Coronavirus OH Guide 2

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Introduction

On 31^st January 2020, the chief medical officer (CMO) for England confirmed the first two cases of novel coronavirus (covid-19) in the UK. In response I attempted to pull together available health and wellbeing information to try help make a difference to the coronavirus crisis. Since then, our lives professionally and personally have changed drastically. We have all cried, suffered loss, felt angry, had our ways of living changed, all desperately sought ways of responding, pushed through exhaustion, learned a lot quickly to understand and respond effectively to the crisis. We have done all of that at a speed like I have never known. We are changed. Has OH given good account of itself?

The Coronavirus (Covid-19) outbreak has been devastating, globally. As of 17^th July 2020, over 13.7 million cases have been diagnosed globally with more than 589,000 fatalities. In the 14 days to 17^th July, more than 2.9 million cases were reported (European Centre for Disease Prevention and Control, situation update worldwide). Of the deaths registered in w/e 3 July 2020, 532 mentioned COVID-19, the lowest number of deaths involving COVID-19 in the last 15 weeks, and accounting for 5.8% of all deaths in England and Wales (ONS, July 2020). The percentage of people testing positive for COVID-19 in England has decreased over time since 27 April 2020, and this downward trend appears to have now levelled off (ONS, July 2020).

One of the huge number of people lost, so far, was a member of my family and I therefore write this update in my Aunty Kath’s memory. The following are some of what I have found to be important questions or are topics new to me because of the pandemic or things I needed to study to help me both professionally and personally cope with the pandemic. Thank goodness there is scientific evidence to easily access. I have no doubt that in a few months’ time I will have more questions – I am hopeful that science will further provides the solutions so urgently required.

Keep safe and well.

Carol xx

“This infection is not going to disappear…without science leading us to vaccines, we will get second and third waves of this“

Jeremy Farrar, Director of the Wellcome Trust

What are Viruses?

Extract from Professor Baron Peter Piot (2020) London School of Hygiene and Tropical Medicine TEDMED.

1. The name virus was coined from the Latin word meaning slimy liquid or poison.
2. Walter Reed discovered the first human virus, yellow fever virus, in 1901.
3. Viruses are not alive – they are inanimate complex organic matter. They lack any form of energy, carbon metabolism, and cannot replicate or evolve. Viruses are reproduced and evolve only within cells.
4. The genetic information of viruses can be DNA or RNA; single or double stranded; one molecule or in pieces.
5. The first human influenza virus was isolated in 1933. In 2005, the 1918 pandemic influenza virus strain was constructed from nucleic acid sequence obtained from victims of the disease.

A virus is a very tiny particle of RNA or DNA genetic code protected by an outer protein wrapper. Of the millions of types of viruses, only a few hundred are known to harm humans. New viruses emerge all the time. Most are harmless. Viruses are everywhere. Because virus particles are so incredibly small, billions can float on tiny droplets in the air from just one cough. Virus particles try to insert themselves into living cells in order to multiply, infect other cells and other hosts.  It’s how viruses “reproduce.” Viruses act like parasites. They hijack living cells in order to force each cell to make more viruses. When a cell is hijacked, the virus sends out hundreds or thousands of copies of itself.  It often kills the hijacked cell  as a result. 

Has mankind ever wiped out a virus completely?

Yes. Smallpox, which used to kill millions of people. And, we’re very close with polio thanks to the Gates Foundation and many governments around the world.

Do different viruses spread more easily than others?

Yes. Measles is the worst. You can get measles by walking into an empty room that an infected person left 2 hours earlier! That’s why we have measles outbreaks when vaccination rates go down. It’s a very tough disease. The common cold spreads fairly easily. HIV is much harder  to spread, and yet we’ve had 32 million deaths. 

Are there more pandemics in our future?

Definitely yes. This is part of our human condition and of living on a “virus planet.”  It is a never-ending battle. We need to improve our preparedness. That means committing ourselves to seriously invest in pandemic preparedness. 

What is the Coronavirus?

Extract from Professor Baron Peter Piot (2020) London School of Hygiene and Tropical Medicine TEDMED (2020).

There are 7 coronaviruses that have human- to-human transmission. 4 generate a mild cold. But 3 of them can be deadly, including the viruses that cause SARS and MERS, and now the new coronavirus, SARS-CoV2. Being infected with the new coronavirus, “SARS-CoV2” means that SARS-CoV2 has started reproducing in the body.   SARS-CoV2 is the virus; COVID-19 is the disease which that virus spreads.  SARS-CoV2 spreads fairly easily from person to person, through coughs and touch. The disease often starts in the throat (which is why tests often take a swab from the throat) and then as it progresses it moves down to the lungs and becomes a lower respiratory infection. It is a “respiratory transmitted” virus. SARS-CoV2 is different in 4 critical ways:

1. many infected people have no symptoms for days, so they can unknowingly infect others, and so we don’t know who to isolate. This is very worrisome because SARS-CoV2 is highly infectious.
2. 80% of the time, COVID-19 is a mild disease that feels like a minor cold or cough,  so we don’t isolate ourselves, and infect others.
3. the symptoms are easily confused with the flu, so many people think they have the  flu and don’t consider other possibilities.
4. perhaps most importantly, the virus is very easy to spread from human to human because in the early stages it is concentrated in the upper throat. The throat  is full of viral particles so when we cough  or sneeze, billions of these particles can be expelled and transmitted to another person.  

Where did the new coronavirus come from?

Previous outbreaks of human disease caused by coronaviruses, such as SARS and MERS, happened when a virus jumped from animals to humans. Investigations of virus genetics have shown that bats are host to a diverse range of coronaviruses, and the transfer of SARS and MERS viruses to humans involved intermediate hosts, camels in the case of MERS. On-going investigations of the new coronavirus, the cause of COVID-19, also suggest that bats are the original host. Pangolins are a possible bridge between bats and humans but this has not yet been proven.

Coronavirus: What is the R number and how is it calculated?

What is R? The reproduction number is a way of rating a disease’s ability to spread. It’s the number of people that one infected person will pass the virus on to, on average Measles has one of the highest numbers in town with a reproduction number of 15 in populations without immunity. It can cause explosive outbreaks. The new coronavirus, known officially as Sars-CoV-2, has a reproduction number of about three, but estimates vary. How is R calculated? It is not possible to capture the moment people are infected; instead scientists work backwards. Using data – such as the number of people dying, admitted to hospital or testing positive for the virus – allows you to estimate how easily the virus is spreading. Generally, this gives a picture of what the R number was two to three weeks ago. Regular testing of households should soon give a more timely estimate. Why is a number above one dangerous? If the reproduction number is higher than one, then the number of cases increases exponentially. But if the number is lower, the disease will eventually peter out, as not enough new people are being infected to sustain the outbreak. The reproduction number is not fixed. Instead, it changes as our behaviour changes, or as immunity develops. The R number has come down across every part of the UK since the start of the epidemic.

The reproduction number is one of three numbers. Another is disease severity, coronavirus, and the disease it causes, Covid-19, can be severe and deadly. The last is the number of cases, which is important for deciding when to act. Ideally case numbers and the R number (below one) before restrictions are eased otherwise there will be a high number of cases. Having a vaccine is another way to bring down the reproduction number.

How did the UK cut the rate of infection?

• Self-isolation for those with symptoms
• Social distancing
• Closing of schools
• Lockdown

Coronavirus vaccine: When will we have one?

Coronavirus continues to spread around the world, currently there are no vaccines to protect the body against Covid-19.

A vaccine would normally take years, if not decades, to develop. Researchers have changed the way they undertake vaccine research in order to achieve a vaccine(s) in a few months. About 200 groups around the world are working on vaccines and 18 are now being tested on people in clinical trials.

• The first human trial data appears positive showing the first eight patients all produced antibodies that could neutralise the virus.
• A group in China showed a vaccine was safe and led to protective antibodies being made. It is being made available to the Chinese military.
• Trials of the vaccine developed by Oxford University show it can trigger an immune response and a deal has been signed with AstraZeneca to supply 100 million doses in the UK alone.
• And completely new approaches to vaccine development are in human trials.

However, no-one knows how effective any of these vaccines will be. It is likely a vaccine will become widely available by mid-2021. 60-70% of people need to be immune to the virus in order to stop it spreading easily (herd immunity); which means billions of people around the world even if the vaccine was effective. If a vaccine is developed, then there will initially be a limited supply, so it will be given to targeted groups e.g. healthcare workers who come into contact with Covid-19 patients. As the disease is most deadly in older people they would be a priority if the vaccine was effective in this age group. A coronavirus vaccine developed by the University of Oxford appears safe and triggers an immune response (July, 2020). Trials involving 1,077 people showed the injection led to them making antibodies and T-cells that can fight coronavirus. The findings are hugely promising, but it is still too soon to know if this is enough to offer protection and larger trials are under way. These study results are published in the Lancet.

Why do cases of COVID-19 vary?

Understanding the course of infection and how people are affected is key to slowing the spread of COVID-19. Most people experience only mild symptoms when they have COVID-19 but a minority will have a severe or life-threatening response. Whilst some of the difference can be explained by higher risk factors such as older age or underlying health conditions, the reasons why some fit, young people become so ill is one of the puzzles of the COVID-19 pandemic. Genetic factors are well-known to play a role in human susceptibility to infectious diseases. Human genes involved in the response to infection are numerous and highly diverse within the genome. Some are located on the X chromosome and this could be one reason why males (who have only one copy of X) are more severely affected by COVID-19 infection than females (who have two copies). Whether genes turn out to play a major or minor part in determining the response to coronavirus infection, tracking them down is important because they could provide clues about the biological pathways involved in COVID-19 disease. If these pathways are affected by drugs already used to treat other diseases, these drugs might be repurposed to treat COVID-19 too.

How does the coronavirus cause serious COVID-19 disease?

A detailed understanding of how to prevent or treat this severe disease is needed, and research is underway to find this out. The most important consequence of severe COVID-19 is a reduction in the lung’s ability to transfer oxygen from the air into the blood – leading to low blood oxygen levels (hypoxia). The virus enters the lungs in droplets and infects cells lining the air sacs where it multiplies. Supportive treatment in hospital is therefore mainly to increase blood oxygen. However, unlike many other common respiratory viruses, severe COVID-19 has diverse effects that affect multiple organs of the body. Blood clots in the lung are a common feature of severe COVID-19. High blood pressure and diabetes both damage blood vessels, and patients with these conditions are at high risk of severe COVID-19. A minority of individuals suffer severe COVID-19, where the body’s organs are damaged by the virus itself, by the body’s inflammatory response to the virus and by clots in the blood vessels. In patients with severe COVID-19, cytokine levels are far higher than in patients with mild disease. Treatments targeting the inflammatory response, rather than the virus itself, exist for severe COVID-19. Steroid therapy dampens the immune response in general, but newer treatments are emerging that can block specific cytokines involved in these harmful responses. The concern with these new treatments is that they may impede protective immune responses as well, which is why drug trials are underway to measure their benefits and risks.

Is the new coronavirus more deadly than common flu?

According to recent studies, the new coronavirus causes a death rate six to 16 times higher than common flu, killing about 0.6–1.6% of those infected. The risk of dying from COVID-19, as with common flu, increases with age – up to 3% or more in the over 60s, although there is still much uncertainty around these estimates.

Risk communication

The outbreak of the novel virus covid-19 has created many uncertainties for communities, scientists and political leaders. The absence of an effective vaccine or treatment for coid-19 has meant reliance on population behavioural changes, such as handwashing, self-isolation, social distancing to reduce transmission. This has created challenges (and need for evidence) of how to best communicate appropriate behaviours to mitigate the risks to the public:

• What are the effective message characteristics for managing the risk and preventing disease during an unprecedented pandemic?
• What influences people’s responses to messages about health risk communications?

  Key evidences

1. Engage communicate in the development of messaging
2. Uses credible and legitimate sources
3. Address uncertainty quickly
4. Transparency
5. Increase understanding
6. Encourage and empower personal responsibility

How many people have died from COVID-19?

How many people have died from COVID-19 in the UK?  You’d think this was an easy question to answer, but you would be wrong. There are numerous places in which you can find this data, and they don’t always give the same answer.

Regular updates of COVID-19 cases and deaths globally and by individual country are compiled by Johns Hopkins University, the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) etc. In England and the UK, there are three main sources of death data: 

• Public Health England (PHE), 
• NHS England, 
• Office for National Statistics (ONS). 

Data for England are combined with death counts provided to the Department of Health and Social Care – GOV.UK  (DHSC) by the devolved administrations.  These are published for the UK at 2 pm every day; Deaths outside NHS services are not included. 

Sadly, thousands of people in the UK have now died with coronavirus. There were 50,335 deaths involving the coronavirus (COVID-19) that occurred between 1 March and 30 June 2020, registered up to 4 July 2020 in England and Wales; of these, 46,736 had COVID-19 assigned as the underlying cause of death (ONS, July 2020). We are facing a tragic loss of life, often under very difficult and painful circumstances. Bereaved people may have to deal with increased trauma and may be cut off from some of their usual support network. Those who are already struggling with bereavement, or whose relatives or friends die through other causes will also be affected. Of the deaths involving COVID-19 that occurred in England and Wales in March to June 2020, there was at least one pre-existing condition in 91.1% of cases; this is a similar level to that shown in March to May. ONS states their definition of COVID-19 as includes some cases where the certifying doctor suspected the death involved COVID-19 but was not certain, for example, because no test was done. Of the 46,736 deaths with an underlying cause of COVID-19, 3,763 (8.1%) were classified as “suspected” COVID-19. Including mentions, “suspected” COVID-19 was recorded on 8.4% (4,251 deaths) of all deaths involving COVID-19. Click here for  a very good overview of how COVID-19 death data in the UK is reconciled.

Are there different strains of the SARS-CoV-2 virus circulating?

Viruses evolve over time. Viruses change naturally by mutation. They may also evolve through “natural selection” to adapt to the challenges they face at different stages of their life cycle. There have been several recent reports of new “strains” of SARS-CoV-2 arising through mutation that have the potential to increase the severity of the pandemic. However, further analysis has shown these conclusions were premature and there is currently no robust evidence that any of the mutations that have been described have any implications for the spread of COVID-19. Future evolution of the virus may lead to changes that positively or negatively affect human health outcomes and monitoring of viral genetic changes is important. Mutations in the virus are being actively monitored by extensive sequencing of viral genomes isolated from patients across the world. This information will allow researchers to track new variants of the virus with unique genome mutations, improve their understanding of virus transmission, and quickly determine whether new mutations are changing the properties of the virus. So far, there is no evidence that the mutations in SARS-CoV-2 affect the way the coronavirus is transmitted, its ability to cause infections, or the severity of the disease. Nor is there any evidence yet that mutations will hinder the development of vaccines. But the virus is being observed.

Why do people from ethnic minorities suffer more from COVID-19?

Are the ethnicity differences explained in terms of exposure to coronavirus infection, or susceptibility to severe illness and death following infection, or both? People from minority ethnic groups in the UK have a higher risk of severe illness and death from COVID-19 than people who identify as White. In the UK, one in three patients admitted to critical care with COVID-19 has been from an ethnic minority group, although they make up only one in eight of the UK population. Some of the excess risk can be explained by greater exposure to coronavirus infection at home or work, and some by a higher risk of serious COVID-19 disease linked, for example, to diabetes and heart disease. But much of the excess risk has not yet been explained: further research will determine what combination of factors leads to higher coronavirus infection rates and/or more severe outcomes of COVID-19 among ethnic minorities. The Office for National Statistics (ONS) analysed all deaths in England and Wales with suspected or confirmed COVID-19. Comparing people of the same age, men and women from all ethnic groups (except Chinese women) were at greater risk of dying from COVID-19 than White people. The difference was particularly large for Black men and women, who were more than four times as likely to die from COVID-19 than White men and women. According to the ONS, factors such as overcrowding, illness and disability, geographical location, rural or urban living, local levels of deprivation, socioeconomic class and house ownership together explain about half the excess risk of death from COVID-19 for ethnic minorities as compared to White people. For example, 30% of Bangladeshi households and 16% of Pakistani households in the UK are defined as “overcrowded”, which may increase the risk of COVID-19 infection and severe disease. The lived experiences of individuals, including discrimination and stigma, are also likely to be important in understanding how social and economic factors cause differences in the risk of illness and death from COVID-19. Some of the excess risk can be explained by greater exposure to coronavirus infection at home or work, and some by a higher risk of serious COVID-19 disease linked, for example, to underlying health conditions.

Some jobs are more frequently done by people from certain ethnic groups. People doing ‘front-line’ jobs, like transport workers, come into contact with the public more frequently and may therefore be more exposed to infection. For instance, Bangladeshis and Pakistanis are more highly represented than other groups among transport workers, but it is not yet known whether they are also at higher risk of infection or illness. People from ethnic minorities make up 21% of the total NHS workforce but represent 63% of healthcare workers who have died of COVID-19. Ethnic minorities working in the NHS could be more exposed to infection, but exposure might not explain all of the extra risk: deaths among health staff from ethnic minorities are unexpectedly high within different groups of healthcare workers – such as doctors or nurses – who would be exposed to coronavirus in the same way. Much of the disadvantage faced by ethnic minorities remains to be explained: further research seeks to determine what combination of factors leads to higher coronavirus infection rates and/or more severe outcomes of COVID-19 among ethnic minorities.

Does exposure to COVID-19 infection at work vary?

Globally 3 billion workers employees have / will put themselves at risk for contracting SARS-CoV-2 at work. The COVID-19 pandemic has impacted everyone differently, especially in terms of the occupational risks faced day-to-day. As the coronavirus (COVID-19) spread in the UK, many workers were told to work from home, some have been furloughed, and others have use personal protective equipment (PPE) to try to contain and prevent the spread of the infection. The risk of COVID-19 differs by occupation. Visualizing the Occupations with the Highest COVID-19 Risk has been undertaken by assigning a score for each occupation is based on evaluating the data on three physical job attributes covered in the occupational database:

1. Contact with others:
   How much does this job require the worker to be in contact with others in order to perform it?
2. Physical proximity:
   To what extent does this job require the worker to perform tasks in close physical proximity to others?
3. Exposure to disease and infection:
   How often does this job require exposure to hazardous conditions?

While some of these findings may be obvious—nurses and paramedics have a higher chance of exposure to the virus than lawyers and web developers, for example—these datasets allow us to assign a more quantitative figure to each occupation’s level of risk.

Is it safe to go to work?

The Government’s guidance, first published on 11 May 2020, does not replace existing law. Rather, it provides examples of the sorts of measures an employer might take in order to comply with existing legal obligations in the context of Covid-19. The employer has to do all that it reasonably can to set up a system of safe work and then to ensure that it is implemented. An employer can evidence that what they are doing is reasonably practicable and evidence that they are acting with reasonable care is by following Government Guidance. The Government advice is still to work from home if possible but, where that is not possible, then the Government is encouraging workers to return to work if they can do so safely. There is now a shift towards encouraging people back into work. An employer can’t simply give an instruction to an employee and then expect them to follow it, they must also ensure that it is carried out. The duty to take care cannot be delegated.

Links to the guidance available on working safely during coronavirus in England, Wales, Scotland and Northern Ireland are available as updated to 24 June 2020: https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19

Overall links to UK government guidance may be found through the gov.uk coronavirus home page https://www.gov.uk/coronavirus. This is national guidance that applies to England only – people in Scotland, Wales and Northern Ireland should follow the specific rules in those parts of the UK.

Links to all primary and secondary coronavirus legislation and the changes to related legislation is available here http://www.legislation.gov.uk/coronavirus. In each case, you can access the latest available version of regulations, as amended. For example, the Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 as revised up to 15^th June 2020 is available here: http://www.legislation.gov.uk/uksi/2020/350

Every workplace pre the covid-19 pandemic contained hazards such as:

• Biological hazards include viruses, bacteria, insects, animals, etc., that can cause adverse health impacts. For example, mould, blood and other bodily fluids, harmful plants, sewage, dust and vermin.
• Chemical hazards are hazardous substances that can cause harm. These hazards can result in both health and physical impacts, such as skin irritation, respiratory system irritation, blindness, corrosion and explosions.
• Physical hazards are environmental factors that can harm an employee without necessarily touching them, including heights, noise, radiation and pressure.
• Safety. These are hazards that create unsafe working conditions. For example, exposed wires or a damaged carpet might result in a tripping hazard.
• Ergonomic hazards are a result of physical factors that can result in musculoskeletal injuries. For example, a poor workstation setup in an office (and / or at home), poor posture and manual handling.
• Psychosocial hazards include those that can have an adverse effect on an employee’s mental health or wellbeing. For example, sexual harassment, victimisation, stress and workplace violence.

employers in the UK owe duties under the Health and Safety at Work etc. Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare at work of employees; such duties extending to the provision of a safe working environment to those affected and not to expose third parties to risk. The Control of Substances Hazardous to Health Regulations 2002 (COSHH) also cover infectious micro-organisms. There are other regulations (not health and safety at work regulations) that deal with risks from micro-organisms that also need to be considered, e.g. food safety; environmental protection; and public health.

On 19^th May 2020, the Department for Business, Energy & Industrial Strategy issued “5 Steps to Working Safely” consists of practical actions for business to take based on 5 main steps, whatever the workplace or sector. The risks from coronavirus infection need to dealt with at work in the same way as any other health and safety issue.

Workplaces need to:

• Help people to work from home
• Carry out a COVID-19 risk assessment
• Develop cleaning, handwashing and hygiene procedures control the risks.
• Maintain 2m social distancing, where possible
• Where people cannot be 2m apart, manage transmission risk.

The HSE state that “If through your risk assessment you have identified people who cannot work from home, then you should consider what changes you might need in your workplace to reduce risk and make it ‘COVID-secure’”:

• Social distancing
• Cleaning and hygiene
• Face covering and masks
• Protect vulnerable workers

An employer must: Assess the Risks – Set up the safe system in light of the risks – Implement the system – Review the system.

Not all UK employers across a range of sectors are making the practical changes needed to keep work as safe as possible for their staff; this includes unsafe working practices.

Achievement of covid-secure workplaces requires (as a minimum)

• Clear robust government guidance on the safety measures all employers
• The provision of adequate supplies of appropriate PPE
• Protection from negative consequences for employees with genuine concern of being exposed to COVID-19 risk.
• Regulation to ensure employers undertake proper risk assessments in line with guidance

Whilst the HSE have recently updated its guidance as to when COVID-19 cases will be reportable under the Reporting of Injuries, Disease and Dangerous Occurrence Regulations 2013 (RIDDOR) the likelihood is that few will satisfy the reasonable evidence criteria set out by the HSE in their accompanying guidance. As the prevalence of COVID-19 increases in the UK population, it will be challenging for employers to establish whether or not the individual contracted the disease as a result of their work. The HSE in their reporting guidance have referred to health and social care workers who through their provision of care and treatment of an individual diagnosed with COVID-19 have subsequently developed the disease.  In these circumstances where there is a diagnosis this will satisfy the requirement of “reasonable evidence” that the exposure arose from the workplace.

Employers have to follow a vast and complex body of health and safety legislation. The Health and Safety Executive (HSE) publishes approved codes of practice and guidance on health and safety law.

Relevant regulations

• The Management of Health and Safety at Work Regulations 1999
• The Workplace (Health, Safety and Welfare) Regulations 1992
• The Personal Protective Equipment at Work Regulations 1992
• The Control of Substance Hazardous to Health Regulations 2002

RIDDOR reporting of COVID-19

https://www.hse.gov.uk/news/riddor-reporting-coronavirus.htm

A report under RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) in only made when: 

1. an unintended incident at work has led to someone’s possible or actual exposure to coronavirus. This must be reported as a dangerous occurrence.
2. a worker has been diagnosed as having COVID 19 and there is reasonable evidence that it was caused by exposure at work. This must be reported as a case of disease.
3. a worker dies as a result of occupational exposure to coronavirus.

The message is simple: all employers should act responsibly and ethically, not out of fear of prosecution but out of an appropriate sense of accountability to employees and all stakeholders. Employers should stay current and do all that is reasonably practicable based on government advice and an ever-changing situation.

Shielding

Shielding is a measure to protect people who are clinically extremely vulnerable by minimising the risk of coming into contact with the virus. The UK Government has made a number of significant changes to its guidance on shielding for the clinically extremely vulnerable. However, at present, the guidance on going to work remains the same. It says that employers are expected to make every effort to facilitate home working for extremely vulnerable employees, including by offering them alternative roles. If this is not possible it says employers should furlough shielding employees or, as a last resort, pay them SSP.

On 23^rd June, the guidance was amended to say that from 1 August shielding employees in England will be able to return to work if the workplace is compliant with the Government’s health and safety guidance. The guidance in Scotland, Wales and Northern Ireland has also been amended to lift some of the more restrictive advice for those who are shielding. However, all three nations continue to advise against shielding workers attending the workplace.

Shielding for the 2.2 million people who have been self-isolating will ‘be paused’ from 1^st August 2020. Automatic deeming of coronavirus-related incapacity for SSP purposes for shielders will end from that date.  As with those who are self-isolating, it is not an offence for a person who is extremely vulnerable to attend the workplace. However, if an employer required them to do so there is a strong chance that this could be a breach of its health and safety and equality obligations.

Refusing to go to work

A prolonged period away from the workplace can be a source of anxiety, now heightened in the presence of a pandemic. Workplaces may now be viewed as an unsafe environment from an employee perspective. All workers have an obligation to obey lawful and reasonable instructions that are given by their employer. However, employees who refuse to attend the workplace because they reasonably believe that there is a serious and imminent danger have certain protections under employment rights legislation.

There are still a number of workers who should not be required to attend the workplace. These include:

• Workers who can work from home;
• Shielding workers who are clinically extremely vulnerable to Covid-19;
• Workers who are required self-isolate.

The Government’s working safely guidance says that while workers who are simply clinically vulnerable can be asked to attend the workplace, they must be given the safest possible roles where they can maintain social distancing (2m or 1m with mitigations). Employers must ensure that the measures they adopt do not discriminate on the basis of protected characteristics, including age, disability and pregnancy.

Employers must ensure employees can work in a “Covid-secure” environment and should undertake an individual risk assessment to support individuals who are shielding to return to work and implement adjustments or redeployment for any staff in these groups. It is likely that disagreements will arise between employers and employees over whether it is safe to return to work; occupational health and safety expertise should be accessed where available to address individual case issues.

While falling infection rates potentially means that it would be safe for more vulnerable people to return to work, an extended period of transition is required to allow people to adjust as there are highly likely to be deconditioned and anxious. OH practitioners need much more detailed guidance about managing a return to work after shielding. OH need to develop a process that addresses pre-COVID morbidities, considers physical and mental fitness levels, evaluates of nutrition and assesses psychosocial/emotional wellbeing weeks before a return to the workplace and job role. Return to work plans should be devised in response to employees’ health conditions and health behaviours, should include referral to multidisciplinary therapies to help increase and restore capability, productivity, participation and engagement in the workplace. The return to work should commence several weeks before a return to work to improve the employee’s ability to rebuild their confidence and if possible, improve their health status via engagement with multidisciplinary support. It is unlikely that these employees will not need the support of OH for the duration of their employment. OH should provide ongoing reviews and advice on restrictions and / or reasonable adjustments.

Should clinicians be advising persons at heightened risk for death from Covid-19 to consider stopping work in settings that confer a high risk of exposure?

OH clinicians should engage with employees in individualized risk assessments. A plan is needed for safe workforce re-entry for people with elevated individual and occupational risk from Covid-19. More data are needed to further elucidate occupation-specific risks, including data on availability and effectiveness of PPE according to the worker’s role; policies mandating reporting of the occupational exposures of people undergoing testing would help fill this need.

There is a clear correlation between exposure to disease, and physical proximity to others across all occupations.

The OpenSAFELY Collaborative, Williamson E, Walker AJ, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv. 2020 May. DOI: 10.1101/2020.05.06.20092999.

Rimmer A. Covid-19: Disproportionate impact on ethnic minority healthcare workers will be explored by government. BMJ. 2020 Apr;369:m1562. DOI: 10.1136/bmj.m1562.

ALAMA Covid-Age Tool 

The Association of Local Authority Medical Advisers (ALAMA)(a group of occupational physicians, clinicians and academics) developed a Covid-Age tool. The tool examines personal clinical risk factors and calculates an individual’s ‘Covid-Age’ as a way of quantifying risk. It is intended for use as part of an OH assessment of fitness for work. Assessment of work-related risks in relation to COVID-19 remains complicated. Personal or ‘clinical’ risk factors are one element in considering the reduction of risks for those working in healthcare or elsewhere. The Covid-Age tool alone does not replace the need for other elements of risk assessment and control advice. The tool could be used to support risk assessment conversations with line managers and, where clinical risks are identified, occupational health advice should be sought. 

The knowledge of personal risk factors is still evolving as the pandemic continues and more is understood, various tools have been created based on emerging evidence; these need to be reviewed and updated. The following framework provides a tool to assist clinicians consultations with employees regarding decisions about whether or not to return to work. Along with improved data, there is a needed input from OH experts to establish more specific recommendations, including cut-offs for risk stratification.

ONS has created an estimate of exposure to generic disease, and physical proximity to others, for UK occupations based on US analysis of these factors.

What will the impact of the lockdown be on employment?

Higher healthy life expectancy is strongly correlated with higher employment rates, particularly for men. On average, for every 10 percentage points higher the employment rate, healthy life expectancy is around 5 years higher. Unemployment has consistently been found to have a negative impact on a range of health outcomes. Broadly there are four mechanisms by which unemployment might affect health: poverty, stress, unhealthy behaviours, and implications for future employment. The lockdown has already had a major impact on jobs. The economy has taken a sudden and dramatic hit, perhaps even more severe than the global financial crisis of 2008 since the start of the coronavirus (COVID-19) pandemic. GDP fell by 20.4% in the month, the largest fall since monthly records began in 1997, reflecting record widespread falls in services, production and construction output (ONS, July 2020). Early indicators for June 2020 suggest that the number of employees in the UK on payrolls is down around 650,000 compared with March 2020. Employment is weakening and unemployment is largely unchanged, but there are some signs of economic inactivity rising, with people out of work not currently looking for work. Hours worked has continued to fall reaching record lows both on the year and on the quarter. There are still a large number of people temporarily away from work, including furloughed workers, although this is falling through May. New analysis shows that there were around half a million people away from work because of the pandemic and receiving no pay.

There is much evidence that becoming unemployed has a negative impact on mental health. An adverse change in employment status increases the risk of mental health problems, and since mental health difficulties increase the risk of job loss, it is important not only to help laid-off workers find new jobs quickly, but also to help workers manage mental distress.

An estimated 25%of UK workers are now part of the government furloughing scheme, which has been extended until October 2020. Employers are asked to contribute pension payments and national insurance from August and a larger salary share from September. Currently, employees are not allowed to work at all while they are part of the furlough scheme.  Furlough presents a threat to a return to work as employees become deconditioned (a known risk of long-term sickness absence) and those employees may instead enter the benefit system.

Poor mental health of many workers pre the covid-19 pandemic was prevalent; one in six working-age people in England had a mental health problem. The UK government and employers should significantly invest in the health and wellbeing (especially in mental health, nutrition and physical fitness) of all workers. OH services and primary care services need to stop working separately and collaborate so that the public health agenda can be delivered effectively. Organisations must join together OH, health & safety, infection control and wellbeing specialties – only united can timely, effective, high quality workplace interventions achieve the response to the covid-19 pandemic required. Keeping the economy running must be balanced with employee welfare and wider public health objectives.

Is obesity a risk factor for severe COVID-19 infection?

The coronavirus disease 2019 (COVID-19) pandemic has led to worldwide research efforts to identify people at greatest risk of developing critical illness and dying. Initial data pointed toward older individuals being particularly vulnerable, as well as those with diabetes mellitus or cardiovascular (including hypertension), respiratory, or kidney disease. These problems are often concentrated in certain racial groups (e.g., African Americans and Asians), which also appear to be more prone to worse COVID-19 outcomes. Increasing numbers of studies have linked obesity to more severe COVID-19 illness and death. Having obesity, defined as a body mass index (BMI) of 30 or above, increases your risk of severe illness from COVID-19. Obesity can increase COVID-19-associated risk in three ways, namely, by making the individual more vulnerable to the virus via altered immune responses; because of associated chronic illnesses that boost the risk, such as cardiovascular disease and chronic obstructive pulmonary disease, and finally, because the virus may act differently in obese individuals. As a result of a three-month lockdown, many more people could become obese, from almost 98,000 to 434,000, putting them at high risk for future disease.

Does smoking increase or reduce your risk from coronavirus?

The evidence on smoking and coronavirus (COVID-19) is mixed and developing. There are no peer-reviewed studies (May, 2020) that have evaluated the risk of SARS-CoV-2 infection associated with smoking. However, tobacco smokers (cigarettes, waterpipes, bidis, cigars, heated tobacco products) may be more vulnerable to contracting COVID-19, as the act of smoking involves contact of fingers (and possibly contaminated cigarettes) with the lips, which increases the possibility of transmission of viruses from hand to mouth. Smokers generally have an increased risk of contracting respiratory infection and of more severe symptoms once infected. Coronavirus symptoms may therefore be more severe if a person smokes. There is very little evidence on vaping and coronavirus and it is unknown whether vaping makes someone more susceptible to severe disease if they become infected. If it does, the risk is likely to be much less than if they smoke.

Testing for COVID-19 infection and for immunity

Coronavirus is a completely new infection in people. Nobody had immunity to the virus at the start of the pandemic, but immunity is the key to getting life back to normal. At present there are no antibody tests sufficiently reliable to safely inform decisions on risk assessment. Anyone who has symptoms of coronavirus (COVID-19) can get a free test to check if they have the virus. Some people without symptoms can have the test too. The test usually involves taking a swab of the inside of your nose and the back of your throat, using a long cotton bud. Getting tested – and then tracing people’s contacts – is considered vital to enable health leaders to contain local outbreaks. Speed is important because delays give the virus more time to spread. The swab test aims to determine if a person currently has the virus involves taking a swab up the nose and the back of the throat. These tests won’t show a past Covid-19. Antibody tests look for evidence of past exposure via blood samples.

This can be because the swab sample wasn’t good enough, the stage of infection someone’s at when tested, or problems in the lab.

There are two types of covid-19 tests.

• The Antigen test, a laboratory test, looks directly for the virus’s genetic material (RNA) through a process termed polymerase chain reaction (PCR).
• Antibody tests are currently being evaluated, which look for evidence that the person has been exposed and has immune antibodies to the virus.

Testing holds the potential for significantly enhanced risk assessment and management of COVID-19 in workplaces. Test outcomes can be used to inform risk assessments and help to determine if key workers who have had symptoms of COVID-19, or whose household contacts have symptoms, can be in work.

Testing for immunity, allows greater certainty that individual employees are immune to COVID-19 and safe to be in work, with a much-reduced risk of getting the infection themselves or of passing this on to others.

No clinical test is 100% reliable

Studies have found that 20% of positive cases could falsely appear as negative, wrongly telling someone they are not infected. It is considered that sensitivity(picking up the presence of the virus) of the PCR antigen test is at most 90%. This means though that of 100 people tested who actually have the virus, at least 10 will test negative; a false negative.  Therefore, having a negative test does not necessarily mean the individual does not have the virus, and is safe to go back to work. The Hospital Consultants and Specialists Association (HCSA), which represents hospital doctors, has

called for NHS staff to be tested more than once.

The government has been challenged over its testing capacity and the data it has presented.

Coronavirus (COVID-19) Infection Survey pilot: England, 17 July 2020 (ONS, 2020)

• ONS estimate around 1 in 2,300 individuals within the community population in England had COVID-19 within the most recent week, from 6 July to 12 July 2020.
• This equates to an estimated 24,000 people (95% credible interval: 15,000 to 34,000).
• During the most recent week (6 July to 12 July), we estimate there were around two new COVID-19 infections for every 10,000 individuals in the community population in England, equating to around 1,700 new cases per day (95% confidence interval: 700 to 4,200).
• Between 26 April and 8 July, 6.3% of people tested positive for antibodies against SARS-CoV-2 on a blood test, suggesting they had the infection in the past.

Use of Cloth Face Coverings to Help Slow the Spread of COVID-19

Coronavirus is spread when droplets are sprayed into the air when infected people talk, cough or sneeze. Those droplets can then fall on surfaces. The WHO says there is also emerging evidence of airborne transmission of the virus, with tiny particles hanging in aerosol form in the air. We have learnt that covid-19 is a serious illness and are faced with that fact that currently there is no known treatment or vaccine and that the coronavirus is highly contagious in an immune naive population. Deaths rose steeply and quickly the worlds health systems became under strain. Scientists concluded in Aril 2020 that in the face of a pandemic the search for perfect evidence may be the enemy of good policy and very surprisingly agreed that it was time to act without waiting for randomised controlled trial evidence. Greenhalgh (April 2020) undertook a rapid review and concluded that “masks are simple, cheap, and potentially effective worn both in the home (particularly by the person showing symptoms) and also outside the home in situations where meeting others is likely (for example, shopping, public transport), they could have a substantial impact on transmission with a relatively small impact on social and economic life”. Homemade cloth face coverings can help reduce the spread from people who are contagious but have no symptoms or are yet to develop symptoms (asymptomatic or pre-symptomatic transmission). Since mid-May the public in England have been advised to wear face coverings in enclosed public spaces, such as supermarkets, where it can be difficult to follow social distancing rules. All staff in hospitals in England were provided with surgical masks which they were expected to wear from 15^th June. All NHS visitors and outpatients must wear face coverings at all times. An international report published in The Lancet, which analysed data from 172 studies in 16 countries, found that by wearing a face mask there is just a 3% chance of catching COVID-19. Wearing a face covering will become mandatory in shops and supermarkets in England from 24 July.

Self-care and resilience during Covid-19

There are a number of definitions of self-care produced by different authorities at different times – the World Health Organisation for example has produced three much-cited definitions (in 1983, 1998 and 2009). The WHO 1998 definition is:

‘Self-Care is what people do for themselves to establish and maintain health, and to prevent and deal with illness. It is a broad concept encompassing hygiene (general and personal), nutrition (type and quality of food eaten), lifestyle (sporting activities, leisure etc), environmental factors (living conditions, social habits, etc.) socio-economic factors (income level, cultural beliefs, etc.) and self-medication.’

Different definitions include or emphasise different aspects of self-care.

International Self-Care Day (ISD), on 24^th July each year, provides a focus and opportunity to raise the profile of healthy lifestyle self-care programmes around the world. ISD is a device developed by the International Self-Care Foundation to promote self-care as a vital foundation of health and has been running since 2011.

We all are familiar with “Maslow’s hierarchy of needs” theory. The theory brings our attention to the fundamental needs of humans in a five-tier pyramid model. Abraham Maslow proposed his theory “Maslow’s hierarchy of needs” in his 1943 paper “A Theory of Human Motivation” in Psychological Review.

The sequence in which these needs are classified has its significance and is not coincidental.

According to Maslow, physiological needs must be met first before the safety needs of an individual. And when these two needs are met, humans intrinsically move to seek love and belonging needs and so on. To live a healthy and meaningful life, humans seek higher goals and desires. Or try to meet the needs at the individual levels to complete the hierarchy.

Maslow argues that when people fail to meet the needs at the various stages of the hierarchy, they suffer from mental health issues. And it takes a toll on their overall wellbeing. The very same way when employees’ hierarchical needs are not met, they show a low level of employee engagement. And it impacts employee morale, productivity, and retention severely.

But is this theory still relevant and applicable in 2020 when the global workforce is going through a crisis due to the COVID19 pandemic?

The practice of restorative self-care is hugely important for sustaining energy and building resilience. Self-care consists of a wide range of activities that are universal in their importance to health, but which have to be tailored to an individual’s circumstances. When we make time for self-care, we also model it as a legitimate and important priority for others around us.

Physical restoration

Good nutrition, exercise, sleep, and rest are the foundation of physical energy, but they are also vital for managing emotions and focusing attention. Is your body getting what it needs to properly restore itself each day?

Intellectual restoration

This is about the mental ability for sustained concentration and attention; for data, for memory, and for speed, flexibility and creativity of thought. What do you do to relax that gives your mind the time and opportunity to recover throughout the day?

Emotional restoration

Emotional energy is central to how effectively you understand and regulate your emotions, as well as how you connect with others. What coping mechanisms do you use to process your emotions and develop your self-awareness? Who or what in your life helps you experience positive emotions?

Spiritual restoration

We all have and feel a connection to something bigger than ourselves. What that is will be deeply personal but could include things like values, connection to culture and community, the natural world, and/or to faith and our beliefs. Spiritual energy is ultimately about motivation; it ensures congruence between who we are and what we do (authenticity). What really matters to you?

Helpful guidance

Four Your Body https://www.nhs.uk/oneyou/for-your-body/

For Your Mind https://www.nhs.uk/oneyou/every-mind-matters/

Mindfulness https://www.nhs.uk/conditions/stress-anxiety-depression/mindfulness/

COVID-19’s impact on mental health

A major adverse consequence of the Covid-19 pandemic is likely to be increased social isolation and loneliness. A general population survey (Ipsos MORI, 2020) revealed widespread concerns about the effects of social isolation and distancing, including increased anxiety, depression, stress, and other negative feelings (Holmes, 2020). Both of these can have a detrimental effect on health and wellbeing under normal circumstances. This risk is greater for some than others, and as is often the case, it’s those who are already vulnerable.

There is also a well-documented burden of mental health disorders following disasters, including evidence from previous viral outbreaks. This suggests that COVID-19, and the response to the pandemic, could have a significant impact on the nation’s mental health through increased exposure to stressors. Exacerbating this, there has been a loss of coping mechanisms for many, and reduced access to mental health treatment. Most adults report feeling very worried about the effect COVID-19 is having on their life. The most common issues affecting wellbeing are worry about the future, feeling stressed or anxious and feeling bored. What is clear is that mental health has worsened substantially as a result of the pandemic.

Lockdown has brought social isolation to many, particularly people living alone or those who have been shielding. Social isolation is an objective measure, which may or may not lead to the subjective feeling of loneliness. Social isolation has the potential for detrimental effects other than loneliness. There have, for example, been serious concerns about victims of domestic abuse being locked down with perpetrators. Evidence from past outbreaks, as well as early evidence from this pandemic, indicates that we are likely to see an increase in mental health problems such as depression, substance misuse and post-traumatic stress disorder for front-line health and care workers. The pandemic has diminished many of the mechanisms people typically use to cope with stress. Many though have lost jobs or been furloughed, exercise and access to outdoor spaces has been limited, and some people have not been able to meet with friends or family. There are inequalities in these deficits: job loss is socioeconomically patterned, some groups cannot get outdoors, and some are unable to remain digitally connected to friends and family. All of this increases the likelihood that the pandemic will increase mental health inequalities. While mental health is determined by much broader factors than access to mental health services, these are critical for people experiencing mental illness. Services were already stretched with many providers reporting an inability to meet the demand rising prior to the pandemic, and lockdown is adding pressure that is likely to increase in future. The charity Mind has found that almost a quarter of people who tried to access mental health services during a fortnight in April failed to get any help. Good mental health is an important national asset in its own right. Additionally, poor mental health is strongly associated with worse physical health. Thus, the impacts of the pandemic on mental health could lead to a longer-term erosion of people’s physical health, further affecting their ability to lead fulfilling lives.

The Centre for Mental Health, supported by 13 other mental health charities, published a briefing paper in June 2020: COVID-19: understanding inequalities in mental health during the pandemic. This briefing explores some of these issues in further depth, finding that the virus and lockdown are putting greater pressure on groups and communities whose mental health was already poorer and more precarious.

The pandemic has highlighted that anyone can experience social isolation, mental health issues, loneliness, a lack of meaningful social connections and loneliness at some stage in their life (Holmes, 2020). These are not new problems but their prevalence has been increased by lockdown and social distancing rules and the pandemic is occurring against the backdrop of increased prevalence. Social isolation and loneliness are risk factors for poor mental and physical health (Santini, 2020). A study (Steptoe, 2013) highlights isolation as one of the main risk factors that worsen pre-existing conditions, comparable to smoking. Meta-analysis research has found that feeling lonely, being physically isolated or living alone were each associated with a risk of early death (Holt-Lunstad, 2015). Loneliness is part of a web of social exclusion – living alone and / or without children, poor health, no access to transport, not owning your home, low income, no phone, and old age. Social and community policies have struggled to grasp these complex interlocking problems (Age UK, 2012). If we already live in a time when it’s argued loneliness is itself an epidemic then financial insecurity, the death of a friend or family member and being in poorer health can only worsen this.

Holmes (2020) identifies:

• Immediate interventions – determine the best ways of signposting and delivering mental health services for vulnerable groups, including online clinics and community support. Find evidence-based interventions that can be rapidly scaled up. Identify gaps requiring bespoke remotely delivered interventions.
• Long term interventions – from the gaps identified, design bespoke approaches for population-level interventions targeted at the prevention and treatment of mental health symptoms (e.g. anxiety) and at boosting coping and resilience (e.g. exercise). Develop innovative interventions from experimental and social sciences (e.g. for loneliness consider befriending) that can help mental health; assess the effectiveness of arts-based and life-skills based interventions and other generative activities including exercise outdoors.

The quality of evidence for the majority of interventions for social isolation and loneliness is generally weak. Factors associated with the most effective interventions included adaptability, a community development approach, and productive engagement. Further research is required (Gardiner, 2018; NIHR, 2015; Iriss, 2014).

There have been few randomized controlled trials of interventions for loneliness and social isolation interventions. A recent review and synthesis of the literature (Donovan, 2020) recommended that future interventions should:

• specifically target socially isolated and/or lonely individuals
• have a sound theoretical basis
• utilise established therapeutic approaches with trained facilitators
• Involve active participation of the older adult

There are a number of studies in progress looking at the effects of Covid-19 on mental health.

UCL (2020) has launched a study into the psychological and social effects of Covid-19 in the UK. Researchers are aiming to recruit a large sample of adults living in the UK to help understand the effects of coronavirus and social distancing measures on individuals. The data will help them track trajectories of mental health and loneliness in the UK by identifying which groups are most at risk and to understand the effects of any potentially protective activities people could be engaging in.

Glasgow University’s Institute of Health and Wellbeing is overseeing the largest nationally representative survey of the adult population’s response to the crisis. Interim findings are expected soon, with researchers hoping to gain an impression of the impact of lockdown, along with indications about the groups of people who need immediate support (Guardian, 2020).

What is the purpose of OH during this coronavirus pandemic?

The WHO (“020) states that “the protection of health workers is one of the priorities for the response to COVID19 outbreaks. Occupational health services in health care facilities have an important role for protecting health workers and ensuring the business continuity of health care services. Non-healthcare workplaces, such as businesses and enterprises have also the responsibility to protect the health and safety of their workers and those affected by their operations.”

Occupational health has a key role to play in workplaces and should lead on how to deliver public health in workplace settings. There is a need to end fragmented OH service delivery and form OH multidisciplinary teams, that include doctors, nurses, infection control nurses, health and safety practitioners, wellbeing practitioners, physiotherapists, counsellors, psychologists, liaison psychiatrists, ergonomists, occupational hygienists etc., to operate together within a framework of clinical leadership and governance. It was established by the Boorman review of NHS health and wellbeing and in Dame Carol Black’s report Working for a Healthier Tomorrow that the health of the working population is a priority and individuals’ concerns about their health should be addressed. Early advice and intervention are effective at avoiding long term problems. This is even more important when discussing how to improve people’s health and wellbeing and their quality of life in the context of the covid_19 pandemic.

OH, must deliver practical solutions for managers and their employees. OH needs to be enabled to step up, change how it delivers its service, do new things and continually find answers for the challenges coronavirus has and will continue to present. It is easier to say what needs to be done but much harder to find a way forward and deliver the best OH interventions. It is not possible to deliver what is required of OH services without adequate funding. It is clear that OH services urgently need investment so that the resources required to transform and deliver quality OH services are available. A new OH framework is needed and that should be devised by a collaboration between all of the different OH specialities.

The importance of good employee health and wellbeing has been established but not delivered for decades – that must change. Here are some of what I believe are emerging priorities:

1. The government must address the lack of historic provision of access to OH.
2. There is a need to look at how to support all workers with their mental health – there was poor provision pre the pandemic and therefore nothing was in place to respond effectively – this needs an urgent government review and provision of resources.
3. Health clearance processes need a refreshed risk assessment approach and need to be transformed by technology so that they are safe, high quality and fast response to organisations rapidly changing challenges re employee entry and exit from employment.  
4. OH Physician/OH Adviser high-quality management referrals delivered remotely (on-line/telephone) are increasingly needed to support managers and their employees with old and new challenges emerging due to the context of the covid-19 pandemic.
5. Well-being services will need to reconfigure to capitalise on the multi discipline interventions required to respond to the challenges covid-19 will continue to present.
6. Employees should be encouraged to improve their lifestyle to lessen risk both in the current and subsequent waves of COVID-19. In addition to increasing activity levels, there should be improved messaging on better nutrition.
7. More must be done in workplaces to tackle and prevent obesity in societies for the prevention of chronic disease and greater adverse reactions to viral pandemics.
8. There needs to be workplace health interventions to prevent (or if present better management of) the chronic diseases often associated with obesity, which are the determinants of the excess covid-19 deaths.
9. OH needs to partner with primary care so that employees improve their adherence to medicines for any underlying health conditions exactly as prescribed.

Covid-19 Research

As of 14^th July 2020

The COVID-19 pandemic has sparked an unprecedented wave of research, data sharing and open science as the scientific world seeks to understand the disease, track its spread and analyse the SARS-CoV-2 virus that causes COVID-19. The US has published almost twice as many COVID-19-related articles as China so far, according to Dimensions data. Since 1 January 2020, US researchers have produced 12,404 articles and 1,496 preprints on COVID-19. The United Kingdom was not far behind with 5,137 papers and 467 preprints since January. Italy and India rounded out the top five while smaller nations also made a strong showing. Canada is the sixth most prolific publisher of COVID-19 research with 2,043 articles and 197 preprints. Australia is the ninth most prolific so far, with 1,701 papers and 187 preprints related to the pandemic.

The following websites and resources may be helpful to those work in or are interested in research and evidence-based practice in the context of COVID-19. 

A group of organizations  have  released the COVID-19 Open Research Dataset to mobilize researchers to generate new insights. The free dataset has thousands of scholarly articles and new papers specific to the pandemic are posted each day.

The Lancet created a Coronavirus Resource Centre which brings together new 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. All of the Lancet’s COVID-19 content is free to access.

Infectious Diseases Hub aims to provide up-to-date, essential research and information on all aspects of microbiology, virology, mycology and parasitology – from bench to bedside.

The United States, China and the United Kingdom are the leading producers of coronavirus research output, based on an analysis using the Dimensions COVID-19 app.

Browse the JAMA Network COVID-19 collection below, including Q&A’s with NIAID’s Anthony Fauci, an interactive map of the outbreak courtesy of The Johns Hopkins Center for Systems Science and Engineering, and past publications on vaccine development, infection control, and public health preparedness.

European Centre for Disease Prevention and Control publishes latest evidence on covid-19

Cochrane Reviews and related content from the Cochrane Library relating to the COVID-19 pandemic.

Public Health England National COVID-19 surveillance reports, including weekly summary of findings monitored through various COVID-19 surveillance systems.

British Medical Journal: Latest news and resources on COVID-19

Centre for Evidence-Based Medicine (CEBM): COVID-19 Evidence Service

Council for Allied Health Professionals in Research (CAHPR): Collection of key guidance for the research community

EPPI mapper: an up-to-date map of the current evidence-base related to COVID-19

LitCovid: A curated, international literature hub for tracking up-to-date scientific information about the COVID-19

National Institute for Clinical Excellence (NICE): Information regarding COVID-19

PRSB guidance on SNOMED coronavirus codes

The King’s Fund: Guidance on leading through COVID-19

SNOMED International coronavirus codes

The National Center for Biotechnology (US): Making COVID-19 related articles open-access for a number of international publications

Useful Resources

WHO Covid19 Occupational Health

Guidance on how to stay safe during the coronavirus (COVID-19) pandemic continues to be updated regularly. For the latest government guidance:

• in England, see coronavirus advice on GOV.UK
• in Scotland, see Scottish Government advice
• in Wales, see Welsh Government advice

Employers have a ‘duty of care’ for staff, customers and anyone else who visits the workplace. This means they must do all they reasonably can to support their health, safety and wellbeing.

To make the workplace safe, employers must:

• encourage staff to work from home, wherever possible
• have completed a ‘risk assessment’, and taken reasonable steps to prevent harm in the workplace
• follow the government guidelines on safer working on GOV.UK

To get advice on working safely during coronavirus from the Health and Safety Executive (HSE) employers and employees can:

• find coronavirus advice on the HSE website
• find information on risk assessments on the HSE website

CEBM The Centre for Evidence-Based Medicine develops, promotes and disseminates better evidence for healthcare.

NICE has produced important evidence-based guidance to help support health and care professionals during the COVID-19 pandemic. They have published 20 rapid guidelines & made 25 updates to recommendations as practice, evidence & policy evolves.

HSE eBulletin: An update on the latest information for employers and employees, including guidance on working safely (being COVID secure) during the coronavirus outbreak.

Visit the HSE website on a daily basis for the latest updates.

The following guides help the management of the risk from coronavirus in a business:

• Working safely during the coronavirus outbreak – a short guide – HSE
• Talking with your workers about preventing coronavirus – HSE
• Thorough examination and testing of equipment during the coronavirus outbreak – HSE
• Social distancing, keeping businesses open and in-work activities during the coronavirus outbreak – HSE
• Advice for employers on protecting home workers HSE
• First aid provision in non-healthcare settings. To assist employers ensure first aiders are confident that they can help someone injured or ill at work during the coronavirus (COVID-19) outbreak HSENI have provided this guidance. Employers and their first aiders should also be aware of the specific guidance on giving cardiopulmonary resuscitation (CPR) from the Resuscitation Council UK

Royal College of Nursing RCN, Faculty of OH Medicine FOM, Society of OH SOM continue to provide helpful coronavirus updates and resources.

Council for Work and Health CW&H provide returning to work toolkits for employers and occupational health professionals.

Resources to help cope with loss of life during this coronavirus pandemic

Dealing with bereavement and grief

https://www.cruse.org.uk/get-help/coronavirus-dealing-bereavement-and-grief

Traumatic bereavement

Sudden death: advice for bereaved people

Funerals

National Association of Funeral Directors: Covid-19 advice – including who can attend

Down to Earth: Practical advice for those struggling with funeral costs: Covid-19 advice

Nelson’s Journey – Guidance for families around funerals

Planning an alternative funeral during Covid-19

Children and young people

Childhood Bereavement Network – Covid-19 resources and links

Winston’s Wish – Coronavirus information

Child Bereavement UK – Video on supporting bereaved children during the virus

Nelson’s Journey – Guidance for families around funerals

UK Youth – Covid-19 information for young people and for youth workers

Anna Freud Centre – Covid-19 and mental health support for young people, carers and schools

Online COVID-19 courses I have undertaken via Futurelearn:

1. COVID-19: Tackling the Novel Coronavirus (it takes 3 weeks / 12 hours and is free) created by London School of Hygiene & Tropical Medicine https://www.futurelearn.com/courses/covid19-novel-coronavirus
2. COVID-19: Psychological First Aid (it takes 3 weeks / 3 hours and is free) created by Public Health England https://www.futurelearn.com/courses/psychological-first-aid-covid-19

References

Age UK (2012) Loneliness – the state we’re in (pdf)

Armitage, R and Nellums, LB (2020) COVID-19 and the consequences of isolating the elderly The Lancet (open access)

Brooks (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence The Lancet volume 395, issue 10227, p912-920, march 14 (website)

Donovan, NJ (2020) Timely Insights Into the Treatment of Social Disconnection in Lonely, Homebound Older Adults The American Journal of Geriatric Psychiatry (pdf)

Ipsos MORI (2020) COVID-19 and Mental Wellbeing (website)

Holmes, EA (2020) Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science Lancet Psychiatry (pdf)

Holt-Lunstad, J (2015) Loneliness and social isolation as risk factors for mortality: a meta-analytic review Perspect Psychol Sci. 2015 Mar;10(2):227-37 (paywall)

Iriss (2014) Preventing social isolation and loneliness in older people (pdf)

Santini ZI (2020) Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis Lancet Public Health. 2020;5(1):e62–e70 (open access)

Steptoe, A (2013) Social isolation, loneliness, and all-cause mortality in older men and women Proc Natl Acad Sci USA. 2013;110(15):5797–5801 (open access)

Gardiner, C (2018) Interventions to reduce social isolation and loneliness among older people: an integrative review Health Soc Care Community, 26: 147-157 (open access)

NIHR (2015) Health and wellbeing consequences of social isolation and loneliness in old age (pdf)

UCL (2020) New study into psychological and social effects of Covid-19 (website)

Usher, K (2020) Life in the pandemic: Social isolation and mental health J Clin Nurs (pdf)

Windsor-Shellard B, Kaur J. Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered up to and including 20 April 2020. Office for National Statistics. 2020 May.

Final thoughts

These 3 months have been challenging and strange and I believe will be the start of a new era defined by hyper-awareness of the threat posed by pandemics. It is too soon to say what our lives will be like this time next year let alone what the next decade will look like. Each day has brought fear, worry, sadness and shocks. There are emerging real possibilities, a need for transformation as we tentatively step out lockdown, we get perhaps an illumination a little more of our new reality. All scientific disciplines will study these past five months for decades; historians even longer. I hope we have learnt (and continue) what works against Covid-19. And, by analysing the problems of this coronavirus that become a pandemic this century (along with other infections) lessons are emerging about the kinds of societies and workplaces that will be required to withstand the future outbreaks.

Further pandemics are inevitable, and increasing. Viruses will always kill or make many people ill if we don’t move quickly in response.  I have observed that basic principles for containing a disease, developed and refined with reference to hundreds of previous epidemics, have held true for Covid-19. Irrespective of each countries level of development, the preparedness of their health system, early lockdown worked in containing the epidemic, whereas a late lockdown led to a massive outbreak. The coronavirus outbreak has made clear that it is a universal problem: even countries that knew what works, and had the capacity to act, still hesitated – this lost life and caused much unnecessary ill health. Appropriate governance to swiftly enable the power to act is what has delivered the best results at a country level and this I believe is also true at an organisational level. What is justified during an emergency may become normalised once the crisis has passed and governance is also needed to bring that power to an end.

We all now face the worst economic conditions since the Great Depression. New waves of the virus will be detected. Success will need strong collaborations, honest leadership.  I will never forget the desperate global scramble for personal protective equipment and medical supplies in these past months. Nor the sight of doctors and nurses forced to guard against infection using bin bags and homemade masks. Britain has the NHS and clapped thanks to its health heroes but a decade of austerity had weakened the NHS and left the country in demonstrably worse health when the virus struck. Viruses can see the people who are usually invisible to policymakers and the public. The conditions in which they work and live are everyone’s problem.

I like you will never be the same due to these past five months. I have witnessed, heard and had to think about and cope with things I never expected. I have loved and lost during this strange time. I am grateful for so many remarkable achievements that the virus has made happen. I remain hopeful. I was relieved when the government sought scientific opinion from diverse experts (SAGE) on how to respond to COVID-19 and I am proud of the UK scientific community. It is clear that some crucial judgements could have been swifter and more decisive – public enquires are needed to inform the country’s coronavirus strategy going forward.

Coronavirus has impacted and will continue to impact the workplace in many ways, from the office layout, having more remote workers and tech-savvy employees, to an increased awareness and openness around mental health illness. Organisations have become reliant on tools such as Microsoft Teams and Zoom to stay connected while working remotely. Suddenly employees (and managers) have had to become more comfortable communicating with others through video conferencing – a new skill for many.

Coronavirus has transformed workplaces as we know them, changing the way we work, communicate, learn and undertake research. The future of work requires larger and refreshed focus on employee OH, safety and wellbeing.

OH&S professionals should take confidence and courage from this pandemic that their expertise truly matters; that they are valued experts in organisations, and should act accordingly.

Keep well. Keep safe. Collaborate with Passion.

Best wishes Carol.