Government Dignitaries Give Praise to Ag Community Amid Height of the Pandemic

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State and federal dignitaries echoed one another, during AgSafe’s Innovation virtual conference, in vocalizing high praise for America’s agriculture community amid the height of the COVID-19 pandemic.

Secretary of California’s Department of Food and Agriculture (CDFA), Karen Ross stated, “I hope that every American that uses a knife, spoon, and a fork on a daily basis is thankful to our farmworkers, our farmers, and our ranchers. Because they never stopped. Even when it was hot, even when there were welt fires, even when there was COVID.”

Secretary Ross, along with the other dignitaries that spoke, thanked the agriculture community for their uninterrupted work to keep food on the Nation’s dinner table during “a year like no other” (K. Ross, Secretary CDFA).

The comprehensive event was anchored by a two-day track on state and federal regulatory compliance. Presenters offered tips for compliance and regulatory updates on everything from payroll, paid sick leave, safety, and a robust update on COVID-19’s impact on the health and safety of agriculture workers. This blog entry focuses on COVID-19’s impact on the agriculture community.

Chief of the Division of Occupational Safety and Health of California (Cal/OSHA), Douglas Parker, announced that agricultural work continues to be among California’s most dangerous occupations. In 2019, there were 451 occupational-related fatalities in the state, 48 of which occurred in agriculture. (USBLS 2019) According to Chief Parker, this equates to 13.9 fatal injuries per 100,000 ag workers, which is greater than five times the overall rate of 2.5 for all industries.

The data show that this trend will rise into 2020 due to the prevalence of COVID-19 related deaths among agriculture workers. Since February 2020, 690 deaths have been reported and are being investigated by Cal/OSHA for work-relatedness, with 33 of those deaths reported in agriculture.

Cal/OSHA believes that the number of COVID-19 related deaths reported in agriculture is a “significantly low number” (D. Parker, Chief Cal/OSHA) that may be much higher. This is based on a comparison with preliminary data received from California’s Department of Public Health (CDPH) that suggests that more than 1000 deaths in California from COVID-19 have been traced to agricultural workers, irrespective of work-relatedness.

“[The Data] does suggest that the numbers being reported to us by employers are in all likelihood underreported,” stated Chief Parker.

During the federal fiscal year of October 2019 to September 2020, Reporting Fatalities and Serious Injuries was among the top five commonly cited violations by Cal/OSHA.

Theresa Kiehn, AgSafe President and CEO, stated, “The agriculture community continues to respond to challenges unique to our industry that have been brought on by COVID-19. AgSafe is immensely grateful for all of the brave men and women who have continued to work tirelessly amid a global pandemic.”

Cal/OSHA has been inundated with COVID-19 related complaints. From February 1, 2020 to February 21, 2021, Cal/OSHA received approximately 11,500 complaints from all industries, 213 complaints were from agriculture, with 91 reported serious illnesses. As a result, Cal/OSHA has opened 312 COVID-19 related inspections making agriculture the only industry having more investigations than reported complaints or worker fatalities, other than health care.

According to Chief Parker, the low number of complaints in agriculture may indicate a reluctance by employees to report violations. Employers should consider this as they formulate their education and training programs for employees. Open communication with employees can aid in making sure they understand their rights and their ability to report their concerns about COVID-19.

In addition to the massive enforcement effort commemorated by the data above, Cal/OSHA feels that it has provided a large amount of compliance assistance. The compliance assistance was aimed at ensuring that employers understood their obligations and to verify that they were utilizing the compliance guidance that the Administration was providing.

Chief Parker spent time discussing Cal/OSHA’s Emergency Temporary Standard (ETS). The Administration’s Standards Board promulgated the ETS that went into effect on November 30, 2020. The temporary standards cover COVID-19 Prevention, Multiple COVID-19 Infections and COVID-19 Outbreaks, Major COVID-19 Outbreaks, and COVID-19 Prevention in Employer-Provided Housing and Transportation. Housing and transportation are two areas that are critical to the agriculture industry.

Cal/OSHA’s ETS were issued as emergency regulations. This means that the rules package was not subject to the same type of public input before adoption compared to non-emergency regulatory adoptions. The Standards Board structured its order to accommodate putting the rules into effect and then having the ability to receive public input to adjust the rules accordingly after enactment.

Cal/OSHA’s Advisory Committee meetings were held on December 18, 2020, February 11, 12, and 16, 2021 to receive employer and worker input on the new rules. Suggestions for amending the ETS to create more flexibility in the rules governing the two critical areas that impact agriculture, housing and transportation, were received. According to Chief Parker, Cal/OSHA is taking a “serious look” at the standards in these two areas for appropriate revisions based on stakeholder input. Committee meetings will be available online shortly for viewing.

In addition to Chief Parker and Secretary Ross, dignitaries from California’s Division of Labor Standards Enforcement, Department of Pesticide Regulation, U.S. Department of Labor, U.S. Equal Employment Opportunity Commission, Internal Revenue Service, and the U.S. Environmental Protection Agency were on hand for AgSafe’s annual conference.

Taking the lead from Secretary Ross, I’d like to extend a very sincere thank you to all of the farmworkers, farmers, and ranchers that have put their well-being at risk during this unprecedented time in our nation’s history to ensure our dinner tables and pantries remain full.

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ACOEM Publishes COVID-19 EBM Practice Guideline

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Academics have been fervently working to uncover trustworthy scientific evidence on which to base COVID-19 treatment protocols and business response recommendations. ReedGroup’s MDGuidelines, publishers of the evidence-based occupational medicine practice guidelines independently researched and developed by the American College of Occupational and Environmental Medicine (ACOEM), announced this week its publication of the very first evidence-based medicine (EBM) practice guidelines for Coronavirus (COVID-19) for occupational health. MDGuidelines has made the guideline available free of charge.

The announcement comes at a critical time as state jurisdictions fight to mitigate the pandemic’s effects on their respective economies and workforces. The ACOEM guidelines are adopted, in whole or in part, as the presumptively correct standards for treating occupational-related injuries and illnesses in two of the nation’s hardest-hit markets, California and New York.

Dr. Avrom Gart, Risico Total Managed Care’s Medical Director states, “The new ACOEM guideline on Coronavirus (COVID-19) is important to Occupational Medicine because it establishes a starting point in writing for medical providers to consider. There is too much opinion in the public domain about what could work, or should work, but nothing that provides a transparent base of evidence. At the end of the day, individuals diagnosed with COVID-19 will have to consult and listen to their doctor for the best course of care.”

A Guideline for All Stakeholders

The guideline’s intended audience includes, occupational and other physicians, health care professionals, insurers, employers, attorneys, non-occupational specialists, and all other stakeholders in worker health and workers’ compensation systems. Guidance provided in the guideline for these groups includes information pertinent to contagiousness, incubation, clinical presentation, mortality rates and more.

Employers throughout the country may be particularly interested in the employer considerations section of the guideline. The guidance provided here includes recommendations related to employee contact, general principles and recommended planning for businesses.

ACOEM’s guideline also dives into disability considerations qualifying its findings by stating that while disability will be better defined with studies to come over time, there are major concerns based on preliminary data and information from analogous diseases. In other words, we are still learning about COVID-19’s disability and recovery expectations which will need much attention.

The guideline points out that there are no quality data on disability for patients without hospitalization and estimates recovery from post-infection fatigue to take about two to three weeks for mild cases. For patients with mild to moderate pneumonia treated with oxygen supplementation, recovery is estimated to take four to eight weeks after hospitalization or clinical recovery.

The prognoses for severe pneumonia and acute respiratory distress syndrome (ARDS) are much worse. Approximately 50% of survivors may be projected to not return to work within a year of survival of the acute infection, based on prior experience from diseases that have similar symptoms as ARDS.

Hydroxychloroquine for Treatment of COVID-19

A debate around the use of hydroxychloroquine for the treatment of COVID-19 has developed in the media. Outlets have published concerns about the drug’s potentially dangerous side effects, including sudden death. The drug’s prominence in the public domain came after President Trump expressed confidence in the drug as a promising treatment option for COVID-19.

ACOEM’s new COVID-19 guidelines lists hydroxychloroquine as a “Recommended” treatment of COVID-19 for “select patients”. The recommendation’s Strength of Evidence is listed as Level C, describing the limited evidence-base with at least one randomized study of moderate quality.

The rationale for ACOEM’s recommendation of the drug for select patients is due to the quality evidence available for the efficacy of chloroquines (especially hydroxychloroquine) for the treatment of COVID-19. ACOEM qualifies that the medications are low cost, and adverse effects are minor for short courses of treatment at commonly used doses. Based on the available limited evidence, earlier treatment appears to be important for efficacy versus administering with treatment in an ICU after viral replication has ceased, according to the guideline.

Patients who may be good candidates include those who are moderately to severely affected with COVID-19. However, ACOEM found that there is no quality evidence supporting the drug’s efficacy when used after ARDS is established.

Patients with multiple comorbidities, such as diabetes, cardiovascular disease, COPD may also benefit from the use of hydroxychloroquine when administered early and the effects of COVID-19 are milder but worsening.

This along with other treatment considerations are included in the guideline. ACOEM’s recommendations, or non-recommendation, of specific treatment protocols are substantiated by the studies considered and the scoring of those studies. These elements provide the transparency required by a trustworthy EBM development process.

The Development of the COVID-19 Guideline

ACOEM’s EBM Practice Guidelines are developed in compliance with the Institute of Medicine’s (IOM) Standards for Developing Trustworthy Clinical Practice Guidelines and Appraisal of Guidelines for Research and Evaluation (AGREE). Pursuant to these standards, the development of the guidelines includes the use of various teams and panels throughout the process.

A critical part of each guidelines’ development process is the designation of the Evidence-based Practice Panel. Pertinent to COVID-19, the panel members represent expertise in occupational medicine, internal medicine, pulmonary medicine, and infectious disease. ACOEM’s complete development methodology is available on its website.

MDGuidelines’ ability to produce high-quality EBM guidelines so quickly is a monumental undertaking. Generally speaking, a trustworthy, high-quality EBM guideline can take up to two years to develop and to publish comprehensive content updates according to emerging research.

Provided that MDGuidelines and ACOEM can remain agile with updates to this guideline, this trustworthy EBM Coronavirus (COVID-19) guideline, and its subsequent updated versions, will be an immensely useful tool for users around the globe involved in health and business recovery efforts.

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