Q&A: Healthcare Workers Coming Down With COVID

Infection prevention shouldn’t be left at the hospital door when healthcare workers leave for the day, but too often they behave as if that’s the case. Linda Spaulding, RN, BC, CIC, CHEC, CHOP, is a member of Infection Control Today®’s Editorial Advisory Board. Spaulding tells ICT® that the coming holidays, when families gather, will most likely spike COVID-19 rates, which have been spiking recently anyway. Infection preventionists need to be prepared. Spaulding cites a new guidance by the US Centers for Disease Control and Prevention saying that someone exposed to COVID should be quarantined for 14 days. Having a good number of hospital staff quarantine at home for that many days will be “really tough for hospitals,” says Spaulding. “It’s important that they start getting the word out now. Blitz all of your healthcare departments. Let them know that it’s important if they’re getting together with a family, still wear your mask when you’re at home with other family members. And if possible, just don’t get together.”

Infection Control Today®: What do you what are you seeing out there in the field, so to speak?

Linda Spaulding, RN, BC, CIC, CHEC, CHOP: Essentially, right now, we’re seeing an increase in healthcare workers acquiring COVID. And part of that problem is not exposures at work to patients. But there’s a lot of exposure to these kids that have gone back to school. So, just last week, I took a look at 50 healthcare workers, and about 18 of them ended up being positive for COVID. And it was traced back to birthday parties. Among healthcare workers, because they all got together outside of work. We had husbands becoming infected, and their spouse is a healthcare worker. We’re in the process of working those spouses up. We’ve had daughters, sons, wives, mothers, and grandmothers. And those are the people that our healthcare workers are being exposed to now that is causing them to become positive with COVID. So over Halloween, we saw that New York had a bunch of parties. We should expect a rather large spike from that. Now the holidays are coming up for Thanksgiving and for Christmas. Some states are putting kids off in quarantine when they’re exposed at school. My nephew was just recently exposed, one of his classmates came down with COVID. But he’s the type of kid that always keeps his mask on no matter what. That was a good thing for him. But with the holidays coming up, we’re going to see families deciding to get together for the holidays. And it’s really important that healthcare is monitoring what their employees are doing on a regular basis, because a lot of people that we’re seeing are asymptomatic carriers. If healthcare workers do get off and have parties with their families, then we can expect to see more healthcare workers bringing COVID to work, which will expose other healthcare workers. So IPs and hospital management really need to stay ahead of that. The CDC came out with a new MMWR [Morbidity and Mortality Weekly Report] yesterday. And it’s talking about when people are exposed, they should be quarantined for 14 days. That’s going to be really tough for hospitals. It’s important that they start getting the word out now. Blitz all of your healthcare departments. Let them know that it’s important if they’re getting together with a family, still wear your mask when you’re at home with other family members. And if possible, just don’t get together.

ICT®: Does it give you any comfort that the mortality rate from COVID-19 seems to be plummeting even as the infection rate spikes?

Spaulding: Well, not really, because they’re still almost 1000 deaths a day. The thing right now is we’re in that that middle ground where we’re getting a lot of admissions with patients that are COVID positive. It’s going to take three, four, or five weeks before those people that are in ICU possibly pass away. We’re into this by nine months now. We have the ability to know a little bit about COVID that we didn’t know nine months ago, so we can do different treatments. We know how high oxygen has to be. We have a better grasp on who should go on a ventilator and when. Or can they ride it out without going on a ventilator? We have dexamethasone. So, I think doctors are getting better at tweaking the treatment for people. But it’s still not going to save everybody. We still don’t have that magic bullet to cure people. We don’t have a vaccine yet. We are going to continue to see the death rate increase. And just because people think it’s a little bit low right now. Yes, we don’t have 2000 people die in a week, but we have close to 1000. After Halloween, I think this next two weeks, we’re going to see an increase in the death rate. We’re going to see the same thing after Thanksgiving. We’re going to see the same thing after Christmas. We just have to get information out there constantly. And push healthcare workers because you know, the people in healthcare who are really being exposed to COVID, are those people working in the ICU. In the emergency room. You have med surg floors that aren’t really affected by COVID until the staff decides to throw a birthday party, or some kind of other party. And then you start seeing in those other med surg units, that kind of thing. The real impact is in the ER and the ICU.

ICT®: I know, in previous conversations, you spoke a little bit about your frustration with healthcare workers in terms of hand hygiene compliance being not up to the rates that they should be and when they use the mask, they often don’t use them in the correct way. Are you surprised that healthcare workers are sort of letting their guard down or does it just confirm that healthcare workers are just like everybody else and they just feel that they can let their guard down and have a birthday party? Does that worry you?

Spaulding: Yes, healthcare workers are just like the normal Joe Schmo sitting at home. What is happening at work doesn’t seem to be translating when they walk out the doors. Some healthcare workers are being extremely cautious. They’re only going to work and they’re only going home. They go to the grocery store maybe once every two weeks. Then you have other healthcare workers that pretty much have the attitude of the general public, “Oh, I have to wear a mask at work, but I don’t have to wear it outside work. It’s mandatory at work.” And it may just be a handful of healthcare workers that are doing that. But that handful is enough to affect multiple people.

ICT®: It’s clear that the virus affects mostly older people and people with comorbidities. And that message has gotten out to the public. Is it possible that younger people are just feeling invulnerable to COVID? I mean, younger people in general and younger healthcare workers in particular?

Spaulding: I think that’s a good part of it. I mean, when I was in my 20s, I didn’t think anything was going to affect me. Just because we have a pandemic doesn’t change that mindset of young individuals. We have some older individuals that feel the same way. If your mom and dad have the attitude that you don’t have to wear a mask, then you as a child are going to follow their lead. Some of it has to do with that. There are still people out there that think COVID is a hoax. And I don’t see how they can think that unless they’re in some really small town that has not been affected yet. And so, it doesn't mean anything to them because it hasn’t hit home. The first time somebody in their family gets it, and they are very sick, it’s going to change their attitude toward it. But if someone in the family gets sick, and they just have mild symptoms, or no symptoms, then they say, “Oh, see. It’s not that big of a deal. It’s OK for me not to wear a mask.” So, you know, healthcare workers are just like the general public. And we have varying opinions everywhere. And the best we can do is we follow up on all the exposures. As soon as we find out, there’s a family member of one of our healthcare workers at home sick, then we will make arrangements to put that person off work, test them in seven days, and make sure they don’t become an asymptomatic carrier. If they’re still clear, we let them come back to work. Now, with the CDC guidance yesterday, we should be putting them off for 14 days. That’s going to be a discussion point to have with management today. Because you have to realize it’s a hospital that’s full of patients. And how many healthcare workers can you have off at one time? We’re going to have to get creative.

ICT®: How far can an infection preventionist reach outside the boundaries of the hospital to prevent infection? In terms of, for instance, hearing maybe that fellow employees are going to throw a party for somebody somewhere? Can an infection preventionist say, “That’s great. But please remember to wear your mask.” And the CDC said that if a family member of a healthcare worker has COVID, the healthcare worker should be quarantined. But how will the hospital find out? The healthcare worker would have to report it, right?

Spaulding: Exactly. It’s all on the honor system. But it’s the same thing for any other business outside of healthcare. If any relative of somebody working at any business, whether it’s the grocery store, or a bank, if any of their family members come down with COVID, they also should be put off for 14 days. It affects all businesses. But you’re right, until we find someone that’s COVID positive, and ask them where they think they got exposed, we don’t know that they had a party. We don’t know that they went to a costume party this weekend. You just don’t know. And people aren’t going to come to work and voluntarily tell you no matter what business they’re in. Now, you might overhear somebody talking about it. But unless they tell you that the event happened, you’re never going to know.

ICT®: Does this complicate contact tracing? And how much involved are infection preventionists in contact tracing these days?

Spaulding: Well, I tell you, myself, I worked up 50 healthcare workers last week. And contract tracing for us is just within the hospital. Who were you working with on these three days? Were you around anybody without a mask on? And usually it’s, “Yes. I had lunch with them.” Even though we continuously reinforced don’t do that. They still do it. So, it’s following up on the healthcare worker that got COVID and then following up on their co-workers that they might have exposed. But it doesn’t stop there. Then you have to think, OK, if you have five healthcare workers that may have been exposed to this person, who were the patients that those five healthcare workers were taking care of? And then you have to find out did everybody wear PPE when they were in the room. Did the patient have on a mask, which we’re requiring? If the patient had on the mask and the healthcare worker had on the mask, then we feel pretty good about it. But if you tell me you went into a room you, have COVID, and the patient didn’t have on a mask, then we have to investigate and have the discussion. How long were you with them? What were you doing? And then should we test the patient for COVID? We don’t go outside of the hospital boundaries for contact tracing. But it does get reported to the Department of Health. But if I’m working up 50 cases, the Department of Health does not have the resources to go work those people up outside. They try the best they can. Because we, as IPs, get calls from the Department of Health every day, inquiring about positive cases we had. They either don’t have a phone number, or the incorrect phone number. Or they have to verify the address so they can reach out and contact those people.

ICT®: So, so any final words of advice for your fellow infection specialists?

Spaulding: I would say: Infection preventionists, put your tennis shoes on because over the next two months, we’re predicting to see a huge increase. We’ve had all the political rallies recently. You can have cases from those. We have all the holidays coming up. You’re going to have cases from those. Hospitals have to be prepared. What happens if your staff decreases because of employees having COVID from their experience outside of work? They’re really safer at work than their behavior outside of work. So just gear up and make sure you have enough PPE. Order extra PPE. Try to stay safe and push. If you’re going to have parties over the holidays, everyone in your household should keep their mask on unless they’re eating, and you should try to social distance when you’re eating. And that’s the best we can do right now.

This interview has been edited for clarity and length.