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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">mvjr</journal-id><journal-title-group><journal-title xml:lang="en">Medical Herald of the South of Russia</journal-title><trans-title-group xml:lang="ru"><trans-title>Медицинский вестник Юга России</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2219-8075</issn><issn pub-type="epub">2618-7876</issn><publisher><publisher-name>The Rostov State Medical University</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21886/2219-8075-2023-14-1-101-111</article-id><article-id custom-type="elpub" pub-id-type="custom">mvjr-1638</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>OCCUPATIONAL MEDICINE</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>3.2.4 МЕДИЦИНА ТРУДА</subject></subj-group></article-categories><title-group><article-title>Challenges for occupational medicine during the pandemic of a new coronavirus infectious disease (COVID-19)</article-title><trans-title-group xml:lang="ru"><trans-title>Задачи медицины труда в период пандемии новой коронавирусной инфекции (COVID-19)</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-9107-7964</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Горблянский</surname><given-names>Ю. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Gorblyansky</surname><given-names>Y. Y.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Горблянский Юрий Юрьевич, д.м.н., проф., заведующий кафедрой профпатологии </p><p>Ростов-на-Дону</p></bio><bio xml:lang="en"><p>Yuri Yu. Gorblyansky, Dr. Sci. (Med.), Professor, Head of the Department of Occupational Pathology </p><p>Rostov-on-Don</p></bio><email xlink:type="simple">gorblyansky.profpatolog@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0961-9603</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Рамазанова</surname><given-names>Э. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Ramazanova</surname><given-names>E. R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Рамазанова Эльмира Ражидиновна, ординатор кафедры профпатологии </p><p>Ростов-на-Дону</p></bio><bio xml:lang="en"><p>Elmira R. Ramazanova, Resident of Department of Occupational Pathology </p><p>Rostov-on-Don</p></bio><email xlink:type="simple">ellmira.rnd@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0050-5645</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Конторович</surname><given-names>Е. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Kontorovich</surname><given-names>E. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Конторович Елена Павловна, к.м.н., доцент кафедры профпатологии </p><p>Ростов-на-Дону</p></bio><bio xml:lang="en"><p>Elena P. Kontorovich, Cand. Sci. (Med.), Associate Professor of the Department of Occupational Pathology </p><p>Rostov-on-Don</p></bio><email xlink:type="simple">kontorovichep@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0149-1281</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Понамарева</surname><given-names>О. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Ponamareva</surname><given-names>O. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Понамарева Оксана Петровна, к.м.н., доцент кафедры профпатологии </p><p>Ростов-на-Дону</p></bio><bio xml:lang="en"><p>Oksana P. Ponamareva, Cand. Sci. (Med.), Associate Professor of the Department of Occupational Pathology </p><p>Rostov-on-Don</p></bio><email xlink:type="simple">oksanaponamareva@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Ростовский государственный медицинский университет</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Rostov State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>28</day><month>03</month><year>2023</year></pub-date><volume>14</volume><issue>1</issue><fpage>101</fpage><lpage>111</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Gorblyansky Y.Y., Ramazanova E.R., Kontorovich E.P., Ponamareva O.P., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Горблянский Ю.Ю., Рамазанова Э.Р., Конторович Е.П., Понамарева О.П.</copyright-holder><copyright-holder xml:lang="en">Gorblyansky Y.Y., Ramazanova E.R., Kontorovich E.P., Ponamareva O.P.</copyright-holder><license license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.medicalherald.ru/jour/article/view/1638">https://www.medicalherald.ru/jour/article/view/1638</self-uri><abstract><p>The article describes the current issues in occupational medicine and the ways to resolve them in the context of the spread of a new coronavirus infection COVID-19. The risks of COVID-19 infection in medical and non-medical workers are considered. Modern approaches to establishment of COVID-19 causal relationship with occupation and medical examinations in patients with COVID-19 are presented. The main provisions of the National concept of healthcare-associated infections relevant in the context of COVID-19 pandemic are presented. Problems in public health care related to restructuring of work of medical organizations in conditions of COVID-19 spread are shown. Attention is paid to mental health disorders in medical workers providing medical care to patients with COVID-19. The prospects of development and implementation of measures for prevention of COVID-19, its complications and adverse outcomes taking into account complex assessment of working environment and professional health of workers are considered from the position of occupational medicine.</p></abstract><trans-abstract xml:lang="ru"><p>В статье изложены современные проблемы медицины труда и пути их решения в условиях пандемии COVID-19. Рассмотрены риски заражения COVID-19 у медицинских и немедицинских работников. Описаны современные подходы к установлению причинно-следственной связи COVID-19 c профессией и проведению медицинских экспертиз у пациентов с COVID-19. Представлены основные положения Национальной концепции профилактики инфекций, связанных с оказанием медицинской помощи, актуальные в период пандемии COVID-19. Освещены проблемы в здравоохранении, связанные с перестройкой работы медицинских организаций в условиях пандемии COVID-19. Обращено внимание на нарушение психического здоровья у медработников, оказывающих помощь пациентам с COVID-19. С точки зрения медицины труда рассмотрены перспективы разработки и внедрения мероприятий по профилактике COVID-19 и её последствий с учётом комплексной оценки рабочей среды и профессионального здоровья работников.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>коронавирусная инфекция</kwd><kwd>профессиональные риски</kwd><kwd>рабочая среда</kwd><kwd>профилактика</kwd><kwd>медицинские&#13;
работники</kwd><kwd>медицина труда</kwd></kwd-group><kwd-group xml:lang="en"><kwd>coronavirus infection</kwd><kwd>occupational risks</kwd><kwd>working environment</kwd><kwd>prevention</kwd><kwd>medical workers</kwd><kwd>occupational&#13;
medicine</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Исследование не имело спонсорской поддержки.</funding-statement><funding-statement xml:lang="en">The study did not have sponsorship.</funding-statement></funding-group></article-meta></front><body><sec><title>Introduction</title><p>Occupational medicine is an integrated field of preventive and curative medicine, aimed at managing the state of health of an employee; the subject of occupational medicine is the scientific justification and practical implementation of means and methods for health preservation and strengthening [<xref ref-type="bibr" rid="cit1">1</xref>]. According to the specialty passport “3.2.4. Occupational Medicine”, the content of this specialty implies “the study of a person in the process of labor activity and the impact of working conditions on the human body in order to maintain and strengthen health and performance, prolong life, prevent and treat both occupational and professionally caused diseases”.</p><p>In the current conditions of the spread of a new coronavirus infection, maintaining and strengthening the health of employees as a socially significant category of citizens is becoming a priority for occupational medicine. At the same time, occupational medicine faces the need to maintain and strengthen the professional health and performance of people who have already experienced COVID-19.</p></sec><sec><title>Occupational medicine and healthcare during the COVID-19 pandemic</title><p>The pandemic has posed challenges for occupational medicine and practical healthcare that require an interdisciplinary approach and joint efforts of healthcare professionals, occupational health and safety specialists, psychologists, etc. to solve them.</p><p>Occupational medicine considers the coronavirus SARS-CoV-2 causing COVID-19 as a new biological factor in the work environment. The high pathogenicity of the SARS-CoV-2 virus allows attributing it to pathogenicity group II1, which is taken into account when resolving issues of a causal relationship between the disease and the profession.</p><p>Today, one of the important tasks of occupational medicine is to assess the risks of COVID-19 infection for employees in various sectors of the economy and to prevent pandemic-related stress-induced health disorders.</p><p>The need to assess the risk of COVID-19 infection is relevant for both medical and non-medical workers [2–7].</p><p>Studies by a number of authors [8–12] allowed identifying the following main risk groups for contracting COVID-19 in the workplace:</p><p>Socioeconomic status can also act as a risk factor for infection. According to the ILO guide (2020)2, social sectors of the population that are particularly susceptible to infection with COVID-19 include the following people:</p><p>The main risk factors for nosocomial transmission of COVID-19 by medical workers are contact with infected patients, insufficient provision of personal protective equipment (PPE), non-compliance with personal hygiene rules [<xref ref-type="bibr" rid="cit13">13</xref>], microorganisms of pathogenicity groups 1–1U when working in the laboratory,3 or the lack of knowledge about anti-epidemic measures in the workplace [14–15].</p><p>Among non-medical workers, service workers (bank workers, personal trainers, teachers, hotel staff, cleaners, and others) who have contact with people, money, or goods may be at risk of COVID-19 infection [<xref ref-type="bibr" rid="cit16">16</xref>].</p><p>Recently, there have been reports of numerous outbreaks of COVID-19 in meat and poultry processing plants [<xref ref-type="bibr" rid="cit8">8</xref>], where a high transmission rate of the SARS-CoV-2 coronavirus has been established [<xref ref-type="bibr" rid="cit17">17</xref>]. According to Durand-Moreau et al. (2021), during the COVID-19 pandemic, the work environment in these facilities is conducive to SARS-CoV-2 persistence (metal surfaces, low temperatures, and relative humidity) and to SARS-CoV-2 transmission (crowded workplaces, shared transport, aerosol and droplet generation). In addition, the transmission of infection is facilitated by a vulnerable low-paid workforce forced to continue working despite the symptoms of coronavirus infection [<xref ref-type="bibr" rid="cit17">17</xref>].</p><p>The risk group for COVID-19 infection includes truck drivers involved in the transportation of goods over long distances and being in contact with a significant number of people [<xref ref-type="bibr" rid="cit18">18</xref>].</p><p>Today, the possibility of contracting COVID-19 outside the workplace is being considered, for example, through regular social contacts with colleagues outside of work [<xref ref-type="bibr" rid="cit19">19</xref>], which is especially dangerous for workers from high-risk groups [<xref ref-type="bibr" rid="cit20">20</xref>].</p><p>In the context of the spread of COVID-19, infection prevention issues occupy an important place in occupational medicine.</p><p>Non-specific prevention of COVID-194 is performed in relation to the source of infection (a sick person and an asymptomatic carrier), the mechanism of transmission of the infectious agent (use of PPE for medical workers, disinfection measures, personal hygiene, disinfection and disposal of class B medical waste), and susceptible contingent (restrictive measures, isolation measures).</p><p>At the same time, given the importance of using PPE to prevent the spread of COVID-19, a number of researchers draw attention to the side effects of using various PPE (dermatitis of the face and neck, facial pain, dry nose, etc.) due to their long-term wearing (from 6 to 12 hours a day, for example, in medical workers), which requires the adoption of preventive measures, in particular, reducing the time spent wearing PPE, reducing overtime work to ensure safe and reliable working conditions [<xref ref-type="bibr" rid="cit21">21</xref>].</p><p>In the context of the COVID-19 pandemic, it became necessary to increase control over epidemiological safety and prevention of healthcare-associated infections (HCAI). The relevance of this issue was confirmed at the VIII Congress with international participation held in November 20205, where the experience of organizing the work of medical institutions during a pandemic, legal and regulatory regulation in the field of epidemiology and prevention of HCAI, protection of medical staff from HCAI, organization of epidemiological surveillance and control of HCAI, and introduction of advanced technologies for the prevention of HCAI were discussed.</p><p>In order to prevent both infection and the formation of severe cases of COVID-19 during a pandemic, it is necessary to apply the following basic provisions of the National Evidence-Based Guidelines for the Prevention of HCAI6:</p><p>Vaccination is an important means of specific prevention of COVID-19.</p><p>Vaccination of the population against COVID-19 is performed in accordance with the temporary guidelines “Procedure for vaccination against a new coronavirus infection (COVID-19)” approved by the Ministry of Health of the Russian Federation)7.</p><p>The following vaccines are registered in the Russian Federation for the specific prevention of COVID-19 in adults8:</p><p>The current system of occupational pathology service in Russia allows solving complex issues of diagnosing occupational diseases among employees in various sectors of the country's economy. The pandemic caused by a new coronavirus infection dictates the need to consider the possibilities of establishing a causal relationship between COVID-19 and the profession, especially among employees with a high risk of infection in the workplace [<xref ref-type="bibr" rid="cit22">22</xref>].</p><p>In a number of foreign countries (Belgium, Italy, Germany, South Africa, and Canada), COVID-19 has been considered up until recently as a consequence of occupational exposure of the SARS-CoV-2 coronavirus to the body [<xref ref-type="bibr" rid="cit23">23</xref>]. To date, COVID-19 has been defined as a new occupational disease that gives employees the right to compensation and is proposed for recognition worldwide [<xref ref-type="bibr" rid="cit24">24</xref>].</p><p>According to the international definition, an occupational disease is a disease that has developed “as a result of an exposure to risk factors arising from work activity” [<xref ref-type="bibr" rid="cit25">25</xref>]. In Russia, the concepts of occupational disease and occupational risk are approved by law9 (“Occupational disease is a chronic or acute illness of the insured, which is the result of exposure to a harmful production factor (factors) and resulting in temporary or permanent loss of his professional ability to work and (or) his death”, “Occupational risk is the likelihood of injury (loss) of health or death of the insured, associated with the performance of his duties under an employment contract and other established by this federal law cases”).</p><p>The concepts of occupational disease and occupational risk adopted in Russia determine the fundamental approaches to establishing the relationship of a disease with a profession and are taken into account in the order of the Ministry of Health of Russia No. 36n10.</p><p>In 2020, in the structure of occupational pathologies, “for the first time in 10 years, diseases caused by biological factors took the second rank (20.19%)” and came after diseases caused by physical factors11; moreover, the vast majority of diseases (92.7%) in this group were induced by the SARS-CoV-2 coronavirus.</p><p>At present, guidelines have been developed in the Russian Federation on the procedure for examining the relationship of COVID-19 with the profession of medical workers, as well as the substantiation of COVID-19 as an occupational disease among health workers and the algorithm for linking this pathology with the profession12. The necessary documents for resolving expert issues are the sanitary and hygienic characteristics of working conditions, a map of the epidemiological investigation of the focus of an infectious disease, the conclusion of an infectious disease specialist, a copy of the work book, as well as data on medical examinations and an extract from the employee's medical records13. According to these recommendations, if an employee becomes infected with COVID-19 while performing his/her job duties, a causal relationship of a new coronavirus infection with the profession is established. At the same time, the diagnosis of a new coronavirus infection assumed by the doctor must be confirmed by an infectious disease specialist, then the patient is consulted by an occupational pathologist and referred to an occupational pathology center for an examination of the connection between the disease and the profession.</p><p>To date, issues have been developed on organizing an investigation into insurance cases of harm to the health of medical workers being in contact with patients with diagnosed or suspected COVID-1914.</p><p>In Russia, the main approaches to maintaining the health and safety of medical workers during the pandemic are being developed and implemented, such as a comprehensive assessment of the risks of COVID-19 infection and health status, optimization of preventive measures, addressing issues of professional suitability examination, etc.15</p><p>Changes in working conditions during the COVID-19 pandemic are accompanied by pronounced work stress and the formation of stress-induced syndromes (diseases), in particular, mental health disorders of employees manifested by anxiety, depression, and burnout [26–28]. In medical workers, mental disorders are associated with a significant uncontrolled workload, isolation, and a high risk of contracting COVID-19 [29–30].</p><p>Due to the possible long-term impact of COVID-19 on the mental health of medical personnel [<xref ref-type="bibr" rid="cit31">31</xref>], in Russia, when providing medical care to patients with COVID-19, a system of comprehensive psychological support for the activities of employees of medical organizations has been developed and is being implemented. The specified system includes special measures to reduce the psychological burden on the staff, special measures for the protection of personnel, maintaining a healthy climate in the team, and organizing professional and competent psychological assistance16.</p><p>According to the WHO, during the COVID-19 pandemic, “mental health care is essential both at work and in the community”17.</p><p>The methodology for assessing occupational risks developed by domestic scientists allows considering the possibilities of predicting work-related diseases [<xref ref-type="bibr" rid="cit32">32</xref>].</p><p>The currently known features of the development and course of a new coronavirus infection (long-term symptomatic and post-COVID syndromes), the formation of severe forms of the disease in risk groups (elderly patients, people with comorbid diseases) allow assessing the prognosis of COVID-19, which creates the prerequisites for the scientific substantiation of therapeutic and preventive measures based on the experience of managing occupational infections and accumulated knowledge about a new coronavirus infection.</p><p>Taking into account the urgency of the COVID-19 problem and the need to train medical personnel on the diagnosis, prevention, and rehabilitation of patients who have undergone a new coronavirus infection, training manuals have been created on the professional aspects of maintaining the health of medical workers during the pandemic [<xref ref-type="bibr" rid="cit33">33</xref>] and medical rehabilitation of patients who have suffered COVID-19 [<xref ref-type="bibr" rid="cit34">34</xref>].</p><p>In connection with the established long-term multiple organ manifestations of the disease, including the post-COVID period, there is a need to combine the efforts of practical health care and occupational medicine to develop effective methods of interdisciplinary work and ongoing cooperation [<xref ref-type="bibr" rid="cit35">35</xref>][<xref ref-type="bibr" rid="cit36">36</xref>].</p><p>In the context of a pandemic of a new coronavirus infection, the most important issues include the following ones: proactive restoring of the health of patients, the widespread use of telecommunication technologies, as well as telerehabilitation programs [<xref ref-type="bibr" rid="cit37">37</xref>]. It is recommended to begin medical rehabilitation of patients with coronavirus pneumonia in intensive care units (ICUs) and continue it after completion of inpatient treatment at home.18</p><p>Patients treated for COVID-19 in the ICUs experience a long-term decline in quality of life in the post-COVID period, especially in the area of “physical functioning” (performing daily activities and tasks), which complicates returning to work and remaining able to work in the profession [<xref ref-type="bibr" rid="cit38">38</xref>].</p><p>Currently, Russia has determined the procedure for discharge of patients who have experienced COVID-19 from a medical organization and the procedure for admission to employment19: “Discharge of patients for employment (training), admission to organized teams after treatment (both inpatient and outpatient) and recovery are performed without a laboratory examination for COVID-19 in case when the treatment takes seven or more calendar days. If the period of observation of a patient with laboratory-confirmed infection with the COVID-19 pathogen is less than seven calendar days, then discharge to employment (training), admission to organized teams are performed after receiving one negative result of a laboratory examination for COVID-19, done no earlier than three calendar days after receiving a positive result of a laboratory examination for COVID-19”.</p><p>However, returning to work after contracting the new coronavirus remains one of the debated issues. Cavasin et al. (2021) believe that excessive search for negative polymerase chain reaction results leads to a waste of resources and an additional burden on the healthcare system [<xref ref-type="bibr" rid="cit39">39</xref>]. Joyce et al. (2020) consider that the most pragmatic approach to addressing issues of return to work should include both the results of serological testing and the disappearance of clinical symptoms of the disease [<xref ref-type="bibr" rid="cit40">40</xref>]. The issue of returning to work after suffering COVID-19 is widely discussed due to the emerging social stigma regarding COVID-19. Prejudice is spreading against people who have recovered from COVID-19, including against medical workers, which makes it necessary to provide both the employee and the employer with information to combat this stigma [<xref ref-type="bibr" rid="cit41">41</xref>].</p><p>According to Kobayashi et al. (2021), during the pandemic, various measures were taken to reduce the risks of workers’ infection with COVID-19, such as organizing work from home (30%), reducing working hours (24%), and providing unpaid leave (19%) [<xref ref-type="bibr" rid="cit42">42</xref>].</p><p>The pandemic caused by the new coronavirus infection has created a number of problems for the working population (financial difficulties, remote work and social isolation, increased workload on workers in socially important professions, the stressful situation associated with the pandemic, difficulties in assessing the professional suitability of workers after suffering a coronavirus infection) [<xref ref-type="bibr" rid="cit43">43</xref>].</p><p>In foreign practice, when addressing the issues of professional suitability examination, the occupational risk of SARS-CoV-2 infection, vaccination status, psychosocial and economic factors, the employee’s subjective assessment of health and the possibility of returning to work, objective information about working capacity and workload [<xref ref-type="bibr" rid="cit44">44</xref>][<xref ref-type="bibr" rid="cit45">45</xref>], ensuring adaptation of working conditions to the employee’s capabilities are taken into account.20</p><p>However, even when adapting working conditions or switching to remote work, patients report difficulty in performing work with the same efficiency, psychological problems, and recurrence of post-COVID symptoms after returning to work [<xref ref-type="bibr" rid="cit46">46</xref>].</p><p>An examination of professional suitability is performed in order to determine the compliance of the employee's health condition with the possibility of performing certain types of work; it is implemented by the medical commission of a medical organization with the involvement of specialists based on the results of preliminary medical examinations and periodic medical examinations. Based on the results of the examination of professional suitability, the medical commission issues a medical opinion on the suitability or unfitness of the employee to work.</p><p>In Russia, in order to resolve the issue of admission to work of a person who has recovered from COVID-19, an examination of the professional suitability of the employee should be performed in accordance with the current regulatory documents21,22. The professional suitability examination is aimed at determining “the compliance of the employee's state of health with the possibility of performing certain types of work”23. Professional suitability examination is implemented by a permanent medical commission of a medical organization while taking into consideration the results of mandatory preliminary or periodic medical examinations.</p><p>The medical commission of a medical organization makes one of the following decisions and recognizes the employee24 as fit (for health reasons to perform certain types of work), temporarily unfit (for health reasons to perform certain types of work), permanently unfit for health reasons to perform certain types of work.</p><p>When determining the temporary unfit for work of an employee for health reasons, “the rationale for this decision and the timing of temporary unfit for work are indicated with recommendations for additional studies/ consultations with specialists and (or) appropriate treatment”25.</p><p>After receiving disability due to COVID-19, an employee must be sent by the employer for an extraordinary medical examination26 followed by an examination of professional suitability to work.</p><p>Currently, there is a need to expand knowledge and increase research on COVID-19 from the perspective of occupational medicine.</p><p>New approaches to the assessment of the production biological factor are being formed. For medical workers, a biological production factor is a potential hazard at the workplace, an occupational health risk factor, which must be taken into account when conducting a special assessment of working conditions [<xref ref-type="bibr" rid="cit47">47</xref>].</p><p>As specified by GOST 12.0.003-201527, the factor of biological nature – the SARS-CoV-2 virus – should be considered from various positions (occupational medicine, labor protection, occupational health, industrial sanitation), both in terms of the nature of penetration and the characteristics of the impact on the employee's body.</p><p>In the context of the spread of coronavirus infection, the role of a comprehensive assessment of the work environment as a determinant of employee health disorders is growing. The physical work environment, the psychosocial environment as well as the lifestyle are the components of a healthy and safe workplace model28. This three-component model is the basis for an integrated approach to maintaining the occupational health of workers [<xref ref-type="bibr" rid="cit48">48</xref>].</p><p>The physical work environment in the context of the COVID-19 pandemic, associated with exposure of the employee to the new biological production factor of the coronavirus SARS-CoV-2, is currently combined with numerous psychosocial factors that have emerged in the workplace. At present, the relationship between traditional (physical, chemical) and psychosocial factors has been established.29</p><p>The pandemic demands for a systematic approach to assessing the work environment, in particular, the psychosocial work environment affecting the health of employees. The psychosocial work environment includes the “macrolevel” (economic, social, and political structures, including modes of production, division of labor, types of social security or legal system), “mesolevel” (workplace structures – type of employment contract, staffing), and “microlevel” (factors acting on an individual or group of individuals) [<xref ref-type="bibr" rid="cit49">49</xref>][<xref ref-type="bibr" rid="cit50">50</xref>]. The psychosocial work environment is considered a key area of research aimed at establishing the relationship between social structures, environmental influences, and psychological and psychophysiological processes affecting the health of an employee [<xref ref-type="bibr" rid="cit50">50</xref>].</p><p>In modern conditions, one of the crucial areas of occupational medicine is the prevention of stress in the workplace [<xref ref-type="bibr" rid="cit51">51</xref>].</p><p>In order to reduce stress, improvement of psychosocial factors of work (increasing control over the situation at work, providing adequate social protection or job security&gt;30) is recommended.</p><p>In the context of the COVID-19 pandemic, the tasks of occupational medicine include strengthening the occupational health of employees (health in the workplace). The occupational health paradigm implies the need to control workplace hazards and health risks, as well as rehabilitation, support, and health promotion in the workplace [<xref ref-type="bibr" rid="cit52">52</xref>].</p><p>One of the concerns for the occupational health of employees associated with the COVID-19 pandemic is the need to work remotely. A new type of work appeared to be possible for certain professions (computer systems, law, architecture, management, etc.) or has limited opportunities for others (catering, education, healthcare) [<xref ref-type="bibr" rid="cit53">53</xref>][<xref ref-type="bibr" rid="cit54">54</xref>]. Currently, the possibilities of adapting the workload to an isolated environment are being considered to preserve the productivity, well-being, and health (primarily mental) of employees engaged in remote work [<xref ref-type="bibr" rid="cit55">55</xref>][<xref ref-type="bibr" rid="cit56">56</xref>]. Recommendations for maintaining the productivity of working from home have been published [<xref ref-type="bibr" rid="cit57">57</xref>]; it is proposed to form a comfortable online work environment, create network structures of the workplace and resources [<xref ref-type="bibr" rid="cit58">58</xref>].</p><p>During a pandemic, employees performing temporary and low-paid work deserve special attention [<xref ref-type="bibr" rid="cit59">59</xref>]. This category of employees, as well as working women, is most affected by the impact of COVID-19 on the labor market31.</p><p>In the post-COVID period, patients who have suffered from COVID-19 can both return to their previous job and find employment in other jobs, including non-standard types of work that provide for new regulation of labor relations (for example, work hours depending on the load, work schedule at the choice of the candidate, work anywhere and/ or at any time, etc.). Moreover, regardless of the form of employment, employees must exercise their right to a fair wage, be provided with guarantees and compensations due to labor relations, and be protected by collective agreements and agreements in the field of labor [<xref ref-type="bibr" rid="cit60">60</xref>].</p><p>The challenges posed by COVID-19-related work changes require occupational health and safety professionals to analyze risks, guidance, and best practices to ensure the future health of employees [<xref ref-type="bibr" rid="cit61">61</xref>], develop and implement interventions to promote work engagement by increasing employees’ autonomy in the workplace [<xref ref-type="bibr" rid="cit62">62</xref>].</p><p>In recent years, there has been a shift in the occupational safety paradigm from measuring specific individual risk factors to studying the system “employee – work environment – employer” [<xref ref-type="bibr" rid="cit63">63</xref>]. It has been established that the risks existing in the workplace are most often associated with the organization of work and the subsequent harm affects mental health more than the physical one [<xref ref-type="bibr" rid="cit64">64</xref>].</p><p>One of the main directions of preserving the health of workers at present is the development of comprehensive measures to assess and manage health risks [<xref ref-type="bibr" rid="cit65">65</xref>].</p><p>During the accumulation of scientific and practical information in the context of the COVID-19 pandemic, one of the priority areas of research is the identification of risk factors for the development and complicated (severe) course of infection. The many-sided nature of the disease development and the variability of its manifestations from an asymptomatic course to severe multiple organ disorders require timely correction in the development of therapeutic measures [<xref ref-type="bibr" rid="cit66">66</xref>].</p><p>In the context of a pandemic caused by the new coronavirus infection, there is a need to expand research on COVID-19 from the perspective of occupational medicine in order to preserve the health of the working population as a socially and economically significant category of citizens ensuring the welfare of the country.</p></sec><sec><title>Discussion</title><p>At present, the new coronavirus infection COVID-19 is an acute health problem associated with both high levels of morbidity and mortality, including in the post-COVID period, and significant socio-economic damage caused by it.</p><p>In occupational medicine, the new coronavirus infection is considered an occupational disease among medical workers directly involved in the provision of medical care to patients with COVID-19, as well as among employees in other sectors of the economy from high-risk groups of contracting COVID-19 at the workplace.</p><p>Prevention of infection and development of severe forms of COVID-19 is based on the integration of hygienic and epidemiological measures. The accumulation of experience in the work of occupational health and safety services in a pandemic has shown the need to control the risks of infection, taking into account both droplet, aerosol, and contact transmission of infection, as well as to ensure effective disinfection measures not only in the main rooms, but also in the back rooms of medical organizations [<xref ref-type="bibr" rid="cit67">67</xref>][<xref ref-type="bibr" rid="cit68">68</xref>].</p><p>Numerous cases of contracting COVID-19 at work required a quick review of the strategy to combat the pandemic, followed by a comprehensive investigation of this situation [<xref ref-type="bibr" rid="cit69">69</xref>]. To date, international cooperation has allowed the development of evidence-based guidelines for managing the risks associated with COVID-19, approaches to optimizing anti-epidemic measures, tactics for managing patients with comorbid diseases, organizing respiratory and cardiological resuscitation of patients with COVID-19, and infectious safety of medical workers [<xref ref-type="bibr" rid="cit70">70</xref>].</p><p>The pandemic has posed a number of problems for the working population related to maintaining professional health, efficiency, well-being in the workplace and, as a result, maintaining a sufficient level of life quality, which is of undoubted medical and social significance for society as a whole [<xref ref-type="bibr" rid="cit71">71</xref>].</p><p>In the future, constructive collaboration within the international scientific community to assess potential causal relationships between COVID-19 and post-COVID syndrome will be essential in order to prevent persistent health problems in the post-COVID period, creating opportunities for a return to normal life32.</p></sec><sec><title>Conclusion</title><p>The tasks of occupational medicine in the context of a pandemic caused by new coronavirus infection are as follows:</p><p>During the period of the spread of the new coronavirus infection, the preservation and strengthening of the health of employees is possible provided that the occupational health service and practical health care are integrated, which meets the goals and objectives of occupational medicine.</p><p>1. Interim guidelines approved by the Ministry of Health of the Russian Federation “Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)”, February 22, 2022, Version 15.
2. An employers’ guide on managing your workplace during COVID-19. ILO 2020 / https://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/--act_emp/documents/publication/wcms_741557.pdf
3. Guidelines MU 1.3.2569-09 “Organization of the work of laboratories using nucleic acid amplification methods when working with material containing microorganisms of pathogenicity groups I–IV (approved by the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Chief State Sanitary Doctor of the Russian Federation, December 22, 2009)
4. Interim guidelines “Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)” approved by the Ministry of Health of the Russian Federation, February 22, 2022, Version 15.
5. VIII ONLINE Congress “Control and prevention of healthcare-associated infections” (HCAI-2020) with international participation, November 25–27, 2020
6. National Evidence-Based Guidelines for the Prevention of HCAI (approved by the Chief State Sanitary Doctor of the Russian Federation on November 6, 2011).
7. Temporary guidelines “Procedure for vaccination against a new coronavirus infection (COVID-19)” approved by the Ministry of Health of the Russian Federation (Letter of the Ministry of Health of Russia dated December 22, 2021 No. 30-4/ I/2-21694)
8. Interim guidelines “Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)” approved by the Ministry of Health of the Russian Federation, Version 15, February 22, 2022.
9. Federal Law “On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases” No. 125-FZ dated July 24, 1998 (as amended on December 30, 2021 N474-FZ)
10. Order of the Ministry of Health of the Russian Federation dated January 31, 2019 No. 36n “On approval of the procedure for conducting an examination of the relationship of a disease with a profession and the form of a medical report on the presence or absence of an occupational disease”
11. On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2020: State report. Moscow: Federal Service for Supervision of Consumer Rights Protection and Human Welfare, 2021. 256 p. ISBN 978-5-7508-1849-5
12. Coronavirus infection (COVID-19) as an occupational disease in healthcare workers: an algorithm for linking the disease with the profession. Guidelines/ Compilers: Garipova R.V., Yusupova N.Z., Berkheeva Z.M. – Kazan. – 2020. – 30 p.
13. Ibidю
14. Letter of the Ministry of Labor of Russia No. 15-3/10/P-4559, of the Ministry of Health of Russia No. 28-0/2-6772 dated May 19, 2020 “On the organization of the investigation of insured events of causing harm to the health of medical workers directly working with patients with diagnosed or suspected coronavirus infection (COVID-19)”
15. New coronavirus infection COVID-19: professional aspects of health care and safety of medical workers: guidelines/ed. I. V. Bukhtiyarov, Yu. Yu. Gorblyansky. – 2nd ed. revised and additional. – Moscow: AMT, FGBNU “NII MT”, 2022. – 136 p.
16. Letter of the Russian Ministry of Health No. 28-3/I/2-6111 dated May 7, 2020 “On sending recommendations on the organization of psychological and psychotherapeutic assistance in connection with the spread of the new coronavirus infection COVID-19”
17. World Health Organisation. Mental health and psychosocial considerations during the COVID-19 outbreak. Geneva. World Health Organisation, 2020.
18. Temporary guidelines “Medical rehabilitation in case of a new coronavirus infection (COVID-19)” approved by the Ministry of Health of Russia, Version 2 (July 31, 2020).
19. Temporary guidelines “Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19)” approved by the Ministry of Health of the Russian Federation, Version 15. February 22, 2022.
20. FOM Guidance. Guidance for healthcare professionals on return to work for patients with long-COVID. – URL: https://www.fom.ac.uk/wp-content/uploads/longCOVID_guidance_04_small.pdf
21. Federal Law No. 323-FZ of November 21, 2011 (as amended on April 1, 2020) “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (as amended and supplemented, effective from April 12, 2020)
22. Order of the Ministry of Health of the Russian Federation No. 282 “On approval of the procedure for conducting an examination of professional suitability or unsuitability for certain types of work” dated May 05, 2016
23. Federal Law No. 323-FZ of November 21, 2011 (as amended on June 8, 2020) “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, Article 63
24. Order of the Ministry of Health of the Russian Federation No. 282 “On approval of the procedure for conducting an examination of professional suitability or unsuitability for certain types of work” dated May 05, 2016
25. Ibid.
26. Order of the Ministry of Health of Russia No. 29n “On approval of the Procedure for conducting mandatory preliminary and periodic medical examinations of workers provided for by part four of Article 213 of the Labor Code of the Russian Federation, a list of medical contraindications for work with harmful and (or) dangerous production factors, as well as work in the course of which mandatory preliminary and periodic medical examinations are performed” (section III Procedure for conducting periodic examinations, paragraph 19) dated January 28, 2021
27. GOST 12.0.003-2015 Occupational safety standards system (SSBT). Dangerous and harmful working factors. Classification. (Instead of GOST 12.0.003-74). Introduced January 3, 2017. Moscow: Publishing House of Standards; 2017.
28. Health Canada, “Corporate Health Model: A Guide to Developing and Implementing the Workplace Health System in Medium and Large Businesses,” Health Canada, Catalogue No H39-225/1991. URL: http://www.hc-sc.gc.ca
29. GOST R 55914-2013. Risk management. Guidelines for the management of psychosocial risk in the workplace [Electronic resource]: national standard of the Russian Federation, introduced December 1, 2014. Moscow: Standartinform, 2014. URL: http://docs.cntd.ru/document/1200108135
30. Health 2020: A European Policy Framework and Strategy for the 21st Century [Electronic resource] / WHO Regional Office for Europe // WHO Regional Office for Europe. – Copenhagen: WHO, 2018. Access: http://www.euro.who.int/ru/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being (Date of access: February 20, 2019).
31. Statistics Canada. (2020e) Labor Force Survey, June 2020: context: COVID-19 restrictions gradually ease. The Daily; July 10, 2020.
32. Long COVID: the elephant in the room. The Lancet Diabetes &amp; Endocrinology. 2022, April 7. DOI: https://doi.org/10.1016/S2213-8587(22)00111-5
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