7
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Occupational risks for COVID-19 infection

      editorial
      1 , 2
      Occupational Medicine (Oxford, England)
      Oxford University Press

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Coronaviruses are enveloped RNA viruses found in mammals, birds and humans. At present, six coronavirus species are known agents for illnesses in humans. Four viruses—229E, OC43, NL63 and HKU1—are prevalent and can cause respiratory symptoms. The other two—severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)—are zoonotic in origin and can cause fatalities [1]. SARS-CoV originated in Guangdong Province, China and was responsible for the severe acute respiratory syndrome outbreaks in 2002 and 2003. It rapidly spread across the globe and resulted in 8098 reported cases and 774 deaths (case-fatality rate, 9.6%) in 37 countries. MERS-CoV originated in the Middle East and caused severe respiratory disease outbreaks in 2012. Since 2012, there have been 2494 reported MERS-CoV cases resulting in 858 deaths (case-fatality rate, 34%) in 27 countries. There were also several rapid outbreaks reported, mainly in hospitals in Saudi Arabia, Jordan and South Korea [2]. On 31 December 2019, the World Health Organization (WHO) China office was informed of cases of pneumonia of unknown aetiology detected in Wuhan city in Hubei Province, central China [3]. By 9 January 2020, WHO released a statement on the cluster of cases, which stated that ‘Chinese authorities have made a preliminary determination of a novel (or new) coronavirus, identified in a hospitalized person with pneumonia in Wuhan’ [4]. The virus was initially referred to as 2019-nCoV, but has since been re-named as SARS-CoV-2 by the WHO on 12 February 2020. Early indications are that the overall case-fatality rate is around 2%. An analysis of the first 425 cases provided an estimated mean incubation period of 5.2 days (95% confidence interval [CI] 4.1–7.0) and a basic reproductive number (R o) of 2.2 (95% CI 1.4–3.9) [1]. It is possible that people with Coronavirus Disease 2019 (COVID-19) may be infectious even before showing significant symptoms [5]. However, based on currently available data, those who have symptoms are causing the majority of virus spread. The WHO declared this disease as a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 [6]. A significant proportion of cases are related to occupational exposure. As this virus is believed to have originated from wildlife and then crossed the species barrier to infect humans, it is not unexpected that the first documented occupational groups at risk were persons working in seafood and wet animal wholesale markets in Wuhan. At the start of the outbreak, workers and visitors to the market comprised 55% of the 47 cases with onset before 1 January 2020, when the wholesale market was closed. In comparison, only 8.5% of the 378 cases with onset of symptoms after 1 January 2020 had a link with exposure at the market [1]. As cases increased and required health care, health care workers (HCWs) were next recognized as another high-risk group to acquire this infection. In a case series of 138 patients treated in a Wuhan hospital, 40 patients (29% of cases) were HCWs. Among the affected HCWs, 31 (77.5%) worked on general wards, 7 (17.5%) in the emergency department, and 2 (5%) in the intensive care unit (ICU). There was apparently a super-spreader patient encountered in the hospital, who presented with abdominal symptoms and was admitted to the surgical department. This patient infected >10 HCWs in the department [7]. China’s Vice-Minister at the National Health Commission said that 1716 health workers had been infected in the country as of Tuesday 11 February 2020, among whom 6 have died [8]. Outside of China, the first confirmed case of COVID-19 infection in Singapore was announced on 23 January 2020 by the Ministry of Health, Singapore (MOH-Sg). The MOH-Sg issues daily press reports to describe case details of confirmed COVID-19 patients. As of 11 February 2020, a total of 47 cases have been confirmed [9]. Among the first 25 locally transmitted cases, 17 cases (68%) were probably related to occupational exposure (Table 1). They included staff in the tourism, retail and hospitality industry, transport and security workers, and construction workers. Table 1. Probable occupationally acquired COVID-19 among 25 locally transmitted cases in Singapore, 4–11 February 2020 Case description (case no.a) No. of cases Staff working in a retail store selling complementary health products primarily serving Chinese tourists (Cases 19, 20, 34, 40) 4 Domestic worker who worked for Case 19 (Case 21) 1 Tour guide who led tour group from China (Case 24) 1 Jewellery store worker who served Chinese tourists (Case 25) 1 Multinational company staff attending an international business meeting in Singapore (Cases 30, 36, 39) 3 Taxi driver (Case 35) 1 Private hire car driver (Case 37) 1 Resorts World Sentosa employee (Case 43) 1 Security officer who served quarantine order to two persons (Case 44) 1 Casino worker (Case 46) 1 Cluster of two workers at the same construction siteb (Cases 42 and 47) 2 aThe case no. denotes the order of cases according to the time of announcement by the Ministry of Health, Singapore. The first 18 cases were imported cases. bTwo other cases (Cases 52 and 56) were reported from the same worksite 2 days later. An international business meeting for 109 staff was organized by a multinational company from 20–22 January 2020 in Singapore. At this event, healthy company workers interacted with other infected participants, which resulted in the transmission of the virus to three employees based in Singapore. Besides those infected from Singapore, one employee from Malaysia, two participants from South Korea and one staff member from the UK were also infected. They presented as cases after leaving Singapore. Crew on board cruise ships with infected passengers are also at risk. At least 10 cases have been reported among the 1035 crew on the liner Diamond Princess, which is currently docked in Yokohama with around 3600 people quarantined since 3 February 2020. A Hong Kong man boarded the ship on 20 January in Yokohama at the beginning of a 14-day round trip cruise. The passenger sailed from Yokohama to Hong Kong, where he disembarked on 25 January. The ship continued its journey, until news was received that the passenger tested positive on 1 February 2020. The Diamond Princess returned to Yokohama a day early, and has been quarantined since then, with guests isolated in their cabins and screened [10]. The quarantine period will end on 19 February 2020. Another cruise ship, the Dutch liner Westerdam, sailed out of Hong Kong on 1 February 2020. It was turned away by the Philippines, Taiwan, Korea, Japan, Thailand and the US territory of Guam, because of fears arising from the COVID-19 outbreak—even though there was apparently no confirmed case on board [11]. The ship was finally allowed to dock in Sihanoukville, Cambodia after 13 days at sea. Besides fears of contagion from people on board cruise ships, which have been likened to ‘floating petri dishes’, fears are also widespread on land. There are increasing reports of HCWs being shunned and harassed by a fearful public because of their occupation. A Member of Parliament in Singapore highlighted what he termed as ‘disgraceful actions’ against HCWs stemming from fear and panic [12]. Some examples of behaviour described were: Taxi drivers reluctant to pick up staff in medical uniform. A healthcare professional’s private-hire vehicle cancelled because she was going to a hospital. A nurse in a lift asked why she was not taking the stairs and that she was spreading the virus to others by taking the lift. A nurse scolded for making the Mass Rapid Transit train “dirty” and spreading the virus. An ambulance driver turned away by food stall workers. However, not all the reactions from the public towards HCWs have been negative. There are probably an equal number of stories of public support and encouragement. Members of the public have showed their appreciation for HCWs and have volunteered to help the more vulnerable in society [13]. For example, a ride-hailing transport operator started a new service offering a dedicated 24-h service for HCWs travelling from work. Volunteers have also stepped forward to distribute hand sanitizers and masks to the elderly and vulnerable in their community, while sharing important public health messages. Such reactions are reminiscent of behaviour during the 2003 SARS outbreak, where not only the general public, but even close family members were afraid of being infected by HCWs exposed to the disease. A survey of over 10 000 HCWs in Singapore during the SARS outbreak of 2003 reported that many respondents experienced social stigmatization. Almost half (49%) thought that ‘people avoid me because of my job’ and 31% felt that ‘people avoid my family members because of my job’. For example, some parents of schoolchildren forbade their children to play or be close to children of HCWs. A large number (69%) of HCWs also felt that ‘people close to me are worried they might get infected through me’ [14]. On the other hand, there was also massive public support for HCWs, who were hailed as heroes in the fight against the disease. Most of the HCWs (77%) felt appreciated by society. COVID-19 is the first new occupational disease to be described in this decade. Our experiences in coping with the previous SARS-CoV and MERS-CoV outbreaks have better prepared us to face this new challenge. While the explosive increase in cases in China has overwhelmed the health care system initially, we know that public health measures such as early detection, quarantine and isolation of cases can be effective in containing the outbreak. All health personnel should be alert to the risk of COVID-19 in a wide variety of occupations, and not only HCWs. These occupational groups can be protected by good infection control practices. These at-risk groups should also be given adequate social and mental health support [15], which are needed but which are sometimes overlooked.

          Related collections

          Most cited references6

          • Record: found
          • Abstract: found
          • Article: found

          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

            Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

              To the Editor: The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world. 1 Since identification of the virus in late December 2019, the number of cases from China that have been imported into other countries is on the rise, and the epidemiologic picture is changing on a daily basis. We are reporting a case of 2019-nCoV infection acquired outside Asia in which transmission appears to have occurred during the incubation period in the index patient. A 33-year-old otherwise healthy German businessman (Patient 1) became ill with a sore throat, chills, and myalgias on January 24, 2020. The following day, a fever of 39.1°C (102.4°F) developed, along with a productive cough. By the evening of the next day, he started feeling better and went back to work on January 27. Before the onset of symptoms, he had attended meetings with a Chinese business partner at his company near Munich on January 20 and 21. The business partner, a Shanghai resident, had visited Germany between January 19 and 22. During her stay, she had been well with no signs or symptoms of infection but had become ill on her flight back to China, where she tested positive for 2019-nCoV on January 26 (index patient in Figure 1) (see Supplementary Appendix, available at NEJM.org, for details on the timeline of symptom development leading to hospitalization). On January 27, she informed the company about her illness. Contact tracing was started, and the above-mentioned colleague was sent to the Division of Infectious Diseases and Tropical Medicine in Munich for further assessment. At presentation, he was afebrile and well. He reported no previous or chronic illnesses and had no history of foreign travel within 14 days before the onset of symptoms. Two nasopharyngeal swabs and one sputum sample were obtained and were found to be positive for 2019-nCoV on quantitative reverse-transcriptase–polymerase-chain-reaction (qRT-PCR) assay. 2 Follow-up qRT-PCR assay revealed a high viral load of 108 copies per milliliter in his sputum during the following days, with the last available result on January 29. On January 28, three additional employees at the company tested positive for 2019-nCoV (Patients 2 through 4 in Figure 1). Of these patients, only Patient 2 had contact with the index patient; the other two patients had contact only with Patient 1. In accordance with the health authorities, all the patients with confirmed 2019-nCoV infection were admitted to a Munich infectious diseases unit for clinical monitoring and isolation. So far, none of the four confirmed patients show signs of severe clinical illness. This case of 2019-nCoV infection was diagnosed in Germany and transmitted outside Asia. However, it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific. 3 The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak. In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery. Yet, the viability of 2019-nCoV detected on qRT-PCR in this patient remains to be proved by means of viral culture. Despite these concerns, all four patients who were seen in Munich have had mild cases and were hospitalized primarily for public health purposes. Since hospital capacities are limited — in particular, given the concurrent peak of the influenza season in the northern hemisphere — research is needed to determine whether such patients can be treated with appropriate guidance and oversight outside the hospital.
                Bookmark

                Author and article information

                Journal
                Occup Med (Lond)
                Occup Med (Lond)
                occmed
                Occupational Medicine (Oxford, England)
                Oxford University Press (UK )
                0962-7480
                1471-8405
                March 2020
                28 February 2020
                : 70
                : 1
                : 3-5
                Affiliations
                [1 ] PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam , Brunei Darussalam
                [2 ] SSH School of Public Health, National University of Singapore , Singapore
                Author notes
                Article
                kqaa036
                10.1093/occmed/kqaa036
                7107962
                32107548
                b28a831b-262f-4950-9e5f-c9dca259a7d0
                © The Author(s) 2020. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Page count
                Pages: 3
                Categories
                Editorials
                AcademicSubjects/MED00640

                Occupational & Environmental medicine
                Occupational & Environmental medicine

                Comments

                Comment on this article