Little is known about occupational SARS-CoV-2 exposures and COVID-19 outcomes. We established a Doctor’s First Reports of Occupational Injury or Illness (DFR)-based surveillance system to study cases of work-related COVID-19 exposures and disease. The surveillance data included demographics, occupation, industry, exposure, and illness, details including hospitalization and lost work. We classified workers into ‘healthcare’, non-healthcare ‘public-facing’, or ‘other’ worker groups, and rural–urban commuting areas (RUCAs). We describe worker exposures and outcomes overall by worker group and RUCA. We analyzed 2848 COVID-19 DFRs representing workers in 22 detailed occupation groups and 19 industry groups. Most DFRs were for workers in metropolitan RUCAs (89%) and those in healthcare (42%) and public-facing (24%) worker groups. While DFRs were from 382 unique worksites, 52% were from four hospitals and one prison. Among 1063 DFRs with a suspected exposure, 73% suspected exposure to a patient or client. Few DFRs indicated hospitalization (3.9%); however, the proportion hospitalized was higher among nonmetropolitan (7.4%) and public-facing (6.7%) workers. While 56% of DFRs indicated some lost work time, the proportion was highest among public-facing (80%) workers. Healthcare and prison workers were the majority of reported occupational COVID-19 exposures and illnesses. The risk of COVID-19 hospitalization and lost work may be highest among nonmetropolitan and public-facing workers.

To assess changes in COVID-19 mortality rate and disparities over variants/waves by industry groups. We used a population-based retrospective cohort study approach. We identified COVID-19 deaths that occurred between January 2020 and May 2022 among the California working population age 18-64 years using death certificates. We used the Current Population Survey to derive estimates for working-age Californians at risk of COVID-19 mortality. The waves in deaths were categorized as Wave 1: March -June 2020, Wave 2: July -November 2020, Wave 3/Epsilon & Alpha variants: December 2020-May 2021, Wave 4/Delta variant: June 2021-January 2022, and Wave 5/Omicron variant: February -May 2022. Poisson regression was used to generate wave-specific mortality rate ratios (MRR). We assessed significance of change in MRR for each industry across waves by including an interaction term between industry and wave in different models. In all waves of the pandemic, Healthcare (MRR_{wave 1}=2.49, 95%CI (1.78 - 3.49)), Other Services (MRR_{wave 4}=2.89, 95%CI (2.39 - 3.50)), Manufacturing (MRR_{wave 2}=2.01, 95%CI (1.59 - 2.53)), Transportation (MRR_{wave 4}=2.64, 95%CI (2.20 - 3.17)), and Retail Trade industries (MRR_{wave 5}=1.87, 95%CI (1.48 - 2.36)) had higher mortality rates than the Professional, Scientific, and Technical industry which had one of the lowest mortality rates. Healthcare industry had the highest relative rate earlier in the pandemic, which diminished over time while Other Services, Utilities and Accommodation and Food Services industries had substantial increases in mortality rate ratios in later waves. Industries that consistently had disproportionate burden of the COVID-19 mortality may have benefitted from protections that consider workers' increased exposure and vulnerability to severe outcomes.