KFF Health News: Essential Criteria for Medical Facilities and CDC Guidelines

The organization is creating an essential set of criteria that medical facilities will need to follow for years to come in order to prevent the spread of dangerous diseases.

TFD – Dive into the latest insights from KFF Health News, focusing on essential criteria for medical facilities, CDC guidelines, airborne transmission, and N95 masks. Stay informed with us.

Dr. Sonya Stokes, an emergency physician in New York City, is still shocked by how ill-prepared and misdirected the American healthcare system was, even four years after hospitals in the city inundated with Covid patients.

As the number of COVID cases increased in the first few months of 2020, hospital administration gave the order for medical staff to stop using protective N95 masks. Stokes stated, “We were told we didn’t need a high level of protection from people who weren’t taking these risks while we watched patients die.”

Many front-line personnel became ill while attempting to rescue lives without wearing the appropriate face masks or taking other precautionary steps. Thirty-plus percent perished in the first year. Stokes noted that “nurses were going home to their elderly parents, transmitting Covid to their families.” “It was terrible.”

Hospital administrators across referenced recommendations from the Centers for Disease Control and Prevention regarding the limitations of airborne transmission. Early remarks from the agency supported businesses’ claims that N95 masks, often known as respirators, were only required for specific medical operations carried out at extremely close quarters.

These regulations run counter to medical professionals’ observations and scientific experts’ recommendations about the spread of airborne viruses. According to their findings, breathing in SARS-CoV-2 viruses suspended in minuscule droplets in the air caused infected patients to get COVID.

According to Peg Seminario, an occupational health expert and former director of the American Federation of Labor and Congress of Industrial Organizations, which represents over 12 million workers, disregarding this body of knowledge was handy during a period when N95 masks were expensive and in short supply.

She now worries, along with a lot of other people, that the CDC is making the same mistakes it did in the past while it creates an important set of rules that healthcare facilities such as jails, nursing homes, and hospitals will follow to stop the spread of dangerous diseases. The rules are an update from those that were set about twenty years ago. For many years to come, they will be utilized to create policies and procedures.

Seminario declared, “This is the foundational document.” “It becomes the standard for managing infectious pathogens.”

The committee that was advising the CDC on the guidelines submitted its final draft late last year so that the agency could review it. Workplace safety specialists, unions, and aerosol scientists said that it gave companies leeway to make risky choices about employee protection from airborne illnesses.

“If we applied these draft guidelines at the start of this pandemic, there would have been even less protection than there is now — and it’s pretty bad now,” Seminario said.

The CDC responded to the outrage in January with an unprecedented move: it handed the contentious draft back to its committee so that it might address issues about airborne transmission. “Make sure that a draft set of recommendations cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct,” the director of the CDC’s National Institute for Occupational Safety and Health asked the group.

The CDC also declared that more specialists will now contribute to their approach. The majority of last year’s Healthcare Infection Control Practices Advisory Committee members, according to critics, are representatives of sizable hospital systems. Furthermore, roughly one-third of them had written articles criticizing masks in a variety of contexts. For example, committee member Dr. Erica Shenoy, the infection control director at Massachusetts General Hospital, wrote in May 2020, “We know that wearing a mask outside health care facilities offers little, if any, protection from infection.”

Critics are relieved that the draft from last year was reexamined, but they are still worried. “It is imperative that the CDC ensures that employers are not given any discretion to put profits ahead of safety,” stated Jane Thomason, the chief industrial hygienist for the National Nurses United union.

She is a member of an expanding coalition of union, APHA, and other organization specialists who are assembling an external statement on topics that should be covered in the CDC guidelines, like the significance of N95 masks and air filtration.

That feedback, though, might not be taken into account.

The identities of the specialists that the CDC added this year have not been made public. It’s also unclear if such specialists will be able to offer suggestions alone or cast votes on the committee’s upcoming draft. This year, the group convened, but discussion of the proceedings is beyond limits to participants. KFF Health News sent questions and requests for interviews, but the CDC did not reply.

The draft guidance’s recommendation of distinct methods for airborne viruses that “spread predominantly over short distances” vs those that “spread efficiently over long distances” is a major source of disagreement. This reasoning permitted businesses to deny numerous workers safety gear in 2020.

For instance, when medical assistants accompanied patients who seemed to have Covid through clinics, they were not provided with N95 masks by Sutter Health, a sizable hospital system in California. Sutter filed an appeal when the Occupational Safety and Health Agency of California issued a citation, citing the CDC’s claims that the illness primarily transmits over short distances.

According to Dr. Don Milton, a researcher at the University of Maryland who focuses on the aerobiology of respiratory viruses, making a differentiation based only on distance is a sign of a lack of scientific understanding. Generally speaking, viruses that are present in sweat, snot, or saliva are spread by droplets that are too heavy to go very far. But people can also inhale viruses riding on teeny-tiny, lighter droplets that travel farther through the air. What matters is which route most often infects people, the concentration of virus-laden droplets, and the consequences of getting exposed to them, Milton said. “By focusing on distance, the CDC will obscure what is known and make bad decisions.”

Frontline staff members were well aware that hospitals and assisted living facilities were high-risk environments for coronavirus exposure. Some have since filed lawsuits, alleging that employers caused illness, distress, and death by failing to provide personal protective equipment.

One class-action suit brought by staff was against Soldiers’ Home, a state-owned veterans’ center in Holyoke, Massachusetts, where at least 76 veterans died from Covid and 83 employees were sickened by the coronavirus in early 2020.

“Even at the end of March, when the Home was averaging five deaths a day, the Soldiers’ Home Defendants were still discouraging employees from wearing PPE,” according to the complaint.

It describes the experiences of employees, one of whom claimed to have held six veterans as they passed away in her arms. “She remembers that during this time in late March, she always smelled like death. When she went home, she would vomit continuously.”

The CDC has come under fire from researchers time and time again for failing to address airborne transmission during the pandemic. “The CDC has only used the words ‘COVID’ and ‘airborne’ together in one tweet, in October 2020, which mentioned the potential for airborne spread,” claims a recent analysis.

Why infection control professionals on the CDC committee are less circumspect about airborne transmission than other experts is unknown. Deborah Gold, an industrial hygienist, stated. She said, “I believe these might be true beliefs, supported by the fact that respirators cost three times as much whenever they’re needed.”

Critics worry that hospitals won’t properly stockpile N95 masks if the final recommendations don’t expressly say that they’re necessary, which might lead to shortages in the event of a future medical emergency. Additionally, healthcare facilities won’t make improvements if the document isn’t updated to place more emphasis on ventilation and air filtering.

“Health systems will err on the side of doing less if the CDC doesn’t prioritize the safety of health providers, especially in an economic downturn,” according to Stokes. “Those who are responsible for making these decisions ought to be compelled to assume those risks.”

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