by Marnie Dobson Zimmerman, PhD & Pouran Faghri, MD*
Work stress during the pandemic
The COVID-19 pandemic has been causing much uncertainty, anxiety, and stress, touching on nearly every aspect of our lives, and is likely to stay for a while more. Research has shown, long before the pandemic, that work stressors (sources of stress at work) including, high job demands, low job control, long working hours, and imbalance between efforts and rewards, can negatively impact mental and physical health. During the pandemic, many of these work stressors have intensified including lack of social support (due to lockdowns and social distancing) and balancing work and family life, especially for working families with very young school-age children. On the flip side, business closures or staffing cuts have led to the most significant rise in unemployment and underemployment since the Great Depression, both major causes of stress and mental health issues.
Essential workers (e.g. health care, first responders, food and agricultural, grocery and transportation workers) are more likely to be exposed to the virus on the job. Their jobs can’t be performed at home, require face-to-face contact with the public or working in close proximity to coworkers, and are often in indoor environments that may not be properly ventilated nor allow social distancing. Essential workers are also more likely than other workers to be exposed to work stressors that negatively affect their health.
While unhealthy working conditions pre-existed this pandemic, especially in many essential and low-wage jobs, they have worsened as a result of the pandemic. Those working in grocery stores, for example, dealt with long lines of customers, many who did not follow social distancing rules or wear masks properly. Those working in meat-packing industries (locations of major outbreaks) work in close proximity to co-workers and may need to work while sick because of job and financial insecurity. Healthcare workers must deal with overwhelming patient numbers during extreme COVID-19 surges, often without adequate PPE to protect from COVID-19, and resulting in burnout and in some cases suicide.
African-American and Latinx communities have also been hit hard by the COVID-19 pandemic, partly because many also work in essential jobs with higher exposure to the virus. The number of African-American and Latinx people working in animal slaughtering and meat processing plants (for example) is significantly higher than whites. Furthermore, workers of color tend to have lower-wage jobs, and live in crowded neighborhoods and multigenerational households, increasing the spread of the virus to household and community members.
What research shows
Our recent scientific editorial, “COVID-19 Pandemic: What Has Work Got to Do With It?”, by Pouran Faghri, MD, Marnie Dobson, PhD, Paul Landsbergis, PhD, and Peter Schnall, MD, published in the Journal of Occupational and Environmental Medicine, discusses the effects of work stress on the severity of COVID-19 and the implications of that for essential workers and workers of color. Over the last 40 years, research has shown that many job stressors contribute to chronic stress which accumulates over time and changes the physiology of the body, contributing to obesity, diabetes, high blood pressure, heart disease, and perhaps most importantly to immune dysfunction.
Stressors affect the function of the immune system by increasing inflammatory cytokines which have also been linked to more severe outcomes of COVID-19.
Low-wage, essential workers and workers of color are more likely than white workers to have these “comorbidities” caused, in part, by stressful work as well as stressful living conditions, financial strain, and exposure to violence or discrimination. Those with comorbid conditions (obesity, diabetes, high blood pressure and heart disease) have a higher rate of COVID-19 infection and related death.
Making work healthier matters now more than ever.
Addressing health inequity and improving unhealthy working conditions, and other social determinants of health, is an important ongoing goal to protect essential workers. Vaccination rates in the U.S. have stalled partly due to a large number of people who may be “vaccine-hesitant,” making it unlikely the U.S. or the world will reach “herd immunity” in the very near future. SARS-CoV2 is likely to become endemic. Those in essential jobs who are immunosuppressed, have comorbid conditions or remain unvaccinated, may well continue to get sick. Thankfully, there are workers, worker advocacy groups, and labor unions fighting to protect the health and safety of essential workers, during this pandemic and beyond.
Recently on the Healthy Work Campaign website, we posted some examples of the efforts various groups have made to reduce COVID-related work stressors. For example:
- Collective bargaining/union organizing: Members of the New York State Nurses Association (NYSNA) faced major physical, mental, and emotional challenges at the height of the pandemic in New York. In the midst of the pandemic, an emergency policy was enacted by the NYC Health and Hospitals Corporation (HHC) that restricted the nurses’ sick leave (presumably to compensate for a shortage of nursing staff). Paid sick leave (paid time off from work) allows workers to stay home and recover from illness, to reduce their burnout from understaffing or overtime, or to protect other workers from contracting an illness from a sick co-worker. The union organized a “COVID Action Team” Zoom meeting city-wide. Within two days of petitioning the mayor’s office, the HHC ended the policy.
- Laws & regulations: While several states (VA, MI, CA, NJ) took the initiative earlier in the pandemic to protect workers through executive orders or a state OSHA infectious disease “emergency temporary standard” (ETS), there is no federal standard. However, after pressure from various health & safety advocacy groups, a federal OSHA infectious disease ETS has just been sent to the Office of Management and Budget for review, and we need to push the Biden administration for its immediate approval. An ETS is enforceable and will require all employers to protect workers adequately from current and future (airborne) infectious disease epidemics, by requiring masks, social distancing and effective ventilation. These kinds of regulations can reduce worker concerns about COVID-19 exposure at their workplace, and give them a mechanism for reporting employers who are not in compliance with the standard.
- Workers Compensation: As of December 9, 2020, 17 states and Puerto Rico had extended workers’ compensation coverage of COVID-19 as a work-related illness for various workers. Despite these laws and orders that provide greater access to workers’ compensation for COVID-19, many claims continue to be held up or denied. Allowing workers who are ill to recover at home without loss of wages is essential to reduce worker stress related to economic insecurity, as well as to protect co-workers from further infection.
- Community organizations are advocating for their members and working to establish guidelines for safe re-opening of workplaces, to protect both consumers and workers. For example, the California Healthy Nail Salon Alliances has released guidelines limiting the number of people in the salon, frequent and thorough disinfection between clients, reducing the amount of services offered to clients, as well as the right to refuse service for anyone who has been exposed to or is showing symptoms of the virus. These guidelines limit workload as well as exposure to the virus.
- Public Health Councils: In November 2020, the Los Angeles County Board of Supervisors approved a program for workers to form public health councils to help ensure employers follow COVID health & safety guidelines. Nonprofits and unions will train council members on health & safety protocols and how to report violations. Involving workers in addressing their health & safety concerns gives them greater “job control” and allows them to influence employer policies and is therefore potentially health protective.
Healthy work and healthy workplaces
Our goal is healthy work and healthy workplaces. So what is healthy work? People have a fundamental need to be valued, to use their skills, and have reasonable and fair job demands. Healthy work must also include a certain level of autonomy and “decision latitude”, that is having a say over how their job is done. Being treated with respect (not as expendable objects), respecting front-line knowledge & skills, and being part of an organization that is genuinely concerned with the health, safety and well-being of all workers, is all part of healthy work.
- If you want to read the full editorial in the Journal of Occupational and Environmental Medicine (April 2021), “COVID-19 Pandemic: What Has Work Got to Do With It?”, click here.
- If you want to learn more about the challenges of finding work-life balance right now, check out our May 2020 article, “Blurred Boundaries: Work-Life Balance in the Time of COVID19.”
- If you want to know about the impact of precarious work in a pandemic, check out our June 2020 article, “Freelance and Gig Work during COVID-19.”
- If you are interested in our public health perspective on reopening schools, check out our July 2020 article, “Reopening Schools: Mental health vs Health & Safety?”.
- If you are interested in learning about pandemic air travel risks, check out our August 2020 article, “Air Travel and the Pandemic: an Epidemiologist’s Perspective.”
*This article was commissioned as part of the Healthy Work Campaign. To learn more and obtain free resources, visit https://healthywork.org.
Dr. Marnie Dobson is the Co-Director of the Healthy Work Campaign, as well as the Associate Director of the Center for Social Epidemiology. She is also an Assistant Adjunct Professor at the University of California, Irvine Center for Occupational and Environmental Health (COEH) where, for the last 12 years, she has been involved in work stress research, including qualitative, participatory methods, enhancing epidemiological studies and intervention development with several blue-collar working populations including firefighters and urban transit operators. She continues to teach in occupational health classes at UCI and UCLA, as well as publish academic articles and book chapters and present at scientific conferences. (LinkedIn, Twitter)
Dr. Pouran Faghri is the Principal Investigator for the Healthy Work Campaign, Dissemination and Implementation Project and a Researcher with the Center for Social Epidemiology. She is an Adjunct Full Professor at the University of California Los Angeles, Department of Environmental Health Sciences, Fielding School of Public Health, and on the Advisory Board of the NIOSH Southern California Education and Research Center. She is also an Emeritus Professor at the University of CT and was the Director of the Center for Environmental Health and Health Promotion at the University of Connecticut. (LinkedIn, Twitter)
We would like to acknowledge the contributions made to this article by our colleagues: