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Occupational health is “thin line” protecting the Covid-19 frontline
The workload in healthcare occupational health has increased 20-fold as a result of the Covid-19 pandemic, according to a team of OH professionals working in a tertiary NHS trust. This increase is primarily driven by the need to carry out individual risk assessments of staff whose health notifications at recruitment indicated they were at increased risk of complications.
Five OH staff completed individualised risk assessments among more than 400 staff working in the most high-risk areas in four days at the beginning of the pandemic. “Telephone consultations with staff required skill, patience and an assessment of psychological factors,” the authors explain, adding that some colleagues with health conditions were willing to remain in their acute role, despite a perceived higher risk of complications if they were to become infected, whilst others with similar conditions were not.
The authors conclude that, “our experiences show just how important it is that we retain UK OH workforce, because of our ability to deal with assessment of unknown risk whilst exercising empathy and compassion.”
In a separate article published online by the Journal of Occupational and Environmental Medicine, a group of Bronx-based OH professionals reports on how they prepared their hospital-based services for the pandemic. This included reconfiguring space, adding staff and expanding data tracking of staff absences due to the virus.
Walker-Bone K et al. “Occupational health: the thin line protecting the front line”, Occupational Medicine, published online 1 June 2020.
Sydney E et al. “Preparing occupational health services for pandemic: lessons from the Bronx”, Journal of Occupational and Environmental Medicine, published online 4 June 2020.
Psychological impact of quarantine
Providing healthcare workers with suitable alternative accommodation and personalised monitoring if they are required to quarantine as a result of Covid-19 are useful interventions to prevent them experiencing adverse psychological effects, according to this literature review.
Clear public health communication can also help reduce any feelings of uncertainty, guilt or stigma that they might feel. Financial aid should be considered for the more severely affected workers. Mental healthcare should be a priority for healthcare workers as quarantine can be a trigger of mental distress.
Gomez-Duran E L et al. “Psychological impact of quarantine on healthcare workers”, Occupational & Environmental Medicine, published online 10 June 2020.
Physician suicide and the Covid-19 pandemic
The Covid-19 pandemic presents additional suicide risks in the general population, but physicians (who have a higher suicide risk than the general population) face even more risk factors, including burnout, moral injury and post-traumatic stress disorder. This article highlights the role of one particular risk factor – moral injury to physicians arising from ethical dilemmas generated by the pandemic, for example, decisions on which patients to admit to hospital, or to withdraw life support.
This risk of moral injury is increased by professional isolation and burnout. The authors recommend two strategies to reduce the suicide risk facing physicians during the pandemic: every hospital should establish a Covid-19 Clinical Ethics Committee with multidisciplinary input, and peer groups of doctors should prioritise “safe space” meetings using video-conferencing so that colleagues can more easily identify those in their number who might be struggling.
In a letter to the Journal of Occupational and Environmental Medicine, a group of British-based physicians report on a survey of 106 healthcare workers carried out at a cardiac centre in the north west of England to assess the psychological burden of Covid-19 on the workforce.
Only 40% of respondents felt fairly or very well prepared mentally to work during the pandemic and the majority (81%) were scared of contracting Covid-19. Only 19% were confident that they would not experience burnout if the pandemic extended into the second half of 2020, a finding the authors describe as “certainly worrying”.
Gulati G and Kelly B D. “Physician suicide and the Covid-19 pandemic”, Occupational Medicine, published online 4 June 2020.
Choudhury T et al. “Covid-19 pandemic: looking after the mental health of our healthcare workers”, Journal of Occupational and Environmental Health, published online 12 May 2020.
OH challenges as lockdown lifts
The forecast worldwide economic recession that will follow the pandemic presents its own health problems in addition to those related to the virus, this editorial suggests. Occupational health and safety can play an important role in mitigating the health impacts of recession by providing advice to workers and employers on creating safe employment and new, attractive ways of working, it argues.
It is undeniable that recessions have an adverse impact on the health and wellbeing of the population but health improvements are also possible, for example, because people have less money to spend on products associated with unhealthy behaviours there is more time to exercise and sleep (during lockdowns) and air quality improves. However, research on the health impacts of previous recessions also shows that the lockdown may well exacerbate existing health inequalities, as workers in lower socioeconomic groups have less access to protective equipment, fewer options to work from home and a higher risk of losing their job.
As we emerge from lockdown, those in occupational health and safety, either at a policy level or in the field, have an opportunity to, “translate their valuable insights on the complex relationship between work and health into workable action. As such, they will be able to reduce the toll of an approaching recession”, the editorial concludes.
Godderis L and Luyten J. “Challenges and opportunities for occupational health and safety after the Covid-19 lockdowns”, Occupational & Environmental Medicine, published online 8 June 2020.
Cost-effectivness of return-to-work interventions for mental ill health
Return-to-work interventions for workers with medically certificated mental ill health absence can be cost-effective, according to this literature review. However, the use of economic evaluations to assess the effectiveness of rehabilitation interventions is in its infancy, and currently many evaluations are based around healthcare settings, limiting their usefulness in the context of a workplace or non-health organisation, the authors conclude. “This may present the opportunity to introduce newer approaches that include work-related measures of effectiveness and analytical approaches,” they suggest.
Dewar C S et al. “Evidence for the cost-effectiveness of return-to-work interventions for mental illness related sickness absences: a systematic literature review”, Journal of Occupational Rehabilitation, published online 3 June 2020.