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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations
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people in the United States in barely over a year, and infected millions more CDC, May 24, 2021a. And the impact of this new illness has been borne disproportionately by the healthcare and healthcare support workers tasked with caring for those infected by this disease. As of May 24, 2021, over 491,816 healthcare workers have contracted COVID19, and more than 1,600 of those workers have died CDC, May 24, 2021b. OSHA has determined that employee exposure to this new hazard, SARSCoV2 the virus that causes COVID19, presents a grave danger to workers in all healthcare settings in the United States and its territories where people with COVID19
are reasonably expected to be present.
This finding of grave danger is based on the science of how the virus spreads and the elevated risk in workplaces where COVID19 patients are cared for, as well as the adverse health effects suffered by those diagnosed with COVID19, as discussed in Grave Danger Section IV.A. of this preamble.
OSHA has also determined that an ETS is necessary to protect healthcare and healthcare support employees in covered healthcare settings from exposures to SARSCoV2, as discussed in Need for the ETS Section IV.B. of this preamble. Workers face a particularly elevated risk of exposure to SARSCoV2 in settings where patients with suspected or confirmed COVID19
receive treatment or where patients with undiagnosed illnesses come for treatment e.g., emergency rooms, urgent care centers, especially when providing care or services directly to those patients. Through its enforcement efforts to date, OSHA has encountered significant obstacles, revealing that existing standards, regulations, and the OSH Acts General Duty Clause are inadequate to address the COVID19

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hazard for employees covered by this ETS. The agency has determined that a COVID19 ETS is necessary to address these inadequacies. Additionally, as states and localities have taken increasingly more divergent approaches to COVID19 workplace regulation ranging from states with their own COVID19 ETSs to states with no workplace protections at allit has become clear that a Federal standard is needed to ensure sufficient protection for healthcare employees in all states.
The development of safe and highly effective vaccines and the on-going nationwide distribution of these vaccines are encouraging milestones in the nations response to COVID19.
OSHA recognizes the promise of vaccines to protect workers, but as of the time of the promulgation of the ETS, vaccination has not eliminated the grave danger presented by the SARSCoV2
virus to the entire healthcare workforce.
Indeed, approximately a quarter of healthcare workers have not yet completed COVID19 vaccination King et al., April 24, 2021. Nonetheless, vaccination is critical in combatting COVID19, and the standard requires employers to provide paid leave to employees so that they can be vaccinated and recover from any side effects. Additionally, certain workplaces and well-defined areas where all employees are fully vaccinated are exempted from all of the standards requirements, and certain fully vaccinated workers are exempted from several of the standards requirements.
OSHA will continue to monitor trends in COVID19 infections and deaths as more of the workforce and the general population become vaccinated and the pandemic continues to evolve. Where OSHA finds a grave danger from the virus no longer exists for the covered workforce or some portion thereof, or
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new information indicates a change in measures necessary to address the grave danger, OSHA will update the ETS, as appropriate.
To protect workers in the meantime, however, a multi-layered approach to controlling occupational exposures to SARSCoV2 in healthcare workplaces is required. As discussed in the Need for Specific Provisions Section V of this preamble, OSHA relied on the best available science for its decisions concerning appropriate provisions for the ETS and its determinations regarding the kind and degree of protective actions needed to protect against exposure to SARSCoV2 at work and the feasibility of instituting these provisions. More specifically, the agencys analysis demonstrates that an effective COVID19 control program must utilize a suite of overlapping controls in a layered approach to protect workers from workplace exposure to SARSCoV2. OSHA emphasizes that the infection control practices required by the ETS are most effective when used together; however, they are also each individually protective.
The agency has also evaluated the feasibility of this ETS and has determined that the requirements of the ETS are both economically and technologically feasible, as outlined in Feasibility Section VI of this preamble.
Table I.1, which is derived from material presented in Section VI of this preamble, provides a summary of OSHAs best estimate of the costs and benefits of the rule using a discount rate of 3 percent. The specific requirements of the ETS are outlined and described in the Summary and Explanation Section VIII of this preamble. OSHA requests comments on the provisions of the ETS
and whether it should be adopted as a permanent standard.

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