Table 2 Summary of key findings and recommendations from coroner file review and media scan

Recruitment and Travel Risks

Exploitative recruitment

• One worker arrived in Canada after third-party recruiters had misrepresented his employment, leading to debt and illegal deductions and poor/crowded housing conditions that could not be reported

• Legislators should set out the duties of agencies/recruiters under the Occupational Health and Safety Act.

Travel as a risk factor for transmission

• Several workers became ill with COVID after initially testing negative on arrival, suggesting that they became infected during travel to Canada, transportation to farm/quarantine accommodations, or during the initial quarantine

• In several cases, workers entered Canada twice in the same year to work at different farms

• Implement measures to minimize exposure to SARS-CoV-2 during travel, taking into account the significance of airborne transmission. These measures should include the provision of N95 or KN95 masks, or equivalent, with instructions on their use.

• Provide accessible, independent mobile testing for migrant agricultural workers at regular intervals during quarantine.

Missed Steps and Substandard Conditions of Healthcare Monitoring, Quarantine, and Isolation

Precarious housing and living conditions

• Workers often shared accommodations with several other workers, especially during the initial quarantine period

• A worker who died of motor vehicle blunt trauma while working/travelling at night on a dirt road

• A national housing standard should be established and enforced, aligned with recognized international standards.

• Clear and consistent guidelines should be put in place for the quarantine period that allow for physical distancing, including robust standards that account for the size of living quarters and common areas.

• High standards for ventilation (i.e., open windows, HEPA filters, maintenance of HVAC systems, etc.) should be developed, communicated, and enforced.

• Regular oversight and adequate investment should be provided for public health units to perform timely, in-person, unannounced housing inspections.

• There should be investment in regional transportation plans that account for migrant agricultural workers, and seek to address isolation faced by this group, and also provide road safety infrastructure to protect this workforce from nearby traffic.

Inadequacy of medical check-ins

• Many workers had a very rapid deterioration after testing positive for SaRS-COV-2 or first demonstrating symptoms

• Several workers died during quarantine or isolation

• Check-ins were sometimes delegated to employers without medical expertise

• One worker was found dead during quarantine with several over-the-counter medications, likely provided to them by the employer

• Workers in quarantine should receive standardized health assessments. These assessments should examine both objective (e.g., temperature reading, pulse oximeter) and subjective (e.g., sore throat, chest pain, shortness of breath) indicators of health status, involve direct communication with the migrant agricultural worker (rather than an employer), and be performed at regular intervals by healthcare professionals with professional interpreters and/or trusted support persons/specialized staff with a track record of working with migrant agricultural workers.

Barriers to accessing healthcare

Challenges seeking emergency care

• When one worker fell ill, workers in another bunkhouse reached out to academics that they had met during a previous growing season (thousands of miles away) to help them call an ambulance

• An ambulance was dispatched to the wrong location for an ill worker, delaying medical attention by over 40 minutes

• Workers’ addresses should be clearly posted in their place of residence, along with instructions in their preferred language(s) of how to call emergency medical services.

Lack of language concordant care

• A worker initially declined intubation (a potentially life-saving intervention) due to a misunderstanding that he would have to pay for it

• Workers should be reassured, in culturally appropriate ways (i.e. in languages and terms that they understand), that emergency care, especially in the COVID-19 context, is not associated with a fee or loss of employment. Any existing fees for emergency treatment that are currently not free of cost for this workforce should be systematically waived.

Missing info raising questions

Referenced medical documentation

• Many coroner reports did not contain copies of referenced medical documentation or contact tracing information to better ascertain source of viral transmission.

• Consideration of this population’s social/geographic isolation, language barriers, international travel, and workplace and living conditions should be part of death reporting. Attending clinicians and coroners should work together to identify and document these factors to ensure relevant issues are identified in the death investigation. A social determinants of health framework may be useful to adopt in the reporting of each death, given the various structural vulnerabilities faced by this group.

Workers’ compensation

• It was also unclear whether families of deceased workers had a clear path to accessing eligible compensation through the provincial workers’ compensation board.

• Workers, and, when deceased, their next-of-kin, must be made aware of WSIB eligibility, and be given the opportunity to connect with legal advocates who can assist with WSIB applications.