Workers and COVID-19: Who lives and who dies

I rant frequently about the lack of data — or possibly interest — revealing the severe health impact of COVID-19 on workers over the past couple of years.

I was especially disturbed when the Bureau of Labor Statistics issued its report last December on workplace deaths in 2020 that gave the impression that 2020 was about the safest year ever in the workplace because acute fatal injures had fallen that year. Why had they fallen? Because deaths from acute injuries went down along with falling economic activity, while the report did not factor in worker deaths as a result of COVID-19 contracted on the job. Despite the conclusion of the survey, in reality, workplace-related COVID deaths probably made 2020 the deadliest year for American workers in recorded history.

But how many died, where and why, we’re only beginning to learn.

Finally, more national data is emerging showing the impact of COVID-19 on workers. And to no one’s surprise, the highest risk was experienced by so-called “essential workers” —  those who were forced to keep traveling to a workplace and working in close proximity with the public or co-workers while others were able to hunker down at home in front of their computers. [Full Disclosure: I was  one of those lucky enough to hunker down in the basement in front of a computer.)

These were the findings of a recently released report by the National Center for Health Statistics on “COVID-19 Mortality by Usual Occupation and Industry: 46 States and New York City, United States, 2020.” The report presents both COVID mortality rates and proportional mortality rates by usual occupation and industry extracted from death certificates and compares the rates to the COVID-19 death rates among all workers aged 15-64 during 2020. The findings support the need for strong, effective measures to limit workplace exposures to SARS-CoV-2.

Who were the workers most at risk in 2020, the first year of COVID-19? Workers in healthcare & social assistance; waste services; public administration; protective service occupations; agriculture, forestry, fishing, & hunting; wholesale trade; accommodation & food services; & manufacturing, waste services industries, building and grounds cleaning and maintenance, installation, maintenance, and repair. Smaller studies of workers in Wisconsin, Massachusetts and California had similar findings.

In other words, the police who keep us safe, health care and social service workers who care for the sick, meatpacking, agriculture and other food preparation workers who provide the food we need to eat, warehouse and transportation workers who assemble and distribute food and other essentials for everyone staying at home, and those providing other necessary services that kept our society functioning through the darkest days of the pandemic.

“Work is a core social determinant of health and working conditions, and job tasks influence transmission of severe acute respiratory syndrome coronavirus 2.” In other words, the work you do largely determines whether you’re healthy or sick; whether you live or die.

As the report states: “Work is a core social determinant of health and working conditions, and job tasks influence transmission of severe acute respiratory syndrome coronavirus 2.” In other words, the work you do largely determines whether you’re healthy or sick; whether you live or die.

Did Zoom Kill Workers?

So it is becoming increasingly clear that who lived and who died depended on where people worked (as well as the protections they had at work.) Although we still have no good count of how many workers got sick and died of COVID-19 as a result of workplace exposures, at least we have more proof that those workers on the front line were most at risk.

Why weren’t these workers better protected?

And a more serious question — applying to both the Trump and Biden administrations —  is: Did Zoom kill workers?

That’s the provocative question asked by former OSHA head Dr. David Michaels in a Twitter thread following release of the NCHS report. Michaels also served on President Biden’s COVID advisory board in the weeks before he took office.

The initial failure to adequately protect workers from COVID-19 in 2020 was clearly the fault of the Trump administration’s efforts to minimize worker risk, failure to issue an ETS, failure to establish an effective COVID enforcement program and collusion with the meat processing industry to keep meatpacking facilities running despite deadly outbreaks. Not only did the Trump administration fail to recognize work is a core social determinant of health and working conditions, but they blamed worker illnesses and deaths — especially those of immigrant workers — on their living conditions.

No one ever accused Trump of being pro-worker or pro-worker protection.  But what about the Biden administration, arguably “the most labor-friendly administration” in almost a century?

We have also discussed extensively OSHA’s failure during Biden’s first year to issue an OSHA Emergency Temporary Standard (ETS) protecting all workers. Despite President Biden’s commitment on the first day of his administration to issue an ETS protecting all workers, OSHA issued a belated ETS protecting only healthcare workers, and then followed that with a emergency temporary standard that required unvaccinated workers to be tested weekly, instead of mandating workplace protections for all workers. (The vax-or-test mandate was later overturned by Republican appointees on the Supreme Court.)

Michaels argues that the failure of both administrations to adequately protect workers was related to which workers were most at risk:  meatpacking, transportation, warehousing, food preparation workers, who also happen to be those “industries where Black and brown workers are over-represented and have a higher risk of death.”

“If CEOs, executives, attorneys & other people had to go to work daily, the outcry demanding safe workplaces would have been enormous. Instead, the government did little to ensure the safety of those who were forced to work in person. Many died.” — Dr. David Michaels

And the workers least at risk, thanks to Zoom and other online platforms, were those workers — mostly white and white-collar —  who were able to work from home.

“Zoom granted safety only to the privileged. Less-privileged, less powerful workers, especially Black and brown workers, went to work risking their lives to keep society and the economy functioning. Many died as a result.”

And how did those discrepancies affect national COVID-19 policy?

“If CEOs, executives, attorneys & other people had to go to work daily, the outcry demanding safe workplaces would have been enormous. Instead, the government did little to ensure the safety of those who were forced to work in person. Many died.”

So what needs to be done to prevent worker deaths, Michaels asks?

“We need a strong OSHA airborne infectious disease standard that protects all workers from all airborne diseases (not just COVID). We started working this rule when I was running OSHA, but the effort was killed by the Trump Administration.” 

Indeed, OSHA started working on a comprehensive infectious disease standard during the H1N1 pandemic in 2009. The only infectious disease standard that OSHA currently has covers bloodborne pathogens like HIV/AIDS and Hepatitis B. The new infectious disease standard would cover all other infectious diseases — whether spread through the air, by  oral-fecal contamination or skin contact.

But the problem with OSHA’s planned infectious disease standard is that, as originally envisioned, it would only apply to healthcare workers. As we learned from COVID, however,  workplace protections are likely required for all workers during a pandemic.

In addition to improved workplace protections, Michaels tweeted:

“We need legislation requiring employers to provide paid family and medical leave so potentially infectious workers can stay home. And we need a national effort to provide clean, safe indoor air.”

Writing in the New York Times, Michaels, along with Ezekiel Emmanuel, Michael Osterholm and Rick Bright, also members of the Biden advisory board, elaborated on the missed opportunities to permanently improve American health and the public health system.

The most important missed opportunity was the failure to prioritize systematic improvement of indoor air quality. All sorts of respiratory infections, including flu and common colds, as well as asthma and other medical conditions, arise because of airborne pathogens and particulate matter.

Better ventilation would clearly have made workplaces safer. And the importance of having workplace safety experts (like Dr. Michaels) on national public health advisory boards was clear in the authors’ statement that:

Improving worker safety has been another missed opportunity. Everyone in a workplace benefits if colleagues feeling flulike symptoms remain home. But this will happen only with a change in culture around sickness and, more important, the provision of paid sick leave to workers, especially for those in low-income jobs and the gig economy. Paid sick leave is particularly important in the health care, hospitality, public transportation and retail industries, where infections can most easily spread. But many employers still do not provide paid sick and family medical leave, and Congress has refused to pass legislation requiring it, despite the mountain of data on workplace spread from coronavirus and other respiratory infections.

Trump’s OSHA: Denial, Deregulation and Death

While more and more data is still coming in, it was clear from the start of the COVID-19 pandemic that essential workers — and often workers of color — were at high risk and were suffering the most infections and deaths due to COVID-19.  So in that first year, what actions were taken by the Occupational Safety and Health Administration — the only federal agency assigned to protect the health and safety of 130 million workers in the country’s 8 million workplaces?  And were they enough to protect workers?

The Department of Labor’s Office of the Inspector General looked at this question for the first year of COVID and the last year of the Trump administration (the period February 1, 2020, through January 31, 2021) and in a report issued last week concluded:

OSHA’s enforcement activities did not sufficiently protect workers from COVID-19 health hazards because OSHA: (1) did not issue citations to enforce the standard for recording and reporting occupational injuries and illnesses in 15 percent of sampled fatality COVID-19 inspections, (2) lacks complete information on COVID-19 infection rates at worksites, and (3) closed inspections without ensuring it received and reviewed all items requested from employers to demonstrate alleged COVID-19 health hazards had been mitigated.

These issues occurred because OSHA had not established controls to ensure citations were issued or to document the rationale, does not require employers to report all COVID-19 cases among workers, and does not have a tool to ensure it receives and reviews all requested documentation prior to closing inspections. Due to the lack of citations, incomplete information on infection rates at worksites, and insufficient evidence of hazard mitigation, there is a heightened risk that workers suffered unnecessary exposure to the virus.

OSHA did not cite many employers who failed to record deaths, injuries, and illnesses, and failed to require employers to report all COVID-19 infections in their workforce.

The Trump administration’s initial COVID policy, you may remember, was denial. “We have it under control,” President Trump insisted in the early months of the pandemic. Even when it became apparent that workers were at high risk — especially those in meatpacking plants and other workplaces where insufficiently protected employees worked closely together, the Trump administration colluded with meatpacking companies to keep plants open despite the deadly COVID outbreaks in their facilities. And, of course, the Trump administration refused to issue an Emergency Temporary Standard to protect workers, even those at highest risk such as healthcare workers.

The Trump administration’s initial COVID policy, you may remember, was denial and deregulation. “We have it under control,” President Trump insisted in the early months of the pandemic. Even when it became apparent that workers were at high risk.

To address OSHA’s failures in 2020, the OIG made the following recommendations:

1. Provide additional training to CSHOs to enforce the recording and reporting standard for fatalities.
2. Update guidance or policy to include supervisory review of inspection files to ensure they contain adequate support for the reasons regarding citation issuance decisions before closing inspections.
3. Develop a plan for a future pandemic or epidemic to collaborate with external agencies on worksite case data and to use this data to maximize rapid response and enforcement actions in worksites.
4. As part of OSHA’s rulemaking on infectious diseases, require employers to notify all employees of all known positive cases of infectious diseases at the worksite.
5. Develop and implement a tracking tool to ensure OSHA receives and reviews all items CSHOs request during inspections to ensure alleged hazards have been mitigated. This recommendation resulted from the OIG’s finding that OSHA had determined in some cases that violations did not exist, but may not have received adequate information from employers to ensure that problems identified were adequately addressed, especially during “remote” inspections.

In response, OSHA agreed with recommendations 1 and 2, and agreed to look into the feasibility of recommendation 3. OSHA rejected recommendation 4 because (as mentioned above), its comprehensive infectious disease standard is planned scope of the infectious disease rule is limited to health care and the social assistance sectors. To broaden the scope of the standard to include all infected workers, OSHA argued, would essentially be a new standard, significantly slowing down issuance of the standard OSHA is currently working on.

OSHA also rejected Recommendation 5, “maintaining essentially that the OIG should have to prove a material impact on inspection effectiveness such as unmitigated hazards to warrant use of a tracking tool.”

What is to be done?

Although the threat of COVID-19, especially for workers, is still present, public health officials and federal and state governments need to focus on lessons learned and how to implement them to protect workers in the next inevitable pandemic — one that could be far worse than COVID-19.

As mentioned above, Michaels, Emmanuel, Bright and Osterholm point to the work that still needs to be done to protect all Americans — including workers — from the next pandemic: better ventilation, paid sick leave, better data collection and analysis, better means to engage high-risk but hard-to-reach populations, more secure domestic supply chains for personal protective equipment, and an improved system of clinical research for vaccines and treatments. All of those issues need to be addressed and funded.

Protecting Workers

Focusing in on workers, clearly OSHA needs a comprehensive standard to protect all workers — not just healthcare workers — from all infectious diseases they may be exposed to on the job.  While healthcare workers are always first on the front lines, an easily transmittable disease can threaten all workers — especially those who are not able to stay home.

The problem here is not that OSHA or the White House is unaware or uncaring of the need for a standard to protect all workers, but that the OSHA regulatory process is dysfunctional: it takes the agency from 10 to 20 years to finalize a major standard.

OSHA is currently working on a permanent COVID-19 standard protecting healthcare workers which is expected to be finalized soon, as well as a comprehensive infectious disease standard to protect healthcare workers. It is unlikely that the comprehensive infectious disease standard will be finalized in this term.

Neither of these standards will provide coverage for workers outside the healthcare sector. The problem here is not that OSHA or the White House is unaware or uncaring of the need for a standard to protect all workers, but that the OSHA regulatory process is dysfunctional: it takes the agency from 10 to 20 years to finalize a major standard.  And they’ve already been working on the comprehensive infectious disease standard for over 12 years. This lengthy process is hardly adequate in today’s world where workers face can face new hazards that require a quick and nimble response from the only federal agency tasked to protect them. And it’s hard to believe that the bipartisan originators of OSHA envisioned a process where new standards would take decades to issue.

More protective standards

Improving the regulatory process and enforcement of OSHA standards requires increased funding — and changes in the law that allow much faster and easier rulemaking to protect workers. Neither of these is likely in the near future. OSHA’s regulatory budget was cut during the first year of the Trump administration from a paltry $20 million to $18 million. To this date, it has still not recovered — remaining at $19.5 million in the FY 2022 budget. And Republicans are more focused on slowing or killing the regulatory process than making it faster and more efficient.

If OSHA is unable to issue a comprehensive infectious disease standard covering all workers, there may be other, less onerous, things that OSHA can do: for example, improving recordkeeping around infectious diseases, requiring reporting of outbreaks to OSHA, or adding infectious diseases to the Hazard Communication standard (which currently requires workers to be trained about any chemicals they are exposed to but not infectious diseases.) OSHA, along with other federal agencies and state, could collaborate to require and fund improved ventilation in all public buildings and workplaces.

A Republican Congress?

With strong Republican resistance to any regulatory protections, it is highly unlikely that the Occupational Safety and Health Act will be improved or receive significantly increased funding adequate to make standard-setting easier and faster.

Tomorrow’s elections are about how we are governed, about the preservation of our Democracy and about who lives and dies in American workplaces.

Vote Accordingly.

And the likelihood of addressing pandemic precautions are also more unlikely if  Republicans capture either house of Congress in tomorrow’s elections.

If Republicans take the Senate majority, for example, the Chair of the powerful Health, Education, Labor and Pension’s committee may be Rand Paul (R-KY), who has opposed all pro-labor legislation and whose main life obsession seems to be to blame Dr. Anthony Fauci for the COVID pandemic. Paul’s campaign website features “Fire Fauci” banner and he “called for more research into treatments such as ivermectin, noting that it was already in clinical trials to test its effectiveness against a number of viruses, including SARS-CoV-2. The drug was subsequently shown to be ineffective against the coronavirus.”

We’re not sure who will take over the House Education and Labor Committee. Current ranking member Virginia Foxx (R-NC) who thinks there’s a hammer and sickle tattooed on very Democrat’s back, may be termed out, leaving the Chairmanship to other, equally anti-labor members. The only firm plan House Republicans seem to have is to change the name to Committee on Education and the Workforce  because the word “labor” is so negative.

OSHA can also expect more attacks and investigations on over-reach of the defunct “vaccine mandate,” and their enforcement and regulatory process in general. If Republicans take both Houses, expect funding cuts (or at least no significant increases) and attempts at appropriations riders that will restrict OSHA rulemaking.

Tomorrow’s elections are about how we are governed, about the preservation of our Democracy and about who lives and dies in American workplaces.

Vote Accordingly.