As the COVID-19 pandemic began, California was the only state where workers in high-risk workplaces including healthcare and prisons were protected under a comprehensive occupational health standard for aerosol transmissible diseases (ATD Standard). The ATD Standard provides clear, enforceable requirements to protect workers from an emerging, novel pathogen. Based on open access sources and public information requests, we present findings on 524 COVID-19-related enforcement inspections in certain specified industries covered by the ATD Standard from January 1, 2020 to January 1, 2024, and on the 460 inspections that resulted in citations for violations of the ATD Standard. Evidence showing that 80% of identified ATD hazards were abated demonstrates a substantial impact on worker protection. We describe citation details from acute care hospitals, skilled nursing facilities, and state prisons. Based on California's experience, we recommend enhancing enforcement staffing, updating the ATD Standard, and adopting a Federal OSHA infectious diseases standard.
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