California Against COVID-Positive Health Workers: Keep Working

Days of waiting for the emergency room. No one to answer the phones. No one to take out the trash. And every day more patients arrive.

That’s the scene unfolding in some Southern California hospitals as the Omicron-fueled wave of COVID-19 contributes to a crippling shortage of doctors, nurses and other health professionals. While Omicron causes significantly less severe illness than last year’s winter wave, the unprecedented number of people becoming infected has put the medical infrastructure on edge.

State officials are trying to address the California workforce shortage through a sweeping policy change that will allow asymptomatic health workers who have tested positive for the coronavirus to return to work immediately, without isolation or testing. The policy, which will remain in effect until February 1, aims to keep many health workers on the job at a time when hospitals expect more patients.

Some experts say the California setup is an unorthodox but necessary solution to a difficult problem. Still, many health professionals and community members say the policy is not only unwise, but potentially dangerous.

“The situation just feels so hopeless,” said Erin McIntosh, an emergency room nurse at Riverside Community Hospital. “I went into healthcare to help people, but now I’m the vector. Someone comes to me in their time of need, and I could potentially pass on COVID to them.”

McIntosh said Monday that more than 300 nurses and many other staff at the hospital are sick due to COVID-19, and those who remain are being stretched to their limits. Some nurses have to take on way too many patients, while others can’t even find an assistant to take patients to the bathroom.

But potentially exposing patients to hospital workers who have tested positive — even if the workers don’t feel sick or show symptoms — isn’t the answer, McIntosh said. She has already heard of coronavirus-positive workers caring for women during labour, chemotherapy patients and patients in the neonatal intensive care unit.

“Now they’re even more vulnerable,” she said.

The California Department of Public Health said hospitals are reaching capacity, and the decision was largely driven by staff shortages that make it difficult to provide essential care.

“Given those circumstances, the department is offering temporary flexibility to help hospitals and emergency services respond to an unprecedented surge and staff shortages,” the agency said.

The guidelines require hospitals to exhaust all other options before resorting to the new policy, and employees who have tested positive for the virus should be “preferably assigned to work with COVID-19-positive patients.” The workers must always wear N95 masks.

The announcement was met with outrage by many in the health sector.

The decision is “irresponsible and a major mistake that endangers the health of everyone,” said Rosanna Mendez, executive director of SEIU 121RN, a union that represents workers in Southern California. “This plan is unscientific and dangerous, and given what we know about the transmissibility of the new variant, we believe it will pose unnecessary risks to health professionals and patients.”

But some experts say that patients seen by asymptomatic workers who follow proper protocols are relatively safe, and that the policies — while not perfect — are a necessary interim solution to prevent the system from collapsing.

“Is the situation ideal? No,” said Dr. Robert-Kim Farley, an epidemiologist and infectious disease expert at the UCLA Fielding School of Public Health. “Is it the lesser of the two evils of having no one to take care of patients versus having staff taking care of them and potentially having COVID? Yes, it is the lesser of two evils.”

Kim-Farley said the policy is in recognition of the significant tension hospitals are experiencing amid increasing numbers of patients and reduced staff numbers. The chances of transmission from an asymptomatic worker are minimal, he said, especially since he or she would take precautions, including wearing high-quality medical masks.

But, he added, “when patient burdens start to fall and staff shortages are also reduced, we need to move away from this extraordinary approach.”

The situation in many hospitals already seems untenable, with some health professionals saying the new policies are putting more stress on an already overstretched workforce. Others said it was hypocritical of the state to ask coronavirus-positive staffers to come forward after they imposed a vaccine mandate that cost some workers their jobs.

Gabriel Montoya, an emergency medical technician at Kaiser Downey, said when he arrived at work one day last week, there were still patients in the waiting room who had been sitting there when he left the night before.

All of the emergency department’s beds — including 80 in the ER and 20 in a tent outside — have been full since the beginning of the year, he said. Housekeepers, environmental workers, delivery drivers and even the lab workers who process COVID-19 tests are sick.

Still, the policy change doesn’t take into account the realities of everyday patient care, which often requires “working inches apart,” he said. Instead of fixing the problem, it could make it worse.

“You’re going to make more people sick,” Montoya said. “That’s what’s going to happen.”

In addition, he said the change not only exposes patients and employees, but also their loved ones. Montoya takes care of his mother at home.

“Workers feel that they are being devalued — their own lives, that of their families — are not respected,” he said. “And then they’re traumatized again by going back to the workplace with obstacles that we didn’t have to deal with the day before.”

dr. Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at UC San Francisco, said Omicron’s newness makes it difficult to compare the risk of staff shortages with the risk of patient exposure, as there is little data on the new variant to work with.

What is clear is that understaffing poses a significant risk to patients. Research has found that short staffing results in more deaths, more morbidity and more accidents and errors, she said.

“Hospitals are really stuck between a rock and a hard place because you really have staff shortages and the number of patients is increasing,” Spetz said. “What are you doing?”

Some hospitals, including Los Angeles County-USC — the largest public hospital in LA — are weighing the options. The LA County Department of Health Services is reviewing proposed guidelines but has not yet issued an official policy, hospital officials said in an email.

“As always, in addressing any changes to our anticipated practices, the LA County Department of Health Services will make adjustments that follow data-driven science and uphold our responsibility for the well-being of our staff, our patients, and the communities we serve.” , they say. said.

California Health and Human Services Secretary Dr. Similarly, Mark Ghaly said Monday that the guidelines are not a requirement and asked health care systems to use the measure only after they have explored all other options.

But on Tuesday, nurses and representatives of the SEIU 721 union gathered outside the Los Angeles County Board of Supervisors meeting in downtown LA to speak out against the measure. The California Nurses Assn. said it similarly plans a “day of action” on Thursday to condemn the state’s decision.

dr. Ileana Meza, a SEIU union chairperson and nurse practitioner at LA County-USC, said the staffing situation at the hospital was deplorable. When she arrived at work on Monday, the parking lot looked empty because so many people were sick. Thirty emergency room nurses and 40 operating room nurses called in sick last week and some patients are waiting up to 20 hours to be admitted.

But there are safer solutions to the staffing crisis than asking coronavirus-positive health professionals to care for patients, she said, including investing in more staff, making efforts to improve compensation and morale, tightening visitor controls, all non-residents. cancel electives and non-critical procedures and focus on telemedicine.

“With this new decision, if you come to the hospital for a routine checkup, you could be checked by a clerk who is positive, your vital signs can be taken by a nurse who is positive, you could be seen by a doctor who is positive.” is,” Meza said.

“That means you enter the facility without the virus and you can contract the virus,” she said. “This is not the way to contain this pandemic.”

Times staff writer Gregory Yee contributed to this report.

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