(Beyond Pesticides, March 14, 2023) A study published in Environmental Research and Public Health finds occupational pesticide exposure increases the risk of sleep disorders among farmworkers and pesticide applicators. Specifically, many pesticides, like organophosphates (OPs), are detrimental to neurological function through inhibition of the enzyme acetylcholinesterase (AChE) responsible for ending a neurotransmission event after relaying the necessary information. Without an end to neurotransmission events, individuals experience a buildup of acetylcholine, resulting in convulsions, headaches, weakness, impacts on bodily senses, and other cognitive/mental changes. In addition to illnesses from chemical exposure, inadequate sleep has links to several chronic diseases like type 2 diabetes, cardiovascular disease, obesity, and depression. Therefore, given research links to sleep-related disorders and bodily functions, including endocrine, metabolic, neurological, and cognitive disorders, studies like this can help government and health officials identify how pesticides’ impact on the brain elevates health concerns. The study notes, “The study’s findings can be used to create strategies for addressing mental health issues and promoting mental health and quality of life.” Researchers assess the sleep patterns among individuals living in southeast Spain, near the coast of Almeria, where chemical-intensive agriculture from greenhouses is prevalent. Of the 380 participants in the study, 189 were […]

(Beyond Pesticides, March 7, 2023) Exposure to glyphosate (Roundup) and its breakdown products is associated with an increased risk of liver and metabolic disorders in children and young adults, according to research published in Environmental Health Perspectives earlier this month. While glyphosate has developed a well-deserved reputation as a carcinogen, research is finding that cancer is one of a myriad of chronic diseases associated with the notorious chemical. As this body of literature grows, growing awareness by the public is increasing pressure on the U.S. Environmental Protection Agency to cancel its allowed uses. Researchers began their investigation concerned about the rise of liver disorders and metabolic syndrome among young people. This trend has been pronounced among populations of color. The worrying increase has led many to consider synthetic chemical exposure as a contributing factor, as lack of diet and exercise is unlikely to account for the entirety of the increase. To better understand these impacts, researchers enrolled existing participants in the CHAMACOS (Center for the Health Assessment of Mothers and Children of Salinas) study, a long running cohort of mothers and their children born between the years 2000 and 2002 in the Salinas Valley of California. Enrolled participants consistent mostly […]

(Beyond Pesticides, March 6, 2023) After the Trump EPA was blocked from weakening the application exclusion zone (AEZ) provisions for protecting farmworkers, the rules reverted to the Obama era rules. Now, EPA proposes to reaffirm part of that rule, while accepting some of the weakening amendments from the Trump administration. Tell EPA to strengthen pesticide rules to protect farmworkers. Tell President Biden to sign the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families.    EPA’s Worker Protection Standards (WPS) are rules that govern labor safety standards within federal pesticide law (the Federal Insecticide Fungicide and Rodenticide Act, or FIFRA). Farmworkers are not covered for toxic chemical exposure by the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA), and WPS have long been criticized by farmworker, labor, and health advocates for providing insufficient protections for farmworkers, their children and communities. Under the WPS, AEZs are buffer zones where people are not allowed to enter during the course of a pesticide application. Like all buffer zones, they are designed to allow application of toxic pesticides while providing a nominal degree of protection. Pesticides drift long distances when being applied and they […]

(Beyond Pesticides, February 7, 2023) U.S. Senator Cory Booker (D-N.J.) reintroduced legislation last week to increase protections against exposure to toxic pesticides. The Protect America’s Children from Toxic Pesticides Act of 2023 (PACTPA), S.269, addresses many of the controversial issues with the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), which governs the registration and use of pesticides in the U.S. This major reform legislation tackles some of the documented deficiencies in the regulation of pesticides and removes a number of loopholes in the law. The legislation, introduced with Senators Kirsten Gillibrand (D-NY), Bernie Sanders (D-VT), Elizabeth Warren (D-MA) and Brian Schatz (D-HI), also includes a ban on all organophosphate and neonicotinoid insecticides, as well as  the weed killer paraquat, which is known to cause Parkinson’s disease and lung fibrosis. Despite these reform provisions, the legislation does not touch the core of FIFRA’s pesticide registration process and chart a path for the systemic, transformative change that Beyond Pesticides says is essential to meet the existential challenges of current times—devastating health threats, biodiversity collapse, and the climate crisis. FIFRA, which is under the jurisdiction of the agriculture committees of Congress, has long been criticized for failing to protect the public and workers […]

(Beyond Pesticides, February 6, 2023) During Black History Month, it is of note that on January 10, the Biden-Harris Environmental Protection Agency (EPA) announced funding of approximately $100 million for “projects that advance environmental justice in underserved and overburdened communities across the country” through its Environmental Justice Government-to-Government (EJG2G) program. While viewed as assistance for those communities “disproportionately impacted by pollution and climate change,” it is important to recognize that the same communities are also disproportionately impacted by activities that produce pollution and climate change. Tell EPA, Governors (Mayor in DC), and Congress to support environmental justice by eliminating activities leading to pollution and climate change. EPA must reverse its historical bias against preventive action to ensure the protection of those disproportionately poisoned by toxic chemicals. While critically important to clean up contaminated communities, EPA must stop the flow of toxic pesticides at the front end because of the disproportionate poisoning effects of use, handling, transportation, and disposal. We live in an age of practices and products that make toxic pesticides unnecessary and their use unconscionable. Yet, EPA insists on the acceptability of harm (which it calls risk), despite its failure to (i) recognize comorbidities and preexisting health conditions, (ii) […]

(Beyond Pesticides, January 16, 2023) Martin Luther King, Jr. spoke about individual greatness on February 4, 1968 to his congregation at Ebenezer Baptist Church in Atlanta two months before he was assassinated. We take this day—Monday, January 16— to commemorate the life and work of Martin Luther King, Jr. as an inspiration for taking on the challenges of justice, equity, and safety as a central part of all our work for a sustainable future. It will take the recognition of the greatness that all individuals have within to raise our voices in our communities to stop the toxic petrochemical assault and advance viable solutions that effect a transformation to organic practices and products. In so doing, we will address those who suffer the most harm from petrochemicals—in their production, transportation, use, and disposal. Whether determining our community’s management of public lands, playing fields, and parks, or choosing food grown without toxic chemicals, or creating habitat for biodiversity, we as individuals and collectively are the instruments for effecting meaningful change. This is true whether focused on an individual chemical exposure or in taking on the existential health, biodiversity, and climate crises of our day. Dr. King’s complete quote from which the […]

(Beyond Pesticides, January 9, 2023) The Biden EPA still needs a new vision in order to meet the existential crises in public health, climate change, and biodiversity. The Trump Environmental Protection Agency (EPA) reversed in four years much of the progress made by the EPA in decades. Despite a broad new perspective embodied in President Biden’s Executive Memorandum (EM) Modernizing Regulatory Review issued on his first day in office, the Biden EPA has not adopted a new direction for regulating pesticides. Tell President Biden, EPA, and Congress to adopt a new direction for pesticide regulation. Immediately following his inauguration, President Joe Biden issued the EM, which directs the heads of all executive departments and agencies to produce recommendations for improving and modernizing regulatory review, with a goal of promoting public health and safety, economic growth, social welfare, racial justice, environmental stewardship, human dignity, equity, and the interests of future generations. This EM could reverse the historical trend of status-quo regulatory reviews required by the White House Office of Management and Budget (OMB) that typically support vested economic interests of polluters (e.g., petroleum-based pesticide and fertilizer manufacturers). The President’s EM sets the stage for the adoption of agency policy across government to […]

(Beyond Pesticides, January 3, 2023) The California Department of Pesticide Regulation (DPR) announced new rules that remove existing limits on the use of 1,3-dichloropropene (1,3-D or Telone), allowing Californians to breathe much more 1,3-D than state toxicologists in the Office of Environmental Health Hazard Assessment (OEHHA) say is safe and highlighting the dangers to which farmworkers are routinely exposed. It is outrageous that the state of California and the U.S. Environmental Protection Agency (EPA) would allow farmworkers—whose labor was judged “essential” during the pandemic—to be routinely exposed to highly toxic pesticides, which could be replaced by organic practices. While the state of California describes its action as increasing protection, advocates point to continued use, unacceptable harm, and the availability of alternative organic agricultural production methods that eliminate the use of 1,3-D. Since over a third of the country’s vegetables and three-quarters of the country’s fruits and nuts are grown in California, most people who buy their food in a grocery store have a stake in how food is grown in the state and the impact that it has on those who live and work there. Tell the state of California, U.S. EPA, an the U.S. Congress to cancel the registration […]

(Beyond Pesticides, November 4, 2022) Rural populations in the U.S., a new study finds, are particularly at risk for agriculture-related exposures associated with respiratory diseases and other kinds of airway inflammation. The exposures include those to pesticides, livestock facilities, smoke from biomass burning, agricultural dust, and endotoxin. The study paper also looked at potential protective roles for dietary DHA, and for raw milk consumption (early in life). Beyond Pesticides has regularly covered the relationships between pesticide exposures and asthma (including the outsized risks for children), COPD (chronic, obstructive pulmonary disease), and other respiratory anomalies. See our webpage on Pesticide-Induced Diseases: Asthma/Respiratory Effects for more information. Published in Immunology and Allergy Clinics of North America [please note: this research paper is behind a paywall], and authored by a team from the Division of Allergy and Immunology at the University of Nebraska Medical Center in Omaha, the study used data from the past five years plus literature reviews of research on asthma and respiratory issues in rural populations. The team notes that multiple studies have suggested that “farming-related exposures as an adult increase the risk of asthma or asthma-like symptoms development,” adding that agricultural workers are exposed to “a complex working environment […]

(Beyond Pesticides, October 17, 2022)  A recent report, Exposed and At Risk: Opportunities to Strengthen Enforcement of Pesticide Regulations for Farmworker Safety, by the Center for Agriculture and Food Systems at Vermont Law and Graduate School, in partnership with the nonprofit advocacy group, Farmworker Justice, again highlights the systemic racism of our country’s pesticide policies. Our nation depends on farmworkers, declared “essential workers” during the COVID-19 pandemic to ensure sustenance for the nation and world. Yet the occupational exposure to toxic pesticides by farmworkers is discounted by the Environmental Protection Agency (EPA), while study after study documents the disproportionate level of illness among farmworkers. While we are encouraged to see the formation of EPA’s new Office of Environmental Justice and Civil Rights, the agency has a historical bias against preventive action to ensure the protection of those disproportionately poisoned by toxic chemicals. While critically important to clean up contaminated communities, EPA must stop the flow of toxic pesticides at the front end because of the disproportionate poisoning effects of use, handling, transportation, and disposal. We live in an age of practices and products that make toxic pesticides unnecessary and their use unconscionable. Yet, EPA insists on the acceptability of harm […]

(Beyond Pesticides, September 22, 2022) A study published in the International Journal of English, Literature, and Social Science (IJELS) finds an association between pesticide exposure and anemia among female farmers in Indonesia. Anemia is an autoimmune blood disorder negatively affecting the number of red blood cells (RBCs) and subsequent oxygen distribution via available hemoglobin proteins in RBCs. Types of anemia include iron deficiency, pernicious (lack of vitamin B-12 absorption), aplastic (lack of RBC production), and hemolytic (RBC destruction). Although risk factors for anemia consist of age, genetics, lifestyle, and gender, environmental factors such as pesticide use and exposure contribute to disorder development. Pesticides can interfere with cells in the body, causing blood profile abnormalities that affect blood cell formation and immune system function. Anemia disproportionately impacts women and children across the globe, prevalent in over half a billion women. The disorder was more prevalent among pregnant individuals because of blood loss and iron deficiency, causing adverse reproductive outcomes among children. These outcomes include preterm delivery, low birth weight, and decreased iron stores, impairing cognitive and motor development. Considering research already demonstrates many chemicals (e.g., pesticides, heavy metals) can enter the bloodstream through ingestion, absorption through the eyes and skin, or inhalation, studies like […]

(Beyond Pesticides, September 16, 2022) A report issued on September 7 analyzes the U.S. regulatory structure that is supposed to protect agricultural workers from the harms of pesticide use. Its conclusion? The current, “complex system of enforcement . . . lacks the capacity to effectively protect farmworkers. . . . [and] the cooperative agreement[s] between federal and state agencies makes it nearly impossible to ensure implementation of the federal Worker Protection Standard.” The report, Exposed and At Risk: Opportunities to Strengthen Enforcement of Pesticide Regulations for Farmworker Safety, was developed by the Center for Agriculture and Food Systems at Vermont Law and Graduate School, in partnership with the nonprofit advocacy group, Farmworker Justice. Beyond Pesticides’ coverage of farmworker exposure to pesticides and resultant harms began in the late 1970s; it continues today, most recently with attention to incidence of kidney damage, systemic racism in the farmworker policies of EPA (the U.S. Environmental Protection Agency), and extra risks endured by farmworkers during the COVID-19 pandemic. Exposed and At Risk is issued as part of the Center for Agriculture and Food Systems (CAFS) Food System Workers Law and Policy Project. Previously, CAFS issued a report in conjunction with the Johns Hopkins Center […]

(Beyond Pesticides, August 11, 2022) A study in the International Journal of Environmental Research and Public Health finds that Brazilian agricultural workers are more likely to die from acute kidney failure (AKF) than other acute illnesses. Among the agricultural workers, the prevalence of AKF is higher for individuals at younger ages, who are female, and located in regions south of chemical use, particularly rural areas. However, the AKF mortality rate in urban areas is also increasing, but not as fast as in rural areas. Over six million people in the U.S. have kidney disease (i.e., nephritis [kidney inflammation], nephrotic syndrome (improper protein filtration), and nephrosis). Although many studies find an association between exposure to environmental contaminants like pesticides and chronic kidney disease (CKD), the association between pesticides and acute kidney failure remains unclear. CKD is a risk factor for AKF, and other environmental factors can increase the risk of AKF mortality. Therefore, studies like this highlight the need for comprehensive information regarding co-occurring exposure patterns and disease prevalence that can have global implications. The study notes, “Our findings reinforce the need for more robust epidemiological studies that account for co-exposures and conditions of agricultural work in the relationship between pesticide exposure and kidney […]

(Beyond Pesticides, July 20, 2022) Flood cleanup in Houston after Hurricane Harvey increased resident exposure to a range of pesticides and other industrial chemical compounds, according to a study published recently in the International Journal of Environmental Research and Public Health by scientists at Oregon State University (OSU). The findings are particularly concerning for a community already subject to some of the highest rates of environmental contamination in the country. “Houston is one of our most industrialized cities,” said study co-author Kim Anderson, PhD, of OSU. “When we look a year after the storm, we see that several neighborhoods that are closer to industrial zones — socioeconomically disadvantaged neighborhoods — had higher concentrations of chemicals right from the get-go, and that was only exacerbated when the hurricane came in.” Hurricane Harvey made landfall in Southern Texas as a category 4 hurricane in 2017. Widespread flooding resulted in damage to chemical plants and oil refineries throughout the city, including 13 of the astounding 41 Superfund sites present in the city of Houston. Clean up and remediation efforts brought concern among residents that chemicals from these industrial sites were being mixed with floodwaters, exposing individuals to a range of hazardous compounds. To […]

(Beyond Pesticides, June 19, 2022) On Juneteenth Day, we commemorate the abolition of slavery and celebrate human freedom. At the same time, we recognize that we have significant work to do to eliminate systemic racism and advance environmental justice. We strive to ensure that people of color are not disproportionately harmed by pesticides and other toxic chemicals—from production, use, to disposal—and that all people have access to sustainable and organic food and organically managed communities. Acute and chronic exposure to chemicals like pesticides cause a plethora of harmful effects, including (but not limited to) brain and nervous system disorders, birth abnormalities, cancer, developmental and learning disorders, endocrine disruption, immune disorder, and reproductive dysfunction, among others. However, people of color may experience more servere health effects from exposure, resulting in elevated rates of diseases. Communities of color and those living in low-socioeconomic conditions experience an inequitable number of hazards, including toxic waste plants, garbage dumps, and other sources of environmental pollution and odors that lower the quality of life. Therefore, these populations experience greater exposure to harmful chemicals and suffer from health outcomes that affect their ability to work and learn. When discussing health disparities and environmental justice, we need to […]

(Beyond Pesticides, June 9, 2022) A report from the Organic Center finds that people in U.S. BIPOC (Black, Indigenous, and People of Color) communities endure a significant disproportionate risk of exposure to pesticides and subsequent harms. The report also contains a lesson plan that informs young activists on how to improve the food system. Many communities of color and low-socioeconomic backgrounds experience an unequal number of hazards, including nearby toxic waste plants, garbage dumps, and other sources of environmental pollution and odors that lower the quality of life. Therefore, these populations experience greater exposure to harmful chemicals and suffer from health outcomes that affect their ability to learn and work. Doctoral candidate at Northwestern University and author of the report and lesson plan, Jayson Maurice Porter, notes, “Urban planning and city policy considers certain people in certain communities more or less disposable and puts them in harm’s way, giving them an uneven burden of experiencing and dealing with things like pollutants.”  The father of environmental justice, Robert Bullard, Ph.D., defines environmental racism as any policy or practice that unequally affects or disadvantages individuals, groups, or communities based on their race. Dr. Bullard stated that, until the 1980s, environmentalism and pollution were separate. During the Jim […]

(Beyond Pesticides, May 19, 2022) A study published in the Journal of the American Heart Association finds a correlation between the number of fires fought annually and atrial fibrillation (AF), one of the most common medical arrhythmias that increases the risk of stroke, heart failure, and other cardiovascular health issues. In the firefighting occupation, firefighters can experience exposure to chemicals and particulate matter in smoke, pollutants, volatile organic compounds, and polycyclic aromatic hydrocarbons (PAHs) that increase cardiovascular (heart) and respiratory distress risk through oxidative stress and autonomic function disruption. However, firefighters encounter both personal and occupational (work-related) risk factors for cardiovascular diseases, making this subset of the population particularly vulnerable to heart-related fatalities. Considering firefighters live 10 to 15 years less than non-firefighters, studies like these are significant for understanding how chemical exposure contributes to health and wellness disparities. Lead author Paari Dominic, Ph.D., notes, “Clinicians who care for firefighters need to be aware of the increased cardiovascular risk, especially the increased risk of [AF], among this unique group of individuals… The conditions that elevate their risk further, such as high blood pressure, type 2 diabetes, lung disease and sleep apnea, should be treated aggressively. In addition, any symptoms of [AF], such as […]

The organic solutions to problems highlighted in the latest issue of Pesticides and You—based on the importance of healthy ecosystems and public health protection—are within reach, and the data creates an imperative for action now that phases out pesticides within a decade, while ensuring food productivity, resilient land management, and safe food, air, and water. (Beyond Pesticides, April 15, 2022) The current issue of Pesticides and You, RETROSPECTIVE 2021: A Call to Urgent Action, is a look at a year of science, policy, and advocacy that informs both the existential problems that the U.S. and the world are facing due to toxic pesticide dependency, and solutions that can be adopted now. The information in this issue captures the body of science that empowers action at the local, state, and federal level, and provides a framework for challenging toxic pesticide use and putting alternatives in place. The issue finds that 2021 was a pivotal year in both defining the problem and advancing the solution. This year in review is divided into nine sections that provide an accounting of scientific findings documenting serious pesticide-induced health and environmental effects, disproportionate risk to people of color and those with preexisting conditions, regulatory failures, at the same time […]

(Beyond Pesticides, February 10, 2022) A National Institute of Environmental Health Sciences (NIEHS)-funded study finds that patterns of pesticide exposure among farmers have geographical and temporal significance. Specific use of and exposure to organophosphate and carbamate chemicals decrease enzyme activity within the body, resulting in greater health anomalies among farmers, especially during agricultural seasons. The use of xenobiotic (foreign chemical compounds) substances like pesticides and fertilizers in agriculture are increasing. Thus, those working with and around these toxicants must have protection. Considering that agricultural workers often experience pesticide exposure at higher rates due to occupation, long-term research must identify potential health concerns surrounding common pesticides. The study author, Dana Barr, Ph.D., states, “The majority of farmers in this study reported that they had at least one health symptom associated with pesticide intoxication. This investigation can be used to promote safer use of pesticides among farmers and mitigate exposure among residents living near a rice field. The findings will be critical for establishing and launching several preventive programs in the future.” Researchers evaluated the health effects of pesticide exposure among a cohort of farmers in Thailand during inactive and active rice farming periods. Using geographic information system (GIS) mapping, researchers compared […]

(Beyond Pesticides, January 24, 2022) The advisory board of health experts who counseled President Biden during his transition have now called for an entirely new domestic pandemic strategy geared to the “new normal” of living with the virus indefinitely. While this new strategy addresses important issues like “reimagining public health” and disparities in vulnerability to COVID, it misses out on an important one—reducing vulnerability to disease by eliminating exposure to toxic chemicals, especially those that threaten the immune, nervous, and respiratory systems. Tell the President, EPA, and Congress to address the ongoing threat of Covid-19 by eliminating toxic pesticide use that elevates overall, and disproportionately for people of color, the public’s vulnerability to the virus. The strategic initiative is organized by Ezekiel J. Emanuel, MD, PhD, an oncologist, medical ethicist, and University of Pennsylvania professor who advised former President Barack Obama. The group published a collection of opinion articles in the Journal of the American Medical Association (JAMA). In those articles, the group advises President Biden to give up on an eradication goal, accept that COVID-19 is here to stay—that is, that it is becoming endemic—and adopt a goal of living with it. These articles explore what that means. The […]

(Beyond Pesticides, November 30, 2021) The chronicle of developments in the glyphosate saga has just grown longer: the California Supreme Court has rejected a request by Bayer AG for review of the August 2021 First District Court of Appeal (San Francisco) ruling, for the plaintiffs, that Monsanto knowingly marketed a product — Roundup — whose active ingredient (glyphosate) could be dangerous. The $87 million in damages awarded to the plaintiffs in the litigation, Alberta and Alva Pilliod, has thus survived Bayer’s challenge. This highest state court decision racks up another loss for Bayer (which now owns the Monsanto “Roundup” brand) — despite its dogged insistence, throughout multiple lawsuits (with many more still in the pipeline), that glyphosate is safe. Beyond Pesticides has covered the glyphosate saga extensively; see its litigation archives for multiple articles on glyphosate lawsuits. Glyphosate has been the subject of a great deal of public, advocacy, and regulatory attention, as well as the target of thousands of lawsuits — particularly since the 2015 declaration by the IARC (International Agency for Research on Cancer) that the compound is a likely human carcinogen. In June 2020, facing approximately 125,000 suits for Roundup’s role in cancer outcomes, Bayer announced a $10 billion […]

(Beyond Pesticides, November 19, 2021) Thanksgiving offers an opportunity for people to come together and give thanks for the bounty of an organic harvest. Unfortunately, many Thanksgiving meals are produced by chemical farming practices that utilize hazardous pesticides, genetically engineered (GE) crops, and petroleum-based synthetic fertilizers. These inputs, apart from being unnecessary, degrade ecosystems and affect the health of consumers and agricultural workers alike. It’s never too late to start a new tradition – for this year and into the future, make your Thanksgiving feast sustainable by going organic. Now, more than ever, it’s important to go organic: For Our Own Health Going organic drastically reduces the amount of pesticide in a person’s body. Although Thanksgiving is generally no time to think about dieting, we’ll aim to make it instructive: recent research finds that one of the biggest health benefits of the Mediterranean Diet comes when you go organic. Compared to individuals on a Mediterranean diet filled with chemically farmed foods, those that ate organic had 91% lower pesticide residue. This finding is backed up by a considerable body of prior research. A 2015 study based on self-reported food intake found that those who eat organic generally have much lower […]

(Beyond Pesticide, November 4, 2021) A scientific literature analysis by the Federal University of Goias, Brazil, finds occupational (work-related) exposure to agricultural pesticides increases the risk for 45 different types of cancer. This analysis assesses studies from the last decade—2011 to 2020—to identify cancer risk associated with occupational exposure by country, pesticide type, and methods used to diagnose disease. Many pesticides are “known or probable” carcinogens (cancer-causing agents), and widespread uses only amplify chemical hazards, adversely affecting human health. However, research on cancer and pesticides lacks comprehensive information regarding human health effects associated with long-term chemical use. This study highlights the significant role that long-term research plays in identifying potential health concerns surrounding registered pesticides. The use of these xenobiotics (foreign chemical compounds) substances in agriculture are increasing. Thus, it is important those working with and around these toxicants have protection. The analysis notes, “Overall, then, the results of the present study emphasize the need to evaluate overuse of pesticides and the concomitant increase in the number of cancer cases. Future research should thus include active intervention in the correct use of pesticides by farmworkers and encourage adequate training and the use of PPEs [personal protective equipment], as well as routine periodic medical […]