{"id":2147,"date":"2023-12-14T10:48:45","date_gmt":"2023-12-14T10:48:45","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=2147"},"modified":"2023-12-14T10:48:51","modified_gmt":"2023-12-14T10:48:51","slug":"rift-over-when-to-use-n95s-puts-health-workers-at-risk-again","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=2147","title":{"rendered":"Rift Over When to Use N95s Puts Health Workers at Risk Again"},"content":{"rendered":"
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Three years after more than 3,600 health workers died of covid-19<\/a>, occupational safety experts warn that those on the front lines may once again be at risk if the Centers for Disease Control and Prevention takes its committee\u2019s advice on infection control guidelines in health care settings, including hospitals, nursing homes, and jails. In early November, the committee released a controversial set of recommendations the CDC is considering, which would update those established some 16 years ago.<\/p>\n

The pandemic illustrated how a rift between the CDC and workplace safety officials can have serious repercussions. Most recently, the giant hospital system Sutter Health in California appealed a citation from the state\u2019s Division of Occupational Safety and Health, known as Cal\/OSHA, by pointing to the CDC\u2019s shifting advice on when and whether N95 masks were needed at the start of the pandemic. By contrast, Cal\/OSHA requires<\/a> employers in high-risk settings like hospitals to improve ventilation, use air filtration, and provide N95s to all staff exposed to diseases that are \u2014 or may be \u2014 airborne.<\/p>\n

The agencies are once again at odds. The CDC\u2019s advisory committee prescribes varying degrees of protection based on ill-defined categories, such as whether a virus or bacteria is considered common or how far it seems to travel in the air. As a result, occupational safety experts warn that choices on how to categorize covid, influenza, and other airborne diseases \u2014 and the corresponding levels of protection \u2014 may once again be left to administrators at hospitals, nursing homes, and jails or prisons.<\/p>\n

Eric Berg, deputy chief of health at Cal\/OSHA, warned the CDC<\/a> in November that, if it accepted its committee\u2019s recommendations, the guidelines would \u201ccreate confusion and result in workers being not adequately protected.\u201d<\/p>\n

Also called respirators, N95 masks filter out far more particles than looser-fitting surgical masks but cost roughly 10<\/a> times<\/a> as much, and were in short supply in 2020. Black, Hispanic, and Asian health workers more often went without N95 masks than white staffers, which helped explain why members of racial and ethnic minorities tested positive for covid nearly five times as often<\/a> as the general population in the early months of the pandemic. (Hispanic people can be of any race or combination of races.)<\/p>\n

Cal\/OSHA issued dozens of citations to health care facilities that failed to provide N95 masks and take other measures to protect workers in 2020 and 2021. Many appealed, and some cases are ongoing. In October, the agency declined Sutter\u2019s appeal against a $6,750 citation for not giving its medical assistants N95 masks in 2020 when they accompanied patients who appeared to have covid through clinics. Sutter pointed to the CDC\u2019s advice early in the pandemic, according to court testimony. It noted that the CDC called surgical masks an \u201cacceptable alternative\u201d in March 2020, \u201cseemed to recommend droplet precautions rather than airborne precautions,\u201d and suggested that individuals were unlikely to be infected if they were farther than 6 feet away from a person with covid.<\/p>\n

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This is a loose interpretation of the CDC\u2019s 2020 advice, which was partly made for reasons of practicality. Respirators were in short supply, for example, and physical distancing beyond 6 feet is complicated in places where people must congregate. Scientifically, there were clear indications that the coronavirus SARS-CoV-2 spread through the air<\/a>, leading Cal\/OSHA to enact its straightforward rules<\/a> created after the 2009 swine flu pandemic. Workers need stiffer protection than the general population, said Jordan Barab, a former official at the federal Occupational Safety and Health Administration: \u201cHealth workers are exposed for eight, 10, 12 hours a day.\u201d<\/p>\n

The CDC\u2019s advisory committee offers a weaker approach in certain cases, suggesting that health workers wear surgical masks for \u201ccommon, often endemic respiratory pathogens\u201d that \u201cspread predominantly over short distances.\u201d The draft guidance pays little attention to ventilation and air filtration, and advises N95 masks only for \u201cnew or emerging\u201d diseases and those that spread \u201cefficiently over long distances.\u201d Viruses, bacteria, and other pathogens that spread through the air don\u2019t neatly fit into such categories.<\/p>\n

\u201cGuidelines that are incomplete, weak, and without scientific basis will greatly undermine CDC\u2019s credibility,\u201d said a former OSHA director, David Michaels, in minutes from an October meeting<\/a> where he and others urged CDC Director Mandy Cohen to reconsider advice from the committee before it issues final guidance next year.<\/p>\n

Although occupational safety agencies \u2014 not the CDC \u2014 have the power to make rules, enforcement often occurs long after the damage is done, if ever. Cal\/OSHA began to investigate Sutter only after a nurse<\/a> at its main Oakland hospital died from covid and health workers complained they weren\u2019t allowed to wear N95 masks in hallways shared with covid patients. And more than a dozen citations from Cal\/OSHA against Kaiser Permanente, Sharp HealthCare, and other health systems lagged months and years behind health worker complaints and protests.<\/p>\n

Outside California, OSHA faces higher enforcement obstacles. A dwindling budget left the agency with fewer workplace inspectors than it had in 45 years<\/a>, at the peak of the pandemic. Plus, the Trump and Biden administrations stalled the agency\u2019s ongoing efforts<\/a> to pass regulations specific to airborne infections. As a result, the agency followed up on only about 1 in 5<\/a> covid-related complaints that employees and labor representatives officially filed with the group from January 2020 to February 2022 \u2014 and just 4% of those made informally through media reports, phone calls, and emails. Many deaths among health care workers weren\u2019t reported<\/a> to the agency in the first place.<\/p>\n

Michaels, who is now on the faculty at the George Washington University School\u00a0of Public Health, said the CDC would further curtail OSHA\u2019s authority to punish employers who expose staff members to airborne diseases, if its final guidelines follow the committee\u2019s recommendations. Such advice would leave many hospitals, correctional facilities, and nursing homes as unprepared as they were before the pandemic, said Deborah Gold, a former deputy chief of health at Cal\/OSHA. Strict standards prompt employers to stockpile N95 masks and improve air filtration and ventilation to avoid citations. But if the CDC\u2019s guidance leaves room for interpretation, she said, they can justify cutting corners on costly preparation.<\/p>\n

Although the CDC committee and OSHA both claim to follow the science, researchers arrived at contradictory conclusions because the committee relied<\/a> on explicitly flawed trials comparing health workers who wore surgical masks with those using N95s. Cal\/OSHA based its standards on a variety of studies, including reviews of hospital infections and engineering research on how airborne particles spread.<\/p>\n

In decades past, the CDC\u2019s process for developing guidelines included labor representatives and experts focused on hazards at work. Barab was a health researcher at a trade union for public sector employees when he helped the CDC develop HIV-related recommendations in the 1980s.<\/p>\n

\u201cI remember asking about how to protect health care workers and correction officers who get urine or feces thrown at them,\u201d Barab said. Infectious disease researchers on the CDC\u2019s committee initially scoffed at the idea, he recalled, but still considered his input as someone who understood the conditions employees faced. \u201cA lot of these folks hadn\u2019t been on hospital floors in years, if not decades.\u201d<\/p>\n

The largest organization for nurses in the United States, National Nurses United, made the same observation. It\u2019s now collecting signatures for an online petition<\/a> urging the CDC to scrap the committee\u2019s guidelines and develop new recommendations that include insights from health care workers, many of whom risked their lives in the pandemic.<\/p>\n

Barab attributed the lack of labor representation in the CDC\u2019s current process to the growing corporate influence of large health systems. Hospital administrators prefer not to be told what to do, particularly when it requires spending money, he said.<\/p>\n

In an email, CDC communications officer Dave Daigle stressed that before the guidelines are finalized, the CDC will \u201creview the makeup of the workgroups and solicit participation to ensure that the appropriate expertise is included.\u201d<\/p>\n