Socio-Demographic Composition and Potential Occupational Exposure to SARS-CoV2 under Routine Working Conditions among Key Workers in France.

This study aims to describe the socio-demographic profile of so-called "key workers" during the first lockdown in France and to assess their potential occupational exposure to SARS-CoV-2 under routine, pre-pandemic working conditions. We used the French list of essential jobs that was issued during the first lockdown to identify three subgroups of key workers (hospital healthcare, non-hospital healthcare, non-healthcare). Based on the population-based "Conditions de travail-2019" survey, we described the socio-demographic composition of key workers and their potential work-related exposures (to "infectious agents," "face-to-face contact with the public," and "working with colleagues") using modified Poisson regression. In general, women, clerical and manual workers, workers on temporary contracts, those with lower education and income, and non-European immigrants were more likely to be key workers, who accounted for 22% of the active population. Non-healthcare essential workers (57%) were the most socially disadvantaged, while non-hospital healthcare workers (19%) were polarized at both extremes of the social scale; hospital healthcare workers (24%) were intermediate. Compared to non-key workers, all subgroups had greater exposure to infectious agents and more physical contact with the public. This study provides evidence of accumulated disadvantages among key workers concerning their social background, geographical origin, and potential SARS-CoV-2 exposure.

Trends in social exposure to SARS-Cov-2 in France. Evidence from the national socio-epidemiological cohort-EPICOV.

BACKGROUND: We aimed to study whether social patterns of exposure to SARS-CoV-2 infection changed in France throughout the year 2020, in light to the easing of social contact restrictions. METHODS: A population-based cohort of individuals aged 15 years or over was randomly selected from the national tax register to collect socio-economic data, migration history, and living conditions in May and November 2020. Home self-sampling on dried blood was proposed to a 10% random subsample in May and to all in November. A positive anti-SARS-CoV-2 ELISA IgG result against the virus spike protein (ELISA-S) was the primary outcome. The design, including sampling and post-stratification weights, was taken into account in univariate and multivariate analyses. RESULTS: Of the 134,391 participants in May, 107,759 completed the second questionnaire in November, and respectively 12,114 and 63,524 were tested. The national ELISA-S seroprevalence was 4.5% [95%CI: 4.0%-5.1%] in May and 6.2% [5.9%-6.6%] in November. It increased markedly in 18-24-year-old population from 4.8% to 10.0%, and among second-generation immigrants from outside Europe from 5.9% to 14.4%. This group remained strongly associated with seropositivity in November, after controlling for any contextual or individual variables, with an adjusted OR of 2.1 [1.7-2.7], compared to the majority population. In both periods, seroprevalence remained higher in healthcare professions than in other occupations. CONCLUSION: The risk of Covid-19 infection increased among young people and second-generation migrants between the first and second epidemic waves, in a context of less strict social restrictions, which seems to have reinforced territorialized socialization among peers.

Social inequalities and dynamics of the early COVID-19 epidemic: a prospective cohort study in France.

OBJECTIVE: Although social inequalities in COVID-19 mortality by race, gender and socioeconomic status are well documented, less is known about social disparities in infection rates and their shift over time. We aim to study the evolution of social disparities in infection at the early stage of the epidemic in France with regard to the policies implemented. DESIGN: Random population-based prospective cohort. SETTING: From May to June 2020 in France. PARTICIPANTS: Adults included in the Epidémiologie et Conditions de Vie cohort (n=77 588). MAIN OUTCOME MEASURES: Self-reported anosmia and/or ageusia in three categories: no symptom, during the first epidemic peak (in March 2020) or thereafter (during lockdown). RESULTS: In all, 2052 participants (1.53%) reported anosmia/ageusia. The social distribution of exposure factors (density of place of residence, overcrowded housing and working outside the home) was described. Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia. Women were more likely to report symptoms during the peak and after. Racialised minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak. CONCLUSION: The shift in the social profile of the epidemic was related to a shift in exposure factors under the implementation of a stringent stay-at-home order. Our study shows the importance to consider in a dynamic way the gender, socioeconomic and race direct and indirect effects of the COVID-19 pandemic, notably to implement policies that do not widen health inequalities.