Last summer, the federal Healthcare Infection Control Practices Advisory Committee (HICPAC) began meeting to update their guidance on infection control in healthcare settings for the first time in sixteen years. The committee’s draft recommendations, released in November, argue that surgical masks are adequate protection against airborne viruses, and allow employers to decide whether to implement infection control guidance based on their own risk assessments. Last week, the Centers for Disease Control (CDC) returned HICPAC’s draft, asking for a revision, in what was seen by many as a win for frontline workers, unions, and patients who have been advocating for different recommendations.
The initial HICPAC draft sparked concern among healthcare workers, many of whom have been impacted by Covid-19 and Long Covid. These recommendations would mean “that healthcare employers have more free rein to prioritize their profits over protecting patients and healthcare workers,” said Jane Thomason, Industrial Hygienist for the union National Nurses United (NNU).
Instead, NNU wants HICPAC to add frontline workers, unions, and patient representatives to their working group. They also advocate for final guidelines that recommend the use of respirators, ventilation standards, and negative pressure rooms for airborne viruses, as well as measures such as screening, isolation, and exposure notification for general disease tracking and preventing transmission. NNU is part of a group of unions, public health organizations, patient advocacy groups, and individuals that have begun fighting back in the months since HICPAC’s draft recommendations were released — organizing, drafting petitions, speaking at hearings, and writing op-eds.
With the CDC’s recent request for revision, it seems advocacy efforts have paid off. The CDC is requesting clarification on whether N95 respirators should be used for all airborne pathogens.
Healthcare workers are at high risk for Long Covid
Healthcare workers face an especially high risk of developing Long Covid, given the high rate of Covid-19 exposures in their work settings. According to a recent survey conducted by NNU, which included 2,600 registered nurses nationwide, 28.1 percent of nurses who reported ever having Covid-19 experienced ongoing symptoms that lasted for more than 12 months. Nearly sixty percent of nurses who had Covid-19 at least once required time off work to recover from their post-Covid symptoms, and 53.1 percent of nurses who had Covid-19 at least once said Long Covid symptoms have affected their ability to work.
Healthcare workers with Long Covid, like other long-haulers, are sometimes unable to work due to disabling symptoms and often sidelined from their jobs as a result of dismissal from employers, coworkers or a lack of adequate accommodations including masking and ventilation, such as the ability to safely avoid reinfection.
To make matters worse, sparse public health education on Long Covid has resulted in some healthcare workers being unaware of the risks associated with contracting Covid-19. Thomason has been running clinical education workshops on Long Covid to educate nurses about the disease and the need for ongoing protections at work. “I would [put] the responsibility at the feet of the CDC for not having done extensive education about the risks of Long Covid,” Thomason said.
When Shoharab Chaudhary, a registered nurse in Sacramento, California, developed debilitating Long Covid symptoms in the winter and spring of 2021, he didn’t know the disease existed. Even in the fifth year of the pandemic, he said that awareness of Long Covid among fellow healthcare workers is low. “I still forced myself to go back to work,” Cahudhary said. “I was worried about [health] insurance.”
Mirasol Streams, a registered nurse in West Covina, California, also returned to work after her Covid-19 infection in December 2020, even though she was having trouble breathing and was experiencing dizziness. She eventually saw a pulmonologist in March 2021 who recommended that she stop working and has since received a clinical diagnosis of Long Covid. Streams worries about her fellow workers who may not understand the risk of contracting Covid-19.
Reinfections can lead to worse symptoms
Emerging research indicates that repeat Covid-19 infections can increase the risk of developing Long Covid and other severe outcomes. Covid-19 can cause changes to the immune system, and many people with Long Covid report feeling sicker when infected with new viruses or reinfected with SARS-CoV-2. Despite their best efforts to avoid the virus, both Streams and Chaudhary have been reinfected since the onset of their Long Covid symptoms. Both say their health deteriorated after reinfection.
NNU’s survey shows that 69.5 percent of nurses have been diagnosed with Covid-19, with 56.4 percent reporting one infection, 29.8 reporting two infections, and 10.5 percent reporting three infections — though NNU cautions these numbers are likely an undercount due to lack of testing and asymptomatic cases. The same survey found that only 61.2 percent of hospital nurses reported wearing a respirator for every encounter with a COVID-19-positive patient. “I find that egregious because it is so clear at this point that this virus is transmitted through the air,” Thomason said.
Thomason said HICPAC’s draft guidance would put workers like Chaudhary and Streams at greater risk “of getting infected at work with Covid, but also a wide range of other pathogens.” The risk is higher for nurses who’ve had Long Covid or repeated infections, as their “immune systems might be disrupted by their infections,” she said.
Since developing Long Covid, Chaudhary and Streams have done everything they can to avoid getting sick again. “I’m up to date on all the vaccinations,” Streams said. “We mask up whenever we’re in a crowded space.”
The debate over infection control is not new
While ongoing Covid-19 surges and decreased social safety nets make the stakes especially high in today’s debate over infection control in healthcare settings, the issue is far from new.
Surveillance, tracking, data, and transparency have been “chronic problems” for the CDC since long before the pandemic, said Kevin Kavanagh, chairman of Health Watch USA — a patient advocacy, health care, and research integrity organization.
His group has previously urged action for other infectious agents, including Candida auris, MRSA, C. diff, and CRE. Critics of HICPAC’s draft guidance have pointed out that the recommendations would increase the risk of infection for a wide range of pathogens beyond SARS-CoV-2, including influenza, RSV, measles, and Ebola. The recommendations would also do little to prepare healthcare centers for future airborne disease outbreaks.
Kavanagh believes the CDC’s failures to better track and prevent the spread of these pathogens before 2020 contributed to a lack of preparedness when SARS-CoV-2 first emerged. “The strategic stockpile had dwindled,” he explained, referring to a shortage of personal protective equipment (PPE). “At one point there was an advisory that healthcare workers…could wear a bandana. That to me is a lack of preparation beyond comprehension.”
Chaudhary and Streams remember this early era of the pandemic; they both became infected in the winter of 2020-2021. Streams recalls that it was hard to acquire N95s; she was forced to wear one respirator for an entire shift, despite recommendations to change after treating an infected patient.
Infection control is a labor justice issue
Despite being infected on the job, Chaudhary and Streams have experienced issues with worker’s compensation failing to cover necessary medical care, and both are concerned about their ability to survive financially while accounting for their health.
Employers often argue that their workers could have been infected in the community and refuse to provide benefits, Kavanagh said. Last spring, California’s Supreme Court ruled that workers who contracted Covid-19 on the job would not be able to sue employers, because the judges believed it would create “an avalanche of litigation.” California Nurses Association has co-sponsored a presumptive eligibility bill that attempts to fight back by automatically extending workers’ compensation to many who are currently struggling to receive benefits.
“The reality is that…nurses are leaving the bedside because conditions have been dangerous [and] because their health and safety has been sidelined by their employers.”
Jane Thomason, Industrial Hygienist for the union National Nurses United
A similar fight is taking place abroad. Hundreds of doctors with Long Covid in the U.K. announced last week that they are launching a class action lawsuit. “Many of our members contracted Covid at work whilst providing vital care to patients in absence of adequate airborne protection,” said Kelly Fearnley, the chair of Long Covid Doctors for Action, in an article about the litigation in The BMJ.
Kavanagh and Thomason believe a lack of adequate protections for healthcare workers is contributing to staffing shortages. Employers claim “that the nursing shortage is preventing them from hiring,” Thomason said. “But the reality is that…nurses are leaving the bedside because conditions have been dangerous [and] because their health and safety has been sidelined by their employers.”
This has certainly been true for Streams, who still has not returned to work. “I’m afraid of what I’m coming back to,” she said, explaining that she fears the risk of reinfection, given that respirators often aren’t worn in hospitals where Covid-19 patients are being treated.
While Chaudhary has not taken time off for fear of losing benefits, his sickness has made it difficult to return to his prior position. He now works in a hospital office — a job he describes as less exhausting, but that still leaves him with little energy after work to shower or run errands. He said he misses nursing: “I can’t even do what I love.”
“The reality is that..nurses are leaving the bedside because conditions have been dangerous [and] because their health and safety has been sidelined by their employers.”
An opportunity for the CDC to regain trust
The CDC’s decision to return HICPAC’s draft reflects the power of push-back from health advocacy and labor groups. It also comes amidst an increase in some workplace protections around the country. Los Angeles County, Illinois, Berkshire Health System in Massachusetts, and New York City reinstated mask mandates for healthcare facilities this winter, as did New York’s Fire Department. Kavanagh called CDC’s decision to return HICPAC’s draft “important and impactful,” but warned that “much work still needs to be done.”
This decision also presents an opportunity for the CDC to regain the confidence of healthcare workers. “There’s been a lot of trust breached,” said Thomason, suggesting that the agency could recoup support with a proactive education campaign around Long Covid. Streams said to win her back, the agency would need to recommend safer working conditions and pay more attention to healthcare workers’ needs. “Listen to what the nurses are asking for,” she said. “It’s us out there [on the frontlines]…not management.”
Fiona Lowenstein (they/them) is an award-winning independent writer, journalist and editor, covering health justice, wellness culture, LGBTQ+ issues and more. Their writing has been published in The New York Times, The Nation, Teen Vogue, WIRED, Vox, The Guardian and Business Insider, among other publications. They are the editor of The Long COVID Survival Guide, and the founder of Body Politic, which housed one of the first Long Covid support groups from 2020-2023. They are based in Los Angeles.
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