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SARS-CoV-2, the virus that causes COVID-19, is wreaking havoc around the world. This unprecedented pandemic has led to illness, death and economic destruction. The pandemic has challenged healthcare systems globally for a range of reasons. In developed economies, the focus on noncommunicable diseases rather than infectious diseases has caught us short. A period of complacency and a lack of focus on potential pandemics have meant that documented shortages of personnel, workforce and equipment have limited healthcare delivery. The lack of access to personal protective commitment (PPE), lack of training and workforce shortages have exposed the vulnerability of healthcare workers (Daly, Jackson, Anders, 68%) which is unusual in the context of what we know about the health professions. This may be the result of the fact that more men tend to work in critical care units and emergency departments. Table 3 reports the age distribution of self-reported death. Missing age information was present in 44 cases. The age data tend to follow the general infection rate of the public. Most of the deaths were in those aged 50 years and older. The finding is congruent with the CDC report on age and deaths. They report that 97% of deaths in the general population are older than 45 years (National Center, 2020). The regression analysis of mortality rates by profession and by country has provided useful insights into the higher-risk professions. Overall, nurses were associated with a significantly (p < .05) higher rate of death than physicians in Italy, Brazil, Spain and France (Table 4). The increased risk of nurse death relative to physician death in Spain exceeded an odds ratio of 50.0, and in France, nurse risk of death exceeds an odds ratio of 120.0. There were not significant differences in mortality between physicians and nurses in USA, UK or Australia. Licensed practical nurses did not have enough observed deaths in order to provide conclusive results in this analysis, which limited our analysis to a simple logistic regression (MD vs. RN mortality) as opposed to multinomial logistic regression (MD vs. RN vs. LPN). MacIntyre and colleagues argue that many infection control procedures, which health workers follow, are driven primarily by concerns about patient safety (MacIntyre, Chughtai, Seale, Richards, & Davidson, 2015). Protecting patients from nosocomial infection and the protection, occupational health and safety of the healthcare worker, as well as preventing transmission of infections and patient safety, should be equally weighted. Beurhaus and colleagues report that many hospital-based registered nurses, non-hospital-based registered nurses and physicians are 55 years of age or older (Buerhaus, Auerbach, & Staiger, 2020). The higher risk of COVID-19 in older individuals and in particular those with chronic conditions has led to recommendations for those older than 60 years, to stay at home and practice social distancing to slow the spread of infection and help avoid overwhelming hospitals. However, we know that many nurses and physicians in this age group and with cardiovascular and other conditions are still going to work, increasing their vulnerability. Many stories of heroism and sacrifice have been presented in the media. Occupational health services for all workers, irrespective of age, sex, nationality, type of employment, and size or location of workplace, has been a recommendation of the World Health Organization (WHO) (Burton & WHO, 2010). Models of occupational health services vary from country to country and are influenced by regulatory and policy frameworks (Salguero-Caparrós, Pardo-Ferreira, Martínez-Rojas, & Rubio-Romero, 2020). Models of occupational health are now also expanding beyond physical health to consider psychological and social issues. Occupational health and safety is commonly embedded in the human resource function, and a review of the literature demonstrates limited data in the context of crisis management, particularly in the context of what we are seeing in the context of COVID-19 (Fan et al., 2020). In the Emergency Response Framework, the WHO define an emergency as a situation that has an impact on the lives and well-being of a large number of people or a significant percentage of a population and requires substantial multisectoral assistance (WHO, 2018). There appears to be a disconnect in some organisations between the approaches of usual work and a crisis. Although some organisations increased preparedness following recent infectious disease outbreaks, this has not been consistent across healthcare systems and countries. Moreover, COVID-19 challenges many models of mandatory reporting where causation and attribution of the infectious source may not be clear. There are also hot spots of infection and death such as nursing homes where detailed forensic analysis is warranted (Davidson, Padula, Daly, & Jackson, 2020). We recognise the many gaps in these data and methodological limitations but it is important to present this information, provide a voice to the voiceless and place this important issue front and centre. The highly dynamic nature of the COVID-19 pandemic means that the pictures provided by these data may change over time. But we hope this information will make countries take a deeper look at the well-being of their workforce. The percentage of deaths from healthcare workers compared to the general population is lower given they are using PPE to decrease the risk of exposure and have the skills to protect themselves. The general population risk without social distancing could mean that 81% of the world population could be infected (Ferguson, 2020). The modelling for projecting the actual number has varied widely. The bottom line is the number of healthcare workers who potentially can be infected remains high—nurses are particularly vulnerable to COVID-19 mortality given the number of contact hours that they have with infected patients compared to physicians, and specific groups, such as anaesthetists, are at a higher risk in activities such as intubation. Given the urgent need for health care services in time of pandemic, the need to keep health workers well and uninfected is critical and efficient and effective models of prevention are vital. The COVID-19 pandemic has caused unprecedented deaths among nurses and physicians signalling a need to examine and improve occupational health and safety for nurses and physicians and indeed, all health workers. In countries where there is a dire shortage of health professionals, the death or disability of physicians and nurses can have a cumulative and calamitous effect on populations. Exploring strategies to improve personal protection, policies for monitoring and surveillance of workplace characteristics are critical in ensuring the health and well-being of patients, staff and visitors. As the world pivots to a new era where the risk of new infectious diseases is increasing and another wave of COVID-19 looks us in the eye, this is a crucial issue requiring global focus and attention.
Jackson et al. (Tue,) studied this question.