The problem with allowing COVID-positive health care workers to continue working

On November 9th, the governor of North Dakota, Doug Burgum, decided to allow hospital workers with COVID-19 to continue to come to work. He required that they be asymptomatic and that they only work on COVID-19 wards with COVID-19 patients. Given at-capacity hospitals and skyrocketing case counts in that state, health care workers (HCW) had asked state leadership to take extraordinary measures to curb disease spread. HCW were (and are) sick and tired. Since March, they have been asked to sacrifice their health, time with loved ones, and sometimes even their lives, to take care of COVID-19 patients. As a physician, my initial reaction was negative, but it took me several hours to put into words why that was. When I finally did, I realized my reaction was complex because there were so many things wrong in this picture.

Essential workers of all types have been asked to give more than the rest of society. However, the pandemic has truly laid bare how little the rest of society is willing to give to us. The governor of North Dakota could have issued a state-wide mask mandate (he eventually did on November 14, 2020). He could have asked more of his populace by limiting indoor dining and other non-essential indoor activities such as gyms and group sports. And yet, he did not. He instead chose to ask more of HCW in his state. He asked them to give more by coming to work when they should have been quarantining at home with their close contacts.

To be fully transparent, I should mention that the CDC does allow for this in its “Strategies to Mitigate Healthcare Personnel Staffing Shortages”:

Developing criteria to determine which HCP with suspected or confirmed COVID-19 (who are well enough and willing to work) could return to work in a health care setting before meeting all Return to Work Criteria—if staff shortages continue despite other mitigation strategies.

However, this particular mitigation strategy has many flaws (as I will outline below). Though there may be a time and a place for such a strategy, it should be after mask mandates and activity restrictions have failed.

Now let’s go back to those COVID positive hospital workers for a moment. Yes, Governor Burgum required that they be asymptomatic and only working on COVID wards. However, does anyone just beam themselves from home into their workplace? No, we sure do not. We sometimes stop for gas. We take elevators. We touch dozens of surfaces such as switches, buttons, and knobs. When COVID positive HCW take their mask off to eat or drink in the breakroom during a long shift, who are they exposing? If they are parents, who are watching their close-contact children? Would they sometimes lose against their better judgment and stop at the store to pick up a gallon of milk on the way home, exposing other essential workers? It wouldn’t be outside of human nature if they did.

It is dangerously unfortunate that the use of masks has been politicized in many parts of our nation. The Dakotas (or North and South COVID as they were recently called on Saturday Night Live) are far from exempt from this phenomenon. Likely, if Governor Burgum’s decision was less influenced by fear of criticism from his constituents and political retaliation, he would have required a mask mandate long before making it acceptable for infected individuals to leave their home. Masks have time and again proven to be safe and effective. It’s not a big ask.

The last several weeks have proven that we, as a society, have failed in containing this pandemic. In March, we all talked about working together to flatten the curve, but we eventually got tired and gave up. To be fair, it isn’t just our fault. It is apparent to those who choose to follow science, that our government could have handled this better. But the bottom line is, health care workers are tired and burned out. Many of us are familiar with the cynical memes stating “essential” is really code for “sacrificial.” But after these last eight months, I think many of us are convinced it isn’t just cynicism. Governor Burgum’s decision to allow HCW to return to work COVID-19 positive before asking more of society really made it crystal clear.

Sheetal Khedkar Rao is an internal medicine physician.

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