Risk of SARS-CoV-2 Infection Among Essential Workers in a Community-Based Cohort in the United States.

Objectives: The objective of this paper is to identify the risk factors for SARS-CoV-2 infection that are related to occupation type as well as workplace conditions. Identifying such risk factors could have noteworthy implications in workplace safety enhancement and emergency preparedness planning for essential workers. Methods: We conducted a retrospective analysis of visits at a community-based SARS-CoV-2 testing site in the greater Boston area between March 18th and June 19th, 2020, for individuals between 14 and 65 years of age. Nasopharyngeal swab specimen, medical review, and self-administered questionnaire were obtained, and SARS-CoV-2 infection was determined with real-time, reverse transcriptase-polymerase chain reaction (RT-PCR). Medical record-verified job classification, customer-facing, and work patterns were extracted from each individual's response through chart review and validated by licensed clinicians. The occupational patterns were coded by occupational medicine physicians with pre-specified criteria and were analyzed with logistic regression and inverse probability weighting. Results: Among the 780 individuals included in the final analysis, working in healthcare-related jobs was associated with a four-fold increase in risk of SARS-CoV-2 infection (Adjusted OR: 4.00, 95% CI: 1.45-11.02). Individuals with customer-facing jobs had a two times risk increase (Adjusted OR: 1.97, 95% CI: 1.12-3.45) in having a positive SARS-CoV-2 RT-PCR assay result compared to participants with non-customer facing positions. Conclusions: In this U.S. community-based population during the initial wave of the pandemic, a significant increase in risk of SARS-CoV-2 infection was observed in those employed in the healthcare sector or with customer-facing positions. Further research is warranted to determine if these correlations continued with the buildup of population immunity together with the attenuation of SARS-CoV-2 virulence.

Comparison of COVID-19 mitigation and decompression strategies among homeless shelters: a prospective cohort study.

PURPOSE: To compare the effectiveness of COVID-19 mitigation strategies in two homeless shelters in Massachusetts during the pandemic. METHODS: We conducted a prospective cohort study that followed guests in two Massachusetts homeless shelters between March 30 and May 13, 2020, which adopted different depopulation strategies. One set up temporary tents in its parking lot, while the other decompressed its guests to a gym and a hotel. The outcome was assessed by comparing the odds ratios of positive SARS-CoV-2 RT-PCR assays. RESULTS: Guests residing at the shelter that used temporary tents had 6.21 times (95% CI = 1.86, 20.77) higher odds of testing positive for SARS-CoV-2 at follow-up after adjusting for loss to follow up, age, gender, and race. The daily COVID-19 symptoms checklist performed poorly in detecting positive infection. CONCLUSIONS: The study highlights the importance of depopulating shelter guests with stable and adequate indoor space to prevent SARS-CoV-2 transmission. Daily temperature and symptom checks should be combined with routine testing. With the rising homelessness due to mass unemployment and eviction crisis, our study supports further governmental assistance in decompressing homeless shelters during this pandemic.