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Serious violations of health workers’ rights during pandemic

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2824 (Published 14 July 2020) Cite this as: BMJ 2020;370:m2824

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Linked Opinion

New patterns of violence against healthcare in the covid-19 pandemic

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Re: Violations of health workers’ rights during pandemic

Dear Editor,

Some health workers’ rights can be violated during pandemic [1] e.g. the principle of informed consent to invasive procedures. Medical personnel in Russia must undergo regular (once in 7-10 days) SARS-CoV-2 antibody tests using venous blood. Repeated intravenous manipulations are associated with risks and discomfort especially for patients with narrow, collapsed veins. If the antibody test is positive, both nasal and pharyngeal swabs are taken for the PCR-based assay, also from known convalescents and persons with the positive viral tests in the past who thereafter have tested negatively twice.

The smears may be taken with urogenital swabs using excessive force. Mucosal damage might predispose to infections. Nasal swabs are taken also from persons with atrophic rhinitis, a history of nasal bleedings, septum ulcerations etc. An inquiry directed to the health care authority was replied with a reference to the instructive Letter Nr. 02-706-2020-27 of 21 January 2020 issued by the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor) that swabs from the nasal cavity and nasopharynx are obligatory. Indeed, there are no specific contraindications for collecting specimens with nasopharyngeal swabs. However, clinicians should be cautious if the patient has had recent nasal trauma or surgery, has a markedly deviated nasal septum, a history of chronically blocked nasal passages or severe coagulopathy [2]. When collection of a nasopharyngeal swab is not possible, the following are acceptable alternatives: an oropharyngeal specimen, a nasal mid-turbinate specimen (using a flocked tapered swab), an anterior nares specimen (using a flocked or spun polyester swab), a nasopharyngeal wash/aspirate or nasal aspirate specimen [3].

Serologic antibody tests can reveal those individuals who were infected and didn’t know it. However, for known convalescents and those who tested positively for SARS-CoV-2 but have become negative, the repeated serological tests seem to be useless. If a person is serologically found immune, it is unlikely that he or she would get reinfected [4]. In fact, the antibody testing can be used to return people with immunity to the workforce or keep them there, starting with health care professionals. “A positive antibody test could be a sort of get-out-of-isolation card” [4]. Admittedly, there is not enough evidence to conclude that the detection of SARS-CoV-2-specific antibodies can be linked to the end of the viral infectivity [5]. More details are in [6].

References

1. Sheather J, Hartwell A, Norcliffe-Brown D. Serious violations of health workers’ rights during pandemic. BMJ 2020;370:m2824
2. Marty FM, Chen K, Verrill KA. How to obtain a nasopharyngeal swab specimen. N Engl J Med. 2020;382(22):e76. doi:10.1056/NEJMvcm2010260
3. La Marca A, Capuzzo M, Paglia T, Roli L, Trenti T, Nelson SM. Testing for SARS-CoV-2 (COVID-19): a systematic review and clinical guide to molecular and serological in-vitro diagnostic assays. Reprod Biomed Online. 2020; doi: 10.1016/j.rbmo.2020.06.001.
4. Abbasi J. The promise and peril of antibody testing for COVID-19. JAMA. 2020; doi: 10.1001/jama.2020.6170.
5. Özçürümez MK, Ambrosch A, Frey O, et al. SARS-CoV-2 antibody testing-questions to be asked. J Allergy Clin Immunol. 2020;146(1):35-43.
6. Jargin SV. COVID-19: economic damage is a health risk. Am J Prev Med Public Health. 2020; 6(3): 62-64. doi: 10.5455/ajpmph.20200402032426.

Competing interests: No competing interests

18 July 2020
Sergei Jargin
medical reviewer
Clementovski per 6-82