Most of the articles on this blog consider the positive and important advantages of particular interventions in controlling our exposure to SARS-CoV-2 and reducing the risk of developing Covid-19. We have discussed the benefits of ventilated headboards in minimising concentrations of airborne virus particles within a hospital ward or ICU area. However, this blog piece looks ahead to 2021 and aims to flag up some of the potential unintended consequences of interventions that have been essential in the course of tackling Covid in 2020 whilst the virus has been on the rise. In the future – hopefully not too late in 2021 – the balance of benefits and risks of these preventive measures may begin to change.
Managing risk is often about balancing population-level benefits with potential disadvantages or costs. And for much of 2020 the dangers of uncontrolled spread of Covid and the potential stress on the healthcare system and the mortality from the disease have rightly been given priority. Population level interventions such as lockdowns and targeted restrictions in opening particular venues (such as pubs and restaurants) or movement around the country have been the focus of much of the debate around public health benefits versus financial and societal costs, including loss of employment through to wider mental health impacts. Government decisions have been difficult and often finely balanced.
More direct interventions and measures within the workplace have been less openly examined in terms of benefits and costs, beyond the financial costs associated with structural changes. Few would argue that perspex barriers to protect supermarket workers are not a ‘good idea’ and that their relatively low cost is worthwhile to protect them and members of the public and help prevent Covid transmission. Effective cleaning regimes in our schools, shops and hospitals are similarly sensible protective measures. But what of other interventions in the workplace?
Perhaps the commonest impact of Covid-19 interventions for most workers has been the requirement to ‘work from home where possible’. Across the country office workers have set up workstations to allow them to work with laptops propped up on books on dining room tables, hunched over poorly-lit screens in places never designed to minimise the ergonomic risks of musculoskeletal or repetitive strain injuries. Pre-Covid, office workers had regular Display Screen Equipment (DSE) assessments to check that their seating, screens and desks were appropriate and not likely to lead to long-term back, arm and hand injury. These mandatory assessments were largely ignored in the early weeks of restrictions in March, before being partially acknowledged with the provision of basic online guidance for home-workers as the weeks turned to months, but it seems likely that many employers have not been able to fulfil their responsibilities to protect their workers from such injuries during much of 2020. Will we have a cohort of workers who have chronic neck, back and arm problems when Covid begins to fade from memory?
There may be other unintended consequences of Covid-control measures. Alcohol-based hand gels are now placed at the entry, exit and many other positions of most workplaces and guidance recommends frequent hand sanitisation with these materials. Before Covid we knew that frequent hand-washing or use of alcohol hand gels could increase the risk for workers of developing occupational irritant contact dermatitis: an often debilitating disease with life-long consequences. It seems plausible that the increased use of these materials over an extended period of time could produce an additional proportion of the workforce with long-term dermatitis. The numbers of extra workers who will suffer from dermatitis and the severity of their disease is unknown, and has tended not to be considered in the risk-benefit decisions of the ‘clean hands’ part of the Covid intervention guidance. Workplace interventions to protect the population from the risk of uncontrolled transmission of Covid, mortality and unsustainable burdens on our health services, have been essential and, taken together, have been a huge public health success in 2020. However, as occupational health experts it is worth our thinking of what, if any, the longer-term unintended consequences may be from the measures we’ve deployed to help overcome the risks. Measuring and tracking these impacts will be important for public and occupational health researchers in 2021 and beyond.