Marc R. Larochelle
May 26, 2020
I propose a framework to help clinicians counsel patients about continuing to work in the midst of the pandemic that is based on their occupational risk of contracting SARS-CoV-2 and their risk of death if they are infected (see diagram). Though data on occupational risk are limited, the Occupational Safety and Health Administration has published guidance and proposed a scheme for classifying the risk of SARS-CoV-2 infection as high, medium, or low based on potential contact with persons who may or do have the virus (www.osha.gov/Publications/OSHA3990.pdf). Low-, medium-, and high-risk categories of individual risk of death from Covid-19 are based on age and the presence of high-risk chronic conditions identified by the CDC. Persons with high risk in both domains should consider stopping work, and those with high risk in one domain and medium risk in the other should discuss risk with their clinician. Physicians should also inquire and counsel about risks to household or to other contacts who may be at high risk for poor outcomes.
New England Journal of Medicine – DOI: https://www.doi.org/10.1056/NEJMp2013413