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CDC updating protocol for COVID-positive healthcare providers

Officials must consider how to keep hospitals adequately staffed for a surge of COVID-19 patients.

LANCASTER, Pa. —

As the number of COVID-19 patients ramps up in Pennsylvania, health experts expect more healthcare providers will also become infected. In preparation for greater staffing needs at healthcare systems, the CDC is updating its guidelines for protocol when healthcare providers contract COVID-19.

In normal conditions, a doctor or nurse who had a high-risk exposure to an infectious disease like COVID-19 would cease treating patients for at least 14 days. In the current crisis, the CDC says  “all [healthcare professionals] are at some risk for exposure to COVID-19, whether in the workplace or in the community.”

“It is coming. No matter how careful you are, there will be cases where there are exposures,” said Dr. Raghav Tirupathi, medical director at Keystone Infectious Diseases.

The CDC therefore updated their guidelines to allow healthcare professionals to continue working after an exposure—including those who test positive for COVID-19—as long as they aren’t showing any symptoms.

The CDC guidance states:

“Facilities could consider allowing asymptomatic HCP who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program… If HCP develop even mild symptoms consistent with COVID-19, they must cease patient care activities, don a facemask (if not already wearing), and notify their supervisor or occupational health services prior to leaving work.”

Now health officials are preparing for a new problem: healthcare workers who get COVID-19 and do have symptoms.

“That is going to the be the reality,” Dr. Tirupathi said. “We will be seeing that situation ramp up in situation, as it has in the rest of the country and the world.”

In Italy, 20 percent of healthcare professionals in the Lombardy region have become infected, according to an Italian academic study published March 13.

Healthcare workers in the U.S. are starting to test positive, with outbreaks in multiple states, including New York, Massachusetts, Washington and Pennsylvania.

With a surge of COVID-19 patients expected to tax Pennsylvania’s healthcare system in the coming weeks, officials must now consider how to keep hospitals adequately staffed. At this point in the crisis, health systems have to balance the risk of spreading the virus with the very real need to take care of those already sick.

“I think the hospitals are also finding themselves on very difficult ground in terms of making these very difficult decisions,” Dr. Tirupathi said.

According to CDC-issued guidance for COVID-19, in an emergency healthcare systems may allow symptomatic, COVID-19-positive providers to keep working in order to mitigate staffing shortages. 

The CDC guidance states: 

“Healthcare systems, healthcare facilities, and the appropriate state, local, territorial, and/or tribal health authorities might determine that the recommended approaches cannot be followed due to the need to mitigate HCP staffing shortages. In such scenarios:

  • HCP should be evaluated by occupational health to determine appropriateness of earlier return to work than recommended above

  • If HCP return to work earlier than recommended above, they should still adhere to the Return to Work Practices and Work Restrictions recommendations”

Some in the medical community are pushing back against potentially contagious healthcare workers coming in and spreading the virus.

“I would be concerned about being positive and going into the hospital,” said Dr. Ed Balaban, a retired oncologist and trustee-at-large for the Pennsylvania Medical Society. “Obviously you’re taking care of patients that are positive but I’d be really concerned about passing it around to the other healthcare workers at a moment in time when I may not have my mask on or be wearing my gloves.”

If higher patient numbers lead to such a large staffing shortage that sick workers must come in, health officials are considering measures to prevent them from infecting other people, including both patients and fellow healthcare providers. One measure would separate healthcare providers into cohorts of those who are COVID-positive and those who are COVID-negative.

“For example, a COVID-positive healthcare worker with minimal symptoms can work on a COVID floor, relieving the COVID-negative healthcare workers to work elsewhere,” Dr. Tirupathi said.

Medical workers are also directed by CDC guidelines to wear personal protective equipment, like masks, if possible. However, many healthcare systems are quickly running through their PPE supplies.

“The PPEs are on short supply,” Dr. Balaban said.

Dr. Tirupathi said doctors should trust CDC guidelines, as they reflect what the medical community has decided is the best current practice. He warned the guidelines could change again in the fluid COVID-19 situation, so healthcare providers should be prepared, but flexible for the challenges that will come in the next few weeks.

“We need to be diligent about how we handle these exposures and follow all the relevant guidelines,” Dr. Tirupathi said.