Post by Nadica (She/Her) on Sept 16, 2024 2:15:37 GMT
A better approach to mitigate the risk of airborne infections in workplaces - Published Sept 13, 2024
In 2010, this journal highlighted the potential challenge of a pandemic in the ensuing decade [1] and so it came to pass. During the peak of the pandemic, ‘Occupational Medicine’ played its part both in disseminating new knowledge and in expressing authoritative opinion. Looking to the future, many observers are awaiting cues from the outcomes of the coronavirus disease 2019 (COVID-19) Public Inquiry. The Module 1 report showed that the UK Government failed its citizens with its lack of preparation or a preventive strategy [2]. The report also emphasized the need to build resilience in government, associated institutions and their plans, but it has yet to address the resilience built into traditional occupational health control measures such as ventilation [3]. Module 3 [4] might address these measures but the limitations of the Inquiry could disappoint those concerned with workplace health, such as by addressing only health and social care workplaces (HSCW). Analyses of ‘lessons learned’ from COVID-19 [5–7] indicate various but sufficient reasons to eschew attitudes of ‘living with the virus’ or of reversion to ‘business as usual’ when facing common airborne infections at work such as coronaviruses, influenza and respiratory syncytial virus (RSV).
Several studies attest to the increased risk of COVID-19 for many workers besides in HSCW [8]. Long COVID has had a profound impact on the UK’s workforce and economy [9]. Regrettably, the UK Government has considerably scaled down COVID-19 monitoring. Despite this, the data show persistent significant COVID-19 infection with recurrent waves, fuelled both by waning immunity and by new variants, and which are not limited to the winter during which seasonal influenza and RSV also contribute significantly [10]. Perhaps unsurprisingly in 2022, the UK sickness absence rate rose to 2.6% (the highest since 2004) [11]. The contribution of airborne infections to this absence may be variously coded as ‘minor illnesses’ (includes coughs, colds and flu), ‘other’ (includes coronavirus and infectious diseases) as well as ‘respiratory conditions’- comprising, respectively, 29%, 24% and 8% of the total sickness absence occurrences in 2022 [11]. Measures to reduce the risk of contracting airborne infections should, therefore, contribute to any strategy to reduce sickness absence and presenteeism and thus to improve productivity and benefit the economy. However, better data collection and analyses are needed for the quantification of the employment cost of common airborne infections in workplaces, as well as for monitoring interventions.
The COVID-19 pandemic has illustrated both the legal duty and the means for employers to ensure, so far as is reasonably practicable, the health at work of all their employees by reducing their exposure to a common airborne infection at work [12]. Similarly, employers are also obliged to ensure that other persons who may be affected are not exposed to risks to their health from the work being undertaken [12]. These could include children at school, passengers using public transport, the public in retail premises and hospitality venues, as well as in hospitals where the risk and burden of transmission are perhaps most obvious [13]. Schools, catering establishments and hospitals need to tackle the risk of airborne infection with the same commitment with which they currently address infestations, food hygiene and wound infection, respectively. Special considerations also apply to protect individuals who are more susceptible, according to Equality law [12,14].
On the basis of extant knowledge [6,7], if a workplace were to be truly ‘health promoting’ [3], then it would have to exceed mere compliance with the law and would have to rise to the challenge of having less exposure to airborne pathogens within the workplace than the average in the community outside. Such an endeavour would contribute to public health through a reduction in the overall incidence of airborne infection and in the pool of replicating and mutating pathogens. It would also make workplaces and society much more resilient in the face of the next airborne infection outbreak, especially during the lag period before a reliable vaccine or other pharmaceutical intervention were to become available.
Many might baulk at the challenge of developing a proactive strategy to mitigate the risk of airborne infection in the workplace perhaps because of the ubiquitous exposure throughout the community and the multifactorial contributions to the individual or societal burdens. However, the occupational health community has successfully dealt with analogous heterogeneous and complex challenges through a combination of good science and good policy in the past. The development and successful implementation of the Health and Safety Executive’s (HSE) ‘Tackling work-related stress using the Management Standards approach’ with its emphasis on prevention is an excellent example [15]. Such a national strategic approach would require widespread and systematic consultation involving a range of stakeholders such as regulators, notably the HSE, researchers, practitioners, workers’ representatives and employers. Extensive collaboration would be needed for the background research and development as well as to monitor the implementation of the strategy. The multiple actions that would result might include an ‘Approved Code of Practice’ or an approach as in the ‘Management Standards’ [15].
Whilst it might be premature to pre-empt the conclusion of the development of such broad-based and wide-ranging initiatives, some considerations regarding a better paradigm for mitigating airborne infection risk in the workplace can already be highlighted on the basis of current evidence. The traditional ‘hierarchy of control’ as applied to airborne hazards needs adaptation for airborne infection hazards (e.g. the hazard is not amenable to substitution) and a ‘source/pathway/receptor’ approach is better suited [16,17]. Although the World Health Organisation had a flawed position which denied airborne transmission from the onset of the COVID-19 pandemic [17], it has progressed and is developing risk assessment tools for ‘aerosolized infectious respiratory particles’ [18].
Lessons learnt during the pandemic regarding source control [17] such as ‘working from home’ would need to be built into codes of practice. Moreover, evidence needs to be reviewed, for example, regarding the extent to which respirators can limit transmission from infected people [19] since such mitigation could protect health workers exposed to the source [17,19] or help them fulfil legal duties [12,14] towards susceptible patients or co-workers. However, the main emphasis would have to be on pathway control to reduce exposure to airborne pathogens through building design and engineering means notably ventilation ‘as a primary tool for controlling transmission of respiratory pathogens’ [6,7] and other measures such as germicidal ultraviolet light [6]. These measures would likely need supplementation by statutory air quality standards [20] as surrogates for pathogen exposure—analogous to the long-standing but specific exposure limits for airborne chemical agents. Thus society would progressively achieve a ‘clean air revolution’ in workplaces, through a structural engineered resilience. This would add a much-needed dimension to the resilience [2] of institutions and organizations in response to a pandemic. The best efforts in controlling the sources and pathways of transmission of airborne pathogens should reduce the need for personal protection of the ‘receptor’, notably respiratory protective equipment [3,19] as the first or main line of defence. Guidance would be needed as to the role of specific types of respirators such as facepieces or powered devices [3], especially when they might remain indispensable during high exposure in the ‘near field’ [5,17]. The Joint Committee on Vaccination and Immunisation [21] is refraining from advising on occupational health vaccination programmes and is deferring this consideration to HSCW employers. Therefore, it is incumbent on the relevant regulator, that is, the HSE, in consultation with stakeholders to include vaccination guidance as part of a national mitigation strategy.
The development and application of a national strategy to individual workplaces would rely heavily on a range of disciplines from microbiology to engineering. However, implementation in workplaces would be driven mainly by occupational health professionals such as hygienists and physicians as they have long-standing competencies and experience in applying control measures for airborne hazards [3] ranging from asbestos and crystalline silica to Legionella and Mycobacteria. The COVID-19 pandemic taught us that the uncritical application of fallacious public health guidance resulted in a lack of protection for workers [5,17,22] as well as others in workplaces such as patients [13] whose airborne exposure is inextricably linked to that of workers. Occupational health standards of control tend to be higher [17] than those in a public health context and can contribute to the good practice of infection control and public health [22] as part of the collaboration between specialists in all these disciplines. Occupational health specialists should be able to advise employers on aspects of employers’ legal obligations including with reference to those in workplaces who are not workers [12] as well as on adjustments relating to susceptible individuals that may be needed to comply with Equality legislation [12,14].
A ‘let them rip’ attitude towards the mitigation of the risk of common airborne infections in the workplace is unacceptable in terms of law, good occupational medicine practice and public health. A proactive strategy underpinned by a better paradigm is urgently needed for the benefit of society and especially to protect those vulnerable through significant exposure or those susceptible for reasons such as co-morbidity. Even if the will to do what is needed at a national level remains lacking, forward-looking workplaces and other stakeholders should still take proactive steps to mitigate the risk of airborne infection. Thus they would fulfil the duty of care to workers and others as well as improve the resilience and productive potential of workplaces.
References
1. Agius R. Occupational medicine in the first decade of this millennium: looking to the future. Occup Med 2010;60:585–588.
2. UK Covid-19 Inquiry. Module 1: The Resilience and Preparedness of the United Kingdom. 2024. A Report by the Rt Hon the Baroness Hallett DBE Chair of the UK Covid-19 Inquiry. 2024. covid19.public-inquiry.uk/wp-content/uploads/2024/07/18095012/UK-Covid-19-Inquiry-Module-1-Full-Report.pdf (19 July 2024, date last accessed).
3. Agius R and Seaton A. Reduction of the risks of work-related ill-health & health promotion in the workplace. In: Agius R, Seaton A. eds. Practical Occupational Medicine. 2nd edn. London: Hodder Arnold, 2006; 129–160 and 253–269.
4. UK Covid-19 Inquiry. Module 3 Provisional Outline of Scope. 2022. covid19.public-inquiry.uk/wp-content/uploads/2023/05/Module-3-Provisional-Outline-of-Scope-in-English.pdf (22 July 2024, date last accessed).
5. Agius R. COVID-19 in workplace settings: lessons learned for occupational medicine in the UK. Med Lav 2023;114:e2023055.
6. Marr LC, Samet JM. Reducing transmission of airborne respiratory pathogens: a new beginning as the COVID-19 emergency ends. Environ Health Perspect 2024;132:55001.
7. Morawska L, Li Y, Salthammer T. Lessons from the COVID-19 pandemic for ventilation and indoor air quality. Science 2024;385:396–401. www.science.org/doi/10.1126/science.adp2241
8. Burdorf A, Rugulies R. The importance of occupation in the development of the COVID-19 pandemic. Scand J Work Environ Health 2023;49:231–233.
9. Reuschke D, Houston D. The impact of Long COVID on the UK workforce. Appl Econ Letters 2022;30:2510–2514.
10. UK Health Security Agency. UKHSA Data Dashboard. ukhsa-dashboard.data.gov.uk/ (19 July 2024, date last accessed).
11. Office for National Statistics. Sickness Absence in the UK Labour Market: 2022. 2023. www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2022/pdf (19 July 2024, date last accessed).
12. Agius RM, Kloss D, Kendrick D, Stewart M, Robertson JFR. Protection from covid-19 at work: health and safety law is fit for purpose. BMJ 2021;375:n3087.
13. Cooper BS, Evans S, Jafari Y et al. . The burden and dynamics of hospital-acquired SARS-CoV-2 in England. Nature 2023;623:132–138.
14. Pump Court Chambers: Employment and Discrimination Team. Covid-19, Service Providers, and Reasonable Adjustments. www.pumpcourtchambers.com/2024/06/03/does-equality-act-2010-impose-obligations-on-service-providers-in-light-of-covid-19/ (5 August 2024, date last accessed)
15. MacKay CJ, Cousins R, Kelly PJ, Lee S, McCaig RH. ‘Management Standards’ and work-related stress in the UK: policy background and science. Work Stress 2024;18:91–112.
16. McCullough NV, Brosseau LM. Selecting respirators for control of worker exposure to infectious aerosols. Infect Control Hosp Epidemiol 1999;20:136–144.
17. Agius RM. Prevention of COVID-19 in workers: preparation, precaution and protection. Ann. Work Expo Health 2024;68:1–7.
18. World Health Organization. Indoor Airborne Risk Assessment in the Context of SARS-CoV-2: Description of Airborne Transmission Mechanism and METHOD TO develop a New Standardized Model for Risk Assessment. 2024. ISBN 978-92-4-009057-6 iris.who.int/handle/10665/376346 (24 July 2024, date last accessed).
19. Greenhalgh T, MacIntyre CR, Baker MG et al. . Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024;37:e0012423.
20. Morawska L, Allen J, Bahnfleth W et al. . Mandating indoor air quality for public buildings. Science 2024;383:1418–1420. www.science.org/doi/full/10.1126/science.adl0677
21. Joint Committee on Vaccination and Immunisation. JCVI Statement on the COVID-19 Vaccination Programme for Autumn 2024. 2024. www.gov.uk/government/publications/covid-19-autumn-2024-vaccination-programme-jcvi-advice-8-april-2024/jcvi-statement-on-the-covid-19-vaccination-programme-for-autumn-2024-8-april-2024 (4 August 2024, date last accessed).
22. Godderis L, Lerouge L, Samant Y, Noone P. Lessons learned from the COVID-19 pandemic—what occupational safety and health can bring to public health . J Public Health Pol 2023;44:138–146.
In 2010, this journal highlighted the potential challenge of a pandemic in the ensuing decade [1] and so it came to pass. During the peak of the pandemic, ‘Occupational Medicine’ played its part both in disseminating new knowledge and in expressing authoritative opinion. Looking to the future, many observers are awaiting cues from the outcomes of the coronavirus disease 2019 (COVID-19) Public Inquiry. The Module 1 report showed that the UK Government failed its citizens with its lack of preparation or a preventive strategy [2]. The report also emphasized the need to build resilience in government, associated institutions and their plans, but it has yet to address the resilience built into traditional occupational health control measures such as ventilation [3]. Module 3 [4] might address these measures but the limitations of the Inquiry could disappoint those concerned with workplace health, such as by addressing only health and social care workplaces (HSCW). Analyses of ‘lessons learned’ from COVID-19 [5–7] indicate various but sufficient reasons to eschew attitudes of ‘living with the virus’ or of reversion to ‘business as usual’ when facing common airborne infections at work such as coronaviruses, influenza and respiratory syncytial virus (RSV).
Several studies attest to the increased risk of COVID-19 for many workers besides in HSCW [8]. Long COVID has had a profound impact on the UK’s workforce and economy [9]. Regrettably, the UK Government has considerably scaled down COVID-19 monitoring. Despite this, the data show persistent significant COVID-19 infection with recurrent waves, fuelled both by waning immunity and by new variants, and which are not limited to the winter during which seasonal influenza and RSV also contribute significantly [10]. Perhaps unsurprisingly in 2022, the UK sickness absence rate rose to 2.6% (the highest since 2004) [11]. The contribution of airborne infections to this absence may be variously coded as ‘minor illnesses’ (includes coughs, colds and flu), ‘other’ (includes coronavirus and infectious diseases) as well as ‘respiratory conditions’- comprising, respectively, 29%, 24% and 8% of the total sickness absence occurrences in 2022 [11]. Measures to reduce the risk of contracting airborne infections should, therefore, contribute to any strategy to reduce sickness absence and presenteeism and thus to improve productivity and benefit the economy. However, better data collection and analyses are needed for the quantification of the employment cost of common airborne infections in workplaces, as well as for monitoring interventions.
The COVID-19 pandemic has illustrated both the legal duty and the means for employers to ensure, so far as is reasonably practicable, the health at work of all their employees by reducing their exposure to a common airborne infection at work [12]. Similarly, employers are also obliged to ensure that other persons who may be affected are not exposed to risks to their health from the work being undertaken [12]. These could include children at school, passengers using public transport, the public in retail premises and hospitality venues, as well as in hospitals where the risk and burden of transmission are perhaps most obvious [13]. Schools, catering establishments and hospitals need to tackle the risk of airborne infection with the same commitment with which they currently address infestations, food hygiene and wound infection, respectively. Special considerations also apply to protect individuals who are more susceptible, according to Equality law [12,14].
On the basis of extant knowledge [6,7], if a workplace were to be truly ‘health promoting’ [3], then it would have to exceed mere compliance with the law and would have to rise to the challenge of having less exposure to airborne pathogens within the workplace than the average in the community outside. Such an endeavour would contribute to public health through a reduction in the overall incidence of airborne infection and in the pool of replicating and mutating pathogens. It would also make workplaces and society much more resilient in the face of the next airborne infection outbreak, especially during the lag period before a reliable vaccine or other pharmaceutical intervention were to become available.
Many might baulk at the challenge of developing a proactive strategy to mitigate the risk of airborne infection in the workplace perhaps because of the ubiquitous exposure throughout the community and the multifactorial contributions to the individual or societal burdens. However, the occupational health community has successfully dealt with analogous heterogeneous and complex challenges through a combination of good science and good policy in the past. The development and successful implementation of the Health and Safety Executive’s (HSE) ‘Tackling work-related stress using the Management Standards approach’ with its emphasis on prevention is an excellent example [15]. Such a national strategic approach would require widespread and systematic consultation involving a range of stakeholders such as regulators, notably the HSE, researchers, practitioners, workers’ representatives and employers. Extensive collaboration would be needed for the background research and development as well as to monitor the implementation of the strategy. The multiple actions that would result might include an ‘Approved Code of Practice’ or an approach as in the ‘Management Standards’ [15].
Whilst it might be premature to pre-empt the conclusion of the development of such broad-based and wide-ranging initiatives, some considerations regarding a better paradigm for mitigating airborne infection risk in the workplace can already be highlighted on the basis of current evidence. The traditional ‘hierarchy of control’ as applied to airborne hazards needs adaptation for airborne infection hazards (e.g. the hazard is not amenable to substitution) and a ‘source/pathway/receptor’ approach is better suited [16,17]. Although the World Health Organisation had a flawed position which denied airborne transmission from the onset of the COVID-19 pandemic [17], it has progressed and is developing risk assessment tools for ‘aerosolized infectious respiratory particles’ [18].
Lessons learnt during the pandemic regarding source control [17] such as ‘working from home’ would need to be built into codes of practice. Moreover, evidence needs to be reviewed, for example, regarding the extent to which respirators can limit transmission from infected people [19] since such mitigation could protect health workers exposed to the source [17,19] or help them fulfil legal duties [12,14] towards susceptible patients or co-workers. However, the main emphasis would have to be on pathway control to reduce exposure to airborne pathogens through building design and engineering means notably ventilation ‘as a primary tool for controlling transmission of respiratory pathogens’ [6,7] and other measures such as germicidal ultraviolet light [6]. These measures would likely need supplementation by statutory air quality standards [20] as surrogates for pathogen exposure—analogous to the long-standing but specific exposure limits for airborne chemical agents. Thus society would progressively achieve a ‘clean air revolution’ in workplaces, through a structural engineered resilience. This would add a much-needed dimension to the resilience [2] of institutions and organizations in response to a pandemic. The best efforts in controlling the sources and pathways of transmission of airborne pathogens should reduce the need for personal protection of the ‘receptor’, notably respiratory protective equipment [3,19] as the first or main line of defence. Guidance would be needed as to the role of specific types of respirators such as facepieces or powered devices [3], especially when they might remain indispensable during high exposure in the ‘near field’ [5,17]. The Joint Committee on Vaccination and Immunisation [21] is refraining from advising on occupational health vaccination programmes and is deferring this consideration to HSCW employers. Therefore, it is incumbent on the relevant regulator, that is, the HSE, in consultation with stakeholders to include vaccination guidance as part of a national mitigation strategy.
The development and application of a national strategy to individual workplaces would rely heavily on a range of disciplines from microbiology to engineering. However, implementation in workplaces would be driven mainly by occupational health professionals such as hygienists and physicians as they have long-standing competencies and experience in applying control measures for airborne hazards [3] ranging from asbestos and crystalline silica to Legionella and Mycobacteria. The COVID-19 pandemic taught us that the uncritical application of fallacious public health guidance resulted in a lack of protection for workers [5,17,22] as well as others in workplaces such as patients [13] whose airborne exposure is inextricably linked to that of workers. Occupational health standards of control tend to be higher [17] than those in a public health context and can contribute to the good practice of infection control and public health [22] as part of the collaboration between specialists in all these disciplines. Occupational health specialists should be able to advise employers on aspects of employers’ legal obligations including with reference to those in workplaces who are not workers [12] as well as on adjustments relating to susceptible individuals that may be needed to comply with Equality legislation [12,14].
A ‘let them rip’ attitude towards the mitigation of the risk of common airborne infections in the workplace is unacceptable in terms of law, good occupational medicine practice and public health. A proactive strategy underpinned by a better paradigm is urgently needed for the benefit of society and especially to protect those vulnerable through significant exposure or those susceptible for reasons such as co-morbidity. Even if the will to do what is needed at a national level remains lacking, forward-looking workplaces and other stakeholders should still take proactive steps to mitigate the risk of airborne infection. Thus they would fulfil the duty of care to workers and others as well as improve the resilience and productive potential of workplaces.
References
1. Agius R. Occupational medicine in the first decade of this millennium: looking to the future. Occup Med 2010;60:585–588.
2. UK Covid-19 Inquiry. Module 1: The Resilience and Preparedness of the United Kingdom. 2024. A Report by the Rt Hon the Baroness Hallett DBE Chair of the UK Covid-19 Inquiry. 2024. covid19.public-inquiry.uk/wp-content/uploads/2024/07/18095012/UK-Covid-19-Inquiry-Module-1-Full-Report.pdf (19 July 2024, date last accessed).
3. Agius R and Seaton A. Reduction of the risks of work-related ill-health & health promotion in the workplace. In: Agius R, Seaton A. eds. Practical Occupational Medicine. 2nd edn. London: Hodder Arnold, 2006; 129–160 and 253–269.
4. UK Covid-19 Inquiry. Module 3 Provisional Outline of Scope. 2022. covid19.public-inquiry.uk/wp-content/uploads/2023/05/Module-3-Provisional-Outline-of-Scope-in-English.pdf (22 July 2024, date last accessed).
5. Agius R. COVID-19 in workplace settings: lessons learned for occupational medicine in the UK. Med Lav 2023;114:e2023055.
6. Marr LC, Samet JM. Reducing transmission of airborne respiratory pathogens: a new beginning as the COVID-19 emergency ends. Environ Health Perspect 2024;132:55001.
7. Morawska L, Li Y, Salthammer T. Lessons from the COVID-19 pandemic for ventilation and indoor air quality. Science 2024;385:396–401. www.science.org/doi/10.1126/science.adp2241
8. Burdorf A, Rugulies R. The importance of occupation in the development of the COVID-19 pandemic. Scand J Work Environ Health 2023;49:231–233.
9. Reuschke D, Houston D. The impact of Long COVID on the UK workforce. Appl Econ Letters 2022;30:2510–2514.
10. UK Health Security Agency. UKHSA Data Dashboard. ukhsa-dashboard.data.gov.uk/ (19 July 2024, date last accessed).
11. Office for National Statistics. Sickness Absence in the UK Labour Market: 2022. 2023. www.ons.gov.uk/employmentandlabourmarket/peopleinwork/labourproductivity/articles/sicknessabsenceinthelabourmarket/2022/pdf (19 July 2024, date last accessed).
12. Agius RM, Kloss D, Kendrick D, Stewart M, Robertson JFR. Protection from covid-19 at work: health and safety law is fit for purpose. BMJ 2021;375:n3087.
13. Cooper BS, Evans S, Jafari Y et al. . The burden and dynamics of hospital-acquired SARS-CoV-2 in England. Nature 2023;623:132–138.
14. Pump Court Chambers: Employment and Discrimination Team. Covid-19, Service Providers, and Reasonable Adjustments. www.pumpcourtchambers.com/2024/06/03/does-equality-act-2010-impose-obligations-on-service-providers-in-light-of-covid-19/ (5 August 2024, date last accessed)
15. MacKay CJ, Cousins R, Kelly PJ, Lee S, McCaig RH. ‘Management Standards’ and work-related stress in the UK: policy background and science. Work Stress 2024;18:91–112.
16. McCullough NV, Brosseau LM. Selecting respirators for control of worker exposure to infectious aerosols. Infect Control Hosp Epidemiol 1999;20:136–144.
17. Agius RM. Prevention of COVID-19 in workers: preparation, precaution and protection. Ann. Work Expo Health 2024;68:1–7.
18. World Health Organization. Indoor Airborne Risk Assessment in the Context of SARS-CoV-2: Description of Airborne Transmission Mechanism and METHOD TO develop a New Standardized Model for Risk Assessment. 2024. ISBN 978-92-4-009057-6 iris.who.int/handle/10665/376346 (24 July 2024, date last accessed).
19. Greenhalgh T, MacIntyre CR, Baker MG et al. . Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024;37:e0012423.
20. Morawska L, Allen J, Bahnfleth W et al. . Mandating indoor air quality for public buildings. Science 2024;383:1418–1420. www.science.org/doi/full/10.1126/science.adl0677
21. Joint Committee on Vaccination and Immunisation. JCVI Statement on the COVID-19 Vaccination Programme for Autumn 2024. 2024. www.gov.uk/government/publications/covid-19-autumn-2024-vaccination-programme-jcvi-advice-8-april-2024/jcvi-statement-on-the-covid-19-vaccination-programme-for-autumn-2024-8-april-2024 (4 August 2024, date last accessed).
22. Godderis L, Lerouge L, Samant Y, Noone P. Lessons learned from the COVID-19 pandemic—what occupational safety and health can bring to public health . J Public Health Pol 2023;44:138–146.