key: cord-307751-4r44ww59
authors: Tran, Bach Xuan; Vu, Giang Thu; Latkin, Carl A.; Pham, Hai Quang; Phan, Hai Thanh; Le, Huong Thi; Ho, Roger C.M.
title: Characterize health and economic vulnerabilities of workers to control the emergence of COVID-19 in an industrial zone in Vietnam
date: 2020-05-12
journal: Saf Sci
DOI: 10.1016/j.ssci.2020.104811
sha: 
doc_id: 307751
cord_uid: 4r44ww59

The detection of first COVID-19 infected industrial worker in Vietnam on 13 April 2020 prompted timely effort to examine the health problems, behaviors, and health services access of industrial workers to inform effective and appropriate COVID-19 control measures, minimizing the risk of industrial sites becoming the next disease cluster. A search strategy involving search terms corresponding to ‘health’, ‘industrial worker’, and ‘Vietnam’ was applied to search for related papers published in English on Web of Science, PubMed, and Google Scholar. Duplicates were removed, and relevant data were extracted from the full text of remaining publications. Results showed that underlying health problems, including respiratory system problems, were common among industrial workers. Many suffered occupational diseases and/or work-related injuries. Self-treatment (without medication) was the most used method when having health problems (by 28.2% to 51% of participants), followed by visiting commune health centers (24%) and self-medication (20.3%). Findings suggest a high risk of disease spreading among industrial workers and of them suffering more severe conditions when infected. Economic vulnerabilities may be the reason for workers’ reluctance to taking time off work to attend hospital/clinic. These imply a need for involving local pharmacies, commune health centers, traditional health providers or village health collaborators as local health gatekeepers who are the first point of detecting and reporting of suspected COVID-19 cases, as well as a channel where accurate information regarding COVID-19, protective equipment, and intervention packages can be delivered. Having COVID-19 testing centers at or near industrial sites are also recommended.

On 13 April 2020, Vietnam reported the COVID-19 case numbered 262, a twenty-six years old man who works for Samsung Display Company at the Samsung industrial site in Bac Ninh Province of Vietnam (Vietnam Ministry of Health, 2020) . This is the first case of an infected industrial worker confirmed in Vietnam. Moreover, tracing of travel and contact history of the patient showed that he has continued to go work during the period of 31 March to 6 April while experiencing mild COVID-19 symptoms, travelling by company bus and being in close contact with at least 100 people, mostly at the workplace (Thanh Nam, 2020) . Given the crowded nature of industrial factories with workers travelling to work on packed company bus from various locations in a region -the 262 patient lives in Ha Loi, Me Linh, Hanoi and likely infected by his relative, who is a confirmed case living in the same village (Vietnam Ministry of Health, 2020), with the detection of this case in Vietnam, industrial sites present a risk of becoming the next disease cluster.

This indicates the need for timely efforts to examine the characteristics of health status, health-related behaviors, and health services access of industrial workers, a vulnerable population, such that effective and appropriate COVID-19 control measures would be established. We believe that these informed measures would not only be critical to minimize the threat of cluster transmission in a Vietnamese industrial zone but also provide useful insights and suggestions for similar settings elsewhere.

For evidence on health problems, behaviors, and healthcare access of industrial workers in Vietnam, we conducted a review of relevant literature. We first applied a search strategy which involves a series of search terms that correspond to 'health', 'industrial worker' and 'Vietnam' combined using Boolean operator 'OR' to search for related papers published in English, on three databases of Web of Science, PubMed and Google Scholar (Table A .1). The articles from these three sources were then extracted and imported to EndNote software for duplicates removal. Screening of titles and abstracts of the combined list of papers were then conducted by two independent researchers and papers not directly relevant to the topic interested be removed. Finally, we examined the full text of remaining articles and extracted information regarding author name, year of publication, characteristics of research subjects including their health problems, risky/ protective health behaviors as well as healthcare access.

Main findings are presented in Table 1 . The result showed that underlying health problems were common among industrial workers (Pham et al., 2019; Tran et al., 2019b; Tran et al., 2019c) , with many suffering occupational diseases (Quynh Nguyen et al., 2017; Tran et al., 2016) and/or work-related injuries (Marucci-Wellman et al., 2010; Phung et al., 2008; Ratnasingam et al., 2012) . A high prevalence of respiratory system problems was also reported (Chien et al., 2002) . Self-treatment (without medication) was found to be the most used method when having health problems (by 28.2% to 51% of participants), followed by visiting commune health centers (24%) and self-medication (20.3%). Health-related information was usually obtained through medical staff and online sources (Tuyen et al., 2019) .  76.7% exposed with noise  57.7% exposed with high temperature  50.2% exposed with dust  35.8% exposed with toxic chemicals  37.6% exposed with toxic gas  Over 50% of workers were exposed to heat, dust and noise 17 S. Matsuda (1996) (Matsuda, 1996) Factory workers in 

Our rapid review of published papers on health problems, behaviors, and health services access of industrial workers indicated a high prevalence of underlying acute and chronic health issues, of which many are workrelated, in this population. Industrial workers thus can be considered a vulnerable population, at higher risk of suffering more severe COVID-19 conditions should they get infected, as reports found the disease likely to develop complications on people with underlying health problems (Centers for Disease and Control

Prevention, 2020). In terms of health services access, commune health stations and local pharmacies (for self-medication) appear to be first place industrial workers visit when having health problems, instead of hospitals or private clinics. In addition, a high proportion of workers who self-treated without medication possibly were practicing traditional and home remedies that are handed-down through older generations or from friends and relatives, a practice common among Vietnamese people. In the context of COVID-19, such behaviors can be considered risky. For example, an infected COVID-19 worker may confuse their mild symptoms with that of the common cold and continue to work, travel, and have close contact with other people while inappropriately self-medicated, increasing the risk of disease transmission and developing complications. This likely occurred in the case of patient numbered 262 when he continued working for a whole week while having cold-like symptoms. Our findings can also be considered reflecting the barriers to healthcare access faced by industrial workers due to their economic disadvantages. The reason a large proportion of workers studied in previous researches chose self-treatment or self-medication rather than taking time off work and go to hospital/ clinic maybe their fear of having payment cut for the time not working, or even their concern of low performance evaluation (due to being off work) and being denied the opportunity of promotion and bonus. Afraid of having salary reduction, shift cut, or being laid off may also pressure industrial workers to continue going to work despite their possible worries about the safety of commuting to and working in factories amidst the COVID-19 outbreak.

Indeed, the risks of disease spreading can be amplified considering the typical features of industrial zones in Vietnam. Industrial sites are often clusters of factories that are usually located at or near a traffic hub of a region, which in normal time would ensure ease of transportation of materials and products as well as of workers commute. In times of disease spreading, however, this would mean a greater possibility of workers being in close contact with people from various regions when commuting to and from work or mingle around the areas. Workers at these industrial factories in many cases are from other locations in the province or other provinces who may come home after a shift or on the weekend, increasing the possibility of being in contact with an infected person or chance of them infect other people. Even without these travelling, the crowded nature of these factories would make having safe distance between workers during shift and at the end of workday challenging.

Appropriate and effective detection and control measures can be informed based on these understandings of vulnerabilities and behaviors of industrial workers as well as the characteristics of their workplace. Since the first COVID-19 case was detected in the country, in addition to restrictions on mobility and social gathering, centralized quarantine and aggressive contact tracing, there should be involvement of local pharmacies and commune health centers, as well as other unofficial health taskforces like traditional health providers or village health collaborators in detecting and reporting of suspected cases, such as people who buy cold medicine or come for home remedies advice. These local health 'gatekeepers' can also be utilized as points of delivery of accurate information regarding COVID-19, protective equipment, and intervention packages. Having testing centers at or near industrial sites can also be helpful to avoid unnecessary travelling of workers to have themselves tested. When mobility restrictions are gradually relaxed over time, it is crucial that travelling from and to industrial sites continued to be monitored closely and strict adherence to protective measures of people wearing masks and keeping safe distances.

With manufacturing worldwide being reduced and halted and uncertainty looming over the global economy as a result of COVID-19, industrial workers are faced with not only the risk of having the disease but also challenges to maintain their living. Measures that can effectively control the emergence of COVID-19 in industrial sites not only support the overall effort of combating the disease, but also help to protect this vulnerable population from more suffering in the future. The insights and recommendations provided by this study hopefully can also provide a timely reference to similar situations elsewhere in the world.

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