Extraordinary measures (2)

This is the second part of a column describing some legitimate health care worker (HCW) objections to policies that aim to avert hospital staff shortage in light of our sharp increase in COVID-19 cases. Last week I ended by saying that prior to their adaptation in the Philippines, many objections were raised abroad about the Centers for Disease Control and Prevention (CDC) guidance on shortening isolation for confirmed COVID-19 positive HCWs, and shortening quarantine for close contacts to as few as zero days.

I also mentioned that prior to recent Department of Health (DOH) policy revisions, there was also hesitation that the evidence supporting such measures could be extrapolated here. A local infectious disease expert called the CDC-recommended guideline shortening isolation for confirmed cases “problematic,” citing as of the first week of January that this is not yet advisable for the Philippines. For a more thorough and reader-friendly look at the objections and supporting evidence for the CDC revisions, I refer the reader to the CDC documents themselves (posted on the cdc.gov website, “What we know about quarantine and isolation”) and the Associated Press’ summary of criticisms on the guidance dated Jan. 4, 2022. My focus is not on the implications for the general population, but how HCWs are impacted differently.

Since the printing of the first part of this column, many HCW groups have released statements objecting to the difference in guidance for HCWs in particular. The Alliance of Health Workers national president called the policy “inhumane, unjust, illogical.” The president of one Metro Manila hospital’s association of HCWs had similar objections as the ones raised by nursing groups in the US: even vaccinated and boosted health workers are still vulnerable to infection and to spreading the virus among themselves, their patients, and their communities.

It has also been pointed out that HCWs may feel safer complying with such policies for non-quarantine (for high-risk exposures) and shortened isolation (for confirmed cases) if they and their dependents could avail of free, more accessible, testing. Unfortunately, this is not the case. HCW access to testing is disappointingly uneven. Rare is the institution that will test a household contact for free. Some institutions even encourage their HCWs to shoulder the costs of their own testing.

Defenders of the policy point out that this is a contingency measure, and that the DOH advises hospitals to use their own discretion and risk assessment prior to implementation. Moreover, as mentioned previously, such policies are obviously an extraordinary measure only put in place to mitigate HCW shortages. Clearly, any public health official must balance opposing needs and limited and evolving evidence.

It is still unacceptable that the party on the losing end must inevitably be frontliners and their households. Such policies make an already vulnerable population even more vulnerable. I mentioned the American Heart Association updates in the first part of this column because, like the CDC guidelines on shortened quarantine and their local adaptation, they all point to a willingness to place increased risk on HCWs and their households for the sake of public safety.

HCWs are already burnt out and, particular to our setting, woefully undercompensated. There is no safety net in case any of them or their households will suffer a COVID-19 infection because of work exposure. Moreover, many HCWs are also caring for young children, the immunocompromised, and other groups who may be unvaccinated or unable to vaccinate. As anyone familiar with the culture may know, HCW employers do not always look kindly on exceptions, and many HCWs, despite exposure, may be forced to go to work anyway and make the most out of adjustments at home.

If such policies cannot be adjusted, then HCWs should at least be able to expect some things that should be within their rights: accessible, free testing, and increased compensation. Some will again accuse HCWs of being “mukhang pera.” It must be said that just compensation for HCWs should not only cushion the blow of a COVID-19 illness in the family from work exposures but could also help many to create accommodations to allow them to distance themselves from family members. This should be the objective, too, of the much-discussed special risk allowances (SRA). Much ado has been made of increasing these but the fact is, all that talk has been low-yield for those on the ground: a viral photo from Camarines Sur physician Beng Rivera-Reyes showed how her SRA for six months was only P2,045.45, with other HCW team members getting less or zero.

We’re on the brink of a third year of the pandemic. While science and policies evolve, one thing appears to remain the same: health workers will continue to be hailed as heroes, while their rights to safety, protection, living wages, and commensurate risk allowances will continue to be sidelined.

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