Risk Factors Associated With SARS-CoV-2 Infection Among Farmworkers in Monterey County, California.

Importance: Essential workers in agriculture and food production have been severely affected by the ongoing COVID-19 pandemic. Objective: To identify risk factors associated with SARS-CoV-2 infection among farmworkers in California. Design, Setting, and Participants: This cross-sectional study invited farmworkers in California's Salinas Valley (Monterey County) receiving transcription-mediated amplification (TMA) tests for SARS-CoV-2 infection at federally qualified community clinics and community sites to participate. Individuals were eligible if they were not pregnant, were 18 years or older, had conducted farmwork since the pandemic started, and were proficient in English or Spanish. Survey data were collected and SARS-CoV-2 tests were conducted among participants from July 16 to November 30, 2020. Exposures: Sociodemographic, household, community, and workplace characteristics. Main Outcomes and Measures: TMA- and immunoglobulin G (IgG)-positive SARS-CoV-2 infection. Results: A total of 1107 farmworkers (581 [52.5%] women; mean [SD] age, 39.7 [12.6] years) were included in these analyses. Most participants were born in Mexico (922 [83.3%]), were married or living with a partner (697 [63.0%]), and worked in the fields (825 [74.5%]). Overall, 118 of 911 (13.0%) had a positive result on their TMA test for SARS-CoV-2 infection, whereas 201 of 1058 (19.0%) had antibody evidence of infection. In multivariable analyses accounting for recruitment venue and enrollment period, the incidence of TMA-positive SARS-CoV-2 infection was higher among those with lower than primary school-level education (adjusted relative risk [aRR], 1.32; 95% CI, 0.99-1.76; non-statistically significant finding), who spoke an Indigenous language at home (aRR, 1.30; 95% CI, 0.97-1.73; non-statistically significant finding), who worked in the fields (aRR, 1.60; 95% CI, 1.03-2.50), and who were exposed to a known or suspected COVID-19 case at home (aRR, 2.98; 95% CI, 2.06-4.32) or in the workplace (aRR, 1.59; 95% CI, 1.18-2.14). Positive results on IgG tests for SARS-CoV-2 infection were more common among those who lived in crowded housing (aRR, 1.23; 95% CI, 0.98-1.53; non-statistically significant finding), with children aged 5 years or younger (aRR, 1.40; 95% CI, 1.11-1.76), with unrelated roommates (aRR, 1.40; 95% CI, 1.19-1.64), and with an individual with known or suspected COVID-19 (aRR, 1.59; 95% CI, 1.13-2.24). The risk of IgG positivity was also higher among those with body mass index of 30 or greater (aRR, 1.65; 95% CI, 1.01-2.70) or diabetes (aRR, 1.31; 95% CI, 0.98-1.75; non-statistically significant finding). Conclusions and Relevance: In this cross-sectional study of farmworkers in California, both residential and workplace exposures were associated with SARS-CoV-2 infection. Urgent distribution of COVID-19 vaccines and intervention on modifiable risk factors are warranted given this population's increased risk of infection and the essential nature of their work.

Farmer and farm worker illnesses and deaths from COVID-19 and impacts on agricultural output.

Farmers and farm workers are critical to the secure supply of food, yet this population is potentially at high risk to acquire COVID-19. This study estimates the prevalence of COVID-19 among farmers and farmworkers in the United States by coupling county-level data on the number of farm workers relative to the general population with data on confirmed COVID-19 cases and deaths. In the 13 month period since the start of the pandemic (from March 1, 2020 to March 31, 2021), the estimated cumulative number of COVID-19 cases (deaths) was 329,031 (6,166) among agricultural producers, 170,137 (2,969) among hired agricultural workers, 202,902 (3,812) among unpaid agricultural workers, and 27,223 (459) among migrant agricultural workers. The cases amount to 9.55%, 9.31%, 9.39%, and 9.01% of all U.S. agricultural producers, hired workers, unpaid workers, and migrant workers, respectively. The COVID-19 incidence rate is significantly higher in counties with more agricultural workers; a 1% increase in the number of hired agricultural workers in a county is associated with a 0.04% increase in the number of COVID-19 cases per person and 0.07% increase in deaths per person. Although estimated new cases among farm workers exhibit similar trends to that of the general population, the correlation between the two is sometimes negative, highlighting the need to monitor this particular population that tends to live in more rural areas. Reduction in labor availability from COVID-19 is estimated to reduce U.S. agricultural output by about $309 million.

Partnerships as an Avenue to Translate Emerging Disease Ecology of SARS-CoV-2 to Agricultural Groups.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated coronavirus disease 19 (COVID-19) has brought farmers and farmworkers the designation of "essential", while placing them into heightened vulnerability for the disease. Many factors diminish access to education and prevention technologies emerging to combat COVID-19. For farmers, advanced age and rural location play a part. Farmworkers encounter numerous additional barriers including language and cultural differences, socioeconomic pressures, and immigration status. The unusual persistence and multiple transmission pathways of SARS-CoV-2 emerging from ongoing scientific study require customization of otherwise standard prevention messaging to farmers and farmworkers to prevent infection and disease exacerbation. AgriSafe Network and Migrant Clinicians Network, both national organizations and major stakeholders in agricultural health, are on the front lines of translating science into practical prevention strategies for those providing health services to farmworkers and farmers. The partnerships pursued provide a blueprint for quickly translating emerging disease ecology to support the health of agricultural populations during the COVID-19 pandemic.

Reaching Invisible and Unprotected Workers on Farms during the Coronavirus Pandemic.

Deemed by the federal government as "essential" to the country, immigrant field and dairy workers were told to keep working despite statewide stay-at-home directives in New York State. Undocumented workers that might choose not to comply would risk the loss of employment (with no access to unemployment benefits due to their immigration status) and eviction from employer provided housing. Due to the nature of working and living conditions on farms, social distancing among farmworkers is nearly impossible and farmworkers were not provided with Personal Protective Equipment (PPE) until infections were at an alarmingly high rate in NYS. Once infected, farmworkers were directed to contact County Health Departments that were frequently unfamiliar with the farmworker population and often lacked the necessary language or cultural competency skills to provide services to that community. Local community members expressed opinions that immigrant farmworkers were transmitters of the virus contributing to high levels of fear and mistrust in rural communities. Trusted organizations such as the Cornell Farmworker Program (CFP) mobilized to provide information, PPE, and other needed supports during the coronavirus pandemic. To support these efforts, the Cornell Farmworker Program transitioned from face-to-face interactions to large-scale two-way communications through cell phones and text messages and partnered with Finger Lakes Community Health, a federally designated migrant farmworker health provider to bridge the gaps in rural health provision to farmworkers.

Finding the Edges of Problems: Social Media as an Exploratory Research Tool.

Social media use in public health and other health related research applications has seen a rapid increase in recent years. However, there has been very limited utilization of this growing digital sector in agricultural injury research. Social media offers immense potential in gathering informal data, both text and images, converting them into knowledge, which can open up avenues for research, policy, and practice. There are a number of ways social media data can be utilized in agricultural injury research. This paper touches on the adoption of these data sources in health research and discusses the use of social media as an exploratory research tool that can peer into and identify the edges of potential health and safety problems.

Working along the Continuum: North Carolina's Collaborative Response to COVID-19 for Migrant & Seasonal Farmworkers.

North Carolina employs 78,000+ migrant/seasonal farmworkers (MSFWs) annually. Arrival/departure dates are crop and weather dependent. MSFWs may be employed by a grower or a farm labor contractor (FLC). Like farmworker housing, FLCs may be registered or unregistered. Primary care or enabling services are provided by the NC Farmworker Health Program or community health centers that receive dedicated federal funding for MSFWs. The arrival of NC's growing season, MSFWs, and COVID-19 brought unforeseen challenges even to those experienced in caring for MSFWs. Challenges include congregate activities, consistency/accuracy of COVID-19 related communications, availability of alternate housing, barriers to testing and contact tracing, lack of internet connectivity in farmworker housing and insufficient personal protective equipment. Challenges are discussed in no order of occurrence or level of importance as many are inter-related. To meet these challenges, a migrant health and housing workgroup was convened. Members include the NC Department of Labor-Agricultural Safety and Health Bureau, NC Department of Health and Human Services - Communicable Disease Branch and NC Farmworker Health Program, NC Community Health Center Association and NC Agromedicine Institute. Members work collaboratively along the continuum from local to state levels and across agencies and communities to facilitate strategies to address COVID-19 challenges. Implications exist for practice, research and policy including testing of MSFWs on arrival with a 14-day quarantine before moving to assigned farm, a "strike team" to do on-farm tests for workers in the event of a positive case or exposure; and, research on COVID-19 outbreaks and impact of telehealth on MSFWs wellbeing.

Horticulture in Queensland Australia, COVID-19 Response. It Hasn't All Been Bad on Reflection.

Australia and with that Queensland have been extremely fortunate with the impact of COVID-19. Queensland has only had 1,067 cases as of June 30, 2020, of which 78% have been overseas acquired. Australia and Queensland acted early to address COVID-19 by putting in place a range of strategies including travel bans (international and domestic), isolation measures, testing regimes, advice to business, economic support, and research funding. Agriculture was designated an essential business and as such has continued operating throughout the pandemic. They have however had to develop and implement COVID plans to keep workers safe. To help agricultural business establish plans information was developed by Safe Work Australia, National Farmers Federation and the Queensland Department of Workplace Health and Safety. Workforce issues were identified early, particularly seasonal workers (those who travel from their usual place of residence to another place to work). The Queensland Government enacted a directive about how seasonal workers were to be managed and also developed a guide specifically for horticulture to help manage their COVID-19 response. We provide two case studies demonstrating how agriculture has responded to COVID-19. Agriculture has successfully, in Queensland, adapted quickly to the changing work conditions due to COVID-19. This is due to all levels of government coming together with industry to find solutions. Some changes have had wider benefits such as improved sanitation, better communication and a greater recognition of seasonal worker needs. Being prepared and resilient has enabled agriculture to alleviate the impact on their businesses ensuring the health of all.

Rapid Response to COVID-19 in Agriculture: A Model for Future Crises.

Objective: The Western Center for Agricultural Health and Safety (WCAHS) at the University of California, Davis implemented a multifaceted rapid response to COVID-19 in the western United States. This paper describes the center's response from mid-March through June 30, 2020. Methods: A comprehensive needs assessment was conducted with agricultural stakeholders. Agriculture-specific COVID-19 resources were developed and disseminated, and a farmer/employer survey was launched. Results: The WCAHS COVID-19 resources web page, worksite checklist, and training guide were shared on over 50 web pages nationally. As of June 30, 2020, 282 online surveys have been received. Ongoing informal discussions with agricultural stakeholders indicate a disconnect between the experiences of farmers/employers and farmworkers in relation to COVID-19 prevention at the worksite. Initial survey responses indicate that implementing social distancing is one of the greatest challenges at the worksite. Confusion over local, state, and federal guidelines and which to follow is another concern. Conclusion: The WCAHS response to COVID-19, in close collaboration with agricultural stakeholders, represents a useful model for a rapid response to a public health crisis by regional centers. Key elements to its success include rapid personalized communication with a wide range of agricultural stakeholders, an actively engaged External Advisory Board, the development of industry-specific resources and information, recurring and iterative engagement with stakeholders as new COVID-19 information emerged and resources were developed, and the identification of the unique gap WCAHS was positioned to fill. The multipronged dissemination approach enhanced the reach of WCAHS COVID-19 resources.

From Bad to Worse: The Impact of COVID-19 on Commercial Fisheries Workers.

This commentary provides an overview of the impact of COVID-19 on the commercial fishing industry. The information highlighted in the article was gathered from fishermen, fishing industry experts, health and safety advisors, and advocates. From these first-hand accounts, we provide the immediate and expansive impacts of COVID-19 on fishermen's health and wellbeing. In particular, we discuss the economic impact of COVID-19 market disruptions, as well as the very real, logistical challenges of protecting workers on fishing vessels. We also provide examples of how these combined issues have led to increased occupational risk in one of the nation's most deadly industries. Lastly, we identify a number of recommendations for providing much-needed support for commercial fishermen in light of the COVID-19 pandemic.

The COVID-19 Impact on Childcare in Agricultural Populations.

The corona virus pandemic pulled back the curtain on rural America's already fragile childcare system and shed light on the critical role that quality, affordable, accessible childcare plays in the lives of workers and families, as well as in the success of agricultural businesses. This commentary aims to describe how existing childcare problems were exacerbated by the COVID-19 pandemic, potentially impacting both the health and economics of farm households and farmworker families. For solutions to be successful, efforts will need to be collaborative, with federal interventions spurred on by childcare stakeholders. Successful collaborations will result in a better childcare system that nurtures children while their parents contribute to our nation's production of agricultural products.

Invisible No More: The Impact of COVID-19 on Essential Food Production Workers.

From the farms to the packing plants, essential workers in critical food production industries keep food on our tables while risking their and their families' health and well-being to bring home a paycheck. They work in essential industries but are often invisible. The disparities illuminated by COVID-19 are not new. Instead, they are the result of years of inequities built into practices, policies, and systems that reinforce societal power structures. As a society, we are now at an antagonizing moment where we can change our collective trajectory to focus forward and promote equity and justice for workers in agriculture and food-related industries. To that end, we describe our experience and approach in addressing COVID-19 outbreaks in meat processing facilities, which included three pillars of action based on public health ethics and international human rights: (1) worksite prevention and control, (2) community-based prevention and control, and (3) treatment. Our approach can be translated to promote the health, safety, and well-being of the broader agricultural workforce.

Health Care and Health Insurance Access for Farm Families in the United States during COVID-19: Essential Workers without Essential Resources?

In the midst of the COVID-19 pandemic, farmers and farm workers have been deemed essential workers across the world. Yet, despite working in one of the most dangerous occupations, and despite being especially vulnerable to the virus (due to existing health risk factors and risk of infection stemming from difficulties adopting control measures), many farmers and farm workers in the United States have long lacked essential resources to ensure they can meet their health needs: affordable and accessible health insurance and health care. In this commentary, we draw on our own research focused on farm families and collective experiences to discuss three main challenges farm families have faced meeting their health needs: reliance on off-farm work for health insurance coverage, the need to forecast income when purchasing a plan on the health insurance marketplace, and barriers to health care in rural areas. As we discuss these challenges, we highlight the ways in which the COVID-19 pandemic is likely exacerbating these pressures. Recognizing that major crises in the past have led to major shifts in economic, social, and political systems, the disruptions brought on by COVID-19 could be leveraged to work toward increasing access to affordable and adequate health insurance and health care. As such, we conclude our commentary by outlining policy reforms and research efforts that are needed to ensure that those working in the farm sector have access to essential resources to preserve their health and safety.

LGBTQ+ Farmer Health in COVID-19.

The limited data on LGBTQ+ farmers demonstrate that this population lacks adequate healthcare access and faces stigma in agricultural communities. Given that COVID-19 disproportionately impacts LGBTQ+ populations, we investigate how working conditions and healthcare bias may expose LGBTQ+ farmers - essential employees - to high risk of transmitting the virus. During COVID-19, LGBTQ+ farmers may experience worse mental health outcomes as they face occupational and identity-based stressors. Conversely, LGBTQ+ farmers may also demonstrate mental health resilience during COVID-19 due to pre-existing socially distant networks they created in light of agricultural heterosexism. What is unique about COVID-19 is that healthcare inequities of a relatively small percentage of the agriculture workforce has amplifying implications for the entire agrifood system. We call for research on LGBTQ+ farmers to understand how sexuality impacts agricultural health, to uncover health risks and protective factors that may increase the health of farming communities, and to support essential food production during a pandemic.

The Potential Impact of COVID-19 on H-2A Agricultural Workers.

The disproportionate impact of COVID-19 on farmworker communities has been well documented by the media. The virus overlays existing health disparities among farmworkers, but the population is not homogenous. One group of workers that may be even more vulnerable to the transmission of COVID-19 is the H-2A temporary worker population, because they have less control over their physical environments than domestic farmworkers, who may obtain their own housing and transportation. The H-2A program was recently altered at the federal level to ensure a steady flow of essential workers that can protect the nation's food supply during a crisis. Yet, in spite of increasing numbers of COVID-19 cases in states with significant H-2A worker populations, the federal rule that temporarily expanded the H-2A program did not address needs to protect workers' health. Although the CDC has developed recommendations for the agricultural industry to safeguard against COVID-19, most health and safety regulation for farmworkers are left to state and local agencies that may lack knowledge or resources to effectively address the needs of a specialized growing workforce such as H-2A workers. More research is needed on the disparate health and safety needs of H-2A workers to assess how policy can be tailored to reduce the transmission of the COVID-19 virus among the population.

Essential and Vulnerable: Implications of Covid-19 for Farmers in Ireland.

Objectives: This paper seeks to: provide an overview of the impacts of and responses to the spread of COVID-19 in Ireland; assess the vulnerability of the population living in rural areas to COVID-19; compare the health status of male farmers to underlying medical conditions frequently associated with those experiencing the worst impacts of the illness; and assess the implications of COVID-19 for farmers living alone and farm households with children. Methods: We present an overview of the impact and response to COVID-19 through the use of public health statistics and reference to policy documents. We subsequently draw on the results of ongoing geographic and health research to present an overview of the impacts and potential implications of COVID-19. Results: The population of many rural areas and farmers in particular are highly vulnerable to adverse outcomes to COVID-19 infection. Single person farm households are at particular risk of isolation, whilst those families with children are at increased risk of stress. Conclusions: There is an urgent need to address both COVID-19 challenges and the health and wellbeing issues confronting farmers and farm families arising out of the current pandemic by supporting these populations adopt and sustain health behaviour changes, improve their wellbeing and develop the resources that support resilience.

Virtual Outreach: Using Social Media to Reach Spanish-speaking Agricultural Workers during the COVID-19 Pandemic.

Face-to-face outreach and in-person training have traditionally been key strategies in reaching agricultural producers, workers, and communities with safety and health information, but the COVID-19 pandemic has forced outreach educators to be creative and find alternative ways to reach, communicate, and share such information. In this commentary, we describe our use of social media to reach Latino/a cattle feedyard workers with COVID-19 related information. As a result of our effort, we reached over 54,000 people and demonstrated there is an audience for Spanish-language agricultural safety and health information. Social media can be a cost-effective method for virtual outreach in this new normal. We should look at this time as an opportunity to learn more about how our stakeholders obtain information and about how best we can connect with them. Although our outreach methods may be changing, our goal is not - we will continue to work to improve the safety and health of those who work in agriculture.

How Vulnerable Are U.S. Crop Workers?: Evidence from Representative Worker Data and Implications for COVID-19.

Objectives This paper examines health profiles and work environments of hired U.S. farmworkers to understand the risk to essential workers and their employers, to the food supply, and to rural health systems such as what is possible with the COVID-19 pandemic. Methods Large-sample statistical methods and proprietary data from the National Agricultural Workers Survey from 2000 to 2018 were used to assess factors associated with exposure to COVID-19 and vulnerabilities associated with medical complications. Results An aging workforce and increased access to health care within the crop worker population has been associated with a higher reported incidence of diabetes, asthma, and heart disease among workers over time. These trends confirm a vulnerable, but essential, workforce with higher risks for COVID-19 complications than would have been true of U.S. farmworkers as a group in earlier years. Conclusions Increasing age and disease burden in the U.S. agricultural labor force puts workers at increased risk for developing COVID-19 complications. Limits to field sanitation and housing quality inflate the probability of the development of COVID-19 hotbeds in rural communities that could further compromise the physical health of workers, the economic health of farm establishments, the agricultural supply-chain, and rural health capacities. Additional and more targeted worker protections may minimize public health and economic costs in the long run.