Managing Covid-19 ‘clusters’ set to be a key challenge for occupational health

first_imgRelated posts: Managing Covid-19 ‘clusters’ set to be a key challenge for occupational healthBy Nic Paton on 2 Oct 2020 in Shielding, Stress, Mental health conditions, Coronavirus, Health surveillance, OH service delivery, Return to work and rehabilitation, Occupational Health, Personnel Today Shutterstock A recent SOM/Royal College of Nursing webinar offered occupational health practitioners valuable advice on how to manage Covid-19 outbreaks as we head through the autumn and into the winter and how, despite all the added pressures it is bringing, the pandemic could actually be an opportunity for the profession. Nic Paton listened in.As we head into the autumn there is a lot still that we don’t know or understand about Covid-19. One issue increasing becoming clear, however, is that the government’s so-called ‘whack-a-mole’ strategy for dealing with local flare-ups – implementing temporary local lockdowns or restrictions – is likely to cause challenges for occupational health as well as, potentially, community tensions on the ground.Especially where an outbreak is centred on a specific employer or premises, it stands to reason that how that employer responds will be in the media and public spotlight, with the occupational health team, if there is one, also potentially likely to be centre-stage.That was very much the case, for example, with the cluster of cases that emerged at food manufacturer Greencore in August, where occupational health provision is led by the highly regarded head of occupational health Julie Routledge.Over the summer we also saw clusters emerging at, to pick out just a few, a Tesco Extra in Swindon, a food processing plant in Scotland, and a bar in Aberdeen. Indeed, a report by the European Centre for Disease Prevention and Control in August calculated that there had been 1,376 clusters of Covid-19 in occupational settings within the UK and 15 European Union/European Economic Area countries between March and early July, with the health sector, food processing and packaging, manufacturing and office settings all highlighted.The role of occupational health practitioners in providing advice, guidance and leadership to employers and individuals in the event of a Covid-19 outbreak or cluster was at the heart of a recent webinar on OH and Covid-19 run by SOM, the Society of Occupational Medicine, and the Royal College of Nursing.Chaired by SOM’s president, Professor Anne Harriss, the webinar brought together Susie Singleton, consultant nurse, health protection, and national lead for Integrated Personal Commissioning, Centres and Regions, at Public Health England, and Dr Shriti Pattani, chair of the NHS Health at Work Network and clinical director at London North West University Hospitals NHS Trust.Defining an ‘outbreak’Singleton began the event by recapping how the pandemic had unfolded since the beginning of the year and where we are now. As she conceded: “This is unprecedented. I have been involved in previous epidemics, pandemics, big outbreaks – but nothing of this scale. And I think that everybody is really trying to work hard to get the best information out to everybody as quickly as possible.”When managing an outbreak, it was important, first, to recognise what was even meant by the term ‘outbreak’, she emphasised. “Within this country we have very defined terminology and, within epidemiology, it is normally defined as more than two cases related in place and time,” she said.“But I must also stress that you can have an ‘outbreak’ with one case. If we have an unusual disease that is not normally associated with this country, or it has been imported; something like polio, then one case would constitute an outbreak, and we would then instigate outbreak control measures. So the definitions will change depending on what it is we are looking at,” she added.It was also important to try to gauge whether what you are dealing with is a workplace outbreak or a workforce outbreak, she advised.“We are seeing asymptomatic carriage within the community coming into the workplace. And then it can be transferred on to other colleagues at work. Some of the high-profile ones that have hit the news are some of the food manufacturing plants. So there is a lot of work undergoing and being underpinned in identifying what is happening within the regions and within the workplaces, and there are health protection teams and contact tracing teams up and down the country now.“In some of the high-prevalence areas local authorities are also undertaking contact tracing when people are not responding to digital platforms or being contacted by email or telephone. Some of the local authorities are now contact tracing and going door to door. So there is a lot of work, and a lot of very tired staff out there,” Singleton said.“It is really, really important to try and understand what we know, what we don’t know, what we actually think is happening; developing a sort of hypothesis, and then going on to test it to see if we can understand what is going on. This in public health terms also includes what I like to call ‘shoe leather epidemiology’.“You can’t manage an outbreak from an office; you can’t manage an outbreak without physically going and seeing what is going on. Because a lot of the information we pick up is ‘soft’ intelligence. It might be about the environment, the ventilation, the airflows. It might be about waste control. It may be about human behaviours. So it is very, very important to talk to the people on the ground, and they are often the ones who will have the information that best helps to control the outbreaks,” Singleton added.Key steps of effective risk assessmentSingleton also recapped on some of the key steps of effective risk assessment. “If you suspect an outbreak, then we need to investigate; it needs to be reported on suspicion and not wait until it is actually confirmed. We need to ensure that we have identified the hazard. We need to decide who might be harmed. We need to assess the risks and what action to take. We need to make a recording of the findings. We need to review the risk assessments. And we need to learn the lessons and cascade the lessons.”The second speaker, Dr Shriti Pattani, focused on risk assessment for Covid-19 and the issue of protecting vulnerable staff within the workplace. She emphasised that, of course, risk assessment by itself is not enough. “It needs to be followed through with appropriate control measures and monitoring.”Within this, it was important not just to look at how an individual might get Covid-19 but also the extent of harm that could occur if they became infected. “As OH practitioners, we need to make an assessment on the likelihood of that harm occurring to the individual health of the worker,” she pointed out.This had led not only to an increase in workload for many within OH but also the need to be working with managers in a different way. “We [occupational health] promote the idea that they [managers] look at functional capacity, not individual health. I personally don’t know of any other risk assessments over my years of practising as an OH physician under health and safety law that has required this level of input from occupational health. In my department over the last month we have received 1,350 risk assessments that we personally needed to get involved with,” she said.At her trust, the OH service had created a risk assessment tool with an appendix of all the health conditions outlined by Public Health England as making an individual vulnerable to Covid-19. “We asked managers to simply ask their member of staff, ‘do you have one of these conditions?’, and not to actually to go into the detail of the condition or what it is or any of the treatments. And that actually produced a very efficient way of dealing with this particular issue around managers having access to health information,” said Dr Pattani.Along with the ongoing and updated guidance from the Health and Safety Executive and Public Health England (at least until is replaced by the government’s proposed new National Institute for Health Protection), Dr Pattani highlighted the Welsh Government’s Covid-19 risk assessment tool as being valuable, along with the ‘Covid age’ medical risk assessment tool developed by ALAMA (the Association of Local Authority Medical Advisors) and SOM’s suite of return-to-work guidance and toolkits.New national clinical assessment toolkitDr Pattani also pointed to the development of a new national clinical assessment toolkit by the government that would be available for clinicians, including occupational health practitioners, “later in the year”.As she outlined: “The idea is that we can actually give our patients, our workers, a consistent approach to assessing their clinical vulnerability. And, as healthcare practitioners – GPs, specialists and OH practitioners – we can all sing from the same hymn sheet and give our patients and our workers the same clinical risk advice.”For all the challenges Covid-19 was posing for occupational health practitioners, and all the added pressure and workload it was creating, the pandemic was, arguably, also an opportunity for the profession to show its worth to employers and the wider public, Dr Pattani argued.“I think there has never been a better opportunity for us to demonstrate the value that a well-resourced occupational health service can bring, and our special skills in actually managing and supporting and assessing the fitness to work of our workforce,” she said.“Certainly, I know that in the NHS occupational health has had a very high profile and we’ve had many staff who have been redeployed in my service. We went from 12 staff to 36 within two weeks to deal with Covid hotlines, swabbing, antibody testing, risk assessment, now track and trace and the big asymptomatic staff testing programme that is starting,” she said.“Nationally, certainly, there is more of a focus on investing in occupational health. So, I hope this might be a real opportunity for occupational health to be recognised as an important speciality [sic] in its own right, and an investment made in occupational health services,” she added.Possibility of a Covid-19 vaccineDuring the webinar’s question and answer session, Dr Pattani was asked to offer her advice on how OH should best be managing and supporting workers who are anxious or fearful about returning to physical workspaces. She emphasised it was vital to understand their anxieties – it could be, for example, it was more about travelling on public transport than actually being in the work environment – and whether the fears were more perception than reality.In her trust, all workers who had been shielding had been sent individual letters outlining the trust’s risk mitigation actions, managers had arranged personal calls to run through a Covid risk assessment and, where appropriate or necessary, workers had been referred to the trust’s employee assistance programme. “For those who were extremely anxious, within occupational health we have been running Covid hotlines; so we actually called them to have an independent conversation with them as well,” she pointed out.Susie Singleton was then asked for her view on the chances of a viable vaccine becoming available by the end of this year. “The rule of thumb has always been that, if we identify a new vaccine, it normally takes 10 years from lab to shelf or patient or client or whoever we are giving it to,” she pointed out.“In reality, yes there are a couple of vaccines currently in the human trials aspect, and the UK is one of the leading lights in this. To have it one the shelf and ready by December I would doubt very much. It is the safety mechanism – there is a vaccine out there that is looking very, very promising – but in reality I would say, if everything goes to plan, we are probably looking at spring 2021 or after. I hope I’m wrong!” she added.The webinar concluded with the results of a poll of participants asking how they felt OH professionals would be involved, and where they would most add value, if there was a second wave of Covid-19 this autumn.The majority (90%) said return to work would be the key area, along with case management and managing sickness absence (84%), managing and supporting mental ill health (79%) and leading on risk assessment (78%).As well as contributing to the webinar, Dr Pattani has written about her experiences as an NHS occupational health physician during Covid-19 in the August edition of the journal Occupational Medicine. This has included how the trust set up a call centre-style hotline, a drive-through and community testing programme, and a seven-day OH and testing service. The article can be found at“Coronavirus: Prime minister says ‘we’ll be doing whack-a-mole’ on local flare-ups”, Sky News, May 2020,“Greencore’s Covid 19-positive workers ‘huge disaster’ says council leader”, BBC News, August 2020,; Statement Regarding COVID-19 Outbreak in Northampton, Greencore, August 2020,“Coupar Angus food processing plant closed after coronavirus cluster”, BBC News, August 2020,“Coronavirus: Outbreak among staff at Tesco Extra supermarket in Swindon”, Sky News, August 2020,“‘We are truly sorry’ Aberdeen bar at centre of coronavirus cluster apologises and says it is not ‘rushing to reopen’”, Daily Record, August 2020, clusters and outbreaks in occupational settings in the EU/EEA and the UK, European Centre for Disease Prevention and Control, August 2020,“Government creates new National Institute for Health Protection”, Department of Health and Social Care, August 2020, workforce risk assessment tool,, Covid-age, August 2020, to the workplace after the Covid-19 lockdown – toolkits, SOM, No comments yet. Leave a Reply Click here to cancel reply.Comment Name (required) Email (will not be published) (required) Website Talking toolkits: unpicking Covid-19 return-to-work advice for occupational healthWith the UK now gradually reopening for business, organisations across the workplace health spectrum have been developing toolkits and resources…center_img Previous Article Next Article Coronavirus: lockdown ‘phase two’ may bring added headaches for occupational healthNiggles, aches, pains and anxieties stored up during lockdown need to be nipped in the bud before they become long-term… Coronavirus, anxiety and return to work – how occupational health can make a differenceWith both the government and employers now firmly focused on encouraging workers out of home-working and back into physical workplaces,…last_img read more

Breaking and tying record not the same

first_imgHaving been an observer of the “Gazette Almanac” for some time and keep the records going back to the 1800s, I know nothing of the weather other than what I read and observe.For some time now, the “Weather Almanac” has been listing temperatures as new records, when in fact, the record for that temperature on that day took place years ago in some instances, decades ago. For example, the “Gazette Almanac” listed May 2, 2018, as the record of 88 degrees. In fact, 88 degrees was the record high set in 2001 for May 2.As a jock in school, I was taught that a record was a record until broken, not tied. I realize that you publish what is given you, but perhaps your opinion might change this going forward. I’m sure you could agree that historical fact is lost in not doing so.Let your readers decide.L.J. KingDuanesburgMore from The Daily Gazette:EDITORIAL: Beware of voter intimidationLocal movie theater operators react to green lightFoss: Should main downtown branch of the Schenectady County Public Library reopen?Schenectady County warns of possible COVID-19 exposure at Schenectady restaurant, Rotterdam barEDITORIAL: Thruway tax unfair to working motorists Categories: Letters to the Editor, Opinionlast_img read more

Liverpool stunned by Burnley, Chelsea rally to win

first_img(REUTERS)-Liverpool were sent spinning to a 2-0 defeat at promoted Burnley in the Premier League yesterday while Chelsea came from behind to win 2-1 at Watford thanks to late goals from Michy Batshuayi and Diego Costa.Elsewhere, Sergio Aguero and Nolito scored twice apiece as Manchester City won 4-1 at Stoke City to give Pep Guardiola’s men their second straight victory while champions Leicester City were held to a 0-0 home draw by Arsenal.Sam Vokes and Andre Gray scored first-half goals to put Burnley in command against Liverpool who were a pale shadow of the team that beat Arsenal 4-3 in their opening game of the season last weekend.“How can I be happy with this?”, said Liverpool manager Juergen Klopp. “Everybody needs to be more clinical.“Burnley deserved to win with a very passionate performance. We have to say it wasn’t enough today.”Vokes netted with a rasping shot in the second minute before Gray bagged his first top-flight goal with a crisp low strike from 18 metres.Etienne Capoue gave Watford a 55th-minute lead against Chelsea after smashing a swerving shot into the top corner of the net.Substitute Batshuayi equalised in the 80th minute with his first goal for the club before Costa, who scored a late winner against West Ham United on Monday, finished calmly three minutes from time after being found by another sub, Cesc Fabregas.“I’m pleased to see a reaction from my players,” said Chelsea manager Antonio Conte. “This win’s very important for us as it gives everyone confidence.”Manchester City were arguably flattered by the 4-1 scoreline at Stoke.SHAWCROSS FOULAguero, who missed two penalties in City’s 5-0 Champions League playoff first-leg victory at Steaua Bucharest in midweek, opened the scoring from the spot after Ryan Shawcross impeded Nicolas Otamendi.The Argentine then doubled his tally after 36 minutes, meeting a sumptuous Kevin De Bruyne free kick to send a fine header into the far corner of the goal.Stoke fought back when Spanish forward Bojan beat keeper Willy Caballero from the spot but substitute Nolito struck twice late on for Manchester City.“I am really impressed with the players as human beings and with their performance,” said Guardiola.Leicester were left fuming after they had two strong penalty appeals denied against Arsenal.A staid first half came to life in the final minutes when Danny Drinkwater was felled by Laurent Koscielny but referee Mark Clattenburg waved away frantic appeals from Jamie Vardy and Riyad Mahrez, prompting a cacophony of boos from the home fans.Substitute Ahmed Musa was then brought down by Hector Bellerin in the 88th minute as Leicester’s counter-attacking pace put Arsenal under pressure, only for Clattenburg to again wave play on.“I don’t want to talk about the decisions,” said City boss Claudio Ranieri. “The managers make mistakes, the referees make mistakes, the players make mistakes.”Victor Wanyama netted in the 83rd minute as Tottenham Hotspur beat Crystal Palace 1-0 while Everton won 2-1 at West Bromwich Albion.Hull City became the first promoted side since Bolton Wanderers in 2001 to win their opening two matches when they triumphed 2-0 at Swansea City.last_img read more