The hidden occupational health burden of COVID: work-related cardiovascular diseases related to long working hours

Dear Editor:

The COVID-19 pandemic has changed work. At different times of the pandemic, Canadian provincial and territorial governments have either recommended or mandated telework as a way to limit the spread of COVID. However, telework is usually associated with increased work hours, because of the flexibility offered and the blurred distinction between regular and additional working hours (Eurofound and the International Labour Office, 2017).

Furthermore, the increase in worked hours has been documented for healthcare workers (Llop-Gironés et al., 2021): 26% of nurses worked overtime in the first months of the pandemic.

In 2021, the World Health Organization and the International Labour Organization released a joint report on the work-related burden of disease and injury (World Health Organization and International Labour Organization, 2021). The main findings are that working 55 hours per week and more increases the risk of ischemic heart disease and stroke, compared to standard work hours (35 to 40 hours per week). Long working hours are estimated to have been responsible for 745,000 deaths and 23.26 million disability-adjusted life years (DALYs) from ischemic heart disease and stroke worldwide in 2016. This represents 39.5% of all work-related deaths. The comparable estimates for Canada for 2016 (i.e., attributable to long working hours) are 325 deaths as a result of stroke and 823 as a result of ischemic heart disease.

COVID-19 already represents a direct and visible occupational health burden. The Workers’ Compensation Board of Alberta has accepted 13,945 COVID-19 claims in 2021, a majority of which would be from the “municipal government, education, health” sector (Workers’ Compensation Board Alberta, 2022). In Ontario, WSIB (Workplace Safety and Insurance Board) has accepted a total of 36,111 COVID-19 claims, including 109 fatalities, as of February 2022 (Workplace Safety and Insurance Board Ontario, 2022). In British Columbia, WorkSafe BC has allowed a total of 5375 COVID-19 claims, 2821 of which would be for claimants working in healthcare and social services (WorkSafe BC, 2022). However, not all workers are entitled to workers’ compensation benefits. Data from workers’ compensation boards are just the tip of the iceberg, with adjudication rules that vary depending on the province or the territory. There are challenges with the fitness for work of workers experiencing long-COVID or fearing to go back to workplaces where they caught the disease that has brought them to the intensive care unit.

We must also be mindful of indirect and less visible occupational risks related to COVID. Working hours may increase because of telework for any worker eligible for remote work, or because of in-person additional working time, especially for healthcare workers facing successive waves of COVID. Requiring additional hours as a tool to manage peaks of the pandemic is not a sustainable approach for the occupational health of healthcare workers as this constitutes an occupational hazard when exceeding 55 hours per week. Moreover, patients diagnosed with stroke or myocardial infarction should be asked about their weekly working hours.

Not all workers are exposed equally to occupational hazards. The pandemic is another opportunity to illustrate this inequity. Frontline workers are likely to be exposed to these additional occupational hazards. Improvement of occupational health and safety of all workers is critical and should include stronger regulations on the number of weekly worked hours.