In the first week of 2022, the U.S. officially surpassed one million new Covid-19 cases in a single day. With the spread of omicron, health care providers are experiencing a massive increase in demand, while at the same time facing staggering shortages of staff across every role. It's not just a shortage of nurses—the entire health care workforce is affected, from pharmacists and pharmacy technicians to people processing Covid-19 tests.
We've seen this play out before, but this time around is alarmingly different. Here's why: there are mass numbers of breakthrough Covid-19 cases, driven by a variant which seems to evade the protection of vaccines. For instance, in Massachusetts, breakthrough Covid-19 cases increased 122% the week of January 4 compared to the week prior. While current evidence shows that vaccines (and boosters) thankfully still significantly reduce the risk of severe outcomes of Covid-19, the reality is that many vaccinated Americans will get infected in the coming weeks.
With increasing numbers of cases, leaders must realize—if it's not happening already—that mass absences are likely. And with Covid-19 hospitalizations up 65% across the country in the two-week period leading up to January 6, hospitals may face high patient volumes without adequate staffing.
To help address the omicron variant's potential impact on the health care system, the CDC released new workplace guidelines for health care workers in December 2021. Even with these new guidelines in place, the sheer number of daily new cases impacting health care workers has the potential to leave gaping holes in staffing—even among hospitals who have already begun to pause nonemergency procedures to preserve staffing.
What should leaders keep in mind—and learn to accept—as we face the impact of the omicron surge on our health care workforce?
1. Significant numbers of health care workers will be unable to work.
Omicron is significantly more contagious than prior Covid-19 variants. As such, and with such a high level of the variant circulating in the community, both vaccinated and unvaccinated individuals have a higher risk of infection than they did a couple of months ago. While boosted health care workers have less strict isolation requirements, they still face the risk of breakthrough infection, and a mandatory isolation period whether they are symptomatic or not.
Staff members may also need to call out because individuals in their household are infected and need care, or due to unexpected school and daycare closures. Competing home and childcare obligations will once again keep health care workers home.
Between these reasons, enough staff are likely to be absent as omicron peaks in the local area to impact normal operations.
2. Staff may need to work while positive with Covid-19—whether or not they feel ready.
Under current CDC guidelines, staff may come back to work while still testing positive or experiencing mild Covid-19 symptoms. The CDC has outlined contingency and crisis plans—if staffing shortages get really bad—that have health care workers working even if they're technically supposed to be isolated. In order to keep patient care operating, staff with active infection can be asked to come into work, a situation some states and health systems are already facing.
This has significant implications for staff and for patients. Staff may experience pressure to work when they are still feeling sick because they are not technically required to stay home—or because they feel guilty for leaving more work on their already overburdened colleagues.
This pressure on staff is problematic as it may exacerbate the burnout many are already struggling with after two years of Covid-era patient care. Staff feeling compelled to come into work before fully recovering is bad for morale, which is already low among frontline workers.
At the same time, staff working while infected with Covid-19 has the possibility to impact patient safety—or at minimum, patient confidence in the care delivered. Patients knowing staff in hospitals are working while sick will only further erode patient trust in the health care system.
3. The omicron-related strain should be short-lived, but there may be serious long-term impact.
The omicron surge is predicted to be bad, but this is not 2020—we have vaccines and therapeutics, and according to estimates from other countries, omicron infections are predicted to peak soon. Data from South Africa indicate that omicron-related hospitalizations peaked about one month after the variant's detection. If America's experience with omicron mirrors that of South Africa—which we can't fully predict at this time—then the virus would burn through the workforce fairly quickly. Thankfully, current evidence shows that infections are relatively mild compared to prior variants, especially in vaccinated and boosted individuals. As such, it seems likely that widespread staff absence issues will be short-lived.
While absences are expected in the short-term, omicron could have long-term implications on staff leaving the field. Some staff may consider working while Covid-positive to be the breaking point for their careers after a long two years of burnout and struggling to balance individual safety, work, and home obligations while coping with the extreme stress and disrespect many health care workers have faced. Staff may no longer be willing to put their own physical and mental well-being at risk for their job. It is critical for leaders to support their staff members and watch for signs of burnout and turnover, both during and after the omicron surge.
The next few weeks won't be easy—but leaders need to understand all factors at play as staff absences increase in order to both maximize operational capacity and to support staff through a challenging time. As always, we are here to help.