A recent study in the Journal of the American Medical Association contained a major finding which largely flew under the radar. It reported that 41% of 138 hospitalized COVID-19 patients in Wuhan, China acquired their infection from the facility. Presumably this was due to a lack of proper preventive strategies and possibly a lack of readily available personal protective equipment (PPE). Having these problems are bad enough in a healthcare system which first encountered this pathogen, but there is little excuse to be having these problems in an affluent country with a healthcare industry which had months to prepare.
A CNN commentator made the alarmist statement that we may get to the point where the national guard is escorting patients to a high school gym for placement on ventilators. This is of course a ridiculously misinformed statement since we do not have enough ventilators. We need to change how as a society, we live, and as a healthcare system, how we approach dangerous pathogens.
Our lack of redundancy in our healthcare system and lack of preparation for pandemics has exposed horrendous shortcomings. As a stopgap measure, the US Centers for Disease Control and Prevention (CDC) has recommended new staffing guidance for those exposed to COVID-19, so we have an adequate supply of trained professionals to treat patients.
Too many are viewing these recommendations as new guidance which can be followed to prevent major disruptions in our facilities. However, they should be viewed as LAST RESORT. We do not want to create a COVID-19 “Typhoid Mary” to be evaluating the frailest members of our society, where healthcare workers with inadequate PPE are taking care of patients until they develop symptoms as well.
We have gone far too long with not making the proper investments and attention to infectious disease even with some facilities not screening and decolonizing S. aureuspatients before surgery (recommendations of the World Health Organization) or even isolating patients with MRSA. I fear, that as a society, we may well have to pay the price for this neglect.
Facilities may be quick to enact these emergency staffing recommendations to ease strains on their operating budget and choose a path of least financial resistance. But COVID-19 workers should not come out of isolation unless a facility has:
· Curtailed all other elective services, including surgeries, and shifting the additional staff (and patient rooms) to COVID-19 care activities.
· Obtained additional workers on an emergency basis.
This would include workers from temporary agencies and reactivation of young newly retired workers or personnel who recently left their facility to another profession or to be with their family. State governments also have to engage to free up resources for facility staffing. This includes making sure the National Guard has proper PPE and training and possibly deploying into hospitals to help reduce staffing needs. A 2018 RNnetwork survey found that 49% of nurses considered leaving their profession over the last two years. There is a huge problem with nurse retention which has also created an untapped community resource. In addition, state nursing boards need to have plans to temporarily reactivate lapsed licenses of the large number of nurses who have left the profession for family reasons and burnout.
The needs of the patient need to be placed first and infection preventionists can play a vital role at the frontlines to help determine when these last resort procedures need to be implemented.
Will this fix our response? The short answer is no. The United States will also have to address shortages in PPEs and the tens of millions of those in the United States who have no access to healthcare and who may well serve as carriers and a nidus to spread infections.