COVID-19 could be the most frequent occupational disease in Romania in 2020

Marina Ruxandra Oțelea 1 , Oana Cristina Arghir 2 , 3 , Raluca Constantin 4 ,  and Agripina Rașcu 1 , 5
  • 1 University of Medicine and Pharmacy “Carol Davila”, Clinical Department 2, Bucharest, Romania
  • 2 Faculty of Medicine, “Ovidius” University of Constanța, 4th Department of Clinical Diseases, Romania
  • 3 Clinical Pneumophthisiology Hospital, , Constanța, Romania
  • 4 St Andrew Clinical County Emergency Hospital, , Constanța, Romania
  • 5 Clinical Hospital Colentina, Clinic for Occupational Diseases, , Bucharest, Romania


The definition of COVID-19 as occupational disease follows the investigation of any other occupational disease caused by an infectious agent. The risk is not equal for all occupations and the occupational physician has to assess the working conditions to conclude a diagnosis of occupational COVID-19. In the pandemic context, employees face also other occupational hazards. The high level of work load and the scarce resources lead to stress, physical and mental exhaustion and irregular sleep. The protection measures, of undisputable benefit, increase the risk for contact dermatitis. There is a high probability for medium and possible long term effects of COVID-19, such as the post-traumatic stress disorder or the respiratory sequelae. These consequences need to be acknowledged and properly manged by the medical team taking care of the patient. This review presents the main characteristics of the occupational related disorders during and after the current pandemia.

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  • 1. Wang, Y, Wang, Y, Chen, Y, Qin, Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020; 1–9.

  • 2. The Lancet. Editorial. 2020: 395(10228):922.

  • 3. National Institute of Public Health.

  • 4. Davenne E, Giot JB, Huynen P. Coronavirus and COVID-19 : focus on a galopping pandemic. Rev Med Liege. 2020;75(4):218-225.

  • 5. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109:102433.

  • 6. Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA, 2020. doi:10.1001/jama.2020.2565.

  • 7. D’Amico F, Baumgart DC, Danese S, Peyrin-Biroulet L4. Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention and management. Clin Gastroenterol Hepatol. 2020 Apr 8. pii: S1542-3565(20)30481-X. doi: 10.1016/j.cgh.2020.04.001.

  • 8. Zhao S, Lin Q, Ran J, Musa SS, Yang G, Wang W, et al. The basic reproduction number of novel coronavirus (2019-nCoV) estimation based on exponential growth in the early outbreak in China from 2019 to 2020: A reply to Dhungana. Int J Infect Dis (2020), doi:

  • 9. Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond). 2020;20(2):124–127.

  • 10. Sim MR. The COVID-19 pandemic: major risks to healthcare and other workers on the front line. Occup Environ Med 2020. doi: 10.1136/oemed-2020-106567.

  • 11. Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB et al. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020; 1–7.

  • 12. Stafford N. Covid-19: Why Germany’s case fatality rate seems so low. BMJ. 2020;369:m1395.

  • 13. Risk assessment and management of exposure of health care workers in the context of COVID-19.

  • 14. Definitiile de caz pentru Sindromul respirator acut cu noul coronavirus (COVID-19). Actualizare 27.03.2020.

  • 15. West, CP, Dyrbye, LN, Shanafelt, TD. J Intern Med 2018; 283: 516–529.

  • 16. WHO. ICD-11. International classification of diseases 11th Revision. The global standard for diagnostic health information.

  • 17. Demerouti E, Bakker A. B., Nachreiner F, Schaufeli WB. The job demands-resources model of burnout. J. Appl. Psychol. 2001; 86: 499–512.

  • 18. Kristensen TS, Borritz M, Villadsen E, Christensen KB. (2005). Copenhagen Burnout Inventory (CBI) [Database record]. APA PsycTests.

  • 19. Tavella G, Hadzi-Pavlovic D, Parker G. Burnout: Re-examining its key constructs. Psychiatry Res. 2020:287:112917.

  • 20. Doulougeri K, Georganta K, Montgomery A. Diagnosing” burnout among healthcare professionals: Can we find consensus?. Cogent Med; 2016; 3:1.

  • 21. Eguchi H, Wada K, Smith DR. Recognition, Compensation, and Prevention of Karoshi, or Death due to Overwork. J Occup Environ Med. 2016:58(8): e313-e314.

  • 22. Ke DS. Overwork, stroke, and karoshi-death from overwork. Acta Neurol Taiwan. 2012:21(2):54-9.

  • 23. Otsui K, Yamamoto J, Inoue N. Overwork accelerates thrombotic reaction: implications for the pathogenesis of Karoshi. J Thromb Thrombolysis. 2018;45:222–224.

  • 24. Wong CW, Chan YH, Cheng YH, Lam CS.Is overwork a precipitant factor of idiopathic ventricular fibrillation? Int J Cardiol. 2016; 223:218 – 219.

  • 25. Xiao N, Yang BF, Shi JZ, et al. Karoshi May Be a Consequence of Overwork-Related Malignant Arrhythmia. Med Sci Monit. 2019;25:357–364.

  • 26. Lo EV, Wei YH, Hwang BF. Association between occupational burnout and heart rate variability: A pilot study in a high-tech company in Taiwan. Medicine (Baltimore). 2020;99(2):e18630.

  • 27. Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z, et al. Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak. Frontiers in Psychiatry. 2020;11:306.

  • 28. Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976.

  • 29. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168(10):1245 – 1251.

  • 30. Mo Y, Deng L, Zhang L, Lang Q, Liao C, Wang N, et al. Work stress among Chinese nurses to support Wuhan for fighting against the COVID-19 epidemic. J Nurs Manag. 2020;Apr 7. doi: 10.1111/jonm.13014.

  • 31. American Stroke Association. Temporary Emergency Guidance to US Stroke Centers During the COVID-19 Pandemic. Stroke. 2020 Apr 1. doi:10.1161/STROKEAHA.120.030023.

  • 32. Ross RW, Lauer CW, Miles WS, Green JM, Britton Christmas A, May AK, Matthews BD. Maximizing the Calm Before the Storm: Tiered Surgical Response Plan for Novel Coronavirus (COVID-19). J Am Col Surg 2020 doi:

  • 33. Puliatti S, Eissa A, Eissa R, Amato M, Mazzone E, Dell’Oglio P, et al. COVID-19 and Urology: A Comprehensive Review of the Literature. BJU Int. 2020 Apr 6. doi: 10.1111/bju.15071.

  • 34. Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res.2014;58:193–210.

  • 35. Brown RL, Shahane AD, Chen MA, Fagundes CP. Cognitive reappraisal and nasal cytokine production following experimental rhinovirus infection. Brain, Behavior, & Immunity – Health. 2020;1:100012.

  • 36. Petzold MB, Plag J, Ströhle A. Dealing with psychological distress by healthcare professionals during the COVID-19 pandemia. Nervenarzt. 2020;1–5

  • 37. World Health Organization, War Trauma Foundation and World Vision International (2011). Psychological first aid: Guide for field workers. WHO: Geneva.

  • 38. Meding B, Anveden Berglind I, Alderling M, Lindahl G, Wrangsjö K. Water exposure – challenging differences between occupations. Contact Dermatitis. 2016: 74: 22–28.

  • 39. Australian Government. Australian safety and Compensation Council. Guidance on the prevention of dermatitis caused by wet work. ISBN 0642325308.

  • 40. Flyvholm MA, Lindberg M. OEESC-2005 -- Summing up on the theme Irritants and Wet Work. Contact Dermatitis. 2005;55:317-321.

  • 41. Jungersted JM, Scheer H, Mempel M, Baurecht H, Cifuentes L, Høgh JK, et al. Stratum corneum lipids, skin barrier function and filaggrin mutations in patients with atopic eczema. Allergy; 2010; 65: 911-918.

  • 42. Tiedemann D, Clausen ML, John SM, Angelova-Fischer I, Kezic S. and Agner T. Effect of glove occlusion on the skin barrier. Contact Dermatitis. 2016; 74: 2–10.

  • 43. Agner T. An experimental study of irritant effects of urea in different vehicles. Acta Derm Venereol Suppl (Stockh) 1992: 177: 44–46.

  • 44. Lin P, Zhu S, Huang Y, Li L, Tao J, Lei T, et al. Adverse Skin Reactions Among Healthcare Workers During the Coronavirus Disease 2019 Outbreak: A Survey in Wuhan and Its Surrounding Regions. Br J Dermatol. 2020 Apr 7. doi: 10.1111/bjd.19089.

  • 45. Yan Y, Chen H, Chen L, Cheng B, Diao P, Dong L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against coronavirus disease 2019. Dermatol Ther. 2020 Mar 13:e13310. doi: 10.1111/dth.13310

  • 46. Lee AM, Wong JG, McAlonan GM, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry. 2007;52(4):233-240).

  • 47. Su TP, Lien TC, Yang CY, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan. J Psychiatr Res. 2007;41(1-2):119–130

  • 48. Das KM, Lee EY, Singh R, Enani MA, Al Dossari K, Van Gorkom K, et al. Follow-up chest radiographic findings in patients with MERSCoV after recovery. Indian J Radiold Imaging. 2017(3):342-349.

  • 49. Zhang P, Li J, Liu H, Han N, Ju J, Kou Y et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res. 2020;8: 8.

  • 50. Wu J, Pan J, Teng D, Xu X, Feng J, Chen YC. Interpretation of CT signs of 2019 novel coronavirus (COVID-19) pneumonia. Eur Radiol. 2020;1-8. doi:10.1007/s00330-020-06915-5.


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