key: cord-0293187-1lv92wxm
authors: Caban-Martinez, A. J.; Gaglani, M.; Olsho, L. E. W.; Grant, L.; Schaefer-Solle, N.; Tyner, H. L.; Yoon, S. K.; Naleway, A. L.; Lutrick, K.; Meec, J.; Odean, M.; Thiese, M. S.; Kuntz, J. L.; Rose, S.; Wesley, M. G.; Ellingson, K. D.; Mak, J.; Louzado-Feliciano, P.; Respet, K.; Phillips, A. L.; Groom, H. C.; Dunnigan, K.; Groover, K.; Gerald, J. K.; Yoo, Y. M.; Noriega, R.; Lundgrenn, J.; Hegmann, K. T.; Smith, M.; Mayo Lamberte, J.; Cruz, A.; Hunt, A.; Bruner, M. M.; Murthy, K.; Edwards, L. J.; Fowlkes, A. L.; Gallimore-Wilson, D.; Viergutz, J.; Brown, R.; Odame-Bamfo, L.; Sokol, B
title: High Burden of COVID-19 among Unvaccinated Law Enforcement Officers and Firefighters
date: 2021-11-26
journal: nan
DOI: 10.1101/2021.11.24.21266396
sha: d093b24d0dbca50d5e509cab2e621ff3cd20c653
doc_id: 293187
cord_uid: 1lv92wxm

Law Enforcement Officers (LEOs), firefighters, and other first responders are at increased risk of SARS-CoV-2 infection compared to healthcare personnel but have relatively low COVID-19 vaccine uptake. Resistance to COVID-19 vaccine mandates among first responders has the potential to disrupt essential public services and threaten public health and safety. Using data from the HEROES-RECOVER prospective cohorts, we report on the increased illness burden of COVID-19 among unvaccinated first responders. From January to September 2021, first responders contributed to weekly active surveillance for COVID-19-like illness (CLI). Self-collected respiratory specimens collected weekly, irrespective of symptoms, and at the onset CLI were tested by Reverse Transcription Polymerase Chain Reaction (RT-PCR) assay for SARS-CoV-2. Among 1415 first responders, 17% were LEOs, 68% firefighters, and 15% had other first responder occupations. Unvaccinated (41%) compared to fully vaccinated (59%) first responders were less likely to believe COVID-19 vaccines are very or extremely effective (17% versus 54%) or very or extremely safe (15% versus 54%). From January through September 2021, among unvaccinated LEOs, the incidence of COVID-19 was 11.9 per 1,000 person-weeks (95%CI=7.0-20.1) compared to only 0.6 (95%CI=0.2-2.5) among vaccinated LEOs. Incidence of COVID-19 was also higher among unvaccinated firefighters (9.0 per 1,000 person-weeks; 95%CI=6.4-12.7) compared to those vaccinated (1.8 per 1,000; 95%CI=1.1-2.8). Once they had laboratory-confirmed COVID-19, unvaccinated first responders were sick for a mean+/-SD of 14.7+/-21.7 days and missed a mean of 38.0+/-46.0 hours of work. These findings suggest that state and local governments with large numbers of unvaccinated first responders may face major disruptions in their workforce due to COVID-19 illness.

Ethics Review: This study is governed by Centers for Disease Control and Prevention IRB review board and gave ethical approval for this work. Ethics committee/IRB of University of . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 26, 2021. ; https://doi.org/10.1101/2021.11.24.21266396 doi: medRxiv preprint ABSTRACT Law Enforcement Officers (LEOs), firefighters, and other first responders are at increased risk of SARS-CoV-2 infection compared to healthcare personnel but have relatively low COVID-19 vaccine uptake. Resistance to COVID-19 vaccine mandates among first responders has the potential to disrupt essential public services and threaten public health and safety. Using data from the HEROES-RECOVER prospective cohorts, we report on the increased illness burden of COVID-19 among unvaccinated first responders. From January to September 2021, first responders contributed to weekly active surveillance for COVID-19-like illness (CLI). Selfcollected respiratory specimens collected weekly, irrespective of symptoms, and at the onset CLI were tested by Reverse Transcription Polymerase Chain Reaction (RT-PCR) assay for SARS-CoV-2. Among 1415 first responders, 17% were LEOs, 68% firefighters, and 15% had other first responder occupations. Unvaccinated (41%) compared to fully vaccinated (59%) first responders were less likely to believe COVID-19 vaccines are very or extremely effective (17% versus 54%) or very or extremely safe (15% versus 54%). From January through September 2021, among unvaccinated LEOs, the incidence of COVID-19 was 11.9 per 1,000 person-weeks (95%CI=7.0-20.1) compared to only 0.6 (95%CI=0.2-2.5) among vaccinated LEOs. Incidence of COVID-19 was also higher among unvaccinated firefighters (9.0 per 1,000 person-weeks; 95%CI=6.4-12.7) compared to those vaccinated (1.8 per 1,000; 95%CI=1.1-2.8). Once they had laboratory-confirmed COVID-19, unvaccinated first responders were sick for a mean±SD of 14.7±21.7 days and missed a mean of 38.0±46.0 hours of work. These findings suggest that state and local governments with large numbers of unvaccinated first responders may face major disruptions in their workforce due to COVID-19 illness.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Among 1415 first responders, 17% were LEOs, 68% firefighters, and 15% had other first responder occupations (Table) . Mean age (±SD) was 41.3±9.7 years. Most participants were male (79%), White race (95%), and non-Hispanic (71%). Unvaccinated (41%) compared to fully vaccinated (59%) first responders were less likely to believe COVID-19 vaccines are very or extremely effective (17% versus 54%) or very or extremely safe (15% versus 54%). Only onethird (35%) of 1163 first responders who completed an attitude survey said they trusted what the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. During the study period, LEOs and firefighters who remained unvaccinated were 20-and 5-times more likely, respectively to become sick with COVID-19 than their colleagues who were fully vaccinated against COVID-19. On average, first responders were sick with COVID-19 for over 2 weeks and missed close to 40 hours of work due to their illness. Although this is among the largest prospective studies of its kind, 4-6 the relatively small number of COVID-19 illnesses among fully vaccinated participants limited the precision of estimates and precluded models of incidence that could adjust for potential confounders. Nonetheless, these findings suggest that state and local governments with large numbers of unvaccinated first responders may face major disruptions in their workforce due to COVID-19 illness. Workplace requirements for employees to be vaccinated against COVID-19 have been established for healthcare workers. Given that COVID-19 vaccines have proven highly effective in controlling COVID-19 and its variants to . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 26, 2021. ; https://doi.org/10.1101/2021.11.24.21266396 doi: medRxiv preprint date, during this public health emergency, state and local governments should consider vaccine mandates for first responders with a particular focus on LEOs, and regular COVID-19 testing or alternative work assignments for unvaccinated personnel. The low trust in government among first responders in this cohort additionally suggests a need to develop alternate strategies relying on trusted non-governmental information sources to increase vaccination rates.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 26, 2021. ; https://doi.org/10.1101/2021.11.24.21266396 doi: medRxiv preprint

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Officer Down Memorial. Honoring officers killed in 2021. Officer Down Memorial Page, Inc., (ODMP) 2021

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Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) Study: Protocol for a Multi-site Longitudinal Cohort

COVID-19 Infection, Reinfection, and Vaccine Effectiveness in a Prospective Cohort of Arizona Frontline/Essential Workers: The AZ HEROES Research Protocol

It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintThe copyright holder for this this version posted November 26, 2021. ; https://doi.org/10.1101/2021.11.24.21266396 doi: medRxiv preprint CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprintThe copyright holder for this this version posted November 26, 2021. ; https://doi.org/10.1101/2021.11.24.21266396 doi: medRxiv preprint