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NZSSD COVID-19 Occupational risk assessment

18 Aug 2021

COVID-19: Recommendations for people with diabetes working in the health care setting - A reminder, document dated 22 April 2020

The categorisation scheme is relevant to all members of staff working in those zones, irrespective of their work or role. Kitchen staff, orderlies, maintenance and engineering staff, environmental services and any other staff visiting any zone even on an intermittent and short-lived basis will be considered as working in that zone. 

The NZSSD acknowledges there is currently a paucity of high-quality evidence on which to base these recommendations. From international experience to date, there does not appear to be an increased risk of contracting COVID-19 in people with diabetes, but there is sufficient evidence to suggest that people with diabetes are more at risk of adverse outcomes if they do contract it. We feel this justifies our position that those with diabetes should avoid known or highly probable COVID cases (of which the numbers are very small). 
The NZSSD also consider that people with diabetes outside healthcare settings can reasonably follow the same guidance as for all New Zealanders, given the low risk of community transmission at the current time, acknowledging Government recommendations during Alert Level 3 that people are to work from home where it is possible to do so. It is harder to know what to do about the category 1 work zones, where people with diabetes will be exposed to patients awaiting COVID-19 results for example or participating in initial screening. 
From a pragmatic perspective, those with higher HbA1c and complications are probably at higher risk of an adverse outcome, so it is recommended for these individuals to avoid these situations where they can. 
While an individual assessment would be ideal for all patients with diabetes, it is difficult to know who should perform these assessments from a practical perspective and what further criteria should be used to stratify risk. An individual assessment for all people with diabetes comes with practical challenges given there are over 250,000 individuals in this group. It should also be noted that these are recommendations only, and that individuals should be able to negotiate their own duties within healthcare settings according to their personal views of risk, alongside other competing factors such as potential loss of income from being excluded from working in particular settings, and the impact on their family/whānau situation of any decisions that are made in regards to their employment. 

The NZSSD recognises that these employment recommendations will impact Maori staff disproportionately due to the disparate underlying rates of type 2 diabetes in the Maori workforce. We encourage occupational health services and employers to consider pro-actively the impact of this on the decisions they make, and ensure that the mana motuhake of Maori staff is considered at all levels of 2 22 April 2020 
These recommendations may change at any time if the risk of community transmission or the prevalence of COVID-19 increases significantly. 

Decision making:.Overall, it is anticipated that following these guidelines will have minimal impact on the workforce in healthcare settings given the average number of inpatients with confirmed or probable COVID-19 has been consistently less than 20 at any given time across the country, and could reasonably be expected to continue to decrease in the foreseeable future given current trends. It is also anticipated this will provide reassurance to those working outside healthcare settings that we consider they are able to participate in work within the restrictions of a given alert level. Workplaces have a responsibility to ensure everything possible is done to keep their workforce safe as per WORKSAFE guidance