Estimated Association of Construction Work With Risks of COVID-19 Infection and Hospitalization in Texas

Remy F Pasco,Michael Pignone,Lauren Ancel Meyers,S Claiborne Johnston,Spencer J Fox

doi:10.1001/jamanetworkopen.2020.26373

Remy F Pasco, Michael Pignone + Show 3 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2020.26373

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Journal: JAMA Network Open	Publication Date: Oct 29, 2020
Citations: 51	License type: cc-by

Affiliation: The University of Texas at Austin

Abstract

Policy makers have relaxed restrictions for certain nonessential industries, including construction, jeopardizing the effectiveness of social distancing measures and putting already at-risk populations at greater risk of coronavirus disease 2019 (COVID-19) infection. In Texas, Latinx populations are overly represented among construction workers, and thus have elevated rates of exposure that are compounded by prevalent high-risk comorbidities and lack of access to health care. To assess the association between construction work during the COVID-19 pandemic and hospitalization rates for construction workers and the surrounding community. This decision analytical model used a mathematical model of COVID-19 transmission, stratified by age and risk group, with construction workers modeled explicitly. The model was based on residents of the Austin-Round Rock metropolitan statistical area, with a population of 2.17 million. Based on 500 stochastic simulations for each of 15 scenarios that varied the size of the construction workforce and level of worksite transmission risk, the association between continued construction work and hospitalizations was estimated and then compared with anonymized line-list hospitalization data from central Texas through August 20, 2020. Social distancing interventions, size of construction workforce, and level of disease transmission at construction worksites. For each scenario, the total number of COVID-19 hospitalizations and the relative risk of hospitalization among construction workers was projected and then compared with relative risks estimated from reported hospitalization data. Allowing unrestricted construction work was associated with an increase of COVID-19 hospitalization rates through mid-August 2020 from 0.38 per 1000 residents to 1.5 per 1000 residents and from 0.22 per 1000 construction workers to 9.3 per 1000 construction workers. This increased risk was estimated to be offset by safety measures (such as thorough cleaning of equipment between uses, wearing of protective equipment, limits on the number of workers at a worksite, and increased health surveillance) that were associated with a 50% decrease in transmission. The observed relative risk of hospitalization among construction workers compared with other occupational categories among adults aged 18 to 64 years was 4.9 (95% CI, 3.8-6.2). The findings of this study suggest that unrestricted work in high-contact industries, such as construction, is associated with a higher level of community transmission, increased risks to at-risk workers, and larger health disparities among members of racial and ethnic minority groups.

Highlights

During March 2020, cities across the United States enacted stay-at-home orders to combat the emergence of the coronavirus 2019 (COVID-19) pandemic
The observed relative risk of hospitalization among construction workers compared with other occupational categories among adults aged 18 to 64 years was 4.9
Fitting the COVID-19 transmission model to Austin area hospitalization data through May 3, 2020, suggests that when SARS-CoV-2 first emerged in Austin in February or March of 2020, the virus had a basic reproductive number of 4.14 and a doubling time of 2.53 days

Summary

Introduction

During March 2020, cities across the United States enacted stay-at-home orders to combat the emergence of the coronavirus 2019 (COVID-19) pandemic. New York, and San Francisco severely restricted allowable projects.[1,2] Other cities and states deemed commercial and home construction essential.[3] Most of the nation’s 7.3 million construction workers remained employed throughout April and May of 2020, representing 4.5% of the labor workforce, ranging from 1.8% in the District of Columbia to 10.5% in Wyoming.[4] The risk of viral transmission on construction worksites is amplified by the physical proximity required for many tasks.[5] Latinx populations are overly represented among construction and essential industries,[6] and have elevated rates of exposure that are compounded by prevalent high-risk comorbidities and lack of access to health care.[7] These overlapping risks likely contribute to the disproportionate burden of COVID-19 infections and deaths reported within Latinx communities.[8]

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