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Coronavirus: The risks to essential workers with hidden health conditions

April 16, 2020
By Arif Jetha/University of Toronto

Photo: Luca Lorenzelli/Getty Images

The COVID-19 pandemic has left many in Canada’s workforce worried about their health and finances. Those worries are even greater for workers living with an underlying and invisible chronic health condition.

In the planning of health and safety responses to COVID-19 and the ultimate reopening of workplaces, employers should be aware of the unique needs of this potentially vulnerable group of workers.

Data show that some of the most commonly reported chronic health conditions experienced by Canada’s working population have no visible signs or symptoms and may go unnoticed by employers.

According to the 2019 Sanofi Canada Healthcare Survey on workplace benefit plans, 54 per cent of workers reported having such a condition, with high blood pressure, arthritis and diabetes among the top five. In the same survey, employers estimated that only 29 per cent of their staff had a chronic condition, pointing to a gap in awareness within workplaces.


Our growing understanding of COVID-19 illustrates that the virus poses a particular threat to workers with underlying health conditions.

A review of 46,000 people with COVID-19 in China found that the odds of having severe symptoms were two or more times higher for people with an underlying health condition. Although the data are limited, a recent analysis conducted by the Centers for Disease Control and Prevention also shows that 38 per cent of COVID-19 cases in the United States had an underlying health condition including diabetes, cardiovascular disease, chronic lung disease and immmunocompromised conditions.

Essential workers are on the job

Going to work, therefore, could mean being exposed to a virus that disproportionately targets those with underlying health conditions. Of course, staying at home would be the best solution for workers with chronic health conditions. But even after the provinces ordered the closure of businesses, people in a large cross-section of essential services found themselves having to continue to show up for work.

These include people who work in health care, grocery stores, drug stores, warehouses, gas stations, fast-food chains and other restaurants, hotels, long-term care homes, among many others.

Despite the provinces encouraging workers who feel unwell to stay home and the availability of emergency relief for compensation, workers with chronic health conditions may not want to sacrifice a paycheque during a period of economic uncertainty. They may decide to accept the risk of going to work.

This is a predicament that many community groups are highlighting. As Sian Bevan, chief science officer at the Arthritis Society, puts it:

“Some people in these essential roles may be fearful for their employment if their condition makes them unable to work — and fearful to let their employer know about their health concerns for fear of losing their jobs. Many immunosuppressed people with rheumatic conditions are afraid to go to work, but afraid to tell their employer why.”

Commendably, some employers are offering “hero pay” to compensate for the added risk that workers face.

Yet the extra wages could also have the unintended effect of encouraging people with chronic health conditions who face income insecurity to go to work.

Some conditions fluctuate

Growing research conducted by the Toronto-based Institute for Work & Health highlights the challenges that workers with chronic health conditions face when asking for accommodations that will allow them to continue working productively while maintaining their health. This is especially the case for those living with invisible health conditions that may fluctuate in severity, young workers, those new to their jobs and other vulnerable groups.

In the current health and economic crisis brought about by COVID-19, the inability of these individuals to ask for protective accommodation poses a potentially serious risk to the health and safety, and the long-term employment, of people with chronic health conditions in the workforce.

These are trying times, and from many accounts, employers are doing their best to keep essential services running while safeguarding the health and safety of workers. As they continue to navigate the way forward and develop back-to-work plans, employers should acknowledge that they may have workers with a chronic health condition who could be reluctant to ask for support.

Employers should also be encouraged to open up the lines of communication with all workers so that those with underlying conditions feel supported in bringing forward their concerns. While workers are not obligated to talk about their health, more than ever, supportive workplace environments are needed to encourage people to communicate what assistance they need to stay healthy while working productively.

Laurie Proulx, vice-president of the Canadian Arthritis Patient Alliance, sums it up well. She sees the COVID-19 pandemic as:

“… an opportunity for employers to build credibility with their employees by listening and finding ways for workers with underlying health conditions to still make important contributions and not put themselves and their families at risk.”

Arif Jetha is a scientist with the Institute of Work and Health at the University of Toronto.

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