Although the worst of the coronavirus disease 2019 pandemic appears to be over, the burden of airborne infection in workplaces remains unacceptably high, leaving society vulnerable, and harming workers and others. A better approach is needed to mitigate the risk of infection as actively as other multifactorial ubiquitous risks such as workplace stress. Sources and pathways of transmission need much improved control, with special emphasis on ensuring the protection of the vulnerable and susceptible.

BACKGROUND:As a consequence of their occupation, doctors and other healthcare workers were at higher risk of contracting coronavirus disease 2019 (COVID-19), and more likely to experience severe disease compared to the general population. However, systematic information on post-acute COVID complications in doctors is very limited.AIMS:This study aimed to determine the symptoms, perceived determinants, health and occupational impact, and consequent needs relating to post-acute COVID complications in UK doctors.METHODS:An online cross-sectional survey was distributed to UK doctors self-identifying as having Long COVID or other post-acute COVID complications.RESULTS:Of 795 responses, 603 fulfilled the inclusion criteria of being a UK-based medical doctor experiencing one or more post-acute COVID complications. Twenty-eight per cent reported a lack of adequate Respiratory Protective Equipment at the time of contracting COVID-19. Eighteen per cent of eligible respondents reported that they had been unable to return to work since acquiring COVID.CONCLUSIONS:Post-acute COVID (Long COVID) in UK doctors is a substantial burden for respondents to our questionnaire. The results indicated that insufficient respiratory protection could have contributed to occupational disease, with COVID-19 being contracted in the workplace, and resultant post-COVID complications. Although it may be too late to address the perceived determinants of inadequate protection for those already suffering with Long COVID, more investment is needed in rehabilitation and support of those afflicted.

In May 2023 the World Health Organization (WHO) Director General announced the "end" of the COVID-19 Public Health Emergency of International Concern. Although the scale of the pandemic was unprecedented in living memory, it had not been unforeseen. Previous outbreaks of viral respiratory disease have shown important lessons regarding the need to protect healthcare workers (HCW), and research has also been undertaken into the relative effectiveness of control measures and their resource implications. Relevant guidance for worker protection, including HCW protection, which existed at the onset of the COVID-19 pandemic was disregarded both at international and national governmental levels. In many countries there were significant systemic flaws in strategy, culture, and resource availability, and hence in overall preparedness. When the pandemic struck, many experts and organizations advocated a precautionary approach with regard to worker protection, consistent with good occupational hygiene science, practice, and standards. In many Asian countries, protective measures were relatively stringent. However, many workers were left unprotected especially as the WHO, the United States, the United Kingdom, and other governments did not pursue adequate COVID-19 protective measures at work. As the pandemic progressed, improvements in protection were patchy. A notable lack of protection arose from the underestimation of the contribution of aerosol exposure to infection risks, particularly among HCWs providing routine care of potentially infectious patients. A disciplined strategy of source control, pathway control (such as ventilation), and receptor control notably Respiratory Protective Equipment is needed, as well as worldwide vaccination, to contend with this pandemic. Control measures appropriate to the risk of infections transmitted through the air will remain necessary in the longer term, as well as adaptations in the workplace to take account of long-term COVID-19 morbidity and new work practices.

The Rössing Uranium Limited (RUL) open-cast uranium mine in Namibia has operated since 1976. Studies of underground uranium miners from Europe and North America have shown increased cancer risks (principally lung cancer). We explored the association between radiation doses and selected cancers in RUL mineworkers. Employees with at least one-year of continuous employment between 1976 and 2010 were included. Incident cancer cases [lung, extra-thoracic airways (ETA), leukemia, brain and kidney] occurring before the end of 2015 were identified from the Namibian and South African National Cancer Registries, and RUL’s occupational health provider. Using a case-cohort design, data on exposure and confounding factors were collected for all cancer cases among the study cohort and a stratified random sample (sub-cohort) of the cohort, including cases. Radiation doses were estimated based on annual dose records held by RUL. In total, 76 cancer cases (32 lung, 18 ETA, 8 leukemia, 9 brain, 9 kidney) and a sub-cohort of 1,121 sampled from 7,901 RUL employees were included. A weighted Cox model, adjusted for available known confounders, produced a rate ratio (95% CI) for lung cancer of 1.42 (0.42, 4.77) and 1.22 (0.26, 5.68), respectively, for medium and higher cumulative lung dose categories compared to the lower category, and 1.04 (0.95, 1.13) for a dose increase of 10 mSv. This study faced considerable challenges with respect to case ascertainment, exposure estimates, and ensuring accuracy of key variables. Persuasive consistent evidence for elevated cancer risk was not found for radiation or other exposures studied at the Rössing uranium mine.

This paper addresses lessons learned from the COVID-19 pandemic from a UK Occupational Medicine perspective to permit comparison with other national accounts. In spite of good prior research and statute, the necessary resources to protect workers' health were seriously lacking when the pandemic struck. Weak public health guidance, which did not recognise dominant airborne transmission, was applied to workplaces, leaving workers and others unprotected, especially in respect to Respiratory Protective Equipment (RPE). The Health and Safety Executive (HSE) as regulator was lacking, for example, in not producing guidance to protect HealthCare Workers (HCW) who were amongst the most at risk. The UK COVID-19 Public Inquiry should address shortcomings such as these, but recommendations must be accompanied by robust means to ensure appropriate implementation. These should range from substantial measures to improve indoor air quality, to a permanent pandemic management organization with adequate resources. The enforcing authority has to be obliged to publish more specific workplace guidance than the public health authorities. Occupational medicine as a discipline needs to be better prepared, and hence to assert its responsibility towards high standards of workers' health protection. Future research has to include investigating the best means of mitigation against airborne infection and the management of post-acute covid sequelae.

IntroductionJunior doctors have previously reported high levels of burnout;and additional stressors have likely emerged from the COVID-19 pandemic may further accelerate burnout. There is a need to identify which particular stressors are most likely to lead to burnout in junior doctors in order to develop appropriate interventions. Objectives1) To develop a comprehensive list of stressors that are relevant to junior doctors, which includes general work and non-work related stressors as well as stressors that have specifically emerged with the pandemic. 2) To assess which of these stressors are most strongly associated with burnout.MethodsAn anonymous online questionnaire was sent to 1000 randomly selected junior doctors in the North West of England between 10/07/20 to 04/08/20. It included 37 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory (MBI) Health Services Survey. Stepwise regression analyses were undertaken to assess associations between stressors and burnout.ResultsIn total, 326 responses were collected (response rate=33%). Of the top 10 stressors rated by junior doctors, 60% were related to the pandemic. Multiple stressors were found to be associated with the burnout dimensions. Fatigue (β=0.43), pandemic-related workload increase (β=0.33) and feeling isolated (β=0.24) had the strongest associations with Emotional Exhaustion, whereas fatigue (β=0.24), uncertainty around COVID-19 information (β=0.22) and doing unproductive tasks (β =0.22) had the strongest associations with Depersonalisation.ConclusionJunior doctors experience a combination of general stressors and additional stressors emerging from the pandemic which significantly to impact on burnout. Monitoring these stressors and targeting them as part of interventions could help mitigating burnout in junior doctors.

Objective The authors examined associations between stressors and burnout in trainee doctors during the COVID-19 pandemic. Methods An anonymous online questionnaire including 42 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory-Health Services Survey (MBI-HSS), was sent to 1000 randomly selected trainee doctors in North-West England. Main outcomes were burnout scores that were stratified into Emotional Exhaustion (EE), Depersonalisation (DP), and reduced Personal Accomplishment (PA) and associations between stressors and burnout using stepwise regression analysis. Results A total of 362 complete responses were received giving a response rate of 37%. Mean scores for EE, DP, and PA derived from the MBI-HSS were 27.7, 9.8, and 34.3 respectively. Twenty-three stressors were found to be associated with burnout dimensions. "Increase in workload and hours due to COVID-19," "Poor leadership and management in the National Health Service," and "Not feeling valued" were found to have strong associations with burnout dimensions. Only "Not confident in own abilities" was found to be associated with all burnout dimensions. Conclusions Associations with burnout were found to be identified in a range of work, pandemic, and non-work-related stressors, supporting the need for multi-level interventions to mitigate burnout.

OBJECTIVES:This study aims to develop a comprehensive list of stressors relevant to junior doctors and will also report findings exploring the associations between burnout and stressors, which include work and non-work-related stressors as well as pandemic-related stressors.METHODS:An anonymous online questionnaire was sent to 1000 randomly selected junior doctors in the North-West of England. The questionnaire included 37 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory Health Services Survey. The main outcomes of interest were junior doctor ratings of stressors and scores for burnout (emotional exhaustion [EE], depersonalisation [DP], and personal accomplishment [PA]). Stepwise regression analysis was undertaken to assess associations between stressors and burnout.RESULTS:In total, 326 responses were collected (response rate = 33%). Of the top 10 stressors rated by junior doctors, 60% were related to the pandemic. Multiple stressors were found to be associated with the burnout dimensions. Fatigue (β = .43), pandemic-related workload increase (β = .33), and feeling isolated (β = .24) had the strongest associations with EE, whereas fatigue (β = .21), uncertainty around COVID-19 information (β = .22) and doing unproductive tasks (β = .17) had the strongest associations with DP. Working beyond normal scope due to COVID-19 (β = -.26), not confident in own ability (β = -.24) and not feeling valued (β = -.20) were found to have the strongest associations with PA.CONCLUSIONS:Junior doctors experience a combination of general stressors and additional stressors emerging from the pandemic which significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigating burnout in junior doctors.

Khunti and colleagues advocate integrating "the workplace, the workforce, and the individual" in "assessing risk for healthcare workers during the covid-19 pandemic." 1 The same approach is relevant to other workers, notably in social care.It also warrants highlighting that health and safety law requires a "suitable and sufficient" risk assessment and the involvement of workers and their representatives.

In the course of the COVID-19 pandemic, it has become clear that primary healthcare systems play a critical role in clinical care, such as patient screening, triage, physical and psychological support and also in promoting good community advice and awareness in coordination with secondary healthcare and preventive care. Because of the role of social and environmental factors in COVID-19 transmission and burden of disease, it is essential to ensure that there is adequate coordination of population-based health services and public health interventions. The COVID-19 pandemic has shown the primary and community healthcare (P&CHC) system's weaknesses worldwide. In many instances, P&CHC played only a minor role, the emphasis being on hospital and intensive care beds. This was compounded by political failures, in supporting local community resilience. Placing community building, social cohesion and resilience at the forefront of dealing with the COVID-19 crisis can help align solutions that provide a vision of 'planetary health'. This can be achieved by involving local well-being and participation in the face of any pervasive health and environmental crisis, including other epidemics and large-scale ecological crises. This paper proposes that P&CHC should take on two critical roles: first, to support local problem-solving efforts and to serve as a partner in innovative approaches to safeguarding community well-being; and second, to understand the local environment and health risks in the context of the global health perspective. We see this as an opportunity of immediate value and broad consequence beyond the control of the COVID-19 pandemic.

There is clear evidence that healthcare workers (HCWs) are at increased risk of contracting COVID-19. Compared to nonessential workers, HCWs have a seven-fold increase in risk of severe COVID-19 (testing positive in hospital or death).1 Frontline, or patient-facing, HCWs have a three-fold increase in risk of testing positive for COVID-19 compared to the general population.2 Compared to non-patient facing HCWs they have a three-fold risk, and their household members have a two-fold risk of hospital admission with COVID-19.3 COVID-19 risk is also specialty dependent: ‘front-door’ speciality HCWs (A&E, medical specialties including general, acute, and geriatric medicine, and infectious diseases) are at increased risk compared to intensive care HCWs,3 who in some studies had a lower risk than other HCWs.4 The only publicly available data on COVID-19-related deaths of doctors in the UK comes from tributes in the medical press, …

Background: Air pollution has been consistently linked with dementia and cognitive decline. However, it is unclear whether risk is accumulated through long-term exposure or whether there are sensitive/critical periods. A key barrier to clarifying this relationship is the dearth of historical air pollution data. Objective: To demonstrate the feasibility of modelling historical air pollution data and using them in epidemiological models. Methods: Using the EMEP4UK atmospheric chemistry transport model, we modelled historical fine particulate matter (PM2.5) concentrations for the years 1935, 1950, 1970, 1980, and 1990 and combined these with contemporary modelled data from 2001 to estimate life course exposure in 572 participants in the Lothian Birth Cohort 1936 with lifetime residential history recorded. Linear regression and latent growth models were constructed using cognitive ability (IQ) measured by the Moray House Test at the ages of 11, 70, 76, and 79 years to explore the effects of historical air pollution exposure. Covariates included sex, IQ at age 11 years, social class, and smoking. Results: Higher air pollution modelled for 1935 (when participants would have been in utero) was associated with worse change in IQ from age 11–70 years (β = −0.006, SE = 0.002, p = 0.03) but not cognitive trajectories from age 70–79 years (p > 0.05). There was no support for other critical/sensitive periods of exposure or an accumulation of risk (all p > 0.05). Conclusion: The life course paradigm is essential in understanding cognitive decline and this is the first study to examine life course air pollution exposure in relation to cognitive health.

The British Occupational Hygiene Society (BOHS) COVID-19 Working Group developed a control banding matrix to provide guidance for employers and others to help assess the risks of COVID-19 infection during the pandemic. The matrix was based on occupational hygiene principles and the judgement of the occupational health practitioners involved; since objective data on workers' exposure were unavailable. Users of the matrix identify one of five exposure categories based on generic job descriptions and example occupations, and these categories are linked to generic guidance on interventions at source, on the exposure pathway and for individual workers. The risk matrix was published on the BOHS website and the guidance has been downloaded more than 2000 times. The matrix has had limited evaluation for reliability, but the data suggest that the highest exposure ranked jobs were associated with higher age-standardized mortality in Britain during the pandemic. However, there was considerable variability in exposure assignments between assessors, which underlines the need for the control guidance to be precautionary. The BOHS calls on academic researchers to undertake further work to validate the reliability of the tool.

Shortcomings in protection from contracting covid at work arise from legislation being ignored, argue these authors

Although evidence relating to facial dermatoses associated with the use of personal protective equipment (PPE) has been limited during the pandemic,1 these associations have previously been well recognised and quantified. …