RI Health Dept. opens door for COVID-infected staff to work at hospitals, nursing homes
PROVIDENCE — A memo went out to employees at the state-run Eleanor Slater Hospital on Friday telling them they can work even if they have tested positive for COVID, if there is a staffing crisis.
Under those circumstances, the memo advised the employees that "those who are exposed or have a positive Covid test but are asymptomatic" can work "in crisis situations for staffing," as long as they wear N95 masks.
The Rhode Island Department of Health has in recent days also opened that same last-resort, crisis-staffing option to COVID-19 infected health-care personnel at hospitals and skilled nursing homes who are "mildly symptomatic."
Asked if the Slater Hospital or any other facility in the state had reached this crisis level, Health Department spokesman Joseph Wendelken told The Journal:
"No, no facility has reported to us yet that they are in a position that requires COVID-19 positive healthcare providers to be working. If a facility does reach that point, that information would be posted publicly so patients and families would be aware."
The severity of the hospital worker shortage in Rhode Island has been a growing concern for weeks, with hospital leaders begging for relief on many fronts. It is not clear yet where they stand on having infected staff working in their hospitals.
The memo from the Slater hospital's chief medical officer, Dr. Elinore McCance-Katz, cited the most recent Rhode Island Department of Health guidance for "crisis staffing."
The Journal obtained a copy of the guidance the health department initially issued on Dec. 30 and it reaches beyond the state hospital campuses in Cranston and Burrillville that provide care to about 200 medical and psychiatric patients.
It is titled: "Updated COVID-19 Quarantine and Isolation Guidance Due to the increased transmissibility of the Omicron variant of SARS-CoV-2, the virus that causes COVID-19, and concerns about its impact on the healthcare system."
It says, in part: "The Rhode Island Department of Health (RIDOH) is updating its COVID-19 quarantine and isolation guidance for healthcare personnel at hospitals and nursing homes who are exposed to or test positive for COVID-19."
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In response to Journal inquiries on Saturday morning, Wendelken, the health department spokesman, provided this context:
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"This change was not unique to ESH. Last week Rhode Island updated its quarantine and isolation guidance for the general public and for healthcare workers in hospitals and nursing homes'' to mirror "a national change,'' and more specifically, updated guidance from the CDC on Dec. 23.
"For the general public, the updated guidance (which shortens the isolation and quarantine period in some instances) is reflective of science that indicates that most SARS-CoV-2 transmission occurs early in the course of illness,'' he wrote.
"For healthcare providers, the CDC is recognizing that states across the country are experiencing healthcare worker shortages. If a facility is experiencing a significant staffing challenge, facility administrations may make a determination on the need to have ... COVID-19 positive healthcare providers work.
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"However, asymptomatic or mildly symptomatic workers should be considered first in these instances, and of course masks are required."
"Also, facility administrators should be using their clinical judgement in making staffing decisions. For example, a facility may opt for a COVID-19 positive worker to only care for COVID-19 positive patients."
Asked who will decide if a hospital is in crisis, Wendelken said: "Facility administrators understand their patient populations and staffing ratios best, so they are making those kinds of status determinations."
Any hospital that opts to go into crisis staffing mode is obligated to notify the Department of Health and post the information on its website so patients and their families will know.
After the posting came to light over the weekend, Twitter lit up with questions, statements of concern and in some cases condemnation.
For example, Republican state Sen. Jessica de la Cruz Tweeted: "RIDOH will allow healthcare staff who test positive w/COVID to work but not unvaxxed healthcare staff who test negative?! Its time for the state to admit its mistake. We need all hands on deck to address the healthcare crisis. Rehire these qualified & experienced professionals."
Among the questions:
Why not bring back "healthy, unvaccinated workers" before employees with known COVID infections? Are there any standards for what constituted a staffing crisis or is that decision entirely up to the facilities?
Is Wendelken saying that those who are asymptomatic or have mild symptoms should be considered before administrators bring back people with more serious symptoms?
On Sunday night, Wendelken provided some answers.
As for bringing back unvaccinated workers, he said: "An unvaccinated healthcare worker is at greater individual risk, given how many COVID-19 positive patients are in facilities.
"Additionally, someone who is vaccinated and who tested positive for COVID-19 has a much lower viral load, compared to someone who is COVID positive and unvaccinated. This means that the likelihood of transmission is much less."
He again stressed: "Rhode Island is implementing the CDC’s updated quarantine and isolation guidance for healthcare workers. States across the country are implementing this same approach."
Asked the definition of a "crisis" that justifies use of infected workers, he said: "The CDC does not quantity what constitutes “crisis status” at facilities. As I wrote yesterday, facility administrators understand their patient populations and staffing ratios best. Facility administrators are making status determinations."
Wendelken said there is more coming.
"We are working with [the R.I. Department of Education] on updated Q&I guidance for the school setting. That guidance should be available to school leaders shortly."
One Eleanor Slater Hospital employee said N95 masks and other PPE have been locked up and unavailable when employees arrive at the hospitals for their shifts, so staff have been forced to wear regular surgical masks day after day.
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"Oh crap. We don't have enough people," said this worried staffer of the memo she and others received about the new crisis staffing rules.
Said another staffer who also asked not to be named of the McCance-Katz memo: "She is doing the right thing as we, and all hospitals, [struggle] with staffing. We have no choice."
This article originally appeared on The Providence Journal: COVID positive staff allowed at RI hospitals if in a 'staffing crisis'