Estimated Association of Construction Work With Risks of COVID-19 Infection and Hospitalization in Texas | Infectious Diseases | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Characterizing the Austin Construction Worker Population
    Joseph Struzeski, BS | University of Florida
    In this recent article that I read with great interest, Pasco et al. developed a COVID-19 transmission model that factored in age and risk structures and the estimated number of construction workers in the Austin metropolitan area [1]. While there is precedent for the attributes applied to the population of construction workers, it is possible that population sizes and age categorizations are inappropriate for the population in question.

    Pasco et al. estimated the number of construction workers in the Austin metropolitan area to be 50,000 using data from the Austin Chamber of Commerce [2]. The Austin Chamber of Commerce
    reports employment numbers by occupation and also by industry, and the reported workforce size for construction and extraction occupations is reported as 63,343 in 2018 while the workforce size for the construction, natural resources, and mining industry is reported as 69,000 in 2019. Using either value, it is not clear where the estimate of 50,000 originated from and if that number should be interpreted as relatively exact or a rough approximation.

    The authors also state that the estimated number of Austin construction workers does not account for undocumented workers. This may present a significant number of overlooked individuals in the Austin construction workforce, as a 2013 report by the Workers Defense Project found that 50% of surveyed construction workers in Texas were undocumented [3]. If 50% of construction workers in Austin in 2020 are undocumented, the study in question may have used a substantial underestimation of the number of construction workers in Austin.

    Finally, the model used by Pasco et al. assumes that construction all construction workers are aged 18-49. While one may assume that construction workers tend to be younger, 2019 data from the United States Bureau of Labor Statistics lists the median age of construction workers as 42.6 years [4]. Furthermore, 43.7% of construction workers were over the age of 45 and 22.1% were over the age of 55. While construction workers are not likely to be elderly, this example provides another discrepancy between the parameters used in the transmission model and reality.

    While the study by Pasco et al. brings valuable insight into a dynamic pandemic situation, some parameters utilized in the transmission model may not have been entirely appropriate and further characterization of at-risk populations may be necessary to provide a more accurate picture of the effects of construction work in the context of COVID-19.

    1. Pasco RF, Fox SJ, Johnston SC, Pignone M, Meyers LA. Estimated Association of Construction Work With Risks of COVID-19 Infection and Hospitalization in Texas. JAMA Network Open. 2020;3(10):e2026373-e2026373.
    2. Austin Chamber of Commerce. Workforce overview. Accessed Nov 2, 2020.
    3. Workers Defense Project. A Case for Comprehensive Immigration Reform. 2013.
    4. Labor Force Statistics from the Current Population Survey. Accessed Nov 2, 2020.
    Original Investigation
    Public Health
    October 29, 2020

    Estimated Association of Construction Work With Risks of COVID-19 Infection and Hospitalization in Texas

    Author Affiliations
    • 1Department of Integrative Biology, The University of Texas at Austin
    • 2Dell Medical School, The University of Texas at Austin
    • 3Santa Fe Institute, Santa Fe, New Mexico
    JAMA Netw Open. 2020;3(10):e2026373. doi:10.1001/jamanetworkopen.2020.26373
    Key Points

    Question  Is construction work associated with increased community transmission of coronavirus disease 2019 (COVID-19) and disproportionate morbidity among construction workers in US cities?

    Findings  This decision analytical model of COVID-19 found that resuming construction work during shelter-in-place orders was associated with increased hospitalization risks in the construction workforce and increase transmission in the surrounding community. Based on COVID-19 hospitalization data through August 20, 2020, construction workers had a nearly 5-fold increased risk of hospitalization in central Texas compared with other occupational categories.

    Meaning  The findings of this study suggest that enacting workplace safety policies and providing paid sick leave could protect essential workers in high-contact industries and prevent further widening of disparities in COVID-19 morbidity and mortality.


    Importance  Policy makers have relaxed restrictions for certain nonessential industries, including construction, jeopardizing the effectiveness of social distancing measures and putting already at-risk populations at greater risk of coronavirus disease 2019 (COVID-19) infection. In Texas, Latinx populations are overly represented among construction workers, and thus have elevated rates of exposure that are compounded by prevalent high-risk comorbidities and lack of access to health care.

    Objective  To assess the association between construction work during the COVID-19 pandemic and hospitalization rates for construction workers and the surrounding community.

    Design, Setting, and Participants  This decision analytical model used a mathematical model of COVID-19 transmission, stratified by age and risk group, with construction workers modeled explicitly. The model was based on residents of the Austin–Round Rock metropolitan statistical area, with a population of 2.17 million. Based on 500 stochastic simulations for each of 15 scenarios that varied the size of the construction workforce and level of worksite transmission risk, the association between continued construction work and hospitalizations was estimated and then compared with anonymized line-list hospitalization data from central Texas through August 20, 2020.

    Exposures  Social distancing interventions, size of construction workforce, and level of disease transmission at construction worksites.

    Main Outcomes and Measures  For each scenario, the total number of COVID-19 hospitalizations and the relative risk of hospitalization among construction workers was projected and then compared with relative risks estimated from reported hospitalization data.

    Results  Allowing unrestricted construction work was associated with an increase of COVID-19 hospitalization rates through mid-August 2020 from 0.38 per 1000 residents to 1.5 per 1000 residents and from 0.22 per 1000 construction workers to 9.3 per 1000 construction workers. This increased risk was estimated to be offset by safety measures (such as thorough cleaning of equipment between uses, wearing of protective equipment, limits on the number of workers at a worksite, and increased health surveillance) that were associated with a 50% decrease in transmission. The observed relative risk of hospitalization among construction workers compared with other occupational categories among adults aged 18 to 64 years was 4.9 (95% CI, 3.8-6.2).

    Conclusions and Relevance  The findings of this study suggest that unrestricted work in high-contact industries, such as construction, is associated with a higher level of community transmission, increased risks to at-risk workers, and larger health disparities among members of racial and ethnic minority groups.