With growing concerns about staff shortages in hospitals as Omicron cases spread rapidly, the Centers for Disease Control and Prevention on Thursday cut isolation periods for healthcare workers who contract Covid-19.
The agency recommended that health workers who are asymptomatic after seven days and test negative return to work, adding that “isolation time can be further shortened if there are staffing shortages.”
The agency also said the workers who received all recommended doses of vaccine, including boosters, will not be required to self-quarantine after being exposed to high-risk.
Many major hospital systems had already been forced to move forward on their own in recent days, creating a patchwork of guidelines regarding infected workers in anticipation of a winter surge.
The shortest return to work policy — five days, with some different terms — is half the 10-day norm previously set by the CDC.
The agency’s new recommendations do not apply to the public. At the beginning of the pandemic, the CDC imposed a 14-day isolation period for infected Americans to reduce the risk of infection, but that was then reversed as more research confirmed that a typical patient would be contagious for a shorter amount of time.
The CDC’s decision to only recommend the changes to health professionals, criticized for shifting guidance and mixed reporting, is likely to add to the confusion among Americans, especially as Britain on Wednesday issued a broad recommendation for shortened isolation that would benefit everyone. applies.
The UK Health Security Agency has reduced the period for all infected individuals from 10 days to seven days if they tested negative twice with rapid antigen tests.
Some medical experts pointed to limited evidence as to when a person infected with the Omicron variant is no longer contagious. But other researchers have pushed for shorter periods, saying the CDC revisions were overdue.
“They are consistently lagging behind in updating recommendations that are needed now, especially as we face the daunting prospect of a sudden increase in cases,” said Angela Rasmussen, a virologist with the Vaccine and Infectious Disease Organization at the University. of Saskatchewan in Canada.
dr. Ashish Jha, dean of the Brown University School of Public Health, said it would also make sense to reduce isolation times for the public, especially for those who have been vaccinated.
“Since a large proportion of health professionals, like other Americans, will become infected, it is critical to find a shorter period of isolation,” said Dr. yah.
“I think with Delta we have pretty good evidence that vaccinated people clear the virus much faster. There’s no reason to believe that wouldn’t be true for Omicron.”
Hospital administrators have emphasized that the new changes that allow workers to return to work earlier pose no risks to patients.
Since health professionals are often tested, largely vaccinated and must be masked, “the chances of causing a significant number of infections appear very low” if isolation periods are shortened, said Dr. Bob Wachter, chair of the department of medicine at the University of California, San Francisco.
“The implications of keeping the workforce away are huge when you think about the impact on health,” he added. UCSF is also considering whether to reduce employee isolation to five days: “I don’t know if five days will save us, but it’s better than seven and better than 10.”
dr. However, Jha stressed that more research is needed to definitively answer questions about how long a person with an Omicron infection can remain contagious. The variant is much more contagious than previous versions of the coronavirus.
Many of the new hospital policies also include requirements related to testing, vaccination status and symptoms.
In New York State, which has reported a seven-day average of more than 4,600 hospitalizations as Omicron cases rise, major hospitals have recently changed isolation protocols for vaccinated workers.
NYU Langone shortened its return to work policy to five days after an employee gets a positive test, or three days after the fever has cleared, whichever is longer. NewYork-Presbyterian has reduced the isolation period to seven days. On Thursday, the Mount Sinai Health System also shifted from 10 to seven days.
“Guided by the latest science, our current protocols allow fully vaccinated workers to return to work after seven days,” said Joy Valenzuela, a spokesperson for NewYork-Presbyterian. “Nothing is more important to us than the health and safety of our patients, visitors and employees.”
Northwell Health guidelines now allow fully vaccinated workers to return to work eight days after a positive test or symptom onset, if their symptoms improve and they have not had a fever for 24 hours.
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Many hospitals are already overloaded as admissions rise, especially with patients who have not been vaccinated and those who have postponed necessary care during the pandemic.
“Speaking on behalf of Rhode Island, we are already in a disastrous level of concern,” said Dr. Megan Ranney, an emergency physician and academic dean at Brown University’s School of Public Health.
“We don’t have beds in the emergency room. We do not have IC beds that are staffed. We are making treatment and triage decisions that are demoralizing and beyond what I imagined we would be doing at this point in the pandemic.”
The research on how long people remain contagious with Omicron is so far meager. A study in Norway of a large group of individuals infected with the variant at a Christmas party in Oslo suggested that the incubation period was about three days, shorter than for Delta.
The study authors sent a questionnaire this week to find out how long those infected remained symptomatic, said Frode Forland, specialized director for infectious diseases at the Norwegian Institute of Public Health.
CDC guidelines say that vaccinated individuals who become infected with Delta are likely to be contagious for a shorter period of time than unvaccinated people.
Ann Marie Pettis, the president of the Association for Professionals in Infection Control and Epidemiology, acknowledged that decisions were made based on limited data. Federal officials, she said, had to weigh the risk of returning people to work too soon with the potentially greater risk of not having enough health workers to care for patients.
“The staff shortage is a terrible situation right now, pretty much across the board,” she said. Hospitals that continued with reduced isolation periods are likely concerned that large numbers of employees will become infected and stay away for 10 days.
“They just can’t take care of the patients they’re trying to see,” Ms. Pettis said.
While the situation isn’t nearly as dire as it was at the start of the pandemic, she said, the choices now recall a time when federal officials, faced with a severe shortage of personal protective equipment, relaxed guidance around face coverings.
Deciding how best to protect workers and patients is challenging, she said, “I’m not jealous of the CDC making the call.”
Others were not so understanding. “The fact that we need to discuss this before clarifying guidelines from public health authorities is indicative of the impact the spread of the Omicron variant will have on an already overburdened health care system,” said Dr. Daniel Diekema, a physician and epidemiologist at the University of Iowa Carver College of Medicine.
Some health professionals say they are concerned that shortened isolation periods could put both staff and patients at risk. “That would be absolutely unscrupulous,” said Jane Thomason, the chief industrial hygienist for National Nurses United, a major union that has been outspoken about the need to protect their members.
dr. Ranney warned that the new protocols must be followed carefully: “This should not be the equivalent of, ‘I don’t care if you have an N95, go ahead and take care of patients anyway,'” she said, referring to protective masks. “That’s not fair to the workers, and that’s not fair to the patients.”
