A new editorial takes an in-depth look at the occupational groups with a high risk of COVID-19, including some of the stigmatization that these groups experience.

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Healthcare workers have a high risk of contracting SARS-CoV-2.

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

Many of these questions concern the ways in which the SARS-CoV-2 virus is transmitted: “How does the virus spread?” “How long does it survive on surfaces?” “Which disinfectants can kill the virus?”

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

Still, the majority of the transmission is from people who have significant symptoms, and a considerable number of cases are related to occupational exposure.

In this context, David Koh — a professor at the Universiti Brunei Darussalam’s PAPRSB Institute of Health Sciences — took an in-depth look at the occupational risks of COVID-19.

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

According to the editorial, the first documented occupational groups at risk of COVID-19 were people working in “seafood and wet animal wholesale markets” in Wuhan, China — the place where the outbreak originated.

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

Specifically, 55% of the 47 COVID-19 cases with symptom onset recorded before January 1, 2020, involved people who had worked at or visited the market in Wuhan.

By contrast, only 8.5% of the 378 cases with symptom onset that occurredbetween January 1 and January 22 had any links with the market. The authorities closed the market on January 1.

As the number of cases rose and more people needed medical assistance, healthcare workers became the next occupational group at high risk of COVID-19.

For instance, among 138 patients who received treatment in a Wuhan hospital, 40 patients — or 29% — were healthcare workers, notes Prof. Koh.

He continues: “Among the affected [healthcare workers], 31 (77.5%) worked on general wards, 7 (17.5%) in the emergency department, and 2 (5%) in the intensive care unit.”

Additionally, a “super-spreader” infected more than 10 healthcare workers in the hospital.

Meanwhile, in Singapore, 17 of the first 25 cases that were locally transmitted — or 68% — were likely linked to occupational exposure, notes the author.

These “included staff in the tourism, retail, and hospitality [fields], transport and security workers, and construction workers.”

Specifically, there were 4 cases among staff who worked in a retail store that sold complementary health products primarily to Chinese tourists.

Three cases occurred among employees of a multinational company who had attended an international business meeting, two cases involved construction workers who worked at the same site, and other cases involved taxi and private car drivers, a tour guide, and a security officer.

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

Healthcare workers have also been on the receiving end of harassment and discrimination as a result of COVID-19 fears.

“There are increasing reports of [healthcare workers] being shunned and harassed by a fearful public because of their occupation. A member of parliament in Singapore highlighted what he termed as ‘disgraceful actions’ against [healthcare workers] stemming from fear and panic,” notes 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.”

The author draws comparisons between these reactions and those during the 2003 SARS outbreak, when, “Not only the general public, but even close family members were afraid of being infected by [healthcare workers] exposed to the disease.”

At the time, a survey of over 10,000 healthcare workers in Singapore found that “Many respondents experienced social stigmatization. Almost half (49%) thought that ‘People avoid me because of my job,’ and 31% felt that ‘People avoid my family members because of my job,’” the author reports.

“All health personnel should be alert to the risk of COVID-19 in a wide variety of occupations, and not only [healthcare workers],” concludes the editorial.

“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

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