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January 12, 2022

'We don't have good choices': More hospitals are asking Covid-positive staff to stay on the job

Daily Briefing

    The combination of record-high Covid-19 hospitalizations and widespread staff absences is overwhelming health systems—and leading some to ask their Covid-positive employees to continue caring for patients.

    Access our new omicron surge toolkit 

    'We don't have good choices'

    According to a Wall Street Journal analysis of HHS data, the United States hit its highest number of recorded hospitalized Covid-19 patients on Tuesday, reaching a seven-day average of 140,576 hospitalizations.

    And as many health care workers contract Covid-19 themselves, some overwhelmed hospitals are asking staff to return to work quickly—or, in some cases, never stop working at all, Politico reports.

    The practice is allowed by CDC guidance released last month, which allows institutions to speed up health care workers' return via several strategies, which the agency says are "meant to be considered and implemented sequentially":

    • Under conventional conditions, workers may return 10 days after their first symptoms or positive test—or after seven days if they've received a negative Covid-19 test and have no or only mild, improving symptoms.

    • Under contingency conditions, workers may return after five days, even without a negative test, as long as they are asymptomatic or have only mild, improving symptoms.

    • Under crisis conditions, there is no work restriction, although CDC encourages "prioritization considerations," such as considering whether workers are asymptomatic or mildly symptomatic.

    For instance, Dignity Health in Arizona recently changed its policy to allow staff members who are infected with the coronavirus but feel well enough to work to request clearance from their managers to return. "We are doing everything we can to ensure our employees can safely return to work while protecting our patients and staff from the transmissibility of Covid-19," Dignity Health said in a statement.

    Some hospitals say they're allowing staff to return to work without a negative test simply because Covid-19 tests are in such short supply nationwide. Shereef Elnahal, CEO of University Hospital in New Jersey, said, "We have long lines outside of our testing clinic for patients and families, and if I had to disproportionately keep testing my employees to bring them back to work, that would compromise access to testing for the community."

    Elnahal added, "We don't have good choices—or the choices that we want." Out of University Hospital's 3,700 employees, 300 are currently out, a situation that Elnahal says is "the worst it's been since the spring of 2020."

    Celine Gounder, an infectious disease expert at Bellevue Hospital, said her hospital now requires only a five-day isolation period—but she said it also requires doctors and nurses to wear N95 masks, regardless of their infection status. "If people are truly wearing their mask, I think it's very low risk," Gounder said.

    Meanwhile, the California Department of Public Health, citing "critical staffing shortages," issued new guidance allowing asymptomatic health care workers who have tested positive with Covid-19 to return to work immediately. Such workers must wear N95 masks and should, if possible, be assigned to treat patients who already have Covid-19, the department said.

    "Facilities implementing this change must have made every attempt to bring in additional registry or contract staff and must have considered modifications to non-essential procedures," the guidance added.

    Despite the current staffing crunch, some hospitals nationwide have elected not to allow Covid-positive staff to remain on the job. University of Michigan Health, for example, is still requiring infected staff to isolate for 10 days, and a spokesperson said it doesn't intend to change its policy.

    Reactions

    Chip Kahn, president of the Federation of American Hospitals, says hospitals generally support CDC's new guidance because it allows them flexibility to decide when to bring workers back. Some public health experts also support the measure, Politico notes, citing the importance of keeping health systems running to treat Americans' illnesses.

    However, a number of health care workers and advocate groups have come out against CDC's recent guidance and hospital policies.

    The California Nurses Association, for example, argued the state's new policy could lead to more Covid-19 infections. Cathy Kennedy, president of the association, said, "We want to care for our patients and see them get better—not potentially infect them." (Levy, Politico, 1/10; Licon/McDermott, Associated Press, 1/11; Bomey, Axios, 1/10; Kamp/Evans, Wall Street Journal, 1/11)

     

    Advisory Board's take

    What to do when there are no good choices

    The omicron surge is representing a true staffing crisis situation for employers across the country, and health care providers are among the hardest hit. No one wants to think about what happens when the essential workers can’t work—and that’s what is happening now.

    The emergency plans many states are putting in place are unquestionably needed in order to maintain continuity of care during the surge but are also agonizing to consider. Even setting aside the potential challenges to patient safety caused by staff working while infected, the impact on the workforce will be intense.

    Health care workers have been fighting the pandemic for nearly two years now, and fatigue and burnout were problematic even before omicron.  It remains to be seen what the long-term impact will be of calling staff in to work while testing positive, but I am concerned this will represent a breaking point.  Staff are exhausted and under pressure to continue to maintain efficiency in the face of illness, patient and family anger, and lack of childcare.   Where the early days of the pandemic brought 7 p.m. balcony applause in communities and meal offerings from employers, providers are now having to continue with all of the same challenges, and little of the same support.  Staff may also face significant moral distress from potentially exposing patients or colleagues to the virus.

    At minimum, leaders should do what they can to offer support to staff, knowing the weight these decisions put on their shoulders. 

    We are in a crisis point—and sometimes there are no good choices in a crisis. The health care industry, and states putting these policies in place, believe they are making the best decisions they are able to make given the surge, and the early data indicating that the omicron variant is milder, especially in vaccinated individuals. However, I would not be surprised to see more and more clinicians making their own choices coming out of the surge—choices that may take them out of the direct care workforce entirely.

    Learn more: Check out our new omicron surge toolkit

    We've collected our best resources and insights for creating capacity, supporting staff, communicating with patients, and more. This page will be a consistent work in progress as we compile the newest and most helpful resources. Check out all the resources, including:

    Access the toolkit

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