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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations Windsor-Shellard and Butt, June 26, 2020.
Windsor-Shellard, B and Nasir, R. 2021, January 25. Coronavirus COVID19
related deaths by occupation, England and Wales: deaths registered between 9
March and 28 December 2020. https
www.ons.gov.uk/peoplepopulation andcommunity/healthandsocialcare/
causesofdeath/bulletins/coronavirus covid19relateddeathsbyoccupation englandandwales/deathsregistered between9marchand28december2020.
Windsor-Shellard and Nasir, January 25, 2021.
Yi, H et al., 2020, September 7. Health equity considerations in COVID19:
geospatial network analysis of the COVID19 outbreak in the migrant population in Singapore. J Travel Med.
DOI: 10.1093/jtm/taaa159. Yi et al., September 7, 2020.

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IV. Conclusion OSHA finds that healthcare employees face a grave danger from exposure to SARSCoV2 in the United States.10 OSHAs determination is based on three separate manifestations of incurable, permanent, or non-fleeting health consequences of exposure to the virus, each of which is independently supported by substantial evidence in the record. The danger to healthcare employees is further supported by powerful lines of evidence demonstrating the transmissibility of the virus in the workplace and the prevalence of infections in employee populations where individuals with suspected or confirmed COVID19
receive care.
First, with respect to the grave health consequences of exposure to SARS
CoV2, OSHA has found that regardless of where and how exposure occurs, COVID19 can result in death. The risk of death from COVID19 is especially high for employees who have underlying health conditions, older employees, and employees who are members of racial and ethnic minority groups, who together make up a significant proportion of the working population. Second, even for those who survive a SARSCoV2 infection, the virus often causes serious, long-lasting, and potentially permanent health effects. Serious cases of COVID19
require hospitalization and dramatic medical interventions, and might leave 10 The determination that COVID19 presents a grave danger to healthcare employees is not based on a determination that workplace protections previously adopted by any particular employer to address the risk of infection are necessarily inadequate. As discussed in the Feasibility section, many such workplace protections are consistent with the uniform nationwide requirements set forth in the ETS. The purpose of the ETS is to ensure sufficient protections for workers are consistently implemented across the country.

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employees with permanent and disabling health effects. Third, even mild or moderate cases of COVID19
that do not require hospitalization can be debilitating and require medical care and significant time off from work for recovery and quarantine. People who initially appear to have mild cases can suffer health effects that continue months after the initial infection.
Furthermore, racial and ethnic minority groups are at increased risk of SARS
CoV2 infection, as well as hospitalization and death from COVID
19.
Each of these categories of health consequences independently poses a grave danger to individuals exposed to the virus. That danger is amplified for healthcare employees because of the high potential for transmission of the virus in healthcare settings where individuals with suspected or confirmed COVID19 receive care. The best available evidence on the science of transmission of the virus makes clear that SARSCoV2 is transmissible from person to person in these settings, which can result in large-scale clusters of infections. Transmission is most prevalent in healthcare settings where individuals with suspected or confirmed COVID19 receive care, and can be exacerbated by, for example, poor ventilation, close contact with potentially infectious individuals, and situations where aerosols containing SARSCoV2 particles are likely to be generated. Importantly, while older employees and those with underlying health conditions face a higher risk of dying from COVID19 once infected, fatalities are certainly not limited to that group. Every healthcare workplace exposure or transmission has the potential to cause severe illness or even death, particularly in unvaccinated healthcare workers in settings where patients with suspected or confirmed COVID19 receive care. Taken together, the multiple, severe health consequences of COVID19 and the evidence of its transmission in environments characteristic of the healthcare workplaces where this ETS
requires worker protections demonstrate that exposure to SARSCoV2
represents a grave danger to employees in these workplaces throughout the country.11
11 Note that OSHA has made no determination regarding the significance of the risk to employees from exposure to SARSCoV2, as would be required in a permanent rulemaking under section 6b5 of the OSH Act, 29 U.S.C. 655b5. OSHA
has only considered whether exposure to SARS
CoV2 poses a grave danger, as required for promulgation of a permanent standard under section 6c1A, 29 U.S.C. 655c1A.

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The existence of a grave danger to employees from SARSCoV2 is further supported by the toll the pandemic has already taken on the nation as a whole.
Although OSHA cannot estimate the total number of healthcare workers in our nation who contracted COVID19 at work and became sick or died, COVID
19 has killed 587,342 people in the United States as of May 24, 2021 CDC, May 24, 2021a. That death toll includes 91,351 people who were 18 to 64 years old CDC, May 24, 2021b. Current mortality data shows that unvaccinated people of working age have a 1 in 217
chance of dying when they contract COVID19. As of May 24, 2021, more than 32 million people in the United States have been reported to have infections, and thousands of new cases were being identified daily CDC, May 24, 2021c. One in ten reported cases of COVID19 becomes severe and requires hospitalization. Moreover, public health officials agree that these numbers fail to show the full extent of the deaths and illnesses from this disease, and racial and ethnic minority groups are disproportionately represented among COVID19 cases, hospitalizations, and deaths CDC, December 10, 2021; CDC, May 26, 2021; Escobar et al., 2021; Gross et al., 2020; McLaren, 2020. Given this context, OSHA is confident in its finding that exposure to SARSCoV2
poses a grave danger to the healthcare employees covered by the protections in this ETS.
The above analysis fully satisfies the OSH Acts requirements for finding a grave danger. Although OSHA usually performs a quantitative risk assessment before promulgating a health standard under section 6b5 of the OSH Act, 29
U.S.C. 655b5, that type of analysis is not necessary in this situation. OSHA
has most often invoked section 6b5
authority to regulate exposures to chemical hazards involving much smaller populations, many fewer cases, extrapolations from animal evidence, long-term exposure, and delayed effects.
In those situations, mathematical modelling is necessary to evaluate the extent of the risk at different exposure levels. The gravity of the danger presented by a disease with acute effects like COVID19, on the other hand, is made obvious by a straightforward count of deaths and illnesses caused by the disease, which reach sums not seen in a century. The evidence compiled above amply support OSHAs finding that SARSCoV2 presents a grave danger in to the healthcare employees covered by the protections in this ETS.
In the context of ordinary 6b rulemaking, the Supreme Court has said
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