Covid-19: Third of people infected have long term symptomsBMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1626 (Published 24 June 2021) Cite this as: BMJ 2021;373:n1626
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Failure to prescribe: how UK workers with occupational-caused and occupationally-related long Covid-19 have been ignored:
Those people with long term Covid-19 symptoms (1) who need support continue to raise major questions and major challenges for occupational health. Long Covid may be poorly understood, as the REACT study points out, requiring better identification and management of the condition. Yet the Office for National Statistics estimates 385,000 people have had long Covid for one year or more but only 9% had been hospitalised when first infected (2). With 3,872 Covid-19 outbreaks in workplaces and 4,253 outbreaks in education settings, many workers will have contracted the disease at or in the course of their work and we know Covid-19 occupational morbidity as well as mortality has been seriously under-estimated (3).
One mechanism for addressing the lack of reporting could be to list all those in workplace outbreaks as occupational Covid cases. This would then trigger financial support through the Industrial Injuries Disablement Board (IIDB) scheme based on recommendations from the UK industrial Injuries Advisory Council(IIAC). The most vulnerable low paid and precarious workers would automatically and quickly receive both disease recognition and the vital financial and other support they need with such a mechanism .
Yet almost a year and a half after the pandemic began, Covid-19 is still not recognised as a UK prescribed industrial disease. In that time, a great deal has been done ‘at pace’ to address other Covid-19 challenges. Covid-vaccines have been developed at record speed, special hospitals built to treat potential Covid-19 cases and billions spent within weeks and months, albeit not always wisely and well, on PPE and test and trace schemes. If the UK government can be persuaded to give billions of ‘Covid’ pounds to businesses on the basis of phones calls from government ministers, it should be possible to persuade this government now to prescribe occupational Covid to ‘level up’ care and support for workers.
The UK All Party Parliamentary Group on the Coronavirus called for Covid-19 to be listed as a prescribed occupational disease earlier this year following the lead for example of Belgium, Denmark, France, Germany, and Spain. Since then, even more evidence has emerged about Covid-19 adverse effects (4)(5)(6) . Nevertheless the call has been ignored. Why bodies such as IIAC have not yet been able to recommend listing of Covid-19 as an occupational disease. is becoming clearer. IIAC in June 2021 are still examining the evidence for prescription and may postpone making their case for a further year. This now looks like faint-hearted and an unnecessary and damaging delay for affected workers.
Other somewhat more doubtful obstacles may exist relating to the systemic failures within the UK occupational disease recognition system that looks increasingly unfit for purpose during the pandemic (7). There are suggestions the IIDB system would be unable to cope with the potentially large Covid-19 numbers who may claim but this could be easily addressed by increasing capacity . The ‘interim’ IIAC position paper on Covid-19 in March 2021 did recognise several UK occupations had more than a two-fold risk of Covid including social care, nursing, bus and taxi driving, food processing, retail work, local & national administration & security (8). IIAC also accepted Norway and Belgium had already recognised Covid as an occupational disease. Yet this evidence was insufficient to sway the Council to prescribe the disease. The Council went on to argue socio-economic influences could be a contributing factor when occupational Covid cases occur, good quality evidence was still being gathered, and details on exposures for example needed to be considered.
Some of these arguments are quite bizarre because many occupational diseases in the past have occurred in population experiencing high levels of deprivation but this has not been used as an obstacle to their prescription. IIAC concluded that overall “the evidence is not at present sufficient for recommending prescription” because “ it will recommend prescription if and when there is strong enough evidence that occupational exposures cause disabling disease on the ‘balance of probabilities.”(8) The IIAC balance of probabilities proof would be 51 to 49 but then the IIAC maths is often skewed by reference to the need to show a doubling of risk to workers which ironically it did on Covid-19 for various categories of workers. Even the double risk condition is not accepted in several countries and has been heavily criticised in the UK for several years (7).
IIAC, it must be concluded, cannot respond rapidly enough or appropriately enough to the need for prescription. The Council looks more of an obstacle in its present form and an outlier in international terms. It denies justice to some of the most vulnerable UK workers who did and do bear the brunt of keeping society functioning during the pandemic. It effectively denies recognition of the toll Covid has taken among doctors, nurses, other health care and public-facing workers over the last fifteen months. It is locked into mechanisms which render many of its reports either worthless or, much worse, barriers to disease recognition. The IIDB scheme itself continues to fail many workers badly. The Covid pandemic reveals how flawed the UK system is and part of any public inquiry should entail a detailed examination of these failures and how to rectify them urgently.
(1) O’Dowd A . Covid-19: Third of people infected have long term symptoms. BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1626 24 June 2021
(2) Ayoubkhani D and Pawelek P. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 July 2021. Office for National Statistics.
(3) Wall T. Thousands of work-related Covid deaths going unreported, says TUC. May 22nd 2021. https://www.theguardian.com/world/2021/may/22/thousands-of-work-related-...
(4) AAPG. Oral Evidence. Long Covid and occupational disease. 8th March 2021. https://d3n8a8pro7vhmx.cloudfront.net/marchforchange/pages/675/attachmen...
(5) APPG oral evidence on long Covid and employment Oral Evidence Session. 29 June 2021https://d3n8a8pro7vhmx.cloudfront.net/marchforchange/pages/740/attachmen...
(6) Limb M. Covid-19: Recognise long covid as occupational disease and compensate frontline workers, say MPs. BMJ 2021; 372 doi: https://www.bmj.com/content/372/bmj.n503 19 February 2021
(7) Watterson A and O’Neill R. Double Trouble on Relative Risk for Occupational Diseases. Hazards. March 2015. https://www.hazards.org/compensation/meantest.htm
(8) Industrial Injuries Advisory Council. COVID-19 and occupation: position paper 48. 25 March 2021.
Competing interests: No competing interests