OBJECTIVE: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment. METHODS: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research-relatedness of risks, and evaluating the risk of non-invasive clinical tests in occupational settings. RESULTS: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk evaluation for OSH research involving human participants. CONCLUSIONS: The insights gleaned may help guide Institutional Review Boards and Human Research Protection Programs as they consider the ethical issues of human subjects research in occupational settings.

We appreciate the comments of Chirico and Szarpak1 and their efforts to elucidate several important issues related to antigen testing in the employment setting. We agree that screening testing is one part of a comprehensive approach to reducing transmission in workplaces, which also includes vaccination, risk assessments, contact tracing, physical distancing, and mask use. | | Chirico and Szarpak reiterated the false negative issue in persons with low viral load but confirmed the utility of antigen testing in those with high viral load and no symptoms. They noted that the cost of antigen testing may be an issue in some countries, and this is true. However, in many countries the costs should be within the range of doing business and not constraining. In addition, it is important to consider the potential cost savings and other benefits associated with preventing workplace transmission of SARS-CoV-2. We agree with the point raised that there is more to the costs than the cost of the actual test and emphasize that there is also the need for contact tracing and trained personnel.

OBJECTIVES: To propose a framework for considering SARS-CoV-2 antigen testing of unexposed asymptomatic workers in selected workplaces. METHODS: This is a commentary based on established occupational safety and health principles, published articles, and other pertinent literature, including non-peer-reviewed preprints in medrixiv.org prior to April 16, 2021. RESULTS: Not applicable to this commentary/viewpoint article. CONCLUSION: Antigen testing is a rapidly evolving and useful public health tool that can be used to guide measures to reduce spread of SARS-CoV-2 in the community and in selected workplaces. This commentary provides a proposed framework for occupational safety and health practitioners and employers for considering antigen testing as a method to screen asymptomatic workers in selected non-healthcare settings. When applied selectively, antigen testing can be a useful, effective part of a comprehensive workplace program for COVID-19 prevention and control.

OBJECTIVES: To identify important background information on pooled tested of employees that employers workers, and health authorities should consider. METHODS: This paper is a commentary based on the review by the authors of pertinent literature generally from preprints in medrixiv.org prior to August 2020. RESULTS/CONCLUSIONS: Pooled testing may be particularly useful to employers in communities with low prevalence of COVID-19. It can be used to reduce the number of tests and associated financial costs. For effective and efficient pooled testing employers should consider it as part of a broader, more comprehensive workplace COVID-19 prevention and control program. Pooled testing of asymptomatic employees can prevent transmission of SARS-CoV-2 and help assure employers and customers that employees are not infectious.

Concerns about the purported “skills gap” (a mismatch between the skills workers have and the skills prospective employers want and need) in the United States are widespread. Young people are at the epicenter of debates about the preparedness of the emerging labor force to compete in a dynamic, global economy and are the focus of national efforts to promote skills-based training, apprenticeships, and jobs.1

Evaluation of scientific evidence is critical in developing recommendations to reduce risk. Healthcare was the first scientific field to employ a systematic review approach for synthesizing research findings to support evidence-based decision-making and it is still the largest producer and consumer of systematic reviews. Systematic reviews in the field of occupational safety and health are being conducted, but more widespread use and adoption would strengthen assessments. In 2016, NIOSH asked RAND to develop a framework for applying the traditional systematic review elements to the field of occupational safety and health. This paper describes how essential systematic review elements can be adapted for use in occupational systematic reviews to enhance their scientific quality, objectivity, transparency, reliability, utility, and acceptability.

We read with interest a recent report by D'Andrea and Reddy1 describing differences in hematologic and hepatic blood profiles among a cohort of workers involved in Gulf oil spill cleanup activities relative to an unexposed cohort. They report that cleanup workers had lower average levels of platelets, blood urea nitrogen, and creatinine, and higher levels of hemoglobin, hematocrit, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase. The authors also postulate that “the oil spill exposure appears to play a role in the development of hematologic and hepatic toxicity.” The relation of these findings to exposures associated with cleanup activities cannot be interpreted given the current study design, lack of exposure history, and laboratory analysis. | With regard to the study design, we have concerns about both the validity and generalizability of the results. Blood chemistries from workers participating in cleanup activities along the coast of Louisiana for 3 months or longer are compared to a cohort of randomly selected patients visiting a clinic for a wellness checkup, located 100 miles away from the Gulf coast of Louisiana. Additional selection and exclusion criteria, such as employment history, demographic and lifestyle characteristics, and medical history are not included. This recruitment design provides little assurance that the 2 groups come from the same base population or that cleanup workers chosen for this study are representative of the broader group of cleanup workers. The use of a well-characterized control group, such as workers with similar demographic, lifestyle, and medical characteristics, without exposure to cleanup activities, or an appropriately matched external referent group of subjects selected from the National Health and Nutrition Examination Survey cohort would have been preferable.2