Melody Butler, a registered nurse in New York, woke up the day after Christmas with a headache, chest tightness and a feeling of malaise — an at-home rapid test confirmed she was Covid-positive. Eight days later, she returned to work at the hospital, still a bit fatigued and prepared to wear full protective gear to prevent any potential spread.
As the highly transmissible omicron variant took hold and spread throughout the holidays, the Centers for Disease Control and Prevention last week revised its isolation recommendations, reducing the isolation time for asymptomatic health care workers from 10 days to seven with a negative test — or fewer days “if there are staffing shortages.”
Out of an abundance of caution and concern, Butler, who is fully vaccinated, weighed her options when deciding when it was safe to go back to work. But, she said, knowing how overwhelmed her colleagues were with staffing shortages only added pressure on her to return.
The hospital “did inform me about the new recommendations, but they said, ‘You come back to work when you feel you’re ready,’” Butler, 35, said. “I did not feel threatened, but I know how tight staffing is right now. I’m very well aware of how many people are out sick.”
Health care workers across the country find themselves once again at the forefront of another Covid-19 surge, but this time many are being sidelined after testing positive, leading to a nationwide hospital staffing shortage. Hospital staff now find themselves toeing the line between patient safety and care and staffing shortages when trying to decide when it’s safe to return to work after a Covid infection.
“You want to be as safe as possible and reduce the spread of the virus, but you don’t want your health care infrastructure to totally break down or suffer too much from unneeded isolation,” said Franklin Rosenblat, an infectious disease doctor in Michigan. “Lots of health care workers have tested positive for Covid, and there have been staffing shortages because of the amount of hospital staff affected.”
While his hospital had discussions with its staff about developing policies for Covid-positive workers after the holidays, he spent much of Monday fielding questions from nurses who tested positive or feared testing positive.
“I think the main fear is always for our patients,” Rosenblat said. “Nurses especially have a tight bond with their patients, and they want to make sure that they’re not putting the patients at risk, so that anxiety is really something that I have to respect because they have a patient’s best interest foremost in their mind.”
He recommends taking a rapid test if possible before returning to work and wearing personal protective equipment — an N95 mask, eyewear, face shield and gloves — after a shorter quarantine. These measures, he said, are proven mitigating strategies for both health care staff and patients. And symptomatic people, he said, regardless of how mild the symptoms are, should “definitely stay home.”
Case counts have been rising across the country, with the United States hitting 1 million new Covid cases Monday, according to NBC News data.
For the past few weeks, Rosenblat, 59, has come in to work to find the emergency room full of patients. He said that he’s used to the frantic pace of the pandemic, and that he’s treated more than 100 Covid patients since March 2020. But, he added, the past few weeks have been the most concerning so far.
Anna Bershteyn, an assistant professor in the department of population health at the New York University Grossman School of Medicine, emphasized the need to be cautious after leaving isolation and quarantine.
“Something people often forget is, you don’t just go back to what you were doing,” she said. “After five days, you do need to wear a mask and socially distance. You can go out and do those essential things, but you need to be cautious as you do them.”
Bershteyn said she wants to reassure the public that the changing CDC recommendations for isolation are founded on data and research compiled over almost two years. In late November 2020, a study led by researchers at the University of St. Andrews in Scotland, published in the peer-reviewed Lancet Microbe, found that SARS-CoV-2 viral load peaked in the upper respiratory tract the first five days after the onset of symptoms.
She also said that while recommended isolation periods are shorter now, the return-to-work recommendations for immunocompromised or symptomatic people outlined on the CDC site are a little more stringent, proposing a Covid test-based strategy and consultation with infectious disease specialists.
But in the short-term, according to Bershteyn, as long as recommendations are backed by data and people keep the most vulnerable in mind, she’s hopeful for the coming months.
“The goal is not zero transmission; the goal is to get us all through this,” she said. “Let’s keep up essential services while also reducing transmission.”
As the nation continues to navigate the spread of new variants, hospitals need to find alternative methods to bolster their staff, said Miles Corak, a professor of economics at the City University of New York’s Graduate Center. With much of his research on inequality, he said that bringing in more staff could leave room to address the concerns of current health care workers, who are feeling two years of exhaustion and fear. He suggested rehiring newly retired health care workers with higher pay or improving working conditions, hospital ratios and pay, for all staff, so more people apply.
“In some measure, we are sort of facing the consequences of a lot of structural forces,” he said. “We don’t pay as much attention to workers as we pay to other forms of investment.”
Though Butler said she was fortunate enough to return to work when she felt comfortable, she’s concerned that as cases rise and more health care workers test positive, people will get back to work sooner than they should.
“My concerns are that if a health care worker is sick and they’re informed about the new return-to-work policy, that they may feel pressured to come back sooner than they’re physically able,” she said. “And it’s really important that they do listen to their body and make sure they are meeting the criteria to return to work.”