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The Looming Threat: CDC Proposals Pose Risk for Front Line Health Workers

Three years following the covid-19 outbreak, in which over 3,600 health workers perished, fresh warnings from experts in occupational safety suggest that frontline health workers could again be imperiled. The threat is posed by the potential adoption of new infection control guidelines in healthcare settings by the Centers for Disease Control and Prevention (CDC). These guidelines, under consideration by the CDC, were proposed by a committee in early November and are intended to substitute guidelines set 16 years ago.

A gaping fissure between the CDC and workplace safety authorities was laid bare as the pandemic raged. A recent incident involving Sutter Health, a vast hospital system in California, shows the struggle vividly. Sutter Health challenged a citation issued by the state’s Division of Occupational Safety and Health (Cal/OSHA) by referencing the CDC’s inconsistent advice on the use of N95 masks at the beginning of the pandemic. In stark contrast, Cal/OSHA mandates employers in high-risk settings, like hospitals, to enhance ventilation, utilize air filtration, and supply N95 masks to all staff exposed to airborne diseases.

The recent stand-off repeats old battles. The CDC’s advisory body furnishes different protective protocols based on ambiguous classifications, such as whether bacteria or a virus could be classified as common, or the distance they travel in the air. Consequently, occupational safety experts express concern that decisions about how to classify diseases like covid, influenza, and other airborne illnesses – and the corresponding protective measures – may again fall to hospital, prison, and nursing home administrators. Cal/OSHA further muddied the waters when, in November, it cautioned the CDC that accepting its committee’s recommendations would generate confusion and workers could end up inadequately protected.

Additionally, N95 masks, known to be more proficient in filtering particles than loose-fitting surgical masks, cost approximately ten times more and were in short supply in 2020. This compounded the hardship for Black, Hispanic, and Asian health workers who were more likely to be without these masks. This discrepancy partially explains why ethnic minorities were almost five times more likely to test positive for covid in the early months of the pandemic.

Numerous citations were issued by Cal/OSHA during 2020 and 2021 to health care facilities failing to provide N95 masks or take other protective measures for their staff. However, many were challenged and some cases are still in progress. An example included the agency declining Sutter’s appeal against a $6,750 citation for not supplying medical assistants with N95 masks in 2020 when attending covid-suspected patients.

Nonetheless, the potential acceptance by the CDC of the proposed guidelines raises further concerns. Critics caution it may undermine the CDC’s credibility, suggesting the draft guidance, despite appearing scientifically-based, lacks thoroughness and strength. While regulatory power rests with occupational safety agencies, enforcement often happens after the harm has occurred. A combined approach taking the broader lessons from the pandemic into account, including insights from healthcare workers who risked their lives, may prove optimal to prevent a repeat of such situations.


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