The need for capable healthcare staff was an urgent concern for me as my surgery for a major medical condition was placed on hold.
This occurred in September 2021, at the height of the Delta surge, when medical staff were stricken by COVID-19 as their immunity waned and the need for boosters was still under debate.
I watched as the CDC’s immunization approval committee ACIP stressed the need for a healthy medical workforce. A committee member from Vanderbilt (the hospital I was waiting to have my surgery at) stated it did not matter whether staff acquired COVID in the hospital or the community, they needed to be well and at work.
The booster needed approval for healthcare workers. To my horror, the committee voted against approval. To her credit, CDC Director Rochelle Walensky, M.D., promptly reversed this decision. This occurred two years ago, and unfortunately, the condition of our healthcare workforce does not appear to have markedly improved.
Earlier this month, a news article from the U.K. reported that more than 2600 National Health Service staff have missed work due to Long COVID, some up to two years. The vast majority of those impacted were nurses. Two days later, the Journal of Infection Control and Hospital Epidemiology reported that 27.4% of Brazilian healthcare workers who were diagnosed with COVID-19 developed long COVID. Over half had three or more persistent symptoms. Having recurrent infections increased the risk of long COVID, but the good news was that those who received 4 doses of a COVID-19 vaccine were at lower risk of reinfection.
This finding was confirmed by a meta-analysis of 4 studies which found that Vaccination resulted in a 43% decrease in long COVID. Universal masking is also beneficial. A recent study in Swiss school systems found that mask mandates reduced SARS-CoV-2 (the virus which causes COVID-19) aerosols by 69%, a testament that masks protect others, not just the wearer.
Preadmission testing for COVID-19 also appears to lower the risk of facility transmission. An analysis of data from Scotland and England found that the discontinuation of universal SARS-CoV-2 admission testing was associated with an increase in hospital-onset infections.
An interesting observation is that the lead author of the Brazilian healthcare worker study, along with two of the co-authors were affiliated with the University of Iowa, another with West Virginia University, and all of the authors in the Scotland and England Study were from Harvard. This is an indication of how bad the United States’ data is and the flawed method which is used to measure hospital-acquired infections. Only currently hospitalized patients who develop COVID-19 fourteen or more days after admission are counted. Problems with the United States’ tracking and reporting of COVID-19 was confirmed by a Twitter message from the Harvard study’s lead author which stated, "… this was the rationale for using UK data, it is much better quality than anything publicly available in the US."
The best defense against long COVID is to not get infected in the first place. But in high-risk settings, infections will occur. The goal must be to mitigate their occurrence and the occurrence of long COVID.
It is imperative we maintain a healthy hospital workforce. Testing, masking with respirators, and improvements in air filtration are a small price to pay to maintain a healthy workforce. And the need to measure staff and patient COVID-19 acquisitions is of utmost importance. Without this data we will not be able to determine the effectiveness of mitigation strategies and if additional interventions are needed. What is measured is managed.
Unless we commit to a reliable and robust measurement system of hospital-acquired infections, we will continue to have a stressed workforce and need to rely on data generated in other countries. If this does not occur, the United States will take a back seat in public health and healthcare safety and will lose its leadership position in the world.
Kevin Kavanagh, M.D., is the founder and president of the patient advocacy group Health Watch USA.