Protecting the Health and Safety of our Essential Workers

A grocery store in Seattle, with a cashier checking out a customer's items.

A call to action for public health

As the coronavirus crisis continues, essential workers’ needs will increasingly become more urgent, and stark. There is an enormous responsibility to take care of our workers and provide the tools needed by workers who are risking their lives by having to continue to work outside the home. The actions of Illinois government and the public health resources in the State in the coming weeks could prevent larger outbreaks in essential workplaces and lay the foundation for an organized strategy that can also be scaled up when workers in non-essential industries begin to return to work.

Millions of essential workers are at risk of contracting the highly contagious disease. Without adequate health and safety training, protections, and enforcement, many of these essential work settings have the potential to develop into large COVID-19 outbreak sites. In addition, many essential workers are already economically-disadvantaged and fall outside of traditional employment relationships and safety net protections, and are therefore unprepared to manage COVID-related health impacts on themselves and their families. As stated in an email by a local worker center partner, “as this pandemic escalates a growing number of workers will risk either contracting and transmitting the virus, or will stay home from work without compensation. Either of these options will result in greatly diminished capacity for these workers – and industries – to respond to the public's needs for essential goods and services."

This Call to Action seeks to identify the most immediate risks to all non-medical essential workers and to begin to formulate a public health strategy for Chicagoland and Illinois to help provide information and support to some of our most essential and at-risk workers.

Public health actions needed immediately include:

  • task Illinois public health institutions and experts to create a state level task force to address essential worker needs during the COVID-19 pandemic
  • develop consistent health and safety messaging across all agencies and programs
  • develop and mandate training on prevention of COVID-19 infection for all essential workers and employers
  • develop and share a system of enforcement triage that assures workers that actions are being taken to address complaints of unsafe/unhealthy work practices
  • provide access to insurance and free COVID-19 testing for all essential workers
  • implement policies such as sick pay, health insurance, access to childcare and path to return to work for essential workers impacted by COVID-19.

Background

The Department of Homeland Security issued guidance to assist state, local and industry partners to identify essential sectors and workers that are needed to maintain critical infrastructure1. Many of these essential industries including food and agriculture, transportation, manufacturing and healthcare will see continued demand for their products and services. While quite a bit of media attention has understandably been focused on health care workers in hospital settings, there has been less focus on other sectors of the essential workforce. A recent report emphasizes the responsibility to protect our essential workers “who will continue to report to their jobs at home care agencies, grocery stores, warehouses, utility services, transportation, delivery services, and other work sites—all to ensure the rest of the country can maintain some semblance of a typical life during this health crisis.”2 A large portion of these workers already earn lower wages, carry less health-related insurance and do not receive paid time off. The report goes on to state that, “Since many of these workers risk their lives to protect ours, the nation has a responsibility to protect the health and financial stability of these individuals and their families.”2

For the past three weeks, public health experts at the University of Illinois at Chicago (UIC) School of Public Health have been receiving requests from workers, unions, health departments and worker advocacy organizations (some who have had longstanding relationships with the School) requesting guidance, training and support to protect the health and safety of some of these at-risk essential workers. Here are a few considerations for the public health community:

  • Some of the confusion and need for additional guidance stems from the fact that the Occupational Safety and Health Administration (OSHA) has failed to adopt an emergency standard, or issue guidance for essential workers in this crisis, creating a life-threatening gap. This lack of a standard has led to requests from workers, employers and unions, for more information about their duties and responsibilities, how to protect essential workers, and the accessibility of benefits for essential workers, many of whom are already vulnerable and economically disadvantaged. OSHA has detailed COVID-19 related guidelines for preparing workplaces3 and recently released statement reminding employers that “it is illegal to retaliate against workers because they report unsafe and unhealthful working conditions during the coronavirus pandemic,”4 but who in Illinois is responsible for enforcing OSHA guidelines for these workers and workplaces?
  • Individual truckers, homecare workers, grocery store workers, warehouse workers have reached out to ask for guidance on how to protect themselves. For example, drivers delivering packages for companies have raised concerns about exposure to the virus when handling packages and interacting with customers. According to inquiries received workers have been asked to disinfect their trucks with bleach – without training, being given appropriate gloves, or sufficient time to conduct the cleaning. What actions will Illinois take to close this gap?
  • Unions are requesting assistance with developing just-in-time training to train and protect their members employed in the essential service industries. Many organizations do not have the expertise, or capacity, to translate existing COVID-19 related worker protection and workplace safety guidelines into trainings for essential workers in diverse settings. It is not business as usual, and essential workers must receive training on how to protect themselves. Who is responsible for ensuring this happens?
  • In Illinois, workers are calling health department hotlines to express concerns about unsafe conditions at work that could expose them to the virus, such as crowded assembly lines without social distancing. Worker centers are reporting stories of workers being asked to provide their own Personal protective Equipment (PPE) and being forced to work even after COVID-19 positive cases have been identified on site. The Illinois State Attorney General’s office is fielding questions or concerns about whether a business is violating the Stay at Home Order by not allowing for safe social distancing, or that it is not maintaining a safe and sanitary work environment to minimize the risk of spread of COVID-19. They have a telephone helpline answered by attorneys and then are reaching out to the businesses in question. How can the Illinois public health professional network supplement efforts of the State to protect our workers?
  • Workers express concerns about not having access to testing (if they are experiencing symptoms), and worrying about not having insurance, or paid time off, if they fall sick. In addition, some temp staffing agencies are requiring workers to prove that they have tested negative for COVID-19 in order to be placed at a job. In normal times many workers go to work sick, because they cannot afford to lose their jobs. They are fired if they don’t show up. This problem will grow exponentially with the COVID-19 pandemic. Where and how would workers be able to be tested if they do not qualify for health insurance?
  • A recent report on coronavirus and farmworkers highlights “the growing concerns about the impacts of COVID-19 on the supply of farmworkers, who may be unable to work if they become infected.”5 Farmworkers are already exposed to numerous health and safety hazards, including environmental and biological hazards. COVID-19 presents additional challenges to farm employers and workers.4 How can we protect our farmworkers to ensure the stability of our food supply chains?
  • These complaints and queries received are not unique to Illinois. The month of March saw a number of workers across the country in diverse organizations and sectors- Amazon warehouses, Instacart, UPS, McDonald’s – petitioning and protesting to voice their concerns, and ask for protections. Some have walked off the job, engaging in wildcat strikes. Workers’ rights advocates have recently petitioned Governor Pritzker “to ban the use of biometric scanners requiring workers to make finger prints when punching in and out, to reduce crowded assembly lines to achieve social distance, and to provide paid sick leave and paid leave time for temp workers who must place their children in childcare in order to go to work.”6 We should all be concerned about the impact of these conditions on the sustainability of the economy and production in the State of Illinois. Why do our essential workers have to protest to ask for protections when serving us?

State and local response

States are responsible for maintaining continuity of essential services/industries and for protecting essential workers. Many federal, state, local agencies and health departments have developed guidelines and recommendations for preparing the workplace but there is limited evidence of how much of this is translating to employer actions to protect workers. According to Governor Pritzker’s Executive Order issued on March 20, 2020, “to the greatest extent feasible, Essential Businesses and Operations shall comply with Social Distancing Requirements as defined in this Executive Order, including by maintaining six-foot social distancing for both employees and members of the public at all times, including, but not limited to, when any customers are standing in line.” Unfortunately, companies in Illinois and nationally appear to be violating this and similar Executive Orders. The Wall Street Journal article,  U.S. Plant Workplaces Emerge as Coronavirus Battlegrounds highlights the reality that companies needlessly make it impossible for workers to practice social distancing and protect themselves, their colleagues, and their communities from potentially fatal – and potentially preventable – disease.7

State and local agencies are trying to address the health and safety of essential workers. Many state attorneys general – even those without dedicated worker right’s units- are working to protect workers facing unprecedented challenges, including essential workers who are working without adequate protections. The Illinois State Attorney General’s office has set up a hotline to document and respond to employees’ complaints of Executive Order violations by employers; and despite limited resources and competing priorities, local and state health agencies have developed a number of guidance documents for essential businesses, messaging for testing services, and messaging to protect vulnerable populations. However, state leaders and health agencies are also focused on responding to larger systems’ needs related to the pandemic- procuring ventilators, preparing field hospitals for the potential case surge, protecting vulnerable populations, and securing PPE for our hospitals and healthcare workers on the frontlines.  It is unclear how much capacity they have for these efforts, or the extent to which these efforts are being translated into actions at the employer and worker level. Greater levels of coordinated strategy and scale are necessary to meaningfully protect our essential workers.

Call to Action

Public health institutions and professionals (including occupational health and safety professionals) across the State of Illinois have longstanding partnerships with health departments, organizations protecting worker health and rights, and worker communities. There is an opportunity for leaders and experts of public health institutions to support our state and local agencies by facilitating the organization of resources and actions to protect our essential workers so that health agencies can focus on other immediate needs.  By fostering communication and partnership between public health resources, workers’ advocates and service providers, and state and local agencies and enforcers, we can better protect our essential and at-risk workers.

What public health experts/institutions/networks can do to assist in these needed public health actions

  • Facilitate the creation of a state level workgroup or task force to focus on the health and safety of all essential workers. Ensure the taskforce includes representatives from stakeholder organizations (including health agencies), so that we can organize and leverage resources across a shared purpose. Task force duties could include:
    • Develop common/shared messages or guidelines for workers and employers who contact the state or private institutions. Right now there is no decision tree or protocol for triaging these requests that has been shared with public health and community groups. Common topics might include:
      • Where to get testing and treatment
      • Resources for workplace safety training
      • Surveillance
      • Applying for and access to unemployment insurance
      • Availability of paid time off
      • Fear of retaliation for organizing or refusing to work
    • Provide assistance and training to employers. Most employers do not have an occupational health and safety, or medical professional on site, to assist with the implementation of the recommended guidelines.
    • Coordinate the development and implementation of trainings for diverse essential worker groups. These could be shared via community dissemination channels (including unions, worker centers, religious institutions, community organizations). Such training could include information about availability of PPE, testing, and protocols to report violations. Some of this training can be modified in future to address needs of non-essential workers.
    • Partner with enforcement agencies, such as OSHA and the State AGs office, to ensure essential service employers are following the recommended guidelines and protecting our workers. The vast network of industrial hygienists and occupational safety and health professionals can be contracted to help inspect and consult with workplaces.
    • Assist with the creation of a centralized system or resource portal to respond to all essential worker and employer needs (instead of multi-agency hotlines). For example, the UIC School of Public Health is creating a resource guide outlining benefits available to workers in the State of Illinois. A guide for employers is also needed on where they can access resources and receive technical assistance in meeting their needs.
    • Make evidence- based recommendations for best practices, including innovative policies and interventions, that will continue to support workers and employers when we are ready to open non-essential services and businesses.

What the State of Illinois can do to support these needed public health actions

  • Media messaging to acknowledge all essential workers of our state, and commit to protecting the health and safety of these workers. This is not business as usual.
  • Publicize and clearly state the policies and actions the state is already taking to target violators of the EO. Create and share a system of enforcement triage that assures:
    • an immediate follow-up (to the extent possible) of employers violating the EO.
    • use of the ‘send letter and resources’ approach that documents that employer actions are reported and require addressing NOW. This can also be used as an opportunity to assist employers who need help.
    • worker reports will be used to document lack of compliance after the crisis has passed. Non-compliant employers are put on a watch-list.
  • Develop and implement policies and incentives to protect all essential workers, including immigrant and undocumented workers:
    • Childcare assistance
    • Health insurance
    • Paid time off for workers who fall sick and work for an employer not covered by the federal pandemic legislation
    • Job protections to guarantee an opportunity to return to work, if and when they are ready
    • Job protections for whistleblowers or workers who express concerns about health and safety
    • Workers’ compensation for COVID-19 related illness and fatalities (medical care and replacement wages or death benefits)
  • Task Illinois public health institutions and public health experts to convene a state level workgroup or task force to focus on the health and safety of essential workers, and lead this group.
  • Make COVID-related training mandatory for all essential workers by providing funding and resources for development and dissemination of such materials, and for instruction.
  • Ensure industry makes every effort to conduct risk assessments and implement a hierarchy of controls to protect workers.
  • Make efforts to provide Personal protective Equipment (PPE) and cleaning supplies for employers and workers in essential industries, as and when more PPE become available.
  • Ensure access to free testing for all essential workers, including undocumented and immigrant workers. No one should be forced to go to work when sick.

What employers can do to protect the health and safety of essential workers

  • Ensure a safe and healthful workplace free from recognized hazards as required by the Occupational Safety and Health Act.8,9
  • Conduct a risk assessment and implement controls to protect workers from exposure to hazards.
    • A risk assessment should determine which employees are critical and which employees do not need to be present.
    • Source controls should include reducing how often people need to interact. This may mean altering work schedules and very strict enforcement of screening workers for symptoms.
    • Pathway controls should consider a range of engineering controls to prevent the virus from traveling from one worker to the next. Examples include erecting plastic barriers, improving ventilation systems, or utilizing mechanical lifting devices to assist adequate social distancing of at least 6 feet between workers.
    • If feasible source and pathway controls have been implemented and there is still a risk of employee exposure to hazards, as a last resort, employers can place a minimum number of people in PPE. Source controls and pathway controls must be prioritized over PPE, according to OSHA.
    • If PPE is required, it must be provided by the employer at no cost to employees, must be appropriate for the task, and must provide adequate protection. Employees should be properly trained (and fit tested if given respiratory protection) on the PPE’s appropriate use.

What the public can do to support essential workers

  • Sign petitions to support essential workers.
  • Donate to Go Fund Me appeals and similar campaigns to the organizations of your choice.
  • Write to your elected officials, asking for policies and incentives to support our essential workers.
  • Take a moment to thank essential workers at your local grocery store, delivery service operators, transit workers, postal workers.

Please contact Marsha Love at lovem@uic.edu for a list of petitions and Go Fund Me appeals.

About the authors

Preethi Pratap, PhD, MSc, is an assistant professor in the Division of Environmental and Occupational Health Sciences at the University of Illinois Chicago, School of Public Health. She also serves as Director of Continuing Education and Outreach Great Lakes Center for Occupational Health and Safety. A large part of her prior scholarly practice focused on partnering with local and global organizations to develop, deliver and evaluate educational interventions to translate occupational and environmental health best practices for diverse public health audiences (healthcare workers, other at-risk workers, medical and occupational health and safety professionals).  Pratap’s current research interests are in the application of systems thinking tools and participatory action research methods to inform policy, systems and environmental change in occupational and environmental health.

Marsha Love, MA, MA, is the coordinator for the outreach program and activities in the Great Lakes Center for Occupational Safety and Health.  She has over 30 years of experience as an educator, researcher and administrator in occupational safety and health. Love works closely with labor unions, worker centers, faith-based organizations, non-profit workforce development organizations, and community groups to provide technical assistance and develop customized curricula and train-the-trainer workshops to build their organizational capacity to address workplace hazards.  She also has a long-standing commitment to advancing health protections for low wage and immigrant workers in hazardous occupations and precarious employment situations.

Acknowledgements

We would like to thank the following colleagues for their guidance and support in the preparation of this document: Lorraine Conroy, ScD, CIH; Susan Buchanan, MD, MPH; Linda Forst, MD, MPH; Jane Flanagan, J.D; Tim Bell, M.Ed; Margaret Sietsema, PhD, CIH; Carol Rice, PhD, CIH; Christina Welter, DrPH, MPH; Guddi Kapadia, MS, MPH; Caitlin Donato, MPH; Elizabeth Fisher, CHES and Amanda Goldstein (MPH candidate).

References

  1. S. Department of Homeland Security. Guidance on the essential critical infrastructure. Retrieved April 1, 2020.
  2. Tomer A and Kane JW. How to protect essential workers during COVID 19. Brookings Institution Report. Retrieved April 1, 2020.
  3. Occupational Safety and Health Administration (OSHA). Guidance for preparing workplaces for COVID-19 [OSHA 3990-03 2020]. Retrieved March, 2020.
  4. Occupational Safety and Health Administration (OSHA) S. Department of Labor reminds employers that they cannot retaliate against workers reporting unsafe conditions during coronavirus pandemic [News Release]. Retrieved April 8, 2020.
  5. Costa D and Martin P. Farm employment, safety issues, and the H-2A guest worker program. Economic Policy institute Report. Retrieved April 1, 2020.
  6. Chicago Workers Collaborative. Governor Pritzker, Protect IL Temp Workers. The Action Network. (online petition launched March 19, 2020)
  7. Berzon A, Bunge J and Lazo A. U.S. Plant Workplaces Emerge as Coronavirus Battlegrounds. The Wall Street Journal. Retrieved April 1, 2020.
  8. Occupational Safety and Health Administration (OSHA). Occupational Safety and Health Act of 1970. Retrieved April 8, 2020.
  9. Occupational Safety and Health Administration (OSHA). Worker Rights and protections: Employer responsibilities. Retrieved April 8, 2020.

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