Profit and ideology trumped safety
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| Local officials actually had to warn people to disregard Trump's crazy COVID remedies |
The study is the first
in a series that discusses the lessons learned from COVID-19 and the steps
needed to avert deaths in the next pandemic and improve public health.
Frontline workers are those who couldn't work from home and thus were at higher risk of exposure to SARS-CoV-2.
Black and Hispanic workers and immigrants make up high proportions of "essential" workers, or those in healthcare, meatpacking plants, agricultural production, and public transportation.
"Federal policies
on workplace exposure were developed to protect the supply chain of food or
other vital products, or to prevent staff shortages at healthcare facilities,
rather than to protect frontline workers from virus exposure," wrote the
George Washington University–led study authors.
"Some employers, with the
support (and encouragement) of elected officials, put production and profits
ahead of worker safety and health."
'A perfect storm for vulnerable workers'
The study authors said
social, legal, and economic provisions for low-wage workers were weak even
before the pandemic, noting that the United States is one of only six countries
without a national paid sick-leave policy and the only country in the 37-nation
Organization for Economic Co-operation and Development without a national
health insurance program.
Some employers, with the support
(and encouragement) of elected officials, put production and profits ahead of
worker safety and health.
Frontline workers
"were more likely to have precarious work arrangements with unpredictable
scheduling and less control over the conditions of work," they wrote.
"This lack of underlying protections created a perfect storm for
vulnerable workers that was only partially mitigated by emergency measures
during the early stages of the pandemic."
Governmental social
and economic protections during the pandemic (eg, stimulus checks, expansion of
the federal child tax credit) gave workers some financial relief and better
access to health insurance and to COVID-19 testing and care, averting some infections,
hospitalizations, and deaths, the authors said.
But the US
Occupational Safety and Health Administration (OSHA) continued to have limited
authority. "On a national level, OSHA has only enough inspectors to visit
every workplace once every 190 years," they wrote. "So many of the
agency's standards are insufficiently protective that it has taken the unusual
step of recommending that employers adhere to standards developed by other
agencies and organizations."
CDC adherence to droplet dogma
limited response
In addition, guidance
from the Centers for Disease Control and Prevention (CDC) promulgated the
disproven idea that SARS-CoV-2 was primarily transmitted through droplets and
didn't incorporate traditional OSHA strategies for controlling airborne
exposures (eg, ventilation, air cleaning).
"It is now clear
that the CDC (as well as the World Health Organization) erred in clinging to
the droplet dogma," the study authors wrote. "CDC's insistence that
the virus could be controlled by limiting exposure to droplets through surgical
masks, distancing, and handwashing contributed to OSHA's inability to promote
optimal control measures."
Workers also had very
limited access to personal protective equipment (PPE) early in the pandemic and
faced reprisal for complaining about the lack of protections. When OSHA
received thousands of worker complaints, it responded to only a tiny proportion
of them and levied small fines that the authors said likely had little
deterrent effect.
CDC's insistence that the virus
could be controlled by limiting exposure to droplets through surgical masks,
distancing, and handwashing contributed to OSHA's inability to promote optimal
control measures.
"And at least one other opportunity was completely lost," they wrote. "The US president has the authority under the Defense Production Act to order the expansion of production from the US industrial base.
During the pandemic President Trump
invoked this power only once, in April 2020, in an attempt to order the
meatpacking plants to continue to operate. The act could—and should—have been
used instead to deal with the shortage of PPE early in the pandemic."
Researchers propose governmental
action plan
The researchers
recommend a multipronged action plan to address future pandemic threats,
starting with OSHA issuing two new standards on preventing workplace exposure
to airborne pathogens and requiring employers to develop and implement plans to
protect workers through the provision of PPE, vaccines, and other protective
interventions. OSHA should also require employers covered by the airborne
standard to provide paid medical leave, they said.
Other recommendations
include:
- Establishment of universal paid leave to allow employees to stay home when ill
- Updating local building codes to require improved
performance of heating, ventilation, and air conditioning (HVAC) systems and
requiring building owners and operators to provide building tenants, workers,
and guests with data showing the effectiveness of the HVAC systems
- OSHA issuance of a broad safety and health management standard that requires worker participation in workplace risk assessment and abatement activities and improves protections against retaliation for whistleblowers
- Improved data-collection systems, with sharing across worker safety agencies and health departments to identify workplaces and industries in which workers are at increased risk
- Congressional enablement of OSHA to develop a faster, nimbler standard-setting process, provide more inspection resources, and expand its ability to issue civil and criminal penalties with greater deterrent effects
- Restoration of pandemic cash payments, tax credits, increased healthcare insurance, and other actions that improved the lives of workers and their families, made workplaces safer, and addressed social inequality
"The consequences of these failures were appalling and led to tens of thousands of deaths in frontline workers," lead author David Michaels, PhD, MPH, professor at the George Washington University School of Public Health and former OSHA administrator, said in a university news release.
"The risk of exposure
was exacerbated by race- and labor-related economic inequality, resulting in
disproportionally more of the nation’s Black and Hispanic workers being killed
or sickened by the virus."
In a related editorial, Gavin Yamey, MD, MPH, of Duke
University, and colleagues said that the United States, despite its scientific
resources and decades of pandemic-preparedness exercises, struggled to produce
scientific evidence on viral transmission and coordinated policies to mitigate
spread.
"Poor
communication of existing evidence also contributed to confusion and delayed or
inappropriate actions, contributing to the partisan difference in how quickly
US states instituted public health protections and in excess death rates during
the pandemic, especially after vaccines became available," they
wrote.