Fifteen months into the pandemic, the Occupational Safety and Health Administration has issued a mandatory workplace safety rule aimed at protecting workers from COVID-19. But it only applies to health care settings, a setback for unions and worker safety advocates who had called for much broader requirements.

Called an emergency temporary standard, the rule takes effect as soon as it's published in the Federal Register and can remain in place for up to six months, during which a permanent rule could be considered.

The new rule mandates that employers develop and implement a COVID-19 plan and take steps to reduce the chance of transmission, including keeping people at least 6 feet apart indoors, installing barriers between workstations where distancing is not possible, ensuring ventilation systems are working properly, and providing and ensuring each employee wears a face mask when indoors, or a respirator and other personal protective equipment when exposed to people with suspected or confirmed cases of COVID-19.

For unvaccinated workers, employers are now required to provide paid time off to get vaccinated and to recover from any side effects from the shots.

Some of the languages in the rule are vague and appear open to interpretation. For example, fully vaccinated workers are exempt from the requirements when they are in well-defined areas where there is "no reasonable expectation" they will be exposed to the virus.

The rule covers more than 10 million workers

Jim Frederick, OSHA's acting administrator, estimates there are 10.3 million people working in places that will have to comply with the requirements, including hospitals, nursing homes, and assisted living facilities. The rule also covers emergency responders and home health care workers. Not included are people who work in other medical settings such as medical or dental offices.

The United Food and Commercial Workers union, which represents 1.3 million workers, is among a number of groups decrying the rule's narrow scope."Following an extensive review of the science and data, OSHA determined that a healthcare-specific requirement will make the biggest impact," Labor Secretary Marty Walsh said on a call with reporters. Acknowledging the months that have gone by since the Labor Department first considered issuing this rule, he added, "We know it's been a long time coming."

"Today's new COVID workplace safety standard from OSHA represents a broken promise to the millions of American workers in grocery stores and meatpacking plants who have gotten sick and died on the frontlines of this pandemic," UFCW International President Marc Perrone said in a statement. "Vaccinations are helping us take control of this pandemic, but the danger for these essential workers is far from over."

It's the first time in the pandemic that OSHA has imposed any requirements about COVID-19 workplace safety on employers. Until now, OSHA had only issued recommendations for measures employers could voluntarily take to keep workers safe. During the campaign, President Biden criticized the Trump administration for not doing more.Previous COVID-19 standards were voluntary

The bar for issuing an emergency temporary standard is high. OSHA must determine that workers are in "grave danger" due to exposure to toxic substances or new hazards and that an emergency rule is necessary for their protection, according to OSHA's website.

At a hearing, Wednesday of the House Committee on Education and Labor, Walsh, the labor secretary, faced questions about whether a grave danger still exists for American workers.

Business groups say rules are an unnecessary burden pressed by Republican Rep. Tim Walberg of Michigan, Walsh said he was not a scientist and could not answer the question fully. But he added, "I like the signs of where we're headed with COVID-19. I love the fact that our numbers are going down. However, people are still dying, and people are still getting infected."

For months, the business community has argued that an emergency temporary standard could no longer be justified and would be a burden to businesses recovering from the pandemic. The CDC's May 13 guidance that fully vaccinated people no longer needed masks indoors became a talking point.

"A lot of employers are pushing their employees to get vaccinated. Clearly, a lot of workplaces have high levels of people being vaccinated. That really undermines any argument OSHA would have for claiming grave danger," said Marc Freedman, vice president of employment policy at the U.S. Chamber of Commerce, after that guidance was issued.

"Across the country, people have taken off their masks. They're not social distancing. Employers aren't cranking up the ventilation anymore," former OSHA Administrator David Michaels said in May. "That's a terrible mistake. There are so many unvaccinated people who are at risk for this deadly virus."Meanwhile, worker safety advocates pointed to the change in mask guidance and the dropping of state and local mask ordinances as key reasons OSHA still needed to act.

Michaels, now a professor at the George Washington University School of Public Health, said that the new rule is better than no rule, but that if exposure to the virus is not controlled in high-risk industries such as meat processing, corrections, and retail establishments, those industries will continue to drive infections as more infectious variants take over and large numbers of people remain unvaccinated.

Being out of work isn’t just bad for your finances. It’s bad for your health. Most people are aware of the effect of losing a job on mental health: depression, anxiety, social isolation. But job loss can hurt a person’s physical health as well.

Research consistently shows that losing a job and being unemployed — even for just a few months — is associated with reduced overall health and a higher risk of physical ailments, including cardiovascular disease, hospitalization, and death. And the risk can remain higher for years to come, sometimes decades after people have returned to work.

In the first six months of Covid-19, 25 percent of US adults said they or someone in their household lost their job due to the pandemic. Among those who said they lost a job, half reported they were still unemployed six months later. As researchers who study the health effects of job loss and unemployment, we are concerned that the next wave of health problems linked to Covid will not come directly from Covid itself, or the strain it places on health systems — but from its effect on the labor market. 

It’s not hard to see why job loss, followed by a period of unemployment, can be bad for your health. The initial months following a job loss can be incredibly disruptive, straining people’s finances and psychology and limiting their social interactions, which reduces social support. Along with losing a job, some people may lose their health insurance, and therefore forgo seeking medical attention when illness arises. Some may turn to alcohol or drugseat poorly and exercise less, and research has linked unemployment to bad sleep patterns.

But even if someone receives unemployment benefits or gets another job relatively quickly, the risks don’t always go away; some research shows even a few months of unemployment may be associated with worse long-term health and well-being.

Some of the data on which we base these concerning predictions come from other economic recessions and downturns, such as the Great Recession (2007-09), but we expect that there could be even worse outcomes in the wake of Covid-19. The peak unemployment rate during the Great Recession was 10 percent, while the peak unemployment rate in 2020 was almost 15 percent. Economic recovery is more precarious when pandemic restrictions are still in place, and some business operations have changed permanently, making it harder for some laid-off workers to regain their old jobs.

Moreover, many of those who developed serious Covid-19 symptoms are experiencing slow recoveries and may not work at the same capacity for some time. Other adults may need to take on new caregiving responsibilities because kin has remained ill or died, leaving behind others who need care. These consequences are unevenly spread, with job losses and deaths greater in racial and ethnic minority communities.

Already, preliminary analyses are emerging about the potential health effects of Covid-related unemployment, particularly among vulnerable populations. In a recent paper that has not yet been peer-reviewed, researchers estimate that residents of New Zealand may collectively lose 36,900 years of healthy life due to a rise in cardiovascular disease following pandemic-related job loss; among the nation's more vulnerable Indigenous Māori population, the rate of lost years was nearly four times higher than among non-Māoris.

What can be done?

It is critical that policymakers support the health and well-being of displaced workers and their families, particularly those most susceptible to health decline. Although the US has some threads of a social safety net — such as up to 26 weeks of unemployment benefits in most states, plus additional help in the pandemic — that wasn’t enough to prevent a huge increase in food insecurity and use of food pantries during Covid. We need to provide a more robust response to people who are out of work, including continued health insurance coverage, to help buffer the economic toll of job loss, and thereby mitigate some of its health consequences.

Some research shows even a few months of unemployment may be associated with worse long-term health and well-being.

This support is particularly crucial for the people who have been hit hardest by Covid-19 — such as racial and ethnic minorities — who also face longstanding structural inequities in living and working conditions that affect their job prospects and may shape their financial recovery. 

However, given the potential long-term impact of job loss, the best way to protect workers’ health is to incentivize companies to not lay off workers — and, if layoffs are inevitable, incentivize them to rehire laid-off workers as soon as possible. In California, for instance, when jobs become available, companies in hard-hit industries such as hotel and event management must rehire people who were laid off during the pandemic. Policymakers should continue to direct resources toward employers to help them keep businesses going and workers employed.

To address all the health consequences of the pandemic, we must think broadly about interventions and policies. We must recognize the wide scope of job losses across households and industries, not just in workplaces making media headlines, and the unequal burden felt by workers already disadvantaged before Covid. The real solution lies in not just getting back to work, but getting Americans into secure jobs that pay a living wage and allow economic recovery alongside the healing of people and health care systems.