tag:theconversation.com,2011:/ca-fr/topics/front-line-workers-86877/articlesfront-line workers – La Conversation2021-03-15T06:31:47Ztag:theconversation.com,2011:article/1571322021-03-15T06:31:47Z2021-03-15T06:31:47ZHow the latest COVID cases slipped through in NSW and Queensland — and what we can do better<p>Health authorities in Queensland and New South Wales are racing to prevent COVID outbreaks after one community case was recorded in each state over recent days.</p>
<p>Brisbane’s <a href="https://www.health.qld.gov.au/news-events/doh-media-releases/releases/covid-19-case-identified-at-pa-hospital2">Princess Alexandra Hospital</a> was put into lockdown on Friday night after a doctor who treated a returned traveller with COVID tested positive.</p>
<p>In Sydney, <a href="https://www.abc.net.au/news/2021-03-14/nsw-records-one-new-covid-19-case-in-hotel-quarantine-worker/13246856">a security guard</a> who worked at two quarantine hotels returned a positive result yesterday.</p>
<p>Neither state has recorded any further community cases so far, although hundreds of close contacts remain in quarantine. Let’s take a closer look at what’s happened.</p>
<h2>The vaccine doesn’t work immediately</h2>
<p>The Sydney security guard had received a first dose of the Pfizer vaccine. But this isn’t reason to be concerned about the vaccine’s effectiveness.</p>
<p>Reports indicate the man received his first dose <a href="https://www.abc.net.au/news/2021-03-14/nsw-records-one-new-covid-19-case-in-hotel-quarantine-worker/13246856">on March 2</a>, and health authorities’ working hypothesis is that he caught the virus during an overnight shift at the Sofitel Wentworth from March 6-7.</p>
<p>Data on the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2034577">Pfizer vaccine</a> show it only starts to protect 12 days after the first dose. Maximum protection, of course, only comes after the second dose.</p>
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Read more:
<a href="https://theconversation.com/not-sure-about-the-pfizer-vaccine-now-its-been-approved-in-australia-you-can-scratch-these-4-concerns-straight-off-your-list-153719">Not sure about the Pfizer vaccine, now it's been approved in Australia? You can scratch these 4 concerns straight off your list</a>
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<p>So we wouldn’t yet expect this person to be reaping the vaccine’s benefits at the time he was exposed.</p>
<p>It’s possible the first dose may have already conferred some level of protection, and we can hope this person may experience a less severe infection, and be less infectious to other people, than he would have had he not received a single dose days earlier. But we don’t know this will be the case.</p>
<p>We should be more worried about the fact the infected worker was employed at two Sydney quarantine hotels. Reports also indicate he worked a day job in <a href="https://www.abc.net.au/news/2021-03-15/zero-local-covid-19-cases-in-nsw-after-security-guard-infection/13247916">building management</a>. </p>
<p>I’ve <a href="https://theconversation.com/south-australias-6-day-lockdown-shows-we-need-to-take-hotel-quarantine-more-seriously-150368">previously argued</a> we need to create a model in which hotel quarantine workers only need to work across one site to minimise the risk of transmission.</p>
<p>The Victorian government <a href="https://www.vic.gov.au/hotel-quarantine-inquiry-victorian-government-response">adopted a recommendation</a> to discourage secondary face-to-face employment for key staff following the hotel quarantine inquiry.</p>
<h2>The Queensland case</h2>
<p>The doctor who contracted COVID in Queensland, on the other hand, hadn’t received the vaccine. This has <a href="https://www.brisbanetimes.com.au/politics/queensland/d-ath-defends-jab-rollout-after-revealing-covid-ward-doctor-not-yet-vaccinated-20210313-p57afi.html">raised the question</a> of why a doctor working with COVID-positive patients — irrefutably on the frontline — hadn’t got the jab yet.</p>
<p>The vaccine rollout is still in its early phases, and we can’t expect everyone in the first group (<a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-covid-19-vaccination-phase-1a-rollout-presentation">1a</a>) to have already received the vaccine.</p>
<p>However, where a large number of health-care staff have received at least a first dose, it would have been sensible to have a vaccinated doctor treating COVID-positive patients.</p>
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Read more:
<a href="https://theconversation.com/do-i-need-to-register-for-a-covid-vaccine-how-will-i-know-when-its-my-turn-vaccine-rollout-questions-answered-156041">Do I need to register for a COVID vaccine? How will I know when it's my turn? Vaccine rollout questions answered</a>
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<h2>Another hotel quarantine outbreak?</h2>
<p>Queensland is also now facing a possible outbreak within hotel quarantine, with genomic sequencing linking a second case in the <a href="https://www.news.com.au/lifestyle/health/health-problems/covid19-qld-waits-for-contact-tracing-results-as-doctor-tests-positive-hotel-plunged-into-lockdown/news-story/4e8811c26d93d649b3e6b1642b923bc0">Hotel Grand Chancellor</a> to the returned traveller we understand passed the virus to the doctor. This second guest tested positive on day 12 of their quarantine.</p>
<p>We don’t yet know for sure whether this second guest picked the virus up in quarantine; investigations are continuing. But we’ve seen the virus spread in hotel quarantine before, most recently at the <a href="https://theconversation.com/yes-another-lockdown-in-victoria-hurts-but-it-might-be-our-only-way-to-avert-a-third-wave-155212">Holiday Inn</a>, which sent Melbourne into a five-day lockdown.</p>
<p>One thing we could be doing better would be to test returned travellers every day, or at least every second day, rather than only at the beginning and towards the end of their 14 days, or if they develop symptoms. </p>
<p>For example, <a href="https://www.coronavirus.vic.gov.au/mandatory-quarantine-returned-overseas-travellers#when-you-arrive">in Victoria</a>, returned travellers are routinely tested on the third and eleventh days, and the policies seem to be similar in other states.</p>
<p>We’re missing a significant window here. Having a more precise idea of when the person became infected would give us a better idea of how they became infected. </p>
<p>For example, if it was closer to the beginning of their stay in hotel quarantine, it may be more likely they contracted the virus overseas or in transit and were still incubating the infection on arrival. Whereas if they did become infected only around day 12, we may be more inclined to explore the possibility they contracted the virus in quarantine.</p>
<p>This would also allow us to manage cases better, because as soon as someone tests positive, they could be moved to a “hot hotel” to minimise transmission risk.</p>
<p>This daily testing could be less invasive than the standard PCR tests, for example <a href="https://www.healthline.com/health-news/noninvasive-saliva-tests-for-covid-19-as-effective-as-nose-throat-swabs">saliva testing</a>. Any positive result could be validated with a PCR test.</p>
<h2>Hopefully we’ll avoid border closures and hard lockdowns</h2>
<p>Other <a href="https://www.news.com.au/travel/travel-advice/wa-victoria-tasmania-issue-health-alerts-in-response-to-new-nsw-coronavirus-case/news-story/11392aa85f5ac333962a300e238cd99d">Australian states</a> have instructed people who have been at any of the main exposure sites linked to these cases to get tested and quarantine. Victorian health authorities are actively seeking out people who have passed through Sydney to identify anyone who may be at risk.</p>
<p>Being able to trace, test and isolate, <a href="https://theconversation.com/australias-mishmash-of-covid-border-closures-is-confusing-inconsistent-and-counterproductive-152620">without closing borders</a>, is the way the system should ideally work.</p>
<p>These cases in NSW and Queensland remind us leaks are still possible and we have to be prepared. We can never get the risk down to zero, but everything we can do to reduce the risk is critical.</p>
<p>Along with continued infection control measures, the vaccine plays a big role. It can’t eliminate the risk completely, but as more people are vaccinated, the hope is it will reduce the impact of events like these.</p>
<p>We now wait to see the results from the close contacts’ tests in both states. Hopefully, these situations won’t escalate further and we’ll avoid the need for snap lockdowns and border closures. </p>
<p>But even if we’re able to avoid city-wide lockdowns, these events cause significant disruptions in the community. So it’s critical we investigate them thoroughly, and do everything we can to mitigate the risk they will happen again.</p>
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Read more:
<a href="https://theconversation.com/south-australias-6-day-lockdown-shows-we-need-to-take-hotel-quarantine-more-seriously-150368">South Australia's 6-day lockdown shows we need to take hotel quarantine more seriously</a>
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<p class="fine-print"><em><span>Catherine Bennett receives funding from the Medical Research Future Fund (MRFF) and has previously received funding from the NHMRC.</span></em></p>The risk of COVID escaping from hotel quarantine or a health-care setting will never be zero. But in NSW and Queensland, was everything possible done to minimise the risk?Catherine Bennett, Chair in Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1506752020-12-14T15:38:39Z2020-12-14T15:38:39ZSilenced and sacrificed: COVID-19 health-care workers’ secret suffering unveiled<figure><img src="https://images.theconversation.com/files/373634/original/file-20201208-16-14d34ty.jpg?ixlib=rb-1.1.0&rect=549%2C120%2C3476%2C2836&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health-care workers need public support. Hospital workers outside Sick Kids hospital in Toronto, July 17, 2020
</span> <span class="attribution"><span class="source">(OCHU-CUPE)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Health-care workers in Ontario — a workforce that is <a href="https://policyoptions.irpp.org/fr/magazines/may-2020/concern-about-pandemic-differs-across-gender-and-race-lines/">predominantly women, many of whom are racialized</a> — have been made especially <a href="https://btlbooks.com/book/sick-of-the-system">vulnerable during the COVID-19 pandemic</a>. </p>
<p>The <a href="https://theconversation.com/heath-care-workers-lacking-ppe-suffer-from-more-anxiety-and-depression-145612">risk of being infected with COVID-19</a>, the <a href="https://financialpost.com/pmn/press-releases-pmn/business-wire-news-releases-pmn/health-minister-misinformed-87-per-cent-of-ontario-health-care-staff-polled-say-not-enough-ppe-on-hand-to-keep-them-safe">lack of preparedness by governments</a>, little success in arguing for better protection and being barred from speaking publicly have left health-care workers feeling angry, <a href="https://doi.org/10.1177%2F0706743720961729">fearful</a> and sacrificed. The vulnerability and physical and mental health impact on health-care workers also affects health-care delivery to the public.</p>
<p>The COVID-19 pandemic changed the landscape of the health-care system. Health-care workers have been disproportionately infected, making up nearly <a href="https://www.thestar.com/news/canada/2020/09/19/nearly-20-per-cent-of-covid-19-infections-in-canada-among-health-care-workers-by-late-july.html">20 per cent of cases</a>, higher than the global rate among health-care workers. Meanwhile, worldwide <a href="https://www.cbc.ca/news/politics/ppe-shortages-slow-response-1.5684962">shortages of N95 masks influence local protection guidelines</a>. </p>
<p>After the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, an <a href="http://www.archives.gov.on.ca/en/e_records/sars/report/v1.html">independent commission provided a roadmap for handling future pandemics</a>. Recommendations included that N95 masks be available to health-care workers at all times. But governments <a href="https://www.cbc.ca/news/canada/saskatchewan/heath-minister-emergency-stockpile-1.5530081">disposed of expired N95s and other medical supplies and failed to replace them</a>. </p>
<p>Health-care workers in need of protection from COVID-19 and other risky working conditions in their jobs confidentially reported the impact of these decisions in our <a href="https://doi.org/10.1177%2F1048291120974358">recent study</a>. The research, a collaboration between University of Windsor occupational health researchers and the Ontario Council of Hospital Unions (OCHU-CUPE), which funded the study, unveils the stories behind the statistics of the thousands of health-care workers who have been infected with COVID-19.</p>
<h2>Study gives voice to health-care workers</h2>
<p>Health-care workers are not allowed to talk publicly about their working conditions. They are <a href="https://amnesty.ca/news/global-health-workers-silenced-exposed-and-attacked">systematically silenced</a> — disciplined or fired — for speaking out about unsafe working conditions. </p>
<p>We conducted anonymous telephone interviews in April and May 2020 with 10 health-care workers recruited with the assistance of the OCHU-CUPE provincial office. Another five participants cancelled, with two specifically citing fear of discipline or job loss if identified. </p>
<p>Prevalent themes in interviews included psychological distress, inadequacy of protection, inconsistencies in policy, government failings and barriers to agency. The stress and anxiety experienced by health-care workers were most prominent.</p>
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<img alt="Health-care workers in protective equipment" src="https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&rect=72%2C0%2C1205%2C628&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371130/original/file-20201124-21-m861ip.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Health-care workers in Ontario fear workplace risks due to government inaction on COVID-19.</span>
<span class="attribution"><span class="source">(OCHU-CUPE)</span>, <span class="license">Author provided</span></span>
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<p>During study recruitment, potential interviewees said they were too afraid to participate for fear of losing their jobs. A hospital clerical staff person interviewed for the study said,</p>
<blockquote>
<p>All the front-line workers fear reprisal. We are told, “You can’t talk to the media."… It’s just such a travesty and these issues need to be said and people need to know what’s really going on.</p>
</blockquote>
<p>The study safely and anonymously gives health-care workers a public voice and provides insight into their working conditions.</p>
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<img alt="An N95 mask that reads 'Help us'" src="https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371324/original/file-20201125-16-k9cjep.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Health-care workers are at risk of COVID-19 exposure, yet left without adequate protections such as personal protective equipment, including N95 masks.</span>
<span class="attribution"><span class="source">(OCHU-CUPE)</span>, <span class="license">Author provided</span></span>
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<p>Health-care workers share society’s background mental distress as well as stressors related to their work. An authoritarian and hierarchical culture in health-care work is described by health-care workers as contributing to risk and adverse mental health effects. </p>
<p>Interviewees reported that the risk of contracting COVID-19 and infecting family members or patients created intense anxiety. With under-staffing and increased workloads as well, health-care workers are suffering from exhaustion and burnout.</p>
<blockquote>
<p>There’s a lot of anxiety. When COVID-19 is over, the employer won’t have enough counsellors on hand to handle what I think is going to hit. Because people are anxious; people are fearful. They come to work; they don’t know if they have the illness or not, because sometimes you’re asymptomatic. They’re afraid to go home; their families are scared of them. It is just horrendous. And the morale is as low as it can be.</p>
</blockquote>
<p>A personal support worker (PSW) in a long-term care facility described difficulty coping with added stress, increased workload and making the sacrifice of working longer hours to keep up care:</p>
<blockquote>
<p>There’s definitely extra stress, and some days, you just break down and start crying.… Our workload is crazy, and the girls are just running on the floor to keep up.… Before the pandemic, we had a shortage of PSWs, and now we have more and more people going off work because they’re afraid. A lot of the staff are working double shifts.</p>
</blockquote>
<h2>Government failures create risks for health-care workers</h2>
<p>Ontario’s health-care system has been eroded by <a href="https://toronto.ctvnews.ca/ontario-spent-466m-less-on-healthcare-than-planned-ahead-of-covid-19-pandemic-1.5042104?cache=ftdpqpcfvtwjihs%3FclipId%3D104062">economic strains, understaffing and diminished capacity</a>. Interviewees divulged regulatory inadequacies. Health-care workers are at risk of COVID-19 exposure, yet left without adequate protections — including personal protective equipment (PPE) and <a href="https://www.ccohs.ca/images/products/infographics/download/hierarchy-covid.png">administrative and engineering controls</a> — as well as a lack of adherence to the <a href="http://www.archives.gov.on.ca/en/e_records/sars/report/v1-pdf/Vol1Chp3.pdf">precautionary principle, as explicitly recommended in the SARS Commission Report</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1318933702228008966"}"></div></p>
<p>The <a href="https://www.nytimes.com/article/coronavirus-masks.html">controversy around the aerosol transmission of SARS-CoV-2</a> affected health-care workers’ safety. N95 masks, considered the best protection against virus transmission, have not been available to health-care workers as authorities debated the science that <a href="http://doi.org/10.1001/jama.2020.12897">established airborne transmission</a>. Several health-care workers said requests for N95s were ignored. Supervisors warned nurses, saying:</p>
<blockquote>
<p>You are not to wear an N95 mask; you do not need it, you are fine to be wearing the mask with a shield, and if I catch you with one on again, you can be fined.</p>
</blockquote>
<p>Another nurse, told she couldn’t wear her own N95, resorted to hiding one she had purchased herself under a medical mask.</p>
<p>There is little trust in government decisions and policies for protection. A long-term care PSW explained:</p>
<blockquote>
<p>It makes it difficult when we feel that the best decisions for our safety — especially in regard to PPE — are not truly the best practice.… That’s a big concern for us on the front line.</p>
</blockquote>
<p>Another health-care worker interviewed put it very simply:</p>
<blockquote>
<p>All we are asking is, please protect us!</p>
</blockquote>
<figure class="align-center ">
<img alt="Women health-care workers in face masks holding up signs featuring N95 masks reading 'Help us'" src="https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=371&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=371&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371321/original/file-20201125-18-16jcxtp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=371&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health-care workers seek public support for their safety and health.</span>
<span class="attribution"><span class="source">(OCHU-CUPE)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Protecting health-care workers and the public</h2>
<p>Our study uncovers implications for health-care workers and health-care provision, and concludes with recommendations that include:</p>
<ol>
<li><p>Increased staffing levels in Ontario’s hospitals and in long-term care. </p></li>
<li><p>Changes to the workplace culture so health-care workers are heard. </p></li>
<li><p>Strong management support to mitigate mental distress. </p></li>
<li><p>Improved working conditions and PPE.</p></li>
<li><p>Legislated protection to allow staff to speak without reprisal.</p></li>
</ol>
<p><em>This article was co-authored by James T. Brophy, University of Windsor, University of Stirling, Athabasca University; Margaret M. Keith, University of Windsor, University of Stirling; and Michael Hurley, president OCHU-CUPE.</em></p><img src="https://counter.theconversation.com/content/150675/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane E. McArthur received funding for her doctoral research through a SSHRC Doctoral Fellowship, SWS Barbara Rosenblum Cancer Dissertation Award, Gail Rosenblum Memorial Breast Cancer Research Scholarship and Elena Loaring Memorial Award for Breast Cancer Research.</span></em></p>Ontario health-care workers confidentially reported feeling sacrificed on the job and needing protection from COVID-19 and other risky working conditions in a recent study.Jane E. McArthur, Doctoral Candidate, Sociology-Social Justice, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1456122020-09-28T20:08:55Z2020-09-28T20:08:55ZHeath-care workers lacking PPE suffer from more anxiety and depression<figure><img src="https://images.theconversation.com/files/358517/original/file-20200917-16-xad5y.jpg?ixlib=rb-1.1.0&rect=4%2C8%2C2645%2C2110&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A health-care worker is seen wearing full personal protective equipment outside the Royal Columbian Hospital in New Westminster, B.C. on April 3, 2020.</span> <span class="attribution"><span class="source"> THE CANADIAN PRESS/Jonathan Hayward</span></span></figcaption></figure><p>While all workers across Canada and around the world are being affected by COVID-19, health-care workers as a group are most heavily feeling its impact. This is because of their pivotal role in the treatment of people infected with the virus and their high COVID-19 exposure as part of their job. As such, maximizing efforts to enable the health-care workforce to remain free of COVID-19 infection, and stay in good physical and mental health, is essential to the response and management of COVID-19.</p>
<p>Including mental health in these efforts is important. Consider the situation of many health-care workers during the pandemic: their increased workload, the moral dilemmas they may face when providing patient care, their heightened personal exposure to COVID-19 infection, and their associated worries about infecting family and household members. It’s no surprise that <a href="https://doi.org/10.1136/bmj.m1642">previous studies</a> have shown increases in mental health symptoms among health-care workers during disease outbreaks and pandemics. </p>
<p>It is also important to identify workplace factors linked to mental health that can be changed. While personal protective equipment (PPE) and infection control procedures are often discussed as measures to reduce virus transmission, we also need to understand their importance in the context of mental health, especially since the <a href="https://doi.org/10.1136/bmj.m1211">mental health impacts</a> of COVID-19 may linger beyond the pandemic. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A cart holding PPE, including surgical masks, N95 masks, gloves, gowns and caps" src="https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358984/original/file-20200921-24-qsxoax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Personal protective equipment in the COVID-19 intensive care unit at St. Paul’s Hospital in downtown Vancouver on April 21, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p>Our team of work and health researchers recently examined the association between the perceived adequacy of PPE and infection control procedures, and symptoms of anxiety and depression among health-care workers. As reported in our <a href="https://doi.org/10.1177/0706743720961729">paper</a> in the <a href="https://journals.sagepub.com/home/cpa"><em>Canadian Journal of Psychiatry</em></a>, we found greater levels of mental health symptoms among workers who indicated their needs for PPE and infection control procedures were not met.</p>
<h2>Assessing mental health and protection measures</h2>
<p>About 6,000 health-care workers in hospitals, long-term care homes and other community care settings were recruited across Canada through the networks of an ad-hoc pandemic survey group. Responses were collected by the <a href="https://www.ohcow.on.ca/">Occupational Health Clinics for Ontario Workers</a> and then analyzed at the <a href="https://www.iwh.on.ca/">Institute for Work & Health</a>. Surveys were conducted between April 7 and May 13, 2020, during the height of the first wave of COVID-19 infections in Canada.</p>
<p>To assess symptoms of anxiety and depression among health-care workers, we asked questions from two validated screening instruments: the General Anxiety Questionnaire (GAD-2) and the Patient Health Questionnaire (PHQ-2). </p>
<p>We also asked about eight different types of PPE that might be needed such as gloves, hand sanitizer, face shields, procedural masks and N95 masks. For each type of PPE, respondents indicated if these were needed and adequately supplied (both in terms of appropriate type and adequate amounts), needed but not adequately supplied, or not needed. </p>
<p>We further asked about 10 different types of infection control procedures such as screening patients, isolating symptomatic patients from other patients and staff, frequent cleaning, and using engineering controls such as ventilation systems. Again, respondents told us whether these were appropriate and adequately implemented, required but inadequately implemented or not required. </p>
<p>We then grouped respondents based on the proportion of their needs for PPE or infection control procedures that were met, and ran statistical models to estimate the proportion of respondents in each of these groups with symptoms of anxiety and depression. Our models took into account a variety of factors about each respondent (age, gender and visible minority status), where they lived (province and urban/suburban/rural setting), the type of health-care facility they worked in, the hours of work per week and how long they had worked there, their level of exposure to COVID-19 patients, level of infections in their workplace, if they had experienced COVID-19 symptoms and training on PPE. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two health-care professionals, one of whom is adjusting a face shield and the other is putting on a yellow protective gown." src="https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358987/original/file-20200921-14-q0qn3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Health-care workers put on personal protective equipment before testing at a drive-through COVID-19 assessment centre at the Etobicoke General Hospital in Toronto on April 7, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>We found that, among respondents with 100 per cent of their PPE needs met, 42.9 per cent reported symptoms consistent with anxiety; this increased to 60.4 per cent among respondents with none of their needs met. This was after taking into account the factors listed above which might also be related to anxiety symptoms. Similar differences were observed in anxiety symptoms between workers with none or all of their needs for infection control procedures met (43.4 per cent of workers with all their infection control needs met had anxiety symptoms compared to 60.6 per cent of workers with none of these needs met). We also observed differences in the prevalence of depression symptoms among these same groups (differences of 11 percentage points for PPE needs, and 19 percentage points for infection control procedures). </p>
<h2>Implications for health-care workers</h2>
<p>While no silver bullet will adequately address the increased mental health needs of health-care workers during COVID-19, our study demonstrates that the perceived adequacy of PPE and infection control procedures in health-care workplaces is associated with important differences in anxiety and depression symptoms. As such, it is important that health-care workplaces provide adequate and appropriate PPE and institute effective infection control procedures — not just to reduce COVID-19 infection, but to help reduce the mental health strain faced by health-care workers.</p><img src="https://counter.theconversation.com/content/145612/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Smith has received project funding from The Canadian Institutes of Health Research, The Ontario Workplace Safety & Insurance Board, WorkSafe BC, Alberta Futures, and the Australian Research Council</span></em></p>Health-care workers’ access to personal protective equipment, along with appropriate infection control procedures, affected their mental health during the first wave of the COVID-19 pandemic.Peter Smith, Senior Scientist, Institute for Work & Health. Associate professor, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1377492020-05-13T18:33:08Z2020-05-13T18:33:08ZHere’s how the coronavirus is affecting Canada’s labour market<figure><img src="https://images.theconversation.com/files/334521/original/file-20200512-82403-1627iw.jpg?ixlib=rb-1.1.0&rect=486%2C8%2C4727%2C3654&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not only have people lost jobs, they have also stopped looking for work.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The shutdown of non-essential services to control the spread of COVID-19 has had severe economic consequences in Canada, including <a href="https://www.statcan.gc.ca/eng/survey/household/3701">the loss of nearly two million jobs in April</a>. </p>
<p>As economists, we are analyzing the effects of COVID-19 on Canadian labour markets in an ongoing <a href="https://www.lpbeland.com/research.html">research paper</a> by asking the following questions: </p>
<ul>
<li>What are the short-term impacts of COVID-19 on unemployment, hours and wages?</li>
<li>Do the economic consequences vary across demographic groups, union status and immigration status? </li>
<li>Are there larger effects for occupations that are more at risk of contracting the virus? </li>
<li>Are there smaller effects for individuals who can easily work from home? What is the impact on the labour market for essential workers? </li>
<li>Which occupations and industry are seeing the biggest changes in economic outcomes?</li>
</ul>
<p>Understanding which workers are most affected by the coronavirus economic shutdown will help guide policy and Canada’s economic recovery. </p>
<h2>The hardest hit</h2>
<p>COVID-19 has had a severe impact on Canadians in terms of unemployment rates, hours worked and labour force participation — the proportion of the adult population currently employed or seeking employment.</p>
<p>Job losses have been staggering. The unemployment rate more than doubled to nearly 14 per cent between February and April. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/333909/original/file-20200511-49573-1x4kzyc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The unemployment rate in Canada between January 2016 to April 2020. The x-axis represents time in months, with m1 representing January.</span>
<span class="attribution"><span class="source">(Data from Statistics Canada. Calculation by authors)</span></span>
</figcaption>
</figure>
<p>But this measure is an understatement of how dire the situation is — labour force participation fell by five percentage points to 59.8 per cent over the same period. These individuals aren’t included in unemployment calculations, which only capture people who are looking for work. This means that a fall in labour force participation translates to people not searching for work. Not only have people lost jobs (increased unemployment), they have also stopped looking for work (decreased labour for participation). </p>
<p>One concern is that COVID-19 might increase existing inequalities in the Canadian labour market. For example, if minimum wage earners lost their jobs, it could affect their ability to pay for rent or other essentials. Knowing which workers are more affected will help guide effective policy recommendations. </p>
<p>Our results suggest that the negative impacts of COVID-19 are more pronounced for workers who are younger, unmarried or less educated. We also find evidence that workers in unions are less likely to be negatively affected. In sum, our results suggest that COVID-19 may be deepening already existing inequalities. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/remote-work-worsens-inequality-by-mostly-helping-high-income-earners-136160">Remote work worsens inequality by mostly helping high-income earners</a>
</strong>
</em>
</p>
<hr>
<p>COVID-19 has negative labour market outcomes for both men and women, with no discernible differences between the two, suggesting that the shutdown has not increased gender inequalities. Our results also indicate that women without children have experienced slightly larger job losses, reductions in hours, wages and labour force participation than mothers. </p>
<p>We find that immigrants and non-immigrants similarly experienced a near doubling of the unemployment rate to just below 13 per cent, and a six percentage point decline in labour force participation to just below 58 per cent. </p>
<h2>Essential and remote workers are less affected</h2>
<p>To gain further insight into why some workers have been affected by the economic impacts of COVID-19 more than others, we also looked at the characteristics of different jobs. </p>
<p>We built four indices that capture whether workers in a given occupation are regularly exposed to infectious diseases, work in proximity to others, are considered essential workers or are more likely to work remotely. We constructed the indices from various sources, including <a href="https://www.onetonline.org/">O-NET OnLine</a>, which gathers information on occupational tasks and adapted them to the Canadian Labour Force Survey. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=531&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=531&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334523/original/file-20200512-82375-1h2rb0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=531&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Empty storefronts on Queen Street West in Toronto in April 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>Our estimates suggest that the labour market impact of the pandemic was significantly more severe for workers more exposed to disease and people that work alongside others, such as nurses and front-line workers. These workers were more likely to have COVID-19 related work absences, work fewer hours or leave the labour force. Perhaps unsurprisingly, we also found the effects are significantly less severe for essential workers and people who can work remotely.</p>
<p>Additionally, we find that these occupational differences interact with the inequalities noted above. For example, less educated workers are less likely to work from home and more likely to be essential workers. Women without kids are less likely to work from home, perhaps explaining why they were relatively harder hit by the economic shutdown.</p>
<h2>Looking ahead</h2>
<p>These results are important given the trade-off elected officials face when making decisions about reopening sections of the economy and preventing disease. </p>
<p>As policy-makers look to help displaced and affected workers, these findings highlight some of those most in need of assistance: the young, the unmarried and those with less education. Our results also suggest that governments should consider promoting policies that encourage businesses to let their employees work from home.</p>
<p>The federal and provincial governments have provided a variety of aid packages to individuals and organizations that should help alleviate financial burdens. A key concern going forward is that this aid could create <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2769176">a disincentive to work</a>, especially among low-income earners. This could have the unintended consequences, increasing long-term income and wealth inequalities. All levels of governments should monitor this closely.</p><img src="https://counter.theconversation.com/content/137749/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:abrodeur@uottawa.ca">abrodeur@uottawa.ca</a> receives funding from Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Taylor Wright receives funding from the government of Ontario. </span></em></p><p class="fine-print"><em><span>Derek Mikola and Louis-Philippe Beland do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Younger, unmarried or less educated workers are feeling the brunt of the economic effects of COVID-19. The fallout may deepen already existing inequalities.Louis-Philippe Beland, Assistant Professor of Economics, Carleton UniversityAbel Brodeur, Associate professor, L’Université d’Ottawa/University of OttawaDerek Mikola, Ph. D. Candidate, Department of Economics, Carleton UniversityTaylor Wright, PhD Candidate in economics, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.