We should not accept compromises and strive for a goal of zero work-caused fatalities, emphasises Dr Will Ponsonby

Many healthcare workers have died of covid-19. We don’t know if they all acquired their infection at work. However, because of their exposure to patients with covid-19, at least some of those fatalities are likely to be work caused. Every work-related death should be investigated so that lessons can be learnt and shared. 

We hear politicians and managers using war analogies. They speak of the “fight” on the frontline, of inevitable casualties, of healthcare workers making the supreme sacrifice. This must stop. We must change the narrative.

Doctors and nurses do not go to work to make the supreme sacrifice or put themselves in the firing line. They go to work to do their jobs, to follow their vocations to care for the sick and dying. We should not expect them to join the ranks of their patients. They should be able to go home safe and well every day at the end of their shift to care for their own families. We need to change thinking away from the war zone, to the calmer and safer world of risk management.

Risk assessment

Even during pandemic, trusts and managers have legal duties to protect the health of workers. Covid-19 is a biological hazard and covered by Control of Substances Hazardous to Health regulations. Employers must carry out a risk assessment and provide measures to reduce harm to health; they must ensure those measures are used; and provide information and training and health surveillance.

During the ebola outbreak in West Africa, UK clinical teams that went to help suffered no fatalities

The new guidelines on personal protective equipment are welcome and improve the levels of protection for staff, but these should be a minimum. Staff must receive training, fit testing and monitoring. Higher levels of protection, such as air-fed masks for those working in ITU, should be available when needed.

These are important controls, but we must use the hierarchy of controls, eliminating risk for those who don’t need to be in the red zone, use engineering controls such as ventilation, use administrative controls such as fitness to work to ensure we are not exposing vulnerable workers unnecessarily.

This all provides a structured system of care to prevent infection. Occupational health and occupational hygiene professionals are trained to deliver and monitor these systems. There are many OH professionals in the private sector who are under employed as industry is closed. We need to mobilise them to work with and support our colleagues in the health and social care sectors. In fact, we need to extend this protection and target of goal zero to all key workers.

Where there are suspected failures in the safe systems of work, such as dangerous occurrences, or suspected work caused fatalities, these must be reported under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations. All such incidents must be investigated, any breach of controls should be identified and corrected, and learnings cascaded.

During the ebola outbreak in West Africa, UK clinical teams that went to help suffered no fatalities. This was because of the implementation of systems outlined above. Ebola is a more deadly disease; this demonstrates these systems are effective.

At the Cotugno Hospital near Naples in Italy, they have adopted a comprehensive strategy to protect workers. This is a hospital treating only coronavirus patients. So far, they have not had a single work-acquired infection. As Sky news noted: “They have the right gear and follow the right protocols. It [death] does not have to be inevitable, it is not here.”

The challenge with this pandemic is the scale. There are many hundred workplaces and hundreds of thousands of workers. However, the basic principles and controls are clear. We should not accept compromises and we should all strive for a goal of zero work-caused fatalities and accept nothing less.