Guest blog by Dr Jon Spiro
Occupational health (OH) services have been much involved in the response to the pandemic, concentrating their efforts in addressing the risks to workers and the mitigation of these. Advice and guidance to individual employees and organisations have played a crucial role in reducing the risk of contracting and/or spreading the infection. Measures such as risk assessments and recommending the appropriate use of personal protective equipment, distancing, hygiene and cleaning measures are all making a considerable difference in the world of work. Another area where OH services can play a key role is in advising on the prevention of this illness by maintaining good health.
While we can learn about what may be relevant by being aware of the factors that place people at increased risk of the disease, notably older age, male sex, BAME background, having underlying medical conditions, obesity, living in relatively deprived areas and so on (explanations for these associations have included age-related changes, male hormones, genetic factors, socio-economic and cultural ones), there must also be other factors. We know that older people have defective immune systems and that the prolonged, severe and unregulated inflammatory response seen in severe cases of COVID-19 is characteristic of what can happen when older people are challenged by certain infections, but then why do some people approaching, or even exceeding, the age of 100 survive the disease, while some apparently previously fit people in their 30s and 40s become seriously ill? While some of the above are non-modifiable risk factors, there are a number of others we can do something about, while we are waiting for (or at least hoping for) medical treatment and vaccines.
OH departments are well placed to help their clients address modifiable factors and can do plenty to support their clients in mitigating them and reducing the risk of the potentially serious consequences of contracting COVID-19. The following are examples of what OH professionals can discuss with their clients, either individually or collectively. Alternatively, the provision of information in written form or online can get the relevant messages across.
- Diet. This is a major ‘lifestyle’ factor implicated in the immune response. A growing volume of evidence indicates that an at least adequate intake of Vitamins A, B6, C, D and E and minerals such as Iron, Copper, Zinc and Selenium are required to support the normal function of the immune system and a lack of them can undermine it. This underpins the recommendation to maintain a well-balanced diet which includes them all, such as one rich in fruits, vegetables, nuts and seeds, along with dairy products and some fish and lean meat. Fibre has also been shown to be beneficial. In general, food rather than supplements is the way to ensure adequate nutrient intake, except for Vitamin D where supplementation is being recommended (as well as careful sun exposure). Eating a recommended diet also helps maintain a healthy weight.
- Exercise. There have long been recommendations about taking regular, usually aerobic, exercise, such as doing it for 150 minutes a week, while smaller amounts can still be beneficial. Taking exercise can consist of walking, swimming or cycling, although other activities such as gardening can count. Wellbeing generally, as well as health, is likely to improve with exercise, which reduces the risks of ischaemic heart disease, diabetes, cancer and mental illness. Remind your clients to keep their distance when taking exercise!
- Weight. Obese people suffer worse with COVID-19, partly in relation to the fact that obesity is associated with evidence of low grade inflammation and negative effects on immunity. Overweight and especially obesity also increases the risk of diabetes, cancer and other conditions, while lowering weight helps reduce elevated blood pressure. OH professionals may be in a position to check employees’ weight, but can at least enquire about it. A combination of diet and exercise can help in maintaining weight at a healthier level.
- Blood Pressure. It has been stated that this may be a risk factor for developing severe COVID-19 infection. It is certainly a risk factor for ischaemic heart disease, which more definitely is. OH professionals may be able to make measurements and recommend measures to help lower elevated blood pressure, such as attention to the other factors in this list.
- Alcohol. It has been found that while some people are drinking less since the onset of the pandemic, quite a number have increased their alcohol intake, for various reasons. The use of one of the standard screening tools for alcohol use is likely to be worthwhile, to reduce the risk of various chronic diseases, but also the negative effects on immune function of significant alcohol intake.
- Smoking. This is another factor which negatively affects health and increases the risk of chronic disease and of more severe COVID-19 infection. Advice on stopping smoking, support services, use of nicotine replacement and other measures are all able to help those who wish to cut down or stop smoking.
- Sleep. This vital function is often taken for granted and yet it has repeatedly been shown that insufficient and poor quality sleep adversely affects health as well as immune function. While there is no universally effective remedy to deal with sleep problems, there are a number available, such as sleep hygiene measures, programmes such as ‘Sleepio’ and general approaches which can help.
- Stress. Notwithstanding the old debate about what this is, what is good and what is bad, there is a general recognition that unfavourable chronic stress is detrimental to wellbeing and health in a variety of ways. It is also likely to undermine individual approaches to maintaining or improving health. A simple screening tool can be used to tease out problems in this area and lead to advice or to recommend specific training to alleviate the problem, as well as addressing any concerns which arise from work. At the very least, attention to relaxation methods, hobbies and appropriate social contacts are all likely to be beneficial.
- Mental health. This may well have suffered during the pandemic in many individuals, with mental ill health even affecting those with no previous history of problems of this kind. Once again, brief screening can help to identify mental ill health. This, as with stress, may interfere with individual coping strategies and the ability to pursue healthy lifestyles. Dealing with it is likely to bring many benefits and OH professionals are well placed to support and direct individuals appropriately.
- Other relevant measures. What applies in the workplace often applies outside it and Covid-related risk management measures, such as being careful about personal contacts, avoiding crowds or crowded places, correct use of masks and personal hygiene are also very important at home and away from it.
As the above text illustrates, there is a great deal that OH services can contribute to the reduction in the burden that COVID-19 has placed on people and organisations all across the world. OH services have been providing considerable support to their client organisations, but can go even further with some well organised and carefully selected health promotion initiatives, delivered by whatever practical means may be available.