UCLA

As the COVID-19 pandemic continues into a third year, estimates of the proportion of Americans that have been infected at least once range from 42-60%, and an estimated 6% of U.S. adults are currently experiencing the effects of long COVID. The pandemic has uniquely stressed workers in many sectors considered essential, from healthcare workers and first responders to farm workers, retail workers, and manufacturers. This dissertation aims to understand whether and how the impacts of COVID-19 are associated with occupation in the context of Los Angeles (LA) County, California. After an introduction to COVID-19 and its impacts on population mental health and on essential workers, Chapter 2 presents an ecologic analysis using data from the U.S. Census American Community Survey and the LA County Department of Public Health. This analysis examines if LA County communities with a higher share of their workforces in specific occupations (healthcare, first response, education, or food service) were more or less impacted throughout the COVID-19 pandemic. A higher proportion of a community’s workforce employed in healthcare or education was associated with lower COVID-19 impact, while a higher proportion of a community’s workforce in first response or food service was associated with higher COVID-19 impact.

Chapters 3 and 4 use data from a longitudinal cohort study of COVID-19 infection risk in LA-based healthcare workers and first responders to conduct longitudinal analyses on risk factors associated with infection risk and mental health outcomes between May 2020-Sept 2021. Nurses had higher odds of anxiety and of trauma response compared to physicians. Moderate and high levels of hospital bed occupancy were associated with higher odds of low resilience compared to a low level of bed occupancy, but were not associated with anxiety level or trauma response. Infection risk, vaccination rate, and mental health outcomes differed between healthcare workers and first responders. Time since study baseline was associated with most mental health outcomes across models, but the relationship is nuanced. Finally, Chapter 5 discusses the public health implications of the research, including potential polices and interventions that may better protect the physical and mental health of workers across the economy.