EFN Report on COVID19 Biological Agent Directive - November 2020

EFN – European Federation of Nurses Associations

Table of Contents

Executive Summary........................................................................................ 3
Summary Report ............................................................................................ 6

1. Background....................................................................................................................... 6
2. EU legislation .................................................................................................................... 8
3. Challenge of the SARS-CoV-2 classification before the Court of Justice.............................. 10
4. Collecting Data from EFN Members: survey results & policy recommendations................. 11
5. EFN & EU: What can we do at EU level? ........................................................................... 16
6. What can we do locally to support protection of nurses? ................................................. 17
7. Conclusion ...................................................................................................................... 18

EFN Members’ Input to the 3 Questions........................................................19
EFN Members................................................................................................41

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Executive Summary

The COVID-19 outbreak has had an unfathomable impact across all layers of society. The virus does
not recognise national borders, with all Member States of the European Union (EU) affected in equal
measure. During such times of health crises, it is vitally important to strengthen healthcare systems by
extending support to those frontline nurses who are placing their own lives at risk, and those of their
families, while providing care to others. Supporting healthcare professionals is a common priority
across the EU but actions have so far been local, ad hoc and disjointed.

With the above in mind, the EFN Executive Committee commissioned an EU-wide survey among 35
National Nurses Associations member of EFN. The survey was completed over September 2020 and
sought to collect data related to COVID-19 and its impact on nurses across Europe. Specifically, data
were collected with a view to uncovering local insight on whether COVID-19 is being legally recognised
as an occupational injury, if there is a non-legal occupational health scheme that provides this
recognition, and, if governments or employers provide compensation to the healthcare professionals
exposed to or infected by COVID-19 in the workplace.

The EFN survey achieved a 63% response rate, with 22 countries providing responses and offering their
national perspective. Specifically, responses were received from Austria, Belgium, Bulgaria, Croatia,
Cyprus, Denmark, Estonia, Finland, France, Germany, Iceland, Ireland, Italy, Lithuania, Norway, Poland,
Portugal, Slovenia, Spain, Sweden, Switzerland, and the United Kingdom. In summary, most of the
participating EFN Members indicated that exposure to COVID-19 was legally recognised as an
occupational injury in their countries. Moreover, respondents indicated availability of government
compensation to healthcare workers exposed to or infected by COVID-19 in the workplace; though this
was not universal, with some members noting that such compensation was lacking. In some countries
governments and employers offered supplements to frontline workers in recognition of the risk they
accept, to themselves and their family members, while providing care to patients with COVID-19.
However, there are stark differences across countries and across public and private providers.

Overall, the evidence from the EFN survey points to an inconsistent approach across Member States
potentially leading to nurses in some countries finding themselves at a disadvantage. There is
significant disparity across and within countries, which serves to add rather than alleviate the
challenges that face frontline workers.

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Based on the EFN Member’s insight from the frontline, the following policy recommendations are
issued to local and EU health stakeholders:

• Develop a consistent approach across the EU with regard the identification of exposure to
COVID-19 as an occupational injury;

• Consider automatic recognition of frontline nurse exposure to COVID-19 as occupational
injury;

• Consider compensation where appropriate both for the nurse and their family members where
they have been significantly adversely affected;

• Develop a consistent approach to compensation across EU Member States, in recognition of
the risk nurses are exposed to when delivering care during the pandemic;

• Streamline the process of providing compensation to nurses in the event of COVID-19
infection, avoiding the need for prospective estimates of capacity to work;

• Consider offering supplements to frontline workers, and nurses in particular, who work
directly with COVID-19 infected individuals;

• Develop a transparent approach to compensation across public and private sectors, ensuring
parity for frontline healthcare workers exposed to COVID-19; and,

• Provide essential post viral care to those nurses who have been infected with specialist care.
Post viral illness is emerging as a long-term issue for many nurses who are unable to attend
work months post initial infection.

The EFN Members acknowledge that there is a precious and small window of opportunity to prepare
and protect the health workforce, and the health systems of Member States, to continue to respond
to the COVID-19 pandemic. The current pandemic reminds that added EU support to frontline
healthcare workers is vital when such health emergencies arise. EU citizens need EU policies that
protect frontline staff and ensure quality and safe care is provided to those in need. It is time that EU
policymakers engage frontline nurses, who have both the expertise and hands on experience, in policy
decisions that strengthen health systems and protect healthcare workers. Specifically, the EFN
Members call on EU Member states to:

1. Support the EU health workforce, nurses in particular, to respond to the challenge of COVID-
19 pandemic without compromising their safety and wellbeing.

2. Coordinate capacity building in the nursing workforce, providing further access to vital
education and training that includes opportunities for regular drills on donning and doffing

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PPE, and assuring the provision of adequate resources and support for a safe working
environment.
3. Explore the causes, mechanisms and consequences of stigmatisation related to the care and
treatment of COVID-19 within the European Health Research Programme; and, based on
outcomes, take appropriate actions to tackle stigmatisation.
4. Continue to encourage investment in preparedness, learning from the lessons and knowledge
gained so far, and enhancing monitoring and follow up initiatives.
5. Co-create and co-design with frontline nurses fit-for-purpose political decision-making
processes and policies for future pandemic preparedness.
6. Use the research in respect of emerging evidence of effects based on specific underlying health
conditions, pregnancy, ethnicity to protect staff from exposure if research indicates that would
be a greater risk.
We urge healthcare stakeholders at all levels to listen to and protect those on the frontline, since it is
they who ultimately act as the guardians against the ever increasing and real threat of future
pandemics across the EU and Europe.

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Summary Report

1. Background

In these times of pandemic and emergency situations, it is more important than ever to strengthen
healthcare systems in the European Union (EU) and, more importantly, to support and protect
frontline nurses while doing their job and putting their own lives at risk. When a health crisis occurs,
the nursing profession is always at its frontline serving in very difficult conditions the citizens and
patients of Europe. This has been part of the European history since the time of Florence Nightingale.
In times of war and pandemics, when the population of Europe needs healing and support, the nurses
are always at the frontline, day and night.

The COVID-19 outbreak has had an unfathomable impact across all EU countries. It has affected all
layers of society, reshaping political priorities, strategies and budgets all over Europe (at EU and
National level) to get the EU Member States acting as one united voice. Supporting healthcare
professionals is a common priority across the EU but actions have so far been local, ad hoc and
disjointed. Therefore, it is now crucial to take concrete and immediate actions to support and protect
European Citizens and frontline healthcare professionals, and nurses in particular who remain at the
patients’ bedside 7 days/week, 24 hours/day and 365 days/year.

The COVID-19 outbreak and the EU Ebola crisis have shown significant similarities and challenges, to
which frontline nurses have had to respond to with little preparation; as EFN warned in 2015: “We are
not prepared, unless we are all prepared!” (EFN, 20151, 2020). We have a precious and small window
of opportunity to better prepare ourselves and get our health workforce and health systems ready to
respond to the COVID-19 pandemic (EFN Report on Lessons Learned from Ebola & COVID-19 – June
2020, June 2020). We urge stakeholders at all levels to listen to those going to the field and make sure
their needs are covered. Specifically, make sure to:

1. Support the EU health workforce, nurses in particular, to respond to the challenges of COVID-
19 without compromising workers’ safety and wellbeing.

2. Coordinate capacity building in the nursing workforce, providing further access to vital
education and training that includes opportunities for regular drills on donning and doffing
PPE, and assuring the provision of adequate resources and support for a safe working
environment.

1 http://www.efnweb.be/wp-content/uploads/EFN-Report-MS-Preparedness-Ebola-Final-Sept.2015.pdf

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3. Explore the causes, mechanisms and consequences of stigmatisation related to the care and
treatment of COVID-19 within the European Health Research Programme; and, based on
outcomes, take appropriate actions to tackle stigmatisation. Frontline nurses have been
unfairly stigmatised by some citizens as dangerous and as disease-carriers.

4. Continue to encourage investment in preparedness, learning from the lessons and knowledge
gained so far, and enhancing monitoring and follow up initiatives. Protecting the health
workforce, as well as the public, from future health threats should continue to remain a priority
for all Member States individually and the European Commission collectively, ensuring that
relevant protective equipment, appropriate education and training, and protocols are made
available to frontline staff.

5. Co-create and co-design with frontline nurses fit-for-purpose political decision-making
processes and policies for pandemic preparedness. This is a challenge for the European
Commission as their only counterparts are the Member States and sometimes academics who
they ask for advice, but not frontline healthcare professionals. Healthcare professionals and
NGOs are often kept out of the decision-making equation, making political actions often unfit-
for-purpose. This accounts for the lack of pragmatism in the decision taken by the European
Commission handling the COVID-19 crisis.

The new coronavirus outbreak proves that more EU support to the frontline healthcare workers is
needed when such health emergencies arise. EU citizens need EU policies that protect frontline staff
from working overtime and of services being continuously understaffed.

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2. EU legislation

On 3 June 2020, the European Commission updated the Biological Agents Directive (being within the
scope of responsibility of the Commissioner for Jobs and Social Rights, Nicolas Schmit, DG
Employment) to include SARS-CoV-2, the novel coronavirus that causes COVID-19. For frontline nurses,
this means that employers need to assess all risks and put in place the necessary preventive and
protective measures to minimise harm, for example via:

1. Work organisation: Assess the risks; Avoid exposure if possible; Minimise number of workers
exposed; Keep records of workers exposed; Isolation and containment measures for
suspected cases;

2. Information and training: Information on risks, precautions and hygiene requirements; Initial
and updated training; Use of biohazard and other relevant warning signs;

3. Hygiene and individual protection: Appropriate hygiene measures; Appropriate protective
clothing or equipment; No eating or drinking in areas at risk of contamination;

4. Other protective measures: Safe handling of protective equipment and clothing; Safe
collection, storage and disposal of waste.

A few EU legislative frameworks are already in place, which protect the health and safety of healthcare
professionals from risks related to exposure of biological agents at work and from sharp injuries
(2000/54/EC2, 2010/32/EU3).

The Strategic Framework on Health and Safety at Work 2014-20204, identified many important
challenges facing European employers and employees in the area of occupational health and safety.
This settles the need to improve the implementation of occupational safety and health legislation, to
prevent risks to health and safety at work, and to address the challenges posed by an ageing workforce
and longer working careers5.
Some positive results as a consequence of the aforementioned legislative actions have been achieved,
if we consider that many EU Member States have adopted national action plans based on this
framework. However, a lot still needs to be done.

2 Directive 2000/54/EC on the protection of professionals from risks related to exposure to biological agents at work. https://eur-
lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A32000L0054
3 Directive 2010/32/EC on implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector
concluded by HOSPEEM and EPSU. https://osha.europa.eu/en/legislation/directives/council-directive-2010-32-eu-prevention-from-sharp-
injuries-in-the-hospital-and-healthcare-sector
4 https://www.europarl.europa.eu/doceo/document/A-8-2015-0312_EN.html
5 Council of the European Union (2015) EU Strategic Framework on Health and Safety at Work 2014-2020: Adapting to new challenges.
Retrieves from: http://register.consilium.europa.eu/doc/srv?l=EN&f=ST%206535%202015%20INIT

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All healthcare workers are currently at a high risk of exposure to biological agents. As such, and in light
of the implications of COVID-19 for worker protection, the EU moved to add SARS-CoV-2 to the
Biological Agents legislation6, in risk category 3, the second most dangerous category of biological
agents, which holds that all healthcare workers in the EU must be protected by their employers. This
update takes into account new risks in the workplace and offers additional protection to all workers,
especially those working in direct contact with the virus in hospitals, industrial processes and
laboratories.
The Biological Agents Directive (2020/739) lays down minimum requirements for the health and
safety of workers exposed to biological agents at work. Classification in risk group 3 means that the
biological agent can “cause severe human disease and present a serious hazard to workers; it may
present a risk of spreading to the community, but there is usually effective prophylaxis or treatment
available”. The SARS and MERS viruses are examples of risk group 3 viruses, while Ebola is in risk group
4.
Nursing-relevant employer obligations for SARS-CoV-2 as a group 3 biological agent are:

• Risk-assessments must be carried out. The principle of the Directive is that Workers’ risk of
exposure to biological agents should be reduced where possible to protect their health and
safety.

• Employers must ensure hygiene and individual protection including “providing protective
clothing”, and “maintaining protective equipment properly”.

• Workers and their representatives must receive appropriate training.
• Employers must keep a list of exposed workers for at least ten years.
• EU Member State governments must establish arrangements for carrying out relevant health

surveillance of workers both prior to exposure and at regular intervals thereafter.
• Effective vaccines must be made available free of charge for workers not already immune to

the biological agent to which they are (or are likely to be) exposed.
EU Member State governments must bring into force the laws, regulations and administrative
provisions necessary to comply with this Directive by 24 November 2020 at the latest.

6 Commission Directive (EU) 2020/739 of 3 June 2020 amending Annex III to Directive 2000/54/EC of the European Parliament and of the
Council as regards the inclusion of SARS-CoV-2 in the list of biological agents known to infect humans. https://eur-
lex.europa.eu/eli/dir/2020/739/oj

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3. Challenge of the SARS-CoV-2 classification before the Court of
Justice

On 3 August 2020, a Spanish union of nurses SATSE brought an action before the Court of Justice of
the European Union (CJEU) for the annulment of Directive 2020/739 of June 3, 2020 which classifies
SARS -CoV-2 causing Covid-19 in risk biological agent group 3 and not in group 4. This demand for
cancellation echoes the ETUC and certain members of the European Parliament position following the
controversial decision of the European Commission to classify the SARS-CoV-2 virus (the causative
agent of Covid-19) in group 3 of biological agents by adopting Directive 2020/739. The argument is
that this classification does not comply with articles 2 and 18 of Directive 2000/54 / EC on the
protection of workers against the risks of biological agents, as well as the articles of its annex III.
Article 2 of the 2000/54/EC directive reflects a precautionary approach. Some of the criterion laid out
in the article could justify the classification in group 3, others in group 4. Article 18§3 further reflects
such a precautionary approach as it states: “If the biological agent to be assessed cannot be classified
clearly in one of the groups defined in the second paragraph of Article 2, it must be classified in the
highest risk group among the alternatives.” In case of doubts, we should, therefore, adopt the highest
risk category. Such requirement is legally binding for the Commission in its delegated competence.
Point 2 of the Annex to Directive (97/65/EC) explicitly mentions the need to adopt a precautionary
approach. As there is no effective treatment or vaccine against SARS-CoV-2, this virus should be
considered highly contagious with a high risk of spreading and causing serious pathologies and
symptoms in humans. The SARS-CoV-2 virus should be treated as a danger of the highest level with
regard to Directive 2000/54/EC.

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4. Collecting Data from EFN Members: survey results & policy
recommendations

This survey was caried out at the request of the EFN Executive Committee in September 2020,
recognising the importance of collecting data related to COVID-19 and its impact on nurses. The survey
uncovered significant local insight on whether COVID-19 is being legally recognised as an Occupational
injury by the European Institutions (Update of Directive on Biological Agents - 2000/54/EC - adding
SARS-CoV-2 in risk category 3), and if there is a non-legal Occupational Health Scheme that provides
this recognition for infections in health care workers; and if the Government, or the employer, provides
compensation to the healthcare professionals exposed to or infected by COVID-19 in the workplace.
The EFN sent to its members – 35 National Nurses Associations – three questions requesting to provide
a clear overview on the current state of play at national level. The EFN survey had a positive response
rate of 63%, with 22 members providing their input (EU member states response + Norway + Iceland
+ Switzerland = 71% response rate).

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The EFN Members’ responses are presented below, synthesised and grouped under each question:
1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if
acquired in work by nurses or other workers?

Most of the participating EFN Members responded positive to the question (n=13), indicating that
exposure to COVID-19 would be legally recognised as an occupational injury. For example, in Denmark,
COVID-19 is legally recognized in the Workers’ Compensation Act as both an accident at work and an
occupational disease. In some countries, like Sweden, if a nurse is identified to have contracted COVID-
19 it is assumed that exposure happened at work. However, in other countries, for example in Estonia,
it is proving difficult to distinguish between exposure at work and elsewhere; while exposure at work
can be regarded as occupational injury, this would not be the case if exposure was regarded to have
happened outside of work. Elsewhere, like in Spain, a distinction is made between work accidents and
occupational diseases, with COVID-19 falling in the former category. Overall, the evidence points to an
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inconsistent approach across Member States potentially leading to nurses in some Member States
finding themselves at a disadvantage.

Policy Recommendations:
• Develop a consistent approach across the EU with regard the identification of exposure
to COVID-19 as an occupational injury.
• Consider automatic recognition of frontline nurse exposure to COVID-19 as occupational
injury.
• Consider compensation where appropriate both for the nurse and their family members
where they have been significantly adversely affected.

2. Question 2 - In your Country, does the Government provide compensation to healthcare
workers exposed to or infected by COVID-19 in the workplace?

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Only six (n=6) respondents indicated lack of government compensation to healthcare workers exposed
to or infected by COVID-19 in the workplace. For example, in Belgium, nurses exposed to COVID-19
continue to receive a compensatory wage, while specifically in the home care sector nurses have been
granted a ‘COVID supplement’. In other countries, like Bulgaria, such supplements have also been
offered to workers in hospital settings, specifically to those working on ‘COVID wards’ and emergency
COVID settings. Supplements differ across countries and range between €350 and €1000 per month.
Moreover, compensation in some countries, like Denmark, is offered to nurses in recognition of
suffering, permanent injury, treatment expenses and/or loss of earning capacity. However, while most
countries have clear systems for compensation in the event of death, compensation for loss of earnings
is more difficult to secure. For example, in Sweden, to be eligible for compensation nurses require
medical confirmation that their ability to work reduced by at least 15% for at least one year; this is
difficult to establish and provide evidence for prospectively.

Policy Recommendations:
• Develop a consistent approach to compensation across EU Member States, in
recognition of the risk nurses are exposed to when delivering care during the pandemic.
• Streamline the process of providing compensation to nurses in the event of COVID-19
infection, avoiding the need for prospective estimates of capacity to work.
• Consider offering supplements to frontline workers, and nurses in particular, who work
directly with COVID-19 infected individuals.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID-19 in the workplace?

The majority of respondents to question 3 responded negatively, indicating that employers do not
provide compensation to healthcare workers exposed to or infected by COVID-19 in the workplace.
While in some countries, like in Finland, there have been some instances of employers providing
compensation this is not a consistent practice. In other countries, like Germany, employers offer a
compensation, but this is reimbursed from the health insurance. A distinction between nurses working
in the public and private sector is noted in some countries, like in Ireland and Lithuania, where nurses
in the private sector are not generally provided with compensation when exposed to or infected by
COVID-19. However, elsewhere, like in Switzerland, nurses receive compensation by their employer
regardless of public or private status since the usual work provisions apply to COVID-19.

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Policy Recommendations:
• Develop a transparent approach to compensation across public and private sectors,
ensuring parity for frontline healthcare workers exposed to COVID-19.
• Consider a consistent approach to compensation for healthcare workers employed in the
private sector, ensuring parity across private providers and settings.

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5. EFN & EU: What can we do at EU level?

In the current context of COVID-19, and to be prepared for future pandemics, it is crucial that the
European Commission, the EU Member States and the EU Stakeholders increase their efforts to ensure
healthcare professionals, and nurses in particular, are adequately protected. This includes protection
from psychological risks, work-related accidents and diseases, and the inclusion of disabled and older
professionals.
The challenge for the European Commission and the EU Member States is to incorporate in policy
design the experience and expertise of frontline nurses. It is vital to explore how different healthcare
systems within the EU are responding to this crisis and to monitor and measure the impact of any crisis,
such as Ebola and COVID-19, on the nursing workforce. It is clear that the nursing workforce needs to
be better equipped, prepared and protected to be able to enhance the health system response to
future pandemics. Preparing now can only benefit any future response. It is vital to invest and take
into account the valuable expertise and experience of the nursing profession on how to plan and
implement initiatives for this preparedness.
Action at EU level is essential to guide countries to deliver the most appropriate response for all
European citizen during times of crisis. An EU legislative framework exists, which protects workers
from risks related to the exposure of biological agents at work (2000/54/EC)7 and promotes that
employers and health professionals’ representatives work together at the appropriate level to prevent
risks and protect workers’ health and safety (2010/32/EU)8. This is essential to create a safe working
environment, including consultation on the choice and use of safe equipment, identifying how best to
carry out training, information and awareness campaigns.
It is now time to act and make sure all this legislation is taken forward and is genuinely taken into
account to protect our nurses on the COVID-19 frontline. It is crucial that policymakers engage frontline
staff, who have the expertise, as they ultimately act as the guardians and protect against the threat of
pandemics in the EU, Europe and worldwide.

7 https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A32000L0054
8 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32010L0032

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6. What can we do locally to support protection of nurses?

At EU level, there are 21 million professionals active in the hospital and healthcare sector (namely
nursing and care homes, and community care), being one of the largest sectors in Europe, of which 6
million are nurses9. All these professionals, working in all facilities, are all potentially at risk and need
adequate preparation and protection.
The updated Directive 2000/54/EC of the European Parliament and of the Council as regard to the
inclusion of SARS-CoV-2 in the list of biological agents known to infect humans will provide a solid
protection to the healthcare workers, including nurses, implementing strict obligations for the
employers.
Actions to be undertaken:

• Ask your employer how the new legislation on Biological Agents concerning SARS-CoV-2 as a
group 3 biological agent will be implemented in your workplace.

• Ask if aerosol transmission will be taken into account in the workplace risk assessment; this also
applies to the assessment of risks for nursing in the community.

• For nurses working in an operating room environment, ask your employer how scheduling
practices, ventilation, use of PPE and medical devices such as smoke/aerosol evacuators are
being employed to keep elective surgery going.

• Consider possibilities to improve ventilation (doors, windows, air conditioning) and/or aerosol
evacuation in your own daily work practices, and look out for new scientific evidence on safe
workplace practice as and when it becomes available.

• Consider raising the issue with national policy makers and regulators when you are engaging
with them.

• Insist on regular screening of all health care workers by their employer.

9 http://www.euro.who.int/en/health-topics/Health-systems/nursing-and-midwifery/data-and-statistics

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7. Conclusion

Nurses play a fundamental and indispensable role in the provision of safe and quality healthcare; this
is accentuated in times of pandemics. The COVID-19 outbreak poses a threat both to those who receive
and those who delivery healthcare. To ensure the safety of all stakeholders, measures to ensure
adequate protection against the transmission of COVID-19 must be consistently applied across EU
Member States.
The EFN Members call on the EU Member States to strengthen capacity of their health workforce by
implementing Directive 2000/54/EC at the earliest. Member States need to implement the
Commission Directive (EU) 2020/739 of 3 June 2020 amending Annex III to Directive 2000/54/EC of the
European Parliament and of the Council as regards the inclusion of SARS-CoV-2 in the list of biological
agents known to infect humans. The success of all these will hinge on genuine collaborative working
between policymakers, employers and frontline nurses to ensure any initiatives are fit for purpose.
Engaging frontline staff, and nurses in particular, has never been more important. Therefore it is key
to:

1. Work closely with the nursing profession to develop EU policies that protect nurses from
unsafe and challenging working conditions, particularly when caring for COVID-19 patients. It
is key to provide nurses the materials they need to do their frontline nursing care and combat
frontline stigmatisation and violence.

2. Collect Date on the number of nurses infected with COVID-19 and register the number of those
who died due to COVID-19 while doing their job.

3. Foster the co-creation and co-design with frontline nurses to enhance the political decision-
making processes concerning IDHC preparedness, protocols, education selection of
appropriate materials and evidence-based practise to support the effective and efficient
implementation of policy.

Work with nurses! They are the frontline experts! Invest in nursing care!

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EFN Members’ Input to the 3 Questions

AUSTRIA

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - It is considered legally recognised only if the person gets a so called “Absonderungsbescheid”
which means the legal authorities have given you the notice.
See: § 32 Epidemiegesetz 1950
https://www.ris.bka.gv.at/eli/bgbl/1950/186/P32/NOR40223140?ResultFunctionToken=4d40a50
8-c2d7-47b8-92d8-
364f36d0e555&Position=1&SkipToDocumentPage=True&Abfrage=Bundesnormen&Kundmachun
gsorgan=&Index=&Titel=&Gesetzesnummer=&VonArtikel=&BisArtikel=&VonParagraf=&BisParagr
af=&VonAnlage=&BisAnlage=&Typ=&Kundmachungsnummer=&Unterzeichnungsdatum=&Fassu
ngVom=16.09.2020&VonInkrafttretedatum=&BisInkrafttretedatum=&VonAusserkrafttretedatum
=&BisAusserkrafttretedatum=&NormabschnittnummerKombination=Und&ImRisSeitVonDatum=
&ImRisSeitBisDatum=&ImRisSeit=Undefined&ResultPageSize=100&Suchworte=Epidemiegesetz
and
Verordnung des Ministers des Innern im Einvernehmen mit dem Minister für Kultus und Unterricht
vom 22. Februar 1915, betreffend die Absonderung Kranker, Krankheitsverdächtiger und
Ansteckungsverdächtiger und die Bezeichnung von Häusern und Wohnungen
https://www.ris.bka.gv.at/GeltendeFassung.wxe?Abfrage=Bundesnormen&Gesetzesnummer=10
010177

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - See above links

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - See above links

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BELGIUM

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - See:
1. https://fedris.be/fr/FAQ-Covid-19
2. http://www.ejustice.just.fgov.be/eli/arrete/2020/06/26/2020202903/justel
3. http://www.ejustice.just.fgov.be/cgi/article_body.pl?language=fr&pub_date=2020-07-
08&caller=summary&numac=2020202903#top

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - If a nurse falls ill from Covid, he or she continues to receive a compensatory wage (according
to his or her work regime) since it is a disease recognised by the government as an occupational
disease. The Belgian government has also talked about a Covid "bonus" (not linked to an illness)
but there is nothing concrete.
For the home care sector, the INAMI (National Institute for Health and Disability Insurance) has
granted a Covid supplement to nurses in the home care sector because the time taken to care for
patients has increased. See: https://www.inami.fgov.be/fr/covid19/Pages/soins-domicile-2-
mesures-infirmiers.aspx

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

BULGARIA

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO

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IF No: Is there a non-legal Occupational Health Scheme that provides this recognition for
infections in health care workers? IF Yes: Can you please provide details/link to scheme?
NO – There is not such a non-legal Occupational Health Scheme.
2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - There is a Government decision in the form of regulation from the Ministry of health, which
is still not public. It says that doctors, nurses and other healthcare workers, working at the “first
line”, i.e. in the infection’s wards with Covid patients will receive additional 500 Euro per month.
Medical specialists (doctors and nurses) in the Emergency, working with Covid patients, will receive
500 Euro per month, too. It is under employer’s decision to re-organize the working conditions in
every hospital in connection with Covid-19, and to define the healthcare workers, who are at “the
first line” and will receive the additional payment.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - The Employer does not provide compensation himself; the money comes from the state
budget. We, as professional organisation, made an additional contract with our health insurer to
pay additional amount of money to nurses, who have been infected with Covid-19, and have been
hospitalized. For those, who have been infected, but have been cured at home, BAHPN organized
donations from a special donation company, only for infected with Covid-19 healthcare
professionals.

CROATIA

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO
IF No: Is there a non-legal Occupational Health Scheme that provides this recognition for
infections in health care workers? IF Yes: Can you please provide details/link to scheme?
In the Republic of Croatia, Covid 19 is not legally recognized either as an injury at work or as an
occupational disease. It is recognized as an occupational disease if it meets the criteria that more
than one person has fallen ill in one organizational unit and if it is determined that the transmission
of the infection occurred in the workplace.

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2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

CYPRUS

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

DENMARK

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - In Denmark Covid 19 is legally recognized as both an accident at work (an incident or exposure
that occurred suddenly or within 5 days) and an occupational disease. The providing legislation is
paragraph 6 and 7 in the Workers’ Compensation Act. A translated version of the act can be found
at the Labour Market Insurance (Arbejdsmarkedets Erhvervssikring) homepage via link:
https://www.aes.dk/english/industrial-injuries/are-your-injury-covered/legislation). Most cases
are treated as occupational disease cases.

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As for occupational diseases Covid 19 is covered by Group H: Infectious and parasitic diseases in
the Danish list of occupational diseases. More specific Group H.2. concerning “Infectious diseases
from humans” transferred by blood, tissue, tissue fluids, or other biological material from persons
with the same type of infection. A translated version of the list can be found at the Labour Market
Insurance homepage via link: https://www.aes.dk/english/publications/guides-and-information-
material)

On 22 April 2020 The Danish Working Environment Authority (Arbejdstilsynet) published
“Guidance on the assessment of work-related injury cases concerning illness with Covid 19”. The
guidance confirmed the legal status of Covid 19 as an industrial injury and at the same time
provided details on how to rule on cases concerning the recognition on Covid 19 as an industrial
injury.

The guidance has not been transferred to english, but can be found in danish at the ‘The Danish
Working Environment Authority’s’ homepage via link: https://at.dk/regler/at-
vejledninger/vurdering-arbejdsskadesager-covid-19/

Question 2 and 3 (possibility for compensation by the Workers Compensation Act if Covid 19 is
recognized as an industrial injury):

The possibilities for compensation provided for by the law, which also apply for recognized Covid
19, is:

• Compensation for permanent injury (see paragraph 18 in the Workers’ Compensation Act
via link above).

• Compensation for loss of earning capacity (see paragraph 17 in the Workers’
Compensation Act via link above).

• Expenses for treatment, medicine, and aids, etc. (see paragraph 15 in the Workers’
Compensation Act via link above).

If work related Covid 19 causes death, surviving dependents can be entitled to other forms of
compensation (see paragraphs 19-23 in the Workers’ Compensation Act via link above). The
compensation can only be decided after approx. 1 year, as this means that the health
consequences are medically stationary (no prospect of improvement / worsening). Depending on
the circumstances, compensation may be reduced or lapse where the injured person's current
medical or social situation cannot be referred solely to the industrial injury (see paragraph 12 in
the Workers’ Compensation Act via link above).

Fortunately, the law also contains a rule of evidence in favor of the injured person (also paragraph
12) that says:

• An established loss of earning capacity, a permanent injury or a person's death shall be
deemed to be a consequence of the industrial injury, except where it is likely beyond
reasonable doubt that this is not the case or this Act stipulates otherwise.

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A person (except for expenses for treatment) are only entitled to compensation as mentioned
above. This means that the Workers’ Compensation Act does not compensate for instance:

• Compensation for lost earnings
• Compensation for pain and suffering
So, if a person e.g. gets work-related Covid-19, suffers from long term consequences for 6-8
months and recovers without permanent injury and loss of earning capacity they will not be
entitled to any compensation according to the law.
Also, important to mention is that we have a “limit of triviality” meaning minor insignificant
permanent consequences will not be compensated.
The specific conditions regarding compensation, also including the “trivial boundaries”, can be
found translated into english at the ‘Labour Market Insurance’ homepage via link:
https://www.aes.dk/english/industrial-injuries/what-type-compensation-can-you-expect

STATUS REGARDING CASES in Denmark:
 Occupational disease cases:
The Labour Market Insurance has received 1269 cases related to Covid-19. A decision had been
made on 298 cases of Covid-19 infection (all professional groups). All 298 are recognized.
 Accident cases:
The Labour Market Insurance has received 21 cases related to Covid-19. A decision had been
made on 21 cases and all are recognized.

Question 2 and 3 – salary, compensation, lump sum, etc. due to COVID-19 (NOT in relation to
occupational injury):
2. Question 2 - In your Country, does the Government provide compensation to healthcare workers

exposed to or infected by COVID 19 in the workplace?

NO

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - Some specific nurses in the hospital have an agreement regarding salary - BUT not due to
“exposed to or infected by COVID-19 in the workplace” but due to changed terms of
employment/place of employment.
An agreement has been entered into for nurses employed at the hospitals, who have volunteered
or been appointed by the management as part of the covid19 emergency preparedness team.
When you are part of the emergency preparedness team, you are not employed in a department

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that handles care/treatment of covid-19 patients (often ICU or lung medicine departments are the
COVID-19 departments) – but you can be moved to these departments if needed.
Nurses who are employed in a ward that takes care of covid-19 patients are NOT covered by this
agreement, eg intensive care nurses. The agreement only applies to nurses temporarily being
moved to the COVID-19 departments.

• A supplement of DKK 15.735 is granted annually (full-time employee) - paid monthly DKK
1311 and reduced by part-time employment.

• The nurse can be moved to covid19 department from their regular ward with 3 days’ notice
- a fee of 1575 DKK is paid.

• The nurse can be returned to the main ward from covid19 section with 3 days’ notice - a
fee of 1575 DKK is paid

• The nurses covered by this agreement deviate from the collective agreement and their
right to know their shift schedule 4 weeks ahead (only relevant when switching to/from
the covid-19 section)

ESTONIA

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES
IF No: Is there a non-legal Occupational Health Scheme that provides this recognition for
infections in health care workers? IF Yes: Can you please provide details/link to scheme?
Yes and NO: In Estonia, COVID 19 illness in the health care sector was treated similarly to other
illnesses in the workplace. If it turned out that the infection had definitely come from the
workplace and not elsewhere, the illness was registered with an occupational health doctor. A few
hospitals have experience, but the question arises as to how to be 100% sure that the infection
has occurred in the workplace. See Occupational Health and Safety Act:
https://www.riigiteataja.ee/en/eli/512082020009/consolide

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO
We had one incident in the spring, where a care worker was infected with COVID and died. The
government paid extraordinary compensation to the family.

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3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

FINLAND

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - Statutory insurance against accidents at work and occupational diseases covers work-related
accidents at work and occupational diseases. Disease caused by a coronavirus is compensated as
an occupational disease caused by a biological agent if the exposure is likely and mainly due to
work, the area of the workplace, work-related training or work-related travel. Compensating
disease caused by a coronavirus as an occupational disease therefore requires that the source of
the infection be identifiable as having occurred at work. By the end of June 2020 Accident
Compensation Board had processed 38 requests for opinions on Corona exposure on the basis of
insurance against accidents at work and occupational diseases. In 26 of these cases, it was
considered an occupational disease. Almost all cases have been by health care workers, most by
registered nurses or practical nurses. Dozens of claims related to corona are still pending for
insurance companies. Please see: https://www.tvk.fi/en/insurance/workers-comp-in-brief/

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - If you mean financial compensation, so called “corona bonus”, our government is not
providing anything such, not one-time or as increase in the wages in general.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - Not in general. There have been some individual employers that have paid something extra,
but that is random, there is not available any systematically collected information on this.

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FRANCE

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - Since the 1st of July there is an automatic and systematic recognition of COVID-19 in a severe
form as an occupational disease for all health care workers.

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - This recognition as an occupational disease allows the coverage of care costs up to 100% of
the health insurance rates, a more favourable coverage of daily allowances and finally an
indemnity (pension or capital) in case of permanent disability. A pension is paid to the beneficiaries
in the event of death.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - In order to prevent the employers (Hospitals, nursing home, etc.) concerned from bearing
the financial burden of compensation, an order will provide for the mutualization of this expense
among all employers in the mutualized portion of their occupational accident and disease
contributions. It will be provided by the government for self-employed health professionals who
do not benefit from coverage for occupational diseases.

GERMANY

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - responsible for all recognition of occupational illnesses is the Deutsche Gesetzliche
Unfallversicherung DGUV (german statutory accident insurance). Requirements for recognition
are: contact with SARS-CoV-19-inefted person; relevant symptoms, positive test for virus (e.g. via
PCR-test). For details see: https://publikationen.dguv.de/widgets/pdf/download/article/3854 (in
German).

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2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - Most of the state (Laender) governments are paying one-time bonuses between 500 and
1,000 EURO for nurses and sometimes other staff. Regulations differ from state to state. For long-
term care a national one-time bonus (paid for by the national long-term care insurance) of up
to 1,000 EURO has been decided for nurses and cleaning staff. The amount depends on how much
of working hours are spent close for residents, part-time or full-time. Government currently is
discussing a bonus for nurses in hospitals. However, decision on who is eligible for a bonus is
probably going to be more restrictive than in long-term care (only 25% of nurses in hospitals may
be eligible).

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - Some (not many) employers have paid a bonus. But the national bonus (question 2) is paid
through the employer who gets reimbursed by the health insurance or long-term care insurance.

ICELAND

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO - There is a recognition according to law, on work-related injury but diseases have been
evaluated on each case basis and not as strong legislation there. Therefore, we are fighting to get
this changed, in cooperation with other Associations/Unions, such as nursing assistants and
physicians.

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace ?
NO - at this timepoint we haven´t had to rely on that. Fortunately, so far, we have not lost one
nurse to COVID-19 but we have few on prolonged sick-leave which we don´t know yet how will
develop.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace ?
YES - We had the compensations in two categories from the Government:

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- Category A: high acuity units: 1.518 for 100% work
- Category B: support units/lower acuity units: 637 EUR for 100% work.

IRELAND

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - The Government provides a compensation scheme to all employees, including healthcare
workers. The Enhanced Illness Benefit payment is available to employees who have been
diagnosed with COVID-19 or certified by a medical doctor to self-isolate because they are a
probable source of COVID-19. The rate of payment is €350 per week as compared with the normal
Illness Benefit rate of €203 per week.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - in the public sector, and NO - in the private sector.
Public Sector:
Public sector employers provide compensation to healthcare workers exposed to or infected by
COVID-19 in the workplace in the form of special leave with pay. The special leave with pay
arrangements apply to public servants only. Pay is based on basic salary and fixed allowances only
and excludes unsocial hours premium payments.
Special leave with pay only applies to periods of medically/Health Service Executive recommended
self-isolation where the employee is displaying symptoms of COVID-19, and also to medical
diagnoses of COVID-19 infection where the employee is not well enough to work from home.
Special leave with pay applies for the number of days advised by the Health Service
Executive/doctor.
If an employee who is self-isolating due to COVID-19 symptoms receives a positive test result, the
special leave with pay will continue to apply based on the employee’s medical certification. If an
employee who is self-isolating due to COVID-19 symptoms receives a negative test result, the
special leave with pay ceases to apply from the date that the test result is received. If the employee

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is unfit to return to work due to a non-COVID-19 illness, the normal sick leave scheme and rules
will apply for the remainder of the absence.
Special leave with pay for COVID-19 does not apply to employees who are required to restrict their
movements as a precaution as they are not ill. The employer must therefore facilitate working
from home. If remote working in an employee’s current role is not feasible, then the assignment
of work may be outside of their usual core duties. In all such cases, employees remain available for
work whilst at home, where they have been advised to restrict their movements as a precautionary
measure.
There are also special arrangements where employees who are identified as being at very high risk
(extremely vulnerable) and are advised to cocoon. These employees are to be facilitated to work
from home to the maximum extent possible. Where working from home in their current role is not
feasible, then an employee may be assigned work outside their usual core duties/given a new role.
They will continue to be paid their normal basic salary and fixed allowances pending
identification/assignment of appropriate duties.
Up until the 24th August 2020, there were special arrangements in place for essential health care
workers who were exposed to COVID- 19 and who had child-care responsibilities. Where flexible
working arrangements, including working remotely, was not feasible the essential health care
worker was permitted to stay at home to care for children. In such a case, as was the case with the
rest of the public service, the essential health care worker was classified as being available to work
from home and could be allocated different work or roles that could be carried out remotely. This
ceased with effect from 24th August 2020 and currently there is no special arrangement available
for healthcare workers who are exposed to COVID-19 and who have child-care responsibilities.

Private Sector:
In general, private sector employers do not provide compensation to healthcare workers exposed
to or infected by COVID-19 in the workplace. The Government Enhanced Illness Benefit payment,
described above, is available to healthcare workers employed in the private sector.

ITALY

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - From the beginning of pandemic the Government has enacted legislative acts and circulars.
The circulars are published, following legislative acts from the National Insurance Institute for
Occupational injury (INAIL). In these documents Covid 19 is legally recognised as an
Occupational injury.

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Below included: the legislative acts of March 17th changed in National Law in April 24th. Decreto
legge 17 marzo 2020, n. 18, convertito dalla legge 24 aprile 2020, n. 27 "Misure di potenziamento
del Servizio sanitario nazionale e di sostegno economico per famiglie, lavoratori e imprese
connesse all'emergenza epidemiologica da COVID-19. (DECRETO CURA ITALIA).

decreto legge 17 legge 24 aprile
marzo 2020.pdf 2020 n 27.pdf

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?

YES, the two circulars contains clear indication of the situation in which the National Insurance
Institute for Occupational injury (INAIL) provide compensation to healthcare workers infected,
even for the period of quarantine if they result positive to the Covid 19 test.

Below included the two circulars of the National Insurance Institute for Occupational injury, dated
March 17th and May 20th

circolare n 22 del 20 richiesta

maggio 2020 (2).pdf chiarimenti malattia-infortunio da covid-19 (nuovo coronavirus).pdf

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?

NO

LITHUANIA

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO
IF No: Is there a non-legal Occupational Health Scheme that provides this recognition for infections
in health care workers? IF Yes: Can you please provide details/link to scheme?
Covid-19 is not recognised as Occupational injury. We have only a list of Occupational injuries
caused by biological factors (e.g. infections, parasitic pathogens). The last position in the list
is "The other scientifically recognized biological factors" which could probably at this moment
include covid-19. But it is still no separately mentioned occupational injury.

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2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - From the beginning of the quarantine all medical staff who worked with covid-19 infected
patients or who worked with potentially ill patient testings received additional salary supplement,
equal up till 100 percent of basic salary. Government allocated finances for these payments. But
these supplements were paid only during quarantine months till the middle of June. Also in the
case of healthcare workers' illness caused by covid-19 , the State institution of social insurance
covered 100 percent of sick leave.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - In the beginning of the year all medical staff who worked with covid-19 infected patients or
who worked with potentially ill patient testings received salary supplement, equal up till 100
percent of basic salary. Government allocated finances for these payments. These supplements
were paid only during quarantine months till the middle of June. No data about the private
healthcare sector.

LUXEMBOURG

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES
https://guichet.public.lu/fr/citoyens/sante-social/accident-maladie/risques-assures/declaration-

accident-travail-trajet.html
2. Question 2 - In your Country, does the Government provide compensation to healthcare workers

exposed to or infected by COVID 19 in the workplace?
NO

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

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NORWAY

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES (for health care workers infected at work) - NNO approached the Ministry of Labor and Social
Affairs with a demand that Covid-19 infection should be included in the occupational disease
regulations. Following the inquiry, the government decided to change the regulations, which
means that nurses can now receive full occupational injury compensation in the event of disability,
permanent injury or death as a result of complications following the Covid-19 disease. See:
https://lovdata.no/dokument/LTI/forskrift/2020-04-07-726

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - Healthcare workers do not get any compensation for being exposed to or infected by Covid-
19. But NNO made an agreement with the employers in the start of the pandemic allowing for
more flexibility in working time when needed. For this flexibility some nurses got an increase in
pay, but this agreement with the employers were terminated in August.

POLAND

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - since 23 April.

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - additional financial bonus (50% of the monthly salary).

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - compensation from national social insurance fund.

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PORTUGAL

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - Covid-19 infection is considered to be an occupational disease within the meaning and for
the purposes of Article 262b(1) of Law N. 27-A/2020 of July 24th. As regards nurses with an
individual contract of employment (CIT), this results from the provisions of Article 94(2) of Law N.
98/2009, of September 4th, - ex vi Article 262-B(1) of Law N. 27-A/2020, of July 24th, and Article
283(3) of the Código de Trabalho (Labour Code). With regard to nurses holding a contract of
employment in public functions (CTFP), the inherent qualification is enshrined in article 25 of Law
Decree by the Government N. 503/99, of November 20th. In the same sense, Guideline N. 13/2020,
issued by the Directorate General of Health (DGS), states that confirmation of an occupational
disease by the Department of Protection against Professional Risks of the Institute of Social
Security, I.P. will allow the health professional to receive compensation, in kind and/or in cash, in
accordance with what is established in the system of compensation for the professional disease
(Law N. 98/2009, of September 4th and Decree-Law N. 503/99, of November 20th, in the current
wording).
Links:
- Law N. 27A/2020 (in Portuguese) - https://dre.pt/pesquisa/-
/search/138762310/details/maximized
- Law N. 98/2009 (in Portuguese) - https://dre.pt/pesquisa/-
/search/489505/details/maximized
- Law Decree by the Government N. 503/99 (in Portuguese) - https://dre.pt/pesquisa/-
/search/643282/details/maximized
- Guideline N. 13/2020 of DGS (in Portuguese) - https://www.dgs.pt/directrizes-da-
dgs/orientacoes-e-circulares-informativas/orientacao-n-0132020-de-21032020-pdf.aspx
- Labour Code (In Portuguese) -
http://www.pgdlisboa.pt/leis/lei_mostra_estrutura.php?tabela=leis&artigo_id=&nid=1047
&nversao=&tabela=leis&so_miolo=

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES
Prophylactic isolation:

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In this case, the nurse worker has the right to 100% of the reference renumbering, because the
above-mentioned prophylactic isolation is considered similar to illness. The respective legal
framework is set out in Article 19(1) and (4) of Law N. 10-A/2020, of March 13th, with an updated
version by Law Decree by the Government N. 58-B/2020, of August 14th, in conjunction with Order
N. 2875-A/2020, of 3 March. The scheme is applicable to nurses with an individual contract of
employment (CIT) and to those with a public contract of employment (CTFP), with the
responsibility for compensating for the damage arising from the occupational disease being borne
by Social Security.

Infection by Covid-19:
In the event of infection by Covid-19, the nurse worker - CIT - is entitled to the payment of 100%
of the remuneration for absences due to occupational disease. See article 262-B, paragraph 3 of
Law N. 27-A/2020, of March 13th. As for the nurse worker - CTFP - he is entitled to receive, during
the respective period of absence, the full amount of his remuneration (100%). Under the terms
and for the purposes of article 15 of Law Decree by the Government N. 503/99, of November 20th.
In addition, all damages resulting from the occupational disease grant the respective right to
compensation. For CIT, this follows from Article 283(1) of the Labour Code and Article 23 of Law
N. 98/2009, of November 4th, as regards the CTFP of that determined in Article 4(1) of Decree-Law
N. 503/99, of November 20th.

Links:
- Law N. 10-A/2020 (in Portuguese) - https://dre.pt/web/guest/pesquisa/-
/search/131908529/details/maximized
- Law N. 27A/2020 (in Portuguese) - https://dre.pt/pesquisa/-
/search/138762310/details/maximized
- Law Decree by the Government N. 58-B/2020 (in Portuguese) - https://dre.pt/home/-
/dre/140431113/details/maximized
- Order N. 2875-A/2020 (in Portuguese) - https://dre.pt/home/-
/dre/129843866/details/maximized
- Law Decree by the Government N. 503/99 (in Portuguese) - https://dre.pt/pesquisa/-
/search/643282/details/maximized
- Law N. 98/2009 (in Portuguese)- https://dre.pt/pesquisa/-/search/489505/details/maximized

- Labour Code (In Portuguese) -

http://www.pgdlisboa.pt/leis/lei_mostra_estrutura.php?tabela=leis&artigo_id=&nid=1047
&nversao=&tabela=leis&so_miolo=

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?

NO

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SLOVENIA

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES
Infection at work
If an infection with a new coronavirus COVID-19 occurs in the workplace (like example the infection
of a healthcare professional who performed his work in the ward where COVID-19 patients are
treated), and then the insured becomes ill with COVID-19, the reason for temporary incapacity for
work is listed as "Injury at work". It is an illness caused by an accidental accident or force majeure
while performing work. In accordance with Article 66 of Pension and Disability Insurance Act such
an illness is considered an injury at work. In this case, an appropriate report of an injury at work
by the employer is also required. The doctor defines "Injury at work" as the reason for temporary
incapacity for work, and the insured is entitled to compensation in the amount of 100% of the
base, whereby the employer pays the compensation to the insured and the employer is refunded
by the Health Insurance Institute of Slovenia. (Source: The Health Insurance Institute of Slovenia –
Link: https://www.zzzs.si/zzzs/internet/zzzs.nsf/o/55F91A45343677D6C125852D00303245)

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES
Infection at work
If an infection with a new coronavirus COVID-19 occurs in the workplace the insured is entitled to
compensation payed by employer, whereby the employers is refunded by the Health Insurance
Institute of Slovenia, as stated at point 1.
The ordered quarantine
The Act on Intervention Measures for Preparation for the Second Wave COVID-19 regulates the
right to salary compensation for workers who are unable to perform work due to the ordered
quarantine in accordance with the Law governing infectious diseases. An employee is entitled to
salary compensation for the period of quarantine only if the employer cannot organize work at
home for him. The amount of salary is compensated 100 % of the average monthly salary of a full-
time worker to a worker who has been ordered quarantined due to contact with an infected
person in the course of performing work (at the workplace). The employer exercises the right to
reimbursement of paid salary compensations by submitting an application to the Employment
Service of Slovenia within 30 days from the beginning of the employee's absence due to the

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ordered quarantine. (Source: Act on Intervention Measures to Prepare for the Second Wave

COVID-19 – Link: http://www.pisrs.si/Pis.web/pregledPredpisa?id=ZAKO8231)

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - The employer provides compensation to healthcare workers, but in the casa of the infected
healthcare worker with an infection that occurred in the workplace, employer is refunded by the
Health Insurance Institute of Slovenia and in the casa of the ordered quarantine of healthcare
worker due to contact with an infected person in the course of performing work, employer is
refunded by the Employment Service of Slovenia.

SPAIN

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - In Spain, COVID-19 is currently considered a work accident during the period of the pandemic,
but it is not considered an occupational disease. From the General Council of Nursing we have
propose the Ministry of Labour to consider it as an occupational disease, but their response has
been negative.
Real Decreto-ley 28/2020, de 22 de septiembre, de trabajo a distancia:

RDL 28-2020
Teletrabajo-DA4-Covid accidnte trabajo.pdf

The fourth additional provision confers the consideration as a professional contingency derived
from a work accident to the illnesses suffered by the personnel who provide service in health or
social-health centers as a consequence of the contagion of the SARS-CoV2 virus during the state
of alarm.
Disposición adicional cuarta. Consideración como contingencia profesional derivada de accidente
de trabajo a las enfermedades padecidas por el personal que presta servicio en centros sanitarios
o socio-sanitarios como consecuencia del contagio del virus SARS-CoV2 durante el estado de
alarma.

1. Desde la declaración de la pandemia internacional por la Organización Mundial de la Salud
y hasta que las autoridades sanitarias levanten todas las medidas de prevención adoptadas
para hacer frente a la crisis sanitaria ocasionada por el COVID-19, las prestaciones de
Seguridad Social que cause el personal que presta servicios en centros sanitarios o socio-
sanitarios, inscritos en los registros correspondientes, y que en el ejercicio de su profesión,

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hayan contraído el virus SARS-CoV2 por haber estado expuesto a ese riesgo específico
durante la prestación de servicios sanitarios y socio-sanitarios, cuando así se acredite por los
servicios de Prevención de Riesgos laborales y Salud Laboral, se considerarán derivadas de
accidente de trabajo, al entender cumplidos los requisitos exigidos en el artículo 156.2.e) del
texto refundido de la Ley General de la Seguridad Social, aprobado por el Real Decreto
Legislativo 8/2015, de 30 de octubre.
2. El contagio y padecimiento de la enfermedad se acreditará mediante el correspondiente
parte de accidente de trabajo que deberá haberse expedido dentro del mismo periodo de
referencia.
3. En los casos de fallecimiento, se considerará que la causa es accidente de trabajo siempre
que el fallecimiento se haya producido dentro de los cinco años siguientes al contagio de la
enfermedad y derivado de la misma, de conformidad con lo dispuesto en el artículo 217.2
del texto refundido de la Ley General de la Seguridad Social.

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - Here provide it by Social Security. (See Royal Decree above)

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - Some employer can provide compensation to convert 100% the salary. Maybe the Social
Security pay 60-80% and the employer the rest (approx. 20%) - for example.

SWEDEN

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - Since before Covid, if a laboratory worker is found to have been infected it is assumed that
this person got it at work. Since Covid the Swedish government has decreed that according to the
act 1977:284 to count Covid-19 as one of the diseases that constitutes infectious disease. See:
https://www.regeringen.se/49773e/contentassets/dd7ccbc2d5e74b948dade42b941ad509/arbet
sskador-till-foljd-av-smittsamma-sjukdomar.pdf
This means that it opens up the possibility of a person who gets Covid-19 to have it tried as an
occupational injury. For a person such as a nurse working daily with covid patients it is assumed
that they got it at work, but every person (non-nurses) also have their case tried. Harder for them

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to say they got it at work though. If a nurse who has gotten the infection acknowledged as an
occupational injury dies, their family gets extra renumeration. In order to get any remuneration
out of the occupational injury while still alive, you have to get a doctor to write that your ability to
work will be down at least 15% during at least a year onwards. Then the occupational injury
renumeration will cover the difference in your ordinary sick pay and the salary you would have
gotten if working. Since it is generally very hard to get a doctor´s note to prognose that long time,
it is difficult to actually get any occupational injury remuneration even though it is an occupational
injury.

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - But hard to actually get any remuneration, see above.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES - I´m being kind to the employers in answering Yes here. In Sweden we have different employer
compensation based on if you are in private, city/county or state sector. When it comes to covid
and occupational injury they are quite similar. When it comes to the employer compensation it is
complementary compensation to the government compensation. That means that you generally
have to have the government compensation to be eligible for the employer one. So that means at
least a one year of not being able to work full time but when it comes to employer compensation
this falls under the contagion section. And when it comes to contagion you only get compensated
for damages that still persists after 180 days. So, if you get sick and make a complete recovery you
get no compensation by your employer for this time (except sick payments). It takes pretty much
permanent damage or death for any compensation to be paid out.

SWITZERLAND

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
YES - Here is an excerpt from the "FAQ" published on our Website (in French):
"J'ai été infecté par le coronavirus − très probablement au travail. Qui assume les coûts ?
L'assurance accident. Les maladies infectieuses, dont le Covid-19 fait partie, sont considérées
comme des maladies professionnelles pour les professionnels de la santé, notamment les
infirmières, infirmiers et les médecins, au sens de la loi sur l'assurance accident (LAA). L'assureur

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LAA prend en charge les frais de tous les examens médicaux nécessaires, même si le soupçon
d'infection n'est pas confirmé. Si la quarantaine est médicalement indiquée, des indemnités
journalières sont versées pour les jours d'absence".

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO – According to Swiss labour law, compensation is provided by the employer, see Q3

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
YES – The usual rules of the Code of labour apply to COVID. The Employer has to compensate his
employees for a duration depending on the duration of their employment.

UK

1. Question 1 - In your Country, is COVID-19 Legally recognised as an Occupational injury if acquired
in work by nurses or other workers?
NO - We don’t have a system that works like this – It’s all dependent on evidence and then impact.
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)
regulations exist to report occupational exposure to diseases at work to the workplace safety
regulator, the Health and Safety Executive (HSE) to review and, where appropriate, investigate.
However, RIDDOR is open to employer interpretation as to whether there was reasonable
evidence to say COVID-19 or any illness was contracted at work. During the peak, we called for
COVID-19 illness and death to be reported to the HSE as an occupational hazard.

2. Question 2 - In your Country, does the Government provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - However if as a result of workplace ill-health or injury, the impact becomes permanent, there
is a welfare and benefits system in place to provide financial and healthcare support. This is not
specific to COVID-19. There is a life assurance scheme for health and social care workers who die
as a result of occupational exposure.

3. Question 3 - In your Country, does the Employer provide compensation to healthcare workers
exposed to or infected by COVID 19 in the workplace?
NO - See question above.

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EFN Members

ALBANIA
Ms Blerina Duka - President & Official Delegate
Albanian Order of Nurses
www.urdhriinfermierit.org

AUSTRIA
Ms Elisabeth Potzmann - President
Austrian Nurses Association (OEGKV)
www.oegkv.at

BELGIUM
Mr Yves Mengal - Delegate (FNIB) | Ms Deniz Avcioglu – Official Delegate (UGIB)
Fédération Nationale des Infirmières de Belgique | General Nursing Union of Belgium
www.fnib.be | www.ugib.be

BULGARIA
Ms Milka Vasileva - President & Official Delegate
Bulgarian Association of Health Professionals in Nursing (BAHPN)
www.nursing-bg.com

CROATIA
Ms Tanja Lupieri - President
Croatian Nurses Association (HUMS)
www.hums.hr

CYPRUS
Mr Ioannis Leontiou - President & Official Delegate
Cyprus Nurses and Midwives Association (CYNMA)
www.cyna.org

CZECH REPUBLIC
Ms Martina Sochmanová - President
Czech Nurses Association (CNNA)
www.cnna.cz

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DENMARK
Ms Anni Pilgaard - Official Delegate
Danish Nurses’ Organisation (DNO)
www.dsr.dk

ESTONIA
Ms Gerli Liivet - Offical Delegate
Estonian Nurses Union (ENU)
www.ena.ee

FINLAND
Ms Nina Hahtela - President & Official Delegate
Finnish Nurses Association
www.sairaanhoitajaliitto.fi

FORMER YUGOSLAV REPUBLIC OF MACEDONIA
Ms Velka Gavrovska Lukic - President & Official Delegate
Macedonian Association of Nurses and Midwives
www.zmstam.org.mk

FRANCE
Mr François Barrière - Official Delegate
Association Nationale Française des Infirmiers & Infirmières Diplômés ou Etudiants (ANFIIDE)
www.anfiide.com

GERMANY
Mr Franz Wagner - Official Delegate
German Nurses Association (DBFK)
www.dbfk.de

GREECE
Dr Eleni Kyritsi-Koukoulari - President
Hellenic Nurses Association (ESNE)
www.esne.gr

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HUNGARY
Ms Tünde Minya - President & Official Delegate
Hungarian Nursing Association
www.apolasiegyesulet.hu

ICELAND
Mr Guðbjörg Pálsdóttir - President & Official Delegate
Icelandic Nurses Association
www.hjukrun.is

IRELAND
Ms Phil Ni Sheaghdha - Delegate
Irish Nurses and Midwives Organisation (INMO)
www.inmo.ie

ITALY
Ms Stefania Di Mauro – Official Delegate
Consociazione Nazionale delle Associazioni Infermiere - Infermieri (CNAI)
www.cnai.info

LATVIA
Ms Dita Raiska - President & Official Delegate
Latvian Nurses Association
www.masas.lv

LITHUANIA
Ms Danute Margeliene - President & Official Delegate
The Lithuanian Nurses’ Organisation
www.lsso.lt

LUXEMBOURG
Ms Anne-Marie Hanff - President
Association Nationale des Infirmier(e)s Luxembourgeois(es) (ANIL)
www.anil.lu

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MALTA
Mr Paul Pace - President & Official Delegate
Official Delegate
Malta Union of Midwives and Nurses (MUMN)
www.mumn.org

MONTENEGRO
Ms Nada Rondovic – President & Official Delegate
Nurses and Midwives Association of Montenegro

NETHERLANDS
Ms Stella Salden – President & Official Delegate
Nieuwe Unie’91 (NU’91)
www.nu91.nl

NORWAY
Ms Lill Sverresdatter Larsen – President & Official Delegate
Norwegian Nurses Organisation (NNO)
www.sykepleierforbundet.no

POLAND
Ms Grażyna Wójcik – President & Official Delegate
Polish Nurses Association (PNA)
www.ptp.na1.pl

PORTUGAL
Ms Ana Rita Cavaco – President & Official Delegate
Ordem dos Enfermeiros (OE)
www.ordemenfermeiros.pt

ROMANIA
Ms Ecaterina Gulie - President & Official Delegate
Romanian Nursing Association

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SERBIA
Ms Radmila Nešić - President & Official Delegate
Association Health Workers of Serbia
www.szr.org.rs

SLOVAKIA
Ms Iveta Lazorová - President
Slovak Chamber of Nurses and Midwives
www.sksapa.sk

SLOVENIA
Ms Monika Azman – President & Official Delegate
Nurses and Midwives Association of Slovenia
www.zbornica-zveza.si

SPAIN
Mr Florentino Perez – President & Official Delegate
Spanish General Council of Nursing
www.consejogeneralenfermeria.org

SWEDEN
Ms Sineva Ribeiro – President & Official Delegate
The Swedish Association of Health Professionals
www.vardforbundet.se

SWITZERLAND
Ms Roswitha Koch - Official Delegate
Association Suisse des Infirmières et Infirmiers (SBK-ASI)
www.sbk-asi.ch

UNITED KINGDOM
Dame Donna Kinnair - Delegate
Royal College of Nursing (RCN)
www.rcn.org.uk

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EFN – European Federation of Nurses Associations

The European Federation of Nurses Associations (EFN) was established in 1971 and is the
independent voice of the profession. The EFN consists of National Nurses Associations from 35 EU
Member States, working for the benefit of 6 million nurses throughout the European Union and
Europe. The mission of EFN is to strengthen the status and practice of the profession of nursing for

the benefit of the health of the citizens and the interests of nurses in the EU & Europe.

For further information or copies of this report please contact:
The European Federation of Nurses Associations (EFN)
Registration Number 476.356.013
Clos du Parnasse 11A, 1050 Brussels, Belgium
Tel: +32 2 512 74 19 Fax: +32 2 512 35 50
Email: [email protected] Website: www.efnweb.eu

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