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We aimed to describe coronavirus disease 2019 (COVID-19) deaths among first responders early in the COVID-19 pandemic. We used media reports to gather timely information about COVID-19–related deaths among first responders during March 30–April 30, 2020, and evaluated the sensitivity of media scanning compared with traditional surveillance. We abstracted information about demographic characteristics, occupation, underlying conditions, and exposure source. Twelve of 19 US public health jurisdictions with data on reported deaths provided verification, and 7 jurisdictions reported whether additional deaths had occurred; we calculated the sensitivity of media scanning among these 7 jurisdictions. We identified 97 COVID-19–related first-responder deaths during the study period through media and jurisdiction reports. Participating jurisdictions reported 5 deaths not reported by the media. Sixty-six decedents worked in law enforcement, and 31 decedents worked in fire/emergency medical services. Media reports rarely noted underlying conditions. The media scan sensitivity was 88% (95% CI, 73%-96%) in the subset of 7 jurisdictions. Media reports demonstrated high sensitivity in documenting COVID-19–related deaths among first responders; however, information on risk factors was scarce. Routine collection of data on industry and occupation could improve understanding of COVID-19 morbidity and mortality among all workers.

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 6,786,352 cases and 199,024 deaths in the United States.* Health care personnel (HCP) are essential workers at risk for exposure to patients or infectious materials (1). The impact of COVID-19 on U.S. HCP was first described using national case surveillance data in April 2020 (2). Since then, the number of reported HCP with COVID-19 has increased tenfold. This update describes demographic characteristics, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions, stratified by vital status, among 100,570 HCP with COVID-19 reported to CDC during February 12-July 16, 2020. HCP occupation type and job setting are newly reported. HCP status was available for 571,708 (22%) of 2,633,585 cases reported to CDC. Most HCP with COVID-19 were female (79%), aged 16-44 years (57%), not hospitalized (92%), and lacked all 10 underlying medical conditions specified on the case report form† (56%). Of HCP with COVID-19, 641 died. Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% versus 22%), persons aged ≥65 years (44% versus 4%), non-Hispanic Asians (Asians) (20% versus 9%), non-Hispanic Blacks (Blacks) (32% versus 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% versus 41%). From a subset of jurisdictions reporting occupation type or job setting for HCP with COVID-19, nurses were the most frequently identified single occupation type (30%), and nursing and residential care facilities were the most common job setting (67%). Ensuring access to personal protective equipment (PPE) and training, and practices such as universal use of face masks at work, wearing masks in the community, and observing social distancing remain critical strategies to protect HCP and those they serve.

During a pandemic, syndromic methods for monitoring illness outside of health care settings, such as tracking absenteeism trends in schools and workplaces, can be useful adjuncts to conventional disease reporting (1,2). Each month, CDC's National Institute for Occupational Safety and Health (NIOSH) monitors the prevalence of health-related workplace absenteeism among currently employed full-time workers in the United States, overall and by demographic and occupational subgroups, using data from the Current Population Survey (CPS).* This report describes trends in absenteeism during October 2019-April 2020, including March and April 2020, the period of rapidly accelerating transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Overall, the prevalence of health-related workplace absenteeism in March and April 2020 were similar to their 5-year baselines. However, compared with occupation-specific baselines, absenteeism among workers in several occupational groups that define or contain essential critical infrastructure workforce† categories was significantly higher than expected in April. Significant increases in absenteeism were observed in personal care and service§ (includes child care workers and personal care aides); healthcare support¶; and production** (includes meat, poultry, and fish processing workers). Although health-related workplace absenteeism remained relatively unchanged or decreased in other groups, the increase in absenteeism among workers in occupational groups less able to avoid exposure to SARS-CoV-2 (3) highlights the potential impact of COVID-19 on the essential critical infrastructure workforce because of the risks and concerns of occupational transmission of SARS-CoV-2. More widespread and complete collection of occupational data in COVID-19 surveillance is required to fully understand workers' occupational risks and inform intervention strategies. Employers should follow available recommendations to protect workers' health.

During an influenza pandemic and during seasonal epidemics, more persons have symptomatic illness without seeking medical care than seek treatment at doctor's offices, clinics, and hospitals (1). Consequently, surveillance based on mortality, health care encounters, and laboratory data does not reflect the full extent of influenza morbidity. CDC uses a mathematical model to estimate the total number of influenza illnesses in the United States (1). In addition, syndromic methods for monitoring illness outside health care settings, such as tracking absenteeism trends in schools and workplaces, are important adjuncts to conventional disease reporting (2). Every month, CDC's National Institute for Occupational Safety and Health (NIOSH) monitors the prevalence of health-related workplace absenteeism among full-time workers in the United States using data from the Current Population Survey (CPS) (3). This report describes the results of workplace absenteeism surveillance analyses conducted during the high-severity 2017-18 influenza season (October 2017-September 2018) (4). Absenteeism increased sharply in November, peaked in January and, at its peak, was significantly higher than the average during the previous five seasons. Persons especially affected included male workers, workers aged 45-64 years, workers living in U.S. Department of Health and Human Services (HHS) Region 6* and Region 9,† and those working in management, business, and financial; installation, maintenance, and repair; and production and related occupations. Public health authorities and employers might consider results from relevant absenteeism surveillance analyses when developing prevention messages and in pandemic preparedness planning. The most effective ways to prevent influenza transmission in the workplace include vaccination and nonpharmaceutical interventions, such as staying home when sick, covering coughs and sneezes, washing hands frequently, and routinely cleaning frequently touched surfaces (5).

ObjectivesThe Flint Community Resilience Group (Flint, Michigan USA) and the Centers for Disease Control and Prevention (CDC; Atlanta, Georgia USA) assessed behavioral health concerns among community members to determine the impact of lead contamination of the Flint, Michigan water supply.MethodsA Community Assessment for Public Health Emergency Response (CASPER) was conducted from May 17 through May 19, 2016 using a multi-stage cluster sampling design to select households and individuals to interview.ResultsOne-half of households felt overlooked by decision makers. The majority of households self-reported that at least one member experienced more behavioral health concerns than usual. The prevalence of negative quality of life indicators and financial concerns in Flint was higher than previously reported in the Michigan 2012 and 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey.ConclusionsThe following can be considered to guide recovery efforts in Flint: identifying additional resources for behavioral health interventions and conducting follow-up behavioral health assessments to evaluate changes in behavioral health concerns over time; considering the impact of household economic factors when implementing behavioral health interventions; and ensuring community involvement and engagement in recovery efforts to ease community stress and anxiety.FortenberryGZ, ReynoldsP, BurrerSL, Johnson-LawrenceV, WangA, SchnallA, PullinsP, KieszakS, BayleyegnT, WolkinA. Assessment of behavioral health concerns in the community affected by the Flint water crisis — Michigan (USA) 2016. Prehosp Disaster Med. 2018;33(3):256–265.

Objective To describe the methodology of the National Institute for Occupational Safety and Health (NIOSH) system for national surveillance of health-related workplace absenteeism among full-time workers in the United States and to present initial findings from October through July of the 2017–2018 influenza season. Introduction During an influenza pandemic, when hospitals and doctors’ offices are—or are perceived to be—overwhelmed, many ill people may not seek medical care. People may also avoid medical facilities due to fear of contracting influenza or transmitting it to others. Therefore, syndromic methods for monitoring illness outside of health care settings are important adjuncts to traditional disease reporting. Monitoring absenteeism trends in schools and workplaces provide the archetypal examples for such approaches. NIOSH’s early experience with workplace absenteeism surveillance during the 2009–2010 H1N1 pandemic established that workplace absenteeism correlates well with the occurrence of influenza-like illness (ILI) and significant increases in absenteeism can signal concomitant peaks in disease activity. It also demonstrated that, while population-based absenteeism surveillance using nationally representative survey data is not as timely, it is more valid and reliable than surveillance based on data from sentinel worksites. 1 In 2017, NIOSH implemented population-based, monthly surveillance of health-related workplace absenteeism among full-time workers. Methods Each month, NIOSH updates an influenza season-based time series of health-related workplace absenteeism prevalence among full-time workers with the previous month’s estimate (i.e., with a 1-month lag). Data for this surveillance system come from the Current Population Survey (CPS), a monthly national survey of approximately 60,000 households administered by the Bureau of Labor Statistics. The CPS collects information on employment, demographics and other characteristics of the noninstitutionalized population aged 16 years or older. A full-time worker is defined as an employed person who reports that they usually work at least 35 hours per week. Health-related workplace absenteeism is defined as working fewer than 35 hours during the reference week due to the worker’s own illness, injury, or other medical issue. Because the CPS questions refer to one week of each month, absenteeism during the other weeks is not measured. These one-week measures are intended to be representative of all weeks of the month in which they occur. Monthly absenteeism prevalence estimates for the current influenza season are compared to an epidemic threshold defined as the 95% upper confidence limit of a baseline established using data from the previous five seasons aggregated by month. Point estimates that exceed the epidemic threshold signal surveillance warnings ; estimates whose lower 95% confidence limits exceed the epidemic threshold generate surveillance alerts . Estimates of total absenteeism are calculated as are estimates stratified by sex, age group, geographic region (HHS service regions), and occupation. All analyses are weighted using the CPS composite weight and estimates of all standard errors are adjusted to account for the complex design of the CPS sample. Results During the period October 2017 through July 2018, the prevalence of health-related workplace absenteeism among full-time workers began at 1.7% (95% CI 1.6–1.8%) in October, increased sharply beginning in November, peaked in January at 3.0% (95% CI 2.8–3.2%), and declined steadily thereafter to end at a low of 1.4% (95% CI 1.3–1.5%) in July. The January absenteeism peak significantly exceeded the epidemic threshold, signaling a surveillance alert. Absenteeism remained elevated in February, but not significantly, signaling a surveillance warning. (Figure 1) Peak absenteeism in the 2017-2018 influenza season exceeded that of all of the five previous seasons except the 2012-2013 season. (Figure 2) Analyses stratified by sex generated surveillance alerts for male workers in January and February. Surveillance alerts were also signaled for the following strata: workers aged 45–64 years in January and February; workers in HHS Region 6 in January and February and Region 9 in December and March; and workers in management, business, and financial occupations and installation, maintenance, and repair occupations in January and in production and related occupations in February. Unlike surveillance alerts, the numerous surveillance warnings generated in stratified analyses are not reported due to small sample sizes in several strata. Conclusions Results of initial analyses for the 2017–2018 influenza season indicate that, among full-time workers in the United States, the prevalence of health-related workplace absenteeism began to increase in November, peaked in January and was significantly higher than the average of the previous five seasons. These findings are consistent with official characterizations of 2017–2018, based on traditional ILI, hospitalization, and virologic surveillance data, as a high severity season that accelerated in November and peaked in January and February. 2,3 Analyses further suggest that male workers; workers aged 45–64 years; workers living in HHS Regions 6 and 9; and those working in management, business, and financial; installation, maintenance, and repair; and production and related occupations may have been especially impacted. While not timely enough to serve as an early warning system, population-based workplace absenteeism is, nevertheless, a useful syndromic measure of a pandemic’s impact on the working population. It also provides information that can be used to maintain health situational awareness during the inter-pandemic period, to evaluate the impact of pandemic control measures, and to inform future pandemic preparedness and response planning. Absenteeism surveillance can provide an important supplementary measure of a pandemic’s overall impact because morbidity and mortality statistics may not fully reflect the disruption caused to the social and economic life of the community. This is especially true when disease makes people too sick to work but not sick enough to seek medical care. References 1. Groenewold MR, Konicki DL, Luckhaupt SE, Gomaa A, Koonin LM. Exploring national surveillance for health-related workplace absenteeism: Lessons learned from the 2009 Influenza Pandemic. Disaster Med Public Health Preparedness. 2013;7:160–166. 2. Garten R, Blanton L, Elal AI, et al. Update: Influenza Activity in the United States During the 2017–18 Season and Composition of the 2018–19 Influenza Vaccine. MMWR Morb Mortal Wkly Rep 2018;67:634–642. 3. World Health Organization. Review of the 2017–2018 influenza season in the northern hemisphere. Wkly Epidemiol Rec. 2018;34(93):429–444.

Objectives: In January 2014, 4-methylcyclohexanemethanol spilled into the Elk River near Charleston, West Virginia, contaminating the water supply for about 120 000 households. The West Virginia American Water Company (WVAWC) issued a “do not use” water order for 9 counties. After the order was lifted (10 days after the spill), the communities’ use of public water systems, information sources, alternative sources of water, and perceived impact of the spill on households were unclear to public health officials. To assist in recovery efforts, the West Virginia Bureau for Public Health and the Centers for Disease Control and Prevention conducted a Community Assessment for Public Health Emergency Response (CASPER). Methods: We used the CASPER 2-stage cluster sampling design to select a representative sample of households to interview, and we conducted interviews in 171 households in April 2014. We used a weighted cluster analysis to generate population estimates in the sampling frame. Results: Before the spill, 74.4% of households did not have a 3-day alternative water supply for each household member and pet. Although 83.6% of households obtained an alternative water source within 1 day of the “do not use” order, 37.4% of households reportedly used WVAWC water for any purpose. Nearly 3 months after the spill, 36.1% of households believed that their WVAWC water was safe, and 33.5% reported using their household water for drinking. Conclusions: CASPER results identified the need to focus on basic public health messaging and household preparedness efforts. Recommendations included (1) encouraging households to maintain a 3-day emergency water supply, (2) identifying additional alternative sources of water for future emergencies, and (3) increasing community education to address ongoing concerns about water.