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      COVID‐19 as an occupational disease

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          Abstract

          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.

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          Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19

          Maximilian Ackermann, Stijn Verleden, Mark Kuehnel … (2020)
          Progressive respiratory failure is the primary cause of death in the coronavirus disease 2019 (Covid-19) pandemic. Despite widespread interest in the pathophysiology of the disease, relatively little is known about the associated morphologic and molecular changes in the peripheral lung of patients who die from Covid-19.
          Article 0 comments Cited 2827 times – based on 0 reviews     Review now
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            Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study

            Kelvin Kai-Wang To, Owen Tsang, Wai-Shing Leung … (2020)
            Summary Background Coronavirus disease 2019 (COVID-19) causes severe community and nosocomial outbreaks. Comprehensive data for serial respiratory viral load and serum antibody responses from patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are not yet available. Nasopharyngeal and throat swabs are usually obtained for serial viral load monitoring of respiratory infections but gathering these specimens can cause discomfort for patients and put health-care workers at risk. We aimed to ascertain the serial respiratory viral load of SARS-CoV-2 in posterior oropharyngeal (deep throat) saliva samples from patients with COVID-19, and serum antibody responses. Methods We did a cohort study at two hospitals in Hong Kong. We included patients with laboratory-confirmed COVID-19. We obtained samples of blood, urine, posterior oropharyngeal saliva, and rectal swabs. Serial viral load was ascertained by reverse transcriptase quantitative PCR (RT-qPCR). Antibody levels against the SARS-CoV-2 internal nucleoprotein (NP) and surface spike protein receptor binding domain (RBD) were measured using EIA. Whole-genome sequencing was done to identify possible mutations arising during infection. Findings Between Jan 22, 2020, and Feb 12, 2020, 30 patients were screened for inclusion, of whom 23 were included (median age 62 years [range 37–75]). The median viral load in posterior oropharyngeal saliva or other respiratory specimens at presentation was 5·2 log10 copies per mL (IQR 4·1–7·0). Salivary viral load was highest during the first week after symptom onset and subsequently declined with time (slope −0·15, 95% CI −0·19 to −0·11; R 2=0·71). In one patient, viral RNA was detected 25 days after symptom onset. Older age was correlated with higher viral load (Spearman's ρ=0·48, 95% CI 0·074–0·75; p=0·020). For 16 patients with serum samples available 14 days or longer after symptom onset, rates of seropositivity were 94% for anti-NP IgG (n=15), 88% for anti-NP IgM (n=14), 100% for anti-RBD IgG (n=16), and 94% for anti-RBD IgM (n=15). Anti-SARS-CoV-2-NP or anti-SARS-CoV-2-RBD IgG levels correlated with virus neutralisation titre (R 2>0·9). No genome mutations were detected on serial samples. Interpretation Posterior oropharyngeal saliva samples are a non-invasive specimen more acceptable to patients and health-care workers. Unlike severe acute respiratory syndrome, patients with COVID-19 had the highest viral load near presentation, which could account for the fast-spreading nature of this epidemic. This finding emphasises the importance of stringent infection control and early use of potent antiviral agents, alone or in combination, for high-risk individuals. Serological assay can complement RT-qPCR for diagnosis. Funding Richard and Carol Yu, May Tam Mak Mei Yin, The Shaw Foundation Hong Kong, Michael Tong, Marina Lee, Government Consultancy Service, and Sanming Project of Medicine.
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              Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

              Long H Nguyen, David A Drew, Mark S. Graham … (2020)
              Summary Background Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk. Methods We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509. Findings Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93–12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37–3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors. Interpretation In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed. Funding Zoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.
              Article 0 comments Cited 979 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Christopher Carlsten:
                ORCID: http://orcid.org/0000-0003-2455-6575
                carlsten@mail.ubc.ca
                Journal
                Journal ID (nlm-ta): Am J Ind Med
                Journal ID (iso-abbrev): Am J Ind Med
                Journal ID (doi): 10.1002/(ISSN)1097-0274
                Journal ID (publisher-id): AJIM
                Title: American Journal of Industrial Medicine
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Print): 0271-3586
                ISSN (Electronic): 1097-0274
                Publication date (Electronic): 24 January 2021
                Publication date (Print): April 2021
                Volume: 64
                Issue: 4 ( doiID: 10.1002/ajim.v64.i4 )
                Pages: 227-237
                Affiliations
                [ 1 ] Department of Medicine, Division of Respiratory Medicine The University of British Columbia Vancouver British Columbia Canada
                [ 2 ] Department of Pulmonary, Critical Care & Sleep Medicine Yale University New Haven Connecticut USA
                [ 3 ] Department of Medicine University of Maryland Baltimore Maryland USA
                [ 4 ] Department of Medicine, Division of Environmental & Occupational Health Sciences, National Jewish Health University of Colorado Denver Denver Colorado USA
                [ 5 ] Denver Health and Hospital Authority Denver Public Health Denver Colorado USA
                [ 6 ] Occupational & Environmental Health Division, University Health Network University of Toronto Toronto Ontario Canada
                [ 7 ] Occupational and Environmental Medicine Division, School of Public Health and Community Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
                [ 8 ] Department of Occupational and Environmental Medicine Sahlgrenska University Hospital Gothenburg Sweden
                [ 9 ] Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine University of New Mexico Albuquerque New Mexico USA
                [ 10 ] Division of Occupational and Environmental Medicine Icahn School of Medicine at Mount Sinai New York New York USA
                Author notes
                [*] [* ] Correspondence Carlsten, Christopher, MD, The University of British Columbia, 2775 Laurel St, 7th Floor – The Lung Centre, Vancouver, BC V5Z 1M9, Canada.

                Email: carlsten@ 123456mail.ubc.ca

                Author information
                http://orcid.org/0000-0003-2455-6575
                http://orcid.org/0000-0002-8350-9448
                http://orcid.org/0000-0002-2192-5526
                http://orcid.org/0000-0002-4746-5310
                http://orcid.org/0000-0002-8949-9279
                Article
                Publisher ID: AJIM23222
                DOI: 10.1002/ajim.23222
                PMC ID: 8014565
                PubMed ID: 33491195
                SO-VID: 29d9072b-0a65-4a66-a41b-7afead9404fa
                Copyright © © 2021 Wiley Periodicals LLC
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date revision received : 27 December 2020
                Date received : 16 September 2020
                Date accepted : 02 January 2021
                Page count
                Figures: 0, Tables: 2, Pages: 11, Words: 8112
                Categories
                Subject: Review Article
                Subject: Review Article
                Custom metadata
                source-schema-version-number 2.0
                cover-date April 2021
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:01.04.2021

                Keywords: covid‐19,occupational,respiratory disease
                Data availability:
                Keywords: covid‐19, occupational, respiratory disease

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