Reported Exposures Among In-Person Workers With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in 6 States, September 2020-June 2021

COVID-19 mortality among Massachusetts workers and the association with telework ability, 2020

BACKGROUND

Working outside the home put some workers at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure and might partly explain elevated coronavirus disease 2019 (COVID-19) mortality rates in the first months of the pandemic in certain groups of Massachusetts workers. To further investigate this premise, we examined COVID-19 mortality among Massachusetts workers, with a specific focus on telework ability based on occupation.

METHODS

COVID-19-associated deaths between January 1 and December 31, 2020 among Massachusetts residents aged 18-64 years were analyzed. Deaths were categorized into occupation-based quadrants (Q) of telework ability. Age-adjusted rates were calculated by key demographics, industry, occupation, and telework quadrant using American Community Survey workforce estimates as denominators. Rate ratios (RRs) and 95% confidence intervals comparing rates for quadrants with workers unlikely able to telework (Q2, Q3, Q4) to that among those likely able to telework (Q1) were calculated.

RESULTS

The overall age-adjusted COVID-19-associated mortality rate was 26.4 deaths per 100,000 workers. Workers who were male, Black non-Hispanic, Hispanic, born outside the US, and with lower than a high school education level experienced the highest rates among their respective demographic groups. The rate varied by industry, occupation and telework quadrant. RRs comparing Q2, Q3, and Q4 to Q1 were 0.99 (95% confidence interval [CI]: 0.8-1.2), 3.2 (95% CI: 2.6-3.8) and 2.5 (95% CI: 2.0-3.0), respectively.

CONCLUSION

Findings suggest a positive association between working on-site and COVID-19-associated mortality. Work-related factors likely contributed to COVID-19 among Massachusetts workers and should be considered in future studies of COVID-19 and similar diseases.

SARS-CoV-2 antibody prevalence by industry, workplace characteristics, and workplace infection prevention and control measures, North Carolina, 2021 to 2022

Background

The COVID-19 pandemic has disproportionately affected workers in certain industries and occupations, and the workplace can be a high risk setting for SARS-CoV-2 transmission. In this study, we measured SARS-CoV-2 antibody prevalence and identified work-related risk factors in a population primarily working at industrial livestock operations.

Methods

We used a multiplex salivary SARS-CoV-2 IgG antibody assay to determine infection-induced antibody prevalence among 236 adult (≥18 years) North Carolina residents between February 2021 and August 2022. We used the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System (NIOCCS) to classify employed participants' industry and compared infection-induced IgG prevalence by participant industry and with the North Carolina general population. We also combined antibody results with reported SARS-CoV-2 molecular test positivity and vaccination history to identify evidence of prior infection. We used logistic regression to estimate odds ratios of prior infection by potential work-related risk factors, adjusting for industry and date.

Results

Most participants (55%) were infection-induced IgG positive, including 71% of animal slaughtering and processing industry workers, which is 1.5 to 4.3 times higher compared to the North Carolina general population, as well as higher than molecularly-confirmed cases and the only other serology study we identified of animal slaughtering and processing workers. Considering questionnaire results in addition to antibodies, the proportion of participants with evidence of prior infection increased slightly, to 61%, including 75% of animal slaughtering and processing workers. Participants with more than 1000 compared to 10 or fewer coworkers at their jobsite had higher odds of prior infection (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] 1.0 to 21.0).

Conclusions

This study contributes evidence of the severe and disproportionate impacts of COVID-19 on animal processing and essential workers and workers in large congregate settings. We also demonstrate the utility of combining non-invasive biomarker and questionnaire data for the study of workplace exposures.

Potential Work-related Exposure to SARS-CoV-2 by Standard Occupational Grouping Based on Pre-lockdown Working Conditions in France

This study aims to ascertain occupations potentially at greatest risk of exposure to SARS-CoV-2 based on pre-lockdown working conditions in France. We combined two French population-based surveys documenting workplace exposures to infectious agents, face-to-face contact with the public, and working with colleagues just before the pandemic. Then, for each 87-level standard French occupational grouping, we estimated the number and percentage of the French working population reporting these occupational exposure factors, by gender, using survey weights. As much as 40% (11 million) of all workers reported at least two exposure factors. Most of the workers concerned were in the healthcare sector. However, army/police officers, firefighters, hairdressers, teachers, cultural/sports professionals, and some manual workers were also exposed. Women were overrepresented in certain occupations with potentially higher risks of exposure such as home caregivers, childminders, and hairdressers. Our gender-stratified matrix can be used to assign prelockdown work-related exposures to cohorts implemented during the pandemic.

Associations between an international COVID-19 job exposure matrix and SARS-CoV-2 infection among 2 million workers in Denmark

OBJECTIVES

This study investigates the associations between the Danish version of a job exposure matrix for COVID-19 (COVID-19-JEM) and Danish register-based SARS-CoV-2 infection information across three waves of the pandemic. The COVID-19-JEM consists of four dimensions on transmission: two on mitigation measures, and two on precarious work characteristics.

METHODS

The study comprised 2 021 309 persons from the Danish working population between 26 February 2020 and 15 December 2021. Logistic regression models were applied to assess the associations between the JEM dimensions and overall score and SARS-CoV-2 infection across three infection waves, with peaks in March-April 2020, December-January 2021, and February-March 2022. Sex, age, household income, country of birth, wave, residential region and during wave 3 vaccination status were accounted for.

RESULTS

Higher risk scores within the transmission and mitigation dimensions and the overall JEM score resulted in higher odds ratios (OR) of a SARS-CoV-2 infection. OR attenuated across the three waves with ranges of 1.08-5.09 in wave 1, 1.06-1.60 in wave 2, and 1.05-1.45 in those not (fully) vaccinated in wave 3. In wave 3, no associations were found for those fully vaccinated. In all waves, the two precarious work dimensions showed weaker or inversed associations.

CONCLUSIONS

The COVID-19-JEM is a promising tool for assessing occupational exposure to SARS-CoV-2 and other airborne infectious agents that mainly spread between people who are in close contact with each other. However, its usefulness depends on applied restrictions and the vaccination status in the population of interest.

Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021

BACKGROUND

While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states.

METHODS

We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR).

RESULTS

Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9).

CONCLUSIONS

We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people.

Risk factors for COVID-19 among Californians working outside the home, November 2020 - May 2021

BACKGROUND

Higher incidences of COVID-19 mortality and outbreaks have been found in certain industries and occupations. Workplace factors, including working in close proximity to others and contact with the public can facilitate SARS-CoV-2 transmission, especially without appropriate protective measures. Limited information is available about workers at highest risk for SARS-CoV-2 infection.

METHODS

A phone-based, nonprobability study was conducted between November 2020 and May 2021 among California workers who were tested for SARS-CoV-2. Participants were asked about demographics and workplace factors, including industry, occupation, and implementation of COVID-19 mitigation measures. Using the SARS-CoV-2 occupational exposure matrix, three exposure metrics and a combination index were used to categorize occupations. We assessed the association between workplace risks and SARS-CoV-2 test positivity using adjusted logistic regression.

RESULTS

We enrolled 451 (13%) of 3475 potentially eligible workers in the study: 212 with positive and 239 with negative SARS-CoV-2 test results. Those working very close to others and with the highest combined exposure index had a positive association with SARS-CoV-2 positivity. Primarily indoor workers had a lower odds of test positivity compared to those with any outdoor work. There was no association between public-facing occupations and test positivity. Participants with employers who implemented mitigation measures in all three control categories-engineering, administrative, and personal protective equipment-had lower odds of test positivity than those with fewer mitigation measures.

CONCLUSIONS

Worker groups with higher risk factors should be prioritized for outreach. Assessment of occupational risk factors collectively can provide insight to inform preventative actions for workers, employers, and public health entities.

Work: A Social Determinant of Health Worth Capturing

Work is a recognized social determinant of health. This became most apparent during the COVID-19 pandemic. Workers, particularly those in certain industries and occupations, were at risk due to interaction with the public and close proximity to co-workers. The purpose of this study was to assess how states collected work and employment data on COVID-19 cases, characterizing the need for systematic collection of case-based specific work and employment data, including industry and occupation, of COVID-19 cases. A survey was distributed among state occupational health contacts and epidemiologists in all 50 states to assess current practices in state public health surveillance systems. Twenty-seven states collected some kind of work and employment information from COVID-19 cases. Most states (93%) collected industry and/or occupation information. More than half used text-only fields, a predefined reference or dropdown list, or both. Use of work and employment data included identifying high risk populations, prioritizing vaccination efforts, and assisting with reopening plans. Reported barriers to collecting industry and occupation data were lack of staffing, technology issues, and funding. Scientific understanding of work-related COVID-19 risk requires the systematic, case-based collection of specific work and employment data, including industry and occupation. While this alone does not necessarily indicate a clear workplace exposure, collection of these data elements can help to determine and further prevent workplace outbreaks, thereby ensuring the viability of the nation's critical infrastructure.

Vaccines, Variants, and Vigilance: Strengthening the Coronavirus Disease 2019 (COVID-19) Public Health Response Through Partnerships and Collaborations

The US Centers for Disease Control and Prevention (CDC); state, tribal, local, and territorial health departments; other US government departments and agencies; the private sector; and international partners have engaged in a real-time public health response to the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vaccination, variants, and vigilance were themes that arose in the second year of pandemic response in the United States. The findings included in this supplement emerged from these themes and represent some of the many collaborative efforts to improve public health knowledge and action to reduce transmission, infection, and disease severity.