April 4, 2020 Mr. Christopher Gaddis Director of Human Resources JBS USA 1770 Promontory Circle Greeley, CO 80634 Christopher.gaddis@jbssa.com Dear Mr. Gaddis: This letter is a follow-up to our conversation on April 2, 2020. Background • • • • • On March 5, 2020, the Colorado Department of Public Health and Environment’s (CDPHE) public health laboratory confirmed the first presumptive positive COVID-19 test result in Colorado. On March 11, 2020, Governor Polis issued Executive Order D 2020 003 declaring a state of disaster emergency due to the presence of coronavirus disease 2019 (COVID-19) in Colorado. On March 13, 2020, the Weld County Department of Public Health and Environment received the first positive COVID-19 test result in a Weld County resident. On March 16, 2020, acting under the authority granted to me as the Health Officer for Weld County, I issued a Pandemic Health Emergency and Public Health Order calling for the cancelling of all events of 10 or more people and requiring the enactment of social distancing. Social distancing was defined as people staying at least 6 feet away from each other. On March 25, 2020, Governor Polis issued Executive Order D 2020 017 ordering Coloradans to stay at home due to the presence of COVID-19 in the state. o Section II.B. directed all Coloradans to stay at home, subject to limited exceptions such as obtaining food and other household necessities, going to and from work at critical businesses, seeking medical care, caring for dependents or pets, or caring for a vulnerable person in another location. o Section II.D. directed the Executive Director of the Colorado Department of Public Health & Environment (CDPHE) to issue a public health order consistent with the following directives in his Executive Order. Section II.D.1. Recognized certain individuals must continue to work outside their residences to provide goods and services critical to the State’s response to the COVID-19 epidemic emergency. • • Section II.D.1.b. Recognized certain critical businesses would be exempt from this Executive Order, provided they comply with social distancing requirements. Section II.1.c. Called for the public health order to determine the steps all critical businesses must take to comply with social distancing requirements. On March 26, 2020 the Weld County Department of Public Health & Environment received the first report of a positive test for COVID-19 in a JBS employee. On April 1, 2020, CPDHE Executive Director Jill Hunsaker-Ryan issued the Third Updated Public Health Order 20-24 Implementing Stay at Home Requirements. Section II.A ordered Critical Businesses to comply with Social Distancing Requirements at all times, adopt work from home or tele-work policies for any operations that can be done remotely, and implement other strategies, such as staggered schedules or re-designing workplaces, to create more distance between workers unless doing so would make it impossible to carry out critical functions. Community Prevention and Education Measures Taken by Weld County The Weld County Department of Public Health and Environment (WCDPHE), as part of Weld County Government, began providing information and guidance to the community including specific outreach to specific businesses in March when COVID-19 was first confirmed in Colorado. Our website has been updated daily with prevention guidance including washing one’s hands; covering a cough/sneeze; avoiding touching one’s face, eyes or mouth; cleaning commonly touched surfaces frequently, and staying home if sick. My department has communicated with Occupational Health and Human Resources staff at the JBS plant in Greeley; we specifically shared educational materials to assist employees from different cultures and who speak different languages to better understand and practice social (physical) distancing. My team of epidemiologists and disease investigators responded on 3/26/20 to the first positive COVID-19 test in a JBS employee and has since responded on a daily basis to increasing numbers of positive cases at JBS. My teams of epidemiologists immediately contacted employees and worked with supervisors, as necessary, to gather information to determine isolation and quarantine measures to be implemented immediately by workers, their contacts, and families. I’ve held four virtual townhalls since March 12th giving updates on the status of COVID-19 in Weld County and answering questions from agency staff. On April 2, 2020, you and I had a telephone conversation at my request to discuss COVID-19 positive cases in JBS employees working at the plant in Greeley and review the measures taken by JBS USA to prevent the spread of the disease consistent with the orders referenced above. In that conversation, I shared information arising from my public health investigation of COVID-19 in employees of JBS. This included findings from health care providers and systems in Greeley related to the significant increase in the number of JBS employees and dependents being evaluated in their facilities, the severity of illness and level of care many were requiring, and concerns expressed to them about the work environment and culture at the plant from patients under their care. These concerns expressed to clinicians included a perception by employees of a “work while sick” culture that included managers and supervisors coming to work while sick. Community and JBS Case Data Weld County ranks 3rd-4th out of Colorado counties for total cases and 1st-2nd on number of deaths. Since our call of April 2nd, we’ve continued to analyze community data while I’ve had leadership of Greeley’s health care organizations reach out to me concerned about what they’re seeing in their facilities related to JBS. As part of my investigation into COVID-19 and its impact on Weld County, I reviewed Emergency Department (ED) and clinic visit data from two community health care systems (Banner, UCHealth) between March 1—April 2, 2020. The analysis reveals at least 194 JBS employees (and some covered dependents) have been evaluated for respiratory illness suspect or confirmed for COVID-19. Some individuals had multiple visits to these health care facilities. These 194 individuals appear to have generated at least 225 emergency department and other clinical encounters from March 1—April 2, 2020. Sunrise Community Health saw 83 unduplicated individuals who generated 137 visits during this same study period. The average visits per day by JBS employees/dependents in just one of Greeley’s large health care systems rose from 2 in February 2020 to 10 in the last ten days of March. This equates to 100 JBS-associated individuals being evaluated at one facility in the last ten days of March 2020. The graphic below summarizes the encounters per day by JBS employees/dependents at the single system referenced above from March 1 to April 1, 2020. The red trend line raises concerns about the number of cases to yet surface from JBS related persons. Visits per Day to Single Health Care System: March 1--April 1, 2020 14 12 10 8 6 4 2 4/1/20 3/31/20 3/30/20 3/29/20 3/28/20 3/27/20 3/26/20 3/25/20 3/24/20 3/23/20 3/22/20 3/21/20 3/20/20 3/19/20 3/18/20 3/17/20 3/16/20 3/15/20 3/14/20 3/13/20 3/12/20 3/11/20 3/9/20 3/10/20 3/8/20 3/7/20 3/6/20 3/5/20 3/4/20 3/3/20 3/2/20 3/1/20 0 WCDPHE received its first report of a positive test for COVID-19 in a JBS employee on 3/26/20. The table below summarizes JBS case counts through 4/1/20. Report Date for Positive COVID-19 Test 3/26/20 3/27/20 3/28/20 3/29/20 3/30/20 3/31/20 4/1/20 Total through time period Number of Positive Cases 2 0 1 1 4* 5 1 14 *One person on this date had a negative COVID-19 test but was presumed to be a false negative test due to the employee’s high-risk exposure to another COVID-19 positive employee. This person is included as a positive case due to symptoms and high-risk exposure to a known COVID-19 positive person. Our investigation of JBS employees with positive cases reveals that 9 of 14 (64%) worked while symptomatic and therefore were contagious to others. An additional employee appears to have worked while symptomatic, but that information hasn’t been confirmed. Six of the 14 positive cases (43%) have thus far been hospitalized including some to intensive care. In epidemiology, R0 is used to estimate the contagiousness and potential spread of a communicable disease. The R0 in Colorado for COVID-19 is reported to be between 34. This means each person positive for COVID-19 is likely to spread the disease to this many people. If we only consider the positive JBS employees who report working while symptomatic (9), then 27-36 other people have likely become infected with COVID-19 just from these initial cases. These persons could be fellow employees, family members and people in the community with whom the JBS employee had contact. Many of this secondary phase of individuals have likely not been tested given the shortage of test kits. If we assumed only half of this secondary group of infected people are JBS employees who are working while symptomatic (27/2 ~ 14), the disease could be spreading to an additional 42-56 employees. We spoke during our phone call on April 2, 2020 about additional measures to further comply with social distancing orders by the Executive Director of CDPHE, and my public health recommendations of not working while sick, in order to limit spread within the JBS Greeley plant. The analysis of community data about JBS employees/dependents and investigations of employees positive for COVID-19 warrant further aggressive action. Therefore, I’m issuing the following order effective upon receipt. Weld County Public Health Order to Prevent Spread of COVID-19 in JBS USA Greeley Plant Effective immediately no employee may be allowed to work while sick. In addition to actively communicating this to every employee, JBS must individually screen each employee who presents to the plant for work about the following: • • • In the previous 72 hours, presence of a cough, fever (defined as >100.3), or shortness of breath, and In the previous 7 days, exposure to someone with respiratory illness, and In the previous 14 days, exposure to another person known to have COVID-19. In addition, each employee presenting for work at the plant must have a non-touch temperature taken. No employee may work if they exhibit a temperature > 100.3 degrees Fahrenheit. Any employee with signs or symptoms of a respiratory illness must self-isolate at home. They may not return to work until they are afebrile without the use of temperaturelowering medications for at least the last 72 hours prior to returning to work. Their symptoms must also be gone or significantly improved. Each employee must receive education on self-isolation for respiratory illness. Any employee who has been exposed to a COVID-19 person must self-quarantine at home for a period of 14 days. During the quarantine period they must monitor themselves for symptoms of cough, fever, or shortness of breath. Should they develop these or other respiratory symptoms they should report this via telephone to their health care provider. They may not be allowed to return to work until the 14-day quarantine passes without the development of symptoms. If they develop symptoms, the person must be afebrile without the use of temperature-lowering for at least 72 hours prior to returning to work; their symptoms must also be gone or significantly improved; and at least 7 days must have passed since the first day symptoms appeared. JBS must notify each employee who has had a high-risk exposure to another employee who has tested positive for COVID-19 that they must self-quarantine for 14 days from the last date of exposure to their fellow employee with COVID-14. JBS must require 6 feet of space between each person working in any area of the JBS plant in Greeley. JBS must actively assist in a timely manner WCDPHE and its representatives in fulfilling its legal responsibility to investigate positive cases of COVID-19 and issue isolation or quarantine letters to employees of JBS. WCDPHE will be conducting unannounced onsite inspections at the JBS plant in Greeley to monitor that you and your staff are complying with this Order. Be advised that failure of any of your company’s officers and/or employees to comply with this Order could result in penalties against them individually, including a fine of up to one thousand (1,000) dollars and imprisonment in the Weld County Jail for up to one year, pursuant to C.R.S. 25-1-114. Additionally, my authority pursuant to that statute authorizes me to bring an action in Weld District Court for injunctive relief against your company and its persons and property to stop operations that are in violation of this Order. If I find evidence of continued violations of the Third Updated Public Health Order 20-24 Implementing Stay at Home Requirements, I will seek assistance from the District Attorney to consider criminal actions against you and your staff and/or the Weld County attorney to seek injunctive relief against your company. Signed, Mark E. Wallace, MD, MPH Executive Director and Health Officer