What good came out of the covid-19 epidemic? a cluster of cases with occupational lung disease

The Covid-19 epidemic has resulted in many workers having prolonged periods away from work, opening an opportunity to clarify the effect of occupational exposures on workers with equivocal diagnoses, and the effectiveness of previous relocation of workers with confirmed occupational asthma. However, investigations have been confounded by many clinics and physiology departments not running during the epidemic. We report a cluster of cases from an office building where previous investigations including two workplace visits with the ventilation engineer and a workplace challenge had been equivocal, but where prolonged periods away from work clarified the occupational cause for the symptoms. The index case was an intelligence officer (forensic computing) who developed cough and recurrent episodes of 'bronchitis' and voice change within weeks of moving into a large air-conditioned office with air supply delivered from the suspended floor and separate cooling delivered through the ceiling. Oasys ABC analysis of serial PEF records showed one positive timepoint (outside the 95% CI for days off work) in the evening after work but a negative ABC score and normal diurnal variation. A second record showed similar results (one late positive timepoint) making it highly likely that the changes were associated with work. Figure 1 shows the mean 2-hourly PEF on workdays (crosses) and days away from work (squares). The lower grey line shows the 95% CI for days away from work from the Oasys plotter. The mean of 11 workdays between 1830-20.30 is significantly lower than the 16 days away from work. At least two others working nearby were affected, a computer programmer had similar work-related symptoms and a data information officer more obviously asthmatic symptoms. The building has been closed during the epidemic and all substantially improved and are currently repeating PEF measurements, which are the only physiological tests readily available at present. The nature of the disease in the index case remains unclear. The PEF changes could be the very earliest indication of occupational asthma, could be due to hypersensitivity pneumonitis, which usually results in bigger PEF changes, or could represent occupational upper airways disease, but the late fall in PEF is unusual.

S110 What good came out of the Covid-19 epidemic? A cluster of cases with occupational lung disease

S110 Figure 1