ORGANIZATION OF INVESTIGATION AND MEDICAL AND STATISTICAL PATTERN OF ACUTE OCCUPATIONAL DISEASE COVID-19 IN WORKERS OF THE HEALTHCARE SYSTEM OF UKRAINE (FIRST YEAR OF THE PANDEMIC: 2020–2021)

Abstract

In 2020, the problem of human coronavirus infection (2019-nCoV/SARS-CoV-2) became relevant worldwide. On March 11, 2020, the WHO declared a pandemic of SARS-CoV-2. In one year of the pandemic in the world (as of March 12, 2021) 120.1 million cases of SARS-CoV-2 infection were registered, of which 2.7 million people died because of COVID-19.

In Ukraine, 1.451 million people were infected with SARS-CoV-2 (including 68.3 thousand health care workers (HCW)); of whom 28.1 thousand people died because of COVID-19 (including HCW – 612 persons). Today one of the most important scientific and practical problems is risk assessment and prevention of this acute occupational pathology.

Patients and methods. The official statistical data of the Ministry of Health of Ukraine on the normative regulation of the epidemic investigation of COVID-19, on organization of the investigation of COVID-19 in the field of health care, labor protection, registration of cases of COVID-19 were used.

Statistical data on the morbidity of COVID-19 (according to the territorial divisions of the Social Insurance Fund of Ukraine, State Labor Service of Ukraine) for 2020 – March 2021 were obtained and analyzed. Common statistical research methods were used to characterize the data taken from a continuous sample in Ukraine.

Results and discussion. The normative-legal acts on the procedure of investigation of cases of acute occupational disease of COVID-19 were analyzed, namely the Order of the Ministry of Health of Ukraine of February 25, 2020 No 521 “On amendments in the List of especially dangerous, dangerous infectious and parasitic human diseases and carriers of these pathogens”, and also according to Instruction No 374 “On the use of the list of occupational diseases”, approved by a joint Order of the Ministry of Health, the National Academy of Medical Sciences of Ukraine, the Ministry of Labor of December 29, 2000 No 374/68/33”; Order of the Ministry of Health of Ukraine dated July 15, 2020 No 1604 on the List of positions of medical and other workers directly involved in the elimination of the epidemic and implementation of measures to prevent the spread of acute respiratory disease COVID-19 caused by Coronavirus SARS-CoV-2 and treatment of patients with acute respiratory disease COVID-19 caused by Coronavirus SARS-CoV-2”.

Resolution of the Cabinet of Ministers of May 13, 2020 No 394 Section V of the List of Occupational Diseases approved by the Resolution of the Cabinet of Ministers of November 08, 2000 No 1662 was supplemented by acute respiratory disease COVID-19 caused by Coronavirus SARS-CoV-2, concerning only the work of “medical and other workers” directly involved in the liquidation of the epidemic and implementation of measures to prevent the spread of acute respiratory disease COVID-19 caused by Coronavirus SARS-CoV-2, and treatment of patients with acute respiratory disease COVID-19 caused by Coronavirus SARS-2.

Medical and statistical regularities of SARS-CoV-2 infection and morbidity of COVID-19 disease for healthcare workers were determined. The number of reports on cases of SARS-CoV-2 infection at workplace (suspicion of acute occupational disease) received by the State Labor Service of Ukraine (March 12, 2021) was 43,130 employees, including deaths from COVID-19 – 522.

In general, the completeness of acute occupational disease reports was (relative to reported cases on health care workers (HCW) infection): for SARS-CoV-2 infection/COVID-19 disease – 63.5 (4.8–219.3) %; deaths from COVID-19 – 85.6 (36.4–450.0) %.

Fluctuations in the incidence of COVID-19 vary significantly by region; the causes require more careful analysis, they are multifaceted, but the identified regularities can serve as a basis for taking management decisions on accounting, registration, prevention and treatment of this pathology.

Conclusion. The number of patients with acute occupational disease COVID-19 is constantly increasing, is of a wavy nature, in accordance with the general course of the epidemic in the population of Ukraine.

The cumulative risk of infection from SARS-CoV-2 for health care workers is 2.5 times higher than for the general population, and the death rate from COVID-19 is 1.1 times higher.

Dominant causes of SARS-CoV-2 infection in healthcare professionals are: provision of medical care to patients with COVID-19, with intervention procedures (46.3 %); there are organizational shortcomings in ensuring infection control in the health care institutions (HCI) (33.7 %); psychophysiological reasons due to the work of employees in extreme conditions of inpatient care for patients with COVID-19 (“red zone”) (14.0 %); technical reasons (4.5 %); technogenic, natural, ecological and social (1.4 %).

The normative regulation in establishing an acute occupational disease of COVID-19 is regulated only for health care workers and requires its extension to other economic activities in Ukraine (workers of education, social assistance, etc.).

There are significant organizational and resource (personnel) shortcomings: on submission of notifications to the State Labor Service of Ukraine on suspicion of acute occupational disease on COVID-19 and death from it; on objective statistical registration of cases of diseases of healthcare workers on COVID-19; on timely and complete investigation of the connection between illness (death) and working conditions, etc.

Further research will be aimed at improving the system of risk assessment and provision of occupational safety of health care workers in the context of the SARS-CoV-2/COVID-19 epidemic in Ukraine.