Meatpacking plants are breeding grounds for COVID-19 among workers.
Plant employees typically stand shoulder-to-shoulder on their feet for hours at a time, shoving and cutting carcasses. The work causes them to breathe heavily, and if they have COVID-19, they are spreading virus into the air, said Dr. Lisa Gralinski, an assistant professor at the UNC Gillings School of Global Public Health.
Gralinski, who has studied coronaviruses since 2008, said these processing facilities house a combination of risk factors.
"The virus gets into a meat plant and that can turn disastrous," Gralinski said. "The cold air is going to be very conducive to keeping the virus viable for longer, so it's just kind of a bad situation — and unfortunately if we look at the demographics of who tends to be employed in these facilities, they might not have the best access to health care."
Workers then go home and into their communities, giving the virus a firm foothold.
A survey by journalists from seven newsrooms across the state showed local health departments are tracking COVID-19 outbreaks at meat processing facilities and reporting that information to the N.C. Department of Health and Human Services.
But many aren't telling the public where those outbreaks occur — and neither is the state.
DHHS officials say they're aware of more than 2,000 meatpacking workers who've tested positive for COVID-19. They've provided both the number of outbreaks and the counties where they've occurred. But for weeks, those officials have refused to name plants with reported outbreaks, noting that the agency lacks regulatory oversight over the facilities.
Without that oversight, and the reporting requirements that come with it, DHHS Secretary Dr. Mandy Cohen said she's concerned both that the list may be incomplete and that its publication would discourage companies from cooperating going forward.
"What we are saying is this may not be the universe of all of them, so by naming them individually, I think we are calling out ones, frankly, that raised their hand and said, 'We want to work with you'," Cohen said. "And we continue to want to encourage them to do that, because that's the right thing to do from a public health perspective."
Big Employers, Critical In Food Supply
The ramifications of outbreaks in North Carolina meat-processing facilities could be widespread.
This state employs 35,590 workers in the industry, more than any other state except Texas and Georgia, according to U.S. Department of Labor statistics.
The industry also relies heavily on an immigrant labor pool. This population tends to live in higher-density housing, and health officials report difficulties with outreach due to language and cultural barriers, making this a population at high risk for spreading infectious diseases like COVID-19.
What's more, the meat processing industry in North Carolina forms an integral cog in the food supply chain. More than 9 million hogs and 180 million chickens and turkeys are sold in North Carolina, generating more than $9 billion in revenue, according to U.S. Department of Agriculture data.
That not only supports the livelihood of thousands of North Carolina families, but puts pork and poultry on the plates of thousands more families around the world.
Andrew Gunther is executive director of A Greener World, a nonprofit that advocates for more sustainable and responsible livestock farming.
He described how these facilities are set up to be as lean as possible — good for efficiency in the name of the bottom line, but bad for social distancing, and for including much product storage to allow for any slack in the supply chain.
"You're four foot across the table from your colleague doing the same job, and you're looking straight at them. So there's a great way to contaminate each other right there," he said.
Cohen acknowledged the concern that working conditions inside meat processing facilities can lead to a higher risk of spread.
Health Officials Collect Data But Claim No Oversight Role
In North Carolina, some industries — notably nursing homes — must provide DHHS with details about a COVID-19 outbreak. But in most other industries, including meat processing, no such requirement exists.
For DHHS and local health departments to get information about numbers of infections at meat processing facilities, they rely on individuals to report their employers as part of the contact tracing process, which is conducted by local health officials to trace every close contact an infected patient has had in the days before their infection was confirmed.
Statewide tracking of outbreaks at these kinds of facilities appears to have fallen into a responsibility or oversight gap. DHHS has repeatedly said the industry is regulated by the N.C. Department of Agriculture, and that DHHS can play only a supporting role in helping to implement protections for employees.
But state agriculture department officials say their oversight applies only to the food, not the health of workers. State Agriculture Commissioner Steve Troxler repeatedly denied having authority to enforce any safety guidelines for workers at meat processing plants.
"That is not something we're involved in," Troxler said in a recent interview. "Public health is the lead agency on the response to this virus."
Troxler also said it's the responsibility of the state's health agency to document and record the number of COVID-19 cases at processing plants.
"COVID-19 is not a foodborne illness," Heather Overton, assistant director for public affairs at the N.C. Department of Agriculture, said in a May 12 email. "Our meat supply is safe."
"It is in everyone's interest to have healthy workers," she said, adding that a goal would be for all companies to "keep all workers well and minimize the risk of spread at the plants."
But, like Troxler, Overton stressed that the agriculture department does not oversee efforts to curb the spread of human disease.
In a public briefing, Cohen said the state very much wants to know about infections at meat processing facilities so it can help contain the virus. But there's no lever she can pull to force them to cooperate.
"These industries are not ones that are required to report to our local health department or the state," Cohen said. "We find out about these largely because they come to the attention of the local health departments because we want them to. We want to offer our help and assistance, and make sure we slow the spread of the virus, so we very much want them to get in contact with us. However, it is not a required reporting. So we do not have a systematic way of knowing about all of the pieces of this pie."
But the role that meat processing companies play in reporting numbers to local and state health officials remains unclear, as local health officials detail the systematic way they have collected this information.
Despite her comments at previous briefings, Cohen did acknowledge that state and local health officials have a process to trace outbreaks at meat processing facilities in an interview Tuesday for this story. Cohen said the state's numbers come from the contact tracing process and not from reports submitted by the companies.
"It's done by the public health department that does the tracing stuff," Cohen said. "So, it's not the company saying, 'We have 20 people with COVID.' It's that our public health departments are coming back with the numbers."
That process was confirmed by multiple local health departments that responded to questions for this story.
In Catawba County, health department spokeswoman Emily Killian explained that a nurse on the communicable disease team asks each person what their occupation is.
"When we enter the individual's information into the state-level tracking software, we are also able to link a case to a known outbreak, even if it originated in another county," Killian said.
She said that process plays out for all patients, including those in intensive care in the hospital. If someone is put on a ventilator, Killian explained, contract tracers at the health department will get the information from the hospital or a family member.
That process is how the Catawba County Health Department has been able to account for a total of more than a dozen COVID-19 cases from two different processing plants in neighboring counties.
The process in Columbus County, which has 10 cases connected to meat processing facilities, was similar.
Spokesperson Daniel Buck said when a resident tests positive, someone from the health department goes through the multi-page contact tracing questionnaire.
"These conversations can last anywhere from half an hour to an hour, and we go through, you know, their close connections where they work," he said. "Ultimately for these 10, it was found that the only connection that we could find of COVID with that person would be at work, because they were around people who ultimately tested positive that they worked with."
But Cohen said some companies do play a role in self-identification — even without being required to come forward. They've requested guidance on safe operating practices, sought out protective equipment and asked for help testing employees.
Despite this, the state is still not identifying the facilities publicly.
The worry, Cohen said, is that such cooperation will stop if the state begins identifying only the facilities that raise their hands.
"A lot of times, we've been able to bring testing on site, or close to, and where testing has been done not just for the workers, but for their family members in that case," Cohen said. "That's what we want to happen. That's exactly why we're doing this work."
Jim Thomas, a specialist in epidemiology and ethics at the UNC Gillings School of Global Public Health, said transparency about outbreaks is the best policy. With smaller outbreaks, he said, there could be concerns about inadvertently identifying individuals with infection to the public. But that's not the case with bigger outbreaks, which are primarily in question with the meat-packing operations.
"There is an ethical principle in public health of transparency — of communication and honesty in communication and timeliness," Thomas said.
"For the people working in these locations, they need to know what the infection rate is in their location and how concerned they need to be," Thomas said. "They also need to know what steps the employer is taking to protect them."
He also disagreed with a policy of withholding information because it is incomplete, which he said undermines the public's essential trust in government.
"It can be better even to present data that they have and to admit that they don't have the rest," Thomas said. "In many situations, that can be better than saying we're not going to share any of it. It's better to share one's vulnerability, one's inadequacy, and say we're able to get these data but unable to get these others."
Limited Information Released By DHHS, Most Local Health Departments
When workers of Randolph Packing tested positive for COVID-19, the Randolph County health department did what it could to help contain the spread.
In an email exchange, Randolph County wellness administrator Sam Varner complimented Greg Dronen, plant manager of the Asheboro meat-manufacturing facility, on the measures the facility took to prevent the further spread of the coronavirus, but warned him not to grow complacent.
"We appreciate all the efforts you and your team are taking to ensure a safer environment for your employees," Varner wrote in a May 11 email. "However with the growing number of positive cases related to Randolph Packing's workforce, more serious measures need to be addressed including the possibility of plant closure for 14 days."
After sending information about testing sites, including one for those without health insurance, Varner provided some additional safety protocols the plant could implement.
The exchange pulls back the curtain on how one county health department is handling outbreaks at meat processing plants — an important glimpse given the limited information coming from the state.
DHHS spokesperson Amy Ellis said the agency knew of more than 2,000 confirmed cases of COVID-19 at meat-processing facilities in North Carolina as of Tuesday. Those cases are spread across 28 outbreaks in 18 counties: Bertie, Bladen, Burke, Chatham, Davie, Duplin, Hoke, Lee, Lenoir, Randolph, Richmond, Robeson, Sampson, Surry, Union, Wayne, Wilkes and Wilson.
Because that information does not break down case numbers by county, nor by meat-processing facility, reporters from the news collaborative contacted health departments across the state, but were still able to link fewer than 400 cases to specific meat-processing facilities with information provided by those departments.
Some counties turned over no information at all, in some cases not responding to a reporter's inquiry or, in other cases, refusing to provide any information.
Smithfield Foods, in the town of Tar Heel in Bladen County, is the world's largest pork processing plant, employing about 4,500. Its outbreak numbers have not been released by either the company or Bladen County health officials.
But other counties in the area have provided that information.
The neighboring Robeson County Health Department told a reporter that as of Thursday, at least 92 cases of Robeson residents were linked to the Bladen plant — an updated number from what The New York Times reported this week.
Health departments in other counties near the Tar Heel plant told reporters of residents in their county with cases they have linked to the plant: nine Columbus County residents, three in Scotland County, three in Harnett County and one in Johnston County.
The Catawba County Health Department identified eight cases at a plant operated by Case Farms in Burke County and seven cases at the Tyson plant in Wilkes County, which has seen a case count in the hundreds before the company shut it down. In each of those cases, the employees worked at the plants in neighboring counties but lived in Catawba County.
But neither Burke nor Wilkes counties provided information on the number of employees at the plants in their county.
Wilkes County's health department did not respond to a reporter's inquiry.
A spokeswoman for Burke County said her agency would not share information about the number of cases at meatpacking facilities in the county.
"Burke County is not giving out the names and numbers within facilities," spokeswoman Lisa Moore said. "If you want information regarding this information you will need to contact the corporate headquarters to get the information or message they want to disseminate.
"The state's communication team stated that they are not giving out the names of the processing plants with COVID positive cases but only the number of outbreaks across the state, the counties in which have outbreaks and the total number of positive cases across the state."
In Chatham County, Mountaire Farms itself disclosed an outbreak of COVID-19 cases at its Siler City processing plant last month, and the state and county have worked to offer testing to employees and members of their households. But spokesperson Kara Dudley said county officials aren't disclosing outbreak locations to protect privacy "and avoid the stigma that may come with identification."
"This has been a consistent and cornerstone public health practice well before the spread of COVID-19 as an essential element of maintaining trust among those the health department must reach to control the spread of disease, COVID-19 or another communicable disease," Dudley said in an email. "Without that trust, contact tracing becomes much more difficult."
Piedmont Health CEO Brian Toomey told a reporter that the organization met with Mountaire and Chatham officials to coordinate testing, which Mountaire voluntarily wanted to conduct, resulting in 74 positive cases out of 340 tested. This was preceded by pressure from concerned community members and an online "Justice for Mountaire Workers" petition calling for sweeping protections for workers.
Toomey commended Mountaire for "setting a high bar" for poultry plants and wanting to work with Piedmont Health for testing in late April and hoped other plants would do the same.
Mountaire has not yet responded to requests for comment on its disclosure policies sent Wednesday.
Lee County officials coordinated with Piedmont for testing May 27 and 28 of Pilgrim's Pride plant workers in Sanford, which had an outbreak since early April in the same timeframe as Mountaire.
Although Durham health officials said they know of no outbreaks at any Durham meat processing facilities, spokesperson Alecia Smith said they would be reported to DHHS like any other cases. DHHS defines an outbreak as two or more laboratory-confirmed cases of COVID-19.
Meat-Processing Companies Say They're Working With Health Officials
Reporters also reached out to meat processing companies for this story to gauge what involvement they had in reporting numbers to state and local health officials.
Each company said they were in discussion with health officials, and Smithfield Foods said it was reporting case numbers to health officials.
"Smithfield is working closely with a combination of local health departments and private labs to make testing available for free to all employees across our facilities on an ongoing basis," a company spokesperson said.
"We are strongly encouraging our employees to take advantage of this free testing. We continue to report all COVID-19 cases to state and local health officials, as well as the CDC," the spokesperson said.
But a spokesperson for JBS USA, the company that owns the Pilgrim's Pride brand, said in a statement last week that it was not reporting the number of cases identified at its facilities to health officials.
"Given the evolving nature of this situation, we are not attempting to publicly report the number of impacted team members," spokesperson Cameron Bruett said. "What I can share is we are coordinating with local, state and public health officials, and we are following all CDC and OSHA issued guidance at the plant."
Two other companies — Case Farms, which has processing facilities in Burke and Wayne counties, and House of Raeford, which operates multiple facilities in Duplin County — stopped short of saying they were reporting numbers of cases to health officials but said they were in regular contact.
However, both House of Raeford and Case Farms did say they were providing paid sick leave to employees who contract COVID-19. Neither company specified whether that benefit was being extended to contractors who work at the plant.
Along with Purdue and Mountaire, a spokesperson for Tyson Foods did not respond to an inquiry for this story but the company released a statement last week announcing the results of mass testing at its facility in Wilkes County.
"Of the 2,244 team members and contractors who work at the facility and were tested, 570 tested positive, the majority of whom did not show any symptoms and otherwise would not have been identified," the company announced.
The company's release said the Wilkes County facility is among an initial group of 30 plants where the company planned to conduct testing of all employees and contractors and added that it will report the results of that testing to health officials.
"As it is doing at the Wilkesboro facility, Tyson will disclose verified test results at other plants to health and government officials, team members and stakeholders as part of its efforts to help affected communities where it operates better understand the coronavirus and the protective measures that can be taken to help prevent its spread," the statement said.
This story was jointly reported and edited by Kate Martin, Jordan Wilkie and Frank Taylor, of Carolina Public Press; Ames Alexander and Gavin Off, of The Charlotte Observer; Aaron Sánchez-Guerra and Jordan Schrader, of The News & Observer; Nick Ochsner, of WBTV; Emily Featherston, of WECT; Tyler Dukes, of WRAL; and Jason deBruyn and Celeste Gracia, of WUNC-FM.
Correction: A previous version of this story incorrectly reported Durham health officials knew of no COVID-19 cases at Durham meat processing facilities. A spokesperson with the county health agency actually said they knew of no COVID-19 outbreaks. The N.C. Department of Health and Human Services defines an outbreak as 2 or more lab-confirmed cases.