COVID-19: Those that are at high risk

A recent editorial takes a close look at the occupational classes with a high risk of COVID-19, including some of the stigmatization faced by these groups.

Nurse wearing nose mask
Healthcare workers have a high risk of contracting SARS-CoV-2.

As the global number of cases with COVID-19 continues to rise, scientists are faced with numerous questions about the novel coronavirus.

Many of these concerns relate to how the SARS-CoV-2 virus is transmitted: “How does it spread?” What is the period of surface survival? “Which disinfectants can kill the virus??”

Since the first documented case of an asymptomatic person infecting others with SARS-CoV-2, it has been known to the medical community that people may be contagious before symptoms.

Still, most transmission is from individuals with severe symptoms, and a small number of cases are associated with occupational exposure.

David Koh— a professor at the PAPRSB Institute of Health Sciences at the Universiti Brunei Darussalam — took a closer look at the occupational hazards of COVID-19 in this context.

Prof. Koh—who has worked as a World Health Organization (WHO) occupational health consultant and is currently a member of the Brunei Research Council Working Group—published his research as an editorial in the journal Occupational Medicine.

Healthcare workers most at risk

The first recorded occupational groups at risk for COVID-19 were, according to the editorial, people working in “seafood and wet animal wholesale markets” in Wuhan, China — the place where the outbreak occurred.

This is unsurprising: Researchers believe that SARS-CoV-2 started in wildlife and crossed the boundary between species for humans.

Specifically, 55 percent of the 47 COVID-19 cases with onset of symptoms reported prior to January 1, 2020 included individuals who had worked at or visited the Wuhan market.

In contrast, only 8.5 per cent of the 378 symptom-beginning cases that occurred between January 1 and January 22 had any business ties. On January the authorities closed the market 1.

As the number of cases increased and more people sought medical assistance, health-care staff became the next high-risk COVID-19 occupational group.

For example, out of 138 patients receiving treatment at a hospital in Wuhan, 40 patients— or 29 percent — were healthcare workers, states Prof. Koh.

He continues: “Among the affected[ healthcare workers], 31 (77.5 percent) worked in general wards, 7 (17.5 percent) worked in the emergency department, and 2 (5 percent) worked in the intensive care unit.” Additionally, a “super-spreader” contaminated more than 10 hospital staff.

In Singapore, meanwhile, 17 of the first 25 cases reported locally— or 68 per cent— were likely associated with occupational exposure, the author notes.

Those “included tourism, retail and hospitality employees[ fields], transportation and health workers, and construction workers.”

In particular, there were four cases among staff working in a retail store that primarily sold supplementary health products to Chinese tourists.

There were three cases among a multinational company’s employees who attended an international business conference, two cases involving construction workers who worked at the same location, and other cases involving taxi and private car drivers, a tour guide, and a security official.

The stigmatization of healthcare workers

Prof. Koh also mentions the cruise ship Diamond Princess, where 619 cases of COVID-19 were developed, and the Dutch liner Westerdam, which was turned away by ports in several countries due to COVID-19 concerns, despite the fact that no cases had been reported on board.

As a result of COVID-19 concerns, health-care workers were also on the receiving end of harassment and discrimination.

“The[ healthcare workers] are increasingly being shunned and abused by a fearful public because of their profession. A Singapore parliamentarian described what he called” disgraceful actions “against[ healthcare workers] that stem from fear and panic,” states Prof. Koh.

He goes on to list some examples of this behavior, including the fact that:

  • “Taxi drivers [have been] reluctant to pick up staff in medical uniforms.
  • A healthcare professional’s private-hire vehicle [was] canceled because she was going to a hospital.
  • A nurse in a lift [was] asked why she was not taking the stairs and [told] that she was spreading the virus to others by taking the lift.
  • A nurse [was] scolded for making the Mass Rapid Transit train “dirty” and spreading the virus.
  • An ambulance driver [was] turned away by food stall workers.”

Comparisons with 2003 SARS outbreak

The author contrasts these reactions with those during the 2003 SARS outbreak, when, “Not only the general public, but also close family members were fearful of being diagnosed with the disease by [healthcare workers].”

At the time, a survey of more than 10,000 healthcare workers in Singapore found that, “Many respondents faced social stigma. Nearly half (49 percent) claimed that’ people fear me because of my work’ and 31 percent thought that’ people avoid members of my family because of my profession,” the author notes.

“All health professionals in a wide range of professions should be alert to the danger of COVID-19, not just[ healthcare workers],” the editorial concludes.

“These occupational groups can be protected by good infection control practices. [They] should also be given adequate social and mental health support, which are needed but which are sometimes overlooked.”

– Prof. David Koh

For information on how to prevent the spread of coronavirus, this Centers for Disease Control and Prevention (CDC) page provides advice.

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