{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T03:55:37Z","timestamp":1793678137202,"version":"4.5.1"},"reference-count":34,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T00:00:00Z","timestamp":1604361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The need for healthcare workers (HCWs) to wear personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic heightens their risk of thermal stress. We assessed the knowledge, attitudes, and practices of HCWs from India and Singapore regarding PPE usage and heat stress when performing treatment and care activities. One hundred sixty-five HCWs from India (n = 110) and Singapore (n = 55) participated in a survey. Thirty-seven HCWs from Singapore provided thermal comfort ratings before and after ice slurry ingestion. Differences in responses between India and Singapore HCWs were compared. A p-value cut-off of 0.05 depicted statistical significance. Median wet-bulb globe temperature was higher in India (30.2 \u00b0C (interquartile range [IQR] 29.1\u201331.8 \u00b0C)) than in Singapore (22.0 \u00b0C (IQR 18.8\u201324.8 \u00b0C)) (p &lt; 0.001). Respondents from both countries reported thirst (n = 144, 87%), excessive sweating (n = 145, 88%), exhaustion (n = 128, 78%), and desire to go to comfort zones (n = 136, 84%). In Singapore, reports of air-conditioning at worksites (n = 34, 62%), dedicated rest area availability (n = 55, 100%), and PPE removal during breaks (n = 54, 98.2%) were higher than in India (n = 27, 25%; n = 46, 42%; and n = 66, 60%, respectively) (p &lt; 0.001). Median thermal comfort rating improved from 2 (IQR 1\u20132) to 0 (IQR 0\u20131) after ice slurry ingestion in Singapore (p &lt; 0.001). HCWs are cognizant of the effects of heat stress but might not adopt best practices due to various constraints. Thermal stress management is better in Singapore than in India. Ice slurry ingestion is shown to be practical and effective in promoting thermal comfort. Adverse effects of heat stress on productivity and judgment of HCWs warrant further investigation.<\/jats:p>","DOI":"10.3390\/ijerph17218100","type":"journal-article","created":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T09:09:32Z","timestamp":1604394572000},"page":"8100","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Heat Stress and Thermal Perception amongst Healthcare Workers during the COVID-19 Pandemic in India and Singapore"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0171-4112","authenticated-orcid":false,"given":"Jimmy","family":"Lee","sequence":"first","affiliation":[{"name":"Ng Teng Fong General Hospital, Singapore 609606, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8720-1969","authenticated-orcid":false,"given":"Vidhya","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600116, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7250-6284","authenticated-orcid":false,"given":"P K","family":"Latha","sequence":"additional","affiliation":[{"name":"Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu 600116, India"},{"name":"AMET University, Chennai, Tamil Nadu 603112, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1391-7681","authenticated-orcid":false,"given":"Sharifah Badriyah","family":"Alhadad","sequence":"additional","affiliation":[{"name":"NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore 119077, Singapore"},{"name":"Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4651-1821","authenticated-orcid":false,"given":"Clarence Hong Wei","family":"Leow","sequence":"additional","affiliation":[{"name":"Human Potential Translational Research Programme, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-5744","authenticated-orcid":false,"given":"Nicholas Yong De","family":"Goh","sequence":"additional","affiliation":[{"name":"Human Potential Translational Research Programme, National University of Singapore, Singapore 119228, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8720-1432","authenticated-orcid":false,"given":"Esther","family":"Tan","sequence":"additional","affiliation":[{"name":"Ng Teng Fong General Hospital, Singapore 609606, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7951-8245","authenticated-orcid":false,"given":"Tord","family":"Kjellstrom","sequence":"additional","affiliation":[{"name":"Health and Environment International Trust, Nelson 7005, New Zealand"},{"name":"National Centre for Epidemiology and Population Health, Australian National University, Canberra 2601, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8799-4866","authenticated-orcid":false,"given":"Marco","family":"Morabito","sequence":"additional","affiliation":[{"name":"Institute of BioEconomy, National Research Council, 50019 Florence, Italy"},{"name":"Centre of Bioclimatology, University of Florence, 50144 Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4042-795X","authenticated-orcid":false,"given":"Jason Kai Wei","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117593, Singapore"},{"name":"Human Potential Translational Research Programme, National University of Singapore, Singapore 119228, Singapore"},{"name":"N.1 Institute for Health, National University of Singapore, Singapore 117456, Singapore"},{"name":"Global Asia Institute, National University of Singapore, Singapore 119076, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"World Health Organisation (2020, October 13). Coronavirus Disease (COVID-19) Situational Report 51. Available online: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10.","DOI":"10.46945\/bpj.10.1.03.01"},{"key":"ref_2","unstructured":"World Health Organisation (2020, October 13). Coronavirus Disease (COVID-19) Weekly Epidemiological Update. Available online: https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/situation-reports\/20200831-weekly-epi-update-3.pdf?sfvrsn=d7032a2a_4."},{"key":"ref_3","unstructured":"Department of Health and Human Services (2017). Pandemic Influenza Plan: 2017 Update, HHS."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1001\/jama.2020.3972","article-title":"Supporting the Health Care Workforce During the COVID-19 Global Epidemic","volume":"323","author":"Adams","year":"2020","journal-title":"JAMA"},{"key":"ref_5","unstructured":"World Health Organisation (2020). Rational Use of Personal Protective Equipment for Coronavirus Disease (COVID-19) and Considerations during Severe Shortages, World Health Organisation."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jhin.2020.04.012","article-title":"Knowledge, attitude and practice regarding COVID-19 among health care workers in Henan, China","volume":"105","author":"Zhou","year":"2020","journal-title":"J. Hosp. Infect."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.3402\/gha.v2i0.2047","article-title":"Workplace heat stress, health and productivity\u2013an increasing challenge for low and middle-income countries during climate change","volume":"2","author":"Kjellstrom","year":"2009","journal-title":"Glob. Health Action"},{"key":"ref_8","first-page":"258","article-title":"Ebola: Improving the design of protective clothing for emergency workers allows them to better cope with heat stress and help to contain the epidemic","volume":"59","author":"Kuklane","year":"2015","journal-title":"Ann. Occup. Hyg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Potter, A.W., Gonzalez, J.A., and Xu, X. (2015). Ebola Response: Modeling the Risk of Heat Stress from Personal Protective Clothing. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0143461"},{"key":"ref_10","unstructured":"Weather Underground (2020, October 16). Chennai, Tamil Nadu, India Weather History. Available online: https:\/\/www.wunderground.com\/history\/monthly\/in\/chennai\/VOMM\/date\/2020-6."},{"key":"ref_11","unstructured":"Weather Underground (2020, October 16). Singapore, South East, Singapore Weather History. Available online: https:\/\/www.wunderground.com\/history\/monthly\/sg\/singapore\/WSSS\/date\/2020-6."},{"key":"ref_12","first-page":"1","article-title":"Knowledge, Attitude, and Practices Toward COVID-19 in Primary Healthcare Providers: A Cross-Sectional Study from Three Tertiary Care Hospitals of Peshawar, Pakistan","volume":"6","author":"Hussain","year":"2020","journal-title":"J. Community Health"},{"key":"ref_13","first-page":"1","article-title":"Knowledge, Attitudes and Fears of HealthCare Workers towards the Corona Virus Disease (COVID-19) Pandemic in South-South, Nigeria","volume":"1","author":"Ogolodom","year":"2020","journal-title":"Health Sci. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2486\/indhealth.MS1352","article-title":"Calculating workplace WBGT from meteorological data: A tool for climate change assessment","volume":"50","author":"Lemke","year":"2012","journal-title":"Ind. Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/oem.30.4.313","article-title":"Assessment of man\u2019s thermal comfort in practice","volume":"30","author":"Fanger","year":"1973","journal-title":"Occup. Environ. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1108\/IJPPM-08-2014-0121","article-title":"Influence of occupational heat stress on labour productivity a case study from Chennai, India","volume":"65","author":"Chinnadurai","year":"2016","journal-title":"Int. J. Product. Perform. Manag."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/0265673021000054630","article-title":"Effects of heat stress on cognitive performance: The current state of knowledge","volume":"19","author":"Hancock","year":"2003","journal-title":"Int. J. Hyperth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1136\/oemed-2013-101584","article-title":"Association between high temperature and work-related injuries in Adelaide, South Australia, 2001\u20132010","volume":"71","author":"Xiang","year":"2014","journal-title":"Occup. Environ. Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Morabito, M., Messeri, A., Crisci, A., Bao, J., Ma, R., Orlandini, S., Huang, C., and Kjellstrom, T. (2020). Heat-related productivity loss: Benefits derived by working in the shade or work-time shifting. Int. J. Product. Perform. Manag., 1\u201319.","DOI":"10.1108\/IJPPM-10-2019-0500"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/19338240903352776","article-title":"The direct impact of climate change on regional labor productivity","volume":"64","author":"Kjellstrom","year":"2009","journal-title":"Arch. Environ. Occup. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.accre.2020.05.009","article-title":"Occupational heat stress induced health impacts: A cross-sectional study from South Indian working population","volume":"11","author":"Venugopal","year":"2020","journal-title":"Adv. Clim. Chang. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.aap.2013.08.011","article-title":"Management of climatic heat stress risk in construction: A review of practices, methodologies, and future research","volume":"66","author":"Rowlinson","year":"2014","journal-title":"Accid. Anal. Prev."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jcrc.2020.06.005","article-title":"Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 era (PPE-SAFE): An international survey","volume":"59","author":"Tabah","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1016\/S0140-6736(14)62316-3","article-title":"Ebola virus disease: Clinical care and patient-centred research","volume":"384","author":"Roberts","year":"2014","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1055\/s-0032-1304643","article-title":"Ice slurry on outdoor running performance in heat","volume":"33","author":"Yeo","year":"2012","journal-title":"Int. J. Sports Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"424","DOI":"10.3389\/fphys.2019.00424","article-title":"An Evaluation of Personal Cooling Systems for Reducing Thermal Strain Whilst Working in Chemical\/Biological Protective Clothing","volume":"10","author":"Bach","year":"2019","journal-title":"Front Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1055\/s-0033-1337906","article-title":"Cold drink attenuates heat strain during work-rest cycles","volume":"34","author":"Lee","year":"2013","journal-title":"Int. J. Sports Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3389\/fphys.2019.00071","article-title":"Efficacy of Heat Mitigation Strategies on Core Temperature and Endurance Exercise: A Meta-Analysis","volume":"10","author":"Alhadad","year":"2019","journal-title":"Front. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1007\/s00421-010-1436-4","article-title":"Aerobically trained individuals have greater increases in rectal temperature than untrained ones during exercise in the heat at similar relative intensities","volume":"109","author":"Hamouti","year":"2010","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s00421-005-1329-0","article-title":"Effects of physical training on heat loss responses of young women to passive heating in relation to menstrual cycle","volume":"94","author":"Kuwahara","year":"2005","journal-title":"Eur. J. Appl. Physiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1249\/01.mss.0000218134.74238.6a","article-title":"Continuous thermoregulatory responses to mass-participation distance running in heat","volume":"38","author":"Byrne","year":"2006","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_32","unstructured":"GHHIN (2020, August 18). Q&A: How Can Health Workers and Other Responders Manage Heat Stress While Wearing Personal Protective Equipment (PPE)?. Available online: http:\/\/www.ghhin.org\/heat-and-covid-19\/PPE."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"140347","DOI":"10.1016\/j.scitotenv.2020.140347","article-title":"Heat warning and public and workers\u2019 health at the time of COVID-19 pandemic","volume":"738","author":"Morabito","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Morabito, M., Messeri, A., Noti, P., Casanueva, A., Crisci, A., Kotlarski, S., Orlandini, S., Schwierz, C., Spirig, C., and Kingma, B.R. (2019). An Occupational Heat\u2013Health Warning System for Europe: The HEAT-SHIELD Platform. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16162890"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/8100\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:28:35Z","timestamp":1760178515000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/21\/8100"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,3]]},"references-count":34,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17218100"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17218100","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,3]]}}}