Frank Diamond

People with the coronavirus disease 2019 (COVID-19) now have options regarding how long they have to self-quarantine. The US Centers for Disease Control and Prevention (CDC) this week 

 its quarantine guideline. Before, the guideline said that people exposed to COVID-19 or who have COVID-19 should be quarantine for 14 days. In the updated guideline, the agency says that people without symptoms can stop quarantining on day 10 without getting a COVID test. People who are tested and test negative, can stop quarantining on day 7. The CDC said that a “14-day quarantine can impose personal burdens that may affect physical and mental health as well as cause economic hardship that may reduce compliance. Implementing quarantines can also pose additional burdens on public health systems and communities, especially during periods when new infections, and consequently the number of contacts needing to quarantine, are rapidly rising.”

That’s certainly the case currently, as the second wave of coronavirus disease 2019 (COVID-19) continues to break grim records. Yesterday, 100,067 people were hospitalized because of COVID, according to the COVID Tracking Project, and that’s a record. And according to Johns Hopkins University, there were 217,664 newly confirmed cases of COVID-19. Also, 2879 people died from COVID-19 yesterday. Both of those are single day records.

The United States has reported over 100,000 new COVID-19 cases for the 31 straight days. And, according to Johns Hopkins, it was the third time since the pandemic began that the daily number of new COVID cases passed the 200,000 mark.

Since the pandemic began, there have been about 14.2 million confirmed cases of COVID-19 in the United States. About 276,000 people in the United States have died from the disease. In the world, there have been over 65 million confirmed cases of COVID-19; with about 1.5 million people dying from the disease, according to Johns Hopkins University.

In the quarantine guideline change, the CDC also said that “the prospect of quarantine may dissuade recently diagnosed persons from naming contacts and may dissuade contacts from responding to contact tracer outreach if they perceive the length of quarantine as onerous.”

The ray of hope in the midst of the current COVID-19 surge is the progress that’s being made to get a vaccine approved and widely distributed to the public. A vaccine developed by 

 could be ready for distribution by December 15. One developed by 

 could be ready for distribution by December 22. The drug companies asked the US Food and Drug Administration (FDA) to grant emergency use authorization for their products.

And this week an advisory panel to the CDC said that healthcare workers and employees and residents at long-term care facilities should be 

 today says that a black market for the vaccine may already be forming. The rich and people with pull will try to jump to the head of the line. In the 

 article, bioethicist Author Caplan of New York University says that “there will absolutely be a black market. Anything that’s seen as lifesaving, life-preserving, and that’s in short supply, creates black markets.”

Essential workers will also probably be given early access to the vaccine. But who, exactly, is an essential worker? It’s supposed to be people who are needed to keep society functioning but cannot maintain social distance because of their job. As the 

 article indicates, it won’t be as simple as that. There is a lot of leeway there and you can bet that powerful lobbying organizations will argue that their members are essential. To cite one of the more publicized examples, Florida officials this year said that World Wrestling Entertainment counts as an industry with essential workers.

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The CDC says that people without symptoms can stop quarantining on day 10 without getting a COVID-19 test. People who are tested and test negative, can stop quarantining on day 7.

As COVID Rages, CDC Offers Reduced-Days Quarantine Options

No, there is no rest for the weary infection preventionist (IP). Not while the second wave of the coronavirus disease 2019 (COVID-19) 

. The United States recorded 3157 COVID-19 deaths yesterday (December 3), the highest number in a single day and more than 20% higher than the previous record of 2603 deaths set back on April 15, according to Johns Hopkins University. Meanwhile, according to the COVID Tracking Project, more than 100,000 people have been hospitalized for COVID-19, another new record. That’s an 11% increase in hospitalizations in a week; a 26% jump in the past two weeks. Rebecca Leach, RN, BSN, MPH, CIC, is an infection prevention coordinator and a member of 

’s Editorial Advisory Board. She’s also in the thick of the COVID-19 battle, routinely working 10-hour days but, as she says, thinking about the novel coronavirus every waking moment. She has some suggestions for how IPs can cope. Give “yourself permission, when you have those down times, to really let out those emotions and let it happen. It’ll help.” Leach adds, however, that “I honestly think there are going to be a lot of people who have really been working more on the frontlines than I am who are going to have long-term psychological effects from this.” Yesterday, Leach took time out of her busy schedule to file a dispatch from those frontlines via a conversation with 

It’s very busy. It’s very hard, I think, for a lot of us who have been working in this for almost the whole year now. And we all sort of anticipated this would happen over the holidays. And as states started lightening up on their restrictions, but it’s really hard to see it actually happening and to be resilient and to keep moving forward. It is a long journey, for sure.

Another one of our Editorial Advisory Board members, Doctor Kevin Kavanagh, is downright impatient with the public. He says the public isn’t taking this seriously enough. Not to put you on the spot, but are you also a little bit impatient with the public?

I definitely feel impatient in general with the public. I think the hard part is that we all are exhausted from this. Everybody’s tired of having to change their way of life for this and I can understand the fatigue factor in the public. I think my biggest impatience is probably more with leadership and government. Some states are doing more to be more proactive, and some states are not. And that’s where my biggest concern is. That we have leadership that really should be setting the standards and the expectations. And this is the time when public health authorities really need to be the ones to make those statements and be listened to. And I think if that happened, as we saw before, in the summer, when states really locked down or mandated masking and that kind of thing, we saw a decrease. If we did that, again, I think it would work. I just think that there are a lot of people who just don’t want to do that for various reasons; a lot of economic reasons, political reasons. But it just is very frustrating.

How much hope are you placing in a vaccine maybe controlling this thing?

Well, I’m trying to be very hopeful about the vaccine, but also very realistic. We know there are not going to be enough doses until probably well into next year to really cover a lot of people that we would have to change a lot of these behavior modifications we need to do. You know, they say in the next few weeks, potentially, that we would start seeing a vaccine being disseminated here in Arizona, which is exciting news. But it’s going to be limited to however many doses we get. And then of course, that tier of who’s going to get it first, which will be most likely 

healthcare workers and long-term care residents

. And the whole process of how they’re going to distribute it and all of that is a little bit up in the air. There are plans, but do they have the people to actually give the vaccines and track it and how is that going to work? So, you know, it is hopeful. But it’s not the end by any means, especially not in the next few months. I think we’re going to keep seeing cases go up in the next few months until the vaccine is more distributed or we make other changes like we did before with masking and the closing down of gathering places.

Forgive me for forgetting this. You’re in Arizona. You’re an infection prevention expert. How many facilities do you actually oversee the infection prevention for?

Well, right now I’m actually in a different position. I’m in one main facility, but it’s a large facility 570 beds, and then we also have some satellite clinics and a smaller facility that we oversee. It is part of a large healthcare system.

I’m actually here at least 10. But thinking about it and working on it constantly, pretty much. Always thinking about COVID-19 for sure.

Have you discovered tricks regarding how to take the pressure off that you can share with your fellow infection preventionists or fellow healthcare workers who also on the frontlines?

I would say that most of us who have been dealing with this for so long have had our highs and lows, where you have your days where you feel like you’re energized, and you can really do this, and then you have those really hard days. And I think the biggest thing is just having support, whoever it is. If it’s a fellow infection preventionist that you can talk to, people at 

home that you can talk to. It really is that emotional support of being able to talk to each other about your experiences and really process your feelings. And I think a lot of it too is we on the frontlines have to be strong. We’re the ones that have to do the work. And so giving yourself permission, when you have those down times, to really let out those emotions and let it happen. It’ll help. But I honestly think there are going to be a lot of people who have really been working more on the frontlines than I am who are going to have long-term psychological effects from this.

Has spreading the message of infection prevention gotten easier? How do you feel about deputizing other people to be part of an infection prevention team—not officially a part of the team—but part of the infection prevention effort?

I think that actually has improved quite a bit. In the beginning, when we were first doing this, it was infection prevention who was sharing the knowledge and explaining the concepts behind the preventive isolation and transmission and all that sort of thing. And now, since they talked about it so much, there are so many people who are knowledgeable. For example, here on our nursing unit [there are] educators, clinical leaders, who are very well versed in the basic infection prevention concepts and can really be that extra line of defense that we need and can offer that information. Which is really nice in this second wave. That’s a little bit of a different thing for us. We’re not the only ones who have the knowledge, right? Or are seen as the ones who need to answer all the questions. There are other people who they can turn to now. So that kind of takes a little bit of the pressure off of the infection preventionist and we can focus in on maybe other areas like the vaccine development and other things that we’re going to be involved in going forward.

Are there things that only an infection preventionist can deal with?

Well, for example, what we saw with the first wave, the big way here over the summer in Arizona, was a lot of our patients who had COVID also developed other hospital-acquired infections such as CAUTIs [catheter-associated urinary tract infections] or CLABSIs [central line-associated bloodstream infections]. We saw a huge increase in those. And I think that’s been shown pretty consistently across the country and in journals and articles. And so that’s some of the work that we’re trying to focus on here. We know we have these patients who are incredibly challenging treatment-wise. How are we going to prevent this this time around? How are we going to not have CAUTI-CLABSI increases for our patients with COVID? How do we maintain that standard work of the preventive bundles that we know we need to do with such a challenging population and other things we need to do on top of what we’re already doing for these patients? So that’s some of the work that we can focus on as well.

Another expert I spoke to said that within the next 10 years she expects that about 40% of infection preventionists currently working will retire. Do you see COVID, ironically, as maybe holding up infection prevention as a possible career path for younger healthcare providers?

I think so. But I’m also thinking maybe this pandemic will inspire more young providers to become infection preventionists because it’s more exposure to different areas where people didn’t always know what we did or what our jobs involved. And maybe this will inspire people to become involved in infection prevention and public health in different ways. I’m hopeful that that might come out of this; is a little bit more exposure to what our jobs are, as well as a little bit of an evolution in what we do and we’re seeing more of this in the emergency response area as pandemic planning. And other things that we in infection prevention always knew we’re an important part of, but now I think everybody kind of sees how important we are.

Are you at your facility? Are you speaking at home?

So, you’re in an empty room with the proper airflow. When this interview is over, will you be doing all the donning and doffing of personal protective equipment? Putting on the goggles and all that stuff?

Yes. Right now I’m in here by myself. But we have universal masking and eye protection required for all staff who come in the hospital. And then of course, if I were to go in a patient’s room that was in isolation, then I would have the gown and the gloves as well. Or if it was an N95 necessary, then I would put that on. I don’t see myself without goggles and masks very often.

Do you feel a little bit of pressure because you’re the infection preventionist and you have to set the best example?

I’ve always felt that pressure even before all of this. People watch us. If we’re going in and doing rounds on patients, we better be doing our hand hygiene before and after. And we better be making sure we’re following those guidelines. I’ve always felt that. People are always kind of watching you. You set the example. So especially with this, there have been times where I’ve walked out and forgotten my mask, and I’m like, I’ve got to run back and grab it. You just forget, sometimes. That’s normal.

Hospitals can be hierarchical institutions. Have you ever had to flag a surgeon or hospital administrator and say, “Hey, you’re not doing this right?”

We try to really empower everybody to be able to do that, as well as have people understand, if somebody says something, don’t take it personally. We’re all just trying to watch out for each other. It is very hard. And even before COVID, that’s kind of that culture of safety that you always talked about with infection prevention for a long time. Just having anybody from any position in the hospital be able to speak out if they see something that may be a safety issue. With COVID, for sure, that’s important. But it’s been important for a long time, and some facilities are really great at it and have that culture of safety, and others are still on the journey. This definitely is something where because of that sense of personal safety, maybe people feel a little bit more empowered to speak out. But I think there still is that hierarchical concern for certain groups. And that’s something that an organization would need to work on for sure.

Is there a anything that I neglected to ask you about what it’s like on the frontlines that you think might be pertinent and that your fellow infection preventionists or any other healthcare professional should know?

I think the biggest thing that we need to keep in mind is we’re all on the same team. And so there will be times when people are just tired, and we need to be empathetic to that and understand that if people challenge the recommendations or some of the processes that we put in place, to approach it not from a position of defensiveness, but to really understand where they’re coming from. Because their experience may be different than mine. And I need to understand what they’re going through and how it’ll impact them and as well as what they have learned because everybody has learned different things doing different parts of this pandemic response.

This interview has been edited for clarity and length.

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Rebecca Leach:  “I think the biggest thing is just having support, whoever it is. If it’s a fellow infection preventionist…. It really is that emotional support of being able to talk to each other about your experiences and really process your feelings.”

Infection Preventionist: ‘We On the Frontlines Have to be Strong’

Infection preventionists and other healthcare professionals battling coronavirus disease 2019 (COVID-19) fight a foe that’s paving a trail of illness, hospitalizations, and death not seen before during this pandemic. Grim records keep getting broken and trends indicate that the COVID-19 scourge only promises to get worse. The United States recorded 3157 COVID-19 deaths yesterday, the highest number in a single day and more than 20% higher than the previous record of 2603 deaths set back on April 15, according to 

. The number of new cases of COVID-19 confirmed yesterday was 180,083, the fifth highest single-day increase.

, more than 100,000 people have been hospitalized for COVID-19, another new record. That’s an 11% increase in hospitalizations in a week; a 26% jump in the past two weeks.

” that Anthony Fauci, MD, director of the CDC’s National Institute of Allergy and Infectious Diseases, warned about when healthcare experts cautioned the public about traveling and getting together over the Thanksgiving holiday. Travel was indeed less than it had been in previous years, but still way too high in the midst of a pandemic, according to many healthcare experts. When asked in a recent 

 whether the lessening of travel over Thanksgiving was enough to slow down the pandemic, Kevin Kavanagh, MD, a member 

’s Editorial Advisory Board and the founder of the patient advocacy organization Health Watch USA, responded: “Absolutely not. I think it’s very problematic with what I’ve seen. I’m very scared we’re going to have another surge.”

As with the first wave, some states are getting hit harder than others. In Nevada, 29% of all hospital beds are occupied by COVID patients, according to the 

US Department of Health and Human Services

. Seventy-seven percent of that state’s inpatient beds and 80% of the beds in hospital intensive care units are in use. In New Mexico, 27% of hospital beds are occupied by COVID patients. Colorado and Arizona are also being feeling the strain, with 20% of their hospital beds being occupied by patients with SARS-CoV-2. Meanwhile, in 32 other states, at least 10% of all hospital beds are being occupied by COVID patients. 

The shifting of more and more healthcare resources and space to COVID victims, means less healthcare resources and space will be available for non-COVID patients. In addition, as one hospital in New Jersey 

, the relaxing of infection prevention protocols in order to stave off COVID presents an opportunity for other deadly pathogens. That 850-bed urban hospital found itself not only having to deal with COVID, but also with carbapenem-resistant Acinetobacter baumannii (CRAB), a pathogen that has a 55% morality rate.

Infection preventionists and other healthcare workers strive to keep up. “The hard part is we all are exhausted from this,” says Rebecca Leach, RN, BSN, MPH, CIC, an infection prevention coordinator and a member of 

’s Editorial Advisory Board. Leach says that she works at least 10 hours a day but thinks about the pandemic every waking moment.

“Everybody is tired of having to change their way of life for this. And I can understand the impatience with the public. My biggest impatience is with leadership in government. Some states are doing more to be proactive and some states are not. And that’s where my biggest concern is…. As we saw before in the summer, when states really locked down or mandated masking and that kind of thing, we saw the decrease. If we did that again, I think it would work.”

Reports that COVID vaccines developed by by 

 could be approved soon by the US Food and Drug Administration (FDA) and distribution for those vaccines will start as early as December 15 and December 22 respectively, offer some hope that help may be on the way. In addition, an advisory panel for the US Centers for Disease Control and Prevention (CDC) 

 that exhausted infection preventionists and other healthcare professionals should be first in line to get the vaccines, along with residents and employees at long-term care facilities. Meanwhile, though infection preventionists must deal with what’s going on now.

“I’m trying to be very hopeful about a vaccine, but I’m also realistic,” says Leach. “We know that there are not going to be enough doses until probably well into next year to really cover a lot of people. They say in the next few weeks we may start seeing a vaccine here in Arizona, which is exciting news. But it’s going to be limited to however many doses we get…. And the whole process of how it’s going to be distributed is a little bit up in the air. Do they have the people to give the vaccine and track it and how is that going to work? I’m hopeful, but it’s not the end by any means especially in the next few months.”

The United States recorded 3157 COVID-19 deaths yesterday, the highest number in a single day and more than 20% higher than the previous record of 2603 deaths set back on April 15.

Fast and Furious: COVID Surges to Unprecedented Levels in U.S.

As the vaccines for coronavirus disease 2019 (COVID-19) move closer to becoming reality, with the products developed by 

 both up for approval in the United States, the question remains: Who should get it first? Answer: You. That is, infection preventionists and other healthcare professionals, as well as residents and workers at long-term care facilities.

So voted a special advisory committee to the Centers for Disease Control and Prevention (CDC) yesterday. That committee, the Advisory Committee on Immunization Practices, 

 to put healthcare providers and long-term care facilities first in line. The recommendation was 

The term healthcare provider covers a lot of professional territory by this panel’s definition. It includes employees at hospitals and outpatient clinics and long-term care facilities. But also public health workers, home healthcare workers, pharmacy workers, and emergency medical service workers. That comes to about 24 million Americans in all.

 emergency use authorization for the Pfizer/BioNTech vaccine, becoming the first country in the world to approve a vaccine for wide distribution.

Both Pfizer/BioNTech, and Moderna have asked the US Food and Drug Administration (FDA) to grant emergency use authorization for their products. Operation Warp Speed, the special panel created by the White House to oversee the vaccines’ speedy development and distribution, says the Pfizer vaccine could be ready for distribution by December 15; the Moderna vaccine by December 22. States must order the vaccines through Operation Warp Speed.

As healthcare officials have been saying for some time, the arrival of a COVID-19 vaccine will not amount to doing away with social distancing, hand hygiene, and masking.

Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and a member of the White House coronavirus task force, co-wrote a viewpoint in October in 

 in which he argues that these “‘low-tech’ tools to prevent the spread of SARS-CoV-2 are essential, and it must be emphasized that these interventions will still be needed after a vaccine is initially available.”

The one vote on the CDC advisory panel against the recommendation concerning vaccine distribution was by Helen Talbot, MD, a vaccine researcher at Vanderbilt University. She argues that there just aren’t enough data to prove that the vaccine should be used on elderly residents at long-term care facilities.

“I have spent my career studying vaccines in older adults,” Talbot said, as reported by 

. “We have traditionally tried a vaccine in a young, healthy population and then hoped it worked in our frail, older adults. And so we enter this realm of ‘We hope it works and we hope it’s safe.’ And that concerns me on many levels.”

Kevin Kavanagh, MD, also has some misgivings about the coming COVID vaccines. “I’m worried that they are going to cause a significant immune response, not one that’s dangerous, but one which may discourage people from getting the vaccine,” Kavanagh tells 

. “We see this with the shingles vaccine. People take the first dose. They don’t want to take the second dose, because they had a fever and were sick.”

Kavanagh also fears that SARS-CoV-TWO will mutate. And that means that another vaccine will need to be developed to tackle that mutation. “Now, the good news on that front is that with the new technology of mRNA, it looks like these vaccines may be able to be printed in a matter of weeks,” Kavanagh said. “So that you’ll have very rapid response.”

Still, when you consider that according to a Gallup poll in October, 42% of Americans say that they will not get the COVID vaccine, the concerns raised by Doctors Kavanagh and Talbot give pause.

Healthcare providers, according to the CDC advisory panel, includes workers at hospitals, outpatient clinics, long-term care facilities, public health agencies, home healthcare firms, pharmacies, and emergency medical services. About 24 million Americans in all.

Frank Diamond

Articles

As COVID Rages, CDC Offers Reduced-Days Quarantine Options

Infection Preventionist: ‘We On the Frontlines Have to be Strong’

Fast and Furious: COVID Surges to Unprecedented Levels in U.S.

Healthcare Workers to Be First in Line for a COVID Vaccine