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“State officials are attempting to address California’s staffing shortage through a sweeping policy change that allows asymptomatic healthcare workers who have tested positive for the coronavirus to return to work immediately. The policy, set to remain in place through Feb. 1, is designed to keep many healthcare workers on the job at a time when hospitals are expecting more patients.
Some experts say California’s stance is an unorthodox yet necessary solution to a difficult problem. Yet many healthcare workers and community members say the policy is not only ill-advised, it’s potentially dangerous…
The California Department of Public Health said hospitals are reaching capacity, and the decision was driven in large part by staffing shortages making it difficult to provide essential care.
“Given those conditions, the department is providing temporary flexibility to help hospitals and emergency services providers respond to an unprecedented surge and staffing shortages,” the agency said.
According to the guidelines, hospitals should exhaust all other options before resorting to the new policy, and workers who have tested positive for the virus should “preferably be assigned to work with COVID-19 positive patients.” The workers must always wear N95 masks…
“Is the situation ideal? No,” said Dr. Robert-Kim Farley, an epidemiologist and infectious-diseases expert at the UCLA Fielding School of Public Health. “Is it the lesser of the two evils of having no one to care for patients, versus having staff caring for them that may have COVID? Yes, it’s the lesser of two evils.”
Kim-Farley said the policy is a recognition of the significant strain hospitals are experiencing amid an increased number of patients and decreased number of staff. The chances of transmission from an asymptomatic worker are minimal, he said, particularly since he or she would be practicing precautions, including wearing high-grade medical masks…
One thing that is clear, however, is that understaffing poses a substantial risk to patients. Research has found that short staffing results in more deaths, more morbidity and more accidents and errors, she said.
“Hospitals are really stuck between a rock and a hard place, in that you really do have these staffing shortages and you have volumes of patients increasing,” Spetz said. “What do you do?”” (E)
“The new protocol, announced Saturday by the California Department of Health, means health workers exposed to COVID-19 or those who have the virus with no symptoms may return to work “immediately” – without the need for a test or quarantine – and wear an N95 mask. The move comes in response to a severe staffing shortage in the state, amid an upsurge in the omicron variant.
Asymptomatic health professionals who had tested positive for COVID-19 should “preferably be assigned to work with COVID positive patients”, the Californian health officials said, adding that this might not be possible in areas of “extreme” staff shortages or in places such as the emergency room where it wasn’t possible to know who had COVID-19.
According to the Centers for Disease Control (CDC), health professionals with COVID-19 may work without restrictions if “asymptomatic” or “mildly symptomatic” as part of a staff shortage “crisis” plan.
In “conventional” situations, health workers who had tested positive for COVID-19 and had no symptoms or mild symptoms should isolate for 10 days or seven days with a negative test, the CDC says.
Insider reported Thursday that some nurses with COVID-19 in the US are being forced to work, even with symptoms.
The California Department of Health said the measures were due to “critical staffing shortages”. Sites that implement this change must have made “every attempt” to bring on additional staff and considered “modifications to non-essential procedures”, it said…
Robert Siegel, a professor of microbiology and immunology at Stanford University, told the Chronicle, that there might be situations where “we might want to relax some of the testing requirements because staffing situations are dire, but in general, we should be more cautious.”
“It’s clear that a great deal of transmission occurs from asymptomatic people,” he said.” (F)
“The acting head of the US Food and Drug Administration said on Tuesday that most people in the United States are eventually going to get infected with COVID-19.
“It’s hard to process what’s actually happening with now, which is most people are going to get COVID,” Janet Woodcock, acting commissioner of the FDA, said to a Senate Health, Education, Labor, and Pensions Committee hearing.
The highly transmissible Omicron variant is currently sweeping through the country, and Woodcock said that past approaches to mitigating the spread of the virus don’t reflect the current situation in the US.
“What we need to do is make sure that hospitals can still function, transportation, you know, other essential services are not disrupted while this happens,” she said.” (A)
“In a series of tweets last week, Dr. Ashish Jha, dean of the Brown University School of Public Health, stressed that both patients “with COVID-19” and those admitted “for COVID-19,” have an impact on care, utilization, and can stress the health care system.
Patients, who may have come in for another ailment, such as a broken leg, and are found to be positive for the virus must stay in a COVID-19 isolation room, explained Jha, who added that there are already a limited number of such rooms available.
In addition, every time a health care worker enters a room with a COVID-19 positive patient, they must be wearing full PPE, which in turn, prolongs wait times for many patients.
“Admissions with COVID is still very disruptive to the health care system, at a time when it can’t afford more disruption,” Jha said.” (B)
“The number of hospitalized people with COVID-19 in New Jersey rose by 225 Monday night to 6,036, after an overnight adjustment to Sunday’s numbers by the state Health Department due to a reporting error.
That represents a 28% increase in COVID hospitalizations since Jan. 2. And the number of people seriously ill needing a ventilator rose to 500 Monday — a 71% jump in that period. The number in intensive care also rose, to 892, a 39% increase since Jan. 2…
“In reports from some of the state’s hospitals, a profile of ventilator patients is beginning to emerge, with a significant number unvaccinated against COVID, and many with morbid obesity and vascular conditions as complicating, co-occurring conditions,” Bennett said.
While rising steeply, the number of patients on ventilators still remains far below what it was during the first wave of the pandemic in late April of 2020, when more than 1,300 ventilators were in use.” (C)
“There are a lot of ways to describe the we-simply-don’t-have-enough-health-care-workers-to-handle-this-wave staffing crisis that is going on in hospitals around the state, if not the country.
As CEO of RWJBarnabas Health, it is something that Barry Ostrowsky said his team deals with around the clock.
“It takes literally hourly management and leadership to ensure you have the right level of personnel bedside and supporting the bedside personnel,” he said. “And that has been the case through the pandemic.”
Hospitals are again struggling to find enough staff. The surging wave of cases from the COVID-19 Omicron variant hasn’t helped. Hospitalizations have now exceeded 6,000 — a number the state hasn’t seen since the opening months of the pandemic.
Last week, Health Commissioner Judith Persichilli said hospitals should prepare for a 30% absentee rate for workers…
Mike Maron, the CEO at Holy Name in Teaneck, said the long-term outlook is just as tough. Finding additional personnel to assist has been nearly impossible.
“I’ve never seen this many vacancies in 34 years here,” he said….
Horan said Trinitas has become a community health center, which it is not meant to be during a pandemic.
“Patients are coming in just because they want to be tested, not because of an emergency reason,” he said. “They may need a test just to be able to fly someplace or go visit someplace. The problem is, once they get registered into the emergency department, you can’t just say, ‘Oh, we don’t do the test, go home.’ We have to see them.”” (D)
“About 24% of U.S. hospitals are reporting a “critical staffing shortage,” according to data from the U.S. Department of Health and Human Services, as public health experts warn the COVID-19 surge fueled by the omicron variant threatens the nation’s health care system.’’ (G)
“The Chief Medical Officer at the Colorado Department of Health and Environment reactivated Crisis Standards of Care for Emergency Medical Services. Guidance to the EMS providers on how to best use their services is needed at this time. The last time the state activated Crisis Standards of Care for Emergency Medical Services was April of 2020.
These crisis standards provide guidance for call centers, dispatch centers, and emergency medical service agencies, and responders regarding how to:
Interact with potentially infectious patients.
Maximize care for multiple patients with limited staff and emergency vehicles.
Determine what kind of treatment to provide, such as whether and where a patient should be transported for further care, if deemed necessary.” (H)
“Citing the “unprecedented strain” from the latest COVID-19 surge, a majority of Delaware hospitals are implementing emergency rules to cope with the surge of COVID-19 patients.
ChristianaCare, Bayhealth, TidalHealth Nanticoke and Saint Francis announced in a joint statement on Monday that they all will be implementing the rules, called Crisis Standards of Care.
This will allow the hospitals to redeploy clinical and non-clinical staff, adjust staffing ratios and change how treatment resources are distributed, according to a news release.
ChristianaCare, the largest health system in Delaware, was the first hospital to make this announcement.
The rules are implemented only during emergencies. Hospitals across the country have made similar decisions due to the number of COVID-19 hospitalizations.
“The current demand for care surpasses the normal resources that we have available,” hospital officials said in a statement. “Each of our organizations is taking steps to ensure that we are able to prioritize care for those with the greatest needs.”
Delaware’s health systems, officials said, are “stretched beyond capacity.” Hospitals are also asking residents to go to hospitals’ emergency rooms for serious health issues only…
The ChristianaCare release defined the emergency rules as a “framework in which health care providers can modify processes or change the way resources are allocated in order to care for patients with the highest need in conditions when it is no longer possible to deliver care according to normal standards.” (I)
“We have more patients,” Dr. Hassan Khouli, who is head of critical care at the Cleveland Clinic, told Snow when comparing the current situation to last year. “Our patients are sicker. Our teams are tired and exhausted, too.”
He said their unit is seeing patients in their 20s, 30s and 40s.
The conversation between Snow and Dr. Hassan then turned to the possibility that overcrowded COVID conditions in the ICU could lead to life-threatening concerns for other patients.
Snow: “Does that mean that somebody that comes in with a heart attack might end up dying because they can’t get into your ICU?”
Dr. Khouli: “That is possible, or they would wait in the emergency room while waiting for a bed in the intensive care unit — or they may be actually crashing on the floor.”
Snow’s report said most of the patients in the Cleveland Clinic’s ICU are currently on ventilators – 90 percent of which are unvaccinated. Approximately 5 percent of the hospital’s staff is also out sick. One nurse, for example, is now covering as many as 17 patients compared to eight on a typical day.” (J)
“Members of the U.S. Air Force will begin arriving in Ohio over the next several days to begin deployment to Cleveland Clinic.
Starting next week, 20 Air Force members will be helping staff the Clinic to deal with the omicron surge.
Those 20 people could have a big impact.
The hope is that adding these service members will allow Clinic hospitals to open more beds and accept more transfers from other hospitals.” (K)
“The Oregon Health Authority (OHA) has provided the state’s hospitals with an interim crisis care tool to help them prioritize treatment if they reach a point when critical care beds, specialized equipment, such as ventilators, and other resources become scarce due to surging COVID-19 admissions.
Oregon hospitals may activate crisis standards of care if their critical care resources are severely limited, the number of patients presenting for critical care exceeds capacity, and there is no option to transfer patients to other critical care facilities, according to a release from the OHA.
Hospitals may implement OHA’s interim crisis care tool – or one of their own that is consistent with Oregon’s Principles in Promoting Health Equity in Resource Constrained Events – if they have taken specific steps to extend their capacity to deliver care. Those steps include stockpiling supplies, delaying non-urgent care, and repurposing existing beds and staff that are not typically used to provide critical care.
Under the interim triage tool, all patients who can potentially benefit from treatment will be offered care, if health care resources are sufficient. If hospital staff, beds and treatment are insufficient, all patients will be individually assessed according to the best available objective medical evidence. According to the tool:
No one will be denied care based on stereotypes, assumptions about any individual’s quality of life, or judgement about an individual’s “worth” based on the presence or absence of disabilities.
Care decisions should be based on the likelihood of survival to hospital discharge.
Under Oregon’s interim crisis care standards, state health officials expect providers to treat all patients with respect, care and compassion. Hospital clinicians may not base care decisions on an individual’s use of past or future medical or social resources. They should apply reasonable modifications to any triage scoring criteria when considering individuals with underlying disabilities or certain underlying health conditions, according to the release.
Triage decisions will be made without regard to morally or scientifically irrelevant considerations such as income, race, ethnicity, gender identity, sexual orientation, immigration status, health insurance coverage or other factors…
At the same time, OHA also is calling for applicants today to serve on a new Oregon Resource Allocation Advisory Committee.
The Oregon Resource Allocation Advisory Committee’s role will be to:
Review and inform updates to OHA’s Principles in Promoting Health Equity During Resource-Constrained Events, which ensures health equity in decision-making when resource shortages occur.
Review and inform future amendments or changes to the interim crisis care tool.
Guide development of any additional necessary resources – including triage tools, guidance, best practices – to ensure these principles can be readily applied in Oregon during a resource-constrained event.
Inform the norms and expectations regarding patient communication and transparency when health system allocation decisions are necessary due to resources constraints.
OHA is seeking applicants representing: the state’s health care delivery system, including hospitals, health care providers and local public health agencies; and organizations and community members who can speak to community needs, especially communities of color, tribal communities and people with disabilities, including people with intellectual and developmental disabilities.” (L)
“President Joe Biden on Thursday said he was deploying more military health workers to hospitals in six U.S. states, and would give Americans free masks and more free tests to tackle the fast-spreading Omicron variant around the country.
The phased dispatch of 1,000 military health personnel beginning next week comes as U.S. COVID-19 hospitalizations hit a record high with Omicron overtaking Delta as the dominant variant of the coronavirus and health facilities facing a staffing crunch.
The move is “part of a major deployment of our nation’s armed forces to help hospitals across the country manage this surge of the Omicron virus,” Biden said.
“I know we’re all frustrated as we enter this new year,” Biden said, while reiterating his message that COVID-19 continues to be a “pandemic of the unvaccinated.”
In the first wave of the deployment, teams of military doctors, nurses and other personnel will head to Michigan, New Jersey, New Mexico, New York, Ohio and Rhode Island to support at-capacity emergency rooms and free up overwhelmed hospital staff for non-COVID cases, the White House said.
But with the teams ranging in size from seven to 25, hospitals due to receive the health workers welcomed the assistance but warned it would not be enough to combat the surge.
“There is not a silver bullet solution,” said Bob Riney, president of healthcare operations at Detroit’s Henry Ford Health System, which has already received some federal help and expects to welcome new military medics next week.
“We have systemic challenges (with) incredible volume and very, very tired medical practitioners … and that is true of all health systems that have been in the middle of this surge,” Riney said. The White House’s more aggressive stance follows months of criticism from health experts that the administration was relying too heavily on vaccines alone to stop the spread of the coronavirus, especially given a politically motivated anti-vaccine movement pushed by some Republican officials. About 62% of Americans are considered fully vaccinated, according to U.S. data.” (M)
- A.Acting FDA head says most people are going to get infected with COVID-19, by Jake Epstein, https://www.businessinsider.com/covid-19-fda-head-says-most-people-will-get-infected-2022-1
- B.US hospitals strained with influx of patients amid latest COVID-19 surge, staffing shortages, By Arielle Mitropoulos and John Brownstein, https://abcnews.go.com/Health/us-hospitals-strained-influx-patients-amid-latest-covid/story?id=82112893
- C.As COVID hospitalizations continue to rise in New Jersey, ventilator use is up 71%, by James M. O’Neill, and Lindy Washburn, https://www.northjersey.com/story/news/coronavirus/2022/01/11/nj-covid-cases-hospitals-rise-ventilator-use-climbs/9170054002/
- D.Omicron straining health care staffing: Hospital CEOs say workers face waves of stressors, By Tom Bergeron, https://www.roi-nj.com/2022/01/11/healthcare/omicron-straining-health-care-staffing-hospital-ceos-say-workers-face-waves-of-stressors/
- E.As hospitals reel, California tells coronavirus-positive medical workers to stay on the job, BY HAYLEY SMITH, https://www.latimes.com/california/story/2022-01-12/california-to-covid-positive-healthcare-workers-keep-working
- F.California will allow some health workers with COVID-19 to continue working. One top nurse says it could put patients in ‘grave danger.’, by Catherine Schuster-Bruce, https://www.businessinsider.com/health-worker-no-symptom-can-work-covid-san-francisco-19-2022-1
- G.Nearly a quarter of hospitals are reporting a critical staff shortage as Omicron drives a rise in Covid-19 cases, By Dakin Andone and Susannah Cullinane, https://www.cnn.com/2022/01/09/health/us-coronavirus-sunday/index.html
- H.Colorado reactivates Crisis Standards of Care for emergency medical services, by Dani Birzer, https://www.fox21news.com/news/colorado-reactivates-crisis-standards-of-care-for-emergency-medical-services/
- I.ChristianaCare, other Delaware hospitals implement emergency rules to handle COVID-19 surge, by Meredith Newman, https://www.delawareonline.com/story/news/health/2022/01/10/christianacare-moves-crisis-standards-care-citing-strain-covid-19-surge/9158473002/
- J.The fight against COVID: NBC News gets exclusive look inside Cleveland Clinic’s ICU, https://www.wkyc.com/article/news/health/coronavirus/cleveland-clinic-icu-covid-19-concerns-kate-snow-nbc-news/95-eb529efd-efa6-475d-8b1a-bc5abff03d3a#:~:text=The%20fight%20against,a%20typical%20day
- K.US Air Force to deploy to Cleveland Clinic to help with omicron surge, by Talia Naquin, https://fox8.com/news/us-air-force-to-deploy-to-cleveland-clinic-to-help-with-omicron-surge/
- L.Pandemic: OHA issues hospital crisis care standards, https://www.thechronicleonline.com/news_free/pandemic-oha-issues-hospital-crisis-care-standards/article_92345ea4-7087-11ec-b5ca-176de806e1bb.html
- M.Biden to send more military medics to U.S. hospitals in COVID-19 hotspots, By Susan Heavey and Steve Holland, https://www.reuters.com/world/us/more-us-medical-teams-bolster-states-omicron-surges-2022-01-13/