Consider Covid-19 history when screening for HAVS

An occupational physician has urged OH professionals to ask employees about Covid-19 infections and immunisations when screening for hand-arm vibration syndrome (HAVS), particularly among people with symptoms of Raynaud’s phenomenon.

Occupational medicine consultant Roger Cooke told delegates at this year’s joint RCN and SOM annual conference that there could be a link between Raynaud’s phenomenon, which can develop as a result of exposure to vibrations, and Covid immunisation or Covid infection.

“The direct pathological mechanism isn’t known yet and we’re still gathering evidence, but I would urge all of you doing HAVS surveillance to ask about Covid if someone develops Raynaud’s phenomenon,” he said.

“If there is clear relationship then consider monitoring them very closely for a period of months until they recover – which they should do if it’s Covid-related. If they don’t recover, they will need investigation for other causes of Raynaud’s.

“Perhaps it’s worth reducing the exposure [to vibrations] as well, although we don’t know whether the Covid infection increases susceptibility to vibration or not.”

Cooke said that if HAVS is suspected by an occupational health professional, it probably is the diagnosis they should receive.

“If someone’s got symptoms suggestive of it, and nothing to point us away from it, HAVS is the diagnosis until proven otherwise and we treat it appropriately,” he said.

“If we suspect it’s primary Raynaud’s (i.e. it has developed by itself and has not been caused by another condition), we should record it, talk to [the employee] about it, and we need to let their GP know the reasons for that.”

Cooke, an independent occupational physician, challenged the commonly-held belief that someone with primary Raynaud’s cannot work with vibratory tools.

He said: “[HSE guidance] says they shouldn’t do and should be cautious about it, but in fact there’s no evidence that these people are more susceptible to vibration than anybody else.

“But you need to keep an eye on them and the [vibration] exposure should be reduced to as low as practicable. The problem of course is if the symptoms get worse – you then won’t know whether it’s the underlying condition or the vibrations. Most cases seem not to progress.”

HAVS screening does not always have to be done in person, he stressed. Cooke said five out of six HAVS assessments can be dealt with over the phone or a video call, but it was important for OH professionals to ensure they record the employee’s medical history in detail.

He said of remote assessments: “It seems such a shame to me if we lose sight of the evidence we’ve collected and don’t apply that practically, because it’s easier for us, for the employee, and potentially cheaper for the employer if we can take that sort of approach.”