As the COVID-19 pandemic has reminded us, health workers are of paramount importance to any health-care system to guarantee access to quality care for the population. According to WHO data, health workers represent less than 3% of the population of most countries, and less than 2% in low-income and middle-income countries. Yet, 14% of the COVID-19 cases reported to WHO occurred among health workers, indicating that they are at greater risk of infection than the general population. Besides their proximity to potentially infected people, health workers have been asked to work in extraordinary and extremely challenging conditions, which introduced new occupational health hazards and placed them at higher risk of disease and even death. Data availability is limited, but an Amnesty International report, published in September, stated that 7000 health workers have died from COVID-19 worldwide in the attempt to help others.
The increased risk of becoming infected with the SARS-CoV-2 virus is not the only occupational health challenge brought about by the pandemic. Long working hours and insufficient time for recuperation have also increased the risk of fatigue, mental health disorders, and burnout. In press releases in April and July this year, WHO warned that episodes of violence against health workers were increasing, as well as stigma and discrimination. There are also additional physical risks in the context of COVID-19 high workload. For example, an increase in dermatological conditions and body heat stress caused by the increased use of and higher standard of personal protection equipment (PPE), such as gloves, masks, and gowns, compared with pre-pandemic conditions, as initially signalled in March by Jiajia Lan and colleagues from the Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, in the Journal of American Academy of Dermatology.
Health workers globally have expressed their discomfort with the extraordinary working conditions and in different countries felt abandoned by their own governments who failed in their duty to protect them. In the UK, health workers have expressed their appreciation of the gesture of clapping to support the NHS when coming from the public, but not from members of the government, who have been asked a more concrete support—eg, by supplying essential PPE, as reported in a letter to The Guardian on April 29. Similar situations of distress and dissatisfaction have been expressed in Spain, France, Italy, and the USA, to give just a few examples (The New York Times, March 24; The Guardian, April 25).
The lack of adaptation of working conditions to the new situation puts the safety of health workers at risk, favours staff shortages, and pushes health systems to their limits and towards extreme strategies. For example, in North Dakota, USA, the Governor decided to allow asymptomatic nurses to continue to work in COVID-19 units (Grand Fork Herald, November 10). Furthermore, insufficient occupational health and safety measures can result in diminished quality of care, impacting on patients’ health. Along these lines, WHO has included workers’ health in this year's World Patient Safety Day, with the slogan “Safe Health Workers, Safe Patients”. WHO used the occasion to reiterate the call to governments and organisations to take urgent measures to protect health workers. The call echoed those made at the beginning of the pandemic, such as the appeal during the World Day for Safety and Health in April, held with the International Labour Organisation, to assure decent and safe working conditions for health workers.
This call cannot fall any longer on deaf ears. With COVID-19 cases once again on the rise in different countries worldwide, it is imperative to use the knowledge gathered in these past months to put long-term occupational safety measures in place to support health workers. Robust test and trace systems must be a priority for all health-care facilities. Support groups are needed to improve mental health wellbeing, and a zero tolerance approach to violence must be promoted by governments in health-care settings. PPE must be available at all times and in adequate quality and quantity. Each health-care facility should have a focal unit to manage occupational health and safety. In this context, regulations for occupational health risk must be reviewed and upgraded, considering the established risk factors for COVID-19, such as age, ethnicity, or pre-existing clinical conditions (such as obesity and diabetes), and the deployment of health workers decided accordingly. Health workers should be ensured vaccinations against all vaccine-preventable diseases, and they should be granted priority access to newly licensed vaccines against COVID-19. All these measures, if properly established, can contribute to improving the safety of health workers and reduce staff shortages, thus allowing more balanced working shifts and better care for patients during these difficult times. Furthermore, to ensure decent working conditions, governments should work on benefits and compensation policies for those on the front line.
The clapping has faded, but we need to continue to support health workers and ensure that they have what they need to face this emergency. As WHO Director, Tedros Adhanom Ghebreyesus, reminded us recently, “No country, hospital, or clinic can keep its patients safe unless it keeps its health workers safe”. We can all become patients at some point, the time to act is now.
EClinicalMedicine