Return to work guidelines for the COVID-19 pandemic

Evaluation of Cardiovascular Activity and Emotional Experience in Healthcare Workers (HCWs) Operating in COVID-19 Wards

The new 2019 coronavirus or SARS-CoV-2 has been the first biological agent to generate, in this millennium, such a global health emergency as to determine the adoption of public health measures. During this sanitary emergency, the emotional experience of healthcare workers (HCWs) has been hugely tested by several factors. In fact, HCWs have been exposed to greatly tiring physical, psychological and social conditions. The authors investigated the cardiocirculatory activity of a group of HCWs as well as how they perceived stress while working in COVID-19 wards. In particular, every HCW underwent a medical check, an electrocardiographic base exam, systolic and diastolic pressure measurement, and cardio frequency measurement. Furthermore, each HCW was provided with a cardiac Holter device (HoC) and a pressure Holter (Hop). Some psychological factors were considered in order to quantify the stress perceived by each HCW while at work through the administration of two questionnaires: the "Social Stigma towards Patients due to COVID Scale (SSPCS)" and the "Professional Quality of Life Scale (ProQOL)". The HoC and HoP analysis results for HCWs working in COVID-19 OU wards showed significant variations in cardiocirculatory activity. From the analysis of the SSPCS questionnaire answers, it is clear that all of them showed a sense of duty towards their patients. The analysis of the ProQOL questionnaire answers showed that the prevailing attitude is fear; however, HCWs did not absolutely discriminate against those who had COVID-19 nor did they refuse to help those in need. Continuous monitoring of these employees, also carried out through occupational medicine surveillance, allows for the detection of critical conditions and the implementation of actions aimed at preventing chronic processes.

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize “Plan-Do-Study-Act” cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

A quantitative RT-qLAMP for the detection of SARS-CoV-2 and human gene in clinical application

Reverse transcription (RT) - loop-mediated isothermal amplification (LAMP) assay is a rapid and one-step method to detect SARS-CoV-2 in the pandemic. Quantitative estimation of the viral load of SARS-CoV-2 in patient samples could help physicians make decisions on clinical treatment and patient management. Here, we propose to use a quantitative LAMP (qLAMP) method to evaluate the viral load of SARS-CoV-2 in samples. We used threshold time (TT) values of qLAMP, the isothermal incubation time required for the fluorescent or colorimetric signal to reach the threshold, to indicate the viral load of clinical samples. Similar to the cycle threshold (C_t ) values in conventional qPCR, TT values of qLAMP show a linear relationship to the copy numbers of SARS-CoV-2. The higher the viral loadings, the lower qLAMP TT values are. The RT-qLAMP assay was demonstrated to quantify the viral loads of synthesized full-length RNA, inactivated viral particles (BBIBP-CorV), and clinical samples within 15 min by fluorescent reading and 25 min by colorimetric reading. The RT-qLAMP has been applied to detect Alpha, Beta, Kappa, Delta, and Omicron variants of SARS-CoV-2, as well as the human beta-actin gene, and their TT values showed the linear patterns. The RT-qLAMP assays were evaluated by 64 clinical samples (25 positives and 39 negatives) for the assessment of viral loads, and it was also used to quantify the human beta-actin gene, which was used as a control and an indicator of sampling quality in clinical swab samples. The result of RT-qLAMP was in good agreement with the result of RT-qPCR. The RT-qLAMP assay detected all clinical samples, including those with C_t  = 35, within 10 min using fluorescent reading.

Use of an algorithm based on routine blood laboratory tests to exclude COVID-19 in a screening-setting of healthcare workers

Background

COVID-19 is an ongoing pandemic leading to exhaustion of the hospital care system. Our health care system has to deal with a high level of sick leave of health care workers (HCWs) with COVID-19 related complaints, in whom an infection with SARS-CoV-2 has to be ruled out before they can return back to work. The aim of the present study is to investigate if the recently described CoLab-algorithm can be used to exclude COVID-19 in a screening setting of HCWs.

Methods

In the period from January 2021 till March 2021, HCWs with COVID-19-related complaints were prospectively collected and included in this study. Next to the routinely performed SARS-CoV-2 RT-PCR, using a set of naso- and oropharyngeal swab samples, two blood tubes (one EDTA- and one heparin-tube) were drawn for analysing the 10 laboratory parameters required for running the CoLab-algorithm.

Results

In total, 726 HCWs with a complete CoLab-laboratory panel were included in this study. In this group, 684 HCWs were tested SARS-CoV-2 RT-PCR negative and 42 cases RT-PCR positive. ROC curve analysis showed an area under the curve (AUC) of 0.853 (95% CI: 0.801–0.904). At a safe cut-off value for excluding COVID-19 of -6.525, the sensitivity was 100% with a specificity of 34% (95% CI: 21 to 49%). No SARS-CoV-2 RT-PCR cases were missed with this cut-off and COVID-19 could be safely ruled out in more than one third of HCWs.

Conclusion

The CoLab-score is an easy and reliable algorithm that can be used for screening HCWs with COVID-19 related complaints. A major advantage of this approach is that the results of the score are available within 1 hour after collecting the samples. This results in a faster return to labour process of a large part of the COVID-19 negative HCWs (34%), next to a reduction in RT-PCR tests (reagents and labour costs) that can be saved.

Mental health in the post-lockdown pandemic phase: Relief or exacerbation of psychological distress? A cross-sectional study in the general population in Italy

This study is one of the first aiming at investigating the mental health in the post-lockdown period in an Italian adult population and detecting demographic and psychological predictors for a worse outcome. 1401 participants answered a web-based survey including the Emotional Reaction Questionnaire (ERQ), the Positive Affect and Negative Affect Scale (PANAS), the Impact of Event Scale-Revised (IES-R), the General Health Questionnaire (GHQ), the Depression, Anxiety and Stress Scale (DASS-21), and the Dutch Work Addiction Scale (DUWAS). Simple slope analyses highlighted that women, lower age, and suppression were related to higher scores for the PANAS negative affect scale, the DASS-21, the IES-R, the GHQ, and the DUWAS. In our sample, 1.2% of participants showed depressive symptoms, 0.5% anxiety symptoms, and 2% stress symptoms. Moreover, 5.4% of participants reported post-traumatic symptoms and 15% signs of psychological distress. Compared with data on the lockdown period, our results show lower levels of depressive, anxiety, and stress symptoms, possibly due to the slackening of preventive measures adopted since June. Despite this, post-traumatic symptoms and signs of psychological distress were still present. Our data suggest the necessity to monitor psychological adaption over time in general and at-risk subjects.

Returning to Work after the COVID-19 Pandemic Earthquake: A Systematic Review

Background: The ongoing SARS-CoV-2 pandemic has disrupted life and work habits and has produced landmark changes worldwide. This systematic review aimed to analyse the management of Return to Work (RTW) by work organisations following the virus spread. Methods: A selection of 2477 papers, using string research on PubMed, Embase, Web of Science and Scopus from January 2020 to October 2021, were analysed. Results: Fifty-one articles were finally included, and the results obtained were discussed from three different points of view. Twenty articles concerning ‘Remodelling of Work Organization’ proposed some model strategies for resumption to work. Twenty-one papers, including ‘Clinical Evaluation of Workers’, mostly explored the psychosocial impact of returned workers. Finally, twelve articles explored the best ‘Testing Strategies related to RTW’. Despite the heterogeneity of included articles, several interesting approaches have emerged in managing RTW. Conclusions: The reported experiences could help to develop an RTW model for COVID-19 and future pandemics.

COVID-19 and Stressful Adjustment to Work: A Long-Term Prospective Study About Homeworking for Bank Employees in Italy

The COVID-19 evolution has forced the massive introduction of homeworking (HW) for most employees in the initial stages of the pandemic and then return to work, mainly due to the vaccination campaign. These multiple abrupt adjustment demands in work may be a source of intense stress for office workers with consequences on wellbeing and the quality of life. This long-term prospective study aimed at investigating the effect of adaptation demands on a broad population of employees of a large Italian banking group in the job-related stress framework. We administered a web-based survey to 1,264 participants in Reopening after the first lockdown, from June to October 2020, at 841 subjects in Second Wave, corresponding to the rise of contagions from November 2020 to January 2021, and to 491 individuals in Vaccination Round, which ranged from February to June 2021. We assessed workaholism by using the Dutch Work Addiction Scale (DUWAS-10), work-family conflicting overlap by using the Work and Family Conflict Scale (WAFCS), and concern for back to work (BW) and for HW by specific questions. Higher WAFCS scores characterized Reopening and Vaccination Round while Second Wave had the highest level of concern for HW. Women and younger individuals showed the highest concern for BW, WAFCS, and DUWAS-10 scores regardless of the pandemic stage. HW days per week were related to more heightened concern for BW and lower concern for HW, DUWAS, and WAFCS scores. The number of children was related to lower Concern for BW and higher WAFCS scores in Reopening and Second Wave. Our data showed that massive adjustment demands in work and family routine represented a significant source of stress for employees, regardless of the different pandemic stages. The highest level of fatigue emerged in women and younger subjects. These results shed light on the need for a road map to promote a gradual and structured adjustment for workers and encourage organizations to consider homeworking as a valid stable alternative.

Psychological Distress Among Occupational Health Professionals During Coronavirus Disease 2019 Pandemic in Spain: Description and Effect of Work Engagement and Work Environment

The impact of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of hospital health professionals has been widely described, but few studies have focused on occupational health professionals. Therefore, the objective of this study was to assess psychological distress (PD) of occupational health workers and its relationship with their work engagement (WE) and work environment characteristics. A cross-sectional survey was conducted. A sample of 499 nurses and physicians participated in the study. Variables included demographic data, work environment characteristics, work engagement Utrecht Work Engagement Scale (UWES-9) and psychological distress General Health Questionnaire (GHQ-12). The Chi-square Automatic Interaction Detection method was performed for data analysis. Data collection took place via the internet between April 23 and June 24, 2020. A total of 65.53% of the participants had PD, and the total mean score of the UWES-9 scale was 34.80 (SD = 10.69). Workload, conflicts, stressful situations, and less job satisfaction were significantly related to a higher percentage of PD (p < 0.05). Participants with low engagement showed higher levels of PD (76.7%; p < 0.001). The dedication was revealed as the most significant dimension. Interventions aimed at promoting resilience and coping strategies are suggested. WE should be fostered as a preventive measure against PD among occupational health workers. By protecting workers, occupational health departments have a shared responsibility with public health in containing the pandemic. Therefore, it is essential to prevent the psychological impact that this responsibility may have on occupational health workers by implementing prevention measures.

Outbreak of P.3 (Theta) SARS-CoV-2 emerging variant of concern among service workers in Louisiana

During routine industrial quarantine/premobilization procedures, four individuals who recently traveled from the Philippines tested positive for SARS-CoV-2. Subsequent genomic analysis showed that all four were infected with a relatively rare Variant of Interest (P.3, Theta) derived from a single origin. This demonstrates the importance of on-going genomic surveillance of SARS-CoV-2.

Understanding uptake of prevention and mitigation of COVID-19 at work actions in Iran

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has required organizations to make changes to ways of working to prevent and mitigate COVID-19 in employees.

OBJECTIVE

To assess the workplace response to COVID-19 in Iran.

METHODS

255 organizations completed a two-part survey. Part 1 collected data describing the business; part 2 comprised the International Labor Organization (ILO) 30-item Prevention and Mitigation of COVID-19 at Work Actions Checklist. A four-point Likert scale was used to score each item according to whether preventative measures had been actioned.

RESULTS

We found a dichotomy of commitment to managing COVID-19 at work. 42.5%of organizations had fully implemented the ILO recommended preventative actions, and 45.6%workplaces had not implemented any. Large organizations had significantly more preventative actions than SMEs; the healthcare sector had significantly better COVID-19 mitigation measures in place than construction projects; and organizations with a health and safety management system had significantly more prevention actions in place.

CONCLUSIONS

ILO provided a good framework to support risk assessment of COVID-19, however only half the organizations were undertaking the necessary biological hazard control actions to prevent COVID-19 at work. There remains a need to understand the inaction of organizations who do not risk assess despite being in a pandemic.

Time to a Negative SARS-CoV-2 PCR Predicts Delayed Return to Work After Medical Leave in COVID-19 Infected Health Care Workers

OBJECTIVE

To investigate whether HCWs return to work (RTW) after COVID-19 was associated with time to a negative viral detection test.

METHODS

To evaluate the association of RTW with an undetectable RT-PCR adjusting for different factors.

RESULTS

Three hundred seventy-five HCWs who required medical leave for COVID-19 at a hospital in Madrid. Multivariable analyses confirmed the association of delayed RTW with interval to negative PCR (ORadj 1.12, 95% CI 1.08, 1.17) as well as age, sex, and nursing staff and clinical support services compared to physicians. A predictive model based on those variables is proposed, which had an area under the receiver operating curve of 0.82.

CONCLUSIONS

Delayed RTW was associated with longer interval to a negative RT-PCR after symptom onset, adjusting for occupational category, age, and sex.

Readability, content, and quality of COVID-19 patient education materials from academic medical centers in the United States

Background

SARS-CoV-2 has spread rapidly resulted in a global pandemic and public health crisis. The internet is a frequently used resource for providing patient education materials (PEMs). The aim of this study was to evaluate the readability, content, and quality of web-based PEMs on COVID-19 from US academic medical centers.

Methods

The names of US medical schools were obtained from the Association of American Medical Colleges website (n = 145). Institutional, hospital, and heath encyclopedia websites associated with each schools’ medical center were identified using Google. Readability of COVID-19 PEMs was calculated using three validated indices: (1) Flesh-Kincaid Grade Level, (2) Simple Measure of Gobbledygook, and (3) Gunning Frequency of Gobbledygook. Content was evaluated using a scoring matrix based on materials available on the Center for Disease Control website. The Patient Education Material Assessment Tool for Print (PEMAT-P) was used to assess usability and actionability.

Results

A total of 141 (97%) PEMs met inclusion criteria and were analyzed for readability, content, and quality. The mean readability was above the recommended sixth grade reading level (P < .001). Content was variable across PEMs. The PEMAT-P scores reflected good understandability with a median score of 83% (IQR 75%-87%), while actionability was poor with a median score of 41% (IQR 40%-60%).

Conclusions

Despite availability of web-based PEMs for COVID-19, the readability was significantly higher than the National Institute of Health and US Department of Health and Human Services recommended sixth grade reading level and actionability of PEMs was low. It is critical to provide readable PEMs on COVID-19 to effectively disseminate accurate information and facilitate patients’ understanding of the virus, how it spreads, and how to protect themselves.

Serological study of healthcare workers in four different hospitals in Madrid (Spain) with no previous history of COVID-19

OBJECTIVES

Healthcare workers (HCWs) have been one of the most severely affected groups during the COVID-19 pandemic, though few studies have sought to determine the rate of undiagnosed cases among this population. In this study, we aim to determine the rate of undetected infection in HCWs, a potential source of nosocomial infection.

METHODS

Serological screening for IgG and IgM antibodies against SARS-CoV-2 was carried out among HCWs from four different hospitals in Madrid, Spain, from 6 April to 25 April 2020; HCWs with a previous diagnosis of infection based on real-time reverse transcriptase-PCR assay performed after presenting compatible symptoms were excluded. Prevalence of IgG and IgM antibodies was calculated among HCWs to obtain the rate of COVID-19 presence of antibodies in each hospital.

RESULTS

Of the 7121 HCWs studied, 6344 (89.09%) had not been previously diagnosed with COVID-19. A total of 5995 HCWs finally participated in the study, resulting in a participation rate of 94.49%. A positive IgM or IgG test against COVID-19 was revealed in 16.21% of the HCWs studied (n=972).

CONCLUSION

This study reveals the importance of early detection of SARS-CoV-2 infection among HCWs to prevent nosocomial infection and exposure of patients, visitors and workers and the spread of COVID-19 in the overall community.

COVID-19 and Return-To-Work for the Construction Sector: Lessons From Singapore

Singapore’s construction sector employs more than 450,000 workers. During the height of the COVID-19 pandemic in Singapore from April to June 2020, migrant workers were disproportionately affected, including many working in the construction sector. Shared accommodation and construction worksites emerged as nexuses for COVID-19 transmission. Official government resources, including COVID-19 epidemiological data, 43 advisories and 19 circulars by Singapore’s Ministries of Health and Manpower, were reviewed over 8 month period from March to October 2020. From a peak COVID-19 incidence of 1,424.6/100,000 workers in May 2020, the incidence declined to 3.7/100,000 workers by October 2020. Multilevel safe management measures were implemented to enable the phased reopening of construction worksites from July 2020. Using the Swiss cheese risk management model, the authors described the various governmental, industry, supervisory and worker-specific interventions to prevent, detect and contain COVID-19 for safe resumption of work for the construction sector.

History of contact with the SARS-COV-2 virus and the sense of coherence in the development of psychological distress in the occupational health professionals in Spain

The COVID-19 pandemic has affected the psychological well-being of healthcare professionals, among them, on medical and nursing occupational specialists. This study describes the psychological distress that this group has suffered, analyzing the effect that the sense of coherence related with the history of contact with infected people has generated in their mental health. Cross-sectional descriptive study using online questionnaires. Data were collected on a sample of 499 subjects, representing 42.0% and 38.8% of the associations of specialists in Occupational Medicine and Nursing, respectively. A univariate data analysis, independence test, and the CHAID multivariate method were carried out. The percentage of workers with high psychological distress was higher among women than among men; this was also higher in public sector workers than in the private sector. No differences have been observed regarding psychological distress and educational level, coexistence, having children, working away from home, having a pet, or between being a physician or nurse. The most efficient measure to prevent psychological distress was acting regarding the comprehensibility dimension of the sense of coherence. Sex, contact with any infected person, age, living as a couple, working in public or private centers, the availability of diagnostic tests, and the correlation with the manageability dimension were modulating factors. Sense of coherence is an effective measure to prevent psychological distress due to contact with people affected by COVID-19 in Occupational Health professionals.

COVID-19 as an occupational disease

The impact of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 permeates all aspects of society worldwide. Initial medical reports and media coverage have increased awareness of the risk imposed on healthcare workers in particular, during this pandemic. However, the health implications of COVID-19 for the global workforce are multifaceted and complex, warranting careful reflection and consideration to mitigate the adverse effects on workers worldwide. Accordingly, our review offers a framework for considering this topic, highlighting key issues, with the aim to prompt and inform action, including research, to minimize the occupational hazards imposed by this ongoing challenge. We address respiratory disease as a primary concern, while recognizing the multisystem spectrum of COVID-19-related disease and how clinical aspects are interwoven with broader socioeconomic forces.

Pulmonary Rehabilitation in COVID-19: The Contribution of other Chronic Lung Syndromes for the Intervention of a Novel Disease

Abstract::

COVID-19 has spread throughout the world causing a significant number of cases of pneumonia and SARS. Patients with COVID-19 may also have other cardiovascular, respiratory, and neuromuscular disorders. These multisystemic complications present the need for comprehensive interventions focused on improving symptoms, functional capacity, and quality of life. Pulmonary rehabilitation has the potential to offer some of these benefits. However, the evidence related to specific aspects of pulmonary rehabilitation evaluation and intervention in COVID19 is limited. We have learned from experiences with other types of chronic lung diseases that have used pulmonary rehabilitation successfully. While the evidence of rehabilitation emerges in COVID-19, it is necessary to establish some initial recommendations, prepared according to the sequelae found until now.

Health-related factors of psychological distress during the COVID-19 pandemic among non-health workers in Spain

BACKGROUND

Non-health workers engaged in essential activities during the pandemic are less researched on the effects of COVID-19 than health workers.

OBJECTIVE

to study the differences between those who work away from home and those who do so from home, when the effects of fear of contagion cross with those of confinement, about the psychological distress during the COVID-19 in Spain.

DESIGN

Observational descriptive cross-sectional study.

DATA SOURCES

The study was carried out receiving 1089 questionnaires from non-health workers that were working away from home and doing so from their homes. The questionnaire included sociodemographic and occupational data, physical symptoms, self-perceived health, use of preventive measures and possible contacts, and the Goldberg GHQ-12.

RESULTS

71.6% of non-health female workers and 52.4% of non-health male workers had psychological distress, with differences among those working away from home and those working from home. The level of psychological distress among non-health workers is predicted by 66.5% through the variables: being a woman, 43 years old or younger, having a home with no outdoor spaces, poor perception of health, number of symptoms, and having been in contact with contaminated people or material. Among workers who work away from home, being self-employed is another predictive variable of distress.

CONCLUSION

More than the half of the sample showed inadequate management of the psychological distress. There are modifiable factors which provide necessary elements to support a positive attitude of the workers, such as: knowledge of hygiene, transmission of the virus, protective measures, and social distancing measures.