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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations firefighters from March 1 through May 31, 2020, based on medical records. The study had a total of 14,290 participants 3,501 EMS personnel and 10,789
firefighters. From March 1 to May 31, 2020, 9,115 63.8% responders had no COVID19 diagnosis, 5,175 36.2%
were confirmed or suspected COVID19
cases, and 62 0.4% were hospitalized.
Three participants died in a hospital, and one died at home. Researchers found that EMS respondents had more cases of severe COVID19 than firefighters 42/3501 1.2% vs. 21/
10,789 0.19%. The SARSCoV2
infection rate among New York City first responders overall was 15 times the New York City rate. EMS personnel had a 4-fold greater risk of severe disease and 26% increased risk of confirmed COVID19 cases when compared with firefighters. Both firefighters and EMS
personnel responded to the pandemicrelated emergency medical calls and followed the same PPE protocols.
However, EMS personnel had greater COVID19 exposure than firefighters due to greater COVID19-related call volume and being solely responsible for patient transport, nebulization of bronchodilators, and intubation.
Tarabichi et al., October 30, 2020
recruited first responders from EMS
and fire departments to participate in a study in the Cleveland, Ohio area. The authors conducted a first serologic survey and virus test in the period between April 20 through May 19, 2020
and a second between May 18 and June 2, 2020. A total of 296 respondents completed a first visit and 260
completed the second visit. Seventy-one percent of respondents reported exposure to SARSCoV2 and 16 5.4%
had positive serological testing. No subject had a positive virus test. Fifty percent 8/16 of those who tested positive were either asymptomatic or mildly symptomatic. Based on responses to questions about suspected contacts it does not appear that the time period of exposure was considered, the study author concluded that likely sources of transmission in participants who tested positive were patients or co-workers.
In a study examining COVID19
antibodies in employees from public service agencies in the New York City area from May through July of 2020, 22.5% of participants were found to have COVID19 antibodies Sami et al., March 2021. The percentages of EMTs and paramedics found to have antibodies 38.3 and 31.1% were among the highest levels observed in all the occupations. The study authors noted that risk of exposures may be increased for employees who provide
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emergency medical services because those services are provided in uncontrolled, unpredictable environments, where space is limited e.g., ambulances and quick decisions must often be made. Both emergency technicians and paramedics perform procedures such as airway management that involve a high risk of exposure. In fact, the proportions of employees who had antibodies were found to be increased with increasing frequency of aerosol-generating procedures.
In-Home Healthcare Providers In-home healthcare workers provide medical or personal care services, similar to those provided in long-term care facilities, inside the homes of people unable to live independently.
Patients receiving in-home care could receive services from different types of healthcare providers e.g., a nurse administering medical care, a physical therapist assisting with exercise, a personal care services provider assisting with daily functions such as bathing. In addition, a number of workers may provide services to the same patient, while working in shifts over the course of the day. In-home healthcare providers have a high risk of infection from working close to patients and possibly their family members or other caregivers in enclosed spaces e.g., performing a physical examination, helping the patient bathe.
The impact of COVID19 on in-home healthcare workers is not well studied.
In-home healthcare workers might be included in reports of COVID19 cases and deaths in healthcare workers, but those reports do not indicate if any of the affected healthcare workers provided home care. One report from the UK indicated that an occupational category of social care which included care workers and home carers experienced significantly increased rates of death involving COVID19 50.1 deaths per 100,000 men and 19.1 deaths per 100,000 women from March through May of 2020
Windsor-Shellard et al., June 26, 2020.
And in a related study from March through December of 2020, it was reported that nearly three in four deaths involving COVID19 in social care operations were in care workers and home carers, with 109.9 deaths per 100,000 men and 47.1 deaths per 100,000 women Windsor-Shellard et al., January 25, 2021.
Conclusion The representative studies OSHA
described in this section on healthcare provide examples of the pervasive impact that SARSCoV2 exposures
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have had on employees in those industries before vaccines were available. Even since vaccines have become widely available, approximately 20 to 30% of healthcare workers remained unvaccinated as of March 2021 King et al., April 24, 2021, and breakthrough cases among vaccinated healthcare employees are evident. The evidence is consistent with OSHAs determination that SARSCoV2 poses a grave danger to healthcare employees.
Cases or outbreaks in settings such as hospitals, long-term care facilities, and emergency services departments have had a clear impact on employees in those types of workplaces. The evidence establishes that employees in those settings, whether they provide direct patient care or supporting services, have been infected with SARSCoV2 and have developed COVID19. Some of these employees have died and others have become seriously ill. Employees in healthcare are at elevated risk for transmission in the workplace.
Employees in these industry settings are exposed to these forms of transmission through in-person interaction with patients and co-workers in settings where individuals with suspected or confirmed COVID19 receive care. In many cases, close contact with people who are suspected or confirmed to have COVID19 is required of personnel in these types of workplaces, and such close contact usually occurs indoors.
These employees, who form the backbone of the nations medical response to the COVID19 public health emergency, clearly require protection under this ETS.
References Bagchi, S et al., 2021. Rates of COVID19
among residents and staff members in nursing homesUnited States, May 25
November 22, 2020. MMWR 70: 5255.
http dx.doi.org/10.15585/
mmwr.mm7002e2. Bagchi et al., 2021.
Barrett, ES et al., 2020. Prevalence of SARSCoV2 infection in previously undiagnosed health care workers in New Jersey, at the onset of the US COVID19
pandemic. BMC infectious diseases 201: 10. doi: 10.1101/
2020.04.20.20072470. Barrett et al., 2020.
Burrer, SL et al., 2020. Characteristics of health care personnel with COVID19
United States, February 12April 9, 2020. MMWR 6915: 477481. https
www.cdc.gov/mmwr/volumes/69/wr/
mm6915e6.htm. Burrer et al., 2020.
Carter, RE et al., 2021, March 26. Prevalence of SARSCoV2 Antibodies in a Multistate Academic Medical Center.
Mayo Clin Proc. 2021 May; 965: 1165
1174. doi: 10.1016/j.mayocp.2021.
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