Clinical and Economic Impact of COVID-19 on Agricultural Workers, Guatemala1

Abstract

We evaluated clinical and socioeconomic burdens of respiratory disease in banana farm workers in Guatemala. We offered all eligible workers enrollment during June 15-December 30, 2020, and annually, then tracked them for influenza-like illnesses (ILI) through self-reporting to study nurses, sentinel surveillance at health posts, and absenteeism. Workers who had ILI submitted nasopharyngeal swab specimens for testing for influenza virus, respiratory syncytial virus, and SARS-CoV-2, then completed surveys at days 0, 7, and 28. Through October 10, 2021, a total of 1,833 workers reported 169 ILIs (12.0 cases/100 person-years), and 43 (25.4%) were laboratory-confirmed infections with SARS-CoV-2 (3.1 cases/100 person-years). Workers who had SARS-CoV-2‒positive ILIs reported more frequent anosmia, dysgeusia, difficulty concentrating, and irritability and worse clinical and well-being severity scores than workers who had test result‒negative ILIs. Workers who had positive results also had greater absenteeism and lost income. These results support prioritization of farm workers in Guatemala for COVID-19 vaccination.

Keywords: COVID-19; Guatemala; SARS-CoV-2; agricultural workers; clinical impact; cohort; coronavirus disease; coronaviruses; economic impact; influenza virus; productivity; respiratory illness impact; respiratory infections; respiratory syncytial virus; severe acute respiratory syndrome coronavirus 2; severity; viruses; zoonoses.

Figure 1

Flow diagram showing cohort of agricultural workers enrolled in the Agricultural Workers and Respiratory Illness Impact Study, southwestern Guatemala, June 2020‒October 2021, and followed through October 10, 2021. Ineligible and nonconsenting workers were able to provide multiple reasons for not participating. Only workers who completed the day 0 (diagnosis) visit were called on day 7 and day 28. Follow-up visits scheduled for after October 10, 2021, were considered missing.

Figure 2

Study region (area 2,600 km²) for the Agricultural Workers and Respiratory Illness Impact Study, Guatemala, June 15, 2020‒October 10, 2021, showing number of enrolled agricultural workers living in each municipality. A total of 1,819 persons had reported data. Inset map shows location of study area in Guatemala.

Figure 3

Cumulative influenza-like infections (ILI) among agricultural workers in the Agricultural Workers and Respiratory Illness Impact Study, Guatemala, June 15, 2020‒October 10, 2021. During June 2020–October 2021, ILI was defined as cough and fever. During January 2021, the ILI case definition was expanded to cough or fever or shortness of breath. Includes all-cause ILI (yellow), SARS-CoV-2‒positive ILI (blue), SARS-CoV-22‒negative‒ILI (orange), and ILI without testing obtained (gray).

Figure 4

FluiiQ severity scores for agricultural workers in the Agricultural Workers and Respiratory Illness Impact Study, Guatemala, June 15, 2020‒October 10, 2021. Scores (range 0–3), by subdomain, are shown for workers who had SARS-CoV-2‒positive influenza-like illness (ILI), SARS-CoV-2‒negative ILI, and asymptomatic controls. Higher score indicates greater clinical severity (A, B) or greater negative impact on well-being (C, D, E). A) Systemic score; B) respiratory score; C) impact on daily activities; D) impact on emotions; E) impact on others. Significant differences (p<0.05) are identified within each group. Blue indicates SARS-CoV-2‒positive ILI, orange indicates SARS-CoV-2‒negative ILI, and gray indicates asymptomatic control subjects. Error bars indicate means and SDs.

Figure 5

Differences in expenditures between SARS-CoV-2‒positive and SARS-CoV2‒negative agricultural workers who had influenza-like illness (ILI) in the Agricultural Workers and Respiratory Illness Impact Study, Guatemala, June 15, 2020‒October 10, 2021. Workers who had SARS-CoV-2‒positive ILI (dark blue circle) reported greater lost income and combined expenditures related to their illnesses in the week after their illness than SARS-CoV-2‒negative workers who had ILI (orange circle).