Qatar has taken general precautionary measures to prevent the spread of COVID-19. A number of those measures were related to the workplace. They varied from having a complete shutdown (e.g., Public transportation, Education, and some types of retail stores) to a mandatory 80% workforce to work from home, applied to all other businesses. The exceptions were the healthcare sector, national security, food industry, supermarkets, airport, and some major state construction projects that continued their work as usual. Additionally, the following employee categories were classed as high-risk and were urged to work remotely: employees over the age of 55 years, pregnant employees, employees with chronic diseases such as cardiovascular disease, cancer, diabetes, respiratory conditions and hypertension.
The study revealed that the highest positivity rates, irrespective of the frequency of testing, belonged to the retail and wholesale sector as well as the construction sector. Workers within the retail workplace setting, namely supermarkets, have been considered in the current outbreak as one of the occupational groups at increased risk of contracting COVID-19 disease in the workplace, given the necessary public interaction and frontline-focused nature of work[i]. Both the construction and the retail sectors followed the same trend, with the number of cases reaching their peak in May. Although construction sites have no direct occupational or even public exposure, such as in retail and wholesale, the high number of cases might be related to environmental and educational factors.
Multiple elements in different areas can interact with each other, resulting in a cumulative risk that can affect and increase the worker’s overall risk[ii]. For example, most construction companies use buses to transport workers, and at the start of the outbreak, there were no educational materials regarding infection prevention translated in the languages of the workers, who mostly come from Asian countries. Furthermore, Craft and Manual Workers live in crowded shared accommodation in constant proximity of one another, increasing the likelihood of COVID-19 transmission amongst them[iii]. Living in dormitory-style housing compounds challenges with implementing social distancing, and in consequence, increases the risk of spread of COVID-19. Workers also often gather for social and recreational activities, shared dining, and use shared equipment e.g. kitchen appliances. The accommodation type was considered in Qatar as one of the strong forecasters and substantial contributing risk factors for health problems amongst migrant workers[iv].
Although the health care sector has been considered as a workplace with a high risk for occupational exposure to the infection, in this study, health care had the lowest positivity rate. This might be attributed to the enforcement of infection prevention and control and occupational safety measures such as continuously wearing masks, frequent handwashing, and constant availability of sanitizers. Another explanation could be the higher frequency of mandatory regular random testing of health care professionals. Health authorities have also put in place a range of teleconsultation services that proved quite effective in emergency response to deliver care while reducing the risk of contamination[v].
A study highlighting work-related COVID-19 transmission in six Asian countries stressed the importance of work-related transmission of COVID-19 outside healthcare settings such as transportation or retail settings. Also, the proportion of healthcare workers (HCWs) among locally transmitted cases was smaller than non-HCWs in the included countries/areas[vi]. Those findings likely support the efficacy of the use of PPE, screening, and knowledge about the pandemic in healthcare settings. HCWs are also strongly supported by international institutions to prevent and contain any outbreak within healthcare facilities: The World Health Organization has developed several specific guidance documents regarding COVID‐19 for HCWs, including rights, roles, and responsibilities with key considerations for safety and health. They have also established a risk assessment tool that is to be used by health care facilities to determine the risk of infection of all HCWs who have been exposed to a COVID‐19 patient[vii].
Periodic testing and isolation could also be one of the possible explanations for the low positivity rate associated with plateau patterns, which occurred in May and June, namely for the Health care sector and Oil & Gas industry. In addition, tracking back the infection source in healthcare settings is also more straightforward, and thus, containment is smoother. It is therefore crucial to protect essential workers not working in healthcare settings because their risk of infection is often under-estimated, especially when compared to the healthcare sector, and their employers might not always provide adequate Protective Equipment, training or screening[viii].
Qatar began lifting restrictions in a four-phased approach that started in June. The systematic testing of employees who intended to return to work during the first phase of lifting restrictions may explain the sharp increase in cases in the Public Service and the Accommodation & Food industries during this time. This screening initiative enabled the isolation of COVID-19 cases before the opening of public services, hotels, and restaurants to the public.
Lastly, the screened private funded sector was more affected by COVID-19 infections than the public funded sector. It is known that the private sector has higher percentages of workers who perform manual labor than the governmental sector. This disparity requires further investigation for the successful implementation of precautionary measures, given the discrepancy in the level of compliance and in the educational level of the employees between different sectors. These findings also highlight the importance of tailored strategies for prevention and surveillance as well as a tailored communication approach at workplaces to convey consistent health messages that are easy and accessible for all segments of the population for an optimum health outcome.