Extraordinary measures (1)

With the rise of new COVID-19 infections, the country is going into “crisis” mode; we may feel like we’re losing whatever footing we were able to gain back toward the end of 2021, as hospitals are again overwhelmed. Different hospitals are reported to be suffering from a shortage of health care workers (HCWs) who are either infected or in quarantine after exposure.

As part of efforts to mitigate the shortage of staff, the pandemic task force has modified directives for quarantine and isolation among HCWs. Most prominent, and probably the most controversial, is the guidance that fully vaccinated HCWs who are close contacts of COVID-19 patients may no longer undergo quarantine; isolation for HCWs testing positive who are asymptomatic, or mildly to moderately asymptomatic, is also shortened. This guidance mirrors that of the recent updates of the Center for Disease Control and Prevention (CDC). The Department of Health (DOH) still leaves implementation up to the judgment of the hospital or provincial health office concerned.

It is understood that such extraordinary measures have been put in place to deal with extraordinary times. The impact of the HCW shortage can be massive, and in some sectors, there has long been a push for shortened quarantines and isolation periods anyway, even prior to the emergence of new variants. Every public health office in the world will find it a challenge to issue clear guidance with timely changes when so much is unknown and the scale of the problem is unprecedented. But I’d like to take the chance to write about some opinions I am seeing and hearing as part of the medical workforce, about how such policy impacts frontliners. Health guidance, even guidance adapted from respected bodies like the CDC, are sometimes met with sound opposition from the sectors that they most heavily affect—in this case, health workers. Most of the health professionals questioning such guidance do not gain a lot of traction in the mainstream, with outrage confined to health worker group chats and Twitter threads.

Recently there was controversy when the American Heart Association updated its guidance for cardiac life support in patients with COVID-19. Among their recommendations is that with witnessed sudden cardiac arrests, “providers should not delay chest compressions to put on PPE (personal protective equipment) or place face covering on patients.” It supports this by saying that rapid initiation of chest compressions, which is vital for quality care of cardiac arrests, “likely carries a low risk” of COVID-19 transmission to the compressor. A low risk—not zero.

The guidance raised an outcry among HCWs abroad. “Nurses are not disposable,” said one Twitter user, citing instances of first responders who performed CPR on coding patients (inside and outside the hospital) who later contracted the disease and died. Much of the dissent cites how the guidance violates traditional safety-first rules of first-responder situations; logically, a responder must first don PPE to ensure their own safety. Other, more expert opinions question whether it’s supported by sound data. Many have remarked that such guidelines were formulated by those who haven’t run a code blue in a long time, and who may be out of touch with how it is to be a vulnerable frontliner.

Now the recent CDC guidelines, and their local adaptation, have sparked similar debates. Opinion among disappointed HCWs seems to be that it’s exploitative at worst, and poorly thought out at best. Many are worried that shortened isolation periods for positives, and no quarantine for those with high-risk exposure, may endanger both staff and patients. I’d like to refer the reader to other commentaries, such as the American Nurses Association’s criticisms of the policy from the perspectives of those whom it most affects. They underline how the need for an early return to work must be balanced versus the risks carried by health workers, who must also interface with the public and with household contacts, some of whom may be vulnerable and unable to vaccinate. Locally, even those who are usually staunch supporters of the DOH’s policies have expressed hesitation about adapting the guidelines here.

(To be continued)

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