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.

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.

Increases in Prevalent Depressed Mood and Suicidal Ideation among Workers during the COVID-19 Pandemic-Findings from the California Health Interview Survey.

Limited data exist on COVID-19's mental health impact on non-healthcare workers. We estimated the prevalence of depressed mood and suicidal ideation experienced in the past year among California workers and assessed whether the prevalence changed during the COVID-19 pandemic. We analyzed 2013-2020 California Health Interview Survey data using survey-weighted methods to assess the change in the prevalence of depressed mood and suicidal ideation from 2019 to 2020 for working adults by demographics and occupational groups. We used trend-adjusted quasi-Poisson regressions and report rate ratios (RR), comparing the prevalence of outcomes during 2020 to the pre-pandemic period (2013-2019). We identified priority occupation groups with a higher-than-average outcome prevalence in 2020 and rate increases after adjusting for pre-pandemic trends. Our analysis included 168,768 respondents, of which 65% were workers. Production and service workers were the priority occupation groups for depressed mood (RR: 1.46, CI: 1.1-1.9; RR: 1.23, CI: 1.1-1.4) and suicidal ideation (RR: 1.86, CI: 1.0-3.6; RR: 1.47, CI: 1.1-1.9). Workers aged 45-65 years experienced over a 30% relative increase in both outcomes from 2019 to 2020. Depressed mood and suicidal ideation in the past year increased for production, service, and older workers during the pandemic. These groups should be considered for mental health interventions.

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

BACKGROUND: Surveillance systems lack detailed occupational exposure information from workers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The National Institute for Occupational Safety and Health partnered with 6 states to collect information from adults diagnosed with SARS-CoV-2 infection who worked in person (outside the home) in non-healthcare settings during the 2 weeks prior to illness onset. METHODS: The survey captured demographic, medical, and occupational characteristics and work- and non-work-related risk factors for SARS-CoV-2 infection. Reported close contact with a person known or suspected to have SARS-CoV-2 infection was categorized by setting as exposure at work, exposure outside of work only, or no known exposure/did not know. Frequencies and percentages of exposure types are compared by respondent characteristics and risk factors. RESULTS: Of 1111 respondents, 19.4% reported exposure at work, 23.4% reported exposure outside of work only, and 57.2% reported no known exposure/did not know. Workers in protective service occupations (48.8%) and public administration industries (35.6%) reported exposure at work most often. More than one third (33.7%) of respondents who experienced close contact with ≥10 coworkers per day and 28.8% of respondents who experienced close contact with ≥10 customers/clients per day reported exposures at work. CONCLUSIONS: Exposure to occupational SARS-CoV-2 was common among respondents. Examining differences in exposures among different worker groups can help identify populations with the greatest need for prevention interventions. The benefits of recording employment characteristics as standard demographic information will remain relevant as new and reemerging public health issues occur.

COVID-19 Outbreaks and Mortality Among Public Transportation Workers - California, January 2020-May 2022.

Work-related factors can contribute to risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, and subsequent COVID-19-attributable outcomes, including death. Comparing COVID-19 metrics across industries can help identify workers at highest risk. Elevated COVID-19 mortality rates have been reported among all transportation workers, as well as specifically in public transportation industries (1-3). The California Department of Public Health (CDPH) calculated public transportation industry-specific COVID-19 outbreak incidence during January 2020-May 2022 and analyzed all laboratory-confirmed COVID-19 deaths among working-age adults in California to calculate public transportation industry-specific mortality rates during the same period. Overall, 340 confirmed COVID-19 outbreaks, 5,641 outbreak-associated cases, and 537 COVID-19-associated deaths were identified among California public transportation industries. Outbreak incidence was 5.2 times as high (129.1 outbreaks per 1,000 establishments) in the bus and urban transit industry and 3.6 times as high in the air transportation industry (87.7) as in all California industries combined (24.7). Mortality rates were 2.1 times as high (237.4 deaths per 100,000 workers) in transportation support services and 1.8 times as high (211.5) in the bus and urban transit industry as in all industries combined (114.4). Workers in public transportation industries are at higher risk for COVID-19 workplace outbreaks and mortality than the general worker population in California and should be prioritized for COVID-19 prevention strategies, including vaccination and enhanced workplace protection measures.

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.