Em número recém lançado a Occupational Medicine dedica vários artigos (vejam índice aqui) ao tema do momento que é a pandemia de covid-19
Recentemente FórumAT divulgou post sobre os critérios de reconhecimento da Covid-19 como doença relacionada ao trabalho adotados no RIDDOR (sistema de registro de doenças e mortes relacionadas ao trabalho) do Reino Unido.
No artigo do prof Raymond Agius comentado abaixo ele aponta limites nos critérios de notificação adotados no Reino Unido e como esses critérios podem estar influenciando o subregistro de doenças e mortes por Covid-19 relacionada ao trabalho. A leitura é útil e traz dicas valiosas sobre a condução de investigações de nexo causal.
Chamo a atenção para artigo do Raymond Agius intitulado Disease and death from work: RIDDOR and covid-19 em que o autor aponta limites nos critérios adotados no RIDDOR, no Reino Unido, reconhecimento do nexo com o trabalho e registro da doença e ou morte.
Destaco trechos (os destaques são meus):
"Substantial undercounting arises from the HSE guidance quite categorically excluding notification of covid-19 cases in workers whose job does not entail dealing with ill people but with the public [3]. However, the available evidence from the Office for National Statistics (ONS) statistical bulletins [6] shows elevated age-standardized mortality rates (ASMRs) for various occupations dealing with the general public. For example, the ONS data show ASMRs for male security guards and related occupations to be nearly four times higher than for all men of working age. Moreover, for male drivers exposed to passengers (in cabs, taxis, cab, buses and coaches), the ASMRs were also significantly raised being at least two or three times higher than for all the male working age population or than the ASMR for drivers of large goods vehicles (who carry no passengers). In women the ONS data have shown more than doubling of ASMR in national government administrative occupations (such as ‘jobcentre’ staff) [6]."
"RIDDOR data are unlikely to give as good estimates of the work-related burden of covid-19 as ONS data once
the latter are analysed to take account of co-morbidity and adjusted for deprivation and ethnicity [2]."
"Undercounting in the HSE data may give a wrong impression of the overall burden of disease, but more concern arises from circular reasoning with prior assumptions of adequacy of control leading to non-reporting and hence missing opportunities for prevention."
"[...] many concerns have been raised, including in this journal that PHE (public Heath Engalnd) guidance was not adequately precautionary because of spread of the virus in aerosols arising even from breathing."
"The current HSE guidance would imply to an employer that if PHE guidance had been followed this could weigh against their reportingof cases of covid-19."
Chamo especialmente a atenção para o comentário abaixo sobre a necessidade de complementar a investigação epidemiológica:
"However, if they were reported, investigations using sequencing of SARSCoV-2 genomes in these workers, and in the patients or residents who they looked after, could complement epidemiologic approaches to establish the pattern of transmission. (ver Observação no final) This could help determine whether health and social care workers contracted covid-19 occupationally despite following extant PHE guidance, and if so the guidance might be improved in preparation of possible further surges."
E ainda:
"The evidence suggests that the HSE may be systemically underestimating covid-19 caused by work and so
missing vital opportunities to investigate and learn lessons to prevent further disease. The HSE should accept
RIDDOR reporting of cases of covid-19 in workers with close and frequent exposure to the public such as in security, retail and passenger transport."
Os links acima permitem acesso a outros artigos que discutem o tema
Observação:
A referência citada é
Meredith LW, Hamilton WL, Warne B et al. Rapid implementation of SARS-CoV-2 sequencing to investigate
cases of health-care associated COVID-19: a prospective genomic surveillance study. Lancet Infect Dis 2020.
doi:10.1016/S1473-3099(20)30562-4
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