Professional Documents
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Perspective: New England Journal Medicine
Perspective: New England Journal Medicine
Perspective: New England Journal Medicine
Perspective
A
“Is It Safe for Me to Go to Work?”
pprehensively, I dialed Mr. M. for an update. by her facility. She was not aware
Weeks earlier, he and his wife had tested of anyone at the nursing home
testing positive for SARS-CoV-2.
positive for SARS-CoV-2. A few days before We never discussed outright
this call, Mr. M. had been discharged from the whether it was safe for her to con-
tinue to work. Although we can’t
hospital, since his cough and fe- Four weeks earlier, as I worked be certain she became infected at
ver were improving. Unfortunately, my way through my first telemed- work, in retrospect these precau-
Ms. M. had developed worsening icine session of the Covid-19 era, tions seem woefully inadequate.
breathing, needed more oxygen, I came to Ms. M. I had become the Older people and people with
and was at that point being trans- couple’s primary care physician chronic conditions, including di-
ferred to the ICU. Mr. M. picked after they emigrated from Europe abetes, hypertension, and obesi-
up the phone, quiet and tearful. 5 years ago. Mr. M. has been ty, have faced higher mortality
“How are you?” I asked. unable to work, owing to several from Covid-19. In a large case
“Terrible, doctor,” he replied. chronic medical conditions. Ms. series in China, the case fatality
“Maria died last night.” She had M., who was in her 60s, had dia- rate was less than 0.5% among
died, alone, in an ICU. Mr. M. was betes and worked in environmen- people under 50 years of age,
now mourning her loss, alone, at tal services, cleaning at a nursing 1.3% among those 50 to 59, and
home. Their children and grand- home. I called an interpreter, who 3.6% among those 60 to 69.1
children, who live in Europe, connected us to Ms. M., and we People with diabetes had a risk
mourned at a distance much great- began our visit. of death three times that of the
er than the recommended 6 feet. Our conversation quickly overall cohort. These data suggest
As similar scenes play out re- turned to how she could protect that the case fatality rate may ap-
peatedly, I find myself saddened herself at work. I recommended proach 10% for people, like Ms.
and outraged by the inadequacy that she vigilantly perform hand M., who are in their 60s and have
of our response, which failed to hygiene, avoid touching her face, diabetes — more than 20 times
prevent this tragedy for Ms. M. and use the personal protective that among people under 50 with-
and thousands of patients like her. equipment (PPE) recommended out a high-risk chronic condition.
female and Latina health care going testing would help fill this Names have been changed to protect the
family’s privacy.
workers earn less than $15 per need. A combination of reduced Disclosure forms provided by the author
hour.5 Forgoing income even for community spread and increased are available at NEJM.org.
a short period would be devastat- testing will be needed, including
ing to such workers’ ability to consideration of universal testing From the Section of General Internal Medi-
cine, Department of Medicine, Boston Uni-
continue to meet basic needs, in- of staff and patients in health versity School of Medicine and Boston
cluding housing, food, and health care settings. The framework pre- Medical Center, Boston.
care. In Massachusetts, being di- sented here is a starting point to
This article was published on May 26, 2020,
rected to self-quarantine by a assist clinicians in having con- at NEJM.org.
medical professional is a qualify- versations with patients regarding
ing reason to leave work and ap- decisions about whether or not to 1. The Novel Coronavirus Pneumonia
ply for unemployment insurance work. Along with improved data, Emergency Response Epidemiology Team.
The epidemiological characteristics of an
(www.masslegalservices.org/covid we need input from occupational outbreak of 2019 novel coronavirus diseases
-19-and-ui). Congressional relief health experts, medical profes- (COVID-19) — China, 2020. China CDC
bills could include incentives for sionals, and professional organi- Weekly. February 2020 (http://weekly
.chinacdc.cn/en/article/id/e53946e2-c6c4
employers to provide better op- zations representing employees in -41e9-9a9b-fea8db1a8f51).
tions for high-risk workers, in- order to establish more specific 2. CDC COVID-19 Response Team. Char-
cluding paid leave or voluntary recommendations, including cut- acteristics of health care personnel with
COVID-19 — United States, February 12–
furloughs. The Family and Medi- offs for risk stratification. April 9, 2020. MMWR Morb Mortal Wkly Rep
cal Leave Act could be revised to As states move to reopen their 2020;69:477-81.
allow people to take job-protect- economies, millions of nonessen- 3. Folgueira MD, Munoz-Ruiperez C, Alon-
so-Lopez MA, Delgado R. SARS-CoV-2 infec-
ed leave if their clinician deter- tial employees will join essential tion in health care workers in a large public
mines that they or their family employees in putting themselves hospital in Madrid, Spain, during March
member is at increased risk for at risk for contracting SARS-CoV-2 2020. April 27, 2020 (https://www.medrxiv
.org/content/10.1101/2020.04.07
poor outcomes from Covid-19. at work. Physicians should engage .20055723v2). preprint.
Finally, a plan is needed for patients in individualized risk as- 4. Centers for Disease Control and Preven-
safe workforce reentry for people sessments. Our society has the tion. Coronavirus disease 2019 (COVID-19):
people who are at higher risk. 2020 (https://
with elevated individual and occu- moral imperative and means to www.cdc.gov/coronavirus/2019-ncov/need
pational risk from Covid-19. More provide vulnerable employees a -extra-precautions/people-at-higher-risk
data are needed to further eluci- financial safety net until we can .html).
5. Himmelstein KEW, Venkataramani AS.
date occupation-specific risks, in- better ensure their workplace safe- Economic vulnerability among US female
cluding data on availability and ty. It is too late for Ms. M., but not health care workers: potential impact of a
effectiveness of PPE according to for the thousands of our essen- $15-per-hour minimum wage. Am J Public
Health 2019;109:198-205.
the worker’s role; policies man- tial partners, children, parents,
dating reporting of the occupa- siblings, and grandparents whom DOI: 10.1056/NEJMp2013413
tional exposures of people under- we can still protect. Copyright © 2020 Massachusetts Medical Society.
“Is It Safe for Me to Go to Work?”