Racial and Ethnic Disparities Among COVID-19 Cases in Workplace Outbreaks by Industry Sector

Utah, March 6-June 5, 2020

David P. Bui, PhD; Keegan McCaffrey; Michael Friedrichs, MS; Nathan LaCross, PhD; Nathaniel M. Lewis; Kylie Sage, MS; Bree Barbeau, MPH; Dede Vilven, MPH; Carolyn Rose, MPH; Sara Braby; Sarah Willardson, MPH; Amy Carter; Christopher Smoot, MPH; Andrea Winquist, MD, PhD; Angela Dunn, MD


Morbidity and Mortality Weekly Report. 2020;69(33):1133-1138. 

In This Article


During March 6–June 5, COVID-19 outbreaks were identified in nearly all assessed industry sectors in Utah, with approximately one half of workplace outbreak-associated cases occurring in three sectors: Manufacturing, Construction, and Wholesale Trade. Persons with workplace outbreak-associated COVID-19 were disproportionately Hispanic or nonwhite compared with overall racial/ethnic distributions in these industry sectors. Sector-specific COVID-19 guidance, which CDC has generated for many industries,§,¶,** should be followed to account for different production processes, business operations, and working conditions faced by workers in these sectors. When available, efforts should be made to help employers operationalize sector-specific guidance; CDC and UDOH plain-language business guides can help employers manage and prevent workplace outbreaks and exposures.†† Avoiding introduction of SARS-CoV-2 into workplaces is critical to preventing outbreaks, making both community- and workplace-specific interventions important if SARS-CoV-2 transmission in workplace settings is to be prevented. Health departments and employers need to ensure mitigation strategies are provided using culturally and linguistically responsive materials and messages, which reach workers of racial and ethnic minority groups, especially those disproportionately affected by workplace COVID-19 outbreaks.

The racial and ethnic disparities in workplace outbreak-associated COVID-19 cases found in Utah and identified in meat processing facility outbreaks in other states[3] demonstrate a disproportionate risk for COVID-19. These disparities might be driven, in part, by longstanding health and social inequities,[2] resulting in the overrepresentation of Hispanic and nonwhite workers in frontline occupations (i.e., essential and direct-service) where risk for SARS-CoV-2 exposure might be higher than that associated with remote or nondirect–service work.[4] In addition, Hispanic and nonwhite workers have less flexible work schedules and fewer telework options compared with white and non-Hispanic workers.[5] Lack of job flexibility (i.e., ability to vary when to start and end work), lack of telework options, and unpaid or punitive sick leave policies might prevent workers from staying home and seeking care when ill, resulting in more workplace exposures, delayed treatment, and more severe COVID-19 outcomes.[6,7] Whenever employers can provide flexible work schedules, nonpunitive paid sick leave, and telework options, they should offer this equitably to Hispanic and nonwhite workers.

The findings in this report are subject to at least six limitations. First, this analysis is not representative of all workplace outbreaks in Utah. Outbreaks might not be detected or reported in smaller workplaces, and workers with self-limiting symptoms might not be tested. Outbreaks in nursing homes, detention centers, and education settings were not included in this analysis, and thus, the relative impact of COVID-19 in industry sectors represented by those workers were not assessed. Second, worker-to-worker transmission could not be confirmed; some workplace outbreak-associated cases will represent community and household transmission, or transmission between coworkers outside of work (e.g., commuting to work or social gatherings). Third, individual occupation data were unavailable, so assumptions about the types of affected workers (e.g., frontline workers) cannot be confirmed. Gathering detailed individual occupation data during case investigations might help inform more targeted risk-mitigation interventions within sectors by identifying types of work and workers at highest risk for SARS-CoV-2 infection. Fourth, the stay-at-home directives in effect in Utah during the study period likely differentially affected workplace attendance in different sectors (e.g., more telework in information than in construction sectors); therefore, these findings might not be generalizable to states with different restriction levels and sector workforce distributions. Fifth, it is not known to what extent workers in these sectors were familiar with, able, and willing to follow guidance to prevent and reduce the spread of SARS-CoV-2. Finally, workforce estimates used to calculate the outbreak incidence rates by sector could not be adjusted to account for workers in health care, educational, and congregate-living settings that were excluded from this analysis, resulting in underestimated rates; outbreak incidence rates for the Educational Services sector (NAICS code 61) and Health Care and Social Services sector (NAICS code 62) were likely most affected by this limitation.

Understanding the distribution of workplace outbreaks across industry sectors can help health departments identify and target industries where additional guidance and intervention to mitigate SARS-CoV-2 transmission might be needed. Further, health departments should consider obtaining case occupation data to better understand workplace outbreaks to inform more targeted interventions. The overrepresentation of Hispanic and nonwhite workers in frontline occupations has resulted in disproportionate disease incidence among racial/ethnic minority groups. Care must be taken to ensure that prevention and mitigation strategies are applied equitably and effectively using culturally and linguistically responsive materials, media, and messages to workers of racial and ethnic minority groups disproportionately affected by COVID-19.