An Outbreak of COVID-19 Among H-2A Temporary Agricultural Workers

During the COVID-19 pandemic, attention has focused on outbreaks in meatpacking and other food production facilities. However, substantive problems have also arisen among agricultural worker populations, including temporary workers brought to the United States under H-2A visas.^1,2 H-2A workers face the same environmental and occupational health risks as all farmworkers but may be even more vulnerable because they have less control over their living and working environments. Here we report on a COVID-19 outbreak in a crew of more than 100 H-2A workers in north central Florida to characterize factors that may contribute to the spread of COVID-19 in this essential workforce.³

METHODS

We obtained data from interviews conducted by the medical team involved in the screening of workers and from disease investigators affiliated with the local health department. Additional information was gathered from the South Florida health department where individuals in the crew were tested preceding the outbreak.

RESULTS

In late May 2020, approximately 50 H-2A agricultural workers traveled from the Homestead area of Dade County in south Florida to north central Florida, where they joined another group of H-2A workers employed by the same labor contractor. The combined group of approximately 120 workers was harvesting watermelons at farms in north central Florida. After being in the area for about one week, the contractor was notified that two people in the group had positive test results from south Florida for SARS-CoV-2 based on testing done one week prior. The two workers had been administered reverse transcription–polymerase chain reaction tests for SARS-CoV-2 at a health department in south Florida after they developed fever, cough, and body aches. The north central Florida county health department was notified on June 5 that there were workers in this crew who had COVID-19 symptoms and that most if not all of the workers had been exposed to the two individuals who tested positive for SARS-CoV-2.

After work on June 6, the labor contractor transported workers in two school buses to the north central Florida county health department for testing; the cost of testing was absorbed by the local health department. Testing began at 7 pm in the health department parking lot. One of the authors conducting interviews observed that none of the workers were wearing masks. Fifty-four of the 100 workers tested were 20 to 29 years old, whereas five workers were less than 20 years old and three were more than 40 years old; 85% were male. All were from Veracruz, Mexico, with the exception of two workers from other cities in Mexico. None were speakers of indigenous languages, and none spoke English. A bilingual (English/Spanish) testing team, dressed in appropriate personal protective equipment, conducted interviews in Spanish and collected nasopharyngeal swabs from all individuals who were present and willing to be tested. Also on-site was a social worker who evaluated whether there were signs of human trafficking, evidence of which was not identified.

Although the labor contractor stated that he had brought 113 individuals for testing, samples were obtained from only 100 people, with some individuals in the original group apparently leaving the site before testing. Histories were vague, but most of the workers reported some symptoms within the preceding two weeks. None appeared to be critically ill, and all were cooperative. After testing was completed, workers were transported back to the motels in which they were staying.

SARS-CoV-2 was identified in nasopharyngeal swab samples for 91 of the 100 workers tested. Most results were returned six days after samples had been sent to a large commercial lab (LabCorp) for testing; the delay was due to backlogs at the testing laboratory. Eight days after testing, when all results were finally available, a local health department team, donned in appropriate personal protective equipment, met with the crew and contractor to provide linguistically and culturally appropriate disease control information together with masks and personal hygiene and bedding kits.

Workers were found by local health department staff to be housed with six to 10 individuals in each motel room. Despite the recommendation that ill individuals be isolated after initial testing, most had returned to harvesting watermelons the morning after testing was done. Several reported having gone to local emergency departments, and one was reported to have been admitted to the hospital. Further details on these cases could not be obtained. The crew departed Florida shortly after the visit, headed to other states where scheduled work was waiting. Health department inquiries regarding next destinations were unanswered by the labor contractor, precluding notification of the receiving jurisdiction.

DISCUSSION

The H-2A program allows employers to apply for permits to bring workers as “nonimmigrants” from certain countries to fill temporary agricultural jobs in the United States. H-2A workers constitute approximately 10% of agricultural labor in this country; as such, they are an “essential” labor force without whom harvesting many crops would not be possible.⁴ H-2A permit holders must provide housing and transportation for workers, but H-2A workers are not required to have health insurance and generally are not provided medical leave. H-2A workers are paid on an hourly or “piece” rate basis,⁵ providing them a strong motivation to continue working while ill.

The original H-2A regulation contains no health-related provisions beyond requiring employers to comply with all applicable federal, state, and local laws and regulations, including health and safety laws. The COVID-19 outbreak described here highlights the ease with which SARS-CoV-2 can spread through this population when workers are housed and transported in crowded conditions with minimal medical oversight. Although statewide data on frequency of COVID-19 among H-2A workers in Florida are not available, high rates of infection among other agricultural workforces have been reported in the media.^1,2

In response to the special concerns facing farmworkers during the pandemic, the Centers for Disease Control and Prevention and the US Department of Labor developed COVID-19 guidance for agricultural workers and employers that considers issues related to worker transportation and housing.⁶ However, this guidance is not regulatory and does not address issues specific to H-2A workers. Some states have stepped in to provide a regulatory basis for specific actions to protect migrant workers from COVID-19. For example, the Michigan Department of Health and Human Services has implemented requirements regarding screening and testing of migrant workers, including a requirement that all migrant workers be tested for SARS-CoV-2 within 48 hours of arrival at a migrant worker camp and that all workers coming from outside locations be housed separately from other workers for 14 days.⁷

H-2A workers represent a particularly vulnerable group: they frequently do not speak English and are under the control of the H-2A permit holder. They do not have agency over matters such as transportation, housing, and worksite conditions. Although conditions vary by state, H-2A workers are often exposed to environments well recognized to promote transmission of SARS-CoV-2. Testing for SARS-CoV-2 is generally not required by state or local authorities, and, although testing may be available through local health departments, workers may be reluctant to be tested as a result of fear of losing their jobs, lack of language skills, lack of transportation, or lack of knowledge about resources. There may be significant delays in obtaining test results or there may be no way for results, when obtained, to be relayed to individual workers traveling with crews through multiple states. Workers’ contractors may be designated as contacts, but these individuals may also be mobile and difficult to contact.

The case described here illustrates further potential issues when an H-2A crew experiences an outbreak. In this instance, two previously positive workers were not identified until after they had exposed the larger crew, no one was responsible for ensuring that exposed workers were separated or isolated during transportation or at their housing site, and public health officials’ recommendations to keep the ill and exposed crew members from working or moving to their next worksite or to notify individuals at that site were not heeded. Importantly, H-2A workers likely lacked the knowledge, capacity, or willingness to alter their working or living conditions and activities to alleviate the situation.

The plight of essential workers during the COVID-10 pandemic has been highlighted in multiple publications.⁸ Serious consideration should be given at the local, state, and national levels to the implementation of public health strategies to protect H-2A and other agricultural workers, particularly in light of their essential role in maintaining the US food supply.