key: cord-0010657-n9kozfnn
authors: Ćurković, Marko; Košec, Andro; Brečić, Petrana
title: Redistributing working schedules using the infective principle in the response to COVID-19
date: 2020-04-21
journal: nan
DOI: 10.1017/ice.2020.155
sha: 81059d5922e947ca8dd9688a46cf2c914b84c683
doc_id: 10657
cord_uid: n9kozfnn

nan

institutions dealing with health conditions considered significant risk factors for severe COVID-19 disease.

In these units, among other widely used measures (eg, vigorous screening for possible COVID-19 infection, stringent testing, and triage of suspected cases as well as developing and adopting different care, safety, allocation, and communication strategies), it is of immense importance in controlling possible transmission of infection among and by healthcare professionals. Healthcare professionals may remain unaware of their COVID-19 status due to the mild or even asymptomatic course in healthy individuals; thus, they may unknowingly become supervectors. [6] [7] [8] 10 Healthcare settings are usually inadequately prepared for infection prevention and control, especially in the context of limited resources (eg, personal protective equipment), and professionals may become infected through their contact with even seemingly noninfected patients. In addition to previously reported measures, alternative distribution of working schedules may contribute to minimizing the likelihood of virus transmission.

In centers where infected patients are treated, healthcare staff are usually organized in 2-week shifts and then spend the next 2 weeks in self-isolation, preferably being (re)tested before starting a new shift. This approach to staff scheduling seems logical because it follows the COVID-19 incubation period.

Work schedules in "COVID-free" institutions should be organized such that after 1 shift (preferably a 12-hour or, exceptionally, a 24-hour shift), healthcare staff remain in self-isolation for 48 hours. Such a redistribution of shifts makes it possible to resolve the nature of possible infective exposure because the COVID-19 infection window seems to be 48 hours (ie, patients become contagious 48 hours before the onset of symptoms). If a healthcare professional comes into close contact with a patient who later develops symptoms, it is prudent to automatically prolong the self-isolation period until the COVID-19 status of that patient is resolved, allowing enough time to contain possible events of disease transmission. Such a redistribution of working hours, together with rigorous tracking of any relevant close contacts (which could be assisted by novel technologies) limits possible introduction and spread of infection within the institution.

This approach may have special importance in the pandemic timeline. When measures of self-isolation and/or quarantine are in place and local disease transmission has been demonstrated, clinical spread of infection will become the most important. Furthermore, since healthcare professionals among the few persons allowed free movement under "stay at home" orders, this scheduling strategy may have important repercussions for the entire community because it can limit the potential pandemic vector effect, which not yet well understood. 2, 6, 10 This scheduling approach may be feasible in institutions with sufficient staff to maintain a work schedule of continuous rotation, which may be difficult, but it may prove useful in the long run. Additionally, through alternative methods of care delivery, like those provided through novel digital technologies, staff that are not physically present may remain fully involved in providing care for those who need it most. Finally, this scheduling approach may preserve the bulk of physically and mentally healthy staff sorely needed to combat later effects of pandemic, which will have dire consequences for healthcare systems that have not made every effort to prevent intrainstitutional transmission.

Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China

Novel coronavirus and old lessons-preparing the health system for the pandemic

Fair allocation of scarce medical resources in the time of COVID-19

The emotional impact of coronavirus 2019-nCoV (new Coronavirus disease)

Managing mental health challenges faced by healthcare workers during covid-19 pandemic

How should US hospitals prepare for coronavirus disease 2019 (COVID-19)?

The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform

Protecting health-care workers from subclinical coronavirus infection

Novel coronavirus and hospital infection prevention: preparing for the impromptu speech

Unprecedented solutions for extraordinary times: helping long-term care settings deal with the COVID-19 pandemic

Acknowledgments. None.Financial support. No financial support was provided relevant to this article.Conflicts of interest. M.Ć. and P.B. have received lecture honoraria from Lundbeck, Sandoz, Janssen, Pliva (Teva), and Alkaloid. A.K. has no conflicts of interest to declare.