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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations
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virus has only been transmitted between humans since the end of 2019.
Therefore, to fully appreciate the likely long-term risks to individuals with COVID19, it is important to consider the long-term impacts of similar coronaviruses found among human populations where there has been more time to gather data.
The previous SARS outbreak in 2002
to 2003, caused by the SARSCoV1
virus, is one such example, and it indicates long-term impacts to infection survivors, which might result from the viral infection, medications used, or a combination of those factors. Patients who survived a SARSCoV1 infection report that they have a reduced quality of life at least 6 months after illness Hui et al., October 1, 2005. These patients were found to have reduced exercise capacity; some had abnormal chest radiographs and lung function, and weak respiratory muscles at least 6
months after illness Hui et al., October 1, 2005. Survivors reported experiencing depression, insomnia, anxiety, PTSD, chronic fatigue, and decreased lung capacity with patient follow up as long as four years after infection Lam et al., December 14, 2009; Lee et al., April 1, 2007; Hui et al., October 1, 2005. Long term studies have revealed that some survivors of SARSCoV1 infections have chronic pulmonary and skeletal damage after a 15 year follow up Zhang et al., February 14, 2020. Zhang et al., found that approximately half of the area of ground glass opacities present after infection in a 2003 CT scan 9.4%
remained after 15 years 4.6%. The study also found significant femoral head loss 25.52% remained in 2018.
Bone loss was likely an indirect effect caused by the high pulse steroid therapies used to treat the infection in many patients with severe disease.
Survivors also suffer long-term neurologic complications, deficits in cognitive function, musculoskeletal pain, fatigue, depression, and disordered sleep up to at least three years after infection Moldofsky and Patcai, March 24, 2011.
Individuals at Increased Risk From COVID19
Many members of the workforce are at increased risk of death and severe disease from COVID19 because of their age or pre-existing health conditions.
Comorbidities are fairly common among adults of working age in the U.S. For instance, 46.1% of individuals with cancer are in the 2064 year old age range NCI, April 29, 2015, and over 40% of working age adults are obese Hales et al., February 2020.

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Furthermore, over a quarter of those between 65 and 74 years old remain in the workforce, as well as almost 10% of those 75 and older BLS, May 29, 2019.
In hospitals and other health services e.g., physician offices, residential care facilities, 1,078,000 workers are employed who are 65 years old and older BLS, January 22, 2021.
Individuals who are at increased risk of severe infection hospitalization, admission to the ICU, or death include:
Individuals who have cancer, chronic kidney disease, chronic lung disease e.g., chronic obstructive pulmonary disease COPD, asthma moderate-tosevere, interstitial lung disease, cystic fibrosis, and pulmonary hypertension, serious heart conditions, obesity, pregnancy, sickle cell disease, type 2
diabetes, and individuals who are over 65 years of age, immunocompromised and/or smokers CDC, May 13, 2021. Of 5,700 COVID19 patients hospitalized from March 1 to April 4, 2020 in the New York City area, the most common comorbidities were hypertension 56.6%, obesity 41.7%, and diabetes 33.8%, excluding age Richardson et al., April 22, 2020.
Observed Disparities in Risk Based on Race and Ethnicity During the COVID19 pandemic, research has found that employees in racial and ethnic minority groups, and especially Black and Latinx employees, have often faced substantially higher risks of SARSCoV2 exposure and infection through the workplace than have non-Hispanic White employees Hawkins, June 15, 2020; HertelFernandez et al., June 2020; Roberts et al., November 26, 2020. Among the general U.S. population, American Indian, Alaskan Native, Latinx, and Black populations are more likely than White populations to be infected with SARSCoV2 CDC, April 23, 2021.
Once infected, people in these demographics are also more likely than their White counterparts to be hospitalized for and/or die from COVID19 CDC, April 23, 2021. These observed disparities in risk of infection, risk of adverse health consequences, and risk of death may be attributable to a number of factors, including that people from racial and ethnic minority groups are often disproportionately represented in essential frontline occupations that require close contact with the public and that offer limited ability to work from home or take paid sick days. Disease severity is also likely exacerbated by long-standing healthcare inequities CDC, April 19, 2021.
Hawkins June 15, 2020 compared data on worker demographics from the
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Bureau of Labor Statistics 2019 Current Population Survey and ONET a Department of Labor database that contains detailed occupational information on the nature of work for more than 900 occupations across the U.S. to determine occupation-specific COVID19 risks. The model found that among ONETs 57 physical and social factors related to work, the two predictive variables of COVID19 risk were frequency of exposure to diseases and physical proximity to other people.
The author found that Black individuals were overwhelmingly employed in essential industries and that people of colorwhich in this study included Black, Asian, and Hispanic populationswere more likely than White individuals to work in essential occupations e.g., healthcare and social assistance, personal care aids that were identified as having greater disease exposure risk characteristics. A similar evaluation of workers employed in frontline industries e.g., healthcare found that people of colordefined in this study to include individuals who are Black, Hispanic, Asian-American/
Pacific Islander, or some category other than Whiteare well represented in these types of work Rho et al., April 7, 2020. These studies suggest that people in racial and ethnic minority groups are greatly represented among the American workforce in jobs associated with greater risk of exposure to SARSCoV
2, including those in healthcare and related industries.
Through April 2021, infection rates compared to White, Non-Hispanic persons in the United States are 60%
greater for American Indian or Alaskan Native persons, 100% greater for Latinx persons, and 10% greater for Black persons CDC, April 23, 2021. This disparity is also reflected in studies addressing infections by occupation, race, and ethnicity. In a large study of healthcare employees in Los Angeles, researchers found that increased risk of infection was significantly related to whether an employee was Latinx or Black Ebinger et al., February 12, 2021.
Another study of frontline healthcare workers in the U.S. and UK found that Black, Asian, and minority ethnic workers were more likely to report a positive COVID19 test than nonHispanic, White workers Nguyen et al., September 1, 2020. The study also found that Black, Asian, and minority ethnic healthcare workers were more likely to report reuse of or inadequate PPE, were more likely to work in higherrisk clinical settings e.g., in-patient hospitals or nursing homes, and were more likely to care for patients with
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