We evaluated COVID-19-related practices and its impact on 92 Hispanic agricultural workers in Central Florida and found major health and work risk factors were common among these workers. Workers took personal preventive precautions seriously, but workplace preventions were uncommon. This is congruent with reports of disproportionately greater impact of COVID-19 among Hispanics , and news media reports of large outbreaks among agricultural workers in Florida [20,21,22].
Obesity (body mass index (BMI) ≥ 30), elevated blood pressure, and prediabetes are risk factors for contracting COVID-19 and are associated with severe COVID-19 illness and mortality [23,24,25,26]. Sixty-nine percent of our participants had at least one of those risk factors, and 37% had multiple risk factors. This suggests that if agricultural workers do contract COVID-19, they might be more likely to experience adverse outcomes than the general population.
Despite the many infection risks faced by agricultural workers, only 11% reported getting COVID-19 testing, and one participant tested positive. One confirmed case among 92 similar adults is much lower than expected in a vulnerable, unprotected workforce. For comparison, in Florida in June 2020, the highest daily positive rate for COVID-19 was 17% . Although participants reported symptoms that occur with COVID-19 infection, the main reason for not getting a COVID-19 nasal test was not having COVID-19 symptoms. Anecdotally, participants considered the symptoms they experienced to be related to other factors. For instance, fatigue and body aches were attributed to the number of hours worked, and stuffy nose and sore throat to seasonal allergies. Thus, the number of workers who had COVID-19 is likely to be higher than 1 out of 92 because of lack of testing as well as asymptomatic infection.
Although the participants overwhelmingly reported individual practices of COVID-19 preventive measures such as using a face mask and social distancing, there was a lack of employer-based COVID-19 safety measures implemented at the workplaces. Only a third of the participants reported that their employer provided face masks, and an even a lower percentage reported having their temperature checked at the start of the work shift. All of the workers in our study were settled agricultural workers who lived in independent housing, often with family members. A growing proportion of the agricultural worker population in the U.S., however, are entering the country on H-2A visas. These workers, primarily young males, live in communal housing provided by their employers with shared sleeping environments, baths, and kitchens [13, 28]. A recent article discussed the COVID-19 hazards associated with agricultural worker housing along with the inability to change the regulations in recognition of the pandemic . Alarmingly, neither the agricultural industry nor the federal government have established a protection standard for occupational exposure to COVID-19 for essential workers, such as those in agriculture [6, 8, 9]. More than half of the workers in this study perceived no risk or low risk of COVID-19 exposure at the workplace; this perception may be attributed in part to the lack of enforced workplace protective measures by both the industry and government occupational agencies, such as the occupational safety and health administration (OSHA), CDC, and the United States Department of Agriculture (USDA). The practices needed to reduce infection risk among agricultural workers have been detailed, including the need for widespread testing of this population .
The labor markets have been disrupted by the COVID-19-pandemic, leading to massive lay-offs, furloughs, and decreases in work hours, to the point that the United States government on March 27, 2020 passed the CARES Act to support families with relief funds. Despite categorization of agricultural workers as “essential workers,” 75% of participants reported losing work (furlough or reduced work hours) since the start of the pandemic, and only 18% were eligible for CARES Act relief funds. About the same number of workers reported receiving employer-based relief funds.
Sixty percent of participants reported a willingness to get the COVID-19 vaccine, a quarter were unsure, and 15% were unwilling. COVID-19 vaccination in our cohort (53%) was lower than in Florida’s overall population (59%) but higher than Florida’s overall Hispanic population (33%) . In contrast, during the 2009 H1N1 pandemic, a random sample drawn from the Knowledge Networks assessed the public willingness to take the H1N1 vaccine and found that 17% of Hispanics reported “yes,” 47% “no,” and 36% “don’t know” . The uptake of the H1N1 vaccine was lowest in foreign-born Hispanics (15%) living in the U.S. compared to U.S. born Hispanics (18%) and White non-Hispanics (21%) . The higher vaccine uptake in our cohort may be due to the devastating socio-economic impact (lockdowns, school becoming virtual, jobs lost, etc.) that COVID-19 has had and the disproportionately higher COVID-19 cases, hospitalizations, and deaths among Hispanics [3,4,5]. However, the relatively low vaccination rate among our farmworkers is concerning, especially considering the rising COVID-19 variant cases  and the sharp decline in COVID-19 vaccination rates nationwide since mid-April 2021 . In addition, a study using death records from the California Department of Public Health found that food/agriculture workers had a 39% mortality increase (risk ratio RR = 1.39; 95% CI 1.32–1.48) relative to the pre-pandemic period .
Concern about side effects was the primary reason for not getting the COVID-19 vaccine. COVID-19 vaccines may produce side effects such as tiredness, muscle pain, fever, and headaches which can affect daily activities for a few days . This could interfere with agricultural workers’ ability to perform the physically demanding tasks that their occupation requires. Additionally, most agricultural workers have low wages and no paid sick leave or paid vacation ; thus, agricultural workers may be avoiding the risk of taking leave to recover from the vaccine. Exposure to misinformation may also be distorting perceptions of post-vaccine side effects. The second most common reason for not getting the COVID-19 vaccine was mistrust in the vaccine. While mistrust may be due to the novelty of COVID-19 and its treatments and the rapidity of vaccine development, it could also suggest that the politicization of the COVID-19 outbreak response and vaccine development is contributing to a mistrust of public health information in this vulnerable population .
Limitations of this study include that it was a convenience sample of Florida agricultural workers that may not be generalizable to the wider Florida or U.S. population of agricultural workers. Additionally, all data were self-reported and dependent on the participants’ honesty and memory. While the COVID-19 questionnaire was developed with our community partner, the FWAF, to ensure it was culturally appropriate and applicable to the agricultural population, it has not been validated. Despite these limitations, our findings provide valuable information about the health and work risk factors for COVID-19 in agricultural workers.