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Issue #68

Occupational and racial disparities for covid-19 risks: what can employers do?

04/09/2021

Contributed by Devan Hawkins, ScD, Instructor of Public Health at Massachusetts College of Pharmacy and Health Sciences.

Occupational and racial disparities for COVID-19 risks: What can employers do? (pdf)

It is true that the COVID-19 pandemic has affected everybody. However, the burden of the pandemic has not been borne equally. Black, Hispanic, and Native Americans face risks of infection, hospitalization, and death from COVID-19 many times higher than White Americans. Urban/densely populated counties with more income inequality and lower rates of insurance have higher rates of COVID-19 cases and deaths than other counties. Similar disparities have been documented in Massachusetts cities and towns. Unfortunately, as the COVID-19 vaccines are rolled out, many of these same vulnerable communities have had less access to the vaccine and lower rates of vaccination. 

Racial and occupational disparities in COVID-19 risks

It is important to consider the contribution of work-related factors to these differences. In the early days of the pandemic, work-related transmission was likely an important component of the spread of the virus. Healthcare workers make up a large share of workers infected with COVID-19. Early work also documented. other occupations at a particularly high risk for acquiring COVID-19 due to close proximity to others, including protective services, education, and transportation workers. It was also demonstrated that workers of color were more likely to be employed in these high-risk occupations than White workers. 

Data have started to emerge on the effects of this differential occupational risk. A recent study from Massachusetts found that eleven occupation groups had COVID-19 mortality rates higher than the average for all workers. While all workers in these high-mortality occupations had an elevated risk, it was even higher for Black and Hispanic workers. The findings from this study were consistent with another recent study from California showing that all-cause mortality during the pandemic was elevated among workers in several occupations compared to past years: food/agriculture, transportation/logistics, facilities, and manufacturing. Further, workers in industries like meatpacking, with a large proportion of Hispanic workers, have an elevated risk of COVID-19. 

What employers can do to prevent COVID-19 transmission as restrictions ease

All of this research strongly suggests that the workplace is an important venue for the transmission of COVID-19. The importance of protecting workers in the midst of the current pandemic cannot be overstated. This protection can take a number of different forms. First and foremost, it is important to protect workers from being exposed to the virus in the first place. This protection includes physical distancing, engineering controls, ventilation, and personal protective equipment. Even though vaccinations are underway, transmission rates in may states have also increased during March and April 2021. A recent Massachusetts study revealed that 1 in 3 residents said they worked in places that did not enforce social distancing and half said they received no COVID-19 health and safety training. Employers must enforce distancing and mask-wearing while also actively promoting vaccination to minimize transmission in the workplace. Workers are vulnerable to asymptomatic virus carriers whether they are co-workers or patrons. Employers can demonstrate leadership by setting and enforcing rules that protect those employed in their establishments. Actively encouraging vaccination is another way to keeping employees healthy. Free materials are available from the CDC to help employers talk with essential workers about getting vaccinated. 

Even with protections in place, workers may get sick. Paid sick leave is a crucial tool for employers to prevent COVID-19 transmission in the workplace. One positive action taken by the federal government was to introduce mandatory paid sick leave, but these benefits expired in 2020. Such protections should be made permanent, as they are in almost all other high-income countries. These protections prevent sick workers from potentially infecting co-workers and members of the public and allow workers time to recover from illness without the financial and psychological strain of losing their wages. When workers do become sick, they should be entitled to workers' compensation benefits with the presumption of workplace infection when there are clusters of cases. These benefits are intended for workers who get sick or injured at work, to ensure that medical expenses and some of their lost wages are covered, with the costs of these expenses borne by their employers. Many U.S. states have introduced these benefits for workers infected with COVID-19; however, because of the patchwork workers' compensation system in this country, it has not always been consistent or clear to whom they are available. 

Addressing workplace transmission of this and other infectious diseases is a fundamental component of fighting the COVID-18 and future pandemics. Throughout this pandemic, workers - whether the nurse taking your blood pressure, the bus driver taking you home, or the grocery store worker keeping the shelves stocked - have been putting their safety and the safety of their family at risk. These workers are disproportionally workers of color and many already face disproportionate risk of injury and chronic disease due to the nature of their work. Employers have a legal responsibility to ensure a workplace free of hazards. Leadership is needed in every workplace to enforce feasible and effective measures such as masking, distancing, and vaccination promotion, especially for workers in occupations at highest risk. 

References

  1. Hawkins D. (2020). Social Determinants of COVID-19 in Massachusetts, United States: An Ecological Study. Journal of preventative medicine and public health, 53 (4), 220 - 227.
  2. Hawkins, D. (2020) Differential occupational risk for COVID-19 and other infection exposure according to race and ethnicity. American journal of industrial medicine, 63 (9), 817 - 820.
  3. Hawkins, D., Davis, L., & Kriebal, D. (2021). COVID-19 deaths by occupation, Massachusetts, March 1 - July, 31, 2020. American Journal of Industrial Medicine, 64 (4).238 - 244.
  4. CDC Essential Workers COVID-19 Vaccine Toolkit
Devan Hawkins, ScD., is an instructor of Public Health at the Massachusetts College of Pharmacy and Health Sciences. His research interests include occupational health, deaths of despair including opioid overdoses, and the changing nature of work.