CDC Report - Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection — Nebraska, April–May 2020

In CDC MMWR, an article was posted on the investigation of an COVID-19 outbreak in a meat processing facility. There were 1,216 facility workers tested with 375 (31%) having positive results. They were able to question 241 of those who were infected.

• Approximately one third (78; 32%) of respondents reported no symptoms. Among the 163 symptomatic respondents, two were hospitalized, and no deaths were identified.  Only 24% had a cough and 34% had a measured fever.
• Close contact† with a visibly ill person (or person with diagnosed COVID-19) at work was reported by 70 (29%) workers; the most frequently reported close contact locations were production areas (74%) and cafeteria/break areas (51%).
• Most (87%) reported always having their temperature checked upon entry to work, fewer (41%) reported always being asked about symptoms.
• Thirty of 235 (13%) workers reported close contact with a visibly ill person (or a person with diagnosed COVID-19) outside of work.

What is striking in the report is the difficulty in preventing through just watching for cough and fever.   There will be many who are asymptomatic or just have minor symptoms.  In the end, screening is important (checking temperature and asking about the minor symptoms and potential exposure), but distancing and mask wearing are also very important.

CDC MMWR

https://www.cdc.gov/mmwr/volumes/69/wr/mm6931a3.htm
Notes from the Field: Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection — Nebraska, April–May 2020
Weekly / August 7, 2020 / 69(31);1020–1022
Matthew Donahue, MD1,2; Nandini Sreenivasan, MD3; Derry Stover, MPH2; Anu Rajasingham, MPH3; Joanna Watson, DPhil3,4,5; Andreea Bealle, MPH3; Natasha Ritchison6; Thomas Safranek, MD2; Michelle A. Waltenburg, DVM1; Bryan Buss, DVM2,7; Jennita Reefhuis, PhD3 (View author affiliations)

Coronavirus disease 2019 (COVID-19) has been reported nationwide among meat processing facility workers (1). In late April 2020, through flyers and text messages, workers at a Nebraska meat processing facility were invited by the facility, in partnership with the Nebraska Department of Health and Human Services, to be tested for current SARS-CoV-2, the virus that causes COVID-19, at their worksite, free of charge. Specimens were analyzed using reverse transcription–polymerase chain reaction (RT-PCR) by a contracting laboratory. This investigation was determined by CDC to be public health surveillance.* Among 1,216 Nebraska-resident meat processing facility workers tested, 375 (31%) had positive results. During May 8–25, case investigators attempted to interview the 349 workers who had positive test results and available phone numbers; five refused, 99 were not reached after five attempts, and four did not report symptom status, leaving 241 (69%) of the attempted interviews for analysis.
Among the 241 interviewed workers, 57% were male, the median age was 41 years (range = 18–76 years), and 46% were Hispanic (Table). Approximately one third (78; 32%) of respondents reported no symptoms. Among the 163 symptomatic respondents, two were hospitalized, and no deaths were identified. Workers were queried about exposures during the 14 days before symptom onset (2) or before testing if they were asymptomatic. Close contact† with a visibly ill person (or person with diagnosed COVID-19) at work was reported by 70 (29%) workers; the most frequently reported close contact locations were production areas (74%) and cafeteria/break areas (51%). Among 167 persons who worked in the 14 days preceding symptom onset or testing, approximately half (46%) worked on the conveyor belt in harvesting (i.e., stunning, slaughtering, eviscerating, and halving), processing (i.e., cutting, preparing, and packaging), and rendering (i.e., converting waste animal materials into usable products), where they were in close proximity (<4 ft [<1.5 m]) to others. Most (88%) workers reported using a private vehicle rather than carpooling (11%) to get to work. Although most (87%) reported always having their temperature checked upon entry to work, fewer (41%) reported always being asked about symptoms. Nearly three quarters of workers (73%) reported having a flexible medical leave policy allowing for time off if needed. Approximately one half of workers reported living in a single-family home (53%), with a median household size of three persons (range = 1–13). Thirty of 235 (13%) workers reported close contact with a visibly ill person (or a person with diagnosed COVID-19) outside of work. Limitations of this analysis include the absence of a comparison group and that only persons who participated in testing, had positive test results, had contact information, answered the telephone, and agreed to be interviewed were included.
Reducing workplace exposures is crucial for preventing COVID-19 among meat processing facility workers. Despite broad availability of a flexible medical leave policy and fever screening, approximately one third of workers included in this investigation reported close contact with an ill person at work, which supports the need for symptom screening§ in addition to fever screening and ongoing access to testing. Fewer workers reported contact with an ill person outside work; risk factors such as crowded living conditions and shared transportation were reported infrequently. Approximately one third of workers with COVID-19 were asymptomatic, underscoring the limitations of relying on symptom or fever screening alone, particularly because asymptomatic persons with COVID-19 potentially contribute to transmission (3,4). That nearly one half of interviewed workers worked in close proximity to others highlights the need for physical barriers between workers, physical distancing throughout the facility (especially locations prone to crowding, such as production areas and cafeterias or break areas), and consistent and correct use of masks to reduce transmission in the workplace¶ in this critical industry (5,6).
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Acknowledgments
Allison Newman; COVID-19 investigation and contact tracing teams; workers mentioned in this report; the meat processing facilities across Nebraska.
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Corresponding author: Matthew Donahue, phu0@cdc.gov.
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1Epidemic Intelligence Service, CDC; 2Nebraska Department of Health and Human Services; 3CDC COVID-19 Emergency Response Team; 4Division of Global Health Protection, Center for Global Health, CDC; 5Western States Division, National Institute for Occupational Safety and Health, CDC; 6Dakota County Health Department, Dakota City, Nebraska; 7Division of State and Local Readiness, Center for Preparedness and Response, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

* U.S. Department of Health and Human Services, Title 45 Code of Federal Regulations 46, Protection of Human Subjects. https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=83cd09e1c0f5c6937cd9d7513160fc3f&pitd=20180719&n=pt45.1.46&r=PART&ty=HTML
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† Close contact was defined as being within 6 feet (2 m) for ≥10 minutes in the 2 weeks preceding symptom onset or testing.
§ Symptom screening should include some of the wide range of symptoms that persons with COVID-19 have reported (e.g., fever, cough, shortness of breath, headache, fatigue, myalgia, loss of smell or taste, and sore throat). https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.
¶ https://www.unmc.edu/healthsecurity/education/programs/docs/Playbook.pdf
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