Health Care Workers

It should come as no surprise that health care workers were hit hard by COVID-19. And if there was any doubt, the impact of COVID on health care workers was confirmed this morning by the Department of Labor’s Bureau of Labor Statistics (BLS) which released its “Survey of Occupational Injuries and Illnesses” for calendar year 2020.

At first glance, the report looks like good news: Private industry employers reported a 5.8% decrease in the number of nonfatal workplace injuries and illnesses in 2020, compared with 2019.  There were 2.7 million injuries and illnesses in 2020 compared to 2.8 million in 2019.

But 2020 was not a normal year.  It was the (first) year of COVID which caused widespread disruption of the American economy, including massive shutdowns of businesses across the country for days, weeks or months.

The number of workplace illnesses in 2020 quadrupled to 544,600 cases, up from 127,200 cases in 2019. 

Looking closer at the BLS data we see a number of interesting numbers:

  • The number of injuries dropped from 2.7 million in 2019 to 2.1 million in 2020. The drop is likely attributable to COVID-related shutdowns.
  • The number of illnesses quadrupled to 544,600 cases, up from 127,200 cases in 2019.  Why? A nearly 4,000% increase in employer reported respiratory illness cases in 2020. The number of respiratory illness cases increased from 10,800 in 2019 to 428,700 in 2020.
  • The rate of injury cases also decreased in 2020, from 2.6 cases per 100 Full Time Employees (FTE) to 2.2 cases in 2020.
  • The rate of illness cases increased from 12.4 cases per 10,000 full-time equivalent (FTE) workers to 55.9 cases. The increase in the illness rate was driven by the rise in the respiratory illness rate, which rose from 1.1 cases per 10,000 workers to 44.0 cases.

Health Care Workers

Those are the basic numbers, and it’s clear what’s driving the huge illness numbers:  COVID-19 infections among health care workers.

According to BLS, nursing assistants led the occupations of workers who missed work due to work-related illnesses:  They had 96,480 days-away-from-work (DAFW) cases, which was a 249.7 percent increase from 2019. Registered nurse cases increased by 290.8 percent to 78,740 cases.  Their incidence rates also climbed in 2020.  Nursing assistants, registered nurses, and licensed practical and licensed vocational nurses had notable increases in their DAFW incidence rates in 2020. “Nursing assistants, specifically, had a DAFW incidence rate of 1,023.8 per 10,000 FTE workers in 2020, an increase from 283.5 in 2019.”

Meanwhile, it was a different story in general industry: Heavy and tractor-trailer truck drivers, for example, had 9.4 percent decrease in the number of injuries and illnesses resulting in days-away-from-work in 2020 compared with 2019 and their rate fell from 280.0 per 10,000 workers in 2019 to 259.7 in 2020.  Transportation and warehousing also saw a decrease in the number of DAFW cases and rates, while retail trade and manufacturing saw slight increases in the numbers and rates. Manufacturing, and Transportation and Warehouse did see elevated numbers in a new BLS category: “Other Diseases Due to Viruses Not Otherwise Classified,” so there was apparently some recording of COVID in those industries.

Considering the gender composition of health care workers, it’s no surprise that days-away-from-work for women increased 68.0 percent from 2019 to 2020, while cases for men in private industry increased only 7.8 percent.

Meatpacking: The Safest Industry in America?

The House Select Sub-Committee on the Corona Virus Crisis held a hearing last week on “How The Meatpacking Industry Failed The Workers Who Feed America,” and issued a disturbing report.

The report revealed that:

Newly obtained documents from five of the largest meatpacking conglomerates , which represent over 80 percent of the market for beef and over 60 percent of the market for pork in the United States—JBS USA Food Company (JBS), Tyson Foods, Inc. (Tyson), Smithfield Foods (Smithfield), Cargill Meat Solutions Corporation (Cargill), and National Beef Packing Company, LLC (National Beef)—reveal that during the first year of the pandemic, at least 59,000 employees of these five meatpacking companies contracted the coronavirus—almost triple the 22,700 infections previously estimated for these companies—while at least 269 of these companies’ employees died.

According to testimony from Debbie Berkowitz, a fellow at Georgetown University’s Kalmanovitz Initiative for Labor and the Working Poor, and a former senior official at OSHA during the Obama Administration “More workers have died from COVID-19 in the last 18 months in the meat and poultry industry than died from all work-related causes in the industry in the last 15 years.”

 “More workers have died from covid-19 in the last 18 months in the meat and poultry industry than died from all work-related causes in the industry in the last 15 years.” — Debbie Berkowitz

But you wouldn’t know that from the self-reported records of the meatpacking industry. In fact, if you went by their OSHA injury and illness logs you’d believe that meatpacking was the safest industry in the country last year, recording few, if any, COVID infections or deaths.

For example, Smithfield Food’s internal data obtained by the Committee showed 9,666 employee infections and 25 employee deaths. But that’s not what Smithfield reported on their OSHA injury and illness logs. Large employers are required to send their injury and illness log summaries (Form 300A) to OSHA annually. The calendar year 2000 injury and illness log summary for Smithfield recorded only a small handful of possible COVID-19 infections among the thousands of Smithfield employees across the country.  And because COVID infections are listed under two possible categories on the summary, “Total Respiratory Conditions” or “Other Illnesses,” it’s not entirely clear if even that small handful of reports referred to COVID infections. The non-reporting is similar for other meatpacking companies.

Impact of COVID on Workers: What We Don’t Know

Why does under-reporting occur? Because injury and illness numbers that OSHA and the BLS collect are self-reported by employers and it is well documented that injuries and illnesses are significantly undercounted, even under normal (non-COVID) conditions. OSHA only checks those records for accuracy when they happen to be at the worksite on an inspection or when a worker files a complaint. And OSHA can only cite the employer for falsified records within 6 months of the reportable incident. (For more background on this restriction, check out the history of the Volks Rule.) This means that very few violations of OSHA’s recordkeeping standard will ever be cited.

So even with the elevated health care numbers reported today by BLS, we actually don’t know the real COVID-related illness or death numbers in health care. There is no comprehensive, mandatory reporting mechanism for COVID-related illnesses or deaths in the thousands of hospitals and other health facilities around the country. The only agency that comes close is the Centers for Medicare and Medicaid Services, which reports that over 2100 workers died from COVID-19 infections in long-term care facilities alone, and 660,635 long term health care workers have been infected.

To make matters worse, although OSHA requires all work-related hospitalizations to be reported, a recent OSHA interpretation of the Severe Injury Reporting rule essentially exempts COVID-19 from the rule’s requirements. The rule states that COVID-19 hospitalizations only need to be reported to OSHA if the hospitalization occurs within 24 hours of exposure — which, of course, never happens.  Fatalities only need to be reported if the fatality occurred within thirty days of an exposure to COVID-19 at work. Again, this limitation may miss most work-related deaths from COVID.

Given the free pass that employers generally receive regarding accurate injury and illness recording, the biggest surprise from the BLS report is not how many COVID-related illnesses health care workers suffered in 2020, but that health care employers actually recorded so many infections.  We have no idea whether even this number is accurate or a significant undercount.

We do know health care workers were not the only occupational category that suffered terribly due to work-related COVID-19 infections: workers in meatpacking, retail, transportation, corrections and many other occupations also faced illness and death just from going to work.  And we have no idea if the extent of under-reporting in other industries is as bad as we’re seeing in meatpacking.

When BLS reports on 2020 workplace deaths next month, COVID-related workplace deaths will likely be officially invisible.

Why? Because almost no one is counting. CMS (as mentioned above) counts deaths and infections among health care workers in long term care facilities, but there is no other systematic, comprehensive national count of any other workers. BLS isn’t counting, nor is CDC.  There is no national reporting requirement for occupations outside of long term care.  And the employer self-reporting system used by OSHA and BLS for workplace injuries and illnesses clearly isn’t working either.

Will COVID-Related Workplace Deaths Be Counted?

On December 16, BLS will release its annual Census of Fatal Occupational Injuries (CFOI) which catalogs the number of workplace deaths in 2020.  CFOI is not based on a self-reporting system. It is a much more accurate census, where BLS collects all work-related death reports from OSHA, news reports, hospital and coroner records and anywhere else work-related fatality information is available.  But CFOI reports fatal “injuries,” not illnesses, and the 2020 census will likely include few, if any, COVID-related deaths. In fact, due to COVID-related shutdowns, it is highly likely that for the first time in many years, BLS will report a decrease in work-related deaths.  Despite the fact that more work-related deaths occurred in 2020 than any year in recent US history, most COVID-related workplace deaths will be officially invisible.

There is language in the FY 2022 House Appropriations Report that would require CDC to study the impact of COVID-19 on workers, including disparate impact by race and ethnicity. Passage would be a major step forward. Otherwise, the workers of this country — many of whom risked their lives going to work every day during the height of the pandemic — are facing a national failure to learn the lessons of this pandemic, lessons that could save thousands of workers’ lives when the next pandemic hits.

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