LAUSR

Coronavirus disease (COVID-19) is one of the most consequential occupational diseases we have confronted in a century, requiring a broad and comprehensive approach to workplace mitigation and prevention (1). In this viewpoint, we share data documenting the profound impact of COVID-19 on workers throughout California and describe the legal and policy approaches that have been used. Although the story is still unfolding, California’s experience to date offers lessons for state and national strategies on workplace control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other airborne hazards more generally. In California, 73% of confirmed COVID-19 cases and 29% of confirmed COVID-19 deaths have been in working-age (18–64 yr) adults (2). Although the fraction of these cases and deaths attributable to workplace transmission is unknown, other data suggest that the occupational burden of COVID-19 is substantial. According to the CaliforniaWorkers’ Compensation Institute, there have been more than 180,000 COVID-19 workers’ compensation claims reported through December 2021 (3). At their peak in December 2020, monthly COVID-19 workers’ compensation claims (n=43,705) exceeded non–COVID-19 workers’ compensation claims (n=39,842) and approached the total number of workers’ compensation claims in December 2019 (n=48,285). In addition, employer reporting of workplace clusters was mandated by state law beginning in 2021; data through January 2022 comprise nearly 12,000 confirmed outbreaks involving more than 90,000 cases (4). Furthermore, we identified 862 suspected work-related COVID-19 deaths that occurred between January 1, 2020 and January 13, 2022 and were reported by employers to the Division of Occupational Safety and Health, California Department of Industrial Relations (Cal/OSHA, the nation’s largest Occupational Safety and Health Administration state plan) and/or reported in the media (Table 1). This number is remarkable, considering that before the pandemic, fewer than 500 fatal occupational injuries typically occurred each year in California (5). The impact of COVID-19 has been felt across industrial sectors. The most common industries for COVID-19 workers’ compensation claims through December 2021 were health care (29.9%), public safety and government (18.7%), retail (10.2%), manufacturing (7.1%), transportation (6.9%), food services (4.8%), and administrative and waste management (3.9%) (3). Statewide, workplace outbreaks have occurred in every sector (4). During the first 6 months of the pandemic in Los Angeles County (the state’s largest local health jurisdiction), the most frequent sectors for nonresidential, nonhealthcare workplace outbreaks were manufacturing, retail trade, and transportation and warehousing (6). Among the suspected work-related COVID-19 deaths noted above, we found that the greatest number occurred in healthcare settings other than hospitals, followed by public administration (which includes justice, public order, and safety activities), manufacturing, retail trade, hospitals, and transportation and warehousing (Table 1). A study of excess all-cause mortality among Californians 18–65 years old through November 2020 found the highest relative and per-capita excess mortality in food and agriculture, transportation and logistics, manufacturing, and facilities industries (7). In that study, Latino workers experienced the