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8.A. - Page 32 of 73
<br />► Additional material is
<br />published online only. To view,
<br />please visit the journal online
<br />(http://dx.doi.org/10.1 136/
<br />oemed-2020-106774).
<br />'Environmental & Occupational
<br />Medicine & Epidemiology
<br />Program, Department of
<br />Environmental Health, Harvard
<br />University H Chan School
<br />of Public Health, Boston,
<br />Massachusetts, USA
<br />2Department of Occupational
<br />and Environmental Medicine,
<br />National Cheng Kung University
<br />Hospital, College of Medicine,
<br />National Cheng Kung University,
<br />Tainan, Taiwan
<br />3Management Sciences for
<br />Health, Medford, Massachusetts,
<br />USA
<br />4Department of Occupational
<br />Medicine, Cambridge
<br />Health Alliance, Harvard
<br />Medical School, Cambridge,
<br />Massachusetts, USA
<br />5Department of General Internal
<br />Medicine, Boston University
<br />School of Medicine, Boston,
<br />Massachusetts, USA
<br />Correspondence to
<br />Dr Justin Yang, Environmental
<br />Health, Harvard UniversityT H
<br />Chan School of Public Health,
<br />Boston, MA 02115, USA;
<br />justin.yang@mail.harvard.edu
<br />Received 8 June 2020
<br />Revised 11 September 2020
<br />Accepted 26 September 2020
<br />Published Online First
<br />30 October 2020
<br />is Check for updates
<br />0 Author(s) (or their
<br />employer(s)) 2021. No
<br />commercial re -use. See rights
<br />and permissions. Published
<br />by BMJ.
<br />To cite: Lan F -Y,
<br />Suharlim C, Kales SN,
<br />et al. Occup Environ Med
<br />2021;78:237-243.
<br />Original research
<br />Association between SARS-CoV-2 infection, exposure
<br />risk and mental health among a cohort of essential
<br />retail workers in the USA
<br />Fan-Yun Lan, 1,2 Christian Suharlim,3 Stefanos N Kales,1,4 Justin Yang 1,5
<br />ABSTRACT
<br />Objectives To investigate SARS-CoV-2 (the virus
<br />causing COVID-19) infection and exposure risks among
<br />grocery retail workers, and to investigate their mental
<br />health state during the pandemic.
<br />Methods This cross-sectional study was conducted
<br />in May 2020 in a single grocery retail store in
<br />Massachusetts, USA. We assessed workers' personal/
<br />occupational history and perception of COVID-19 by
<br />questionnaire. The health outcomes were measured by
<br />nasopharyngeal SARS-CoV-2 reverse transcriptase PCR
<br />(RT -PCR) results, General Anxiety Disorder -7 (GAD -7) and
<br />Patient Health Questionnaire -9 (PHQ-9).
<br />Results Among 104 workers tested, 21 (20%) had
<br />positive viral assays. Seventy-six per cent positive cases
<br />were asymptomatic. Employees with direct customer
<br />exposure had an odds of 5.1 (95% Cl 1.1 to 24.8)
<br />being tested positive for SARS-CoV-2 after adjustments.
<br />As to mental health, the prevalence of anxiety and
<br />depression (ie, GAD -7 score >4 or PHQ-9 score >4) was
<br />24% and 8%, respectively. After adjusting for potential
<br />confounders, those able to practice social distancing
<br />consistently at work had odds of 0.3 (95% Cl 0.1 to 0.9)
<br />and 0.2 (95% CI 0.03 to 0.99) screening positive for
<br />anxiety and depression, respectively. Workers commuting
<br />by foot, bike or private cars were less likely to screen
<br />positive for depression (OR 0. 1, 95% Cl 0.02 to 0.7).
<br />Conclusions In this single store sample, we found a
<br />considerable asymptomatic SARS-CoV-2 infection rate
<br />among grocery workers. Employees with direct customer
<br />exposure were five times more likely to test positive for
<br />SARS-CoV-2. Those able to practice social distancing
<br />consistently at work had significantly lower risk of
<br />anxiety or depression.
<br />INTRODUCTION
<br />WHO declared COVID-19 as a pandemic on 11
<br />March 2020.1 Since then, accumulating evidence has
<br />shown the transmission capability of SARS-CoV-2,
<br />the virus causing COVID-19, not just from symp-
<br />tomatic patients but from asymptomatic carriers. 2-4
<br />Interventions have been implemented worldwide to
<br />minimise transmission, including social distancing,
<br />travel bans, stay-at-home orders and school and
<br />non-essential business closures.s 6 All measures are
<br />intended to reduce contact and to prevent trans-
<br />mission, especially when the index patients are in
<br />subclinical stage of SARS-CoV-2 infection.7 While
<br />most community residents benefit from these risk
<br />reduction policies, certain essential employees, such
<br />What is already known about this subject?
<br />► The health of essential workers during the
<br />COVID-19 pandemic is of great public and
<br />media interests.
<br />► Research, however, has largely focused on
<br />healthcare workers with relatively limited
<br />literature investigating non -healthcare essential
<br />workers.
<br />► Previous studies suggested essential workers
<br />are not able to benefit from mitigation policies.
<br />► Their occupational exposures increase their
<br />own risk to SARS-CoV-2 infection, and increase
<br />the risk of secondary transmissions to their
<br />colleagues, families and communities.
<br />What are the new findings?
<br />► The present study fills in the knowledge gap
<br />of COVID-19 impacts on grocery/retail market
<br />workers during the pandemic, from both
<br />physical and psychological perspectives.
<br />► In this single store sample (n=104), we found
<br />an alarming infection rate of 20% positive
<br />SARS-CoV-2 RT -PCR assay result among these
<br />workers and the majority (76%) of them were
<br />asymptomatic at the time of testing.
<br />► Furthermore, employees with direct customer
<br />exposure were five times more likely to test
<br />positive for SARS-CoV-2.
<br />P. Our study also found the inability to practice
<br />social distancing consistently at work was
<br />a significant risk factor for anxiety and
<br />depression.
<br />► At the same time, commuting to work by public
<br />transportation/shared rides was significantly
<br />associated with depressive state.
<br />as healthcare workers (HCWs), first responders
<br />and retail workers, continue to experience poten-
<br />tial SARS-CoV-2 exposure risk due to the nature
<br />of their job.8 Furthermore, once essential workers
<br />are infected with SARS-CoV-2, they may become a
<br />significant transmission source for the community
<br />they serve.9
<br />The psychological stress associated with working
<br />during the COVID-19 pandemic is also of great
<br />public interest.lo Studies have indicated pandemic
<br />awareness, infection fear and family concerns
<br />BMJ Lan F -Y, et al. Occup Environ Med 2021;78:237-243. doi: 10. 1 136/oemed-2020-106774 237
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