“Have they stopped caring about our health?” reads a text from my friend and fellow surgical resident. With it comes a link to a New York Times article displaying the headline “C.D.C. Shortens Covid Isolation Period for Health Care Workers.”
I opened the article while waiting in line to get a Covid test at the first appointment I could snag four days after caring for a patient recovering from surgery who became Covid positive in the hospital. In those few days, I had taken care of more than 40 other patients and interacted with a dozen or so nurses, physicians, and cafeteria workers.
The Times article outlined new guidelines issued in response to renewed concerns of Covid-19 straining health care systems. The recommendation reduced isolation time for Covid-positive health care workers from the standard 10 days set for the general public to seven — with the caveat that the timeline might shrink further in the event of additional staffing shortages.
Four days later, the CDC cut back the isolation period to five days for the general public but not for health care workers, which prompted the viral “CDC Says” Twitter meme. But for those few days over the holidays, health care workers were left wondering: Why shorten the isolation period only for some of the people most exposed to Covid-19?
Today, the question resounds louder after the California Department of Public Health announced that health care workers who test positive for Covid-19 but who have no symptoms may return to work immediately.
The explanation is equal parts clear and frustrating: We can’t afford for the health care workforce to stay home.
As countless headlines convey, the U.S. health care system is at a tipping point. In recent months, it has been overburdened and understaffed — words that sound like a broken record two years into this pandemic, but still feel fresh to those of us who spend our days in hospitals. Health care workers are fleeing the profession as Covid-19 cases once again rise. Hospitals in Massachusetts, like the one I work in, have been busier than ever, possibly playing catch-up from Covid-related health care delays.
I routinely receive alerts that my hospital is in capacity disaster mode, encouraging clinicians to discharge patients who have been admitted as quickly as possible when safe to free up beds for the new patients lining the halls of our emergency department.
Being in capacity disaster mode is the worst time for hospitals to get hit by a new wave of Covid-19 cases — in either patients or health care workers. They need as much on-the-ground support as possible to help manage the current surge of hospitalizations along with Covid-related rises. In that light, the CDC’s rationale for shortening health care workers’ time away from work may be seen as pragmatic. But the announcement heightened a real fear of Covid-positive health care workers spreading the virus to one another and to patients.
With this concern in mind, it may be time to revisit a large, persistent gap in Covid-19 protections: testing asymptomatic health care workers.
“Given that health care workers are tested frequently, are largely vaccinated, and must be masked, ‘the chances of causing a significant amount of infections seem very low’ if isolation periods are shortened,” the Times article says, quoting physician Bob Wachter, chair of the department of medicine at the University of California, San Francisco. Unfortunately, only two-thirds of the Times’ assessment is true. My colleagues in the hospital and I are triple vaccinated and wear masks at work, but we are certainly not tested frequently.
This is not in any way unique to the hospital I work in. Friends of mine from medical school, now physicians scattered across the country, are seeing the same thing.
In fact, we first noticed a testing discrepancy as medical students riding out the first wave of Covid-19 in 2020. Although the clinical-year students (those in their final two years of medical school) sat out for the first couple months of the pandemic — which I argued against in a First Opinion essay in 2020 — when we eventually returned to working in the hospital it was under an entirely different set of testing rules from our preclinical classmates. These first- and second-year students, who were Zooming in from their homes for most of their lectures, underwent mandatory Covid testing multiple times a week, while the third- and fourth-year students working in hospitals helping with patient care were required to be tested only if they developed what might be symptoms of Covid-19.
This discrepancy wasn’t just seen in medical schools. My best friend, a law student at the same university, was tested multiple times a week to attend in-person lectures, while I, then an unvaccinated medical student working in a Covid-19 intensive care unit, was required to get tested only when I had significant exposures to the coronavirus. One could argue that testing students multiple times a week is excessive, but the inconsistency left a nagging concern.
Why the different policies? My peers and I could only speculate. One thought was that the medical school did not want us to take time away from the hospital and possibly be unable to meet the graduation requirements needed to enter the physician workforce. Another thought was that, once we were working in the hospital, we were treated the same as all hospital employees, who were not being routinely tested when asymptomatic.
Now, as 2021 turns to 2022 and the pandemic is still with us in an even more contagious form, I have a bad case of déjà vu. I recently caught up with a friend getting a graduate degree at Harvard who told me that she and her classmates are required to be tested every other day while I, a surgical resident in a Harvard-affiliated hospital, am still required to be tested only when I feel sick or have been exposed to a Covid-positive patient without sufficient protections. Even then, tests aren’t easy to come by for health care workers. A student enrolled in an M.D.-Ph.D. program at Harvard noticed that she could more easily access Covid tests in her role as a graduate student than her physician-fiance could. She responded with an open letter and petition to redistribute excess Covid-19 test kits from Harvard graduate students to Harvard-affiliated health care workers.
Again, I’m left guessing as to why health care workers aren’t routinely tested for Covid-19. But one thing is certain: Identifying Covid-infected health care workers would worsen the staffing shortages hospitals already face. There isn’t a sufficient back-up system in place for a whole swath of nurses, nursing assistants, speech pathologists, phlebotomists, physical therapists, transporters, case managers, chaplains, nutritionists, technicians, environmental service workers, or resident and attending physicians to call in sick. Ironically, staffing shortages from Covid infections make it even harder to staff and maintain testing sites.
U.S. hospitals are stretched thin, struggling to fill nursing jobs and are turning to traveling nurses as well as foreign nurses for hire. The National Guard has been deployed to assist with these shortages. At work, I now see people in military uniforms walking alongside those in scrubs.
We’re now stuck between a rock and a hard place. Either asymptomatic health care workers are routinely tested and hospitals risk being further understaffed and unable to provide adequate patient care as testing may reveal asymptomatic carriers, or they don’t routinely get tested and hospitals are left with an equally frightening scenario: asymptomatic but Covid-positive health care workers spreading highly contagious strains of the virus to their patients and co-workers.
I’m a new doctor, not a public health official, so I’m not the person to make the call on which option to choose. But I can draw attention to the major flaw in many hospitals’ testing systems and question the risk-benefit analysis presumably at play: Is more harm being done to patients and health care workers by identifying asymptomatic disease in health care workers and thereby exacerbating staffing shortages, or is it more damaging to potentially feed the spread of disease by failing to test and isolate asymptomatic, Covid-positive health care workers?
It’s time for health care institutions to be upfront that not routinely testing employees is a choice — one born under difficult circumstances and constrained by limited resources, but nonetheless a choice. Health care workers deserve an explanation for how the pendulum swings to favor the rock or the hard place. And at the very least, we deserve more rapid access to testing following known exposures — for our sake and for our patients’ health.
As I neared the end of the Times article, I made it to the front of the line and stood at a small white table that had a box of tissues and a bottle of hand sanitizer on it. I pulled down my mask, swabbed my nose, replaced the mask, washed my hands, and picked up my phone.
The text “Have they stopped caring about our health?” still lit up my screen. I replied with the shrugging emoji and went back to work.
Orly Nadell Farber is a general surgery resident at Brigham and Women’s Hospital in Boston and a former STAT intern. The opinions here are hers and do not necessarily reflect those of her employer.
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