COVID-19 has already been recognized and declared as a work-related and occupational disease, in order to support workers who risk their lives daily to keep their families alive, and thereby keep the country alive.

However, without adequate safety protocols at work, immediate availability of vaccines, and a well-equipped health care system to protect the healthy and treat the sick, workers are again placed in a vulnerable position.

Workers need financial assistance that they can use to fight off infection, start over once they recover, or unburden their families of some of the cost of losing them, if they unfortunately succumb to the disease.

The Institute for Occupational Health and Safety Development (IOHSAD), Metal Workers Alliance of the Philippines (MWAP), BPO Industry Employees Network (BIEN) and Nexperia Phils. Inc. Workers Union (NPIWU-NAFLU-KMU) present the following recommendations:

(1) Include jobs that carry out essential activities covered by the recognition of COVID-19 as a work-related and occupational disease. By providing essential goods and services to the public, these jobs expose their workers to numerous individuals with unknown COVID-19 status daily.

With risks associated with the type of interaction, duration of interaction and ventilation in the workplace, the following workers should be granted automatic recognition that their COVID-19 infection is occupational:

(a) Those with direct contact with the offending agent or event:
>> Workers in any healthcare setting providing face-to-face services: health care workers, admin staff, nursing aids, maintenance personnel, pharmacy and laboratory staff, security personnel, among others.
>> Contact tracers and screeners for COVID-19 symptoms
>> Personnel assigned in isolation or quarantine facilities

>> Garbage collectors, regardless of area of work

>> Those administering COVID-19 tests outside hospital settings

(b) Those who have direct interactions with various individuals

>> Service workers including those involved in accommodation and food service activities, education, arts, entertainment and recreation, activities of households as employers, delivery riders, courier services or transport of essential goods
>> Those involved in non-Covid-related face-to-face health care services such as those providing outpatient consultations, dialysis services, physical and occupational therapy, mental health services, and palliative care, including those that provide home visits.
>> Workers in government offices
>> Bank employees

>> Those who work in public transport, whether sea, land or air

>> Those who perform field work: engineers,

>> Barbers/hairdressers

(c) Those who stay in close proximity to other co-workers or clients because of the nature of their work

>> Construction industry workers

>> Manufacturing industry workers

>> Garment/retail industry workers

(d) Those who stay in enclosed spaces and perform activities that increase the release of respiratory particles for a prolonged period of time [1,2]

>> BPO workers, who talk for a long period of time

(e ) And the like

(2) Consider as compensable COVID-19 infections contracted while working from home.

Any location other than the regular workplace is considered an alternative workplace [3]. It is important to remember that (a) there is on-going community transmission of the virus in the whole country [4], (b) not all household members are working from home but all have multiple interactions with each other daily and use common areas frequently, and (c) household members need to leave the house and interact with multiple individuals for purchase of essential goods for work and for the home.

Given these factors, exposure to COVID-19 while working from home is inevitable. Contracting COVID-19 while working from home should therefore be considered work-related and compensable as well.

(3) Provide a special lane or department for processing ECC COVID-19 related benefits in the nearest ECC office.

Processing applications via the SSS/GSIS creates a bottleneck as these agencies also handle other types of benefits. By allocating a separate lane or department with adequate personnel to facilitate reviewing COVID-19 claims, outcomes of applications can be relayed faster, and benefits can be released in a timelier manner.

(4) Recognize a positive rapid antigen test result as a valid form of documentation of COVID-19 infection.

RT-PCR testing for COVID-19 remains costly and PhilHealth coverage is not enough to shoulder the cost. Due to the increased out of pocket spending, some companies opt to carry out rapid antigen tests. While not the best for diagnosis, rapid antigen tests are considered reliable in any of the following:

(a) symptomatic individuals, if done within 5-7 days of the onset of symptoms
(b) asymptomatic close contacts, if done within 4-11 days after their last exposure to the probable or confirmed COVID-19 infection

Under these conditions, a person with a positive test is already considered a confirmed COVID-19 case [5,6].

(5) Remove any limitations on the number of applications for COVID-19 claims.

 The immune response generated from a previous COVID-19 infection has been shown as long-lasting [7-9] but little is known as to how well it can protect an individual from succeeding infections. In fact, if unvaccinated, those previously infected still have twice the risk of getting infected compared to their vaccinated counterparts [10]. Their antibodies have also been seen to be less potent against newer variants [11]. And, even among those fully vaccinated, breakthrough infections are still occurring [12]. As more SARS-CoV-2 variants surface, the possibility of getting infected and re-infected also increases. Given the mutating nature of the disease, all individuals face the danger of getting infected multiple times. Therefore, regardless of the number of times a worker contracts COVID-19 infection, he or she should be eligible to apply for a claim.

(6) Establish a schedule for feedback regarding claim applications.

Our workers have been left waiting for months now for the outcome of their applications, leaving them uncertain of the next steps to take. Updating follow-up mechanisms and releasing the outcome of applications within 7 days will provide workers assurance that their claim is being processed and will allow them to immediately prepare an appeal, if needed.

The Delta variant has been declared as the dominant cause of COVID-19 infections in the Philippines [13]. It is known to be more contagious because an infected person carries 1,000 times more viral particles than when infected with previous variants [14] and can infect 5-8 people within seconds to minutes [15]. This has numerous implications for the current protocols in place in the workplace and community as transmission is expected to occur in interactions even beyond 1 meter or in less than 15 minutes [2,16]. Should our current practice fail to adapt to these changes [17], despite improving compliance, outbreaks will most likely occur.

Furthermore, the Delta variant has been seen to cause severe diseases especially in the unvaccinated [18]. Should our vaccination continue at the pace of 387, 176 jabs per day, with only around 2 million out of 35 million essential workers fully vaccinated [19], severe disease among a large fraction of workers can be expected. Given a severe disease requiring hospitalization in a health care system with at least 73% of ICU beds nationwide already occupied [20], numerous deaths can be anticipated. Multiple infections have already been recorded in several workplaces, and we should not wait until we lose more lives to this disease.

Now more than ever, the Employee Compensation Commission and the Department of Labor and Employment should ensure timely provision of COVID-19 related benefits and publish well-defined guidelines for this purpose.

References:

[1] Jones N R, Qureshi Z U, Temple R J, Larwood J P J, Greenhalgh T, Bourouiba L et al. Two metres or one: what is the evidence for physical distancing in covid-19? BMJ 2020; 370 :m3223 doi:10.1136/bmj.m3223

[2] Center for Disease Control and Prevention (07 May 2021). Scientific Brief: SARS-CoV-2 Transmission https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html

[3] Department Order No. 202 Implementing Rules and Regulations of Republic Act No. 11165 Otherwise known as the “Telecommuting Act”

[4] CNN Philippines (31 August 2021). WHO confirms community transmission, dominance of Delta variant in PH. https://cnnphilippines.com/news/2021/8/31/Delta-variant-community-transmission-dominant-Philippines-WHO.html

[5] Health Technology Assessment Council (30 April 2021). Use of Rapid Antigen Test Kits for the Diagnosis of COVID-19 (April 2021 Assessment) https://hta.doh.gov.ph/2021/05/07/use-of-rapid-antigen-test-kits-for-the-diagnosis-of-covid-19april-2021-assessment/

[6] Philippine Society for Microbiology and Infectious Diseases (28 May 2021). Philippine COVID-19 Living Recommendations https://www.psmid.org/philippine-covid-19-living-recommendations/

[7] Reynolds, S. (26 January 2021). Lasting immunity found after recovery from COVID-19. National Institutes of Health. https://www.nih.gov/news-events/nih-research-matters/lasting-immunity-found-after-recovery-covid-19

[8] Turner, J.S., Kim, W., Kalaidina, E. et al. SARS-CoV-2 infection induces long-lived bone marrow plasma cells in humans. Nature 595, 421–425 (2021). https://doi.org/10.1038/s41586-021-03647-4

[9] Abassi, J. (14 July 2021). Study Suggests Lasting Immunity After COVID-19, With a Big Boost From Vaccination. Journal of American Medical Association. https://jamanetwork.com/journals/jama/fullarticle/2782139

[10] Cavanaugh, A.; Spicer, K., Thoroughman, D., Glick, C., & Winter, K. (13 August 2021). Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination — Kentucky, May–June 2021. Morbidity and Mortality Weekly Report Center for Disease Control and Prevention

[11] Planas, D., Veyer, D., Baidaliuk, A. et al. Reduced sensitivity of SARS-CoV-2 variant Delta to antibody neutralization. Nature 596, 276–280 (2021). https://doi.org/10.1038/s41586-021-03777-9

[12] Center for Disease Control and Prevention (23 August 2021). Possibility of COVID-19 Illness after Vaccination.

[13]Cabico, K. (31 August 2021). WHO says Delta variant now dominant in Philippines. PhilStarhttps://www.philstar.com/headlines/2021/08/31/2123862/who-says-delta-variant-now-dominant-philippines

[14] Viral infection and transmission in a large well-traced outbreak caused by the Delta SARS-CoV-2 variant https://virological.org/t/viral-infection-and-transmission-in-a-large-well-traced-outbreak-caused-by-the-delta-sars-cov-2-variant/724

[15] Department of Health (08 Aug 2021). What you need to know about the Delta Variant

[16] ABC News (2021). What we know about the fleeting spread of the COVID-19 Delta variant in Sydney. https://www.abc.net.au/news/2021-06-24/covid-delta-kappa-variant-spread-in-fleeting-moment-nsw-vic/100238680

[17] National Public Radio (27 Aug 2021). Coronavirus FAQ: How do the rules of 6 feet and 15 minutes apply to the Delta variant? https://www.npr.org/sections/goatsandsoda/2021/08/27/1031753581/coronavirus-faq-how-does-the-6-feet-15-minutes-rule-apply-to-the-delta-variant

[18] Center for Disease Control and Prevention (26 August 2021). Delta variant https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html

[19] Department of Health and National Task Force on COVID-19 (29 August 2021). Vaccine statistics

[20] Department of Health (01 Sept 2021). DOH COVID-19 Case Bulletin #536