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      A COVID-19 Risk Reduction Assessment for a Health-Care Employee from an Ethnic Background: A Case Study in the United Kingdom

      Dubai Medical Journal
      S. Karger AG
      Coronavirus disease-2019, Employee, Ethnic, Health-care, Risk reduction assessment

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          Concerns in the United Kingdom (UK) that Black, Asian and Minority Ethnic (BAME) populations have disproportionately higher rates of coronavirus disease 2019 (COVID-19) than white populations have led to ethnicity being identified as a risk factor within the latest guidance from Public Health England. The purpose of this case report was to determine whether the risk reduction assessment would aid the line manager support a BAME health-care employee who was concerned that his ethnicity put him at greater risk of contracting COVID-19. This report described the case, protocol, and outcome of undertaking a risk reduction assessment. It is concluded that the risk reduction assessment may assist line managers implement appropriate adjustments for BAME employees in order to alleviate their concerns and mitigate the risks of COVID-19.

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          Most cited references7

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          Is ethnicity linked to incidence or outcomes of covid-19?

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            COVID-19 lockdowns throughout the world

            David Koh (2020)
            By early April 2020, over a third of the global population was under some form of movement restriction or COVID-19 lockdown. China was the first country to have a COVID-19 lockdown, in Wuhan on 23 January. At its peak, China’s quarantine measures were enforced in at least 20 provinces/regions. India commenced a 3-week coronavirus lockdown, with a total ban on venturing out of homes on 24 March. Singapore closed schools and all non-essential businesses as a COVID-19 ‘circuit breaker’ from 7 April until 1 June. Thailand enacted a curfew between 10:00 p.m. and 04:00 a.m. from 3 April. No date has been set for when the curfew’s end. In Europe, Italy enforced a nationwide lockdown from 10 March. All stores except for grocery stores and pharmacies were closed. Those wishing to travel for valid reasons require police permission. Spain imposed a nationwide quarantine on 14 March, extended to 25 April. The restrictions were further tightened on 6 April, with only essential workers allowed to go to work. UK residents are only allowed to leave their homes for essential work, exercise and purchasing food/medicine from 23 March. There is a ban on gatherings of >2 people. France implemented a full lockdown on 16 March to 15 April, banning public gatherings and walks outside. The lockdown will be extended again. Germany shut down shops, churches, sports facilities, bars and clubs in 16 states. The lockdown has been extended to 19 April. In Russia, Moscow residents were ordered to stay at home on 30 March. At least 27 other Russian regions have followed Moscow’s lead. In the United Arab Emirates (UAE), Dubai imposed a 2-week lockdown from 5 April, while the rest of the UAE has had overnight curfews since 26 March. A police permit is required for every trip outdoors. Saudi Arabia locked down its capital and two holy cities on 25 March and Jeddah on 29 March. On 6 April, it locked down several other major cities. Jordan has a strict indefinite lockdown since 21 March, which was eased a little on 25 March. Israel went into partial lockdown on 19 March tightened restrictions on 25 March and had a full national lockdown for Passover on 7 April. In the USA, Washington cannot decree the entire country to shut down. Most states operate autonomously. Even the Centers for Disease Control and Prevention is not authorized to enforce a nationwide lockdown. By early April, at least 24 states have directed residents to stay at home. Seven have announced closure of schools. In South America, Argentina went into a lockdown on 21 March until 31 March and this has been extended to 13 April. Colombia enacted a nationwide quarantine on 24 March, with people >70 years old told to remain indoors until May. In Peru, men can leave their houses on Mondays, Wednesdays and Fridays. For Panama, these are the days that women can leave. No one is allowed outdoors on Sundays. In Africa, Morocco suspended international flights on 15 March and has closed mosques, schools and restaurants. Kenya closed schools, pubs and restaurants, and blocked non-residents from entering the country on 15 March. South Africa entered a 21-day lockdown on 26 March. Only essential businesses remain open, with soldiers and police monitoring the streets. Australia closed non-essential businesses on 23 March. New South Wales, Australia’s outbreak epicentre, was locked down on 7 April. New Zealand went into a month-long lockdown on 25 March, which will only be partially eased after a month if case trends slow. As the pandemic curve peaks or flattens, the next important but complicated issue will be the timing and degree of relaxation of these lockdowns.
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              COVID-19 and healthcare workers: emerging patterns in Pamplona, Asia and Boston

              Protecting healthcare workers (HCWs) is essential to safely maintaining healthcare systems during the coronavirus (COVID-19) pandemic [1]. A Dutch study of various hospitals during the early outbreak, found a 0–10% attack rate for reverse transcription-polymerase chain reaction (RT-PCR) diagnosed COVID-19 among HCWs with mild viral symptoms [2]. In several Asian countries, HCWs constituted >20% of presumptive occupational COVID-19 cases during the early outbreak [3]. At the Cambridge Health Alliance (CHA), the cumulative attack rate for RT-PCR-confirmed COVID-19 in the workforce is consistent with the Dutch report (>2.5%), with rates increasing from the early phase to the ‘surge’ phase (operation at high capacity with predominantly SARS-CoV-2-positive patients). A consistent picture of clinical COVID-19 among HCWs is emerging. The three most common symptoms are cough, fever and myalgia [4–6]. However, cough is non-specific, whereas systemic symptoms/signs (fever, body temperature ≥ 37.5°C, myalgia and headache) and anosmia/ageusia are much more frequent in HCWs with RT-PCR-confirmed COVID-19 compared to those testing negatively [6]. On the other hand, HCWs at both CHA and Pamplona with no symptoms or isolated sore throat/nasal congestion symptoms typically have negative SARS-CoV-2 RT-PCRs. During a pandemic, HCWs can be infected through travel, at home, in their communities or at work due to unprotected exposure to contagious patients, from infected co-workers and contaminated clinical environments. However, there are reassuring signs that personal protective equipment (PPE) (masks/respirators, gloves, eye protection and gowns), hand hygiene and distancing are effective measures in preventing COVID-19 among HCWs. In Pamplona, preliminary serology results for SARS-CoV-2 antibodies among HCWs on the ‘frontline’ (emergency room, inpatient and ICU wards) demonstrated similar seroprevalence results as compared to non-frontline personnel from the rest of the healthcare system. Further evidence of PPE effectiveness against SARS-CoV-2 comes from swab sampling from HCW PPE after caring for COVID-19 patients. No evidence of SARS-CoV-2 contamination was found on the surface of these gowns, face visor masks, N95 masks or goggles [7,8]. However, at CHA and Pamplona, occupational transmission has been documented in two situations: from infected HCWs to other HCWs; or to HCWs from patients admitted for non-COVID-19 indications, where precautions were not taken, and COVID-19 symptoms manifested later. There is also evidence of community-driven infection with multiple positives seen in HCWs residing in towns with high SARS-CoV-2 attack rates. These persons are more likely to be diagnosed at work because of testing priorities (as of 15 April 2020, CHA HCWs were 6.7 times more likely to be receive an RT-PCR than an average Massachusetts resident). Regardless of workplace infection control strategies, a critical challenge has been the ideal return to work strategy for HCWs who have contracted COVID-19. Strategies based on RT-PCR are safe, but often delay return to work, because positive assays may persist for weeks due to their high sensitivity. Research on viral shedding suggests that quantitative RT-PCR SARS-CoV-2 testing using a viral culture viability threshold may be useful [9,10], as can convalescent antibody testing, but all strategies remain empirical at this point [11].

                Author and article information

                Dubai Medical Journal
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                9 March 2021
                : 1-3
                Occupational Health and Wellbeing Centre, Royal Free London NHS Foundation Trust, London, United Kingdom
                Author notes
                *Laran Chetty, Occupational Health and Wellbeing Centre, Royal Free London NHS Foundation Trust, Pond Street, NW3 2QG, London (UK), laranchetty@ 123456gmail.com
                Copyright © 2021 by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 9 August 2020
                : 31 December 2020
                Page count
                References: 13, Pages: 3
                Educational Corner − Case Report

                coronavirus disease-2019,employee,ethnic,health-care,risk reduction assessment


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