covid-19 hazards among california fast-food workers

Physicians for Social Responsibility: Fast-Food COVID-19 Report 1

COVID-19 HAZARDS AMONG CALIFORNIA FAST-FOOD WORKERS

April 19, 2021

Rajiv Bhatia, MD, MPH, Veterans Affairs Physician & Clinical Professor (Affiliated), Stanford University School of Medicine

Martha Dina Argüello, Executive Director, Physicians for Social Responsibility — Los Angeles

Physicians for Social Responsibility: Fast-Food COVID-19 Report Physicians for Social Responsibility: Fast-Food COVID-19 Report2

ABSTRACT

At the beginning of the COVID-19 pandemic, government officials designated certain classes

of work to be “essential” – that is, critical to social functioning. However, doing so created

a new class of occupational hazard that was particularly perilous for workers lacking access

to customary health and safety protections. Frontline workers, who are more likely to hail

from the demographic sectors bearing the brunt of the COVID-19 pandemic, have faced close,

frequent and/or prolonged indoor contact with others – the precise risk factor for COVID-19

infection motivating lockdown orders. Sadly, throughout the entire pandemic, essential work

continued without the necessary assurances of public health safety. In an industry like fast

food, a low-wage industry plagued with a history of labor abuses and longstanding structural

barriers to equity, self-interested managerial behavior and inadequate regulatory oversight

compounded these risks. In this study, observations of workplace conditions and COVID-19

infection by workers suggest that workplace transmission among fast-food restaurant workers

has been a potentially significant, ongoing contributor to the COVID-19 pandemic as well as

to disparities in COVID-19 disease burdens. Over a five-month period in mid-2020, 69 workers

at 35 fast-food establishments in seven California counties filed 55 complaints with local

public health and occupational safety agencies citing hazards pertaining to occupational

transmission of COVID-19. In the absence of systematic public health investigations for this

occupational sector, these complaints provide a rare lens for understanding COVID-19 impacts

on workers who lack comprehensive occupational protections. Based on worker observations

reported in the aforementioned complaints, most of the establishments cited (31 of 35;

89%) were noncompliant with five or more of 16 defined elements of public health guidance

for preventing workplace transmission.1 On average, workers reported nine elements of

noncompliance, with reports of 10 or more elements at 18 establishments. Within their

complaints, workers identified 124 confirmed and suspected cases of COVID-19 infection,

suggesting a minimum cumulative workplace attack rate of 8.9% (range 0% to 33%). In 24

of the establishments, workers documented outbreaks of two or more cases within a 21-day

period, suggesting a minimum average secondary infection risk of 17%. In two instances,

clusters of infection involved two or more fast-food establishments related by the same

employees or employees who shared households.

INTRODUCTION

I am writing this complaint because I am living in fear every day that I go to work. I

have a family of five, my three kids and my mother, who is 82 and has health problems.

Already I need to care for her because she cannot walk due to an injury. My kids are

28, 21 and 17. My oldest lost his job recently, so I am the only one providing for all five

of us. If I got COVID, it would be a disaster for my family. It would be hard to keep my

mother from catching it because I care for her so closely and she is very high risk if she

gets it.

— Worker, McDonald’s, Complaint filed with Los Angeles County Public Health

Department, May 26, 2020


Governmental actions to mitigate the COVID-19 pandemic have involved trade-offs between

preventing infection and maintaining social functioning. The principal strategy of U.S. public

health agencies to control COVID-19 has relied, variously, on discouraging, restricting and

prohibiting opportunities for close contact among individuals who do not share households.

Yet many jobs considered essential require a physical presence at the job site, and a subset of

these involve close, frequent and/or prolonged public or co-worker contact, often in settings

where distancing is not possible.2 By distinguishing essential from nonessential work,

government mitigation policies accepted the fact that individuals working in some industries

and occupations, along with their families and households, would experience higher-than-

average infection and disease risks.3

Despite the evident risks, to date, neither U.S. federal nor state public health agencies have

systematically evaluated the risk of COVID-19 infection or disease across groups of non-

health care essential, frontline workers. More importantly, while public health agencies

have promulgated precautionary guidance for workers and employers, the actual safety of

essential work has never been established scientifically. Differences in occupational risk may

be the primary drivers of observed disparities in rates of infection and mortality both by race/

ethnicity and neighborhood of residence.

Workers in chain fast-food restaurants represent a class with particular vulnerabilities to

workplace COVID-19 transmission. In fast-food settings, employers have optimized work tasks

for efficiency, and work environments provide little opportunity for physical distancing. Low

levels of economic and job security, high frequencies of wage and other labor violations,

and limited control over work tasks and schedules all practically limit the power of workers

to ensure their own safety. A franchise business structure, in which the responsibility for

compliance falls to individual franchisees, limits corporate liability, reducing the likelihood of

cohesive, effective policies for worker protection, as well as the resources for implementing

them. These vulnerabilities persist for workers despite the existence of governmental

regulatory programs that routinely monitor establishments to prevent infectious disease

among restaurant customers.

In this study, we describe workplace hazards for COVID-19 infection at 35 fast-food

establishments in seven California counties, utilizing worker testimony from a convenience

sample of occupational health and safety complaints filed with local health departments and

the California Department of Industrial Relations Division of Occupational Safety and Health

(Cal/OSHA). Based on knowledge of confirmed and suspected cases volunteered by workers,

we estimate the lower-bound (e.g., minimum) cumulative attack rates and secondary infection

risks for workplace transmission. While we recognize potential biases both from the lack of

systematic case ascertainment, which would lead to an underestimation of cases, and from

worker observations, which may mis-identify suspected cases, overall we consider these

estimates to be conservative. In addition, we describe two instances of possible outbreak

chains of transmission involving multiple fast-food establishments.


METHODS

Between March and September 2020, Fight for $15, a labor organization for fast-food workers,

aided California fast-food workers in filing 55 unique COVID-19 health and safety complaints

with local departments of public health and Cal/OSHA. Specifically, researchers working

on behalf of Fight for $15 interviewed 69 individuals using semi-structured questionnaires

to assess workplace hazards, then collaborated with these individuals to structure the

information gathered by the interviews into formal complaints and file them. The selection of

individuals interviewed stemmed from accounts of incidents or suspected incidents conveyed

by word of mouth to Fight for $15 organizers, and was not random.

The questionnaires, which were translated for monolingual Spanish speakers, included

questions to assess adherence to safety measures for preventing workplace transmission,

including: the use of and access to personal protective equipment; hand washing; physical

distancing; cleaning and disinfecting; screening employees for COVID-19 symptoms and

sending home workers with COVID-19 symptoms; closing an establishment to clean and

disinfect it; notifying and isolating those who came in close contact with a known or suspected

case; and encouraging sick or exposed workers to stay home, with quarantine pay or paid sick

leave as required. Interviewers focused on the areas of greatest concern to workers and did

not assess all issues in the questionnaire in each interview.

Interviewers also recorded worker-volunteered knowledge of COVID-19 cases at the workplace

and in households. Worker-identified cases included (1) laboratory-confirmed infections of

interviewed individuals or their household members, (2) laboratory-confirmed infections

reported by co-workers and (3) laboratory-confirmed infections reported by management.

Additionally, workers identified suspected cases – where they or a household member had

symptoms consistent with COVID-19 or they or a co-worker observed co-workers on the job

who were visibly sick with symptoms consistent with COVID-19.

While systematic case ascertainment among all workers did not occur, we used available

worker-identified cases to estimate a lower-bound cumulative workplace attack rate as the

average count of confirmed and suspected infections at each store during the study period

divided by an estimated count of employees. We further estimated a lower bound of the

secondary infection risk (SIR) as the average of the sum of secondary cases during a 21-day

period at each establishment with two or more cases divided by the estimated number of

workplace contacts of the primary case.

Estimates of the number of employees in an establishment combined worker estimates

and publicly available information. We estimated the typical employee’s number of usual

workplace contacts based on worker information about tasks and schedules and the physical

layout of establishments. We chose a 21-day (versus 14-day) follow-up period to ascertain

infections in contacts to account for lags in diagnosis and sharing information.


RESULTS

Information collected and recorded in worker-filed complaints indicated frequent

noncompliance with public health guidance to reduce the spread of COVID-19 at most

establishments (Table 1). Based on worker allegations reported in complaints, most

establishments (31 of 35; 89%) were noncompliant with five or more of 16 defined elements of

public health guidance for preventing workplace transmission. On average, workers reported

nine elements of noncompliance, with reports of 10 or more elements at 18 establishments.

Alleged noncompliance related to physical workspaces, essential work tasks and standardized

work practices. Noncompliance also involved the lack of training, resources, oversight and

enforcement in areas of preventive guidance. Worker testimony indicated that compliance

varied within the same establishment as a function of the intensity of work demands.

Table 1. Number and Percentage of establishments with worker-alleged noncompliance with

COVID-19 workplace transmission prevention guidance, by requirement.

Requirement Worker Assessment of Non-Compliance

Select Testimony from Filed Complaints

PPE: Masks and Gloves

Employer does not provide adequate face coverings for employees.

54% “In the beginning, managers provided masks made out of doggie diapers or coffee filters. After workers complained, they provided disposable masks but said we needed to use them for multiple days, until they stopped working or fell apart.”

Employer does not ensure proper use of face coverings by workers.

60% “Management does not enforce mask wearing by employees. Approximately half of the co-workers wear the mask correctly all day. Some people wear it correctly about half the time, and the rest of the time they take it off or put in on the chin. Some co-workers wear the mask when they are talking to customers but not when they are away from the customers, even if they are working closely with co-workers.”

Employer does not ensure proper use of face coverings by customers.

40% “I said to my manager, ‘I have a family to protect, I can’t get sick. I have to do my part.’ And I asked her, ‘Why do we give the customer service if they don’t wear a mask?’ And she said, ‘We aren’t going to lose a customer by making those comments.’”

Employer does not provide adequate gloves for employees.

49% “McDonald’s regularly runs out of the correct types and sizes of gloves. McDonald’s regularly runs out of medium and large size gloves, and often McDonald’s provides the wrong types of gloves and gloves of very low quality that break easily. If the gloves are too big, they allow for contamination because they are loose and slip on and off. Also, if they are too big, you can burn yourself because it makes it hard to hold on to the coffee cups. If the gloves are too small, they tear easily. Sometimes McDonald’s provides the type of gloves that are very big and loose that slip off your hands, and we can’t work with them.”


Frequent Cleaning of High-Touch Surfaces

Employer does not ensure frequent cleaning (between users and shifts) of high-touch surfaces.

83% “The store has not changed its cleaning protocols since the pandemic began, and there is no system or training in place for how to clean safely. The lunchroom where we eat is small and dirty, they don’t disinfect it. … They don’t disinfect the area where we clock in and out either. [The worker], who cleans the lobby, got her hours reduced and now she only comes in two or three times per week, so the rest of the days, the lobby isn’t cleaned. … The bathroom is cleaned maybe twice a day. Other areas in the store, such as door handles, are not cleaned regularly.”

Hand Hygiene

Employer does not ensure that workers wash hands frequently (every 30 minutes).

60% “Many co-workers only wash hands once per day, only briefly and without soap.”

Employer does not provide hand sanitizer.

49% “McDonald’s does not provide masks, we have to bring our own masks. McDonald’s often runs out of gloves, for example, sometimes there are only medium-sized gloves, which do not work if you need small or large. McDonald’s also runs out of sanitizers, products to clean the grill, cleaning tablets for the drink machines, disinfectants and hand sanitizer. They even run out of basic supplies for serving customers, like fry boxes and cups.”

Physical Distancing

Employer does not ensure that physical distance is maintained.

91% “In the kitchen where I work, we are usually only about two to three feet apart while we are working. The kitchen is very small. I am a cook and I usually work three or four shifts a week. … This means I am spending many hours each week working very close to people who do not wear masks properly. … The break room is very small, and three or four workers sit right next to each other around a small table without masks, one or two feet apart, like a normal day, like how regular work should be without a global pandemic.”

Prescreening for High Temperature

Employer does not screen all workers for high temperatures before shifts, excluding those with high temperatures.

57% “Also at the June 3 meeting, the managers said that if we are sick we should not come to work. But the managers DO have people work when they are sick. Around May 5th, a floor manager, took my temperature and it came out high, and she told me, ‘No way are you going home,’ and then she took it again and again and it kept coming out high, until the 4th time it came out low, and she told me to go to work.”


If Someone Is Sick

Exclusion of Sick Workers

Employer does not exclude from the workplace workers with high temperatures and/or obvious COVID-19 symptoms.

71%* “On Monday, May 18, I felt sick at work, I had a headache, my legs and feet ached and I felt very hot. I told my manager that I felt sick and I wanted to go home, and that wearing the mask made me feel worse because it was too hard to breathe. He said, ‘There is no one to cover for you, just pull the mask down,’ so I did, and I continued to work sick. The next day, I only felt a mild headache, so I took Advil and went back to work.” [This worker was diagnosed with COVID-19.]

Closing Immediately to Clean and Sanitize

When there is a COVID-19 case, employer does not close store immediately for cleaning and disinfecting.

86%* “[A co-worker] notified the store on Friday, April 3 that she tested positive. The store did not tell us that day and we kept working. … Between Saturday, April 4, and today, April 10, this single Domino’s location has had four confirmed positive cases of COVID-19 among us workers, and instead of closing the store temporarily and allowing exposed workers to quarantine for 14 days with pay, in keeping with [the Los Angeles County Department of Public Health] order from March 25, Domino’s has stayed open without even providing protective equipment to workers or disinfecting the store.”

Notification and Quarantining of Close Contacts

When there is a COVID-19 case, employer does not notify and quarantine all close contacts.

86%* “[A co-worker] and I worked very closely together at the drive-through, even though we tried to stay apart. … Around June 29, the manager, told us there was another COVID-19 case, and I believe it was [that co-worker]. I asked the manager: ‘Was I exposed to this person? Were my co-workers exposed?’ But the manager did not answer, she walked away to attend to someone else. I have never been told by management that I had close contact with anyone with COVID-19 exposure. [That co-worker] worked so closely with us, now everyone is scared, we don’t know who is next.” [The co-worker was diagnosed with COVID-19.]


Use of Sick Leave and Sick Pay

Employer does not provide sick and quarantine pay per regulations.

54% “A co-worker of ours was sick at work on Saturday April 4th. [She] was very sick that day. She had a fever, she was coughing, and she had symptoms of the flu. Please understand, we do not blame [her] for coming in sick. Her husband had already been laid off, her father was sick, she has seven young children at home and our employer has a history of not paying sick leave. Since she left sick on 4/4 [she] has not been paid at all. … The failure to pay sick leave is contributing to the public health risk at our McDonald’s so I want to give you another example. I myself was sick March 8 with sore throat. I would ordinarily have worked, but the doctor told me stay home for a week because of the public health threat of COVID-19. McDonald’s did not pay me when I was out.”

Employer does not ensure that workers are aware of sick leave and sick pay policies, per regulations.

57% “Three people in my house tested positive, but still I went to work one more day because I needed the money and my employer did not ever say we would get paid leave if we were exposed. Even after I told them I tested positive, they did not offer paid leave.”

Retaliation

Employees face retaliation for asking for or using paid sick or quarantine leave.

31% “I was very scared, and I didn’t want to take the test because I was worried that I would have to stop working and that I wouldn’t get paid, and I have to support myself and my family. Management never told us that we needed to quarantine, or that we would get paid during quarantine. I was afraid that if I didn’t go in to work, I would be retaliated against, and my hours would get cut. That week at work my stomach hurt and I was very worried that I would get sick. I went to take the COVID-19 test at 10am on June 2, and then I went to work for my regular shift, from 2pm until 9pm. I found out that I had tested positive for COVID-19 on June 4.”

Employees face retaliation for raising safety issues.

23% “We urge the Los Angeles Department of Public Health to take immediate action to protect workers who speak out about COVID-19 at work from retaliation. Both of us, along with two other co-workers, were fired after filing complaints to the Los Angeles Department of Public Health about COVID-19 cases and safety at the McDonald’s at 1716 Marengo Street in Los Angeles, and speaking up about COVID-19 safety at work.”

Source: Complaints filed with public health departments in Alameda, Contra Costa, Los Angeles, Sacramento, San Bernardino, San Francisco and Santa Clara counties and CalOSHA, April 6, 2020 – September 23, 2020.

*Of stores where workers identified one or more COVID-19 cases.


In our sample, workers identified 124 workplace COVID-19 cases (82 laboratory-confirmed

and 42 suspected) at 28 of the 35 establishments with filed complaints; 25.7% (nine of 35)

establishments had one or two COVID-19 cases, 25.7% (nine of 35) had three to five cases

and 28.6% (10 of 35) had six to 12 cases. Assuming a combined workforce of 1,386 (13 to 78

per store), we estimated a lower-bound-period cumulative workplace attack rate at the 35

establishments of 8.9% (range 3% to 33%).

At 22 establishments, workers identified clusters of two or more cases within a consecutive

21-day period (mean 4.2 cases; range 2 to 10). Assuming that the first identified case was

the source of secondary workplace cases, we estimated a lower-bound workplace secondary

infection risk of 17% (range 3% to 42%).

We identified two instances where outbreaks in distinct establishments appear to be related

to a common chain of transmission involving either shared infected workers or workers from

shared households. Many workers noted that they or their co-workers commonly worked part-

time at two or more establishments, were members of households with multiple fast-food

workers and were occasionally reassigned to cover sick workers’ shifts at a franchise’s related

establishments with COVID-19 outbreaks. In one instance, for example, an outbreak at a

McDonald’s franchise at 4514 Telegraph Avenue in Oakland, occurring May 8–27 and involving

10 workplace cases, appeared connected to an outbreak at a McDonald’s at 1998 Shattuck

Avenue in Berkeley involving 12 workplace cases. Three workers who reported testing positive

for COVID-19 worked at both establishments. Additionally, these two outbreaks may have

been related to an outbreak at a McDonald’s at 14480 San Pablo Avenue in San Pablo involving

six workplace cases. One worker from the Telegraph establishment, whose infection status

was unknown, continued to work at the San Pablo McDonald’s during the outbreak period

after the Telegraph McDonald’s was closed.

In a second instance, an outbreak at a McDonald’s franchise at 1716 Marengo Street in

Los Angeles involving five workplace cases, occurring June 16–July 4, may have been

associated with workplace COVID-19 exposure at four other franchises that share the same

owner. Several workers at the 1716 Marengo site reported living in households with infected

members who also worked at McDonald’s franchises, albeit different ones. Further, workers

describing the outbreak at 1716 Marengo reported that management moved workers among

establishments to clean and to staff operations during outbreaks.


Figure 1. Workplace and household spread of COVID-19 reported by workers: McDonald’s restaurants,

Telegraph Ave, Oakland and Shattuck Ave, Berkeley


Figure 2. Workplace and household spread of COVID-19 reported by workers: McDonald’s restaurant on

Marengo Street, Los Angeles


DISCUSSION

This report has several important limitations. First, we rely on worker-volunteered information

from a convenience sample of workers publicly filing workplace health and safety complaints.

Workers and their establishments are represented based on their direct and indirect

relationships to labor organizers and their willingness to report their perspectives publicly.

Organizers communicated with additional workers who affirmed COVID-19 safety lapses but

were unwilling to participate in interviews or pursue complaints.

Because interviewers focused their questions on the particular concerns of workers, we

did not assess compliance in all domains of guidance for all establishments. Workers’

assessments of noncompliance reported in complaints, while credible, are unverified. Results

of related government complaint investigations have not yet generally become publicly

available.

In contrast to a more systematic outbreak investigation, assessment of case data from

complaints is insufficient to fully assess COVID-19 infection among all workers in the

establishments. Workers’ knowledge of infections is likely to be incomplete, particularly

with regard to co-workers who did not report symptoms or take absence from work. Only a

minority of the workers at the establishments volunteered information. Alleged management

practices discouraging reporting of COVID-19 symptoms and leave-taking for illness or

quarantine may further contribute to underreporting. We were aware of no establishment

that screened or tested all workers in the course of a worker-identified outbreak. Still, worker-

identified cases are a reasonable basis for lower-bound estimates of infection prevalence and

transmission risk.

Despite the several limitations, this report illustrates that workplace COVID-19 outbreaks

in fast-food restaurants and their extension through workers’ households and secondary

employment settings may be significant contributors to the COVID-19 pandemic. There

are 550,000 fast-food employees in California, representing 38% of the state’s food service

and drinking places sector.4 In Los Angeles County alone, 166,000 employees work at

approximately 7,500 fast-food establishments and serve 2.6 million customers daily.5 In a

vulnerable population where there has been limited regulatory oversight or enforcement, the

methods utilized in this report provide one pathway for assessing hazards during an ongoing

public health crisis.

Many governmental actions aimed to protect workers in essential, frontline roles. The federal

Families First Coronavirus Response Act, which expired on December 31, 2020, required

employers with 50 to 500 employees to offer two weeks of paid sick leave to employees

infected with COVID-19 or requiring quarantine, with similar legislation to cover employers

with more than 500 employees at state and local levels in California. The U.S. Centers for

Disease Control and Prevention, the U.S. Food and Drug Administration and the California

Department of Public Health issued and periodically updated guidance for preventing

COVID-19 in non-health care workplaces and specifically for restaurants.6 In November 2020,


California’s Department of Industrial Relations issued emergency temporary standards for

COVID-19 prevention in workplaces.7

However, as illustrated by worker testimony, the “real-world” protections offered by

unenforced or unenforceable occupational health and safety guidance may be limited. While

work that provides paid sick leave is associated with taking leave and seeking medical care

when ill, both employee and work characteristics influence access to leave, regardless of legal

mandates. Workers with lower wages, less job security and fewer alternative employment

options face barriers to utilizing leave.8 Similarly, effective occupational safety regulations

require an expectation and culture of valuing workplace safety. Insecure workers may be

reluctant to initiate complaints, and regulatory compliance often follows, rather than prevents,

injury or illness. The efficacy or adequacy of public health guidance is not established.

While many studies have predicted higher infection risks for frontline, essential workers, little

epidemiology has examined occupational data systematically. One large prospective study

conducted in the United Kingdom found that, relative to nonessential workers, essential

workers had significantly higher risks of severe COVID-19 disease.9 Similar studies in the

United States have not been reported. One U.S. study reported excess death during the

COVID-19 pandemic by occupation.10

Undermining the possibility of high-quality occupational epidemiology, U.S. public health

agencies have, thus far, neglected to systematically collect and report the occupation, industry

and workplace data necessary to scientifically monitor and manage occupational COVID-19

risks. Surveillance case reports include data elements for occupation and industry; however,

thus far, only one state, Washington, has published COVID-19 case rates by occupation and

industry, but incomplete collection of occupational data limits the validity of the state’s

estimates.11 Other states have not reported any data on COVID-19 infection or disease by

occupation or industry. Enumeration of workplace infection based on occupational injury

and illness reporting also appears unreliable. According to California’s OSHA data, in Los

Angeles County, only 220 of the more than 1 million confirmed cases of COVID-19 occurred

due to workplace transmission.12 The failure to monitor infection and disease burdens by

occupation and industry creates a blindness to occupationally related health disparities and

their contributions to the COVID-19 pandemic.

Published reports on workplace COVID-19 outbreaks have called attention to wholesale food

processing and other industrial settings. Relative to other essential, frontline work, workplace

transmission hazards for fast-food restaurant establishments appear to have particularly low

visibility.

Because of the demographics of employment in essential, frontline work, workplace outbreaks

have a disproportionate impact on low-income communities of color.13 In the United States,

Hispanic/Latino persons have experienced a disproportionate burden of COVID-19. Nationally,

compared to white non-Hispanics, Hispanic/Latino persons are 1.3 times more likely to have a

confirmed case of COVID-19, 3.2 times more likely to be hospitalized with the disease and 2.3


times more likely to die from it.14 In California, Latinos comprise about 40% of the population

but 55% of the COVID-19 cases and 46% of the COVID-19 deaths.15 Some research also looks at

within-household transmission risk for Hispanic/Latino households compared to white non-

Hispanic households (SIR 63% versus 51%).16 Eighty-four percent of Los Angeles fast-food

employees are people of color, and a majority are Latino (Latino 62%, white 16%, Black 4%).17

Hazards during an emerging infectious disease epidemic for fast-food and other essential,

frontline workers call for several actions. First, public health agencies must systematically

collect data on occupation, industry and business location for all essential workers. This

will support timely identification and control of workplace outbreaks.18 Workers in fast-food

settings should be among occupation groups prioritized for enhanced screening and contact

tracing. Public health and occupational safety agencies should use monitoring data to

demonstrate the sufficiency of workplace COVID-19 infection prevention rules under real-world

conditions.

To further transparency, OSHA and its state-level counterparts should report complaints

by workplace in real time, along with, ultimately, findings from investigations and actions.

Corporate parents that franchise chain fast-food restaurants should share liability for

occupational hazards with franchisees. Corporations have the capacity and resources to

develop and oversee standardized systems for worker safety in the same fashion used to

ensure quality and standardized food products.

Public health departments, which have a day-to-day presence in food establishments to

ensure food safety for consumers, should monitor businesses to ensure their operations are

in compliance with workplace safety laws. In California, local agencies have the authority to

revoke and suspend restaurant permits for noncompliance with local, state and federal law.19

Workers must have the tools and capacities to protect their health and realize their rights.

Because many fast-food workers are economically insecure and live with other essential

workers or vulnerable populations, access to medical isolation housing at the onset of

symptoms, along with immediate income support, could enhance compliance with isolation

requirements and limit subsequent workplace and household spread of COVID-19. In the long

term, fundamental changes in the legal responsibility of employers or the culture of low-wage

employment may be required before workers are able to utilize sick leave when sick or speak

up without fear when practices are unsafe.


SUPPLEMENTARY MATERIALS

COVID-19 HEALTH AND SAFETY INTERVIEW QUESTIONS

About You

• Name, address, email (if an email user).

• Where do you work? How long have you worked there? How long have you worked in

fast food? What job do you work? What is your typical shift and schedule? Do you hold

a second job?

• Do you have vulnerable household members? Who depends on your income? Do

household members work with vulnerable populations?

• What are you concerned about?

COVID-19 Prevention Practices

• PPE: Does management provide masks and gloves? Does management enforce proper

mask wearing by workers and customers (drive-through and lobby)?

• Is there frequent (between users and shifts) cleaning of high-touch surfaces (restrooms,

headsets, utensils, knobs, touchscreens, etc.)? Are there adequate cleaning and

sanitizing supplies?

• Hand hygiene: Does management enforce regular, frequent hand washing (every 30

minutes), even when the restaurant is busy? Do workers and customers have access to

hand sanitizer?

• Does management enforce physical distancing, even when the restaurant is busy?

• Is there a COVID-19 safety plan? Have you received training to prevent the spread

of COVID-19 (through hand washing, wearing masks and gloves, distancing and

cleaning)?

• Is there COVID-19 screening (for fever, exposure or symptoms)? Are workers sent home

if they fail the screening?

Cases, Outbreaks, Notification and Quarantine, Close Contacts, Quarantine Pay

• Have there been COVID-19 cases at work? When? Were they confirmed or suspected?

Were there cases among workers’ household members (confirmed or suspected)? How

do you know? What did management say and do in response?

• How many cases were there? What shifts and positions did infected workers hold? Who

worked closely with them recently?

• Does anyone at work have COVID-19 symptoms right now? How do you feel?

• What happens when a worker is sick at work? Can they go home? Are they called back

for their next shift?

• If and when has the store been closed for cleaning and disinfecting?

• Was anyone notified as a close contact and quarantined? Who? How long was the

quarantine? Were workers provided quarantine pay, as required?


Sick Pay, Retaliation

• Are workers encouraged to quarantine when sick? Are workers informed of sick pay and

extended sick leave policies?

• Can workers call in sick, take sick days and ask for sick pay without retaliation (threats or actual

cutting of days or hours off shift) and without having to find someone to cover their shifts?

Does the employer pay sick pay properly and in a timely way (including before the COVID-19

pandemic)? Examples?

• Can workers speak up about safety without fear of retaliation? Examples?

Potential for Spread of COVID-19 Among Stores

• Do you or co-workers have second jobs in fast food (who and where)?

• Do your household members work in fast food (who and where)?

• Are workers moved among stores within the franchise group for staffing and cleaning during

outbreaks?


Endnotes1 See Table 1 for a full list of the 16 elements. Generally, they fall into the following categories: per-

sonal protection equipment, cleaning and hygiene, physical distancing, screening for and response to COVID-19 infection, sick leave/pay and retaliation.

2 M. G. Baker, T. K. Peckham and N. S. Seixas, “Estimating the Burden of United States Workers Exposed to Infection or Disease: A Key Factor in Containing Risk of COVID-19 Infection,” PLoS One 15, no. 4 (April 28, 2020): e0232452, doi: 10.1371/journal.pone.0232452; M. G. Baker, “Nonrelocatable Occupations at Increased Risk During Pandemics: United States, 2018,” American Journal of Public Health 110, no. 8 (August 2020): 1126–32, doi: 10.2105/AJPH.2020.305738.

3 D. Michaels and G. R. Wagner, “Occupational Safety and Health Administration (OSHA) and Worker Safety During the COVID-19 Pandemic,” JAMA 324, no. 14 (October 13, 2020): 1389–90, doi: 10.1001/jama.2020.16343.

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About the Authors

Rajiv Bhatia, MD, MPH

Dr. Bhatia is a physician practicing internal medicine at the Veterans Affairs Palo Alto Health

Care System and a Clinical Assistant Professor (Affiliated) at the Stanford University School

of Medicine. From 1998 through 2014, he served as Deputy Health Officer for the City of San

Francisco, where he pioneered work on health impact assessment (HIA), community health

indicators, and open civic data. Dr. Bhatia founded the Civic Engine to advise civil society

organizations, businesses, and governments on innovations to address the community and

economic roots of health.

Martha Dina Argüello

Martha Dina Argüello is the Executive Director of Physicians for Social Responsibility – Los

Angeles, joining in 1998 to launched environmental health programs. She is a board member

of Californians for Pesticide Reform, the California Environmental Rights Alliance, and

Californians for a Healthy and Green Economy. She also co-founded the Los Angeles County

Asthma Coalition and the Coalition for Environmental Health and Justice, and was appointed

to Cal/EPA’s Environmental Justice Committee and the California Air Resources Board’s

Global Warming Environmental Justice Advisory Committee.