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How might this impact on policy or clinical practice in the
<br />foreseeable future?
<br />► This is the first study to demonstrate the significant
<br />asymptomatic infection rate, exposure risks and
<br />associated psychological distress of grocery retail essential
<br />workers during the pandemic, which supports the policy
<br />recommendations that employers and government officials
<br />should take actions on implementing preventive strategies
<br />and administrative arrangements, such as methods to reduce
<br />interpersonal contact, repeat and routine SARS-CoV-2
<br />employee testing, to ensure the health and safety of essential
<br />workers.
<br />► Our significant mental health finding calls for action in
<br />providing comprehensive employee assistance services to
<br />help essential workers cope with the psychological distress
<br />during the COVID-19 pandemic.
<br />contribute significantly to essential workers' mental distress
<br />during an emerging disease pandemic. 1112
<br />Pioneering COVID-19 studies on essential workers have
<br />largely focused on HCWs. Studies showed the attack rates of
<br />SARS-CoV-2 among HCWs in early outbreaks ranged from 0%
<br />to 14%, with fever and loss of smell/taste being the best predic-
<br />tors of the disease.13 14 In terms of mental health, about half of
<br />the HCWs included in one study reported anxiety and depressive
<br />symptoms with psychological stress risk factors including living
<br />in areas with higher prevalence or being frontline HCWs. 15
<br />While HCWs have been widely discussed in COVID-19-
<br />related research, there are relatively limited studies investi-
<br />gating other essential workers. A recent publication looking at
<br />six Asian countries showed that various non -HCWs were also
<br />affected during early COVID-19 transmission, with service and
<br />sales workers comprising 18% of possible work-related cases.9
<br />While previous studies have reported SARS-CoV-2 cluster
<br />infections in supermarket settings, 16 17 no study has examined
<br />the SARS-CoV-2 exposure risks or psychological stress among
<br />grocery retail essential employees. Therefore, we conducted this
<br />study aiming to investigate: 1) SARS-CoV-2 infection rate, trans-
<br />mission and exposure risks among grocery retail employees, 2)
<br />their use of personal protective equipment (PPE) and percep-
<br />tion on COVID-19 and 3) their mental health state during the
<br />COVID-19 pandemic.
<br />METHODS
<br />Study design and study population
<br />This cross-sectional study is reported according to the Strength-
<br />ening the Reporting of Observational Studies in Epidemiology
<br />guideline.18 We used secondary data from a COVID-19 testing
<br />tent site that included information collected from 104 adults
<br />employed at one grocery retail store in the greater Boston
<br />area of Massachusetts, USA as part of a city -mandated group
<br />testing. Clinical evaluation and nasopharyngeal swab sampling
<br />were conducted on each individual over three consecutive days
<br />in early May 2020. All workers older than 18 years sent by
<br />the store and presented for testing were included in this study
<br />(100% response rate).
<br />SARS-CoV 2 RT -PCR specimen collection and testing
<br />The specimens were collected using nasopharyngeal swab inside
<br />the designated COVID-19 testing tent. A trained physician
<br />238
<br />performed the swabbing procedure and transferred each spec-
<br />imen to a 3 mL vial with viral transport media. The samples were
<br />then transported to Quest Diagnostic laboratory in Marlborough,
<br />Massachusetts, where real-time, reverse -transcriptase -PCR (RT -
<br />PCR) diagnostic panels were conducted to detect SARS-CoV-2.
<br />All sampling, specimen storage, transportation and testing
<br />procedures followed the guidelines of the US Centers for Disease
<br />Control and Prevention. 19
<br />Questionnaire survey
<br />As part of the group testing procedure, participants' basic
<br />demographic information, SARS-CoV-2-related exposure infor-
<br />mation, PPE usage and mental health surveys were collected
<br />through a paper-based questionnaire completed on site prior
<br />to testing.
<br />The basic information section of questionnaire included age,
<br />sex, race/ethnicity and medical history including past medical
<br />problems, prescription medication history, smoking status,
<br />alcohol intake, recreational drug use history and primary care
<br />physician information. For past medical issues, participants
<br />responded to a checklist which included the following diseases:
<br />chronic obstructive pulmonary disease/emphysema, asthma,
<br />heart disease, high cholesterol, high blood pressure, diabetes,
<br />HIV, hepatitis C, cancer and other(s).
<br />The following questions were included for employment
<br />history: most recent job position(s) at the store in the past month,
<br />full-time/part-time employment status, work hours per week
<br />(<20 hours, 20-39 hours, 40 hours and above), average length
<br />of shifts, additional employment(s) outside this retail store and
<br />transportation method(s) to work (by foot or bike, private car,
<br />public transportation, shared rides or others). Workers selected
<br />their job position(s) from the following choices: cashier, front
<br />end associate, cart attendant, janitorial crew, stocker, backroom,
<br />receiving, sales associate, fresh food associate, supervisor and/or
<br />specialised roles. Participants were given the choice to answer
<br />with free text for some other position if not listed as above.
<br />Employees were asked to identify any additional employment(s)
<br />in the following categories: healthcare, drivers and transport,
<br />services and sales, cleaning and domestic, public safety, restau-
<br />rant/fast food, others.9
<br />As to COVID-19-related information, participants indicated
<br />new-onset symptoms within the past 1-2 weeks as a yes or no
<br />to a checklist of 11 common COVID-19 symptoms, including
<br />fever/chills, headache, running nose, sore throat, cough (acute,
<br />new onset, dry or productive), shortness of breath, loss of taste
<br />or smell, diffuse body ache, fatigue/ feeling run down, nausea,
<br />diarrhoea. If participants answered yes to any of the above
<br />symptom(s), they were asked to indicate symptom onset. Partic-
<br />ipants were asked if they had been exposed to anyone that has
<br />confirmed SARS-CoV-2 in the past 14 days. If they answered yes,
<br />they were asked of whom the exposure was (colleague, friend,
<br />family/relatives) and how many days ago the exposure occurred.
<br />Information on mental health was recorded using two vali-
<br />dated screening tools on depression and anxiety: Patient Health
<br />Questionnaire -9 (PHQ-9)20 and General Anxiety Disorder -7
<br />(GAD -7).21 For PHQ-9, a total score of no higher than 4 indi-
<br />cates no or minimal depression, with a total PHQ-9 score
<br />ranging from 0 to 27. The score of GAD -7 ranges from 0 to
<br />21. A GAD -7 score of no higher than 4 indicates no or minimal
<br />anxiety. Participants were also asked to self -identify any history
<br />of depression and/or anxiety.
<br />Lan F -Y, et al. Occup Environ Med 2021;78:237-243. doi:10.1136/oemed-2020-106774
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