Stressed hospitals are asking workers with covid to return - even if they may be infectious

Candice Cordero still had a fever and a cough late last month when, she says, her hospital told her it was time to come back to work.

The Bradenton, Fla. nurse was stunned — and worried she could still be contagious seven days into her breakthrough covid-19 infection. When an employee health representative said she could come back anyway, citing updated federal health guidance, Cordero said she refused. She viewed it as too risky.

“I feel like employers are trying to force people back into the workforce too soon,” Cordero said of her hospital’s alleged request, which a spokesperson said was inconsistent with hospital guidelines, including that health care workers should stay home if they have a fever. “People want to go into the hospital and know that they’re going to be safe - not get infected by a virus they could get sick and die from.”

Hospitals are increasingly asking staff who have the coronavirus to work while potentially infectious, underscoring how the hyper-transmissible omicron variant has sidelined employees, overwhelmed resources and upended nearly two years of strict protocols. Though vaccine requirements are common at hospitals, many health care workers are coming down with the virus, exacerbating staffing issues.

Ten-day isolation periods have given way to five-day ones under CDC guidelines updated late last month, with workers sometimes allowed back as long as symptoms are deemed mild and improving. Officials acknowledge even halving isolation may not be enough to keep hospitals staffed: The CDC says health care workers who test positive can keep working uninterrupted in a “crisis” - and one state, California, recently declared that hospitals could take that step for employees without symptoms.

Some in the health care industry call the changes dangerous to already-demoralized front line workers and their patients, especially those most vulnerable to covid-19. Research in a preprint study from the United Kingdom suggests that about 1 in 3 people who get the coronavirus remain infectious after five days.

Others call looser return-to-work standards necessary to keep crucial services running, as federal data shows more than a fifth of U.S. hospitals reporting a “critical staffing shortage” in the past week and about 30 percent anticipating one in the week to come. High-quality protective gear reduces the risks, they emphasize.

“The last thing you want is to say, well, we’re closing the hospital because we don’t have enough doctors and nurses,” said Carlos del Rio, president-elect of the Infectious Diseases Society of America.

At Holy Name Medical Center in Teaneck, N.J., 191 of 3,500 employees were out sick one day last month. Nursing director Michele Acito said hospital officials had to “become creative” in managing the high number of absences, shuffling nurses around.

“We were very happy when the CDC came out and said people could return to work after five days if they have mild to moderate symptoms or no fever,” she said.

Health care is hardly the only area where fears of an omicron-fueled breakdown in essential services have reshaped U.S. guidance. Days after the CDC changed its return-to-work advice for health care workers, the agency halved its recommended isolation time for the general public - telling infected but asymptomatic Americans they could go about their lives after five days, no negative test required. The shift was driven in part by worries that cases could sideline crippling numbers of police, firefighters, grocery store employees and more.

Thousands of schools shifted to virtual learning early this month, with some citing lack of staff and even turning to parents to fill teaching gaps.

But the dilemma for health care workers could become especially acute as staff shortages collide with record nationwide coronavirus hospitalizations. About 160,000 people were hospitalized with the virus on Thursday - surpassing the pre-omicron record set last January, when vaccinations were just becoming available.

The CDC changed its guidance last month to allow hospitals to bring back workers in five days, rather than 10, if symptoms are mild or improving. It also said that isolation periods could be scrapped entirely if made necessary by staffing constraints, though facilities should turn to asymptomatic or mildly ill employees first.

Health care facilities around the country have implemented the relaxed guidance in recent weeks, despite some medical groups expressing serious concerns about even a five-day return-to-work protocol without testing.

“When you have that diminishing chance of transmitting something at five days and then you wear personal protective equipment like a good N95, that’s tightly fitted to the face, you know, it is a step most hospitals feel is safe and effective,” said Nancy Foster, the American Hospital Association’s vice president of quality and patient safety policy.

In Arizona, major health care system Dignity Health told staff earlier this month that they could seek a supervisor’s permission to return to work while infected if they felt up for it. The move was made “to ensure we could consider providing care to the community amid a surge in cases,” a spokesperson said in an emailed statement.

In Rhode Island, two health care facilities have recently used the CDC’s “crisis” standards for dropping isolation requirements. State-run psychiatric facility Eleanor Slater Hospital used two asymptomatic staff on Jan. 1, three on Jan. 3 and none after, said Randal Edgar, a spokesperson for Rhode Island’s Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. And a nursing home, the Respiratory and Rehabilitation Center of Rhode Island, had an asymptomatic employee in the covid unit in late December, spokesperson Lori Mayer said.

California health officials said asymptomatic staff can keep working as a last resort and “should preferably be assigned to work with covid-19 positive patients.”

“However, this may not always be possible in settings such as the emergency department in which you may not know which patients are covid-19 positive or in areas where you may be experiencing extreme staffing shortages,” the state health department continued.

In a statement, the California Department of Health said it is providing “temporary flexibility” to help respond to “an unprecedented surge and staffing shortages. Hospitals have to exhaust all other options before resorting to this temporary tool.”

Erica Ashley, an intensive care nurse at Dignity Health’s St. Bernardine Medical Center in San Bernardino, Calif., described the state’s relaxed guidance as “insult on top of injury.”

For months, she said, nurses have been assigned as many as four patients - double a state-mandated ratio that has been loosened amid the pandemic. She said she has worked 12-hour shifts with no one to relieve her for breaks and filled out multiple “assignment despite objection” forms, used by registered nurses to document unsafe or inadequate staffing situations.

“The more I give, the more you want,” she said. “It’s like, I have nothing left to give.”

A spokesperson for Dignity Health said their facilities are facing “an extremely challenging situation” and a critical staffing shortage, though coronavirus-positive staff in California are not yet returning without an isolation period. She said the organization is taking other steps such as pausing nonessential procedures.

Ali Fuehring, a 31-year-old nurse in Illinois, also opposes the CDC’s return-to-work guidance even as she witnesses the consequences of short-staffing firsthand. During one especially harrowing shift in a full ER this month, she said, she started leaving notes explaining why she gave care off-schedule and had someone coach her over the phone on a new technique for a patient waiting for space in the ICU.

The CDC guidance “reminds so many of us that the system simply views us as disposable,” Fuehring said.

A spokesman for the health system where Fuehring works, Rush University System for Health, said that “extraordinary commitment” from staff and a “proactive, surge capacity strategy” have allowed them to meet patients’ needs.

Cordero, a nurse for 18 years, said working in health care is challenging nearly two years into the pandemic. Appreciation for staff seems to have declined, she said, and “there’s this disconnect with the community because they don’t see what goes on in the hospitals.”

The looser isolation rules added to the difficulty, with Cordero saying the CDC should have been more clear. She said when she called employee health at Blake Medical Center, the representative pointed to the updated guidelines and told her she should have recovered by the five-day mark.

“And I said, ‘Well, not everybody follows the same timeline just because they changed the guidelines. Covid is different for everybody,’” Cordero recalled. At the representative’s direction, she said, she applied for short-term disability.

A spokesperson for HCA West Florida, which includes Blake Medical Center, said the circumstances Cordero described are “not consistent with the guidelines our hospital follows.” The company said in a statement employees quarantine for at least five days and “are not to return to work if there is presence of a fever.”

Cordero went back to work Jan. 14, after her fever cleared. Finally, she said, “I’m confident I’m not going to give it to anybody.”

The Washington Post’s Dan Keating contributed to this report.