'Mixed Message': Oklahoma Officials Say Asymptomatic COVID-Infected Health Workers Can Keep Working

Nov 25, 2020

As Oklahoma attempts to manage its third coronavirus wave, state officials have pitched a controversial tool to address the state’s health worker shortage: allowing infected nurses, physicians and staff to keep working.

The third wave began in November. Case counts again began breaking records, with the 7-day average hitting 3,000 this week. Hospitalizations are off the charts, with an unprecedented 1,604 reported Tuesday night. Statewide, only about 5 percent of staffed intensive care beds are available. In recent weeks, that has meant ambulances driving around with nowhere to go, rural hospitals with nowhere to transfer critical patients, and metro hospitals turning away transfer requests from other parts of the state, as well as other states.

Oklahoma was in a health worker shortage long before the pandemic, but the coronavirus has exacerbated the problem. One of the top issues: quarantines. When workers are exposed to community spread, they have to stay home for two weeks. Hospital administrators said they’ve had scores of nurses out at a time.

During a virtual media availability Tuesday, officials in the Oklahoma State Department of Health said that, in emergencies, hospitals and long-term care facilities can use a practice the Centers for Disease Control and Prevention has already authorized: allowing infected health care professionals to keep working.

Commissioner of Health Lance Frye and Deputy Commissioner Travis Kirkpatrick reiterated that the federal guidance has existed for months.

The CDC guidance recommends workers quarantine when sick, but makes an allowance “if staff shortages continue despite other mitigation strategies.” The guidance urges employers to to consider what type of worker shortage needs to be addressed. Kirkpatrick gave an example of highly trained psychiatric nurses working in long-term care facilities. The guidance recommends considering where the worker is in the course of the virus, which would determine how likely that worker is to shed the virus and be contagious. It says to consider the worker’s degree of interaction with patients. For example, do they work face-to-face or in telemedicine?

“We decided, as a state, we wanted to amplify that federal guidance,” Kirkpatrick said.

Frye said the risk potential would be low, as long as the worker was in a COVID-19 ward. Their non-infected coworkers would be protecting themselves against exposure with personal protective equipment and other measures.

“The chances of spreading to a coworker are pretty minimal because every worker in there, all day long, works with COVID-positive patients,” he said.

During the availability, KWTV reporter Ashley Holden said that nurses have contacted the station with concerns that their employers didn’t have enough protections in place, and that they wanted to know whether the state had its own guidelines on this practice.

Kirkpatrick, the deputy commissioner of health, said that because this practice is so new, the state does not have its own guidelines, and that not many other organizations do.

“We’re in a new era of this guidance, “ he said. “There’s not a whole lot of ‘do this, not that’ that we can really provide. So we’re leaning heavily on the providers themselves to kind of practice best standards.”

Holden asked if non-infected health care workers, who are working with infected staff and concerned about their own safety, had any recourse, such as a contact within the Department of Health they could reach directly. Frye said he’d received emails with that question, and that he’d discussed the matter with industry groups such as the Oklahoma Hospital Association.

“We have the same goals,” he said. “We want to work together to increase nursing capacity within the state of Oklahoma.”

During a separate virtual briefing, Oklahoma Nurses Association CEO Jane Nelson criticized the guidance. She said that keeping infected and noninfected workers separated would prove impossible. But logistics and risk were not her only concerns.

“It is a mixed message to the public to allow asymptomatic COVID-positive nurses, physicians and other health care workers to work,” she said. “They need to be home quarantining like the rest of the public.”

Dr. Scott Michener, the chief medical officer at Comanche County Memorial Hospital, spoke during the same briefing as Nelson. He discussed his hospital’s ICU capacity being at 120 percent, with overflow spilling into several departments, including the emergency room. He echoed that the bed shortage doesn’t refer to the need for physical beds but the lack of workers to staff beds.

“The state health department said today that asymptomatic providers can continue to work, and that’s their way to alleviate staffing shortages,” he said. “Just, to me, that seems like the most insane thing.”

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