With rising concern over hospital staffing shortages as omicron
cases rapidly spread, the Centers for Disease Control and Prevention on
Thursday shortened isolation periods for health care workers who contract
COVID-19.
اضافة اعلان
The agency recommended that health care workers who are
asymptomatic return to work after seven days and a negative test, adding that
“isolation time can be cut further if there are staffing shortages.”
The agency also said that those workers who had received all
recommended vaccine doses, including boosters, do not need to quarantine at
home following high-risk exposures.
The new guidelines apply to all health care facilities that are
directly involved in patient care. That would include hospitals, nursing homes,
dental offices and other medical sites.
While infections with omicron more often lead to milder
illnesses, the variant is highly transmissible, and hospitals have been bracing
for an influx of vulnerable Americans.
Many major hospital systems had already been forced to move
ahead on their own in recent days, creating a patchwork of guidelines regarding
infected workers in anticipation of a winter surge.
The shortest such policy for returning to work — five days, with
some other preconditions — is half the 10-day standard set earlier by the CDC.
Other hospitals have settled on seven days as a safe window for infected staff
members to return to work.
The agency’s new recommendations do not apply to the public.
Early in the pandemic, the CDC had set a 14-day isolation period for infected
Americans, to lower the risk of contagion, but then winnowed that back as more
research confirmed that a typical patient would be infectious for a shorter
amount of time.
Some medical experts pointed to limited evidence regarding when
a person infected with the omicron variant might no longer be contagious. But
other researchers have been urging shorter periods and said that the CDC
revisions were overdue.
“They are consistently behind in updating recommendations that
are needed now, especially as we face the daunting prospect of a sudden surge
in cases,” said Angela Rasmussen, a virus expert at the Vaccine and Infectious
Disease Organization at the University of Saskatchewan in Canada.
Dr. Ashish Jha, dean of the Brown University School of Public
Health, said it would make sense to shorten isolation times for the public as
well — especially for those who are vaccinated.
“Given that a large proportion of health care workers, like
other Americans, are going to get infected, finding a shorter period of time
for isolation is critical,” said Jha.
“I think we have reasonably good evidence with delta that
vaccinated people clear the virus far more quickly. There is no reason to
believe that wouldn’t be true for omicron.”
Hospital administrators have stressed that the new changes
allowing employees to resume work sooner would not put patients at risk.
Given that health care workers are tested frequently, are
largely vaccinated and must be masked, “the chances of causing a significant
amount of infections seem very low” if isolation periods are shortened, said
Dr. Bob Wachter, chair of the department of medicine at the University of
California, San Francisco.
“The consequences of keeping them out of the workforce are
massive when you think about the impact on health,” he added. UCSF also is
weighing whether to reduce the isolation period to five days for workers: “I
don’t know if five days saves us, but it’s better than seven and better than
10.”
Jha stressed, though, that more research is needed to
definitively answer questions regarding how long a person with an omicron
infection may remain infectious. The variant is far more contagious than
previous versions of the coronavirus.
The pandemic has exacerbated labor shortages that plague both
hospitals and nursing homes: Nurses, aides and other workers have suffered
extensive burnout, and many have left the field for more lucrative work. Just
this week, President Joe Biden said 1,000 military medical professionals would
be deployed to help hospitals, and the National Guard is already working in
some nursing homes and hospitals to address understaffing in several states.
Getting medical staff back to work sooner is the aim of several
policy changes at hospitals that are reporting higher caseloads. Along with a
shorter time frame for isolation, the policies include requirements regarding
testing, vaccination status and symptoms.
Hospitals welcomed the revised guidelines. “Today’s announcement
from the CDC will allow health care workers to safely return to caring for
patients sooner, which will help to alleviate the severe workforce shortage
crisis facing hospitals across the country,” said Nancy Foster, vice president of
quality and patient safety policy for the American Hospital Association.
Many hospitals are already overburdened, especially with
patients who remain unvaccinated and those who have delayed necessary care
during the pandemic.
“Speaking on behalf of Rhode Island, we are already in a
disaster level of care,” said Dr. Megan Ranney, an emergency physician and
academic dean at Brown University’s School of Public Health.
“We have no beds in the ER. We have no ICU beds that are
staffed. We are making decisions around treatment and triage that are
demoralizing and beyond what I would have thought we would be doing at this
point in the pandemic.”
The research on how long people remain infectious with omicron
is so far thin. A study in Norway looking at a large cluster of individuals who
were infected with the variant at a Christmas party in Oslo suggested that the
incubation period was around three days, shorter than for delta.
The study authors sent out a questionnaire this week to find out
how long those infected stayed symptomatic, said Frode Forland, specialist
director for infectious diseases at the Norwegian Institute of Public Health.
CDC guidance says that vaccinated individuals who get infected
with delta are likely to be infectious for less time than unvaccinated people.
Ann Marie Pettis, president of the Association for Professionals
in Infection Control and Epidemiology, acknowledged that decisions were being
made on limited data. Federal officials, she said, had to weigh the risk of
letting people go back to work too soon against the potentially greater risk of
not having enough health care workers to care for patients.
“The staffing shortage is a horrible situation right now, pretty
much across the board,” she said. Hospitals that moved ahead with shortened
isolation periods are likely concerned with large numbers of staff getting
infected and staying out for 10 days.
“They just can’t care for the patients they are trying to see,”
Pettis said.
While the situation is not nearly as dire as at the start of the
pandemic, she said, the choices now recalled a time when federal officials,
faced with a severe shortage of personal protective equipment, relaxed the
guidance around face coverings.
Deciding how to best protect workers and patients is
challenging, she said; “I don’t envy the CDC making the call.”
Others expressed frustration with the situation medical and
health professions find themselves in at this stage of the pandemic. “The fact
we have to discuss this in advance of clarifying guidance from public health
authorities is an indication of the impact that the omicron variant’s spread
will have on an already overstressed health care system,” said Dr. Daniel
Diekema, a physician and public health researcher at the University of Iowa
Carver College of Medicine.
Some health care workers themselves say they are concerned that
shortened isolation periods could endanger both staff and patients. “That would
be absolutely unconscionable,” said Jane Thomason, the lead industrial
hygienist for National Nurses United, a large union that has been outspoken
about the need to protect their members.
Ranney warned that the new protocols must be followed carefully.
“This should not be the equivalent of, ‘I don’t care if you have an N95; go
ahead and take care of patients anyways,’” she said, referring to protective
masks. “That’s not fair to the workers, and that’s not fair to the patients.”
Read More Region & World
.jpg)
.jpg)
