The United States is currently undergoing a horrific escalation in Coronavirus disease 2019 (COVID-19) patients and it is evident that the healthcare industry has learned far too little from previous spikes, apparently adopting a strategy of simply hoping the virus would go away. We have not yet seen COVID-19’s peak and are already experiencing alarming supply and medical staff shortages. The Governor of North Dakota advocated for allowing asymptomatic COVID-19 nurse carriers to return to work, taking care of COVID-19 patients. A strategy which received immediate pushback from the medical industry. A policy which shows little understanding of the infectivity of the virus and the dangers of enhanced severity of illness as viral load exposure increases.
At the same time we are facing a shortage of personal protective equipment (PPE). We have not restocked our supplies or significantly increased our production capabilities. We are merely treading water. Faced, as of this writing, with greater than three times the number of cases as the last surge, along with exponential growth with no end in sight, there is little hope healthcare workers can safely treat patients without a drastic change in policy and a more productive and secure supply line.
This lackadaisical attitude toward the pandemic is not only evident by our inadequate preparedness and failure to gear up for the “dark winter,” but also by our flagrant ignoring of public health guidance as evidenced by the all too willing public participation in massive events to advocate for candidates and to celebrate victories. Punches were pulled and the silence heard from our leaders to condemn these activities was deafening. The virus wins and spreads throughout our communities.
All frontline workers have been put in harm’s way. One study from Massachusetts evaluated 104 employees of a single grocery story in Boston. They found 20% tested positive for SARS-CoV-2 and being young, 76% had no symptoms. Thus, they were working and potentially spreading the virus. Let’s not forget that having no symptoms from a viral infection which damages every organ of the body, may well cause symptoms decades later as cardiac and pulmonary reserves drop.
For healthcare workers the situation is even worse. Taking care of COVID-19 patients exposes them to a much higher viral load which places them at higher risk for developing severe COVID-19. In Scotland, one-sixth of all COVID-19 hospitalizations are healthcare workers or their families. And those healthcare workers who were patient facing (directly taking care of patients) were at a threefold-increased risk compared to non-patient facing healthcare workers.
Thus, frontline workers are not only placing themselves in danger, but also their families. And unlike earlier supposition, once a household member becomes infected, SARS-CoV-2 spreads rapidly within the family unit. A recent study found that 53% of 191 household contacts developed a secondary infection from another household member, and that 75% of these infections occurred within 5 days of exposure.
And no one is accurately tracking the dead. On October 25, 2020, National Nurses United estimated that approximately 2000 frontline healthcare workers’ have died.(6) As of November 13, 2020, the US Centers for Disease Control and Prevention (CDC) has confirmed 797 healthcare workers deaths, but because of inaccuracies in the reporting data this figure could approach 5000.
Despite these deaths, effective tracking and investigation of worker safety is not taking place. OSHA oversees worker safety in 28 states. As of August 13, 2020, OSHA has only issued 4 citations related to SARS-CoV-2 and of September 18, 2020, OSHA has only opened inspections on only 191 out of 8909 worker complaints related to COVID-19. This is a dismal example of worker safety assurance.
Many workers are demanding hazard pay, but in actuality a much better safety net is needed for it appears lifelong disability is all too common from COVID-19 infections which result in hospitalization. It is becoming evident that the “long-hauler” syndrome which results in chronic incapacitation, occurs just as commonly in those with mild versus severe COVID-19. Almost a third of “mild” COVID-19 patients are partially depending upon the care of others nine months after their illness.
The healthcare workers in the United States have a long history of placing their lives at risk to save their patients, but we need to give them the safest possible working environment and the supplies they need. At a minimum, presumptive disability should be available for frontline workers who do incompletely recover from COVID-19. And if we are unwilling to provide this protection for them and their families, we should at least activate the Defense Production Act to assure adequate PPE and N95 masks and give our workers a fighting chance.