Responses to the COVID-19 crisis

Can COVID-19 be considered an occupational disease?

Responses to the COVID-19 crisis

Can COVID-19 be considered an occupational disease?

Worldwide almost 2.4 million people die due to an occupational disease, compared to 0.38 million that die because of a work accident. Insurance covering occupational diseases is an important pillar of social security and a safety net to all workers who may be exposed to chemical, physical or biological agents arising from work activities, or may suffer from respiratory and skin diseases, musculoskeletal disorders, post-traumatic stress disorders or occupational cancer.

In view of the rapid spread of the Coronavirus, countries are now facing the urgent question of assessing COVID-19 as an occupational disease. In order to ensure insurance coverage, in particular for workers in the most exposed sectors, rapid measures to facilitate the recognition of COVID-19 have been implemented in a number of countries.

Recognition Process for an Occupational Disease

In order to assess whether or not COVID-19 is an occupational disease, it is essential to have distinct and transparent criteria for the definition of occupational diseases, which will help to distinguish these from diseases of different origins. Around the world, various recognition procedures exist that would determine the occupational nature of the disease. This procedure can be based on individual (medical and technical) assessments. Data relating to exposures in the workplace, as well as scientific surveys on occupational risks, are also useful tools to be used in the recognition procedure, which can be organized in different ways, namely:  

  • A national list of occupational diseases containing the precise recognition criteria, supplemented by a complementary system of recognition for diseases which are not on the list, is in most cases an efficient way to have clear and validated recognition criteria.
  • The recognition procedure can also be based on the individual assessment of cases by experts.
  • A combination of these two systems is possible. This would mean that (a) a national indicative list or the list of occupational diseases published by the International Labour Organization (ILO) or the European Commission is used as a reference and (b) investigations on a case-by-case basis are conducted to further determine the causal link between work and the disease.

Systematic Approach to Occupational Diseases for Social Security

A systematic approach to occupational diseases, starts from individual suspicion of an occupational disease and ends with the final decision on whether or not the disease will be recognized by the social security institution. The decision on such recognition depends on the causality between the disease and the workplace.

System of identification and recognition of occupational diseases
Source: ISSA Guidelines: Prevention of Occupational Risks (2019)

The ILO List of Occupational Diseases

COVID-19 is of course not explicitly mentioned in the ILO list of occupational diseases (2010). It only lists HIV, Hepatitis B and Hepatitis C as virus infections, which are recognized as occupational diseases. However, COVID-19 falls under Article 1.3.9. :

“1.3.9. Diseases caused by other biological agents at work not mentioned in the preceding items where a direct link is established scientifically, or determined by methods appropriate to national conditions and practice, between the exposure to these biological agents arising from work activities and the disease(s) contracted by the worker.“

Practically speaking, there needs to be a direct link between the exposure to the coronavirus itself (SARS-CoV-2) at work and the disease (COVID-19) to be able to classify it as an occupational one. The first condition – the scientific evidence that SARS-CoV-2 causes COVID-19 - is a proven scientific fact, but in many cases, it will be difficult to create the causal link; to prove that the disease was contracted at work. If proved that the virus was contracted through occupational exposure, any worker is covered under the ILO list.

However, not all countries follow the ILO list and many have their own national lists or assessment criteria to determine the occupational nature of a disease.

National examples of COVID-19 recognition

  • The National Employment Accident Insurance Institute of Italy (Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro - INAIL) confirmed that coronavirus infections of doctors, nurses and other employees of the National Health Service (Servizio Sanitario Nazionale – SSN) as well as of any other public or private health facility are considered occupational diseases. The causal link between the work and the infection will be automatically assumed for this group of employees in order to also provide coverage to cases in which the identification of the specific causes and working methods of the infection is problematic. Furthermore, COVID-19 cases where SARS-CoV-2 was contracted while commuting to work or back home are also covered by INAIL.
  • The German list of occupational diseases  mentions virus infections (No 3101), which considers viruses as an occupational disease if the employee works in the healthcare sector. But it does not consider a virus an occupational disease for any other economic sector (like public transport, supermarkets, construction, office workers, etc.)  
  • In South Africa, COVID-19 is recognized as an occupationally acquired virus disease if it is the result of occupational exposure, which happens in a presumed high-risk work environment or during an approved official work assignment to high risk areas or countries. Furthermore, a chronological sequence must exist between the work exposure and the development of COVID -19 symptoms.
  • Canadian Workers’ Compensation boards compensate their workers for COVID-19 if there is medical proof that the worker has been diagnosed with COVID-19 has been exposed to SARS-CoV-2 at work and if the exposure is confirmed to be work-related.

Social Security Prevention Responses to COVID-19

The sooner an occupational disease can be detected and addressed, the higher the chance of a cure and reintegration into work. Hence, the timely diagnosis of relevant symptoms allows not only for effective medical treatment but also for workplace interventions such as changes to work processes (like teleworking), improved hygiene measures and the use of protective devices. The ISSA’s Special Commission on Prevention has published a list of measures that can be shared by occupational accident insurances to ensure that the COVID-19 will not spread at the workplace.