Collecting Occupation and Industry Data in Public Health Surveillance Systems for COVID-19Posted on by
This is the first of two blogs in the series “COVID-19 Surveillance among Workers: What we know and what are we doing to learn more”.
What we know
Though the COVID-19 pandemic continues, critical infrastructure industries are operating and other types of businesses are beginning to reopen. Recent studies have reported outbreaks of COVID-19 in several types of workplaces, including long-term care facilities, meatpacking plants, correctional facilities, and homeless shelters. The media have also reported outbreaks in law enforcement agencies, airport screening agencies, construction sites, manufacturing plants, and other workplaces.
Without good surveillance data on the jobs of all workers with COVID-19, it’s hard to tell what groups are at higher risk because of their jobs.
Ideally, occupation and industry data should be collected on all workers with COVID-19.
Collecting information about the jobs of all workers with COVID-19 would help the public health community identify work-related outbreaks and evaluate risks among various groups of workers. We could then better refine guidance for specific occupational groups. Work is a social determinant of health (like educational status or race) that should be included in all public health surveillance systems. In the context of the current pandemic, work is an important source of potential exposure for the many people who are unable to telework or maintain social distancing in the workplace, and who come into close physical contact with patients, clients, customers, or coworkers.
For case reporting of acute infectious diseases, such as COVID-19, the NIOSH Surveillance Program recommends asking all employed people about their current occupation (type of job) and industry (employer’s type of business). Ideally, these two pieces of information should be recorded as free text that can be coded to standard occupation and industry classification systems, so that consistency can be maintained across data collection efforts. Guidance for collecting these data can be found on the National Institute for Occupational Safety and Health (NIOSH) topic page Collecting and Using Industry and Occupation Data and in the Council of State and Territorial Epidemiologists Occupational Health Subcommittee’s Recommended Interim Guidance for Collecting Employment Information about COVID-19.
This is what these questions might look like on a form:
Occupation: What kind of work does this person do? (for example, registered nurse, janitor, cashier, auto mechanic)
Industry: What kind of business or industry does this person work in? (for example, hospital, elementary school, clothing manufacturing, restaurant)
CDC recommends that healthcare providers report cases of COVID-19 to their local or state health department immediately. CDC provides guidance and standard case report forms to collect and submit data as part of case reporting and notifications sent to CDC. These data are included in the National Notifiable Diseases Surveillance System (NNDSS). The case report forms are kept brief to minimize the burden on health department staff conducting case investigations.
To date, minimal information about the jobs of people with COVID-19 has been collected and included in case notifications sent to CDC.
Before May 5, the only data collected on work in the CDC case report form was whether the patient was a healthcare worker:
Is the patient a health care worker in the United States? □ Yes □ No □ Unknown
As of June 10, 2020, 72,346 cases, including 383 deaths, reported to CDC were identified among healthcare workers. This number is now updated daily.
- It is not clear how many of these infections can be attributed to exposure in the workplace.
- Characteristics of healthcare personnel with COVID-19 reported to CDC from February 12–April 9 have been summarized in an MMWR article.
By investigating outbreaks, we have learned about, and reported on, cases among other groups of U.S. workers. For example:
- As of April 27, 4,913 cases, including 20 deaths, among meat and poultry processing workers had been reported to CDC from 19 states.
- As of April 15, 33 cases were identified among homeless shelter staff in 4 cities.
- As of April 21, 2,778 cases, including 15 deaths, were identified among correctional and detention facility staff.
What we are doing to learn more
Recent developments will improve industry and occupation data for COVID-19 cases at a national level.
1.The CDC COVID-19 case report form released May 5 added questions about categories of healthcare personnel and about workplace exposures in critical infrastructure. States were asked to start using this new form by May 15.
There is a new box focusing on healthcare worker cases:
Questions about other workplace exposures are included as a subsection in the Exposure Information box:
The instructions for completing the case report form include a recommendation that the person filling out the form use the “workplace setting” field to record both industry and occupation.
2. Recently released CDC guidance on case investigation and contact tracing includes recommendations for collecting occupation and work setting (industry) data during COVID-19 case investigation and contact tracing:
- Key Information to Collect During a Case Interview (See the second bullet under risk factors)
- HEALTH DEPARTMENTS: Interim Guidance on Developing a COVID-19 Case Investigation & Contact Tracing Plan (See Appendix C: Data Elements for Case Investigation and Contact Tracing Forms)
3. A standardized message mapping guide for COVID-19 that is currently under development will support collection of one or multiple occupations and industries for each case, so that standardized data elements and responses can be collected and submitted to CDC through NNDSS.
As we wait for these changes to yield data, we are trying to learn more about the burden of COVID-19 among various occupations and industries through other data collected by CDC, state and local health departments, and other organizations.
We are in this together
NIOSH scientists and information technology specialists are available to help organizations and state and local public health partners code and analyze any work data that are collected. Contact NIOSHIOCoding@cdc.gov for help.
Sara Luckhaupt, MD; Sherry Burrer, DVM; Marie de Perio, MD; and Marie Haring Sweeney, PhD; for the CDC COVID-19 Response Worker Safety and Health Team Occupational Epidemiology Branch