In his analysis, Kevin Kavanagh, MD, explores the measures taken by the infectious disease sector in response to the pandemic, pointing out both effective and ineffective approaches. He also discusses how the pandemic has affected the treatment of other infectious diseases.
The United States is evaluating its pandemic response and updating infection control strategies. Another pandemic is all but assured; whether it is from an artificial lab leaked virus or one of natural origin, there is a growing consensus that we will be faced with a new pathogen within the next few decades. In fact, many COVID-19 experts place the odds at 20% in the next two years of experiencing an outbreak comparable to that caused by the Omicron variant.
Yet, we are not even finished with our current pandemic. The recent news of a significant COVID-19 surge in Okinawa, Japan, with cases 25 times baseline and more severe than the peak of their record-setting eighth COVID-19 wave, has raised concerns. There are reports of 8.3% of hospital staff on leave and surgery and treatments being postponed. Many are worried this may be a harbinger of what the United States may experience in the coming months.
However, SARS-CoV-2 is rapidly entering an endemic phase in the United States. SARS-CoV-2’s seroprevalence is over 96%. This does not mean “herd immunity” has snuffed out the virus, but that we may have more of a constant than fluctuating level of infections. There is a continuing toll of long COVID on our society, with patients receiving far too little support. An estimated 2 to 4 million Americans have left the workforce due to long COVID representing 100s of billions in lost wages. Receiving Social Security benefits is difficult at best.
Thus, it is of utmost importance that we mitigate the spread of disease and reduce the number of infections. One will only develop long COVID if one becomes infected with SARS-CoV-2.
Unfortunately, SARS-CoV-2 is not the only disease on the rise; other illnesses, such as syphilis, methicillin-resistant staphylococcus aureus (MRSA), and other antibiotic-resistant infections, are increasing. Screening needs to be the keystone in control strategies. Numerous studies have documented the effectiveness of screening for MRSA pre-surgery and upon hospital admission in preventing surgical and hospital-onset infections. The United Kingdom’s National Health Service (NHS) routinely performs hospital admission screening.
Data from the United States Veterans Health Administration (VHA) clearly shows that screening for MRSA can dramatically reduce hospital-onset infections in acute care settings. During the COVID-19 pandemic, private sector acute care hospitals increased MRSA infections above their 2010 to 2011 baseline, as the VHA had an 83.6% decrease. Even VHA nursing homes (Community Living Centers) had a 68.2% decrease.
The same is true regarding COVID-19. Theodore Pak et al found an increase in hospital-onset COVID-19 once preadmission screening was curtailed in the United Kingdom. This study was performed by Harvard researchers who did not analyze the data from the United States due to the lack of quality COVID-19 hospital-onset data and the poor definition of the COVID-19 hospital-onset metric.
The lack of publicly available data regarding the incidence of MRSA, COVID-19, and other pathogens in the United States is concerning. This data should be readily and publicly available for community and facility-onset infections. For example, in real-time, MRSA data should be posted at least monthly to promote public awareness of current risks in their communities and facilities. To have the primary method of distribution in research papers or websites, where the data is published well over a year later, does a disservice to our citizens and inhibits our ability to address the epidemic of multi-drug resistant organisms.
Unfortunately, our infectious disease policy appears not to be fixing these problems but instead is retreating. The draft CDC Healthcare Infection Control Practices Advisory Committee (HICPAC) updated infection control recommendations need to adequately address screening. They even give the go-ahead for the use of surgical masks with some aerosolized pathogens, such as seasonal influenza.
One of the worst proposed policies is Enhanced Barrier Precautions (EBP), an antiaptronym since they are watered-down precautions that are even being advocated for Candida auris and MRSA. EBP allows contact precautions only to be used some of the time, and the resident is allowed to roam around the facility. “Residents are not restricted to their rooms and do not require placement in a private room.“ Even with low transmission risk activities, such as passing medications, these activities are performed so frequently that transmission can still occur.
Enhanced barrier precautions and not advocating for admission screening of major pathogens is the opposite of determining and modifying a patient’s microbiome to prevent spread to other individuals.
In the 1980s, we used to test everyone admitted to the hospital for syphilis, tuberculosis, and urinary tract infections. It was an accepted practice. Currently, universal admission surveillance is viewed as controversial, being undermined by shoddy research and what appears to be industrial pressure.
For now, patients can only guard against exposure to aerosolized pathogens by wearing a well-fitted N95 mask in healthcare settings and using CO2 monitors to screen for adequate air ventilation. In the future, real-time screening for pathogens will become available. Newly published research describes the ability to detect SARS-CoV-2 in the air after a 5-minute sample analysis utilizing a portable unit (12” x 10” x 10”). The same should also be available for influenza and RSV.
Infection control guidance must be made much more straightforward and shielded from political influences. What is needed to control an organism is what is required to be implemented. The pathogen does not care where it is. The same interventions are needed in nursing homes as are needed in hospitals. And workers need to be protected from all, not some aerosolizing pathogens. No one wishes to be sick for days or weeks at a time. Just because it does not kill you is not an excuse to only provide a worker with a surgical mask or to not take necessary preventative strategies to limit airborne spread.