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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations
investigation uncovers an alternative source for the outbreak. In their May 19, 2021, COVID19 Weekly Report, OHA
reported 71 active clusters, including at three separate hospitals OHA, May 19, 2021.
In a May 21, 2021 report, the Tennessee Department of Health reported 238 active clusters i.e., 2 or more confirmed cases of COVID19
linked by the same location of exposure or exposure event that is not considered a household exposure, with 6 occurring in assisted care facilities, 37 in nursing homes, and 3 in other healthcare settings Tennessee Department of Health, May 21, 2021.
A study on SARSCoV2 testing in Los Angeles from mid-September through October 2020 evaluated 149,957
symptomatic and asymptomatic positive cases associated with an occupation Allan-Blitz et al., December 11, 2020.
Infection rates were found to be particularly high for healthcare personnel and first responders.
A Morbidity and Mortality Weekly Report MMWRs a weekly epidemiological digest published by the CDC reported on the occupational status of COVID19 cases in Colorado.
In the Colorado study, 1,738 COVID19
cases from nine Colorado counties were evaluated; these cases occurred before the state lockdown that began on March 26, 2020 Marshall et al., June 30, 2020.
Half of the individuals were exposed in a workplace setting, with the greatest number of COVID19-positive employees coming from healthcare 38%.
Chen et al., January 22, 2021
analyzed records of deaths occurring on or after January 1, 2016 in California and found that mortality rates in working aged adults 1865 years increased 22% during the COVID19
pandemic March through October 2020 compared to pre-pandemic periods. Relative to pre-pandemic periods, healthcare or emergency workers were one occupational group that experienced excess and statistically significant mortality compared to prepandemic periods 19% increase. The study authors concluded that essential work conducted in person is a likely avenue of infection transmission.
Hawkins et al., January 10, 2021
examined death certificates of individuals who died in Massachusetts between March 1 and July 31, 2020. An age-adjusted mortality rate of 16.4 per 100,000 employees was determined from 555 death certificates that had useable occupation information.
Employees in healthcare support, personal care services, and social services had particularly high mortality
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rates. The study authors noted that occupation groups expected to have frequent contact with sick people, close contact with the public, and jobs that are not practical to do from home had particularly elevated mortality rates.
The impact of COVID19 across diverse healthcare sectors is not limited to the United States. The European Centre for Disease Prevention and Control investigated clusters in occupational settings throughout Europe ECDC, August 11, 2020. The Centre reviewed 1,376 occupational clusters from 16 European countries from March through July of 2020. Indoor settings contributed to 95% of reported clusters.
Hospitals and long-term care facilities accounted for many of the clusters.
References Allan-Blitz, L et al., 2020, December 11.
High frequency and prevalence of community-based asymptomatic SARS
CoV2 Infection. medRxix. https
doi.org/10.1101/2020.12.09.20246249.
Allan-Blitz et al., December 11, 2020.
Centers for Disease Control and Prevention CDC. 2021, April 5. Science Brief:
SARSCoV2 and Surface Fomite Transmission for Indoor Community Environments. https www.cdc.gov/
coronavirus/2019-ncov/more/scienceand-research/surface-transmission.html.
CDC, April 5, 2021.
Centers for Disease Control and Prevention CDC. 2021, May 7. Scientific Brief:
SARSCoV2 Transmission. https
www.cdc.gov/coronavirus/2019-ncov/
more/scientific-brief-sars-cov-2.html.
CDC, May 7, 2021.
Chan, E et al., 2010, December 14. Global capacity for emerging infectious disease detection. Proceedings of the National Academy of Sciences of the United States of America, 10750, 2170121706.
https doi.org/10.1073/
pnas.1006219107. Chan et al, December 14, 2010.
Chen, Y et al., 2021, January 22. Excess mortality associated with the COVID19
pandemic among Californians 1865
years of age, by occupational sector and occupation: March through October 2020. MedRxiv. doi: 10.1101/
2021.01.21.21250266. Chen et al., January 22, 2021.
European Centre for Disease Prevention and Control ECDC. 2020, August 11.
COVID19 clusters and outbreaks in occupational settings in the EU/EEA and the UK. ECDC, August 11, 2020.
Gomez-Ochoa, SA et al., 2021, January.
COVID19 in health-care workers: a living systematic review and metaanalysis of prevalence, risk factors, clinical characteristics, and outcomes.
American journal of epidemiology. 2021
Jan; 1901: 16175. Gomez-Ochoa et al., January 2021.
Hawkins, D et al., 2020, December 21.
COVID19 deaths by occupation, Massachusetts, March 1July 31, 2020.
American Journal of Industrial Medicine
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644: 238244. DOI: 10.1002/
ajim.23227. Hawkins et al., December 21, 2021.
Heinzerling, A et al., 2020, April 17.
Transmission of COVID19 to Health Care Personnel During Exposures to a Hospitalized PatientSolano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 472476.
DOI: http dx.doi.org/10.15585/
mmwr.mm6915e5. Heinzerling et al., April 17, 2020.
Howard, J. 2021, May 22. Response to request for an assessment by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, of the current hazards facing healthcare workers from Coronavirus Disease2019 COVID19.
Howard, May 22, 2021.
Marshall, K et al., 2020, June 30. Exposure before issuance of stay-at-home orders among persons with laboratoryconfirmed COVID19Colorado, March 2020. MMWR: 6926: 8479. Marshall et al., June 30, 2020.
Oregon Health Authority OHA. 2021, May 19. COVID19 weekly outbreak report.
https www.oregon.gov/oha/covid19/
Documents/DataReports/COVID-19Weekly-Outbreak-Report-2021-1-13FINAL.pdf. OHA, May 19, 2021.
Tennessee Department of Health. 2021, May 21. COVID19 critical indicators.
Tennessee Department of Health. May 21, 2021.
Washington State Department of Health WSDH and Washington State Department of Labor and Industries WLNI. 2020, November 10. COVID19
confirmed cases by industry sector.
Publication Number 421002. https
www.doh.wa.gov/Portals/1/Documents/
1600/coronavirus/
IndustrySectorReport.pdf. WSDH and WLNI, November 10, 2020.
Wilkins, JT et al., 2021. Seroprevalence and correlates of SARSCoV2 antibodies in health care workers in Chicago. Open Forum Infectious Diseases. 81: ofaa582.
https doi.org/10.1093/ofid/ofaa582.
Wilkins et al., 2021.
Zhang, M. 2020, November 18. Estimation of differential occupational risk of COVID19 by comparing risk factors with case data by occupational group.
American Journal of Industrial Medicine 641:3947. doi: 10.1002/ajim.23199.
Zhang, November 18, 2020.

b. Studies Focusing on Employees in Healthcare General Surveillance and Surveys Across the U.S.
Burrer et al., 2020 reported surveillance data on COVID19 cases and deaths among healthcare personnel between February 12 and April 9, 2020. Healthcare personnel were defined as paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or
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