key: cord-0915394-kvq4huvs
authors: Côté, Daniel; Durant, Steve; MacEachen, Ellen; Majowicz, Shannon; Meyer, Samantha; Huynh, Ai‐Thuy; Laberge, Marie; Dubé, Jessica
title: A rapid scoping review of COVID‐19 and vulnerable workers: Intersecting occupational and public health issues
date: 2021-05-18
journal: Am J Ind Med
DOI: 10.1002/ajim.23256
sha: 4f774a7d959e330db8cb846d064868d1349ed877
doc_id: 915394
cord_uid: kvq4huvs

BACKGROUND: This article reports the results of a rapid scoping review of the literature on COVID‐19 transmission risk to workers in essential sectors such as retail, health care, manufacturing, and agriculture, and more particularly the experiences of workers in precarious employment and social situations. METHODS: Following scoping review methods, we included 30 studies that varied in terms of methodology and theoretical approaches. The search included peer‐reviewed articles and grey literature published between March and September 2020. RESULTS: Based on the studies reviewed, we found that COVID‐19 infection and death rates increased not only with age and comorbidities, but also with discrimination and structural inequities based on racism and sexism. Racial and ethnic minority workers, including migrant workers, are concentrated in high‐risk occupations and this concentration is correlated to lower socioeconomic conditions. The COVID‐19 pandemic appears in the occupational health and safety spotlight as an exacerbator of already existing socioeconomic inequalities and social inequalities in health, especially in light of the intersection of issues related to racism, ethnic minority status, and sexism. CONCLUSIONS: This review provides early evidence about the limitations of institutions' responses to the pandemic, and their capacity to provide a safe and decent working environment for all workers, regardless of their employment status or the social protections they may enjoy under normal circumstances. It is also important to think about these issues in the postpandemic context, when conditions of precariousness and vulnerability persist and possibly worsen.

The first cases of COVID-19 appeared in late 2019 in Wuhan in central China. 1 Although measures to counter COVID- 19 wrong targets for others, and have been perceived as too drastic and abusive for a considerable part of the population; it is clear that the lack of evidence on the nature of this virus and its mode of transmission has left the impression that it was a trial and error approach without a precise plan. 3 Action had to be taken quickly and in consideration of limited existing knowledge and the technical, financial and human resources on which health systems could rely.

While it is still too early to take a complete step back and draw lessons from the pandemic (at the time of writing, the pandemic is ongoing and not yet under control), it is possible to draw a first picture of the occupational health and safety (OHS) situation in relation to exposure to SARS-CoV-2 (COVID- 19) . From a public health standpoint, in terms of reducing exposure and transmission, it is critical that we understand the impact of precarious working conditions, particularly for the health of populations designated as more vulnerable (e.g., newcomers, foreign migrant workers, ethnic or racial minority workers, women, ageing workers, workers in high risk occupations, those in underserved communities, and those with lower language proficiency). 1 These workers are more likely to be in types of employment (e.g., temporary, part-time, on call, subcontractor, gig workers) where working conditions are less favourable and the risks to their health and safety are greater. For example, agency workers or those with poor working language skills and limited knowledge of their OHS rights may be less likely to ask for better protections or to report symptoms related to COVID-19 for fear of suffering financial losses. Those without citizenship may fear deportation and keep their symptoms under wraps, increasing the risk of transmission in the workplace.

For many researchers, the work context is an unavoidable element to consider, even if OHS and public health are not always integrated entities in various countries and jurisdictions.

The aim of this article is to report the results of a rapid scoping review of the literature on COVID-19 and prevention, and more particularly on the experiences of workers in precarious situations and vulnerable groups. We define precariousness here as a set of accumulated adversities (e.g., type of job contract, working hours, employment relationship, low income, low access to training and career opportunities, migratory status). 4, 5 We prioritised a rapid review of the literature with the goal of providing an understanding of the emerging knowledge base to facilitate the use of evolving evidence in time-sensitive, pandemicdriven decision making at a time when COVID-19 still affects many countries. At the time of writing, the world was still in the first wave of the pandemic and no vaccine was yet available.

To reach our goal, we modified Arksey and O'Malley's 6 framework for scoping reviews to fit an accelerated timeline, given the urgency of the research questions and immediate need for evidence to inform pandemic decision-making.

To meet our aim of reporting the results of a rapid scoping review of the literature on COVID-19 and prevention, and more particularly on the experiences of workers in precarious situations and vulnerable groups, we used the following questions to guide our systematised approach to identifying relevant studies and as a framework for the content analysis. What are the most vulnerable occupations or industries in regard to SARS-Cov-2 infection and transmission? How are precarious employment situations endangering workers' OHS?

What are the conditions that prevent transmission in precarious work environments, and how do employers, workers, and practitioners address this OHS issue? These questions led us to investigate the fields of OHS and public health as they pertain to the COVID-19

pandemic. The literature related to these research questions provides a first picture of prevention approaches and actions in essential services between March 2020 and September 2020, corresponding to the first wave of the pandemic.

We followed a systematised approach to our literature review, 7 using keywords and Boolean logic. To meet our research aim, we adapted existing scoping review methods in the design of our approach. 6, 8 Because our goal was to summarise the scope of the existing literature, we used an integrative approach, 9 which made it possible to include studies that varied in terms of methodology (quantitative, qualitative), the theoretical approaches proposed, and the concepts put forward. This enabled us to capture the full scope of the knowledge landscape without imposing preconceived ideas of the nature of the evidence. The documentary approach and the database query were carried out by a professional librarian specialising 1 Throughout this article, we refer to vulnerable workers, especially when describing groups that face discrimination and other barriers related to social and economic equity. We wish to clarify that we conceptualize vulnerability as a situation that affects these groups in the context of work, and not as an inherent attribute of their social identities. 

After removing duplicates, 74 references were imported to Endnote. 2 Our search criteria enabled us to identify studies addressing COVID-19 workplace issues and challenges to vulnerable groups. We then applied a 5-star rating system so we could sort the studies according to their relevance to our research goals.

Given the urgency of the health situation and the need to share data and thinking on the best strategies to prevent and mitigate coronavirus disease and influence the most informed decisionmaking, we synthesised only 5-star studies for this review. Our criteria for classifying studies were as follows:

• 5-star studies: addressed COVID-19 by (a) providing empirical data on OHS and precarious workers in essential services, (b) providing sociodemographic data, or (c) providing a review of the literature on COVID-19, precarious employment and vulnerabilities;

• 4-star studies: addressed COVID-19 and OHS issues in precarious employment, but from a theoretical perspective (e.g., commentaries, position papers, statements, discussions, etc.);

• 3-star studies: addressed COVID-19 by providing empirical data on OHS issues, but not addressing precarious employment issues;

• 2-star and 1-star studies: addressed interesting theoretical issues, but far from our research goals.

Inclusion and exclusion criteria: Studies identified with our search terms (see Table 1 ) that were (1) peer-reviewed, (2) published in English or French, and (3) rated 5 stars, were included. Studies that did not meet all of these criteria were excluded.

For an overview of the search and selection process, see 

Details about the included articles were extracted systematically.

The extracted data capture the following fields: geographical location; study type (qualitative, quantitative, or mixed methods); study objectives; research approach; workers' occupational identity; definition of vulnerability/precariousness; main results; recommendations for intervention; and, when applicable, recommendations for further research. Key elements of the data extracted are summarised in Tables 2-4.

The extracted data were synthesised by our inter-disciplinary team.

From this synthesis, we mapped main issues by occupational categories (see Table 3 ) and by the main recommendations for levels of intervention (see Table 4 ). The main themes identified were then analysed for the intersections between OHS and public health.

Of the total number of studies imported to Endnote (74), 30 (28 from the database search, 2 added manually) were classified as 5 star and included in this rapid review (see Table 2 for a summary of studies included in the review). Of these studies, 30 were identified as relevant to workplace challenges for vulnerable groups. Of the studies COVID-19 and financial concern were associated with worse mental health during the COVID-19 pandemic Need for workplace and sector-specific guidance or tailored strategies and interventions (incl. culturally responsive)

Brown et al., 11 Sterling et al., 14 Sönmez et al., 17 Waltenburg et al., 19 Smith, 20 Bui et al., 24 Moore et al., 33 

Provide better workers protection and conditions, including access to proper PPE Brown et al., 11 Almeida et al., 12 Alahmad et al., 21 Hawkins 27 For migrant farm workers especially, to set up strike teams to do on-farm testing and prevention Tutor Marcom et al. 10 For temporary workers, to improve housing conditions and communication facilities

Alahmad et al. 21 and Koh 29 To address social inequality among the most vulnerable groups or among groups most at risk for unfair treatment** Sönmez et al., 17 Smith, 20 and Rogers et al. 35 Plans to ensure safe return to work, not only control methods to reduce exposures at work Baker 23 Characteristics of high-risk occupations and composition of the workforce (e.g., gender, wage, PPE, policy) need to be better understood and reflected in governmental actions Lee Only 12 studies dealt with a specific occupational category. Key issues include risks related to physical proximity, lack of access to personal protective equipment (PPE) and information related to prevention, and inadequacy of organisational and government policies to protect vulnerable workers.

While many of the risks identified by the studies covered in Table 3 were known to the OHS authorities and the various workplaces in these sectors, COVID-19 brought a renewed urgency to addressing them. Furthermore, it was not common for OHS authorities to think of physical proximity as an occupational risk before COVID-19; understanding of this risk developed urgently during the pandemic. As such, interactions between colleagues or with clients suddenly had to be adapted very quickly. The identification of physical proximity as a risk, along with the heightened attention to other risks, put significant pressure on workplaces. Many workplaces were not prepared to apply drastic measures to prevent and control the spread of the virus. Furthermore, the pandemic has led to numerous temporary and permanent closures of businesses and bankruptcies, causing a significant increase in the unemployment rate worldwide. 40 The studies that do not focus on a specific sector were grouped thematically as pertaining to social disadvantage, as they all address issues that concern precarious or vulnerable workers. These studies were of a socio-demographic or epidemiological nature. For example, it was claimed that disadvantaged socioeconomic categories expose workers to job strain, stress, and unemployment. 22, 28 These categories largely include workers from ethnic and racial minorities or recent immigrants, including asylum seekers and temporary migrants (generally unskilled). 13, 21, 26, 29, 33, 37, 38 Individuals from these groups were found in greater proportions among frontline workers. 27 Some authors went even further and discussed "occupational segregation" 27 or "structural inequities." 35, 36 50 There is a high ratio of immigrant and minority workers among temporary work agencies in Canada 51 and in designated essential service jobs as well, which are also characterized by a very high proportion of women (e.g., nurse aide, orderly, and patient service associate occupations). 52 The risk level for COVID-19 transmission is considered high for these jobs, in health care and social assistance, and in accommodation and food services, retail trade, and so forth. 53 Several studies 10, 21, 29 focussed specifically on how the pandemic affects migrant workers, including care workers and seasonal farm T A B L E 4 (Continued)

Provide assistance for migrant workers in the long-run Wang et al. 38 Develop better interministerial coordination in the planning of services offered to newcomers Goudet 26 Provide increased capacity or authority of local governments (decentralization) Lyttelton workers. Risks related to housing conditions were discussed in relation to temporary migrants; several countries have temporary work programmes that attract many transnational migrants 54 who are housed by the employer in crowded dormitories that do not allow physical space for distancing. 10, 29, 36 These housing conditions as well as issues with internet connectivity, lack of access to PPE, and overlapping exposures at different levels were identified as particularly relevant to migrant workers. Another study reports that the housing issue not only affects migrant workers, but also precarious and low-wage workers who have to share a cramped space with several family members, some of whom may also have jobs where interpersonal or public contact is frequent. 25 Mental health issues during the COVID-19 pandemic are also reported in many of the reviewed studies: these issues include feelings of guilt in putting relatives at risk, anxiety, stress, uncertainty about the future, social isolation and lack of support. 17, 26, 28, 38, 55 For workers in situations of vulnerability or precariousness, the pandemic may worsen an already challenged state of physical and mental health, especially among populations of immigrant workers. 17 

The studies included in this review make a number of practical re- Table 4 .

In light of this rapid scoping review, it is clear that actions to respond to COVID-19 need to be carried out simultaneously at different levels and in different areas, and that they apply inter- comorbidities, but also with discrimination and structural inequities based on racism and sexism. 10, 11, 18, 24, 25, 27, 28, [32] [33] [34] [35] [36] [37] [38] Racial and ethnic minority workers, including migrant workers, are concentrated in high-risk occupations 31 and this concentration is correlated to lower socioeconomic conditions. 12, 17, 28, 38 Some of the included studies highlight the crucial issue of mental health during the pandemic, calling attention to the harmful effects of stress, anxiety, job insecurity, and social isolation on the health of vulnerable workers. 17, 26, 28, 38, 55 were included in this review due to these workers' potentially increased risk for COVID-19 exposure, their particular financial precariousness, and increased concerns towards their mental wellbeing. 16 The gig economy is subsumed into the neologism "uberization," which is now used worldwide to characterize the "activities through digital platforms that arrange transaction between providers and customers," 71(p4) often with minimal regulation.

The gig economy is structured as a new business model designating workers as self-employed. This designation renders it possible to bypass existing labour and occupational health standards that apply for salaried employees or wage earners. 72 Taken together, the findings of the included studies pose a fundamental question: If various forms of precarious work engagement (gig workers, temporary migrant workers, agency workers, etc.) are here to stay and to respond to the impulses of the market economy, is

it not time to provide these workers with benefits and equal rights? In addition to considering physical and biological occupational hazards, it is now common to consider work contexts and work organisation as risk factors for taking sick leave or as protection factors as well. 73, 74 Scoping reviews function to identify implications for practice. In Table 4 , we have captured the current scope of actions and considerations for addressing COVID-19 transmission risks to vulnerable workers that can be immediately implemented or adapted more broadly. as such, there appears to be a need for further research that explicitly addresses how prevention and protection could be achieved. We also observed that many studies were sparse in detail about sample size and population characteristics (as illustrated in Table 2 ). Furthermore, while a number of studies that did include population data focused on comparison based on presumed nationality or ethnicity, they often did not include details about gender. Inclusion of data pertaining to gender could facilitate a better understanding of the impact of COVID-19 on the most vulnerable workers, given the over-representation of women, and especially women from ethnic-minority groups, in precarious employment.

We note that several scientific journals have recently published comments, position papers or statements calling on public health and OHS authorities to pay more attention to these more vulnerable workers during the pandemic. 58, 60, 61, [75] [76] [77] The studies included in this review appeal for more systematic collection of data on education, employment status, and job characteristics in COVID-19 epidemiological data. 37 This proposed research could increase the statistical evidence on the existence and role of work-related factors in COVID-19 disparities, with a focus on occupational differences within a specific sector. 36 Future studies should also examine the relation between the nature of work during the pandemic (e.g., essential workers, home-based workers) and the occurrence of depression and anxiety problems. 55 Gender and work-family balance should also be central to future studies on this topic. More targeted literature reviews should be elaborated to address issues within specific occupations or industries.

These reviews could pair studies of employment data, compensation, and public health data, with case studies providing thick descriptions of organisational process and work environment dynamics, and corresponding perceptions.

The current COVID-19 pandemic and all the damage following in its wake cannot be reduced to a viral or microbiological reality 

The authors declare that there are no conflicts of interest.

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

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