V Centers for Disease Control and Prevention recently released new COVID-19 guidance aimed at reducing labor shortages, but the guidance could harm patients and healthcare staff, nurses and doctors say.
The CDC recommends that healthcare professionals who are asymptomatic or have mild COVID-19 symptoms and no fever can return to work in hospitals with limited staff after five days of isolation, even if they have not tested negative. Healthcare providers, many of whom are working at their limits or at their limits, are left to weigh the consequences of contaminating workers and patients with the virus and not having enough staff to care for each patient.
“Nurses are getting out of bed,” said Kathleen Murphy, president of the Massachusetts Nursing Association and an intensive care nurse at Brigham and Women’s Hospital in Boston. “They can’t go through it again because of these ethical dilemmas. We are all fighting the CDC cut-off times because we don’t want to put our patients or colleagues at risk. “
Few hospitals are in “crisis” capacity as defined by the CDC, which does not impose restrictions on workers infected with COVID as a last resort. But that could soon change, observers warn.
“We can do it in the coming weeks,” said Margot Wolf O’Donnell, partner at Benesch, Friedlander, Coplan & Aronoff, who focuses on labor and employment issues. “The five day return to work period can be worrisome, but I think it is necessary for the community to keep working for the next few weeks.”
Only about 265, or 9%, of the 3,000 intensive care beds in Illinois were available as of Wednesday. Illinois Department of Public Health… Almost 2 out of 5 beds in the intensive care unit were occupied by a patient with COVID-19. According to IDPH, about 17% of all hospital beds in the state were available. Many hospitals in Illinois and other states are again suspending non-urgent procedures.
About 60% of Brigham’s beds are occupied by unvaccinated COVID-19 patients, and the hospital is operating at full capacity, Murphy said. The hospital had to close some beds due to staff shortages, she said, and about a quarter of the nurses working on the night shift called in patients.
During quarantine, workers often have to take paid leave or sick leave, which can contribute to staff turnover.
“These are not only nurses, but also respiratory therapists and doctors,” Murphy said. “We old people don’t have enough staff.”
The CDC has reduced the recommended isolation periods from 10 days to five based on data which show that COVID-19 is most contagious a day or two before symptoms appear and two to three days after. While many health experts believe that isolation should not last more than five days, most recommend negative tests before returning to work.
“Since the CDC released these new guidelines, there has been division and confusion in healthcare organizations,” said Craig Lazer, assistant professor of clinical practice at Arizona State University. “The staff of the hospitals is now in a crisis mode, so the instructions do not say how to apply them at the present time.”
The American Medical Association said the CDC’s advice was dangerous.
“Potentially hundreds of thousands of people could return to work and school as infectious if they follow the CDC’s new guidelines for ending isolation after five days without testing negative,” AMA President Dr. Gerald Harmon said in a statement, noting that there are an estimated 31 people% of people remain infectious five days after testing positive for COVID-19. “Doctors are concerned that these guidelines put our patients at risk and could further overwhelm our healthcare system.”
Health systems take different approaches to when employees infected with COVID should return to work. Risk disclosure policies also vary.
The health care system in Colorado does not require its employees to take a COVID-19 test when symptoms appear, according to an internal memo. “Personnel and healthcare professionals with symptoms of a runny nose, sore throat, body aches and / or loss of taste or smell may continue to report work if symptoms do not worsen,” it said.
Sanford Health in Sioux Falls, South Dakota said any employee showing symptoms of the disease should not work.
“First of all, we do not ask our employees to come to work if they feel unwell. We want them to be able to stay at home, heal and return to work when they feel good enough, ”said Dr. Jeremy Cowells, chief medical officer at Sanford.
The Cleveland Clinic has accepted the new CDC guidelines. He asks workers who have been vaccinated or have had COVID-19 in the past six months to return to work in five days if they have no symptoms or mild symptoms and no fever. Workers don’t need negative tests to return to work, the clinic said in a statement.
Healthcare workers infected with COVID-19 are required to wear surgical masks or N95 masks, and their responsibilities could be changed to protect immunocompromised patients, according to the Cleveland Clinic.
According to a representative of the clinic, the changes will affect only those places where it is necessary. The Cleveland area is seeing a spike in COVID-19 cases, causing major local systems to postpone non-urgent procedures.
Providence, which operates hospitals in five western states, said it is complying with CDC and local health department requirements to return to work in the event of staff contamination, asymptomatic and symptomatic COVID-19 cases.
“It is only in emergencies that CDC guidelines and some local health department requirements really allow hospitals to staff COVID units with COVID caregivers,” said a Providence spokesman. “While we are facing a talent shortage, fortunately Providence does not use this talent model.”
Neither Providence nor the Cleveland Clinic said whether patients would be notified if they were treated by a COVID-19 positive worker. According to the CDC, healthcare facilities must inform patients and staff when they are operating according to crisis management standards, describe operational changes, and describe infection prevention measures.
According to Nancy Foster, vice president, many systems, as recommended by the CDC, are considering which areas of the hospital should be closed to staff with positive test results and which mitigation strategies will be required, such as permanent masking with an N95 respirator or similar. American Hospital Association’s Patient Quality and Safety Policy.
“This CDC announcement will allow healthcare providers to return to patient care faster, which will help alleviate the severe labor shortage crisis facing hospitals across the country,” the association said in a statement.
The CDC leadership is largely protecting hospitals and other healthcare organizations from lawsuits, attorneys say.
“When they make decisions in a crisis situation, it makes it difficult to successfully complete a trial if they are very careful in the circumstances,” said Colin Luc, partner at Waller Lansden Dortch & Davis. “Hospitals want to be wrong about workplace safety and are doing everything they can to protect staff while meeting the needs of patients.”
Most hospitals are asking workers to return after a five-day isolation period, even if they don’t test negative, industry observers said.
“Medical organizations are betting that if they do not know the status of employees, and employees do not report illness, they are healthy and can work. What is ethical and what is acceptable are two different things, ”said Laser of Arizona State University. said. “Given the nature of this entire pandemic, disclosure of disease and vaccination status remains challenging.”
“It’s absurd that the CDC would tell doctors who test positive for the highly infectious airborne respiratory pathogen that they should go back to work,” said Matthew Courtland, a Massachusetts lawyer.
“This is not normal,” he said.
It is unclear how much healthcare professionals will be protected from malpractice lawsuits, Cortland said, because the rules differ from state to state.
“As far as bioethics is concerned, I think it’s very clear that patients have a right to know if any of the healthcare providers providing their treatment have SARS-CoV-2,” he said.