Twenty workers in meat and poultry processing plants in 19 states have died, and nearly 5,000 have been diagnosed with COVID-19, the Centers for Disease Control and Prevention said in a report released Friday.

The report almost certainly undercounts the number of workers who became sick and died from the virus, in part because four states did not report data. In addition, the counts “are affected by the testing strategies employed, with more infected workers identified in settings with more testing.”

CDC did not identify which four states did not respond, but neither Indiana or Minnesota, where plants have been shut down due to COVID-19, are listed among the states that did report data.

“As a result, data provided on worker infections should not be interpreted as the prevalence of infection for all meat and poultry facility workers,” the report said.

Among the obstacles to preventing and controlling the spread of COVID-19 in the plants is the difficulty of keeping workers six feet apart and "implementing COVID-19-specific disinfection guidelines,” the report said.

Echoing recent guidance issued by CDC and the Occupational Safety and Health Administration, the report said cloth face coverings should be worn in public settings "to potentially help prevent transmission as a complement to social distancing.”

One of the “sociocultural and economic challenges” facing facilities battling COVID-19 is that “some employees were incentivized to work while ill as a result of medical leave and disability policies and attendance bonuses that could encourage working while experiencing symptoms.”

Meat and poultry plants also have had difficulty communicating adequately with employees who come from diverse backgrounds and speak languages other than English, CDC said.

“One facility reported a workforce with 40 primary languages,” CDC said. “This necessitates innovative approaches to educating and training employees and supervisors on safety and health information.”

In addition, “many workers live in crowded, multigenerational settings and sometimes share transportation to and from work, contributing to increased risk for transmission of COVID-19 outside the facility itself,” the report said.

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In cautioning that the results do not provide the full picture at plants, CDC cited “lag time in reporting to the local and state health departments” and “the time from disease onset to death in fatal cases.”

“Widespread community transmission in some settings makes determining the source of exposure and infection difficult,” the report said.

CDC said “as testing becomes more widely available, consideration should be given to its role in rapidly identifying and addressing COVID-19 in this occupational setting.”

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