University of Nebraska Medical Center College of Public Health

Omaha, NE

Faculty and staff at the University of Nebraska Medical Center College of Public Health undertook a number of important initiatives to respond to COVID-19. One of these was aimed at protecting food and commercial essential workers. During the COVID-19 pandemic, an estimated 30 to 50 million people had jobs that were deemed essential. These people were required to consistently and physically be present at their workplace because their jobs were critical to public safety, national security and societal function. The United Food and Commercial Workers (UFCW) International Union represents more than 1 million of these essential workers. To better understand their members’ workplace conditions, experiences and attitudes during this critical period, UFCW leadership partnered with researchers at the University of Nebraska Medical Center (UNMC) Colleges of Medicine and Public Health in the spring of 2021 to create the UFCW Essential Worker Health Survey (EWHS). The goal of this survey was to collect reliable pandemic information and encourage employers to implement stronger workplace safety measures to protect their workers. 

During surveys conducted from July 2021 to May 2022, new monthly COVID infection rates rose from 2% to 15% among UFCW member respondents. These rates of infection were 10 times higher than U.S. incidence rates during the same period. Six percent of respondents who contracted COVID needed to be hospitalized, which is a significantly higher rate than the nationwide 2% rate of hospitalization. These results highlight the great sacrifice America’s essential workers made during this pandemic to keep their communities running and inform future strategies to protect essential workers exposed to infectious diseases at work.  

“This UNMC study makes clear that COVID-19 has — and continues to have — a serious and significant impact on America’s essential workers,” said Marc Perrone, UFCW International president. “These essential workers paid a hefty price for continuing to do their jobs, which kept food on American families’ tables and our economy moving throughout the pandemic.” 

“Policies to protect these essential workers are critical to weathering the current surge of COVID cases nationwide and being ready for the next pandemic,” said Ali S. Khan MD, dean of the College of Public Health, UNMC. 

The UNMC College of Public Health has been particularly focused on meat processing (meatpacking) facilities, as over half of the meatpacking plants in the U.S. are located in the Midwest. Meatpacking is an important industry to the state of Nebraska — producing millions of dollars of economic impact and directly employing nearly 30,000 residents. Much of the meatpacking workforce consists of immigrants, refugees, racially/ethnically diverse workers, veterans and people with justice system involvement. For these vulnerable workers, COVID-19 exacerbated their already precarious circumstances. It intensified the stability of work itself, as employment became increasingly insecure, unstable and uncertain for many people, with limited protections and control over their working conditions.  

Early in the pandemic, a UNMC team developed a tailored playbook for the meat processing industry with best practices to control transmission of the virus (released prior to CDC guidance for employers). The team conducted 14 site visits to facilities across the state to assist facilities in controlling infection risks. In May 2020, a survey1 of 585 Midwestern meatpacking workers was conducted to understand how the work environment had responded to the COVID-19 threat. Recommendations from this study, such as paid sick leave, physical distancing of line workers and culturally and linguistically tailored education were promoted by state legislators to enhance pandemic protections for workers.  

In 2021, an exposure assessment study was conducted to explore SARS-CoV-2 transmission risks. As part of this study, the team collected air samples and assessed ventilation and air flow throughout three meatpacking facilities. The team also interviewed 50 workers to learn about their experiences as an essential worker during the pandemic. Workers described the plants to be places that consistently prioritized production over people: “I do not consider the plant where I work safe,” one of the workers explained. “They only care about filling their production, and they do not care about the health of their workers or the risks of it.” The study resulted in several recommendations, including reducing density of workers and modernizing heating, ventilation and air conditioning (HVAC) systems (e.g., balancing air flow, using higher efficiency filters). It also highlighted the need to focus attention and interventions on crowded common spaces and demonstrated that the design of buildings reflects a prioritization of food safety and production over human health.  

Further, when hospitals throughout the U.S. faced a critical N95 respirator mask shortage, UNMC and Nebraska Medicine experts decided to tackle the problem. A team was set up, led by John Lowe, UNMC assistant vice chancellor for Inter-professional Health Security Training and Education in collaboration with Nebraska Medicine infectious diseases experts, like Mark Rupp, MD.  

“The shortage of PPE is a nationwide issue — each and every one of these items is increasingly precious,” Dr. Rupp says. “Although we were well prepared, our supplies are beginning to dwindle. We had to find a way to keep our providers and patients safe.” 

This team decided to use the ultraviolet (UV) light tower usually found in the Nebraska Biocontainment Unit and used to decontaminate rooms after patients leave. The ultraviolet light disrupts the coronavirus’ genetic material, deactivating it, making masks reusable for their original owners. This innovative solution was attractive to hospitals as this technology was already available to most of them and the process of decontamination was fast. 

Although this solution is only recommended in emergency situations, it helped expand the availability of masks, which were becoming a scarce resource, and responded to the crisis the country was facing.

1[1] Ramos, A.K., Lowe, A., Herstein, J.J., Trinidad, N., Carvajal-Suarez, M., Quintero, S.A., Molina, D., Schwedhelm, S., & Lowe, J.J. (2021). A rapid-response survey of essential workers in Midwestern meatpacking plants: Perspectives on COVID-19 response in the workplace. Journal of Environmental Health, 84(1), 16-25. 

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