Clinical and Economic Impact of COVID-19 on Plantation Workers: Preliminary Results from the Guatemala Agricultural Workers and Respiratory Illness Impact (AGRI) Study

  1. Daniel Olson
  2. Diva M. Calvimontes
  3. Molly M. Lamb
  4. Gerber Guzman
  5. Edgar Barrios
  6. Andrea Chacon
  7. Neudy Rojop
  8. Kareen Arias
  9. Melissa Gomez
  10. Guillermo Antonio Bolanos
  11. Jose Monzon
  12. Anna N. Chard
  13. Chelsea Iwamoto
  14. Lindsey M. Duca
  15. Nga Vuong
  16. Melissa Fineman
  17. Kelsey Lesteberg
  18. David Beckham
  19. Mario L. Santiago
  20. Kendra Quicke
  21. Gregory Ebel
  22. Emily Zielinski Gutierrez
  23. Eduardo Azziz-Baumgartner
  24. Frederick G. Hayden
  25. Hani Mansour
  26. Kathryn Edwards
  27. Lee S. Newman
  28. Edwin J. Asturias

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Abstract

We evaluated the clinical and socioeconomic burdens of respiratory disease in a cohort of Guatemalan banana plantation workers. All eligible workers were offered enrollment from June 15–December 30, 2020, and annually, then followed for influenza-like illnesses (ILI) through: 1) self-reporting to study nurses, 2) sentinel surveillance at health posts, and 3) absenteeism. Workers with ILI submitted nasopharyngeal swabs for influenza, RSV, and SARS-CoV-2 testing, then completed surveys at days 0, 7, and 28. Through October 10, 2021, 1,833 workers developed 169 ILIs (12.0/100 person-years) and 43 (25.4%) of these ILIs were laboratory-confirmed SARS-CoV-2 (3.1/100 person-years). Workers with SARS-CoV-2-positive ILI reported more anosmia (p<0.01), dysgeusia (p<0.01), difficulty concentrating (p=0.01), and irritability (p=0.01), and greater clinical and well-being severity scores (Flu-iiQ) than test-negative ILIs; they also had greater absenteeism (p<0.01) and lost income (median US$127.1, p<0.01). These results support the prioritization of Guatemalan farm workers for COVID-19 vaccination.

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    SciScore for 10.1101/2022.02.07.22270274: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Following written informed consent, study nurses collected contact information as well as demographic, occupational, socioeconomic, and clinical data, including risk factors for severe COVID-19.
    Field Sample Permit: Study nurses also collected a nasopharyngeal (NP) swab, which was placed in viral transport media and tested within 24 hours of specimen collection for SARS-CoV-2 using the Q COVID rapid antigen test (Q-NCOV-01G, SD Biosensor®, Republic of Korea) (24).
    IRB: Ethical Oversight: The study was approved by the Colorado Multiple Institutional Review Board (COMIRB protocol #19-1836) and the Guatemala Ministry of Health National Ethics Committee (HRMC-560-2020).
    Sex as a biological variablePrevious surveys (2015, 2017-18) found a predominantly young, male, and economically vulnerable workforce, in which the farmworkers are typically the sole income earners for their households and report high rates of food insecurity, similar to other agribusiness workers in the region and migrant worker populations in the U.S. (16, 17).
    Randomization” Each week, a sub-cohort of 15 enrolled workers without ILI in the preceding 28 days were selected at random (∼5% of the cohort per month) and considered “controls.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    anti-SARS-CoV-2 nucleocapsid IgG (Roche Elecsys® immunoassay), and in some cases, anti-SARS-CoV-2 neutralizing antibodies (Beckham/Santiago Laboratories, University of Colorado, Aurora, CO, USA).
    anti-SARS-CoV-2 nucleocapsid IgG
    suggested: None
    anti-SARS-CoV-2 neutralizing antibodies
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The AGRI study design has some inherent strengths and limitations. Though the study includes weekly visits to worksites to identify symptomatic ILI cases, it still requires some level of self-reporting to study personnel, and therefore may underestimate incidence. Workers with laboratory-confirmed SARS-CoV-2 are required to isolate and may be incentivized to under-report illness to avoid lost wages, thus providing a bias towards lower incidence and more severe cases of disease being reported. Required isolation likely increases duration of absenteeism in workers who are SARS-CoV-2-positive, though it still reflects the consequences of COVID-19 in this population. Self-reported study outcomes are also subject to recall bias, which we aimed to minimize by including controls with similar follow-up. Laboratory test results are provided to the worker when available, and thus self-reported outcomes may be impacted by diagnostic bias. We did not perform pathogen testing on controls. We relied on an antigen test for detection of SARS-CoV-2 infection and an ELISA assay for anti-nucleocapsid IgG, which may have decreased performance compared to PCR and virus neutralization assays, respectively; future studies will compare these approaches. Future studies will also include company-reported data, which will provide a more objective assessment of wages, allowing us to compare self- and company-reported metrics. Finally, to decrease the risk of healthy worker bias (42), the study collects ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.02.07.22270274 on medRxiv