HOME RESERVED AREA CONTACTS

Ramazzini Days

All Abstracts

Presenting author profile

Dr. McDiarmid directs the Division of Occupational and Environmental Medicine at the University of Maryland School of Medicine and has studied and written about the hazards of the health sector for more than thirty years.


Format

Panel overview

All authors and affiliations

Melissa A. McDiarmid, MD,MPH, DABT
Professor of Medicine and
Epidemiology & Public Health
Director, Division of Occupational & Environmental Medicine
University of Maryland School of Medicine

Background

Even as the planet is brought to its collective knees by a novel corona virus pandemic,
some familiar public health failures are regrettably evident. Inadequate preparation for this pandemic, long predicted by public health experts, resulted from chronic underfunding of public health capacity in both well-resourced and limited-resource countries.

Methods/Approach

Key observations, identified in the Collegium Ramazzini Statement on Work-related Covid-19 infection will be presented in this session.

Results

The spread of Covid-19 is closely related to work. In both direct and indirect ways, occupation influences risk. Work-related exposure to the covid virus played an important role in its spread globally with the health workforce and public- facing workers and those in crowded conditions differentially targeted ( Lan, 2020). The employer’s ‘duty of care’ toward worker safety was lacking in the promotion of perilous work and failure to provide PPE. Environmental exposures were seen to exacerbate Covid-19 disease severity through both personal choice, such as smoking (Vardavas,2020) and from ambient environmental pollutants (Ogen, 2020) increasing both morbidity and mortality of covid patients. Important medical care and public health activities were also suspended, including cancer treatment and vaccination campaigns, causing other unintended harm to population health.

Conclusions

These perilous outcomes arise from systematic public health neglect and were largely preventable.

Presenting author profile

Professor and Director,
Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital
Occupational Medicine and Industrial Hygiene, NTU College of Public Health


Format

Panel overview

All authors and affiliations

Y. Leon Guo1,2,3 Judith Shiao4, Yi-Chuan Chen3,4
1Environmental and Occupational Medicine, National Taiwan University College of Medicine and NTU Hospital
2Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
3National Institute of Environmental Health Sciences, National Health Research Institutes, Zhunan, Taiwan
4School of Nursing, National Taiwan University College of Medicine and NTU Hospital

Background

Coronavirus disease 2019 (COVID-19) was first reported in December 2019 from China. Number of cases in Taiwan was expected to be high due to the proximity and frequent exchanges with China. In Taiwan, healthcare workers (HCWs) are at high risk of exposure to infectious diseases through droplets, surfaces, and other methods of transmission. During the pandemic of severe acute respiratory syndrome (SARS) in 2003, HCWs accounted for one fifth of all SARS cases in the world, and in Taiwan. Many nurses were under stress and considered to leave their profession.

Methods/Approach

We examined the factors why Taiwan had a rather low number of COVID cases, and the current challenge to infection control and to healthcare workers.

Results

After SARS in 2003, National Health Command Center (NHCC) was established to proactively respond to infectious disease outbreaks, which proved to be pivotal in the control of COVID-19 pandemic. Actions included border control, case identification by advanced data technologies, quarantine, and contact tracking/case finding. Personal protective equipment are allocated according to contact risks, as well as manufactured domestically in an accelerated speed. Communications were established between the authorities and the people. The early and proactive actions, namely from December 31st, 2019 helped Taiwan to be among the countries with lowest incidences of COVID-19 cases. Among HCWs though, increased work routine and stress, perceived risk of fatality from COVID, and affected social relationships continue to affect HCWs during this prolonged pandemic of COVID-19.

Conclusions

Proactive measures are warranted to prevent the spread of COVID-19 in the people, as well as among healthcare workers. The current major challenges in Taiwan include timely vaccination of the people, potentially hampered by difficulty in an effective phase 3 trial of domestically manufactured vaccines due to low prevalence of cases, and competitiveness in obtaining international vaccines.

Presenting author profile

Dr. Somkiat Siriruttanapruk is currently a senior advisor on occupational and environmental health under the Department of Disease Control, Ministry of Public Health (MOPH), Thailand. His previous position was the Director of Bureau of Occupational and Environmental Diseases.


Format

Panel presentation

All authors and affiliations

Somkiat Siriruttanapruk (1); Rachaneekorn Weeracharoen (2); Chuleekorn Tanathitikorn (3); Walairat Chaifoo (4).
Department of Disease Control (DDC), Ministry of Public Health, Thailand

Background

The pandemic of COVID-19 infection is the worst public health problem worldwide. In Thailand, most cases are among working populations. The aims of this study are to describe the situation of the disease among this group and currently implemented preventive and control measures.

Methods/Approach

The data from the Situation Awareness Team under the Department of Disease Control (DDC) were collected and analysed in September 2020. The Monitoring and Evaluation Team under DDC also conducted a rapid survey to identify any measures enterprises had implemented to protect their employees from the disease. The checklists were applied from the ILO guideline. The survey was conducted via an on-line questionnaire using Google Form and sent to enterprises and the network of safety officers during 13-17 April 2020.

Results

The total number of cases was 3,447 cases (5.18 per 100,000 population). Most cases (83.6%) were between 20-59 years old. The top 5 occupations among cases included general freelance/temporary jobs (18.3%), trade (small shop) (13.8%), hotel services (11.4%), working in entertainment sectors e.g. pubs/bars, etc. (7.38%), and government services (6.38%). Ninety-six health workers (2.86% of all cases) were infected from their work. Regarding the rapid survey, 101 samples responded. Almost all enterprises reported having a policy and implementation of preventive and control measures. Implemented measures included information sharing (99%), health screening of their workers (97%), work arrangement, e.g., work from home (75.2%), area arrangement for work/social distancing (81.2%), ventilation improvement (59.4%), and provision of masks (100%).

Conclusions

Until now, Thailand has had a lower number of COVID-19 infections than other countries. Occupations, especially working with or contact with foreigners and working in a high density of people, are high-risk factors. Several enterprises had implemented preventive and control measures. Prompt policy advocacy, knowledge-based recommendations and communication with target groups are essential.

Presenting author profile

Dr. Homero Harari is an Assistant Professor at Department of Environmental Medicine and Public Health at Icahn School of Medicine at Mount Sinai, New York. He studies occupational and environmental exposures in vulnerable populations.


Format

Panel presentation

All authors and affiliations

Homero Harari(1); Florencia Harari (2); Raúl Harari (3)

1. Assistant Professor, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA.
2. Researcher and resident physician, School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
3. Executive Director, IFA – Corporación para el Desarrollo de la Producción y el Medio Ambiente Laboral, Quito, Ecuador.

Background

The pandemic has severely affected Ecuador. Although the country quarantined the same day the World Health Organization declared COVID-19 a global pandemic, the subsequent government's response was slow and ineffective.

Methods/Approach

We have documented the effects of the pandemic in Ecuador as well as the response by the government, local municipalities, unions, academia, non-governmental organizations, and community groups.

Results

By the beginning of August 2020, the number of confirmed COVID-19 infections reached over 83,000, with over 9,400 deaths. Lack of medical supplies and personal protective equipment (PPE), accusations of corruption in the purchase of medical supplies and PPE, and lack of testing have led to over 5,000 infections in healthcare workers. The protection of workers has been ignored, and exposures to healthcare workers, police officers, taxi drivers, and other essential workers continue to be out of control.

Conclusions

Internal and external pressures to "reopen" the country and "reactivate the economy" have led to a collapse of the major cities' public healthcare system. Simultaneously, the number of infections continues to rise throughout the country, as new cities become hot spots of this new disease. The social, occupational, economic, and political consequences of the COVID-19 pandemic in Ecuador are devastating and will endure beyond the discovery of a vaccine.

Presenting author profile

Dr. Lucchini is an MD, Professor of Occupational and Environmental Medicine with main research interest on neurotoxicology of metals. From 2012 to 2019 he was the Drirector of the World Trade Center Health Program Data Center, and developed an expertize on epidemiological health surveillance based on the WTC cohort of 9/11 responders.


Format

Panel presentation

All authors and affiliations

Elena de Angelis (1†), Stefano Renzetti (2†), Marialuisa Volta (3,4), Francesco Donato (5), Stefano Calza (2), Donatella Placidi (6), Roberto G Lucchini 6,7*), Matteo Rota (2)
1. Department of Information Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy
2. Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
3. Department of Mechanical and Industrial Engineering, University of Brescia, Via Branze 38, 25123, Brescia, Italy.
4. B+LabNet - Environmental Sustainability Lab, University of Brescia, Via Branze 45, 25123, Brescia, Italy.
5. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Hygiene, Epidemiology, and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
6. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, Italy.
7. School of Public Health, Florida International University, Miami, Florida, USA.
† These authors contributed equally: Elena de Angelis and Stefano Renzetti.
*Presenting Author

Background

Lombardy is the most populated and industrialized Italian region and one of the areas with the highest levels of air pollutants in Europe. In March and April 2020, Lombardy was the epicentre of the first wave of COVID-19 pandemic in Italy, experiencing extremely high incidence and mortality rates. We carried out an ecological study to investigate the role of demographic, socioeconomic and community variables, meteorological factors and environmental particulate matter (PM) on COVID-19 incidence and all-cause mortality.

Methods/Approach

Data were based on the Municipality-level, and obtained from publicly available databases of regional and national sources. PM10 and PM2.5 concentrations covered historical (winter and yearly measures 2016-2019), recent (November-December 2019), and pre-lockdown (January-February 2020) exposure periods. Negative binomial random-intercept mixed regression models were fitted with COVID-19 incidence and all-cause mortality as the outcomes, with computation of incidence rate ratios (IRRs) and standardized mortality ratios (SMR).

Results

Data from 1,439 municipalities out of 1,507 (95%) were included in the analyses, with a total of 61,377 COVID-19 cases and 40,401 deaths from February 20th to April 30th 2020. Demographic, socioeconomic, community and meteorological variables resulted significantly associated with the COVID-19 incidence and all-cause mortality. Recent PM10 and pre-lockdown PM2.5 concentrations were associated with 6% (IRR, 1.06, 95% confidence interval [CI], 1.00 – 1.11) and 18% (IRR, 1.18 , 95% CI, 1.12-1.24) increase in COVID-19 incidence rate, respectively. No significant association was found between historical PM exposure and COVID-19 incidence and between any measure of PM exposure and all-cause mortality.

Conclusions

Our ecologic study indicates that demographic, meteorological, and socio-economic variables were the most relevant factors associated with the disease diffusion and mortality of the COVID-19 outbreak in Lombardy, Italy. Recent exposure to ambient airborne pollutants showed a less strong but significant contribution to the disease diffusion of this outbreak.

Presenting author profile

Dr. Rodriguez-Guzman is the Regional Advisor on Workers' Health at the Pan-American Health Organization since 2011, providing support and technical assistance to Member States in the region of the Americas. After issuing the Plan of Action on Workers' Health 2015-2025, regional/national occupational health, safety and wellbeing policies, action plans/programs are expected to strengthened, addressing the Social Determinants of Workers’ Health with a strong public health perspective. Now part of the health worker team addressing COVID-19.


Format

Panel presentation

All authors and affiliations

Julietta Rodríguez Guzman (1)

1. Pan-American Health Organization/World Health Organization PAHO/WHO, Washington, DC, USA

Background

Latin America and the Caribbean are the most heterogeneous region of the developing world (PAHO,2019). OHS public policies/programs for formal workforce developed during last decades (ALSO/OPS 2019), but in 2019 GDP decreased, and unemployment increased to 8.1% (ILO/ECLAC,2020). COVID-19 causes high morbidity/mortality for health workers(HW) and vulnerable populations(VP). Closing industries/workplaces triggered a severe regional economic, social/health crises (PAHO,2020).

Methods/Approach

Two approaches were used addressing HW and VP: A survey determining OHS policies/programs, social protection, recognition of COVID as occupational disease, and regulations for shiftwork, workplace harassment, and mental health. A logic framework model assessed compliance of public health measures by VP, to determine barriers, causes of unexpected outcomes and rejection of measures, seeking solutions to eliminate such problems.

Results

18 countries responded to the HW survey, showing absence/very weak preexisting OH programs before COVID. Formal HW have social protection, but informal probably remain unknown/unprotected. Three countries declared COVID an OD, one declared it occupational injury. Most countries forbid workplace harassment/violence, but mental health protection needs strengthening. The majority of HW are women facing double burdens of work for family care, increased by school closures.
The high burden of morbidity and mortality for VP relates to very precarious living/working conditions, comorbidities such as NCDs, and poor/no compliance due to lack of access, conditions limiting their implementation and/or rejection.

Conclusions

The pandemic caused health, social and economic crises in LAC.
Health systems and emergency preparedness need strengthening.
Living conditions, limited options to self-isolate, family burdens and multiple jobs threaten HW’s health and wellbeing and need to be considered.
Protecting VP requires addressing pre-existent social and political inequities, eliminating barriers to comply with PH recommendations, and control of the additional adverse conditions.
Actions for VP should involve intersectoral mechanisms, community participation, different levels of government and international organizations, with multisectoral approaches addressing social determinants of health.

Presenting author profile

Rodney Ehrlich is Emeritus Professor and Senior Scholar, School of Public Health and Family Medicine, University of Cape Town. He works on clinical and epidemiological aspects of lung disease in miners in Southern Africa and implications for prevention and social justice.


Format

Panel presentation

All authors and affiliations

Botembetume Mokalali Maboso (1); Rodney Ehrlich (1)
1. School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

Background

Lesotho, a low-income country of 2.2 million encircled by South Africa, has supplied the goldmines with migrant labour for 120 years. It currently suffers the highest tuberculosis incidence globally. Our recent analysis of records of 2 678 ex-goldminers in Lesotho between 2017 and 2019 found a high disease burden: silicosis (ILO>1/0) 42.5%, CXR consistent with tuberculosis (previous or current) 60.9%; active tuberculosis (on treatment or newly diagnosed) 6.8%; silicotuberculosis 25.7%; HIV 30.7%, and on treatment for hypertension 21.9%.

Methods/Approach

This presentation explores the implications of COVID-19 for this large ex-goldminer population.

Results

Covid-19 affects this population in two ways. First, they have a slew of risk factors for adverse outcomes should they become infected: age (median 62 years), chronic lung disease (silicosis, TB and COPD), immunosuppression, hypertension and remoteness from health services. By August 2020, 726 COVID-19 cases and 21 deaths had been reported in Lesotho, certainly an undercount. With the lifting of the lockdown of the South African gold mining industry in May 2020, migrant workers have been returning to work. Should this epidemic spread to former miners, the impact on their health and local health services could be disastrous. Second, there are currently large-scale initiatives to examine former miners for compensation purposes, both statutory and following successful class action litigation. However, medical contact and routine spirometry have been suspended because of the COVID-19 infection risk, making such examination and classification of impairment difficult if not impossible

Conclusions

The need to screen ex-miners in Southern Africa for silicosis, TB and HIV is a public health and social justice imperative. Mechanisms for safe examination need to be found. This population has been ill served by history. Their plight needs to be kept in the public eye and coordinated cross-border and international support mobilized.

Presenting author profile

Dr Silbergeld is Emerita Professor of Public Health at Johns Hopkins University where she has taught and trained many students in PhD and MPH programs


Format

Panel presentation

All authors and affiliations

Ellen Silbergeld
Johns Hopkins University Bloomberg School of Public Health, Baltimore MD, USA

Background

According to the Department of Homeland Security (DHS), essential workers “conduct a range of operations and services that are typically essential to continued critical infrastructure viability." Essential workers are required to work in settings with or provision of protective equipment. Employers are not required to provide these protections or access to health care.

Methods/Approach

This study focused on workers in the food and agricultural sectors who were designated as "essential workers" by the Trump Administration. This study focused on slaughterhouse workers in the poultry industry in Maryland, as persons of very high risk given the conditions of the job. Information was compiled from a variety of sources, including county and state health departments, and the media, along with consultation involving a coalition of persons engaged in social justice, immigrant protection, and other activities, along with on-site knowledge of the conditions in these workplaces.

Results

This study was limited by the access to testing for this workforce and the lack of cooperation from state and national agencies. Using other data, it was possible to estimate that there is strong geographic association between those counties in Maryland with intensive poultry production including slaughterhouses and higher reported rates of covid-19 exposure. These sources also reported that risks of covid-19 spill over into rural communities since slaughterhouses are not controlled environments.

Conclusions

These findings are similar to studies of "essential workers" in health care, including the reliance upon recruiting workers from lower socioeconomic status with reduced opportunites for employment in protected occupations.

Presenting author profile

Dr. Cherniack is the Principal Investigator on a 14 year longitudinal study of musculoskeletal health in the aging workforce -- the University of Connecticut Study on Aging and Musculoskeletal Disease (UConn-SAM). He is co-director of the Center for the Promotion of Health in the New England Workplace, a Total Worker Health Center of Excellence.


Format

Panel presentation

All authors and affiliations

Martin Cherniack (1); Jennifer Garza (1); Janet Cover Caldwell (1); Rick Fortinsky (1); Janet Barnes-Farrell (2)
1. University of Connecticut Health Center, Farmington CT, USA
2. University of Connecticut, Storrs CT, USA

Background

UConn-SAM is a longitudinal study of the aging manufacturing workforce in the American Northeast. Findings are extended retirement insecurity following the 2007 recession, and the importance of social factors, elder care and work flexibility, on employment and retirement. There was extraordinary volatilty in ownership and management from 2014-2020, characterized by internationalization, reorganization and private equity ownership, and redesign of product lines. COVID-19 has dominated the current year. Active tracking of COVID-19 responses identified different timelines in initial response and extent of engineering controls, which appear to be related to company organization and affiliation. Assistance and data collection is ongoing.

Methods/Approach

Information gathering has several formats. First, monthly group meetings were held and documented with the designated Environmental Health and Safety (EH&S) professional(s) to develop shared best practices. Next, each company was formally surveyed through its EH&S representative to identify the timeline for interventions, including re-organizing of physical space, personal protection, staggering shifts, and providing for older and immuno-compromised workers. Finally, four waves of individual data survey data were analyzed to generate a template for workforce health, individual financial resources, and conditions of work, prior to Janaury 2020.

Results

National Guidelines from CDC, OSHA, and professional orgnaizations were of little value. The two companies with Chinese sister plants began preparation in January and had no PPE shortages. Companies with strong internal or corporate engineering groups had refigured plant space by the end of March. Companies owned by private equity were slow responders. Long-term issues regarding older workers are expected to intensify as a pandemic consequence.

Conclusions

The critical time interval between identification and effective action for COVID-19 varied significantly by terms of company ownership. EH&S professionals effectively worked across company lines.

Presenting author profile

Dr. Harrison is Clinical Professor of Medicine at UC San Francisco. His clinical and public health practice focuses on the recognition, tracking, investigation and prevention of occupational diseases.


Format

Panel presentation

All authors and affiliations

Robert Harrison, MD, MPH
University of California, San Francisco, USA

Background

The United States has reported the greatest number of COVID-19 cases worldwide, with a disproportionate impact among communities of color (Hispanic and black). These inequities stem from economic and housing policies, access to health care, and the need to maintain employment in “essential” occupations such as meatpacking, agriculture, services, and health care. Thousands of COVID-19 outbreaks have occurred in US workplaces as a result of these factors, with enormous consequences to the lives and livelihoods of workers.

Methods/Approach

The current systems and approaches to collecting occupational COVID-19 data in the US will be presented, including laboratory-based reporting, local public health population-based contact tracing, and focused outbreak investigations. Each of these methods are highlighted by case examples and data in California including the meatpacking, nursing home and educational sectors. These examples will demonstrate the current successes and challenges in improving the rapid recognition and investigation of work-related COVID-19 infections.

Results

Current experience in the US has shown that (1) laboratory based reporting systems are not designed to identify the incidence of work-related COVID-19 infections; (2) local public health departments are often overwhelmed by the numbers of cases with inadequate resources and infrastructure to collect occupational risk factor information; and (3) data from workplace outbreak investigations have been very useful to highlight the impact of COVID-19 on high-risk workers, but are not a systematic or ongoing method of analyses.

Conclusions

The COVID-19 pandemic has revealed enormous inequities in the social, economic and health impacts among US workers. Collection and analyses of data to track, investigate and prevent work-related COVID-19 infection and outbreaks have been limited by multiple factors and highlight the continued need for a comprehensive occupational disease surveillance system in the US.

Presenting author profile

Dr Karel Van Damme is president of the Belgian High Council on Prevention and Protection at Work. Dr Casteleyn and dr Van Damme work in team at the Center for Human Genetics especially on issues related to the world of work.


Format

Panel presentation

All authors and affiliations

Karel Van Damme (1); Ludwine Casteleyn (1)
1. University of Leuven, Belgium

Background

Stopping the COVID-19 pandemic required lockdowns of economic activities and other societal domains. This has affected the income and even survival of many people around the globe.

Methods/Approach

A descriptive review of covid actions across countries was taken and compared to the Belgian experience.

Results

In many countries, protest emerged against measures to stop the pandemic, nourished by political opportunists—stating that a choice had to be made between work and health protection- arguing that the virus was no more harmful than the yearly influenza, and that existing medication was an effective preventive tool. Some policies approached acceptance of ‘survival of the fittest’ as a guiding principle.
Other countries with a highly developed system of social security succeeded in getting measures accepted without meaningful protest.
In Belgium, measures were taken to guarantee a basic income on top of the existing social security systems, for both employees and independent workers. This is anchored by a long tradition of social concertation between representative employer and employee organizations. Also for protection of health and safety at work, social concertation plays a key role from federal to the company level.
A generic guide was elaborated at the federal level with measures, that if correctly applied in workplaces, transmission of SARS-CoV-2 becomes unlikely. The guide was further completed by social agreements at sector and company level. This has resulted in starting up of economic activities in all non-essential sectors without significant increase of cases. A series of videos and other propaganda material was developed illustrating how work and protection against the virus could go together.

Conclusions

The ‘either work or health’ dilemma is still a reality for many people around the globe. SARS-CoV-2 has dramatically accentuated the need for social protection and for social concertation as a tool for allowing work whilst protection health.

Presenting author profile

Daniele Mandrioli, MD is the Director of the Cesare Maltoni Cancer Research Center of the Ramazzini Institute, Bologna, Italy. He conducts research on environmental toxicants and carcinogens and Evidence Based Toxicology (EBT). Dr. Mandrioli's research on environmental toxicants and carcinogens includes the design and development of bioassays, investigations on the role of aneuploidy in carcinogenesis and reproductive toxicity, and the analysis of different chemical regulations and their implications for public health.


Format

Panel presentation

All authors and affiliations

Collegium Ramazzini (1)
Collegium Ramazzini, Carpi, Modena, Italy

Background

The COVID-19 pandemic has affected every country in the world, caused confirmed illness in nearly 30 million people, unconfirmed disease in millions more, and nearly 1 million deaths. At present, there is no vaccine and no medical treatment for COVID-19. Pandemic control must therefore rely entirely on measures that reduce the spread of infection, flatten the epidemic curve, and gain time to develop more effective responses. Workers whose occupations put them in contact with infected persons and the public are at greatly increased risk of disease and death and have suffered disproportionately in the COVID-19 pandemic.

Methods/Approach

The Collegium Ramazzini proposed principles and best practices to protect workers and workplaces from COVID-19 infection in its 24th and 25th Statement.

Results

Workers are at greatly increased risk of COVID-19 infection and require heightened protection. A partial listing of high-risk workers is the following: health care workers, police, firefighters, transport workers, hotel and food service workers; cruise industry workers; older workers, workers with underlying medical conditions, such as hypertension, obesity, heart disease and cancer; workers occupationally exposed to dusts, gases and fumes; workers of low socio-economic status; workers exposed to high levels of ambient air pollution; and workers in low and middle income countries.

Conclusions

The Collegium Ramazzini calls on governments at all levels and on all employers to fulfill their responsibilities to protect the health of all workers in the COVID-19 pandemic. Recognizing that in many low-income and middle-income countries implementation of these practices has proven challenging, the Collegium Ramazzini now calls attention to the urgent need for a much expanded global public health infrastructure to prevent and contain COVID-19 infection among workers in all countries of the world, acknowledging and reacting to the worldwide shortages of essential supplies, including proper medical supplies, medical screening equipment and laboratories, and personal protective equipment.

Presenting author profile

Mr. Hughes is currently director of an innovative federal safety and health training program based at the National Institute of Environmental Health Sciences. The program supports cooperative agreements to develop and deliver model safety and health training programs for workers involved in hazardous substances response with numerous universities, unions, community colleges and other non-profit organizations throughout the nation.


Format

Panel presentation

All authors and affiliations

Joseph T. Hughes, Jr., MPH, Director, US HHS-NIH-NIEHS Worker Training Program

Background

With new supplemental funding from Congress for coronavirus response in March 2020, NIEHS Worker Training Program (WTP) created a COVID19 virtual safety training initiative for ‘frontline emergency responders and cleanup personnel’. These target populations included critical workers to support key infrastructure functions such as emergency medical personnel, firefighters, water and sewage treatment, sanitation workers and health care facility employees. This is initial focus of the NIEHS WTP grantees was successful because the awardees are well connected to COVID-impacted high risk populations and have pre-existing trust relationships, a long track record of collaboration and established training agreements.

Methods/Approach

Using our hazmat trainers’ understanding of worker safety and health protection issues, knowledge of personal protective equipment (PPE) usage, and experience in training disaster workers, WTP provided awardees with material to develop an evidence-based curriculum that addresses the science of Coronavirus (clinical symptoms, mode of transmission, persistence in the environment, and treatment); infection control and worker protection (isolation/quarantine and PPE); working in the contaminated environment (sampling and decontamination); and behavioral health resiliency .

Results

During the initial phase of the pandemic response, numerous categories of workers benefited from this virtual platform, including workers in the food preparation and delivery sector, public transportation sectors, and utility operation and waste management/collection sectors. Creating trust between local community organizations that serve essential and returning workers and the components of the public health and medical care infrastructure are critical for reducing community spread and recovering from the pandemic.

Conclusions

The Coronavirus pandemic has had a dramatic effect on every workplace in the United States, but it has been most severe among urban communities of color, tribal nations, meatpacking facilities in rural isolated locations and with agricultural workers. Because of underlying health disparities, many workers have contracted COVID-19 at work as employers have avoided taking responsibility.

Presenting author profile

Professor Finkelstein is a graduate of the Israel Technological Institute (MD) and the Hebrew University of Jerusalem (PhD). He specialized in Clinical Neurology and was a Neurobiology fellow at the Weizmann Institute of Science. His professional activity combines basic research in Israel and USA with clinical in-hospital neurology and toxicology service, alongside academic teaching and public activities at parliamentary and governmental levels. He established widely accepted standard clinical therapeutic protocols for CNS poisonings.


Format

Attended poster presentation

All authors and affiliations

Yoram Finkelstein (1); Elihu D. Richter (2)
1. The Hebrew University of Jerusalem, Jerusalem, Israel
2. Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel

Background

There is a close and tragic connection between the fate of Primo Levi and the city of Carpi, where Collegium Ramazzini convenes once a year. To the Carpi train station, familiar to all of us and close to where we gather, the Italian Jews were brought during the holocaust and from there sent to the extermination camps. The Fossoli camp on the outskirts of Carpi was the place where they were expelled from their homes and where they were concentrated before being put on the trains. Primo Levi's poem "Sunset in Fossoli" is currently displayed on the camp’s gates.

Methods/Approach

His final poem is translated into our Hebrew language and presented alongside the Italian source and the translation into English.

Results

Primo Levi, a native of Turin, was a chemist by profession. He belonged to a partisan group captured by the fascist police. Being a Jew, he was sent to Fossoli and from there to Auschwitz. He was one of the few captives who survived and his books documented his experience as a prisoner. He was precise in his use words, in keeping with his scientific background. Even after he became famous as a writer, he continued to work in his scientific work. The massive environmental devastation, caused by uncontrolled industrialization and urbanization, is described in his poetry starting with his first poem "Crescenzago", which he wrote before being arrested. The poem presented here, even though it may not have been intended to be a final, has a parting from the world and summary of Primo Levi's pessimistic worldview regarding human nature and the fate of the earth.

Conclusions

"Almanac" was published in "La Stampa" on New Year's Day 1987, a few months before his suicide. The poet points, as a prophet of wrath, in protest against environmental destruction.

Presenting author profile

Dr. Natali is Secretary-General of the Mediterranean Task Force for Cancer Control (MTCC), a leading Association in Cancer Prevention and Early Diagnosis, and seats in the Advisory Board of the "Cancer Today Journal" addressing cancer awareness, advocacy, and survivorship issues.


Format

Attended poster presentation

All authors and affiliations

Pier Giorgio Natali (1); Margherita Eufemi (2); Fabio Altieri (2), Giuliano Paglia (2); Elisabetta Rubini (2,3)
1. G. D’Annunzio University, Chieti, Italy
2. Sapienza University of Rome, Rome, Italy
3. Universitè Libre de Bruxelles, Campus Plaine, Brussels, Belgium

Background

The beta-isomer of hexachlorocyclohexane (beta-HCH) is one of the most widespread and environmentally persistent organochlorine pesticides, accounting for about 7.2 tons illegally buried worldwide. Due to its physicochemical properties, beta-HCH exhibits high energetic stability and bioaccumulating potential thus representing a significant health hazard in contaminated sites. Epidemiological surveillance programs on a global scale demonstrated a high plasmatic concentration of beta-HCH in exposed subjects. Previous cellular and molecular studies performed by our group on both normal and transformed human continuous cell lines (i.e. lungs, liver, prostate) demonstrated that beta-HCH activates a wide range of signaling pathways and act as an endocrine disruptor, promoting cellular processes related to carcinogenesis, tumor progression, and chemoresistance. Despite its small size, the beta-HCH has a relevant impact on cellular homeostasis thus it is mandatory to explore defense strategies against its multifaceted biological effects.

Methods/Approach

A screening of natural substances was carried out on the above-enlisted cell targets to test their capability to counteract beta-HCH actions by performing viability assay, flow cytometry, and western blot analysis.

Results

Among a wide array of selected compounds, a highly bioavailable natural lycopene (EU patent No. 3052113 -14 772 134.4) shows a dose-dependent significant chemoprotective activity in all the assayed cell lines by contrasting beta-HCH induced intracellular responses such as anti-apoptotic and pro-metastasizing events, the increase in ROS production and DNA damage.

Conclusions

These experimental outcomes identify lycopene as a potential chemoprotective agent, thus supporting the development and testing of tailored lycopene-enriched formulations for β-HCH exposed individuals. Investigations along this line are ongoing.

Ref: Rubini E, Altieri F, Chichiarelli S, Giamogante F, Carissimi S, Paglia G, Macone A, Eufemi M, STAT3a Hub Protein of Cellular Signaling Pathways, Is Triggered by β-Hexaclorocyclohexane. Int J Mol Sci. 2018 Jul 20;19(7):2108.

Presenting author profile

Professor Daniela Pelclová, M.D., Ph.D., FEAPCCT is emeritus head of the Department of Occupational Medicine, Charles University, Prague and is the Head of the Toxicological Information Centre for the Czech Republic. Her research interests are occupational toxicology, occupational pneumology, diagnostic criteria of occupational diseases and new occupational risks, such as nanoparticles exposure in workers and researchers.


Format

Attended poster presentation

All authors and affiliations

Daniela Pelclova (1)
1. Charles University and General University Hospital, Prague, Czech Republic

Background

Toxicological Information Centers answer telephone calls on acute human poisonings and give advice on first aid and treatment of all types of intoxications. In 2019, more than 21,000 calls were answered by Prague center for 10.7 million Czech population. In 2020, an outbreak of calls due to accidents with disinfectants occurred during COVID-19 pandemic. Majority of alcohol-based hand sanitizers contain 80% ethanol or isopropanol and less than 1% H2O2 and glycerol, as recommended by WHO.

Methods/Approach

The calls on disinfectants were extracted and a comparison within last 5 years (2016-2020) was done, with the focus on 2020 data.

Results

The numbers of calls concerning disinfectants from January 1 to July 31 in last 5 years 2016, 2017, 2018, 2019, and 2020 were 18, 25, 33, 41 and 352, respectively. Exposure was accidental in 81% cases, in 4% during their use, in 1% equally following abuse, suicidal and occupational cause, 12% other. Ingestion dominated (71%), followed by inhalation (4%), eye (4%), and skin (1%) exposure, 20% was unspecified. Family was inquiring in 28%, emergency service in 23%, physicians in 18%, patient in 17%, 14 % other subject. 43% of the patients were children, mostly toddlers. 58% subjects were asymptomatic, 24 % had mild symptoms (inebriation or somnolence), 1% severe (coma), in 14% the symptoms were unspecified and in 3 % unrelated. In the age 0-20 years, the males prevailed (35% vs. 21%), females dominated in the age 21+ (28% vs. 16%).

Conclusions

The number of accidents with disinfectants in the households increased more than 10fold during the COVID-19 pandemic in the Czech Republic. Health impacts were minor, however the accidents contributed to the burden of healthcare workers. Similar situation occurred in Australia, Chile, Croatia, Jamaica, Macedonia, Morocco, and Sweden, as reported to the WHO.

Acknowledgement: Progres Q25/LF1 and Q29/LF1

Presenting author profile

Prof Wojciech Hanke is a head of the Department of Environmental Epidemiology at Nofer Institute of Occupational Medicine, Lodz, Poland where Dr. Patrycja Pietrzak is resident in Public Health


Format

Attended poster presentation

All authors and affiliations

Wojciech Hanke1, Patrycja Pietrzak2
1. Nofer Institute of Occupational Medicine, Lodz, Poland
2. Medical University, Lodz, Poland

Background

There is need to identify the main problems regarding the biological security in large workplaces outside the healthcare sector, while simultaneously pointing out the possible solutions to these problems.

Methods/Approach

A literature review was performed with regard to publications (the last 6 months), concerning the issue of risk factors of SARS-CoV-2 infection in large populations. Experts’ opinions and statements released by institutions working in this field were also taken into consideration. On the basis of the available publications, key procedures to protect workers in large workplaces against COVID-19 were established.

Results

Ten crucial points to be considered as far as the SARS-CoV-2 infection in large workplaces is concerned include the following:
1) identification of persons presenting COVID-19 symptoms being and coming to work
2) identification of asymptomatic infected people being or coming to work
3) quick reaction to information about newly infected (despite prevention effects) by COVID-19 persons
4) keeping physical distance
5) change of the working system in order to protect employees against the COVID-19 infection from people outside the workplace
6) increasing the room ventilation
7) protection from contaminated objects and surfaces
8) employee health education
9) safe return to work of person who underwent COVID-19 infection
10) increase readiness of workers to vaccinate against influenza and in future against COVID-19

Conclusions

The scenario involving an uncontrolled epidemic in a large workplace that serves as a work place for groups of people living in a given region is, by all means, the worst-case scenario. Given the high contagiousness of SARS-CoV-2, it could bring tragic results. Nevertheless, the authors have pointed out that there are some reasonable grounds to believe that such a turn of events can be avoided.

Presenting author profile

Domyung Paek is Professor of Occupational and Environmental Medicine at the Seoul National University Graduate School of Public Health, Seoul, Korea.


Format

Work of the Fellows oral presentation

All authors and affiliations

Domyung Paek(1), Jinwook Bahk(2)
1. Seoul National University, Seoul, South Korea
2. Keimyung University, Daegu, South Korea

Background

No case of congenital anomalies among offspring was recognized as occupational in Korea until 2020. Controversies erupted after a cluster of miscarriages and congenital anomalies among offspring had been reported in one of the provincial community hospitals, and epidemiologic study was carried out in 2012 and 2013.

Methods/Approach

The conditions of work were assessed in the area of exposures to x-ray, drugs, infections, shift work, manual handling, and occupational stress. An interview was conducted to assess past medical histories and behaviors, including smoking and drinking. Pregnancy outcomes were ascertained based on maternity or sick leaves. Follow-up was made after the investigation about the management of the reproductive hazards among hospital employees.

Results

Tablet pills dispensed from the pharmacy were crushed before distribution by nurses at the ward until 2010. Based on the prescriptions, the crushed pills included 17 and 37 FDA pregnancy category X and D drugs, respectively. Out of 15 pregnancies in 2010, 5 had ended in miscarriages, and another 4 had resulted in congenital anomalies of cardiovascular system. Among this cohort of pregnant employees, compared to the rate after the stoppage of crushing, the rates of miscarriages and congenital anomalies were 3.3 (p=0.12), and 7.0 (p=0.01) times higher before the stoppage.

Conclusions

Compensation as an occupational disease was filed for the miscarriages and congenital anomalies soon after. However, only the miscarriage was accepted as occupational by the insurance body (Korea Workers Compensation and Welfare Service), and the congenital anomalies were denied, based on the argument that children are not eligible workers for the insurance coverage. The cases went up to the Supreme Court of Korea, and got recognized finally in 2020, based on the opinion that mother and fetus are one body. This decision has opened the door for the management of reproductive problems of workers in other industries, including semiconductors.

Presenting author profile

Dr. Rokho Kim is Unit Head of Methods and Standards Team (MST) of the Department of Quality Assurance for Norms and Standards (QNS) of Chief Scientist Office (SCI) of WHO.


Format

Work of the Fellows oral presentation

All authors and affiliations

Rokho Kim (1)
1. World Health Organization, Geneva, Switzerland

Background

During the United Nations (UN) General Assembly in September 2019, the Climate Action Summit urged that the pace of climate action must be rapidly accelerated, and the first-ever High-level Meeting on Universal Health Coverage (UHC) recognized the strong links of UHC to climate action.

Methods/Approach

Based on evidence review and lessons from building climate-resilient health systems in countries, this presentation proposes three reasons for global health practitioners to advocate climate change as the central agenda of global health of the 21st century.

Results

Firstly, millions of human lives can be saved every year by tackling the health impacts of climate change, mainly through adaptation, and maximizing health co-benefits of climate action, mainly through mitigation. Mitigation measures to shift from fossil fuels to clean energy can contribute not only to reducing carbon emissions globally but also to improving the air quality and saving a substantial number of lives locally every year. Secondly, health equity can be advanced at global, regional, national and local levels through climate action leaving no one behind. Countries and communities that have contributed the least to anthropogenic climate change are often the most vulnerable and the most severely affected by the consequences of climate change. Climate resilience-building activities in these countries will contribute to improving the global health equity. Thirdly, the return to investment for improving climate resilience is largely profitable in the long-term in health systems as well as vulnerable sectors such as water, sanitation, food systems and disaster risk reduction.

Conclusions

These three reasons provide strong arguments for positioning climate action as the central agenda of global health. Obviously, the targets of UHC are not attainable without building climate-resilient health systems in the most vulnerable countries.

Presenting author profile

Daniele Mandrioli, MD, PhD is the Director of the Cesare Maltoni Cancer Research Center of the Ramazzini Institute, Bologna, Italy. He conducts research on environmental toxicants and carcinogens and Evidence Based Toxicology (EBT). Dr. Mandrioli's research on environmental toxicants and carcinogens includes the design and development of bioassays, investigations on the role of aneuploidy in carcinogenesis and reproductive toxicity, and the analysis of different chemical regulations and their implications for public health.


Format

Work of the Fellows oral presentation

All authors and affiliations

Daniele Mandrioli (1); Laura Falcioni (1); Luciano Bua (1); Eva Tibaldi (1); Federica Gnudi (1); Luana De Angelis (1); Martina Iuliani (1); Marco Manservigi (1); Isabella Manzoli (1); Ilaria Menghetti (1); Rita Montella (1); Simona Panzacchi (1); Daria Sgargi (1); Valentina Strollo (1); Andrea Vornoli (1); Fiorella Belpoggi (1)

(1) Cesare Maltoni Cancer Research Center, Ramazzini Institute, Bentivoglio, Italy

Background

In 2011, IARC classified radiofrequency radiation (RFR) as a possible human carcinogen (Group 2B). According to IARC, animal studies, as well as epidemiological studies, showed limited evidence of carcinogenicity. In 2016, the NTP published the first results of its long-term bioassays on near field RFR, reporting increased incidence of malignant glial tumours of the brain and heart Schwannoma in rats exposed to GSM – and CDMA – modulated cell phone RFR. The tumours observed in the NTP study are of the type similar to the ones observed in some epidemiological studies of cell phone users. We previously published preliminary results that showed: a statistically significant increase in the incidence of heart Schwannomas in treated male rats at the highest dose (50 V/m); an increase in the incidence of heart Schwann cells hyperplasia in treated male and female rats at the highest dose (50 V/m), although this was not statistically significant; an increase in the incidence of malignant glial tumours in treated female rats at the highest dose (50 V/m), although not statistically significant.

Methods/Approach

Male and female Sprague-Dawley rats were exposed from prenatal life until natural death to a 1.8 GHz GSM far field of 0, 5, 25, 50 V/m with a whole-body exposure for 19 h/day. We report the final results regarding the observed tumours for all organs and tissues.

Results

All organs and tissues were then examined and the whole study results will be herewith reported.

Conclusions

Previous RI findings on far field exposure to RFR are consistent with and reinforce the results of the NTP study on near field exposure, as both reported an increase in the incidence of glial tumours of the brain and heart in RFR-exposed Sprague-Dawley rats. RFR are included in the priorities of evaluation for IARC Monograph in 2020-2024.

Presenting author profile

Casey Bartrem, Ph.D., is Executive Director of TerraGraphics International Foundation, an NGO that provides assistance to mining and recycling communities. Dr. Bartrem has worked on human health risk assessments, environmental health interventions, and remediation projects in Nigeria, Bangladesh, Kyrgyzstan, and the USA. She is a Senior Fellow at Norwich University’s Center for Global Resilience and Security, a visiting lecturer at the American University of Armenia, and from 2007-2009 was a Peace Corps Volunteer in Lesotho.


Format

Work of the Fellows oral presentation

All authors and affiliations

Casey Bartrem (1), Sandra Spearman (1,2), Margrit von Braun (1,2), Ian von Lindern (1)
1. TerraGraphics International Foundation, Moscow, Idaho, USA
2. University of Idaho, Moscow, Idaho, USA

Background

Batken Province, Kyrgyzstan includes a portion of the Fergana Valley, one of central Asia’s most agriculturally productive areas. Like much of the region, Batken is also home to dozens of active and abandoned mining sites and waste dumps, many of which date back to the Soviet era. One of the last operational primary mercury mining/processing facilities has recently been revitalized to produce mercury for the global market.

Methods/Approach

The Kyrgyz Ministry of Health (MOH), TerraGraphics International Foundation (TIFO), and Médecins Sans Frontières (Doctors Without Borders, MSF) are collaborating to assess mining-related environmental health risks in the region. In 2019, MOH, TIFO, and MSF conducted environmental sampling as part of a human health risk assessment, collecting over 600 soil, water, air, dust, and food samples in one of the largest environmental sampling efforts successfully completed in the area.

Results

Environmental results are being used to assess risks for residents near the mercury mining/smelting operations, with the goal of developing a locally implemented health intervention program to reduce heavy metal exposures. Risks are not limited to local exposures; transboundary pollution is a concern throughout the Fergana valley. Frequent seismic activity and increasing incidents of flooding and landslides due to climate change may result in the movement of mining wastes into waterways and across national borders, escalating existing border disputes and ethnic tensions.

Conclusions

Like much of Central Asia, Kyrgyz mining communities are undergoing dynamic post-Soviet transitions with challenging and interrelated environmental, economic, and political implications. Implications for environmental security should be considered when analyzing environmental health risks at active and legacy mining sites in the region.

Presenting author profile

Dr. Jia Chen is Professor in the Departments of Environmental Medicine and Public Health, Pediatrics and Oncological Sciences at the Icahn School of Medicine at Mount Sinai. She is the Director of the Molecular Epidemiology Lab the Senator Frank R. Lautenberg Environmental Health Sciences Laboratory where she leads a team of scientists examining the complex interactions between the environment and the genome/epigenome and how they contribute to human diseases.


Format

Work of the Fellows oral presentation

All authors and affiliations

Jia Chen (1); Daniele Mandrioli (2)
1. Icahn School of Medicine at Mount Sinai, New York, New York, USA
2. Cesare Maltoni Cancer Research Center, Bologna, Italy

Background

Human exposure to glyphosate has become ubiquitous. Recent studies have described endocrine disrupting properties of glyphosate. Specifically, in our work in Sprague-Dawley rats we observed a positive association between gestational exposure to low-dose glyphosate and its formulation Roundup® and anogenital distance (AGD), a marker of the prenatal hormone milieu. In human population, glyphosate exposure has been associated with shortens gestational length in a recent report from a US birth cohort. To confirm these associations, we conducted a pilot study to investigate in utero glyphosate exposure in relation to gestational length and newborn AGD in a prospective multi-center birth cohort.

Methods/Approach

The pilot study was nested in The Infant Development and the Environment Study (TIDES), which has four university-based centers across the US. We measured glyphosate and its degradation product aminomethylphosphonic acid (AMPA) in 2nd trimester maternal urine using ultra-high-performance liquid chromatography-tandem mass spectrometry. We explored the relation between glyphosate/AMPA and gestational length as well as newborn AGD using sex-stratified multivariable linear regression models adjusted for the infant’s age at exam, weight-for-length Z-scores, study center, gestational age, maternal age and time of urine collection.

Results

Glyphosate and AMPA concentrations were above the limits of detection in the majority of the samples (>90%). Both glyphosate and AMPA levels in urine were associated with shortened gestational length. They were also associated with increased AGD in newborns but only among females; the males showed similar trend but failed to reach significance.

Conclusions

Our results demonstrate widespread exposure to glyphosate in the general population. The previous observation in rodents of an association between glyphosate exposure and increased anogenital distance was also confirmed by the present study in human infants. Moreover, these preliminary findings highlight the urgent need to evaluate the potential health effects of glyphosate in early development and as endocrine disruptor.

Presenting author profile

Vyvyan Howard is a medical toxico-pathologist and is an Emeritus Professor at the University of Ulster. He became involved in investigating Aerotoxic Syndrome in 2005 and has contributed to several published papers adding to our understanding of its aetiology. He is a member of the Irish Delegation to the CEN standards setting group addressing aircraft cabin air quality.


Format

Work of the Fellows oral presentation

All authors and affiliations

Vyvyan Howard(1); Susan Michaelis (2); Colin Soskolne (3); David Gee (4); Andrew Watterson (2).
1. Ulster University, Coleraine, UK
2. University of Stirling, Stirling, UK
3. Alberta University of Edmonton, Alberta, Canada
4. Brunel University, London UK

Background

The flight safety and health consequences of aircrew and passenger exposure to aircraft cabin air supplies contaminated by engine oils and other working fluids, have remained ongoing. Air monitoring studies identifying a consistent pattern of low-level exposures to a complex mixture including VOCs, OPs and UFPs.

Methods/Approach

Monitoring relevant global scientific publications, governmental, regulatory and airline industry outputs.

Results

Standardisation work for exposure to chemical agents in the cabin air; International civil aviation organisation (ICAO) and airline trade bodies aircraft fumes guidance; European aviation regulator (EASA) /EC cabin air quality and oil pyrolysis studies with further research being planned (1); US Congress cabin air quality bill initiated; FAA (US aviation regulator) Safety alert & Reauthorisation Act -Cabin air quality research (2020-2024); ECHA TCP review (2); in Increasing manufacturer/airline patents related to oil leakage into air supply; limited development of total air filtration & detection systems. Other actions of note include the development of an independent narrative review of the health consequences of fume events and medical protocol (3); a recent significant workers compensation in favour of the injured pilot (4) and aircrew settlements with Boeing (5). Biomarker research for triaryl phosphate exposure is continuing.

Conclusions

There is increasing recognition of exposure to oil and aircraft fluids via the cabin air supply, yet the occupational response remains inadequately acknowledged and addressed.

References
1) EASA (2020) EASA Workshop on future Cabin Air Quality Research
2) ECHA (2016) Substance evaluation - CoRAP- Tris(methylphenyl) phosphate- TCP
3) Practical guideline prepared by the International Fume Events Task Force (chaired by S. Michaelis) with working groups from the DiMoPEx COST-Action* and Collegium Ramazzini
4) Myers A (2020) Workers Compensation State Board of Oregon: Claim No. 555232469. opinion and Order.
5) Woods v The Boeing Company & Escobedo v The Boeing Company (2019).