key: cord-0776961-hpougtje
authors: Quigley, Denise D.; Qureshi, Nabeel; Gahlon, Grace; Gidengil, Courtney
title: Worker and employer experiences with COVID‐19 and the California Workers' Compensation System: A review of the literature
date: 2022-01-29
journal: Am J Ind Med
DOI: 10.1002/ajim.23326
sha: 48e0e0803aaaf636b6a25a9669845e88ff5ad091
doc_id: 776961
cord_uid: hpougtje

BACKGROUND: Given workplace risks from COVID‐19, California policymakers passed Senate Bill (SB) 1159 to facilitate access to workers' compensation (WC) benefits for frontline workers. However there has been no review of the available evidence needed to inform policy decisions about COVID‐19 and WC. METHODS: We conducted a literature review on worker and employer experiences surrounding COVID‐19 and WC, adhering to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. RESULTS: Forty articles were included (16 about worker experiences and 24 about employer practices). Most were not about experiences and practices related to COVID‐19 and WC. Worker studies indicated that paid sick leave reduced new COVID‐19 cases and COVID‐19 activity. Studies also found that rural agricultural and food processing workers lacked sick leave protection and faced severe housing and food insecurity. Studies on workplace health and safety indicated that healthcare workers with access to personal protective equipment had lower stress levels. Studies about employer practices found that unrestricted work in high‐contact industries was associated with increased risks to at‐risk workers, and with health disparities. No studies examined worker COVID‐19 experiences and WC claims or benefits, job loss, retaliation, workers' medical care experiences, and return‐to‐work or leave practices. CONCLUSIONS: Our review identified experiences and practice related to COVID‐19 and the WC system, but not specifically about WC and COVID‐19 WC claims or benefits. Further research is needed to document and understand evidence underpinning the need for WC coverage for COVID‐19 and to evaluate the impact of the current SB 1159 bill on WC in California.

The novel coronavirus SARS-CoV-2, which causes the disease known as COVID-19, has led to the most severe global pandemic in over 100 years. The virus is highly contagious, spreading easily through respiratory droplets and aerosol transmission. COVID-19 is deadly for some and can often lead to serious illness or long-term symptoms even in nonfatal cases. From March 2020 through August 2021, over four million Californians have been infected, hospitals have experienced intermittent overwhelming surges, and 65,000 Californians have been killed by COVID-19. 1 In the beginning of the pandemic, there were no vaccines to prevent infection. Even now, once persons are infected there is no cure or effective targeted treatment. As a result, state and local authorities have relied on mask guidelines and other public health measures to save lives. 2 Yet even as some workers were able to minimize their exposure by working from home, healthcare workers, first responders, and workers across most sectors of the economy had to risk infection and death by continuing to work outside the home. 3 In recognition of the deadly workplace risks that millions of workers suddenly found themselves facing, California policymakers moved quickly to facilitate access to workers' compensation (WC) benefits for healthcare workers and other frontline workers who had to continue working outside the home, and who were thus most exposed to the coronavirus. A temporary presumption for COVID-19 covering all frontline workers was established by executive order (EO-N-62-20) 4 on May 6, 2020. Senate Bill (SB) 1159, which was signed into law on September 17, codified this temporary presumption and created two new presumptions for workers who fell ill on July 6, 2020, or later. 5 The COVID-19 presumptions in California cover large segments of the private-sector workforce in addition to public safety workers, and they provide coverage for a disease that is extremely widespread.

Even though presumptions have been used for decades in California's WC system, 6 the presumptions established in response to the pandemic represent a striking departure from the way that presumptions have been used in the past. Critics of SB 1159 7 understandably raised concerns about COVID-19 claims fairness to employers due to the complexity of counting outbreak cases in a given place over a period of time and the associated administrative burden of such an outbreak definition for the SB 1159 outbreak presumption, and its associated impact on WC system costs. Even if the costs and overall system impacts of SB 1159 could be predicted in isolation, interactions with a rapidly evolving policy environment and the unpredictable course of the pandemic itself made the bill's influence and significance exceedingly difficult to foresee at the time of its enactment.

Understanding the context and experiences of workers and employers related to COVID-19 and the WC system is critically important to both the future of this legislative effort and its overall consequence on the WC system. We conducted a systematic review of the available peer-reviewed and grey literature on worker experiences surrounding COVID-19 and the WC system and any related literature regarding employer best practices.

We reviewed English language peer-reviewed literature examining workers' experiences surrounding COVID-19 and the California WC system. We included news reports and findings from literature reviews given that much of the information in this area is likely not to have yet been published in peer-reviewed literature. Although this was not a formal systematic literature review given that we did not rate the quality of the studies, for literature retrieval and review we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 8 

We conducted structured search strategies via PubMed and Web of Science to identify peer-reviewed studies, limited to English-language peer-reviewed articles published from March 2020 to May 26th, 2021, in the United States. We identified articles with at least (1) one COVID-19 term, (2) one worker term inclusive of frontline worker industries (e.g., agriculture, firefighter/public services, etc.), and then (3) 

We reviewed titles and abstracts of published articles retrieved through the search. All three reviewers (DQ, NQ, GG) undertook an initial period of double coding to establish consistency in decisions about inclusion of full articles in this review, with the first author included in all double coding for consistency. Criteria for inclusion were that titles/abstract be US-based, about COVID-19 worker issues, specific to frontline or outbreak workers, employers or both, and WC (including benefits, outbreaks, medical access or care, and leave). Reviewers discussed discrepancies during regular meetings and resolved incongruencies to gain consensus on article inclusion (set at >95% agreement), achieving 100% interrater agreement. Once consistency was established, the remaining abstracts were independently reviewed to determine eligibility for inclusion, with an audit check on every third article conducted by another reviewer to ensure consistency. All abstracts marked for inclusion were then double reviewed by the team lead (DQ).

To ensure a consistent approach to full article review, 15 articles were selected for double review by two coders (five each) and discussion. Once agreement was reached the type and detail of data to abstract, coders independently abstracted the remaining articles. After abstraction, each article was reviewed by another coder to ensure accuracy of abstracted content and discussed, if needed, to gain consensus on the abstracted data. Abstraction focused on identifying data on worker experiences with COVID-19 related to the WC system and included experiences of frontline workers or workers in an outbreak scenario at work.

As shown in Figure 1 

Of the 16 articles that focused on workers, seven analyzed data (five were peer-reviewed studies, two were grey literature studies).

In addition, there were two peer-reviewed literature reviews and seven news reports that we also summarize. Table 1 lists these studies of workers by study type and content.

Of the seven articles that analyzed data, four were about healthcare workers, [9] [10] [11] [12] two were about workers in rural San Joaquin Valley (primarily agricultural and food processing jobs), 13, 14 and one was about workers in general 15 (comparing states where workers had gained the right to paid sick leave to those states where workers had not).

In terms of the data utilized, four of the seven studies used secondary 10, 12, 14, 15 data from a variety of sources, two conducted surveys, 9, 13 and one 11 linked a survey with secondary data.

None of the seven peer-reviewed or grey literature worker studies that analyzed data were about WC claims or benefits or about job loss or retaliation or about medical care. Instead, they were primarily about leave or paid leave (n = 3 studies) [13] [14] [15] and the workplace related to health or safety (n = 3 studies) 9,10,13 as well as some specifically on personal protective equipment (PPE) (n = 2 studies), 9, 14 COVID-19 testing or screening (n = 2 studies). 9, 11 There was one study each on lost work time/return to work (n = 1 study), 12 and hazard pay (n = 1 study). 14 

Three studies 13-15 examined paid sick leave, which is an important adjacent topic to WC in California given that in SB1159 paid leave from other sources must be exhausted before WC benefits can be claimed. One study 15 Other: lack of health insurance/ hazard pay (n = 2)

Peer-Reviewed:

Shenoy (2020) Pichler (2020) Coto (2020) Coto (2020) Coto (2020) Niu (2020) Iddins ( (2021) Almeida (2021) Sclafane (2021) Flores (2020b) Perry 2020

Eidelson (2020) Simpson (2021) Perry (2020) had newly gained the option to take up to two weeks of paid sick leave. The FFCRA emergency sick leave provision also may have been more generous than some of the sick leave available to workers in the control states, implying that these results are lower-bound estimates and recognizing that paid sick leave policies changed throughout the pandemic.

Two grey literature studies 13, 14 focused on workers in agricultural and food processing jobs in San Joaquin Valley. One study 13 summarized the results of a survey fielded in June 2020 from 301 respondents (68% Latino/a) in small rural cities across three counties.

Nearly half (44%) of the sampled households had experienced income reduction since March 2020, with 30% of households having gone without food, or relied on food stamps or a food bank. Fifteen percent of renters were unable to pay rent in April or May. Only 28% of workers said they qualified for 10 days of paid sick leave. In the second study, 14 the authors reported that San Joaquin Valley workers lack robust sick leave protections, despite many valley workers being exposed to consistent and severe housing and food insecurity. 

Three studies 9,10,13 (two peer-reviewed studies 9,10 and one grey literature studies 13 ) examined health and safety in the workplace. One Another study 10 of over 5500 employees at one large health care workplace developed and implemented a set of evidence-based benchmarks over a 9-month period. The benchmarks were designed to support the health and safety of individuals as well as organizational decision-making, with continuity of operations the ultimate goal. The data collected included results from molecular testing and surveillance, screening for SARS-CoV-2 variants of concern, assertive contract tracing, case management of employees with COVID-19, and antibody monitoring of recovered and vaccinated employees.

Overall, the information from these exemplar workplace-related SARS-CoV-2 benchmarks provided evidence upon which clarity, reassurance, and guidance could be delivered to management decision makers.

Finally, a household survey 13 of 301 respondents in small rural cities in San Joaquin Valley found that more than half of workers (57%) stated that they had not been able to work from home-for any amount of time-since the Governor's stay-at-home order in March 2020. Nearly half (46%) were unable to affirm that their workplaces had safe practices for preventing COVID-19 spread.

One study 12 of a testing-based strategy to allow return to work obtained data from 8930 employees tested at a Massachusetts General Brigham (MGB) institution and to assess loss of work time due to testing, and possible delays in subsequent return to work. The testing-based strategy resulted in a median return to work time of 19 days, presumably due to prolonged viral shedding, whereas a symptom-based approach would result in an average of 7.2 days fewer of work lost per employee. The full psychological toll on healthcare workers was not fully assessed, but some workers reported stress and anxiety due to having to isolate in their home for an extended period, as well as to delays in returning to work. The article notes that most employers have shifted away from a testing-based strategy to allow a return to work, and instead rely on a time plus symptom-based approach.

There were two literature reviews, of which one was about gig workers 18 and the other one about frontline workers over 50 years of age. 19 The first review 18 focused on experiences related to sick leave, PPE, and unemployment benefits faced by gig workers who have had difficulty gaining access to "essential worker" status. Based on the authors' review, they conclude that income security for gig workers will be critical for them to engage fully in the economy, and that they should receive the same labor market protections that other workers receive under the law. The Economic Security Act (CARES Act) has since granted gig workers sick leave and federal unemployment benefits.

The second review 19 

Of the seven news reports, three discussed WC at a broad, national level, identifying industries that have large volumes of COVID-19 claims, changes in patterns of medical care due to COVID-19, and potential costs from COVID-19 for the WC system. One news report 20 discussed the WC death benefit. Two news reports 14, 21 discussed job loss and retaliation against workers, with a focus on businesses asking workers not to discuss cases or conditions in the workplace. One news report 22 

Of the 24 articles that focused on employers, three analyzed data (two were peer-reviewed studies and one was a grey literature study). In addition, there were three peer-reviewed literature reviews and 18 news reports. Table 2 lists the employer-focused studies by study type and content.

Of the three studies that analyzed data, one was about nursing homes and their staff, 24 one was about construction workers, 25 and one 26 did not focus on any particular sector. These studies were on workplace health and safety, hospitalizations and medical care, and staffing.

One study 25 used hospitalization data from the Austin-Round Rock metropolitan area in Central Texas to model the impacts of unrestricted construction work on COVID-19 transmission and outcomes.

The findings suggest that unrestricted work in industries with a high level of contact (such as construction) is associated with a higher community transmission rate, increased risks to at-risk workers, and larger health disparities. Another study 24 examined the relationship of staffing in nursing homes and compared homes with and without COVID-19 residents in California. The study found that nursing homes with low registered nurse (RN) and total staffing levels meant that residents were more vulnerable to COVID-19 infections (described in more detail below).

The study 25 that modeled the impact of unrestricted construction work described above found that a lack of restriction was associated with an increase of COVID-19 hospitalization rates from 0.38 to 1.5 per 1000 residents and 0.22 to 9.3 per 1000 workers.

Transmission was reduced by 50% with the implementation of safety measures.

The grey literature study 26 also looked at hospitalizations and medical care, using claims data from the state of Minnesota to estimate costs and impacts of COVID-19, including on medical bills. The claims data that were analyzed revealed a higher-than-expected proportion of indemnity-only claims, which per the authors was likely a reflection of the quarantine period for mild cases. Not surprisingly, the severity of claims increased sharply as the degree of medical care required increased.

Another study 24 

Public Health and RN staffing data to examine the relationship between nursing home staff ratios and COVID-19 infection rates among residents. The study found that nursing homes with staffing ratios for RNs below the minimum standard had twice the probability of having a resident with COVID-19. In addition, nursing homes with lower Medicare five-star ratings on total nurse and RN staffing levels, higher total health deficiencies in the residents, and more beds had a higher probability of having residents with COVID-19.

None of the peer-reviewed or grey literature worker studies were about job loss or retaliation, return to work, or leave. However, the grey literature study that used claims data from the state of Minnesota 26 also looked at WC claims and policies, and WC death benefits in estimating the costs and impacts of COVID-19 as described above.

There were three peer-reviewed literature reviews. [27] [28] [29] Two studies were about return to work 27, 29 including COVID-19 testing or screening and/or health insurance. One literature review 27 Plantes (2021) Plantes (2021) Gravina (2020) Fragala (2021) Fragala (2021) Fragala (2021) Fragala (2021) Grey literature studies (n = 1)

Everling (2021) Everling (2021) Everling ( 

Six news report articles [30] [31] [32] [33] [34] [35] Table S .II under the Employer News

Reports section for the findings on the news reports on employers. denial rates for these two distinct types of claims (to quantify the claims administration burden of these claims); and how denial rates differed across occupations and industries, particularly those covered by the outbreak presumption. Additionally, research on these same issues is needed for claims for post-acute sequelae SARS-CoV-2 infection, often referred to as "long COVID-19," which includes prolonged symptoms (e.g., fatigue, prolonged cough, trouble breathing).

Understanding these issues will be important because large numbers of claims are still being processed and there are few legal cases and little guidance on how to handle COVID-19 cases, including long COVID-19 cases. There is growing concern about how the WC system will handle both COVID-19 and long COVID-19 claims over injured workers' needs to cover medical care, their accommodations to return to work, disability ratings, medical maximum improvement, and future medical needs. Additional research about potential disparities in how the WC law is applied is also essential, particularly given well-documented existing disparities in both the risk of, and outcomes from, COVID-19 in different racial and ethnic groups. [52] [53] [54] [55] Ensuring as full an understanding as possible of the evidence underpinning the need for WC coverage for COVID-19 across a broad set of essential, frontline workers is critical to both evaluate the influence of the current bill and its significance on the WC system. Our 

The authors declare that there are no conflicts of interest.

John Meyer declares that he has no conflict of interest in the review and publication decision regarding this article. 

As a literature review, we did not collect any data. So no data is available.

Denise D. Quigley https://orcid.org/0000-0002-3815-908X

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