Clinical Associate Professor of Medicine; Chief, Division of Occupational Medicine, NYU Langone—Long Island Hospital Clinical Assistant Professor, UC Irvine Schools of Medicine and Public Health; Chief, Occupational Health VA Long Beach Healthcare System Corresponding Author: Manijeh Berenji MD, MPH,1001 Health Sciences Road, Irvine CA 92697-3950, 419-376-3322, [email protected] Funding Sources for ALL Authors: NONE DECLARED Conflict of Interest for ALL Authors: NONE DECLARED Acknowledgments: 1. ALL Sources of Support: NONE2. Specific Author Contributions of every Author listed: Marc Wilkenfeld: contributed content, editingManijeh Berenji: contributed content, editing3. Data AvailabilityYes4. EQUATER Network Reporting GuidelinesNot applicable Ethical Considerations & Disclosure(s) (e.g. IRB Information, consent process, if applicable): NOT APPLICABLE

While many studies have explored the impact of COVID-19 on healthcare workers, there is limited information on the experiences of social workers. This study aimed to examine how social service employees perceived the workplace's pandemic response to identify well-received initiatives and areas for improvement. Data was collected using an anonymous online 21-question survey on REDcap. The forty-participant sample identified as female (57.5%), Asian (85%), and aged 18-34 (55%). Participants worked remote (42.5%), hybrid (40%), or in-person (15%). The organization's pandemic response was perceived positively as effective (40%) or very effective (45%). Factors of pandemic response with the highest efficacy were provision of PPE (55%) and immediacy of efforts (50%). Remote workers had a significantly higher positive assessment of the organization's communication than hybrid or in-person employees (p = 0.0223). Safety was the primary concern among the entire workforce (88.2%). The most frequent source of COVID-19 information was the CDC (35%), and medical professionals (2.5%) were the least. This qualitative study's overall positive evaluation of the pandemic response provides insight into effective measures to prepare organizations for future public health emergencies. Future research investigating an organization's pandemic response can enhance employee well-being and advance quality improvement in pandemic response efforts.

COVID-19 vaccines were developed at unparalleled speed, but racial disparities persist in vaccine uptake. This is a cross-sectional survey that was conducted in mid-2021 in ambulatory clinics across Brooklyn, New York. The objectives of the study were to assess: knowledge of COVID-19, healthcare communication and access, attitudes including trust in the process of vaccine development and mistrust due to racial discrimination, and to determine the relationship of the above to vaccine receipt. 58 respondents self-identified as Black non-Hispanic and completed the survey: the majority were women (79%), <50 years old (65%), employed (66%), and had annual household income <$75,000 (59%). The majority reported having some health insurance (97%) and a regular place of healthcare (95%). 60% of respondents reported COVID-19 vaccination receipt. A significant percentage of the vaccinated group compared to the unvaccinated group scored higher on knowledge questions (91% vs. 65%; p = 0.018), felt it was important that others in the community get vaccinated (89% vs. 65%, p = 0.04), and trusted vaccine safety (86% vs. 35%; p < 0.0001) and effectiveness (88% vs. 48%; p < 0.001). The unvaccinated group reported a lower annual household income of <$75,000 (72% vs. 50%; p = 0.0002) and also differed by employment status (p = 0.04). Majority in both groups agreed that racial discrimination interferes with healthcare (78%). In summary, unvaccinated Black non-Hispanic respondents report significant concerns about vaccine safety and efficacy and have greater mistrust in the vaccine development process. The relationship between racial discrimination, mistrust, and vaccine hesitancy needs further study in order to improve vaccine uptake in this population.

Introduction Since the beginning of the COVID-19 pandemic, the efficacy of various governmental interventions in stemming the spread of SARS-CoV-2 has been the source of much public debate. Through identification of those specific governmental interventions which have been most effective in stemming the spread of SARS-CoV-2, this research has the potential to help guide future governmental responses to the COVID-19 pandemic. Objective To determine the efficacy of various governmental interventions in stemming the spread of SARS-CoV-2. Methods Data pertaining to the number of daily cases of COVID-19 between February or March and August 15th, 2020 were collected from New York, Texas, Florida, Louisiana, California, Italy, and Sweden. We plotted these datasets as epidemiological curves and superimposed various governmental interventions onto them. We also superimposed May 25th onto the domestic curves to reflect mass gatherings following the death of George Floyd and to determine their effect on the spread of SARS-CoV-2. Results In New York, Louisiana, Texas, Florida, and Italy, various governmental interventions appear to have had meaningful impact on the number of daily cases recorded and prevention of future outbreaks. California seemingly did not gain much benefit from these interventions. Sweden, despite no governmental intervention, experienced only a transient surge in daily cases. Conclusions Governmental interventions were largely effective in stemming the spread of SARS-CoV-2. Stay-at-home orders proved efficacious in decreasing daily cases quickly during ongoing outbreaks. Social distancing measures and mask mandates, meanwhile, proved to be effective in preventing subsequent outbreaks, at lesser economic and psychological costs.

Objective: Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings. Methods: Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed. Results: Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health. Conclusions: Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.

Allergic and non-allergic adverse reactions (ARs) to Covid-19 vaccine (Cov19V) have been reported. Understanding the characteristics of Cov19V ARs, particularly those that are allergic in nature, may help us to better counsel patients who are at risk of developing a vaccine AR. We performed a retrospective chart review of ARs voluntarily reported to our Occupational Health Services following Cov19V at a multi-site academic medical center between December 2020-June 2021. 464 Cov19V ARs among 71,281 vaccine doses given (0.65%) were reported. 57 ARs (12.3%) were determined to be allergic (10 after the second dose), 356 were nonallergic, and 51 (11.0%) were undetermined. Of the 47 first-dose allergic ARs, 30 (63.8%) received a second dose, 16 did not complete the vaccine series, and 1 had no data. 3 employees received an alternative Cov19V. Of the 356 nonallergic ARs, 110 were following second dose, 2 were following Janssen, and 4 had no data. 228 of first dose reactions (95.0%, 228/240) completed the vaccine series. 22/57 (38.6%) allergic ARs versus 38/356 (10.7%) nonallergic ARs required ER transfer. More allergic ARs were categorized as moderate/severe (80.7%, 46/57) than nonallergic ARs (66.3%, 236/356). Cov19V ARs are extremely uncommon with nonallergic AR more common than allergic. A vast majority of ARs, allergic or nonallergic, are able to receive subsequent Cov19V. Employees with allergic ARs were less likely to receive a second Cov19V and more frequently required emergent medical evaluation compared to those with nonallergic ARs.

Objective: Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings. Methods: Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed. Results: Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders’ indicated negative effects on mental health. Conclusions: Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.

Climate change is an urgent challenge amplified by socioeconomic factors that demands thoughtful public health responses from OEM professionals. This guidance statement from the American College of Occupational and Environmental Medicine focuses on the different strategies that these health professionals can implement to protect workers from health impacts associated with climate change hazards, foster workplace resilience in the face of rapidly changing environments, and take the necessary steps to mitigate the effects of global climate change.

Objective: To investigate whether paresthesia of the lower extremities following exposure to the World Trade Center (WTC) disaster was associated with signs of neuropathy, metabolic abnormalities, or neurotoxin exposures. Methods: Case-control study comparing WTC-exposed paresthesia cases with “clinic controls” (WTC-exposed subjects without paresthesias), and “community controls” (WTC-unexposed persons). Results: Neurological histories and examination findings were significantly worse in cases than controls. Intraepidermal nerve fiber densities were below normal in 47% of cases and sural to radial sensory nerve amplitude ratios were less than 0.4 in 29.4%. Neurologic abnormalities were uncommon among WTC-unexposed community controls. Metabolic conditions and neurotoxin exposures did not differ among groups. Conclusions: Paresthesias among WTC-exposed individuals were associated with signs of neuropathy, small and large fiber disease. The data support WTC-related exposures as risk factors for neuropathy, and do not support non-WTC etiologies.

OBJECTIVE:Paresthesias can result from metabolic disorders, nerve entrapment following repetitive motions, hyperventilation pursuant to anxiety, or exposure to neurotoxins. We analyzed data from community members exposed to the World Trade Center (WTC) disaster of September 11, 2001, to evaluate whether exposure to the disaster was associated with paresthesias.METHODS:Analysis of data from 3141 patients of the WTC Environmental Health Center.RESULTS:Fifty-six percent of patients reported paresthesias at enrollment 7 to 15 years following the WTC disaster. After controlling for potential confounders, paresthesias were associated with severity of exposure to the WTC dust cloud and working in a job requiring cleaning of WTC dust.CONCLUSIONS:This study suggests that paresthesias were commonly associated with WTC-related exposures or post-WTC cleaning work. Further studies should objectively characterize these paresthesias and seek to identify relevant neurotoxins or paresthesia-inducing activities.

Objective:The aim of this study was to describe the clinical phenotype of a limited group of responders and survivors of the World Trade Center (WTC) disaster who were referred for the evaluation of neuropathic symptoms.Methods:Sixteen patients with WTC exposure were referred to a neurologist for evaluation. All had a neurologic examination. Most had electromyogram and nerve conduction testing/nerve conduction studies as well as appropriate imaging and blood tests.Results:There was a higher probability of a neuropathy diagnosis in WTC-exposed patients than other patients referred for EMG testing. Two WTC-exposed patients had motor neuron disease and not neuropathy.Conclusion:This study provides objective evidence of neuropathy in a relatively high fraction of WTC-exposed patients with neuropathic symptoms. It also emphasizes that the scope of neurologic problems following WTC exposure may include other diagnoses such as motor neuron disease.

Objective: The objective of this research is to determine whether responders and survivors of the World Trade Center (WTC) disaster experience symptoms of neuropathy at a rate higher than those not exposed. Methods: A survey of neuropathic symptoms in patients who were and were not exposed at the WTC based upon the Michigan Neuropathy Screening Instrument (MNSI). Results: Even after correction for medical comorbidities, age, and depression, neuropathic symptoms are much more common in those exposed to WTC dust and increase with increasing exposure. Conclusions: This study provides evidence that exposure to WTC dust is associated with neuropathic symptoms.

Objective: The purpose of this study was to investigate the short-term effects of residual dust from the World Trade Center (WTC) on rat sciatic nerve. Methods: Nerve action potentials were recorded in nerves exposed to dust from the WTC as well as control nerves. Results: There was a reduction in the conduction velocity of nerves exposed to a high concentration of the dust from the WTC when compared with controls. Conclusions: Although there are statistically significant reductions in conduction velocity when exposed to the WTC dust in this pilot study, additional studies both clinical and basic will be needed to further understand the significance of these results.

Wilkenfeld, Marc MD; Crowley, Kathleen A. RPA-C, MPH; Dawodu, Olugbenga MD, MS Author Information