Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks by Industry Sector - Utah, March 6-June 5, 2020

Correlates of and Disparities in Cancellations or Delays of Prenatal Visits During the Covid-19 Pandemic: Emphasis on Racial/Ethnic Minorities and Persons with Low Socioeconomic Status

OBJECTIVES

To investigate barriers and disparities in prenatal visits across population subgroups.

METHODS

This pooled cross-sectional study was conducted using Pregnancy Risk Assessment Monitoring System for 2020 through 2021. Women who reported their experiences of cancellation or delay in prenatal visits were included. A multivariable regression analysis estimated adjusted prevalence ratios (aPR) for cancellations or delays in prenatal care.

RESULTS

Of a total of 11,427, one-third had cancelled or delayed care. Hispanics, compared to their white counterparts, were 22% likelier to have cancelled or delayed care. Women covered by Medicaid and those with depression had 17% and 34% greater likelihoods of cancellation or delay, respectively. Cancellations or delays were comparable for the years 2020 and 2021 across reasons, except for facility closures, which were more common in 2020 than in 2021. Hispanics tended to cancel or delay prenatal visits more often than whites for reasons, such as facility closures, COVID-19-related reasons, a lack of transportation, and loss of insurance, while transportation and insurance issues were greater barriers for blacks. Women with less than a high school diploma were more likely to report cancellations or delays due to transportation issues (aPR 2.86, 95%CI 1.47-5.57; p = 0.002) and loss of insurance (aPR 4.82, 95%CI 1.64-14.23; P = 0.004).

CONCLUSIONS

While a large proportion of women experienced disruptions in prenatal care, subsets of the population, including racial/ethnic minorities and the low socioeconomically disadvantaged, faced disproportionate challenges. The current findings provide practical implications for a tailored approach to reducing barriers and disparities in prenatal care.

The Impact of the COVID-19 Pandemic on Black and Hispanic Americans' Work Outcomes: a Scoping Review

In early 2020, it was hypothesized that COVID-19 would lead to disproportionately negative health and work outcomes for Black and Hispanic adults, but sufficient data had yet been collected to fully support this claim. Now, we have empirical evidence, but little has been done to aggregate this information to fully understand its impact on these communities. Utilizing 44 articles from a scoping review of three databases (PubMed, Web of Science, and Business Source Complete), this study seeks to identify the primary work-related risks that help explain Black and Hispanic adults' disparate COVID-19-related work outcomes (e.g., loss of hours, job disruption, stress). Findings illuminate four primary risks faced by Black and Hispanic workers: (1) being an essential worker, (2) type of work performed, (3) workplace factors; and (4) community and geographic factors. We conclude with policy recommendations that will help inform policy and practice for economic recovery from the pandemic for other marginalized populations.

A SARS-CoV-2 outbreak investigation at a storage and distribution centre in England: an assessment of worker- and workplace-related risk factors

An outbreak of SARS-CoV-2 (1 March to 10 May 2021) with an attack rate of 26.5% among approximately 1150 workers at a storage and distribution centre in England prompted a multidisciplinary outbreak investigation (5 May to 6 August 2021), with the aim of better understanding worker- and workplace-related risk factors for viral transmission in the warehousing sector. Overall, environmental factors (e.g., ventilation, humidity and temperature) were assessed to be appropriate at the facility. Nevertheless, 39 (51.3%) surface samples from across the site tested positive for low/ very low levels of SARS-CoV-2 RNA (Ct value ≥ 32.0 for all). Among the study participants, of whom 35.6% were confirmed or suspected cases, 95.5% reported having received COVID-19 prevention training, 100.0% reported handwashing, and 80.0% reported use of face coverings at work. Notably, 43.9% and 19.0% reported working with a symptomatic and a positive contact respectively. Furthermore, 80.5% and 46.3% had concerns regarding reduction in their income and future unemployment, respectively, due to self-isolation. The findings of this study suggest that, in addition to targeted workplace infection control measures and tailored work area specific risk assessments, an enhanced and equitable sick leave policy may help limit presenteeism and viral transmission in large workplaces.

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.

Examining the Relationship Between Workplace Industry and COVID-19 Infection: A Cross-sectional Study of Canada's Largest Rapid Antigen Screening Program

OBJECTIVES

To control virus spread while keeping the economy open, this study aimed to identify individuals at increased risk of COVID-19 transmission in the workplace using rapid antigen screening data.

METHODS

Among adult participants in a large Canadian rapid antigen screening program (January 2021-March 2022), we examined screening, personal, and workplace characteristics and conducted logistic regressions, adjusted for COVID-19 wave, screening frequency and location, role, age group, and geography.

RESULTS

Among 145,814 participants across 2707 worksites, 6209 screened positive at least once. Workers in natural resources (odds ratio [OR] = 2.1 [1.73-2.55]), utilities (OR = 1.67 [1.38-2.03]), construction (OR = 1.35 [1.06-1.71]), and transportation/warehousing (OR = 1.32 [1.12-1.56]) had increased odds of screening positive; workers in education/health (OR = 0.62 [0.52-0.73]), leisure/hospitality (OR = 0.71 [0.56-0.90]), and finance (OR = 0.84 [0.71-0.99]) had lesser odds of screening positive, compared with professional/business services.

CONCLUSIONS

Certain industries involving in-person work in close quarters are associated with elevated COVID-19 transmission. Continued reliance on rapid screening in these sectors is warranted.

Adoption of virtual prenatal visits linked to recurrent virtual or forgone visits for postpartum care

BACKGROUND

To investigate the association between prenatal and postpartum visits, with a specific focus on the modality of these visits, and to assess whether barriers to virtual visits experienced during the prenatal period are linked to types of postpartum visits.

METHODS

The repeated cross-sectional study used the Pregnancy Risk Assessment Monitoring System from 2020 through 2021. Women who had prenatal visits and who also reported their postpartum visits were included (n = 11,258). The outcome was the modality of postpartum visits, and the key independent variable was virtual prenatal visit experience. Multinomial logistic regression analysis was performed to examine the relationship of postpartum visits with virtual prenatal visit experience.

RESULTS

Among those who had virtual prenatal visits, about one-third used virtual visits again for postpartum care. Individuals who had virtual prenatal visits showed greater odds of utilizing virtual visits (OR 8.54, 95%CI 7.05-10.35, p=<0.001) or no office visits (OR 1.61, 95%CI 1.25-2.07, p=<0.001) compared to in-person visits during the postpartum period. Women who reported a lack of virtual appointment availability (OR 0.58, 95%CI 0.40-0.86, P = 0.006) or cellular data (OR 0.18, 95%CI 0.05-0.68, p = 0.012) in their prenatal care had lower odds of virtual postpartum visits.

CONCLUSIONS

While virtual prenatal visits are linked to greater virtual visits for postpartum care, they are also associated with increased forgone care. The unavailability of virtual appointments and cellular data is a significant barrier to virtual visits. The findings provide practical implications for advancing equitable and sustainable care in a rapidly changing healthcare landscape.

Managing the unknown or the art of preventing SARS-CoV-2 infection in workplaces in a context of evolving science, precarious employment, and communication barriers. A qualitative situational analysis in Quebec and Ontario

Introduction

The issue of communications in the public space, and in particular, in the workplace, became critical in the early stages of the SARS-CoV-2 pandemic and was exacerbated by the stress of the drastic transformation of the organization of work, the speed with which new information was being made available, and the constant fear of being infected or developing a more severe or even fatal form of the disease. Although effective communication is the key to fighting a pandemic, some business sectors were more vulnerable and affected than others, and the individuals in particular socio-demographic and economic categories were proportionately more affected by the number of infections and hospitalizations, and by the number of deaths. Therefore, the aim of this article is to present data related to issues faced by essential workers interacting with the public and their employers to mitigate the contagion of SARS-CoV-2 (COVID-19) at work.

Methods

Following the constructivist paradigm, an interpretative qualitative design was used to conduct one-on-one interviews with precarious/low-wage, public-contact workers (N = 40), managers (N = 16), and key informants (N = 16) on topics related to their work environments in the context of COVID-19 prevention.

Results

This article has highlighted some aspects of communication in the workplace essential to preventing COVID-19 outbreaks (e.g., access to information in a context of fast-changing instructions, language proficiency, transparency and confidentiality in the workplace, access to clear guidelines). The impact of poor pre-pandemic working relations on crisis management in the workplace also emerged.

Discussion

This study reminds us of the need to develop targeted, tailored messages that, while not providing all the answers, maintain dialog and transparency in workplaces.

Why presumptions are important in occupational health: The example of COVID-19 infection as an occupational disease

Workers who become ill or injured on the job while undertaking extraordinary risks on behalf of the public are, at times, granted facilitated access to workers' compensation (WC) benefits through the application of presumptions in the compensation process. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, a broad range of occupational groups faced an elevated risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure at work to perform vital services to maintain our food supply, sustain needed transportation, provide health care, assure energy supply and others. Some states or jurisdictions in the United States recognized both the risk and the service of these workers by enacting COVID-19 presumption laws to streamline selected essential workers' eligibility for WC benefits. Other states did not. Results of these contrasting public approaches permit an examination of the impact of presumptions in compensation by examining the frequency and outcomes of COVID-19 claims in "COVID-19 presumption" and "nonpresumption" states. Despite state-level variations in economic response to the pandemic, industry mix, and presumption eligibility criteria, the use of COVID-19 presumptions appears to have substantially increased claim filing rates and improved access to benefits. Lastly, the additional costs of COVID-19 claims to employers and insurers were lower than initially predicted. In response to future airborne infectious disease outbreaks, workers' compensation presumption laws should be universally implemented to permit a broad range of high-risk workers to work on the public's behalf without fear of losing wages and incurring medical expenses associated with a work-related viral exposure.

Temporal assessment of disparities in California COVID-19 mortality by industry: a population-based retrospective cohort study

PURPOSE

To assess changes in the COVID-19 mortality rate and disparities over variants or waves by industry.

METHODS

We identified COVID-19 deaths that occurred between January 2020 and May 2022 among California workers aged 18-64 years using death certificates, and estimated Californians at risk using the Current Population Survey. The waves in deaths were wave 1: March-June 2020, wave 2: July-November 2020, wave 3/Epsilon and Alpha variants: December 2020-May 2021, wave 4/Delta variant: June 2021-January 2022, and wave 5/Omicron variant: February-May 2022. We used Poisson regression to generate wave-specific mortality rate ratios (MRR) and included an interaction term between industry and wave in different models to assess significance of the change in MRR.

RESULTS

In all waves of the pandemic, healthcare, other services, manufacturing, transportation, and retail trade industries had higher mortality rates than the professional, scientific, and technical industry. The healthcare industry had the highest relative rate earlier in the pandemic, while other services, utilities, and accommodation and food services industries had substantial increases in MRR in later waves.

CONCLUSIONS

Industries that consistently had disproportionate COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes.

Reasons for Not Pursuing Virtual Prenatal Care in 2020 Through 2021 and Policy Implications

Aim: To investigate patterns of virtual prenatal visits and examine reasons for not pursuing virtual visits for prenatal care. Methods: A pooled cross-sectional study used Pregnancy Risk Assessment Monitoring System from October 2020 through June 2021, a nationally representative surveillance system targeted at women who recently gave live birth. Individuals (n = 11,829) who reported their prenatal care experiences were included. A modified poison regression estimated prevalence ratios for virtual prenatal visits and reasons for not using virtual services. Results: One-third of participants used virtual prenatal care. Hispanics were more likely to use virtual prenatal care than whites. Compared with college graduates, those with high school graduation (Prevalence Ratios [PR] 0.87, 95% confidence interval [CI] 0.76-0.99; p = 0.033) or some college education (PR 0.86, 95% CI 0.77-0.96; p = 0.009) were less likely to use virtual visits. A preference for in-person was the most common reason for not pursuing virtual visits (77.1%), followed by no available virtual appointments (29.5%), technology barriers (6.1%), and no private space (1.7%). Individuals with less than or with high school graduation had 4.16 times (95% CI 2.32-7.46; p ≤ 0.001) and 2.72 times (95% CI 1.67-4.43; p ≤ 0.001) greater technology barriers, and 10.03 times (95% CI 3.42-29.46; p ≤ 0.001) and 4.29 times (95% CI 1.56-11.80; p = 0.005) greater likelihood of lacking private space, respectively, while they had a lesser in-person preference. Conclusions: In a disrupted health care landscape, barriers to accessing virtual prenatal care may have further exacerbated access to care and effective management of pregnancy among those underserved. The findings provide practical implications for safe and effective prenatal care.

Occupational Contributions to Respiratory Health Disparities

Occupation is an important contributor to disparities in respiratory disease, affecting financial status, health-care access, and exposure to hazardous substances. Although occupation and associated exposures are included in the socioecological models, work exposures remain persistently absent from research on health inequities and their contribution to health. This article focuses on the occupational contribution to disparities in asthma, chronic obstructive pulmonary disease, silicosis, coronavirus disease 2019, and lung cancer. Because occupational exposures are largely preventable through proper workplace controls, the recognition of occupational causes of disease can provide an opportunity for interventions to bring about health equity.

Occupational COVID-19 Exposures and Illnesses among Workers in California-Analysis of a New Occupational COVID-19 Surveillance System

Little is known about occupational SARS-CoV-2 exposures and COVID-19 outcomes. We established a Doctor's First Reports of Occupational Injury or Illness (DFR)-based surveillance system to study cases of work-related COVID-19 exposures and disease. The surveillance data included demographics, occupation, industry, exposure, and illness, details including hospitalization and lost work. We classified workers into 'healthcare', non-healthcare 'public-facing', or 'other' worker groups, and rural-urban commuting areas (RUCAs). We describe worker exposures and outcomes overall by worker group and RUCA. We analyzed 2848 COVID-19 DFRs representing workers in 22 detailed occupation groups and 19 industry groups. Most DFRs were for workers in metropolitan RUCAs (89%) and those in healthcare (42%) and public-facing (24%) worker groups. While DFRs were from 382 unique worksites, 52% were from four hospitals and one prison. Among 1063 DFRs with a suspected exposure, 73% suspected exposure to a patient or client. Few DFRs indicated hospitalization (3.9%); however, the proportion hospitalized was higher among nonmetropolitan (7.4%) and public-facing (6.7%) workers. While 56% of DFRs indicated some lost work time, the proportion was highest among public-facing (80%) workers. Healthcare and prison workers were the majority of reported occupational COVID-19 exposures and illnesses. The risk of COVID-19 hospitalization and lost work may be highest among nonmetropolitan and public-facing workers.

Increased Hospitalizations Involving Fungal Infections during COVID-19 Pandemic, United States, January 2020-December 2021

Hospitalizations involving fungal infections increased 8.5% each year in the United States during 2019-2021. During 2020-2021, patients hospitalized with COVID-19-associated fungal infections had higher (48.5%) in-hospital mortality rates than those with non-COVID-19-associated fungal infections (12.3%). Improved fungal disease surveillance is needed, particularly during respiratory virus pandemics.

Decisions about College Football during Covid-19: An Ethical Analysis

This manuscript uses competitive college football as a lens into the complexities of decision-making amid the Covid-19 pandemic. Pulling together what is known about the decision-makers, the decision-making processes, the social and political context, the risks and benefits, and the underlying obligations of institutions to these athletes, we conduct an ethical analysis of the decisions surrounding the 2020 fall football season. Based on this ethical analysis, we provide key recommendations to improve similar decision processes moving forward.

Neighborhood Socioeconomic Characteristics Associated with the COVID-19 Incidence in Elementary School Children: An Ecological Study in Osaka City, Japan

We aimed to determine whether neighborhood socioeconomic characteristics are associated with the coronavirus disease 2019 (COVID-19) incidence in elementary school children and, if so, the associated characteristics. We obtained data on the number of infected children from 282 public elementary schools and the socioeconomic characteristics of each school district in Osaka City, Japan. We examined associations between these variables through negative binomial regression analyses. The proportion of employment in the wholesale and retail trade industry and the college graduation rate were significantly positively and negatively associated, respectively, with the total number of COVID-19-infected children. It was discovered that percentages of employment in the accommodation and food service industries in Wave 2, wholesale and retail trade industries after Wave 3, and healthcare and social assistance industries in Wave 5 were significantly positively associated with the number of infected children; likewise, the college graduation rate in Wave 5 was significantly negatively associated with the number of infected children. Our findings provide insight into the relevant and important areas of focus for public health policymakers and practitioners to ensure reduced disparities in COVID-19 infection rates.

COVID-19 Clusters and Outbreaks Among Non-Health Care, Noncongregate Workers in Chicago, Illinois: Surveillance Through the First Omicron Wave

OBJECTIVE

To describe COVID-19 investigations by a large urban health department among non-health care, noncongregate workplaces and the utility of surveillance methods over time.

METHODS

Frequencies of workplace-associated clusters and outbreaks are described by workplace type, workforce size, and method of identification over time.

RESULTS

From April 2020 through January 2022, 496 COVID-19 investigations identified 442 clusters (89%) and 54 outbreaks (11%). Frontline essential workplaces comprised 36% of investigations before versus 15% after vaccine eligibility. Pre-Omicron, most investigations (84%) were identified through case interviews. During Omicron predominance, case interviews decreased dramatically and identified 10% of investigations. Offices (41%) and bars and restaurants (36%) were overrepresented, and only one outbreak was identified, given decreases in confirmatory testing.

CONCLUSIONS

Findings suggest that vaccine prioritization reduced COVID-19 burden among highest-risk workplaces, but surveillance methods likely became less representative over time.

Local health department engagement with workplaces during the COVID-19 pandemic—Examining barriers of and facilitators to outbreak investigation and mitigation

Objectives

To document local health department (LHD) COVID-19 prevention or mitigation activities at workplaces in the United States and identify facilitators for and barriers to these efforts.

Methods

We conducted a web-based, cross-sectional national probability survey of United States LHDs (n = 181 unweighted; n = 2,284 weighted) from January to March 2022, collecting information about worker complaints, surveillance, investigations, relationships and interactions with employers/businesses, and LHD capacity.

Results

Overall, 94% LHD respondents reported investigating workplace-linked COVID-19 cases; however, 47% reported insufficient capacity to effectively receive, investigate and respond to COVID-19-related workplace safety complaints. Prior relationships with jurisdiction employers and LHD personnel with formal occupational health and safety (OHS) training were predictors of proactive outreach to prevent COVID-19 spread in workplaces (p &lt; 0.01 and p &lt; 0.001). LHD size predicted OHS personnel and sufficient financial resources to support workplace investigation and mitigation activities (p &lt; 0.001).

Conclusions

Differences in LHD capacity to effectively respond to communicable disease spread in workplaces may exacerbate health disparities, especially between rural and urban settings. Improving LHD OHS capacity, especially in smaller jurisdictions, could facilitate effective prevention and mitigation of workplace communicable disease spread.

Evaluating the association between in-person work and the risk of SARS-CoV-2 infection through June 2021

OBJECTIVES

Recent studies have evaluated COVID-19 outbreaks and excess mortality by occupation sectors. Studies on SARS-CoV-2 infection across occupation and occupation-related factors remain lacking. In this study, we estimate the effect of in-person work on SARS-CoV-2 infection risk and describe SARS-CoV-2 seroprevalence among working adults.

METHODS

We used Wave 1 data (May to June 2021) from CalScope, a population-based seroprevalence study in California. Occupation data were coded using the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System. Dried blood spot specimens were tested for antibodies to establish evidence of prior infection. We estimated the causal effect of in-person work on SARS-CoV-2 infection risk using the g-formula and describe SARS-CoV-2 seroprevalence across occupation-related factors.

RESULTS

Among 4335 working adults, 53% worked in person. In-person work was associated with increased risk of prior SARS-CoV-2 infection (risk difference: 0.03; [95% CI: 0.02-0.04]) compared with working remotely. Workers that reported job loss or who were without medical insurance had higher evidence of prior infection. Amongst in-person workers, evidence of prior infection was highest within farming, fishing, and forestry (55%; [95% CI: 26%-81%]); installation, maintenance, and repair (23%; [12%-39%]); building and grounds cleaning and maintenance (23%; [13%-36%]); food preparation and serving related (22% [13%-35%]); and healthcare support (22%; [13%-34%]) occupations. Workers who identified as Latino, reported a household income of <$25K, or who were without a bachelor's degree also had higher evidence of prior infection.

CONCLUSIONS

SARS-CoV-2 infection risk varies by occupation. Future vaccination strategies may consider prioritizing in-person workers.

"What's going on?" Racism, COVID-19, and centering the voices of Black youth

This study examined the impact of COVID-19 stress and experiences of racism on COVID-19 adaptability and activism among Black youth. The protective role of perceived peer and adult social support were examined. Data were analyzed from 123 Black youth (M_age  = 15.44, 63% girls) from a school district in the Midwest. The findings revealed that more social support from adults increased Black youth adaptability (e.g., "ability to think through possible options to assist in the COVID-19 pandemic"). Perceived lower social support from adults predicted higher engagement in high-risk activism, and higher levels of peer social support were associated with higher levels of high-risk activism. Further, Black youth reporting higher levels of racism and adult social support were more likely to report higher levels of COVID-19 adaptability. Black youth reporting higher racism and peer social support engaged in high-risk activism. Black youth who reported high levels of racism and low perceived adult social support reported higher engagement in high-risk activism. Research and practice implications that support Black youth during the COVID-19 pandemic and the impact of racism and COVID-19 stress on well-being and activism are discussed.

COVID-19 Incidence and Vaccine Effectiveness in University Staff, 1 March 2020-2 April 2022

Background: University workers undergo intense social interactions due to frequent contact with students and colleagues and lectures in crowdy conditions. The aim of our study was to assess the incidence of COVID-19 infection and vaccine effectiveness in a cohort of workers of the University of Trieste from 1 March 2020 (start of the pandemic) through 2 April 2022. Methods: The University of Trieste implemented a number of public health policies to contain the spread of SARS-CoV-2 on the campus, including prompt contact tracing, enhanced ventilation of all premises, fomites disinfection and mandatory use of face masks indoors. In compliance with the surveillance protocol of the local public health department, university personnel were tested for SARS-CoV-2 by polymerase chain reaction (PCR) on a nasopharyngeal swab on demand, in the event of symptoms consistent with COVID-19 or for contact tracing, following close contact with a confirmed COVID-19 case. The incidence rates of SARS-CoV-2 infections were estimated as number of cases by number of person-days (p-d) at risk. Multivariable Cox proportional hazard regression model was employed to investigate the risk of primary COVID-19 infection, controlling for a number of potential confounders and expressing the risk as the adjusted hazard ratio (aHR) with a 95% confidence interval (95% CI). Results: The incidence of SARS-CoV-2 infection among university staff was lower than that of healthcare workers (HCWs) of the same area. Compared to unvaccinated colleagues (6.55 × 10,000 p-d), the raw incidence of SARS-CoV-2 infection was higher among university workers immunized with one (7.22 × 10,000 p-d) or two (7.48 × 10,000 p-d) doses of COVID-19 vaccines, decreasing in those receiving the booster (1.98 × 1000 p-d). The risk of infection increased only in postgraduate medical trainees (aHR = 2.16; 95% CI: 1.04; 4.48), though this was limited to the Omicron transmission period. After the implementation of the national vaccination campaign against COVID-19, workers immunized with the booster were less likely than unvaccinated workers to be infected by SARS-CoV-2 both before (aHR = 0.10; 95% CI: 0.06; 0.16) and after (aHR = 0.37; 95% CI: 0.27; 0.52) the Omicron transmission period. Vaccine effectiveness of the booster was 90% (=(1-0.10) × 100) before versus 63% (=(1-0.37) × 100) during the Omicron wave, without a significant difference between homologous (three doses of m-RNA vaccines) and heterologous immunization (first two doses of Vaxzevria followed by a third dose of m-RNA vaccine). Conclusions: The incidence of SARS-CoV-2 infection in university staff was lower than that of HCWs of ASUGI, likely because the testing-on-demand schedule inevitably missed the vast majority of asymptomatic infections. Therefore, the observed significantly protective effect of the booster dose in university personnel referred to symptomatic SARS-CoV-2 infections. The infection prevention and control policies implemented by the University of Trieste managed to equalize the biological risk between administrative and teaching staff.

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.

SARS-CoV-2 Seroprevalence in Employees of Four Essential Non-Health Care Sectors at Moderate/High Risk of Exposure to Coronavirus Infection: Data From the "First Wave"

OBJECTIVE

The aim of this study was to evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in Swiss non-health care employees at a moderate to high risk of exposure: bus drivers and supermarket, laundry service, and mail-sorting center employees.

METHODS

Data on 455 essential workers included demographics, SARS-CoV-2 exposure and use of protective measures. Anti-SARS-CoV-2 immunoglobulins G and A targeting the spike protein were measured between May and July 2020.

RESULTS

The overall crude seroprevalence estimate (15.9%; 95% confidence interval [CI], 12.6% to 19.7%) among essential workers was not significantly higher than that of the general working-age population (11.2%; 95% CI, 7.1% to 15.2%). Seroprevalence ranged from 11.9% (95% CI, 6.3% to 19.8%) among bus drivers to 22.0% (95% CI, 12.6% to 19.7%) among food supermarket employees.

CONCLUSIONS

We found no significant difference in seroprevalence between our sample of essential workers and local working-age population during the first lockdown phase of the COVID-19 pandemic. Having a seropositive housemate was the strongest predictor of SARS-CoV-2 seropositivity.

Lost time: COVID-19 indemnity claim reporting and results in the Wisconsin workers' compensation system from March 12 to December 31, 2020

BACKGROUND

The COVID-19 pandemic introduced a new compensable infectious disease to workplaces.

METHODS

This was a descriptive analysis of Wisconsin COVID workers' compensation (WC) claims between March 12 and December 31, 2020. The impact of the presumption law (March 12 to June 10, 2020) was also evaluated.

RESULTS

Less than 1% of working-age residents with COVID-19 filed a claim. COVID-19 WC claim rates (per 100,000 FTE) were notably low for frontline industry sectors such as Retail Trade (n = 115), Manufacturing (n = 88), and Wholesale Trade (n = 31). Healthcare workers (764 claims per 100,000 FTE) comprised 73.2% of COVID-19 claims. Most claims (52.8%) were denied and the proportion of denied claims increased significantly after the presumption period for both first responders and other occupations.

CONCLUSION

The presumption law made benefits accessible primarily to first responders. Further changes to WC systems are needed to offset the individual and collective costs of infectious diseases.

COVID-19 in non-healthcare workplace settings in NSW, Australia

OBJECTIVES

To describe patterns of SARS-CoV-2 transmission in non-healthcare workplace settings during the first six months of COVID-19 spread, in New South Wales (NSW), Australia.

METHODS

Locally acquired COVID-19 cases between February 2020 and August 2020 were reviewed to determine the: total number of workplace-associated cases and clusters; workplace type; and modes of transmission.

RESULTS

There were 72 COVID-19 workplace clusters with 231 cases and an additional 11 workplace-acquired cases who were not part of a cluster. Workplaces most associated with clusters included construction, manufacture and trade (31%, 22 clusters), office and clerical (25%, 18 clusters) and retail (14%, 10 clusters). Most transmission events were best explained by direct transmission, with two workplace clusters demonstrating evidence of partial indirect spread.

CONCLUSIONS

Findings demonstrate workplace settings, particularly construction, office and retail settings have heightened risk of transmission.

IMPLICATIONS FOR PUBLIC HEALTH

The risk of infectious disease transmission is well understood for healthcare workers, despite other workplace types representing higher volumes of workers with less risk controls. This study should assist policy makers and the public to understand COVID-19 transmission in workplaces and the heightened risks associated with certain workplace settings.

One year into the pandemic: the impacts of social vulnerability on COVID-19 outcomes and urban-rural differences in the conterminous United States

This paper first explores spatial distributions and patterns of COVID-19 case rates (cases/100,000 people) and mortality rates (deaths/100,000 people) and their disparities between urban and rural counties in the contiguous US. A county-level social vulnerability index was created using principal component analysis. Social vulnerability components were regressed against both county case and mortality rates. Results suggest that hotspots of case and mortality rates are clustered in Midwest and Upper-Midwest US. We found substantial disparities in case and mortality rates between urban and rural counties. County social vulnerability was positively correlated with both case and mortality rates suggesting counties with higher social vulnerability had higher case and mortality rates. Relationships between social vulnerability components and case and mortality rates vary across the conterminous US. Additionally, counties with increased racial and ethnic minorities, higher percentages of minors, and lower median household income are associated with higher COVID-19 case and mortality rates.

Characteristics Associated With a Previous COVID-19 Diagnosis, Vaccine Uptake, and Intention to Be Vaccinated Among Essential Workers in the US Household Pulse Survey

Objectives. To explore previous COVID-19 diagnosis and COVID-19 vaccination status among US essential worker groups. Methods. We analyzed the US Census Household Pulse Survey (May 26-July 5, 2021), a nationally representative sample of adults aged 18 years and older. We compared currently employed essential workers working outside the home with those working at home using adjusted prevalence ratios. We calculated proportion vaccinated and intention to be vaccinated, stratifying by essential worker and demographic groups for those who worked or volunteered outside the home since January 1, 2021. Results. The proportion of workers with previous COVID-19 diagnosis was highest among first responders (24.9%) working outside the home compared with workers who did not (13.3%). Workers in agriculture, forestry, fishing, and hunting had the lowest vaccination rates (67.5%) compared with all workers (77.8%). Those without health insurance were much less likely to be vaccinated across all worker groups. Conclusions. This study underscores the importance of improving surveillance to monitor COVID-19 and other infectious diseases among workers and identify and implement tailored risk mitigation strategies, including vaccination campaigns, for workplaces. (Am J Public Health. 2022;112(11):1599-1610. https://doi.org/10.2105/AJPH.2022.307010).

High Uptake and Series Completion of COVID-19 Vaccine at Community-Based Vaccination for Latinos With Limited English Proficiency

BACKGROUND

Despite the disproportionate impact of COVID-19 on Latinos, there were disparities in vaccination, especially during the early phase of COVID-19 immunization rollout.

METHODS

Leveraging a community-academic partnership established to expand access to SARS-CoV2 testing, we implemented community vaccination clinics with multifaceted outreach strategies and flexible appointments for limited English proficiency Latinos.

RESULTS

Between February 26 and May 7 2021, 2250 individuals received the first dose of COVID-19 vaccination during 18 free community events. Among them, 92.4% (95% confidence interval [CI], 91.2%-93.4%) self-identified as Hispanic, 88.7% (95% CI, 87.2%-89.9%) were limited English proficiency Spanish speakers, 23.1% (95% CI, 20.9%-25.2%) reported prior COVID-19 infection, 19.4% (95% CI, 16.9%-22.25%) had a body mass index of more than 35, 35.0% (95% CI, 32.2%-37.8%) had cardiovascular disease, and 21.6% (95% CI, 19.2%-24.0%) had diabetes. The timely second-dose completion rate was high (98.7%; 95% CI, 97.6%-99.2%) and did not vary by outreach method.

CONCLUSION

A free community-based vaccination initiative expanded access for Latinos with limited English proficiency at high risk for COVID-19 during the early phase of the immunization program in the US.

Missing science: A scoping study of COVID-19 epidemiological data in the United States

Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.

Occupational characteristics associated with SARS-CoV-2 infection in the UK Biobank during August-November 2020: a cohort study

BACKGROUND

Occupational exposures may play a key role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk. We used a job-exposure matrix linked to the UK Biobank to measure occupational characteristics and estimate associations with a positive SARS-CoV-2 test.

METHODS

People reporting job titles at their baseline interview in England who were < 65 years of age in 2020 were included. Healthcare workers were excluded because of differential access to testing. Jobs were linked to the US Occupational Information Network (O*NET) job exposure matrix. O*NET-based scores were examined for occupational physical proximity, exposure to diseases/infection, working outdoors exposed to weather, and working outdoors under cover (score range = 1-5). Jobs were classified as remote work using two algorithms. SARS-CoV-2 test results were evaluated between August 5th-November 10th, 2020, when the UK was released from lockdown. Cox regression was used to calculate adjusted hazard ratios (aHRs), accounting for age, sex, race, education, neighborhood deprivation, assessment center, household size, and income.

RESULTS

We included 115,451 people with job titles, of whom 1746 tested positive for SARS-CoV-2. A one-point increase in physical proximity score was associated with 1.14 times higher risk of SARS-CoV-2 (95%CI = 1.05-1.24). A one-point increase in the exposure to diseases/infections score was associated with 1.09 times higher risk of SARS-CoV-2 (95%CI = 1.02-1.16). People reporting jobs that could not be done remotely had higher risk of SARS-CoV-2 regardless of the classification algorithm used (aHRs = 1.17 and 1.20). Outdoors work showed an association with SARS-CoV-2 (exposed to weather aHR = 1.06, 95%CI = 1.01-1.11; under cover aHR = 1.08, 95%CI = 1.00-1.17), but these associations were not significant after accounting for whether work could be done remotely.

CONCLUSION

People in occupations that were not amenable to remote work, required closer physical proximity, and required more general exposure to diseases/infection had higher risk of a positive SARS-CoV-2 test. These findings provide additional evidence that coronavirus disease 2019 (COVID-19) is an occupational disease, even outside of the healthcare setting, and indicate that strategies for mitigating transmission in in-person work settings will remain important.

Transmission and Control of SARS-CoV-2 in the Food Production Sector: A Rapid Narrative Review of the Literature

This review aimed to provide an overview of the literature assessing the extent of COVID-19 transmission in the food processing sector along with the risk factors associated with COVID-19 infection/mortality rates in this setting, and the preventive measures used to reduce transmission. An electronic search was conducted using scientific databases, including Web of Science, OVID, PubMed and MedRxiv. The search strategy identified 26 papers that met the inclusion criteria. Six of these studies were based in the UK and the country with the most papers was the USA, with a total of nine papers. Findings showed some evidence of a high transmission level of SARS-CoV-2 within some areas of the food production sector. Risk factors associated with the spread included ethnicity, poor ventilation, lack of social distancing and lack of sick pay. The preventative measures included/recommended were social distancing, testing, adequate ventilation, cleaning regimes and access to PPE. Additional research focusing on the food production sector could show the potential variations in transmission and risk between each sub-sector. Future research focusing on the application of various preventative measures and their efficacy by sub-sector would be beneficial, while further qualitative research could help provide in-depth information regarding knowledge gaps.

Seasonal farm labor and COVID-19 spread

The COVID-19 pandemic in 2020 caused unprecedented shocks to agricultural food systems, including increased risk to worker health, labor-related input costs, and production uncertainty. Despite employer precautions, there were numerous worksite outbreaks of COVID-19. This paper examines the relationship between month-to-month variation in historical agricultural employment and changes in the incidence of confirmed COVID-19 cases and deaths within U.S. counties from April to August 2020. The results show that employment of 100 additional workers in fruit, vegetable, and horticultural production was associated with 4.5% more COVID-19 cases within counties or an additional 18.65 COVID-19 cases and 0.34 additional COVID-19 deaths per 100,000 individuals in the county workforce.

Worker Perspectives on COVID-19 Risks: A Qualitative Study of Latino Construction Workers in Oakland, California

Latino construction workers in the U.S. have faced a disproportionate risk for COVID-19 infection in the workplace. Prior studies have focused on quantifying workplace risk for COVID-19 infection; few have captured workers' experiences and perspectives. This study describes COVID-19-related workplace risks from the perspectives of Latino construction workers. We conducted a qualitative study using semi-structured phone interviews with Latino construction workers from the Fruitvale District of Oakland, California. Twenty individuals were interviewed from December 2020 to March 2021. Nearly all participants (19/20) were Spanish-speaking men; mean age 42.6 years. The majority were low-income and over one-third did not have health insurance. Participants worked in varied construction-related jobs ranging from demolition to office work; additionally, four were day laborers, and three belonged to a labor union. We identified four major themes with public health policy and workplace safety implications: (1) Major concern about the risk of SARS-CoV-2 infection for family health and economic wellbeing; (2) Clarity about mask use and social distancing but not disclosure; (3) Variability in access to additional resources provided by employers; and (4) Uncertainty around structural support for SARS-CoV-2 quarantine/isolation. Our findings provide further evidence from workers' own perspectives of the major gaps experienced during the pandemic in workplace protections and resources.

Workplaces Most Affected by COVID-19 Outbreaks in California, January 2020-August 2021

Objectives. To describe which industries have the highest burden of COVID-19 outbreaks in California. Methods. We assigned US census industry codes to COVID-19 outbreaks reported to the California Department of Public Health (CDPH) from January 1, 2020, to August 31, 2021, and determined numbers of outbreaks, numbers of outbreak-associated cases, and outbreak incidence levels by industry. We determined characteristics of outbreak-associated cases using individual case data linked to COVID-19 outbreaks. Results. Local health departments reported 19 893 COVID-19 outbreaks and 300 379 outbreak-associated cases to CDPH. The most outbreaks (47.8%) and outbreak-associated cases (54.8%) occurred in the health care and social assistance sector, where outbreak incidence levels were highest in skilled nursing facilities and residential care facilities (1306 and 544 outbreaks per 1000 establishments, respectively). High proportions of outbreaks also occurred in the retail trade (8.6%) and manufacturing (7.9%) sectors. Demographics of outbreak-associated cases varied across industries. Conclusions. Certain California industries, particularly in the health care, manufacturing, and retail sectors, have experienced a high burden of COVID-19 outbreaks during the pandemic. Public Health Implications. Tracking COVID-19 outbreaks by industry may help target prevention efforts, including workforce vaccination. (Am J Public Health. 2022;112(8):1180-1190. https://doi.org/10.2105/AJPH.2022.306862).

Close physical proximity on the job-An exposure matrix

BACKGROUND

The workplace is a setting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission via respiratory droplets and aerosols for those working in close proximity to others. Currently, limited methods exist for assessing SARS-CoV-2 exposure. Since occupation serves as a surrogate measure, job exposure matrices (JEMs) can be useful for population-based exposure assessment for a portion of exposure.

METHODS

We developed a JEM to assess physical proximity at work. Scores for questions related to frequency of face-to-face discussions, working closely with others, and working with a team were extracted from a US-based, comprehensive source of descriptive occupational information (Occupational Information Network [O*NET]). We described score distributions using univariate analyses, devised thresholds, and assigned exposure levels for 968 O*NET occupations. Three exposure measures were constructed using combinations of O*NET data, with expert judgment, and accounting for telework. National and California employment estimates were used to assess the workforce proportions by proximity level and demographic characteristics.

RESULTS

We categorized 535 US Census occupations (2010) into four-level ordinal exposure levels (not close to very close). Overall, an estimated 56% of the California workforce worked in very close proximity, which decreased to 46% when accounting for telework. The occupational groups working very close across all three measures were: healthcare support, healthcare practitioner, food preparation and serving, building and grounds cleaning and maintenance, and protective service occupations. Latinos and women were overrepresented within occupations working in very close physical proximity.

CONCLUSION

JEMs can inform SARS-CoV-2 exposure assessment for epidemiologic studies, assist in resource allocation, and inform prevention strategies.

Racial and ethnic disparities in coronavirus disease 2019 disease incidence independent of comorbidities, among people with HIV in the United States

OBJECTIVES

To define the incidence of clinically detected coronavirus disease 2019 (COVID-19) in people with HIV (PWH) in the United States and evaluate how racial and ethnic disparities, comorbidities, and HIV-related factors contribute to risk of COVID-19.

DESIGN

Observational study within the CFAR Network of Integrated Clinical Systems cohort in seven cities during 2020.

METHODS

We calculated cumulative incidence rates of COVID-19 diagnosis among PWH in routine care by key characteristics including race/ethnicity, current and lowest CD4+ cell count, and geographic area. We evaluated risk factors for COVID-19 among PWH using relative risk regression models adjusted with disease risk scores.

RESULTS

Among 16 056 PWH in care, of whom 44.5% were black, 12.5% were Hispanic, with a median age of 52 years (IQR 40-59), 18% had a current CD4+ cell count less than 350 cells/μl, including 7% less than 200; 95.5% were on antiretroviral therapy (ART), and 85.6% were virologically suppressed. Overall in 2020, 649 PWH were diagnosed with COVID-19 for a rate of 4.94 cases per 100 person-years. The cumulative incidence of COVID-19 was 2.4-fold and 1.7-fold higher in Hispanic and black PWH respectively, than non-Hispanic white PWH. In adjusted analyses, factors associated with COVID-19 included female sex, Hispanic or black identity, lowest historical CD4+ cell count less than 350 cells/μl (proxy for CD4+ nadir), current low CD4+ : CD8+ ratio, diabetes, and obesity.

CONCLUSION

Our results suggest that the presence of structural racial inequities above and beyond medical comorbidities increased the risk of COVID-19 among PWH. PWH with immune exhaustion as evidenced by lowest historical CD4+ cell count or current low CD4+ : CD8+ ratio had greater risk of COVID-19.

"Should I stay or should I go?" Nurses' perspectives about working during the Covid-19 pandemic's first wave in the United States: A summative content analysis combined with topic modeling

BACKGROUND

The COVID-19 pandemic had its first peak in the United States between April and July of 2020, with incidence and prevalence rates of the virus the greatest in the northeastern coast of the country. At the time of study implementation, there were few studies capturing the perspectives of nurses working the frontlines of the pandemic in any setting as research output in the United States focused largely on treating the disease.

OBJECTIVE

The purpose of this study was to capture the perspectives of nurses in the United States working the frontlines of the COVID-19 pandemic's first wave. We were specifically interested in examining the impact of the pandemic on nurses' roles, professional relationships, and the organizational cultures of their employers.

DESIGN

We conducted an online qualitative study with a pragmatic design to capture the perspectives of nurses working during the first wave of the United States COVID-19 pandemic. Through social networking recruitment, frontline nurses from across the country were invited to participate. Participants provided long form, text-based responses to four questions designed to capture their experiences. A combination of Latent Dirichlet Allocation--a natural language processing technique--along with traditional summative content analysis techniques were used to analyze the data.

SETTING

The United States during the COVID-19 pandemic's first wave between May and July of 2020.

RESULTS

A total of 318 nurses participated from 29 out of 50 states, with 242 fully completing all questions. Findings suggested that the place of work mattered significantly in terms of the frontline working experience. It influenced role changes, risk assumption, interprofessional teamwork experiences, and ultimately, likelihood to leave their jobs or the profession altogether. Organizational culture and its influence on pandemic response implementation was a critical feature of their experiences.

CONCLUSIONS

Findings suggest that organizational performance during the pandemic may be reflected in nursing workforce retention as the risk for workforce attrition appears high. It was also clear from the reports that nurses appear to have assumed higher occupational risks during the pandemic when compared to other providers. The 2020 data from this study also offered a number of signals about potential threats to the stability and sustainability of the US nursing workforce that are now manifesting. The findings underscore the importance of conducting health workforce research during a crisis in order to discern the signals of future problems or for long-term crisis response.

TWEETABLE ABSTRACT

Healthcare leaders made the difference for nurses during the pandemic. How many nurses leave their employer in the next year will tell you who was good, who wasn't.

Increased Deaths From Fungal Infections During the Coronavirus Disease 2019 Pandemic-National Vital Statistics System, United States, January 2020-December 2021

BACKGROUND

Coronavirus disease 2019 (COVID-19)-associated fungal infections cause severe illness, but comprehensive data on disease burden are lacking. We analyzed US National Vital Statistics System (NVSS) data to characterize disease burden, temporal trends, and demographic characteristics of persons dying of fungal infections during the COVID-19 pandemic.

METHODS

Using NVSS's January 2018-December 2021 Multiple Cause of Death Database, we examined numbers and age-adjusted rates (per 100 000 population) of deaths due to fungal infection by fungal pathogen, COVID-19 association, demographic characteristics, and year.

RESULTS

Numbers and age-adjusted rates of deaths due to fungal infection increased from 2019 (n = 4833; rate, 1.2 [95% confidence interval, 1.2-1.3]) to 2021 (n = 7199; rate, 1.8 [1.8-1.8] per 100 000); of 13 121 such deaths during 2020-2021, 2868 (21.9%) were COVID-19 associated. Compared with non-COVID-19-associated deaths (n = 10 253), COVID-19-associated deaths more frequently involved Candida (n = 776 [27.1%] vs n = 2432 [23.7%], respectively) and Aspergillus (n = 668 [23.3%] vs n = 1486 [14.5%]) and less frequently involved other specific fungal pathogens. Rates of death due to fungal infection were generally highest in nonwhite and non-Asian populations. Death rates from Aspergillus infections were approximately 2 times higher in the Pacific US census division compared with most other divisions.

CONCLUSIONS

Deaths from fungal infection increased during 2020-2021 compared with previous years, primarily driven by COVID-19-associated deaths, particularly those involving Aspergillus and Candida. Our findings may inform efforts to prevent, identify, and treat severe fungal infections in patients with COVID-19, especially in certain racial/ethnic groups and geographic areas.

Effect of socioeconomic factors during the early COVID-19 pandemic: a spatial analysis

Background

Spatial variability of COVID-19 cases may suggest geographic disparities of social determinants of health. Spatial analyses of population-level data may provide insight on factors that may contribute to COVID-19 transmission, hospitalization, and death.

Methods

Generalized additive models were used to map COVID-19 risk from March 2020 to February 2021 in Orange County (OC), California. We geocoded and analyzed 221,843 cases to OC census tracts within a Poisson framework while smoothing over census tract centroids. Location was randomly permuted 1000 times to test for randomness. We also separated the analyses temporally to observe if risk changed over time. COVID-19 cases, hospitalizations, and deaths were mapped across OC while adjusting for population-level demographic data in crude and adjusted models.

Results

Risk for COVID-19 cases, hospitalizations, and deaths were statistically significant in northern OC. Adjustment for demographic data substantially decreased spatial risk, but areas remained statistically significant. Inclusion of location within our models considerably decreased the magnitude of risk compared to univariate models. However, percent minority (adjusted RR: 1.06, 95%CI: 1.06, 1.07), average household size (aRR: 1.06, 95%CI: 1.05, 1.07), and percent service industry (aRR: 1.05, 95%CI: 1.04, 1.06) remained significantly associated with COVID-19 risk in adjusted spatial models. In addition, areas of risk did not change between surges and risk ratios were similar for hospitalizations and deaths.

Conclusion

Significant risk factors and areas of increased risk were identified in OC in our adjusted models and suggests that social and environmental factors contribute to the spread of COVID-19 within communities. Areas in north OC remained significant despite adjustment, but risk substantially decreased. Additional investigation of risk factors may provide insight on how to protect vulnerable populations in future infectious disease outbreaks.

An Ecological Study of COVID-19 Infection Rates within the UK Food and Drink Processing Industry

OBJECTIVES

Food processing facilities represent critical infrastructure that have stayed open during much of the COVID-19 pandemic. Understanding the burden of COVID-19 in this sector is thus important to help reduce the potential for workplace infection in future outbreaks.

METHODS

We undertook a workplace survey in the UK food and drink processing sector and collected information on workplace size, characteristics (e.g. temperature, ventilation), and experience with COVID-19 (e.g. numbers of positive cases). For each site, we calculated COVID-19 case rates per month per 1000 workers. We performed an ecological analysis using negative binomial regression to assess the association between COVID-19 rates and workplace and local risk factors.

RESULTS

Respondents from 33 companies including 66 individual sites completed the survey. COVID-19 cases were reported from the start of the pandemic up to June 2021. Respondents represented a range of industry subgroups, including grain milling/storage (n = 16), manufacture of malt (n = 14), manufacture of prepared meals (n = 12), manufacture of beverages (n = 8), distilling (n = 5), manufacture of baked goods (n = 5), and other (n = 6), with a total of 15 563 workers across all sites. Average monthly case rates per 1000 workers ranged from 0.9 in distilling to 6.1 in grain milling/storage. Incidence rate ratios were partially attenuated after adjusting for several local and workplace factors, though risks for one subgroup (grain milling/storage) remained elevated. Certain local and workplace characteristics were related to higher infection rates, such as higher deprivation (5 km only), a lower proportion of remote workers, lower proportion of workers in close proximity, and higher numbers of workers overall.

CONCLUSIONS

Our analysis suggests some heterogeneity in the rates of COVID-19 across sectors of the UK food and drink processing industry. Infection rates were associated with deprivation, the proportions of remote workers and workers in close proximity, and the number of workers.

Incidence of outbreak-associated COVID-19 cases by industry in Ontario, Canada, 1 April 2020-31 March 2021

OBJECTIVES

The objective of our study was to estimate the rate of workplace outbreak-associated cases of COVID-19 by industry in labour market participants aged 15-69 years who reported working the majority of hours outside the home in Ontario, Canada.

METHODS

We conducted a population-based cross-sectional study of COVID-19 workplace outbreaks and associated cases reported in Ontario between 1 April 2020 and 31 March 2021. All outbreaks were manually classified into two-digit North American Industry Classification System codes. We obtained monthly denominator estimates from the Statistics Canada Labour Force Survey to estimate the incidence of outbreak-associated cases per 100 000 000 hours among individuals who reported the majority of hours were worked outside the home. We performed this analysis across industries and in three distinct time periods.

RESULTS

Overall, 12% of cases were attributed to workplace outbreaks among working-age adults across our study period. While incidence varied across the time periods, the five industries with the highest incidence rates across our study period were agriculture, healthcare and social assistance, food manufacturing, educational services, and transportation and warehousing.

CONCLUSIONS

Certain industries have consistently increased the incidence of COVID-19 over the course of the pandemic. These results may assist in ongoing efforts to reduce transmission of COVID-19 by prioritising resources, as well as industry-specific guidance, vaccination and public health messaging.

Investigation of a SARS-CoV-2 Outbreak at an Automotive Manufacturing Site in England

Workplace-related outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to occur globally. The manufacturing sector presents a particular concern for outbreaks, and a better understanding of transmission risks are needed. Between 9 March and 24 April 2021, the COVID-19 (coronavirus disease 2019) Outbreak Investigation to Understand Transmission (COVID-OUT) study undertook a comprehensive investigation of a SARS-CoV-2 outbreak at an automotive manufacturing site in England. The site had a total of 266 workers, and 51 SARS-CoV-2 infections. Overall, ventilation, humidity, and temperature at the site were assessed to be appropriate for the number of workers and the work being conducted. The company had implemented a number of infection control procedures, including provision of face coverings, spacing in the work, and welfare areas to allow for social distancing. However, observations of worker practices identified lapses in social distancing, although all were wearing face coverings. A total of 38 workers, including four confirmed cases, participated in the COVID-OUT study. The majority of participants received COVID-19 prevention training, though 42.9% also reported that their work required close physical contact with co-workers. Additionally, 73.7% and 34.2% had concerns regarding reductions in future income and future unemployment, respectively, due to self-isolation. This investigation adds to the growing body of evidence of SARS-CoV-2 outbreaks from the manufacturing sector. Despite a layered COVID-19 control strategy at this site, cases clustered in areas of high occupancy and close worker proximity.

Investigation of a SARS-CoV-2 Outbreak at an Automotive Manufacturing Site in England

Workplace-related outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to occur globally. The manufacturing sector presents a particular concern for outbreaks, and a better understanding of transmission risks are needed. Between 9 March and 24 April 2021, the COVID-19 (coronavirus disease 2019) Outbreak Investigation to Understand Transmission (COVID-OUT) study undertook a comprehensive investigation of a SARS-CoV-2 outbreak at an automotive manufacturing site in England. The site had a total of 266 workers, and 51 SARS-CoV-2 infections. Overall, ventilation, humidity, and temperature at the site were assessed to be appropriate for the number of workers and the work being conducted. The company had implemented a number of infection control procedures, including provision of face coverings, spacing in the work, and welfare areas to allow for social distancing. However, observations of worker practices identified lapses in social distancing, although all were wearing face coverings. A total of 38 workers, including four confirmed cases, participated in the COVID-OUT study. The majority of participants received COVID-19 prevention training, though 42.9% also reported that their work required close physical contact with co-workers. Additionally, 73.7% and 34.2% had concerns regarding reductions in future income and future unemployment, respectively, due to self-isolation. This investigation adds to the growing body of evidence of SARS-CoV-2 outbreaks from the manufacturing sector. Despite a layered COVID-19 control strategy at this site, cases clustered in areas of high occupancy and close worker proximity.

Job Satisfaction Level of Safety and Health Manager in Construction Industry: Pandemic Period

In a widespread social turmoil such as the Pandemic, job groups with high turnover rates and high job stress, such as the construction industry, will have a greater adverse impact than the general job group. This is to be used as basic data in preparing management plans by identifying the factors that hinder job stress and job satisfaction of construction workers. In this study, during the Pandemic period (1 September 2021 to 31 December 2021), a survey was conducted on job stress and job satisfaction among safety and health managers working at construction sites. The overall job satisfaction of workers in the construction industry was grasped by analyzing the level of correlation and the mutual influence on job stress, job satisfaction, general characteristics, and work-related characteristics. As a result, in terms of work characteristics, it was found that the smaller the working period in the current position, the more positive the job satisfaction was (p < 0.01). In addition, it was found that job satisfaction increased significantly when there was a promotion opportunity (p < 0.001). The construction industry is a job group with high basic job stress and low job satisfaction. In addition, it was evaluated that job stress increased during the pandemic.

Racial and Ethnic Disparities in Teleworking Due to the COVID-19 Pandemic in the United States: A Mediation Analysis

A growing literature has pointed out disparities in teleworking among different racial and ethnic (hereafter racial) workers. This study estimated racial disparities in teleworking due to the COVID-19 pandemic and the extent to which these disparities were mediated by four-year college education and occupation in the United States. The data source for this study was the Current Population Survey, May 2020 through July 2021. The results showed that in the reduced model, the odds for Black and Hispanic workers to telework were 35% and 55% lower, respectively, and for Asian workers 44% higher than for White workers, controlling for covariates. When four-year college education and occupation were included as mediator variables in the model, the odds for Black and Hispanic workers to telework were reduced to 7% and 16%, respectively. Overall, disparities in four-year college education and occupation explained 83% and 78% of the variation in the odds of teleworking for Black and Hispanic workers, respectively. Between the mediators, occupation explained more than 60% of the total effect. The results of this study could not rule out the possibility of racial discrimination in teleworking. Ultimately, reducing racial disparities in four-year college education and in different occupations might be a long-term solution for reducing racial disparities in teleworking.

Severe Acute Respiratory Syndrome Coronavirus 2 Cumulative Incidence, United States, August 2020-December 2020

BACKGROUND

Reported coronavirus disease 2019 (COVID-19) cases underestimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a national probability survey of US households to estimate cumulative incidence adjusted for antibody waning.

METHODS

From August-December 2020 a random sample of US addresses were mailed a survey and self-collected nasal swabs and dried blood spot cards. One adult household member completed the survey and mail specimens for viral detection and total (immunoglobulin [Ig] A, IgM, IgG) nucleocapsid antibody by a commercial, emergency use authorization-approved antigen capture assay. We estimated cumulative incidence of SARS-CoV-2 adjusted for waning antibodies and calculated reported fraction (RF) and infection fatality ratio (IFR). Differences in seropositivity among demographic, geographic, and clinical subgroups were explored.

RESULTS

Among 39 500 sampled households, 4654 respondents provided responses. Cumulative incidence adjusted for waning was 11.9% (95% credible interval [CrI], 10.5%-13.5%) as of 30 October 2020. We estimated 30 332 842 (CrI, 26 703 753-34 335 338) total infections in the US adult population by 30 October 2020. RF was 22.3% and IFR was 0.85% among adults. Black non-Hispanics (Prevalence ratio (PR) 2.2) and Hispanics (PR, 3.1) were more likely than White non-Hispanics to be seropositive.

CONCLUSIONS

One in 8 US adults had been infected with SARS-CoV-2 by October 2020; however, few had been accounted for in public health reporting. The COVID-19 pandemic is likely substantially underestimated by reported cases. Disparities in COVID-19 by race observed among reported cases cannot be attributed to differential diagnosis or reporting of infections in population subgroups.

Occupation and Educational Attainment Characteristics Associated With COVID-19 Mortality by Race and Ethnicity in California

IMPORTANCE

Racial and ethnic inequities in COVID-19 mortality may be driven by occupation and education, but limited evidence has assessed these mechanisms.

OBJECTIVE

To estimate whether occupational characteristics or educational attainment explained the associations between race and ethnicity and COVID-19 mortality.

DESIGN, SETTING, AND PARTICIPANTS

This population-based retrospective cohort study of Californians aged 18 to 65 years linked COVID-19 deaths to population estimates within strata defined by race and ethnicity, gender, age, nativity in the US, region of residence, education, and occupation. Analysis was conducted from September 2020 to February 2022.

EXPOSURES

Education and occupational characteristics associated with COVID-19 exposure (essential sector, telework option, wages).

MAIN OUTCOMES AND MEASURES

All confirmed COVID-19 deaths in California through February 12, 2021. The study estimated what COVID-19 mortality would have been if each racial and ethnic group had (1) the COVID-19 mortality risk associated with the education and occupation distribution of White people and (2) the COVID-19 mortality risk associated with the lowest-risk educational and occupational positions.

RESULTS

Of 25 235 092 participants (mean [SD] age, 40 [14] years; 12 730 395 [50%] men), 14 783 died of COVID-19, 8 125 565 (32%) had a Bachelor's degree or higher, 13 345 829 (53%) worked in essential sectors, 11 783 017 (47%) could not telework, and 12 812 095 (51%) had annual wages under $51 700. COVID-19 mortality ranged from 15 deaths per 100 000 for White women and Asian women to 139 deaths per 100 000 for Latinx men. Accounting for differences in age, nativity, and region of residence, if all races and ethnicities had the COVID-19 mortality associated with the occupational characteristics of White people (sector, telework, wages), COVID-19 mortality would be reduced by 10% (95% CI, 6% to 14%) for Latinx men, but increased by 5% (95% CI, -8% to 17%) for Black men. If all working-age Californians had the COVID-19 mortality associated with the lowest-risk educational and occupational position (Bachelor's degree, nonessential, telework, and highest wage quintile), there would have been 43% fewer COVID-19 deaths among working-age adults (8441 fewer deaths; 95% CI, 32%-54%), with the largest absolute risk reductions for Latinx men (3755 deaths averted; 95% CI, 3304-4255 deaths) and Latinx women (2329 deaths averted; 95% CI, 2038-2621 deaths).

CONCLUSIONS AND RELEVANCE

In this population-based cohort study of working-age California adults, occupational disadvantage was associated with excess COVID-19 mortality for Latinx men. For all racial and ethnic groups, excess risk associated with low-education, essential, on-site, and low-wage jobs accounted for a substantial fraction of COVID-19 mortality.

Disparities in COVID-19 fatalities among working Californians

BACKGROUND

Information on U.S. COVID-19 mortality rates by occupation is limited. We aimed to characterize 2020 COVID-19 fatalities among working Californians to inform preventive strategies.

METHODS

We identified laboratory-confirmed COVID-19 fatalities with dates of death in 2020 by matching death certificates to the state's COVID-19 case registry. Working status for decedents aged 18-64 years was determined from state employment records, death certificates, and case registry data and classified as "confirmed working," "likely working," or "not working." We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators.

RESULTS

COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18-64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as "confirmed working." The remainder were classified as "likely working" (n = 4,121 [51.2%]) or "not working" (n = 1,443 [17.9%]) using death certificate and case registry data. Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3-30.8). Workers in nine occupational groups had age-adjusted mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7-88.2); material moving (77.8; 95% CI, 70.2-85.9); construction (62.4; 95% CI, 57.7-67.4); production (60.2; 95% CI, 55.7-65.0); and transportation (57.2; 95% CI, 52.2-62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers.

CONCLUSION

Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers; these occupational group should be prioritized for prevention.

COVID-19 vaccine hesitancy among undocumented migrants during the early phase of the vaccination campaign: a multicentric cross-sectional study

STUDY OBJECTIVES

The marginalisation of undocumented migrants raises concerns about equitable access to COVID-19 vaccination. This study aims to describe migrants' hesitancy about the COVID-19 vaccination during the early phase of the vaccination campaign.

SETTING

This multicentric cross-sectional survey was conducted in health facilities providing care to undocumented migrants in the USA, Switzerland, Italy and France in February-May 2021.

PARTICIPANTS

Eligibility criteria included age >16 years, being of foreign origin and living without valid residency permit in the country of recruitment. A convenience sample of minimum 100 patients per study site was targeted.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were collected using an anonymous structured questionnaire. The main outcomes were perceived access to the local COVID-19 vaccination programme and demand for vaccination.

RESULTS

Altogether, 812 undocumented migrants participated (54.3% Geneva, 17.5% Baltimore, 15.5% Milano and 12.7% Paris). Most (60.9%) were women. The median age was 39 years (interquartile range 1). Participants originated from the Americas (55.9%), Africa (12.7%), Western Pacific (11.2%) Eastern Mediterranean (7.9%), Europe (7.6%) and South-East Asia (4.7%). Overall, 14.1% and 26.2% of participants, respectively, reported prior COVID-19 infection and fear of developing severe COVID-19 infection. Risk factors for severe infection were frequently reported (29.5%). Self-perceived accessibility of COVID-19 vaccination was high (86.4%), yet demand was low (41.1%) correlating with age, comorbidity and views on vaccination which were better for vaccination in general (77.3%) than vaccination against COVID-19 (56.5%). Participants mainly searched for information about vaccination in the traditional and social media.

CONCLUSIONS

We found a mismatch between perceived accessibility and demand for the COVID-19 vaccination. Public health interventions using different communication modes should build on trust about vaccination in general to tackle undocumented migrants' hesitancy for COVID-19 vaccination with a specific attention to men, younger migrants and those at low clinical risk of severe infection.

The Role of Poverty and Racial Discrimination in Exacerbating the Health Consequences of COVID-19

There were more than 800,000 confirmed coronavirus disease 2019 (COVID-19) deaths in the United States (U.S) by the end of 2021. The health consequences of COVID-19, however, have not affected all residents equally. In this review, we synthesize recent evidence suggesting that high levels of poverty in the U.S. compared to other high-income countries, as well as historic and ongoing racial/ethnic discrimination, have exacerbated the health consequences of COVID-19, particularly for racial/ethnic minorities. We discuss four mechanisms through which poverty and discrimination affect COVID-19-related health consequences: greater pre-existing health challenges, reduced access to healthcare, lower-quality neighbourhood and housing conditions, and unequal exposure to high-risk occupations. Evidence suggests that economic and policy institutions that contributed to higher pre-pandemic poverty rates in the U.S., particularly among racial/ethnic minorities, have been central determinants of unequal health outcomes during the COVID-19 pandemic.

Characteristics and Outcomes of US Patients Hospitalized With COVID-19

BACKGROUND

Understanding COVID-19 epidemiology is crucial to clinical care and to clinical trial design and interpretation.

OBJECTIVE

To describe characteristics, treatment, and outcomes among patients hospitalized with COVID-19 early in the pandemic.

METHODS

A retrospective cohort study of consecutive adult patients with laboratory-confirmed, symptomatic SARS-CoV-2 infection admitted to 57 US hospitals from March 1 to April 1, 2020.

RESULTS

Of 1480 inpatients with COVID-19, median (IQR) age was 62.0 (49.4-72.9) years, 649 (43.9%) were female, and 822 of 1338 (61.4%) were non-White or Hispanic/Latino. Intensive care unit admission occurred in 575 patients (38.9%), mostly within 4 days of hospital presentation. Respiratory failure affected 583 patients (39.4%), including 284 (19.2%) within 24 hours of hospital presentation and 413 (27.9%) who received invasive mechanical ventilation. Median (IQR) hospital stay was 8 (5-15) days overall and 15 (9-24) days among intensive care unit patients. Hospital mortality was 17.7% (n = 262). Risk factors for hospital death identified by penalized multivariable regression included older age; male sex; comorbidity burden; symptoms-to-admission interval; hypotension; hypoxemia; and higher white blood cell count, creatinine level, respiratory rate, and heart rate. Of 1218 survivors, 221 (18.1%) required new respiratory support at discharge and 259 of 1153 (22.5%) admitted from home required new health care services.

CONCLUSIONS

In a geographically diverse early-pandemic COVID-19 cohort with complete hospital folllow-up, hospital mortality was associated with older age, comorbidity burden, and male sex. Intensive care unit admissions occurred early and were associated with protracted hospital stays. Survivors often required new health care services or respiratory support at discharge.