. 2020; 28(2020). DOI:10.12957/reuerj.2020.49596.
https://doi.org/10.12957/reuerj.2020.495... . Protecting health and establishing safety conditions for these workers is essential, as is maintaining the greatest amount of human resources available to guarantee the continuity of health service provision in the midst of an emergency ⁵5. World Health Organization. Occupational safety and health in public health emergencies: a manual for protecting health workers and responders. Geneva: International Labour Office World Health Organization; 2018..

The International Labor Organization (ILO) has also proposed protecting workers. Its proposals include actions aimed at improving safety and health measures at work, promoting flexible forms of employment that include telework, preventing discrimination and exclusion of workers ⁶6. Fadel M, Salomon J, Descatha A. Coronavirus outbreak: the role of companies in preparedness and responses. Lancet Public Heal. 2020; 5(4):e193. DOI:10.1016/S2468-2667(20)30051-7.
https://doi.org/10.1016/S2468-2667(20)30... , ensure universal access to health for all, as well as expand access to benefits and sick leave ⁷7. International Labour Organization ILO. COVID-19 and world of work: impacts and responses. International Labour Organization ILO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/5dxcR4v .
https://cutt.ly/5dxcR4v... .

METHODS

Methodological framework

The protocol for the development of the scoping review is taken from what is proposed by Arksey & O'Malley. Five steps are proposed for the development of this review: (I) definition of the question to be answered; (II) identification of studies; (III) selection of studies; (IV) charting the data; and, (V) synthesis of the information collected and its dissemination ⁸8. Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Methodol Theory Pract. 2005; 8(1):19-32. DOI: 10.1080/1364557032000119616.
https://doi.org/10.1080/1364557032000119... .

Research question

This review was conducted on the question: What aspects of occupational safety and health have been addressed in the context of the health emergency generated by COVID-19? The review seeks to synthesize the published literature on occupational health and its relationship with this disease.

Search strategy and sources

The search strategy was developed from the use of key terms: "industrial safety" OR "industrial hygiene" OR "occupational exposure" OR "occupational hazard" OR "occupational risk" OR "occupational safety" OR "occupational health" linked by the Boolean "AND" connector to the terms "COVID" OR "SARS-CoV-2" OR "novel coronavirus" OR "COVID-19" OR "severe acute respiratory syndrome coronavirus 2".

Searches were carried out in the databases: PubMed, Academic Search Complete, Science Direct, Medline, Scopus, Web of Science; additionally, a Google Scholar search was included with the terms in English, including the first 60 results ordered by relevance; a search with the terms in Spanish was carried out in this last source, including the 13 results obtained. More documents were obtained from other sources such as ILO, WHO, PAHO, and the snowball searching strategy was used in the references of the analyzed articles.

Citation management

The selected documents were imported to the bibliographic administrator Mendeley; duplicate citations were removed using the bibliographic manager tool. Other repeated citations were manually removed.

Selection criteria

The search was limited to the period 12/01/2019 until 04/09/2020. As inclusion criteria, the documents (articles, reports, letters to the editor, editorials, opinions and case reports) that addressed aspects related to occupational safety and health at the time of COVID-19 written in English, Spanish and Portuguese were considered; and as exclusion criteria articles that did not record simultaneous interaction of the two events.

Relevance of title and abstract

Each researcher independently reviewed the titles and abstracts of potentially eligible articles; letters, editorials and comments were reviewed in full text. The initial evaluation was carried out by three reviewers to exclude those articles that did not meet the inclusion criteria. A template was created in Excel MS where all the preliminary titles and summaries were related. To guarantee the reliability of the process, it was decided by consensus to select the articles that obtained three agreements. The Fleiss kappa calculation was performed using Excel MS and a value of 0.71 was obtained for the group of evaluators, considering it good according to Altman's interpretation ⁹9. Altman D. Practical Statistics for Medical Research. New York. CRC; 1997..

Data analysis, summary, and synthesis of information

Once the relevant citations were obtained after the title and abstract screening stage, 43 complete articles were obtained for a thorough review. At this stage, five reviewers established the relevance of the information, through the complete reading of the documents, none were excluded at this stage. The data was compiled into Word MS files for summarization in the emerging categories.

RESULTS

A total of 120 documents were identified from the search. They were imported into Mendeley and the duplicate files were removed resulting in 102 unique documents. After reading the title and abstract, 5g articles that did not meet the inclusion criteria or did not provide an answer to the asked question were discarded. Read in full text, none were excluded. The final review was made from 43 articles (Figure 1).

Occupational Health and COVID-19

Occupational exposure to SARS-CoV-2, while posing enormous challenges for multiple workers, pays special attention to healthcare workers. The review presented accounts for conditions and factors present in health workers especially, although it also includes brief aspects on other work activities.

Health Workers

Occupational exposure to SARS-C0V-2

Health workers are the first line of defense against SARS-CoV-2 and at the same time they are considered the highest risk occupational group ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... ^,1010. Petersen E, Hui D, Hamer DH, Blumberg L, Madoff LC, Pollack M, et al. Li Wenliang, a face to the frontline healthcare worker. The first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak. Int J Infect Dis. 2020; 93:205-7. DOI:10.1016/j.ijid.2020.02.052.
https://doi.org/10.1016/j.ijid.2020.02.0...

11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7.

12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656...

13. Cuervo WB, Penagos JXV, Tolosa CM, Ortiz KAG. Lineamientos y estrategia de la consulta externa y ámbito hospitalario para el otorrinolaringólogo en tiempos de COVID-19. Acta otorrinolaringol cir cabeza cuello. 2020 [cited 2020 Sept 26]:17-24. Available from: Available from: https://bit.ly/308ZJAU .
https://bit.ly/308ZJAU... ^-1414. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health [Internet]. Geneva: WHO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/ydxnTd8 .
https://cutt.ly/ydxnTd8... . For example, activities related to chest kinesiotherapy maneuvers, inhalation therapy, cardiopulmonary resuscitation techniques with manual and mechanical ventilation; as well as bronchial hygiene through medical devices such as tracheal gold tubes and tracheotomies, pose a high risk of contagion ¹⁵15. Cheung JC-H, Ho LT, Cheng JV, Cham EYK, Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med. 2020; 8(4):e19. DOI:10.1016/S2213-2600(20)30084-9.
https://doi.org/10.1016/S2213-2600(20)30... ^,1616. Organización Panamericana de la Salud / Organización Mundial de la Salud. Guía para el cuidado crítico de pacientes adultos graves con coronavirus (COVID-19) En Las Américas [Internet]. Washington DC, Geneva: OPS, WHO; 2020 [cited 2020 May 12] Available from: Available from: https://cutt.ly/2dxmluw .
https://cutt.ly/2dxmluw... . Aerosols produced during these maneuvers are also potentially dangerous for anesthesiologists ¹⁷17. Bowdle A, Munoz-Price LS. Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Corona-virus Epidemics. Anesthesiology. 2020; 6(132):1292-5. DOI:10.1097/ALN.0000000000003295.
https://doi.org/10.1097/ALN.000000000000... ^,1818. Suresh V. The 2019 novel corona virus outbreak - An institutional guideline. Indian J Anaesth. 2020; 64(3):242-3. DOI:10.4103/ija.IJA_104_20.
https://doi.org/10.4103/ija.IJA_104_20... .

Some procedures performed by otolaryngologists involve direct contact with the mucosa of the respiratory tract, and basic examination of the airways can induce coughing or sneezing in patients, which increases the possibility of SARS-CoV-2 infection by microdroplet inhalation.

Ophthalmologists are also at high risk due to direct and prolonged contact with patients. Although infection through the eye is still uncertain, ocular transmission of the virus may be likely given the presence of ACE2 receptors on the ocular surface and the ability of the virus to transport itself through the nasolacrimal ducts to the inferior meatus of the nose (13,19), therefore the use of eye protection is required for health workers in close contact with patients diagnosed with COVID-19 ²⁰20. Li J-P, Chen Y, Wei D, Chiu D. Novel Coronavirus disease 2019 (CO-VID-19): The importance of recognising possible early ocular manifestation and using protective eyewear. Bristish J Ophthalmol. 2020; 104(3):297-8. DOI:10.1136/bjophthalmol-2020-315994.
https://doi.org/10.1136/bjophthalmol-202... .

Another occupational group whose work involves direct contact with patients, and because of this they have high vulnerability to COVID-1g, are nursing professionals. Therefore, it becomes pertinent to establish specific protocols for the reduction and control of infection during contact with confirmed or suspected patients ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7..

Although WHO focused its initial strategy on managing person-to-person transmission of the virus, it later recognized that fomites also played an important role in the spread of SARS-CoV-2, particularly in the hospital setting; however, transmission via this route was unknown and initially underestimated ²¹21. Yen M-Y, Schwartz J, Chen S-Y, King C-C, Yang G-Y, Hsueh P-R. Interrupting COVID-19 transmission by implementing enhanced traffic control bundling: Implications for global prevention and control efforts. J Microbiol Immunol Infect. 2020; 53(3):377-80. DOI:10.1016/j.jmii.2020.03.011.
https://doi.org/10.1016/j.jmii.2020.03.0... .

COVID-19 in health workers

Since January 2020 in China, different institutions reported numbers of infections among health personnel. According to local reports from China, at the end of February, 22 health workers had died, and according to figures from the National Health Commission, in March more than 3,300 had been infected with COVID-1g. This evidence indicated that 4% of the infections corresponded to health service workers ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7.^,2222. Gan WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers. Saf Health Work. 2020; 11(2):241-43. DOI:10.1016/j.shaw.2020.03.001.
https://doi.org/10.1016/j.shaw.2020.03.0...

23. Lancet T. COVID-19: protecting health-care workers. Lancet. 2020; 395(10228):922. DOI:10.1016/S0140-6736(20)30644-9.
https://doi.org/10.1016/S0140-6736(20)30... ^-2424. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020; 323 (15): 1439-40. DOI: 10.1001/jama.2020.3972.
https://doi.org/10.1001/jama.2020.3972... . Furthermore, the increase in the number of cases in this occupational sector revealed the real magnitude of the pandemic and the initial difficulty in understanding the dynamics of the virus, which was exemplified in the Chinese Province of Hubei, in which the outbreak arose, and where 88% of the cases of infected health professionals were located ²⁵25. Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020; 14:229-31. DOI:10.1007/s11684-020-0765-x.
https://doi.org/10.1007/s11684-020-0765-... .

In turn, Italy recorded that 20% of health workers had been infected ²³23. Lancet T. COVID-19: protecting health-care workers. Lancet. 2020; 395(10228):922. DOI:10.1016/S0140-6736(20)30644-9.
https://doi.org/10.1016/S0140-6736(20)30... . In this country, initial reports indicated that more than 5,000 health workers were positive for coronavirus, and about 40 workers had died in the first weeks of the outbreak ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... .

Regarding Colombia, on April 11, 2020, the first death of a doctor by COVID-1g was confirmed ²⁶26. El Espectador. Fallece médico de urgencias en Bogotá por coronavirus [Internet]. Bogotá: El Espectador; 2020 [cited 2020 May 12]. Available from: Available from: https://n9.cl/q4zu .
https://n9.cl/q4zu... . As of April 28, a total of 5g4g cases and 26g deaths in the general population was confirmed. The percentage of infected health workers compared to the general population was 7.0% ²⁷27. Instituto Nacional de Salud. COVID-19 en Colombia [Internet]. Bogotá: Instituto Nacional de Salud; 2020 [cited 2020 May 12]. Available from: Available from: https://bit.ly/336ylp6 .
https://bit.ly/336ylp6... .

Psychosocial factors and health workers

Psychosocial factors are highly important in the context of the COVID-1g crisis. In China, as the number of infections increased, panic grew in the population, the capacity of the clinics overflowed, and this situation prevented some confirmed or suspected patients from receiving timely treatment. Circumstances as such, caused that the health personnel in Wuhan hospitals manifested psychological problems, and that the risk of SARS-CoV-2 infection could cause high psychosocial stress in medical personnel ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7.^,1212. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... .

The pressure on the health system implies that its workers require attention given the high levels of stress they may face ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... . Likewise, the psychological response of health workers is of great importance regarding the defense effect against the epidemic.

Stress and fatigue in medical personnel is caused by long working hours, linked to strenuous demands prompted by a constantly changing practice scenario ²⁸28. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020; 323(21):2133-34. DOI:10.1001/jama.2020.5893.
https://doi.org/10.1001/jama.2020.5893... . Aspects that affect workers' mental health were identified in a representative sample of health professionals in China, such as symptoms of depression, anguish, insomnia and anxiety ²⁹29. Greenberg N, Docherty M, Gnanapragasam S, Wessely S. Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 2020; 368:m1211. DOI:10.1136/bmj.m1211.
https://doi.org/10.1136/bmj.m1211... ^,3030. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA. Netw Open. 2020; 3(3):e203976. DOI:10.1001/jamanetworkopen.2020.3976.
https://doi.org/10.1001/jamanetworkopen.... . In these circumstances, it is the duty of employers to inform workers of changes in the guidelines and practices of patient care, to reduce their anxiety ²⁸28. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020; 323(21):2133-34. DOI:10.1001/jama.2020.5893.
https://doi.org/10.1001/jama.2020.5893... .

Regarding the PPE, these generate tension in two forms. On one hand, not having good protection supplies is a source of stress in health workers ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... ^,2828. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020; 323(21):2133-34. DOI:10.1001/jama.2020.5893.
https://doi.org/10.1001/jama.2020.5893... . Another source of tension related to PPE is derived from the regular procedures to put on and take off those elements, a situation that generates constant fear in workers ²²22. Gan WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers. Saf Health Work. 2020; 11(2):241-43. DOI:10.1016/j.shaw.2020.03.001.
https://doi.org/10.1016/j.shaw.2020.03.0... .

On the other hand, ethical dilemmas in the midst of care are also important for health workers. Workers are under an ever-increasing workload, high risk of occupational exposure, moral dilemmas, and other emotional factors ²⁸28. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020; 323(21):2133-34. DOI:10.1001/jama.2020.5893.
https://doi.org/10.1001/jama.2020.5893... . Surveys for health workers have revealed the presence of physical and mental exhaustion in healthcare personnel, as well as high levels of anxiety when they have to make difficult decisions at the time of triage, when they face the pain of losing a colleague or a patient ²⁸28. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020; 323(21):2133-34. DOI:10.1001/jama.2020.5893.
https://doi.org/10.1001/jama.2020.5893... , or for fear of passing the infection on to their own family ²³23. Lancet T. COVID-19: protecting health-care workers. Lancet. 2020; 395(10228):922. DOI:10.1016/S0140-6736(20)30644-9.
https://doi.org/10.1016/S0140-6736(20)30... .

An additional factor is violence on and off the job, which is a concern for health workers ²⁸28. Shanafelt T, Ripp J, Trockel M. Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic. JAMA. 2020; 323(21):2133-34. DOI:10.1001/jama.2020.5893.
https://doi.org/10.1001/jama.2020.5893... . Cases of violence against workers have been reported due to the anxiety and tension of the population, and in Latin America, most of the attacks reported have been directed at female nurses on the streets ³¹31. Orellana CI. Health workers as hate crimes targets during co-viD-19 outbreak in the Americas. Rev. Salud Pública (Bogotá) 2020; 22(2):e386766-e386766. DOI:10.15446/rsap.v22n2.86766.
https://doi.org/10.15446/rsap.v22n2.8676... . These workers have been subjected to rejection and harassment by the population ³²32. Koh D. Occupational risks for COVID-19 infection. Occup Med (Lond). 2020:70(1):3-5. DOI:10.1093/occmed/kqaa036.
https://doi.org/10.1093/occmed/kqaa036... .

However, even though there has been evidence of stig-matization and rejection of health workers for fear of contagion, it is pertinent to highlight some actions by society. The community has also shown appreciation and admiration for health workers, to the point of being hailed as heroes in the fight against the disease ³³33. George R, George A. Prevention of COVID-19 in the workplace. South African Med J. 2020 [cited 2020 May 20]; 110(4):269. https://bit.ly/2Ge4VvU.
https://bit.ly/2Ge4VvU... .

Faced with the emotional and psychosocial demands of health workers, institutions must process their consequences ⁶6. Fadel M, Salomon J, Descatha A. Coronavirus outbreak: the role of companies in preparedness and responses. Lancet Public Heal. 2020; 5(4):e193. DOI:10.1016/S2468-2667(20)30051-7.
https://doi.org/10.1016/S2468-2667(20)30... . Health effects such as insomnia, exhaustion, depression, stigma, physical violence, and post-traumatic stress must be addressed ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... ^,1414. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health [Internet]. Geneva: WHO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/ydxnTd8 .
https://cutt.ly/ydxnTd8... . For example, members of the National Nurses United, expressed that workers who received frequent, updated and evidence-based information indicated less anxiety concerning their own health and that of their relatives and close ones ³⁴34. Mason DJ, Friese CR. Protecting Health Care Workers Against CO-VID-19 and Being Prepared for Future Pandemics. JAMA Heal Forum. 2020; 1(3):e200353. DOI:10.1001/jama.2020.18432.
https://doi.org/10.1001/jama.2020.18432... .

Work organization

Health workers can face long working hours amid the outbreak crisis ²⁵25. Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020; 14:229-31. DOI:10.1007/s11684-020-0765-x.
https://doi.org/10.1007/s11684-020-0765-... . Maintaining adequate work and rest schedules is important ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7.^,1414. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health [Internet]. Geneva: WHO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/ydxnTd8 .
https://cutt.ly/ydxnTd8... . The extension of the day has been associated with an increase in the risk of contagion in health personnel ²⁵25. Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020; 14:229-31. DOI:10.1007/s11684-020-0765-x.
https://doi.org/10.1007/s11684-020-0765-... ^,3535. Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk Factors of Healthcare Workers with Corona Virus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China. Clin Infect Dis. 2020:ciaa287. DOI:10.1093/cid/ciaa287.
https://doi.org/10.1093/cid/ciaa287... . Therefore, establishing schedules in the workplace can be essential to preserve human talent in health, in addition to rationalizing equipment, PPE, and reducing the physical and mental burden on workers. Continuous uninterrupted six-hour shifts can lead to pressure of physiological limits, being unable to go to the bathroom when using PPE in the isolation area ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7..

Shift work and overlapping 1 hour allows, among other things, nurses to support each other in tasks that would require assistance, such as taking blood samples and giving injections to children, changing sheets or disinfect the terminal rooms ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7..

Prevention and protection of health workers

The prevention measures to be adopted in the workplace are focused on physical distance, which represents a challenge for work processes that require proximity ³³33. George R, George A. Prevention of COVID-19 in the workplace. South African Med J. 2020 [cited 2020 May 20]; 110(4):269. https://bit.ly/2Ge4VvU.
https://bit.ly/2Ge4VvU... . However, distancing is not the only mechanism to prevent contagion in the workplace.

Health centers have adopted measures such as limiting the number of access doors, establishing control points for taking temperature, reducing the number of patients per room, controlling the number of visits and restricting the number of times that patients leave the medical procedure room (1g). Furthermore, the infection control system should include actions such as: preparation and distribution of materials, training on infection prevention measures, as well as the reorganization of departments and rooms ³⁶36. Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect. 2020; 104(4):454-5. DOI:10.1016/j.jhin.2020.02.018.
https://doi.org/10.1016/j.jhin.2020.02.0... ^,3737. Secretaria de Atenção Primária à Saúde (SAPS). Procedimiento operacional padronizado. Equipamento de proteção individual e segurança no trabalho para profissionais de saúde da APS no atendimento às pessoas com suspeita o infecção pelo novo coronavírus (COVID-19). Secretaria de Atenção Primária à Saúde (SAPS). 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/KdxHSo9 .
https://cutt.ly/KdxHSo9... .

Disinfection of rooms and sterilization of equipment is also important ³⁸38. Yang Y, Wang H, Chen K, Zhou J, Deng S, Wang Y. Shelter hospital mode: how to prevent novel coronavirus infection 2019 (COVID-19) hospital-acquired infection? Infect Control Hosp Epidemiol. 2020; 41(7):872-3. DOI:10.1017/ice.2020.97.
https://doi.org/10.1017/ice.2020.97... . Studies indicate that SARS-CoV-2 can be destroyed by applying ethyl alcohol solutions with a concentration between 62% and 71%, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite ¹⁷17. Bowdle A, Munoz-Price LS. Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Corona-virus Epidemics. Anesthesiology. 2020; 6(132):1292-5. DOI:10.1097/ALN.0000000000003295.
https://doi.org/10.1097/ALN.000000000000... .

Amidst hospital settings, it is not possible to eliminate the source of transmission of the pathogen found in an infected person, therefore, the implementation of environmental controls becomes relevant. It is recommended that the facilities used have high-efficiency particulate air filters (HEPA), with negative pressure, and that the equipment have plastic covers to reduce the biological load on these surfaces ¹⁷17. Bowdle A, Munoz-Price LS. Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Corona-virus Epidemics. Anesthesiology. 2020; 6(132):1292-5. DOI:10.1097/ALN.0000000000003295.
https://doi.org/10.1097/ALN.000000000000... .

As additional measures, health institutions should adopt teleworking and telemedicine organizational strategies to reduce the attendance of patients with comorbidities in the care centers and avoid overloading the hospital network ¹³13. Cuervo WB, Penagos JXV, Tolosa CM, Ortiz KAG. Lineamientos y estrategia de la consulta externa y ámbito hospitalario para el otorrinolaringólogo en tiempos de COVID-19. Acta otorrinolaringol cir cabeza cuello. 2020 [cited 2020 Sept 26]:17-24. Available from: Available from: https://bit.ly/308ZJAU .
https://bit.ly/308ZJAU... ,²⁴24. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020; 323 (15): 1439-40. DOI: 10.1001/jama.2020.3972.
https://doi.org/10.1001/jama.2020.3972... ,³⁹39. Tsai C. Personal Risk and Societal Obligation Amidst COVID-19. JAMA. 2020; 323(16):1555-6. DOI:10.1001/jama.2020.5450.
https://doi.org/10.1001/jama.2020.5450... . The reduction in the number of appointments, as well as the rescheduling of these, makes it possible to reduce the chance of infection. Similarly, health workers over 65 years of age may suspend outpatient activities ³⁶36. Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect. 2020; 104(4):454-5. DOI:10.1016/j.jhin.2020.02.018.
https://doi.org/10.1016/j.jhin.2020.02.0... . Particular attention is required by pregnant health workers, although there is no evidence of greater susceptibility in them, there may be a risk of restriction in the growth of the fetus; as well as premature delivery if the mother becomes seriously ill ⁴⁰40. Rimmer A. COVID-19: pregnant doctors should speak to occupational health, say experts. BMJ. 2020; 368:m1104. DOI:10.1136/bmj.m1104.
https://doi.org/10.1136/bmj.m1104... .

Personal protection equipment

The PPE have become essential supplies in health care centers ⁴¹41. Del Rio C, Malani PN. COVID-19-new insights on a rapidly changing epidemic. JAMA. 2020; 323(14):1339-40. DOI:10.1001/jama.2020.3072.
https://doi.org/10.1001/jama.2020.3072... ^,4242. Balibrea JM, Badia JM, Pérez IR, Antona EM, Peña EÁ, Botella SG, et al. Manejo quirúrgico de pacientes con infección por COVID-19. Recomendaciones de la Asociación Española de Cirujanos. Cirugía Española. 2020; 98(5):251-9. DOI:10.1016/j.ciresp.2020.03.001.
https://doi.org/10.1016/j.ciresp.2020.03... . However, during the pandemic, a critical factor has to do with the shortage of PPE, even when medical personnel have priority ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... ^,2323. Lancet T. COVID-19: protecting health-care workers. Lancet. 2020; 395(10228):922. DOI:10.1016/S0140-6736(20)30644-9.
https://doi.org/10.1016/S0140-6736(20)30... ^,2525. Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020; 14:229-31. DOI:10.1007/s11684-020-0765-x.
https://doi.org/10.1007/s11684-020-0765-... . Healthcare personnel in many countries are waiting for protective equipment, even if they care for possibly infected patients, and in other cases, the protection elements they receive do not meet the expected requirements ²²22. Gan WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers. Saf Health Work. 2020; 11(2):241-43. DOI:10.1016/j.shaw.2020.03.001.
https://doi.org/10.1016/j.shaw.2020.03.0... . The shortage of PPE at the start of the outbreak in China increased the spread of the disease among visitors, patients and health personnel ²⁵25. Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020; 14:229-31. DOI:10.1007/s11684-020-0765-x.
https://doi.org/10.1007/s11684-020-0765-... .

The shortage has led to the development of processes that allow the useful life of Ng5 masks to be extended. This respiratory protection is key to the care of patients with COVID-1g; therefore, it is imperative to equip workers with them ⁴³43. Schwartz A, Stiegel M, Greeson N, Vogel A, Thomann W, Brown M, et al. Decontamination and Reuse of N95 Respirators with Hydrogen Peroxide Vapor to Address Worldwide Personal Protective Equipment Shortages During the SARS-CoV-2 (COVID-19) Pandemic. SAGE Publications. 2020; 25(2):67-70. DOI:10.1177/1535676020919932.
https://doi.org/10.1177/1535676020919932... .

On the other hand, training is essential as an administrative measure to avoid contagion ⁷7. International Labour Organization ILO. COVID-19 and world of work: impacts and responses. International Labour Organization ILO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/5dxcR4v .
https://cutt.ly/5dxcR4v... ^,2525. Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020; 14:229-31. DOI:10.1007/s11684-020-0765-x.
https://doi.org/10.1007/s11684-020-0765-... . Workers must receive ongoing training and education on the correct way to use, withdraw, and discard PPE ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7.^,1313. Cuervo WB, Penagos JXV, Tolosa CM, Ortiz KAG. Lineamientos y estrategia de la consulta externa y ámbito hospitalario para el otorrinolaringólogo en tiempos de COVID-19. Acta otorrinolaringol cir cabeza cuello. 2020 [cited 2020 Sept 26]:17-24. Available from: Available from: https://bit.ly/308ZJAU .
https://bit.ly/308ZJAU...

14. World Health Organization. Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health [Internet]. Geneva: WHO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/ydxnTd8 .
https://cutt.ly/ydxnTd8... ^-1515. Cheung JC-H, Ho LT, Cheng JV, Cham EYK, Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med. 2020; 8(4):e19. DOI:10.1016/S2213-2600(20)30084-9.
https://doi.org/10.1016/S2213-2600(20)30... .

Additionally, the proper use of PPE can be altered when health workers feel exhausted or stressed. Despite their training, they may not be fully aware of their exposure when caring for patients. Therefore, an observation of medical personnel can be made through a computer or monitor in a separate area, or directly verify the correct placement and removal of PPE ¹¹11. Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses' protection during the COVID-19 epidemic. Crit Care. 2020; 24(120). DOI:10.1186/s13054-020-2841-7..

COVID-19 and workers from other productive sectors

Although health workers pay special attention due to their level of exposure and the need to keep an indispensable active workforce for global heath, other sectors of the economy also require preventive measures when presenting occupational exposure to SARS-CoV-2 ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... .

In Thailand, the diagnosis of COVID-1g was reported in an exposed taxi driver when he transported a group of tourists from China ⁴⁴44. Pongpirul WA, Pongpirul K, Ratnarathon AC, Prasithsirikul W. Journey of a Thai Taxi Driver and Novel Coronavirus. N Engl J Med. 2020; 382(11):1067-8. DOI:10.1056/NEJMc2001621.
https://doi.org/10.1056/NEJMc2001621... . On February 11, 2020, the Singapore Ministry of Health confirmed 47 cases, of which 25 were transmitted locally. Of these 25, 17 were related to occupational exposure in tourism and hotel industry workers, construction workers, transportation, security and domestic workers ²2. Hicks MJ, Faulk D, Devaraj S. Occupational Exposure to Social Distancing: A Preliminary Analysis using O*NET Data. Ball State University. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/ndxg7bz .
https://cutt.ly/ndxg7bz... ^,3232. Koh D. Occupational risks for COVID-19 infection. Occup Med (Lond). 2020:70(1):3-5. DOI:10.1093/occmed/kqaa036.
https://doi.org/10.1093/occmed/kqaa036... . Cruise ship workers and flight crews are also exposed to the virus, as well as emergency responders such as firefighters and police ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... .

Migrant workers are in a particularly vulnerable condition, due to difficulties in accessing health services ³¹31. Orellana CI. Health workers as hate crimes targets during co-viD-19 outbreak in the Americas. Rev. Salud Pública (Bogotá) 2020; 22(2):e386766-e386766. DOI:10.15446/rsap.v22n2.86766.
https://doi.org/10.15446/rsap.v22n2.8676... , in addition to the loss of income associated with mandatory isolation measures imposed by governments ⁷7. International Labour Organization ILO. COVID-19 and world of work: impacts and responses. International Labour Organization ILO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/5dxcR4v .
https://cutt.ly/5dxcR4v... . Therefore, it is necessary to ratify the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, in the search for global equity in access to health, improving existing systems in the face of future pandemics and disasters ⁷7. International Labour Organization ILO. COVID-19 and world of work: impacts and responses. International Labour Organization ILO. 2020 [cited 2020 May 12]. Available from: Available from: https://cutt.ly/5dxcR4v .
https://cutt.ly/5dxcR4v... ^,4545. Liem A, Wang C, Wariyanti Y, Latkin CA, Hall BJ. The neglected health of international migrant workers in the COVID-19 epidemic. Lancet Psychiatry. 2020:7(4):e20..

Extra-labor factors and individual conditions in the workforce, from communities with multiple deprivations, high population density, generalized poverty, malnutrition, high prevalence of HIV and tuberculosis, as well as non-communicable underlying diseases (diabetes, high blood pressure, cardiovascular problems, chronic respiratory disease and cancer), potentiate the risk of spreading COVID-1g in the workplace ³³33. George R, George A. Prevention of COVID-19 in the workplace. South African Med J. 2020 [cited 2020 May 20]; 110(4):269. https://bit.ly/2Ge4VvU.
https://bit.ly/2Ge4VvU... .

Psychosocial factors, meanwhile, are not unaware to other workers. In Hong Kong, for example, after a mandatory 33-day isolation (January 8 th - March 2nd, 2020), during which more than 80% of organizations implemented measures such as work at home, stress levels in workers shot up in fear of infection as they resumed face-to-face work activities. In turn, prolonged telecommuting can lead to health problems due to lack of interaction with peers in the workplace ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... .

WHO established recommendations to deal with CO-VID-1g in the workplace; measures that should be considered before the economic reactivation on different countries after lifting the mandatory isolation or quarantine. Such measures include: frequent cleaning of workplaces, promotion of hand hygiene among workers and of a cough and sneeze label, teleworking or work at home, and the definition of an action plan when a positive case is presented in the workplace, which may include articulation with other employers in what constitutes a mutual aid plan ⁴⁶46. World Health Organization. Getting your workplace ready for CO-VID-19: How COVID-19 spreads. Geneva: WHO ; 2020.^,4747. Ramesh N, Siddaiah A, Joseph B. Tackling corona virus disease 2019 (COVID 19) in workplaces. Indian JOccup Environ Med . 2020; 24(1):16-18. DOI:10.4103/ijoem.IJOEM_49_20.
https://doi.org/10.4103/ijoem.IJOEM_49_2... .

In turn, the response of employers in the sectors of the economy that continue to function or that are reactivating must be based on three principles: i) the moral duty to provide workspaces that do not affect mental health, safety and the well-being of its workers, Ii) maintaining the well-being of workers is essential to ensure business continuity, productivity and thus its sustainability and profitability, and Iii) the legal obligation to control the hazards present in the workplace, which includes biological agents such as the new coronavirus ³³33. George R, George A. Prevention of COVID-19 in the workplace. South African Med J. 2020 [cited 2020 May 20]; 110(4):269. https://bit.ly/2Ge4VvU.
https://bit.ly/2Ge4VvU... .

The resumption of office work and the social activities inherent in these, without clear guidelines from national governments and responsible measures, may create a threat to a second wave of COVID-1g worldwide. Therefore, safety and health in the workplace and tripartite involvement (governments, employers and workers) is the key to long-term success in containing the pandemic.

Business preparation for COVID-1g should also focus on emergency response, since public and private entities must continue their production processes or provide their services; therefore, there must be an integration of the companies together with the governmental health contingency plan following the guidelines of the WHO and the ILO. Likewise, it is essential that all health professionals, including occupational health and safety professionals, participate in the development and implementation of recommendations for companies and their environments ⁶6. Fadel M, Salomon J, Descatha A. Coronavirus outbreak: the role of companies in preparedness and responses. Lancet Public Heal. 2020; 5(4):e193. DOI:10.1016/S2468-2667(20)30051-7.
https://doi.org/10.1016/S2468-2667(20)30... ^,4848. Baker MG, Peckham TK, Seixas NS. Estimating the burden of United States workers exposed to infection or disease: A key factor in containing risk of COVID-19 infection. PLoS One. 2020; 15(4). DOI:10.1371/journal.pone.0232452.
https://doi.org/10.1371/journal.pone.023... . The companies' occupational health team must carry out training on disease prevention, good hygiene practices, food provisioning, rest periods and report on family and psychological support ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... ^,2222. Gan WH, Lim JW, Koh D. Preventing intra-hospital infection and transmission of COVID-19 in healthcare workers. Saf Health Work. 2020; 11(2):241-43. DOI:10.1016/j.shaw.2020.03.001.
https://doi.org/10.1016/j.shaw.2020.03.0... .

DISCUSSION

The literature review showed an important interest in recording, in particular, the exposure and effects on health for health personnel. However, other groups of workers were also mentioned, albeit with little depth. The COVID-1g pandemic will have short and long-term effects on society, health systems, workplaces and people ¹1. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020, 46(3):229-30. DOI:10.5271/sjweh.3893.
https://doi.org/10.5271/sjweh.3893... . This essentially means thinking about new approaches to safety and health at work and a strengthening of the importance and need for proper management that protects the health and life of individuals.

COVID-19 may be the first new occupational disease described in this decade. This will imply challenges for occupational safety and health in the medium and long term, not only for workers in the health sector but for a large number of occupations ³²32. Koh D. Occupational risks for COVID-19 infection. Occup Med (Lond). 2020:70(1):3-5. DOI:10.1093/occmed/kqaa036.
https://doi.org/10.1093/occmed/kqaa036... . The effect of the pandemic on the workforce will continue to intensify and impact the global health system and the health of health personnel due to the risk of infection ²⁴24. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020; 323 (15): 1439-40. DOI: 10.1001/jama.2020.3972.
https://doi.org/10.1001/jama.2020.3972... . However, not only healthcare workers will be affected. Telework is presented as an opportunity to face the need for social distancing in other economic activities and will promote new dangers that workers in their homes will have to face.

Similarly, the effects of the economic crisis will aggravate the situation of vulnerable workers ³¹31. Orellana CI. Health workers as hate crimes targets during co-viD-19 outbreak in the Americas. Rev. Salud Pública (Bogotá) 2020; 22(2):e386766-e386766. DOI:10.15446/rsap.v22n2.86766.
https://doi.org/10.15446/rsap.v22n2.8676... , such as informal workers and some migrant workers. Likewise, workers with less qualified, poorly paid, precarious jobs will also feel more strongly the impact of the pandemic. Loss of employment, even temporarily, will also affect workers ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... . The inequalities and vulnerability of millions of workers can generate an exacerbated deterioration of mental health, as well as expand the number of individuals in precarious jobs.

Workers at risk must have the full support of the health system, in addition to the support of society ³²32. Koh D. Occupational risks for COVID-19 infection. Occup Med (Lond). 2020:70(1):3-5. DOI:10.1093/occmed/kqaa036.
https://doi.org/10.1093/occmed/kqaa036... . Strictly applied social distancing measures will contribute to a reduction in the spread of the virus and will allow maintaining an optimal response from the health system and an adequate burden for the personnel responsible for caring for people.

It is of utmost importance to pay attention to the psychological tolerance of health workers, particularly those who are in the first line of care. Due to the pandemic, healthcare systems are and will be operating for longer at a maximum capacity, and healthcare workers cannot be at a 100% for long periods of time compared to wards or equipment ²³23. Lancet T. COVID-19: protecting health-care workers. Lancet. 2020; 395(10228):922. DOI:10.1016/S0140-6736(20)30644-9.
https://doi.org/10.1016/S0140-6736(20)30... .

It will be necessary to accelerate research processes on the exposure and health effects of COVID-1g, both in health workers and other workers at risk of infection ¹²12. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med. 2020; 77:281-2. DOI:10.1136/oemed-2020-106567.
https://doi.org/10.1136/oemed-2020-10656... . Although the crisis affects the entire population, it is necessary to collect, manage and analyze data on the particular risks for workers in their workplaces ♠

Acknowledgment:

The authors thank the Corporación Universitaria Minuto de Dios, Sede Virtual y a Distancia (UVD), for the funding for the style review and translation of this article, as well as the time allocated to two of the researchers for the writing.

REFERENCES

Publication Dates

History