CSOEMA Connection (December 2022)

President’s Insights

  By William Wong, MD, MPH, FACP, FACOEM

Greetings CSOEMA Members and Friends!
As the winter season is upon us, we will soon bid farewell to 2022 and ring in the new year 2023. This time of year provides me with many chances to reflect on the monumental events of the last several years. As we close out the third year of the COVID-19 pandemic, we face a severe and early influenza season, causing experts to warn of an impending tripledemic heading our way this winter, due to the trio of viral threats including respiratory syncytial virus (RSV), influenza (flu) and COVID-19.

These events, and other important happenings in occupational and environmental medicine (OEM) are covered in the articles featured in this edition of the CSOEMA Connection. You will find pictures from the 2022 CSOEMA Fall Seminar held in St. Louis this past September. We thank all the participants for attending, and hearty thanks go to all of the marvelous speakers for presenting and sharing their expertise throughout the conference. We thank Fall Seminar Co-Chairs Tom Kibby, MD, MPH, FACOEM; Austin Stapleton, MD, MPH; and Paul Malek, MD, MPH for planning an outstanding event; and special thanks go to Susan Rittenhouse, CSOEMA Executive Director, for all of the hard work in planning and executing the meeting.  

Also in this edition of the CSOEMA Connection, we introduce the 99th Annual 2023 CSOEMA Spring Seminar held in Lisle, Illinois, on March 9-11, 2023. You can attend the seminar in person or virtually on-line. Registration for the Spring Seminar is now open for what will be an outstanding event. Spring Seminar Co-Chairs Francine Katz, DO, MPH; Ambica Nakhasi, MD MPH; Sarah Lovinger, MD; Margaret Hasek, MD, MPH have been hard at work planning the agenda, topics, and speakers for the Seminar. This year, we are hosting a special day-long seminar on Climate Change on Thursday, March 9. Given the extreme weather we experienced around the globe this year, everyone has a stake in the future of the planet. As OEM specialists, we are in a unique position to take leadership in our respective organizations and in the community to address climate change. The Thursday Climate Change Seminar theme appropriately embodies this sentiment: At the Forefront of Climate Change and Health: Occupational & Environmental Medicine. The Spring Seminar continues on Friday and Saturday (March 10-11) with state-of-the-art presentations on occupational and environmental medicine. The theme for the Friday/Saturday Spring Seminar is: Power of the Past, Force of the Future. Both of these themes inspire us and reflect our passion for OEM; they challenge us to strive for excellence in our OEM practice, competency and education. Furthermore, these themes challenge us to advocate for our patients, for workers, and for the environment. 

As we wrap up the final weeks of 2022, let us reflect on the past year by celebrating our joys and achievements, grieving our disappointments and losses, and accepting the changes that have taken place. The new year is a chance to make a fresh start and embrace the new opportunities to work towards fulfilling our dreams for the future. I send best wishes to you and your family during this holiday season! Have a safe and happy New Year. 

Around the States

International

• The Guardian (December 4, 2022) Qatar World Cup chief says ‘death is a part of life’ after reported worker death. Filipino migrant worker reportedly dies at training site. Comments condemned by human rights groups.Human Rights Watch reports on Qatar and FIFA’s Callous Response to a Migrant Worker’s Death and calls for compensation for migrant workers and their families for the abuses. In February 2021, The Guardian reported 6,500 migrant workers have died in Qatar since World Cup awarded. The analysis indicates a shocking figure over the past decade likely to be an underestimate. 

National

• CBS News (December 9, 2022) CDC recommends masks again in New York City, Los Angeles and other communities as COVID cases climb. A growing number of communities are now seeing COVID-19 cases and hospitalizations at levels high enough to warrant indoor masking and other measures to curb the virus, the Centers for Disease Control and Prevention warned Thursday. A number of major cities are now mulling a return to masking measures.
  
• Washington Post (December 4, 2022) COVID hospitalizations rising post-Thanksgiving after an autumn lull. A post-Thanksgiving uptick in covid-19 patients at U.S. hospitals is arriving even as health systems contend with waves of feverish, coughing people stricken with RSV and influenza infections.

• US News and World Report (December 9, 2022) CDC: New Omicron Subvariants Increasing in the U.S.  Studies have suggested that coronavirus subvariants XBB, BQ.1.1 and BQ.1 are particularly good at evading prior immunity from infections and vaccines. Previously, NPR reported New omicron subvariants now dominant in the U.S., raising fears of a winter surge. Two new omicron subvariants have become dominant in the U.S., raising fears they could fuel yet another surge of COVID-19 infections. The subvariants (BQ.1 & BQ.1.1) appear to be among the most adept yet at evading immunity from vaccination and previous infection, and have now overtaken the BA.5 omicron subvariant that has dominated in the U.S. since the summer.

• Kaiser Family Foundation. (November 30, 2022). Why Do Vaccinated People Represent Most COVID-19 Deaths Right Now? The share of COVID-19 deaths among those who are vaccinated has risen. In fall 2021, about 3 in 10 adults dying of COVID-19 were vaccinated or boosted. By April 2022, CDC data show that about 6 in 10 adults dying of COVID-19 were vaccinated or boosted, and that remained true through at least August 2022. What explains the rising share of COVID-19 deaths among vaccinated people? There are several factors at play here, including a rising share of the population that is vaccinated, waning immune protection and low uptake of boosters, and changes in immunity among the unvaccinated. New variants combined with a reduction in masking and other non-pharmaceutical interventions may also lead to more transmission, which can in turn lead to more deaths.
  
• NY Times. (November 18, 2022) Will Covid Boosters Prevent Another Wave? Scientists Aren’t So Sure.  The shots may help vulnerable Americans dodge serious illness or death. But some experts believe boosters must be improved and are calling for a new strategy.
  
• NY Times (Oct. 23, 2022) A ‘Tripledemic’? Flu, R.S.V. and Covid May Collide This Winter, Experts Say.  Flu cases are higher than usual for this time of year and are expected to soar in the coming weeks. Another virus, R.S.V., already is straining pediatric hospitals in some states.
  
• Scientific American (November 17, 2022) Why Did Flu Season Start So Early This Year? Reduced population immunity resulting from COVID precautions, and a phenomenon called viral interference, may have influenced this flu season’s early start.  The Washington Post reports so far, this flu season is more severe than it has been in 13 years. Influenza is hitting the United States unusually early and hard, resulting in the most hospitalizations at this point in the season in more than a decade and underscoring the potential for a perilous winter of respiratory viruses.
  
• BuzzFeed.News (October 27, 2022) Health Risks Linked To Working In The Cannabis Industry Are Largely Unknown, But A 27-Year-Old’s Death Reveals The Potential Dangers.  The death of an employee early this year at a licensed cannabis facility in Massachusetts is calling attention to the very real threat that the job poses to the health of some workers in the relatively new industry. Lorna McMurrey died of occupational asthma after being exposed to ground cannabis, revealing the health risks involved in the industry.The OSHA inspection also revealed that employees in the “flower production” area “were not provided effective information and training on the hazards involved in the cannabis production and grinding process.”

• Valley News Live (November 1, 2022) Dollar General fined nearly $3 million in penalties for OSHA violations. The company has now been fined more than $12.7 million since 2017. Fines continue to build as additional violations are found. In October, Dollar General fines amounted to over $1.6 Million for worker safety violations after visits by federal inspectors to four locations in Alabama, Florida and Georgia, the Department of Labor said earlier this week. According to the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA), the company, along with Dolgencorp LLC — operator of more than 18,000 Dollar General discount stores in 47 states — faces $1,680,216 in proposed penalties after these inspections. Dollar General Was Issued Four Willful, 10 Repeat Violations After Recent Inspection. OSHA proposed penalties of more than $1.6 million, bringing the company’s total proposed penalties since 2017 to over $9.6 million.
  
• NPR (December 1, 2022) Senate passes railroad legislation to prevent a strike. The Senate has approved a measure meant to avert a railroad strike in eight days — without the paid sick days rail workers have been asking for. Advocates have been asking for a paid sick leave policy to be put in the contract for months. The deal negotiated by the Biden administration only included one paid personal day, causing some unions to reject it — creating the threat of a rail worker strike as soon as December 9. Senators passed the bill to force unions to accept a tentative agreement reached earlier this year between railroad managers and their workers and make an imminent strike illegal — without making any changes — by an 80-15 vote. They rejected a measure to offer paid sick leave, 52-43. Both measures required 60 votes to clear the Senate.

• CDC Blogs (September 7, 2022) Highlights from a New Report on Indicators of Workplace Violence. Workplace violence continues to negatively affect workers, organizations, and communities. This report provides a multi-faceted snapshot of the issue and establishes reliable indicators. Regular updating and monitoring of data on the topic remains critical in guiding law enforcement, researchers, policymakers, and occupational safety specialists in understanding the extent, nature, and context of violence in the workplace that will enable them to effectively address this problem. Amid the ever-changing landscape of what work looks like, additional indicators may prove helpful in understanding how workplace violence continues to manifest.

• CDC MMWR (October 21, 2022)  Monkeypox Virus Infection Resulting from an Occupational Needlestick — Florida, 2022 71(42);1348–1349.  In August 2022, the Florida Department of Health notified CDC of a nurse who acquired monkeypox through an occupational exposure while providing care to a patient with monkeypox. To date, occupationally acquired Monkeypox virus (MPXV) infections in health care personnel (HCP) have been rarely reported during the 2022 multinational outbreak. This report describes the first reported U.S. case and recommends approaches for preventing occupationally acquired MPXV infections in HCP.
  
• US DOL (September 29, 2022) U.S. Department Of Labor Urges Midwest Employers To Emphasize Lawn Worker Safety After Lawn Mower Roll-Over Deaths In Nebraska, Missouri. Since fall 2019, 35 workers nationwide suffered fatal injuries in roll-over incidents
  
• Nature (November 1, 2022) Unequal airborne exposure to toxic metals associated with race, ethnicity, and segregation in the USA. populations living in racially segregated communities are exposed to a form of fine particulate matter with over three times higher mass proportions of known toxic and carcinogenic metals. While concentrations of total fine particulate matter are two times higher in racially segregated communities, concentrations of metals from anthropogenic sources are nearly ten times higher. Populations living in racially segregated communities have been disproportionately exposed to these environmental stressors throughout the past decade.
  
• Natural Resources Defense Council (August 17, 2022)  Heat Stress Is Killing Workers. States Can Protect Them. As climate change continues to progress, workers don’t have years to wait for federal rules. So local advocates are helping states create their own. In the absence of federal heat safeguards and as climate change fuels hotter, longer, and more frequent heat waves, the responsibility falls to the states to protect their workers. California started that effort in 2006. Minnesota followed in 2014. Since then, only Washington, Colorado, and now Oregon, have followed suit with their own standards, but a handful of other states are currently drafting their own rules or have introduced heat safety legislation.

Illinois

• UIC Today (September 12, 2022) First federal center focused on farmworker health and safety to open in Chicago. The University of Illinois Chicago will receive $6 million from the National Institute for Occupational Safety and Health to establish the newest Agricultural Safety and Health Center in the U.S. The new center, called the Great Lakes Center for Farmworker Health and Wellbeing, will be housed at the UIC School of Public Health.
  
• The Guardian. (November 26, 2022) It’s a colorless, toxic gas. A US woman won $363m after years of exposure. An Illinois resident won her case against the company Sterigenics – but other sufferers’ lawsuits hang in the balance. A Cook County (Illinois) jury agreed with 70 year old plaintiff Sue Kamuda that ethylene oxide emissions from the Sterigenics Willowbrook plant caused her cancer.  This was the first ethylene oxide personal injury case to go to trial. The ethylene oxide defense verdict causes ripple effects. On November 18, 2022, the second case to go to trial resulted in a defense verdict. The next case scheduled to go to trial is slated to begin in January of 2023.

• NIOSH (June 30, 2022) Paid-On-Call Fire Fighter Becomes Disorientated and Dies Following Stairway Collapse in Two-Story Vacant Structure Fire – Illinois The NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) conducts independent investigations of firefighter line-of-duty deaths and recommends ways to prevent deaths and injuries.

Minnesota

• Minnesota Public Radio News (December 1, 2022) Minnesota nurses set Dec. 11 strike date, plan 3-week walkout. Members of the Minnesota Nurses Association have set a strike date of Dec. 11 if a long-running stalemate in contract talks isn’t resolved. Union nurses walked out for three days in September. This time, they say most nurses will be out three weeks. The strike would affect more than a dozen hospitals in the Twin Cities and Duluth areas, and would run from 7 a.m. Dec. 11 to 7 a.m. Dec. 31 at most of the facilities. Nurses voted “overwhelmingly” on Wednesday to authorize the strike, the union said in a statement. Nurses with the St. Luke’s system in Duluth and Two Harbors, Minn., have chosen to strike with no end date set, the union said.  In September, The Washington Post (September 12, 2022) reported on the Largest private-sector nurses strike in U.S. history begins in Minnesota. About 15,000 nurses in Minnesota walked off the job for three days to demand better pay and more robust staffing they say is desperately needed to improve patient care. The September strike affected 15 different hospitals. 

• Littler News (August 19, 2022): Minnesota Legalizes THC Products, Germinates New Drug-Free Workplace Issues. Minnesota recently became the latest state to legalize some form of marijuana for recreational use. As of July 1, 2022, Minnesotans who are at least 21 years old can lawfully purchase and consume edible and drinkable products containing hemp-derived tetrahydrocannabinols (THC), the primary intoxicant found in cannabis plants. The new law requires Minnesota employers to reevaluate their drug-free workplace policies and procedures and raises questions that the state legislature may need to address in the future.

• Minnesota Public Radio News (November 17, 2022) THC edibles surge in Minnesota but safety rules are loose, regulators aren’t ready. “We have essentially created an adult use market, with no licensing, less stringent testing and high public risk due to lack of compliance & enforcement capacity,” Chris Tholkes, director of medical cannabis at the Minnesota Department of Health, wrote in an internal email on June 15.

Missouri

• Civil Eats (November 15, 2022) ‘I Was Coughing So Hard I Would Throw Up’. Workers at the tens of thousands of hog, chicken, and cow CAFOs in the US face severe respiratory health burdens. The corporate response is risk management.
  

Indiana

• Indianapolis Star – Special Investigation (October 2022). A Death. A Widow Wondering Why. How Indiana sided with businesses over families. At least seven workers died after IOSHA failed to inspect COVID-19 complaints about workplace safety. The Indiana Occupational Health and Safety Administration was flooded with complaints about safety issues during the pandemic, but an IndyStar investigation found the state agency “dedicated to ensuring Hoosier workplace safety and health” repeatedly let down workers who reached out for help. Workers repeatedly alerted the agency to crowded factories, managers pressuring sick employees to work and disregarding safety practices. Workers said employers put profits over people amid pandemic; IOSHA inspected only 44 of more than 6,000 complaints it received – the worst rate in the U.S. 
  IOSHA conducted inspections on less than 1% of the more than 6,000 complaints it received across all industries related to COVID — the worst rate in the U.S., according to IndyStar’s analysis of federal complaint data.  
  
• The Republic (October 28, 2022) Editorial – Indianapolis Business Journal.  During the initial months of the COVID-19 crisis, when those with office jobs started working from home, thousands of Hoosiers deemed essential kept going to work — in hospitals, nursing homes, manufacturing plants, grocery stores and more. In some cases, their employers did everything they could to minimize workers’ risks of contracting the virus. In other cases, they did not. A recent Indianapolis Star investigation raises serious questions not just about whether the Indiana Occupational Safety and Health Administration (IOSHA) did its job, but also whether it was even equipped to try.

Iowa

• Energy News Network (November 22, 2022)Biogas expansion may compound worker risks. Government incentives are driving larger, more crowded concentrated animal feeding operations while protections lag for the workers inside.

Member Spotlight

Zeke McKinney MD, MPH, MHI, FACOEM, CSOEMA Immediate Past President, was recently featured in the Minnesota Spokesman Recorder in an article titled “What happens if I’m hurt at work?” where he explains the workers’ compensation system in the United States and offers tips for patients on how to negotiate the system. In October 2022, Dr McKinney was interviewed on the online talk show, the Bottomless Coffee Show. In this engaging and informative conversation, Dr. McKinney walks us through how employers and employees can engineer their environment and workplace policies to create healthier work environments.

Dr. McKinney and colleagues published the important and timely article, Law Enforcement Violence in the Black Community: A Catalyst for Clinician Engagement in Social Justice  (Vol 62, Issue 1, p122-127) in the American Journal of Preventative Medicine in October 2021. The paper was authored by Marcus D. Rushing, MD, MPH, Andre G. Montoya-Barthelemy, MD, MPH, Fozia A. Abrar, MD, MPH, Eduardo M. Medina, MD, MPH, and Helen A.O. Popoola-Samuel, BS, and Zeke McKinney MD, MPH, MHI, FACOEM. This article addresses law enforcement violence as an urgent public health issue, and serves as a call-to-action for physicians to respond. The article highlights individual, organizational, and community actions to address law enforcement violence and systemic racism. The full text of the article can be found here; to view the article in PDF format, click here. 

Dr. McKinney is triple board-certified in Occupational Medicine, General Preventive Medicine and Public Health, and Clinical Informatics, and he is Program Director of the MN HealthPartners Occupational and Environmental Medicine Residency Program. Additionally, he currently serves as the Chief Medical Editor for Minnesota Medicine, the state’s medical journal. Dr. McKinney practices clinical occupational and environmental medicine in St. Louis Park, MN, and he conducts research through the HealthPartners Institute.  He is currently involved in a COVID-19 vaccine clinical trial. He has published more than 20 peer-reviewed medical articles. His work focuses on health equity and environmental justice for all communities. During the COVID pandemic, he helped to establish a barbershop vaccine clinic in North Minneapolis. Outside of work, he enjoys spending time with his family, playing the ukulele and saxophone, building computers and spending time outdoors swimming and hiking. For his outstanding accomplishments and many talents, he was recognized as a Top Doctor by Minnesota Monthly in 2021. Bravo and congratulations on your great work, Zeke!

Residents Corner

Jaeyeong Heo, MD

PGY-3 Occupational Medicine Resident
Occupational and Environmental Medicine Residency Program
University of Illinois at Chicago
Chicago, Illinois

Hometown:    Seoul, South Korea

Why did you choose Occupational Medicine as a Specialty?:
I chose occupational medicine as I saw the specialty as the best way for me to increase the quality of life of workers by improving their health.

What are your Long-Term Career Goals?:

I aim to develop a more occupational-medicine-friendly EHR system to facilitate easier tracking of occupational exposure and illness history which will help prevent and detect potential work-related health risks.

Charles Childers, MD, DC

PGY-3 Occupational Medicine Resident
Occupational and Environmental Medicine Residency Program
University of Illinois at Chicago
Chicago, Illinois

Hometown:    San Antonio

Why did you choose Occupational Medicine as a Specialty?

I was a Chiropractor for many years in an MD/Chiro/PT clinic that serviced a lot of companies like Halliburton and Slumberger in Laredo, Tx. with DOT exams and drug screenings; thus, occupational medicine was on the radar.

What are your Long-Term Career Goals?

Occupational Medicine, however, exactly what niche will be determined with experience.