As the spread of COVID-19 infections intensifies nationwide, disparities are emerging among different occupations and businesses in terms of work hours. Declining demand has led to some people losing their jobs and others having to settle for reduced working hours with both groups experiencing a significant drop in income. On the other hand, essential workers, such as healthcare workers, health center and quarantine station staff, civil servants facilitating COVID-19 countermeasures, distributors, IT technicians handling requests for urgent adoption of telework technologies, and others laboring to process the tremendous increase in similar operations have all seen their working hours drastically increase. At the time this article was written, no precise data was available. Instead, this article goes overs previous literature in an attempt to consider the situation of workers who have been forced to work overtime because of the COVID-19 peril.
COVID-19 and the Bipolarization of Working Hours: What We Can Do to Alleviate Overwork of Essential Workers
Faculty Fellow, RIETI
Situation of healthcare professionals
An April 10 news bulletin stated that more than 100 healthcare professionals had died from COVID-19 in Italy. Formenti et al. (2020) reported that, as of March 25, 39 healthcare workers had died in Italy, and, over the past two weeks, the number has risen further. Such circumstances are not confined to Italy. Medscape, a website that distributes medical information for clinicians, updates a list memorializing healthcare workers who have succumbed to COVID-19 around the world on a daily basis (Note 1).
How serious of an impact has COVID-19 had on people working on the frontlines to combat this disease? Precision in scholarly research is premised on data acquisition. Yet, at least at the current point in time, there is only limited quantitative data available other than the aforementioned heartbreaking numbers. Nevertheless, pre-peer-review articles are slowly beginning to be published worldwide. Such examples include studies conducted by Ning et al. (2020), a survey of 150 medical workers working with COVID-19 patients in China's Zhejiang Province which has seen a severe outbreak of COVID-19 infections, and Jing et al. (2020), a survey of 801 medical workers similarly engaged in frontline treatment in Hubei Province where Wuhan City is located. Both studies reported medical workers displaying symptoms associated with sleep disorder, anxiety disorder, depression, as well as fear of the risk of contamination, weight loss, and other such symptoms (Note 2).
Lessons from the Great East Japan Earthquake
Japan's experience of the Great East Japan Earthquake has provided many lessons about excessive work during disasters. At that time as well, nuclear power plant workers, healthcare workers, administrative officials, workers handling the logistics of transporting emergency supplies, caregivers at nursing care facilities, as well as many other people, worked night and day without sleep or rest. Yoshikawa (2017) offers clues about the excessive amounts of work that individuals carried out at that time. The paper was based on information available from a database of certified work-related injuries and deaths. Yoshikawa extracted and analyzed 21 cases of people who suffered from cerebrovascular and cardiovascular diseases in three prefectures afflicted by the earthquake (Iwate, Miyagi, and Fukushima). The analysis found that the principal factors leading to the onset of these health conditions were encounters with abnormal incidents in six cases, excessive workloads within a short period of time in two cases, and excessive workloads over long periods of time in 15 cases (including two cases with overlap in causes). It also identified when the onset of symptoms began, ranging from less than one week from the date of the earthquake in six cases, from one week to less than one month in three cases, from one month to less than six months in seven cases, from six months to less than one year in three cases, and more than one year in two cases. This suggests that overwork and other abnormal burdens placed on an individual at the time of a disaster may have a tremendous adverse effect on the person not only immediately after the disaster, but even after a significant period of time has lapsed.
In addition to the aforementioned cerebrovascular and cardiovascular diseases, the literature also suggests that overwork at such time has an effect on mental illness. Suzuki et al. (2014) conducted follow-up surveys at two points, the second and seventh months after the earthquake, of approximately 4,000 civil servants in Miyagi Prefecture. Roughly 17% of respondents stated that their maximum weekly overtime during the seven-month period after the earthquake was in excess of 80 hours, and approximately 26% of respondents said that there were weeks during the same seven-month period where they had no days off. Suzuki et al. (2014) also reported that, even when controlled for deaths in the family, destruction of homes, and a diverse range of other tragic experiences, those who responded that they had weeks during the first seven-month period after the earthquake with no days off, had an elevated risk for mood and anxiety disorders seven months later that was 3.95 times greater than those who responded that they had been able to secure at least one day off every week. Fukasawa et al. (2018) conducted another follow-up survey that added a third point at 16 months after the earthquake. This study revealed that, while some results indicated that being engaged in long periods of overtime in excess of 100 hours per month immediately after the earthquake had no effect on the individual's mental health 16 months later. However, those who continued to work in excess of 40 hours per month even 16 months after the earthquake had a 1.58 times greater risk of mood and anxiety disorders in comparison to people who did not have to work such large amounts of overtime. It also found that individuals who felt that they had not been able to secure sufficient rest during the one month period prior to the survey conducted in the 16th month (in other words, during the 15th month after the earthquake), had a 2.81 times greater risk of mood and anxiety disorders in comparison to people who responded that they had been able to obtain such rest. These results suggest that damage to mental health resulting from the inability to maintain proper rest over a long period of time is a serious problem (other papers that have reported results relating to the mental health of laborers involved in responding to the earthquake include Kawashima et al. (2016) and Wakashima et al. (2019)).
Although cases where individuals responded to a massive earthquake disaster, a one-time major shock, may not directly apply to the recent COVID-19 response, these reports at least suggest that overworking for long periods of time without rest significantly damages an individual's health. In a situation such as the COVID-19 pandemic where uncertainty remains as to how long the disease will continue to spread and infect people, urgent attention is required to ensure that people working excessively long hours take time to rest, while also bearing in mind that this will be a long-term struggle.
What we can do: devising ways of working
During the past few weeks, the Japanese media has focused its coverage on frontline healthcare workers responding to COVID-19, reporting that healthcare workers are somehow hanging in by preventing hospitals from being overwhelmed. Nevertheless, it is likely that there are still quite a few people who also believe somewhere in the back of their mind that "we will somehow manage because medical practitioners are doing their utmost." Moreover, despite the gradual increase in awareness among the general population about the risk of a collapse in our medical infrastructure, interest in occupations other than healthcare workers, who have been forced to work overtime due to the COVID-19 peril, still remains low.
With enforcement of the revised Labor Standards Act, regulation was introduced for workers at large companies in April 2019 to limit the number of hours of overtime work to less than 100 hours on a monthly basis and 720 hours on a yearly basis (Note 3) with sanctions to be levied for companies that violate these standards. From April 2020, the same regulation was applied to workers at small and medium-sized companies as well. However, application of the law to the construction industry, transportation-related industries, and physicians has been postponed until the end of March 2024. In addition, because of the acute maldistribution of physicians in regional communities with few practicing physicians, a special standard has been established that suspends application of these overtime regulations until further notice even after April 2024. Considering the difficulties such communities face, the special upper limit of 1,860 overtime hours per year has been proposed for physicians (Note 4). As of April 12, 2020, when this article was written, it has been mainly urban areas that have seen a rapid increase in the number of infected individuals. However, once infections begin to impact a larger number of regional areas, it is feared that such community healthcare systems where practitioners are already overworked, would overwhelm the current health care capacity.
In contrast to a sudden natural disaster such as a major earthquake, one principal difference here is that each and every one of us is able to employ our ingenuity and change the way that we work and live in order to reduce the number of new COVID-19 victims. The government has requested that prefectures where emergency declarations were issued on April 7 "reduce the number of people going to work in offices by a minimum of 70%." Although calls have been made for ordinary employees to work from home or telework, various factors have forced many to travel to work as usual. There are also many kinds of work that cannot be done online. Yet, we must change the way we conceptualize work, try to consider once again what work is really unable to be performed online, and reassess a work culture that is fixated on paper documents. In Japan, a negative peer effect, which is grounded in the idea that "because everyone else is working, it is impossible for me to take time off," has been an obstacle to rectifying the long hours that employees work. A major point regarding Tokyo Governor Koike's current request is to what extent the number of people commuting to office on weekdays can be held down after April 13 (Note 5).
Ingenuity is also necessary for finding a way of allocating some workload of overworked employees to other personnel as well as reducing the amount of work that is concentrated to certain individuals. It has long been pointed out that many workplaces in Japan, regardless of the type of business or occupation, are inefficient. As work tends to be overly delegated to a few people, while many others conversely engage in redundant operations spread across different divisions or sections, and clear-cut decisions are not made quickly, but instead several meetings are held to reach every decision, which is due to the ambiguous locus of discretionary authority for making decisions. This pandemic is an opportunity to demand a thorough reassessment of the way in which work has been conducted, including clarifying job description and authority, transferring discretionary power to the field level, and eliminating redundant work.
It should be noted that the transfer of operational authority also applies to the healthcare field. Using the OECD's Program for the International Assessment of Adult Competences (PIAAC), OECD (2016) reports that doctors were 67% more likely, and nurses 14% more likely, to report being under-skilled than workers in other technical and professional occupations. Reviewing whether or not tasks which only physicians and nurses are currently permitted to perform, may also be assigned to other workers, thus leveling out the amount of work that is apportioned to different types of occupations, will also lead to a reduction in the amount of overtime work that healthcare workers, already strained during normal times, have to perform, not to mention the amount of time they must work to handle COVID-19-related cases.
There is still much more that can be done to reassess the way in which we work, change the pattern of our daily activities, and figure out ways to keep COVID-19 infections from spreading further. If healthcare, logistics, and other essential social infrastructure break down, we will be unable to go about our lives. It is imperative for us to recognize that protecting the essential workers currently serving on the front lines will similarly protect each and every one of us.
- ^ https://www.medscape.com/viewarticle/927976
- ^ See also, for example, Kang et al. (2020), Lu et al. (2020) and Kisley et al. (2020).
- ^ The Ministry of Health, Labour and Welfare presented its opinion that overtime work required to respond to COVID-19 corresponds to a clause in the Labor Standards Act Article 33(1), which states: "If there is an extraordinary need due to disaster or other unavoidable events" (employers may extend working hours or have workers work on days off to the extent that is needed).
(https://www.mhlw.go.jp/content/11302000/000598680.pdf, in Japanese)
- ^ Sourced from materials distributed at the 159th Labour Policy Council's Subcommittee on Labour Conditions (held January 10, 2020) and 7th Advisory Committee on Promotion of Reform of Physicians' Work.
https://www.mhlw.go.jp/stf/newpage_08869.html、https://www.mhlw.go.jp/stf/newpage_10091.html : (both in Japanese)
- ^ A press release issued by Tokyo Governor Yoriko Koike on April 13, 2020 reported that congestion during peak hours at Shibuya Station on the Tokyo Metro's Ginza Line was down 20% from its usual level on the morning of Friday, April 10 and 38% from its usual level on Monday, April 13, and that these figures were not even close to the goal of a 70% reduction.
- Yoshikawa, Toru, "Analysis of cases recognized as work-related injury or illness involving cerebrovascular/cardiovascular diseases (CCVD) in relation to the Great East Japan Earthquake," Comprehensive Occupational Safety and Health Research on Clarification of the Actual Circumstances of Death from Overwork and Other Conditions and Applicable Preventive Measures, FY2016 Summary and Contributory Research Report, 2017, pp. 62-73.
- Formenti, Beatrice, Silvia Ussai, Benedetta Armocida, Francesca Palestra, Eduardo Missoni,Saluteglobale, "On the front lines of coronavirus: the Italian response to covid-19, BMJ, 368:m1065, 2020, doi: https://doi.org/10.1136/bmj.m1065.
- Fukasawa, Maiko, Yuriko Suzuki, Akiko Obara, Yoshiharu Kim, "Effects of Disaster Damage and Working Conditions on Mental Health Among Public Servants 16 Months After the Great East Japan Earthquake," Disaster Medicine and Public Health Preparedness, 12(5), 2018, pp. 622-630, doi: https://doi.org/10.1017/dmp.2017.127.
- Jing, Qi, et al., "The Evaluation of Sleep Disturbances for Chinese Frontline Medical Workers under the Outbreak of COVID-19," 2020, doi: https://doi.org/10.1101/2020.03.06.20031278.
- Kawashima Y, Nishi D, Noguchi H, Usuki M, Yamashita A, Koido Y, Okubo Y, Matsuoka, "Post-Traumatic Stress Symptoms and Burnout Among Medical Rescue Workers 4 Years After the Great East Japan Earthquake: A Longitudinal Study," Disaster medicine and public health preparedness, 2016, pp.1 – 65.
- Ning, Sun, et al., "Status of and Factors Influencing the Anxiety and Depression of Front-line Medical Staff Supporting Wuhan in Containing COVID-19, 2020, doi: 10.21203/rs.3.rs-19665/v1.
- OECD, Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places, OECD Health Policy Studies, OECD Publishing, Paris, 2016, doi:org/10.1787/9789264239517-en.
- Suzuki, Yuriko, Maiko Fukasawa, Akiko Obara, and Yoshiharu Kim, "Mental Health Distress and Related Factors Among Prefectural Public Servants Seven Months After the Great East Japan Earthquake," Journal of Epidemiology, 24(4), pp.287-294, 2014, doi:10.2188/jea.JE20130138.
- Wakashima, Koubun, Keigo Asai, Taku Hiraizumi and Shuji Noguchi, "Trajectories of psychological stress among public servants after the Great East Japan Earthquake," Palgrave Communications, 5(37), 2019, doi: org/10.1057/s41599-019-0244-7.
- Kang, Lijun et al., "Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study," Brain, Behavior, and Immunity, 2020, https://doi.org/10.1016/j.bbi.2020.03.028
- Lu, Wen, Hang Wang,Yuxing Linc, and Li Lia "Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study," Psychiatry Research, 288, 2020
- Kisely, Steve, Nicola Warren, Laura McMahon,Christine Dalais, Irene Henry,and Dan Siskind, "Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis," the BMJ, 2020;369:m1642 | doi: 10.1136/bmj.m1642
June 3, 2020