The COVID-19 pandemic introduced significant novel risks for healthcare workers and healthcare services. This study aimed to determine the prevalence, trends, characteristics, and sources of COVID-19 infection among healthcare workers during the early COVID-19 pandemic in Malaysian hospitals. A cross-sectional study used secondary data collected from a COVID-19 surveillance system for healthcare workers between January and December 2020. Two surges in COVID-19 cases among healthcare workers in Malaysia were epidemiologically correlated to a similarly intense COVID-19 pattern of transmission in the community. The period prevalence of COVID-19 infection and the mortality rate among healthcare workers in Malaysia were 1.03% and 0.0019%, respectively. The majority of infections originated from the workplace (53.3%); a total of 36.3% occurred among staff; a total of 17.0% occurred between patients and staff; and 43.2% originated from the community. Healthcare workers had a 2.9 times higher incidence risk ratio for the acquisition of COVID-19 infection than the general population. Nursing professionals were the most highly infected occupational group (40.5%), followed by medical doctors and specialists (24.1%), and healthcare assistants (9.7%). The top three departments registering COVID-19 infections were the medical department (23.3%), the emergency department (17.7%), and hospital administration and governance (9.1%). Occupational safety and health units need to be vigilant for the early detection of a disease outbreak to prevent the avoidable spread of disease in high-risk settings. The transformation of some tertiary hospitals to dedicated COVID-19 care, the monitoring of new procedures for the management of COVID-19 patients, and appropriate resource allocation are key to successful risk mitigation strategies.
The Belt and Road Initiative (BRI) represents the largest infrastructure and development project in human history, and presents risks and opportunities for ecosystems, economies, and communities. Some risks (habitat fragmentation, roadkill) are obvious, however, many of the BRI's largest challenges for development and conservation are not obvious and require extensive consideration to identify. In this first BRI Horizon Scan, we identify 11 frontier issues that may have large environmental and social impacts but are not yet recognised. More generally, the BRI will increase China's participation in international environmental governance. Thus, new cooperative modes of governance are needed to balance geopolitical, societal, and environmental interests. Upgrading and standardising global environmental standards is essential to safeguard ecological systems and human societies.