# Return-to-work, disabilities and occupational health in the age of COVID-19

Diane Godeau, Audrey Petit, Isabelle Richard, Yves Roquelaure, Alexis Descatha

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Diane Godeau, Audrey Petit, Isabelle Richard, Yves Roquelaure, Alexis Descatha. Return-to-work, disabilities and occupational health in the age of COVID-19. Scandinavian Journal of Work, Environment and Health, 2021, 47 (5), pp.408-409. 10.5271/sjweh.3960. hal-03341046

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**Letter to the Editor**

Scand J Work Environ Health 2021;47(5):408-409

doi:10.5271/sjweh.3960

**Return-to-work, disabilities and occupational health in the age of COVID-19**

by Godeau D, Petit A, Richard I, Roquelaure Y, Descatha A

Refers to the following texts of the Journal: 2020;46(3):229-230
2021;47(4):245-247

**Key terms:** Coronavirus; COVID-19; occupational health;
occupational health; return to work

This article in PubMed: www.ncbi.nlm.nih.gov/pubmed/34003294

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This work is licensed under a Creative Commons Attribution 4.0 International License.
Scand J Work Environ Health. 2021;47(5):408-409. doi:10.5271/sjweh.3960

Return-to-work, disabilities and occupational health in the age of COVID-19

We have read with great interest the two editorials by
Burdorf et al: "The COVID-19 pandemic: one year later
- an occupational perspective" (1) and "The COVID-19
(Coronavirus) pandemic: consequences for occupational
health" (2). The authors highlight the importance of the
societal consequences of the outbreak and changes in
the world of work to manage occupational health. The
key points identified - such as individual socioeconomic
factors, psychological effects and occupations with
highest risk of contamination - modify return-to-work
approaches.

It is estimated that around 800 million people of working age worldwide were living with disabilities before the SARS-CoV-2 pandemic. In early January 2021, the cumulative COVID-19 hospitalisation rate reached 207.4/100 000 (18–49-year-olds) and 505.7/100 000 (50–64-year-olds), respectively, in the United States (3). In France, the hospitalisation rate was 411.5/100 000 across all ages (4). A recent cohort study of working-age men who were hospitalised for COVID-19 highlighted the long-term health consequences of such a disease (5).

The SARS-CoV-2 pandemic creates new challenges
for occupational health, shifting attention away from
return-to-work after health problems to resuming work
during an outbreak, dealing with lockdown, and taking
special account of workers with vulnerabilities (6, 7).

We recommend considering three different aspects
of occupational medicine during a pandemic. Firstly,
for most workers at high-risk of severe COVID-19,
the issues of work disability and resuming work had
never occurred before the epidemic. Recommendations
such as physical and social distancing and wearing a
facemask are highly advisable to protect against infec-
tion but may not be enough to enable some individuals
to resume work. Therefore, decision-making requires
individual comprehensive assessments of the underlying
medical condition, the SARS-CoV-2 contamination risk
associated with either regular work or teleworking, and
vaccination opportunities.

The second situation concerns workers who have
suffered from COVID-19. Preliminary studies suggest
that long recovery duration is related to high severity
(7), but this is still a matter of debate for patients suffer-
ing from "long COVID-19" (5, 8, 9), a condition for
which the long-term effects remain unknown. Any long-

running recovery must be considered to be a potential
sign of long COVID-19. These long-lasting syndromes
occur among patients with severe symptoms but have
also been reported independently of acute phase sever-
ity, hospitalisation and receiving medical oxygen (8,
9). Researchers worldwide are currently investigating
such syndromes. Strategies promoting return to work
for these workers will need to be implemented and
could be similar to programmes developed for other
chronic conditions. Moreover, numerous more serious
sequelae following critical illness suggest the need for
enhanced support by rehabilitation and occupational
health specialists.

Finally, the consequences of the epidemic must be
evaluated over time for people who suffered from func-
tional limitations before COVID-19 as their physical
and mental condition may be modified by the epidemic
and, specifically, the consequences of lockdown (10).

In all of these situations, medical, social, financial
and working contexts are key elements. In addition to a
medical assessment, the use of scales such as the Work
Ability Index (WAI) (11) or the Work Productivity and
Activity Impairment (WPAI) (12) can help perform
long-term follow-up and provide information about
work capacity and workload. It also gives a “back to
basics” perspective, urging politicians to move towards a
'decent-work-for-all' policy, as advocated by the United
Nation's Sustainable Development Goal (SDG) 8, which
the WHO has endorsed (13).

References

1. Burdorf A, Porru F, Rugulies R. The COVID-19 pandemic: one year later – an occupational perspective. Scand J Work Environ Health – online first. https://doi.org/10.5271/sjweh.3956

2. Burdorf A, Porru F, Rugulies R. The COVID-19 (Coronavirus) pandemic: consequences for occupational health. Scand J Work Environ Health. 2020;46(3):229-230. https://doi.org/10.5271/sjweh.3893.

3. COVID-19 Hospitalizations [Internet]. Available from: https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html

4. COVID-19 in France, vaccine and allergy management in occupational setting. Descatha A et al. Arch Mal Prof Environ 2021. Accepted for publication.
5. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397(10270):220-32 https://doi.org/10.1016/S0140-6736(20)32656-8

6. Shaw WS, Main CJ, Findley PA, Collie A, Kristman VL, Gross DP. Opening the Workplace After COVID-19: What Lessons Can be Learned from Return-to-Work Research? J Occup Rehabil. 2020;30(3):299-302. https://doi.org/10.1007/s10926-020-09908-9

7. Taylor T, Das R, Mueller K, Pransky G, Christian J, Orford R, et al. Safely Returning America to Work: Part I: General Guidance for Employers. J Occup Environ Med. 2020;62(9):771-9. https://doi.org/10.1097/JOM.0000000000001984

8. Carfi A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-5. https://doi.org/10.1001/jama.2020.12603

9. Tenforde MW, Kim SS, Lindsell CJ, Billig Rose E, Shapiro NI, Files DC, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly. 2020;69(30):993-8. https://doi.org/10.15585/mmwr.mm6930e1

10. Chudasama YV, Gillies CL, Zaccardi F, Coles B, Davies MJ, Seidu S, et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965-7. https://doi.org/10.1016/j.dsx.2020.06.042

11. Tuomi K. Eleven-year follow-up of aging workers. Scand J Work Environ Health. 1997;23(1):1-71.

12. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics. 1993;4(5):353-65. https://doi.org/10.2165/00019053-199304050-00006

13. Organization WH. Health in the 2030 agenda for sustainable development. Sixty-Ninth World Health Assembly. Document A. 2016, p69.

Diane Godeau, MD,<sup>1,2,3</sup> Audrey Petit, MD,<sup>4</sup> Isabelle Richard, MD,<sup>4</sup> Yves Roquelaure, MD,<sup>4</sup> Alexis Descatha, MD<sup>1,4,5</sup>

1 Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France.

2 AP-HP ("Assistance Publique-Hôpitaux de Paris"), Hôpitaux universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Unité des pathologies professionnelles et environnementales, F-93009 Bobigny cedex, France.

3 Université Sorbonne Paris Nord, F-93206 Saint-Denis, France.

4 Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000 Angers, France.

5 CHU Angers, Poisoning Control Center- Clinical Data Center, F-49000 Angers, France.

Correspondence to: Dr D. Godeau, Hôpital Avicenne, Unité fonctionnelle des pathologies professionnelles et environnementales, 125 rue de Stalingrad 93009 Bobigny cedex, France. ORCID: 0000-0001-7746-3191. [Email: diane.godeau@aphp.fr]