24th COLLEGIUM RAMAZZINI STATEMENT - PREVENTION OF WORK-RELATED INFECTION IN THE COVID-19 PANDEMIC

Main Article Content

Collegium Ramazzini

Keywords

statement, Covid-19, prevention, environment, pollution, smoking, occupational, workers, PPE

Abstract

The Collegium Ramazzini is an independent, international society comprised of 180 physicians and scientists from 35 countries. Its mission is to increase scientific knowledge of the environmental and occupational causes of disease and to transmit this knowledge to decision-makers, the media and the global public to prevent disease, promote health and save lives.


The Collegium Ramazzini calls urgently for preventive measures internationally and in every country to reduce risk of COVID-19 infection in workers.The COVID-19 pandemic has affected every country in the world, caused confirmed illness in more than 3 million people, unconfirmed disease in millions more, and more than 200,000 deaths. At present, there is no vaccine and no medical treatment for COVID-19. Pandemic control must therefore rely entirely on measures that reduce the spread of infection, flatten the epidemic curve, and gain time to develop more effective responses.Workers whose occupations put them in contact with infected persons and the public are at greatly increased risk of disease and death and have suffered disproportionately in the COVID-19 pandemic. Workplaces have repeatedly been the source of serious outbreaks. Protection of all workers, and especially workers who continue to provide essential services during the pandemic as well as vulnerable workers, must be a top priority at every stage.


SARS-CoV-2 enters the body though inhalation. Lungs and airways that have been damaged by personal exposures such as smoking or vaping, by toxic environmental exposures such as PM2.5 air pollution or by occupational exposures such as silica dust, asbestos, coal dust, fumes and gases are at heighted risk of infection, severe outcomes and death.
 
High-Risk Workers. Workers whose occupations put them in contact with infected persons and the public are at greatly increased risk of COVID-19 infection. These workers require heightened protection. A partial listing of high-risk workers is the following:
- Very High Risk: Health care workers, paramedics, police, firefighters, airline personnel, transport workers, drivers, sales and service personnel, cleaners, mortuary workers, migrant workers, volunteers, and religious professionals.
- High Risk: Security service workers; hotel and food service workers; cruise industry workers; and military personnel pressed into pandemic service; workers in infrastructure, manufacturing, meatpacking, construction, mining and other occupations with crammed workplaces and poor provision of occupational and personal hygiene measures.
- Workers at Increased Vulnerability: Older workers, workers with underlying medical conditions, such as hypertension, obesity, heart disease and cancer; workers occupationally exposed to dusts, gases and fumes; workers of low socio-economic status; workers exposed to high levels of ambient air pollution; and workers in developing countries.
 
The Collegium Ramazzini calls on governments at all levels – national, state or provincial, and local - and on all employers - large and small, public and private - to fulfill their responsibilities to protect the health of all workers in the COVID-19 pandemic.
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References

Fauci AS., H. Lane HC, M.D., and Redfield RR. COVID-19 — Navigating the Uncharted. N Eng J Med 382:1268-69, 2020.
2 Johns Hopkins University and Medicine’s Coronavirus Resource Center at https://coronavirus.jhu.edu/map.html
3 https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-COVID-19-implications-for-ipc-precaution-recommendations
4 Bourbouida L. Turbulent Gas Clouds and Respiratory Pathogen Emissions - Potential Implications for Reducing Transmission of COVID-19. JAMA. Published online March 26, 2020
5 Van Doremalen N, Morris DH, Holbrook G. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 N Engl J Med 2020; 382:1564-1567. doi/full/10.1056/nejmc2004973
6 Xiao W, Nethery RC, Sabath N, Braun D, Dominici F. Exposure to air pollution and COVID-19 mortality in the United States. April 5, 2020. MedxRiv: https://www.medrxiv.org/content/10.1101/2020.04.05.20054502v1
7 Ranshoff RM. Immunology: Licensed in the lungs. Nature. 2012;488(7413):595-596.
8 Danesh Yazdi M, Wang Y, Di Q, Zanobetti A, Schwartz J. Long-term exposure to PM2.5 and ozone and hospital admissions of Medicare participants in the Southeast USA. Environ Int. 2019;130:104879.
9 Leth-Larsen R, Zhong F, Chow VT, Holmskov U, Lu J. The SARS coronavirus spike glycoprotein is selectively recognized by lung surfactant protein D and activates macrophages. Immunobiology 2007;212(3):201-211.
10 WHO. 2020. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Available on-line: https://www who int/docs/default-source/coronaviruse/who-china-joint-mission-on-COVID-19-final-report pdf.
11 Bialek S, Boundy E, Bowen V, Chow N, Cohn A, Dowling N, et al. 2020. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. Morbidity and Mortality Weekly Report MMWR 69:343-346.
12 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020 Feb 28.
13 Lan FY, Wei CF, Hsu YT, Christiani DC, Kales SN. Work-related COVID-19 transmission. MedRxiv. 2020. doi: https://doi.org/10.1101/2020.04.08.20058297 14 Smithfield Foods Becomes Largest Coronavirus Hotbed In United States, South Dakota. https://www.forbes.com/sites/alexandrasternlicht/2020/04/16/smithfield-foods-becomes-largest-coronavirus-hotbed-in-united-states-south-dakota-governor-yet-to-mandate-stay-home-order/#7ff4bb792143 15 Dorn AV, Cooney RE, Sabin ML. COVID-19 exacerbating inequalities in the US. The Lancet, 395:1243-1244, 2020. DOI:https://doi.org/10.1016/S0140-6736(20)30893-X
16 Blumberg HM, Watkins DL, Berschling JD, et al. Preventing the Nosocomial Transmission of Tuberculosis. Ann Intern Med. 1995;122:658–663. doi: https://doi.org/10.7326/0003-4819-122-9-199505010-0000
17 Chan-Yeung, M. Severe Acute Respiratory Syndrome (SARS) and Healthcare Workers, International Journal of Occupational and Environmental Health, 10:4, 421-427, DOI: 10.1179/oeh.2004.10.4.421
18 Koh D, Sng J. Lessons from the past: perspectives on severe acute respiratory syndrome.
Asia Pac J Public Health. 2010 Jul;22(3 Suppl):132S-136S. doi: 10.1177/1010539510373010.
19 Zumla, A, et al. Infection control and MERS-CoV in health-care workers
The Lancet, Volume 383, Issue 9932, 1869 – 1871, 2014.
20 World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV) Summary of Current Situation July 2019. https://apps.who.int/iris/bitstream/handle/10665/326126/WHO-MERS-RA-19.1-eng.pdf?ua=1.
21 World Health Organization. Health worker Ebola infections in Guinea, Liberia and Sierra Leone: preliminary report, 2015. Available: https:// www.who.int/csr/resources/publications/ebola/health-worker- infections/en/.
22 Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. Published online February 26, 2020.
23McMichael TM, Clark S, Pogosjans et al. COVID-19 in a long-term care facility in King County, Washington, February 27-March 9, 2020. MMWR 2020;69:339-342. DOI: http://dx.doi.org/10.15585/mmwr.mm6921e1.
22
24Burrer SH, de Pseriod MA, Hughes MH et al. Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020MMWR Weekly / April 17, 2020 / 69(15);477–481.
doi.org/10.15585/mmwr.mm6915e6 25 Cruise ships stuck at sea ‘indefinitely’ with sick onboard amid coronavirus pandemic.
https://fortune.com/2020/04/01/cruise-ships-out-of-florida-coronavirus-stuck-at-sea/
26 Collegium Ramazzini Statement No. 16. The Safety and Health of Migrant Labour. 2011. http://www.collegiumramazzini.org/download/16_SixteenthCRStatement(2011).pdf
27 Prof. David Koh, Brunei University, personal communication (email), 12 April 2020.
28 https://www.pix11.com/news/coronavirus/COVID-19-killing-nyc-transit-workers-at-staggering-rate
29Koh D. Occupational risks for COVID-19. Occl Med 2020; 70(1):3–5, doi:10.1093/occmed/kqaa036
30 Ringen K, Dement J, Hines S, Quinn P, Chen A, Haas S. Mortality of older construction and craft workers employed at Department of Energy nuclear sites: Follow‐up through 2016. Am J Ind Medicine, 62:742‐754, 2019. https://doi.org/10.1002/ajim.23018.
31 Vardavas CI, Nikitara K. 2020. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis 18:20. 32WHO. Increased risk of COVID-19 infection amongst smokers and amongst waterpipe users. March 13, 2020. https://untobaccocontrol.org/kh/waterpipes/COVID-19/
33 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020 Feb 28.
34 Nam HS, Park JW, Ki M, Yeon MY, Kim J, Kim SW. 2017. High fatality rates and associated factors in two hospital outbreaks of MERS in Daejeon, The Republic of Korea. Int J Infect Dis 58:37-42. 35 Hwang, J.H., Lyes, M., Sladewski, K. et al. Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria. J Mol Med 94, 667–679 (2016). https://doi.org/10.1007/s00109-016-1378-3.
36 Cui Y, Zhang ZF, Froines J, Zhao J, Wang H, Yu SZ, et al. 2003. Air pollution and case fatality of SARS in the people's republic of china: An ecologic study. Environmental health: a global access science source 2:15.
37 Cui, Op. cit.
38 Xiao W, Nethery RC, Sabath N, Braun D, Dominici F. Exposure to air pollution and COVID-19 mortality in the United States. April 5, 2020. MedxRiv: https://www.medrxiv.org/content/10.1101/2020.04.05.20054502v1
39 Ogen Y. Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality [published online ahead of print, 2020 Apr 11]. Sci Total Environ. 2020;726:138605.
40 Marco Travaglio, Rebeka Popovic, Yizhou Yu, Nuno Leal, L. Miguel Martins. Links between air pollution and COVID-19 in England. medRxiv 2020.04.16.20067405; doi: https://doi.org/10.1101/2020.04.16.20067405
41 EEA. 2020. Reflecting on climate-neutrality ambitions in europe in times of COVID-19. . European Environmental Agency 20 Mar 2020.
42 Chen G, Zhang W, Li S, Zhang Y, Williams G, Huxley R, et al. 2017. The impact of ambient fine particles on influenza transmission and the modification effects of temperature in china: A multi-city study. Environment international 98:82-88.
43 Setti L. 2020. Evaluation of the potential relationship between particulate matter (pm) pollution and COVID-19 infection spread in Italy. SIMA Report 2020
44 Qu G, Li X, Hu L, Jiang G. 2020. An imperative need for research on the role of environmental factors in transmission of novel coronavirus (COVID-19). Environmental Science & Technology. https://www.medrxiv.org/content/10.1101/2020.04.05.20054502v1
45 Sixteenth Collegium Ramazzini Statement. The Safety and Health of Migrant Labour, 2011
46 International Labor Organization. ILO Convention 155 - Occupational Safety and Health Convention, 1981
47 Institute of Medicine, Op. cit.
48 Brosseau LM and Jones R. Commentary: Health workers need optimal respiratory protection for Ebola. http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola 49 Herron JT, Hay-David AGC, Gillian AD, Brennan PA. Personal protective equipment and COVID 19- a risk to healthcare staff? Br J Oral Maxillofac Surg. 2020 Apr 13. doi: 10.1016/j.bjoms.2020.04.015
50 See https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaningdisinfection.html.