Workplace safety has been an important focus of the COVID-19 pandemic response worldwide. Essential workers, particularly those who cannot work from home and those who are precariously employed (e.g., temporary, contract or agency workers), (1) are at increased risk for acquiring SARS-CoV-2. Workplaces have been associated frequently with outbreaks of COVID-19 and household transmission of SARS-CoV-2. (2,3) Policies related to disclosing outbreaks at places of work are both contentious and misunderstood. Should workplace-related outbreaks of COVID-19 be publicly disclosed and, if so, why? We discuss the ethical and public health considerations related to the public identification of workplaces in outbreak.
The Public Health Agency of Canada's Public Health Ethics Consultative Group identified 3 primary public health goals for publicly disclosing surveillance information: helping the public understand COVID-19-related risk to make informed decisions, showing transparency, and building trust by showing that surveillance and response activities are conducted with due diligence. (4) Public health authorities are further guided by certain ethical principles, which include respect for persons and communities, beneficience, nonmaleficience, justice, trust, transparency, accountability and responsibility. (5,6)
The principles of beneficience and respect for persons and communities dictate that public health authorities should disclose sufficient information about outbreaks for people to make informed decisions about the risks that they are willing to accept, and to subsequently take steps to protect their health. However, the desire for information does not equate a right to access surveillance information, as the rights of people and communities to privacy and freedom from discrimination must also be considered. (4)
Furthermore, the principle of nonmaleficience or "First, do no harm," suggests that public health authorities should actively attempt to mitigate the potential risks and harms associated with workplace-related outbreaks. As such, general public health practice dictates that outbreaks are disclosed only if a public health investigation finds an increased risk to the public from the workplace outbreak, beyond background risk in the community, or if close contacts of workplace-related cases cannot be reached without disclosure. (7,8) Where the public is not at risk--for example, where a workplace with an outbreak does not permit public access--public health agencies typically do not issue a broad disclosure naming the workplace. (7,8)
In response to calls for increased transparency, arising out of a broader media debate around the availability and detail of data, several health departments have now created more specific criteria for identifying workplace-related outbreaks with public health importance. (1) Toronto Public Health announced an approach to name workplaces that have outbreaks of...