Over 3,500 healthcare workers have died throughout the COVID-19 pandemic. That figure would be tragic enough, but a new report suggests that CDC guidelines may actually have caused more deaths than they should have. Healthcare workers have been crippled by PPE shortages for months. Some nurses have been asked to reuse their masks, while others get access to N95 face masks, respirators, and hazmat suits.
Since the start of the pandemic, providers performing “aerosol-generating” procedures were considered the most at risk, including those who insert a breathing tube into the patient’s trachea when they can no longer breathe on their own. Without enough PPE to go around, the CDC said that providers performing these procedures should get first access to N95s as they get close to infected patients. Meanwhile, other providers were asked to get by with just a surgical mask.
However, new evidence suggests that may have been a mistake. A recent report from the Journal of the American Medical Association says that “aerosol-generating procedures” aren’t nearly as dangerous as being around an infected patient when they are coughing or breathing heavily, and that anyone caring for COVID-19 patients should have access to an N95.
“A Huge Mistake”
A recent article from The Washington Post estimates that a basic cough produces around 20 times more disease-carrying particles than intubation. It compares being near someone coughing to being right next to a nuclear reactor.
Dr. Michael Klompas, a Harvard Medical School associate professor and one of the authors of the JAMA report said, “The whole thing is upside down the way it is currently framed. It’s a huge mistake.”
Had the CDC guidelines been different from the start, fewer nurses may have died on the front lines. The report suggests that N95s should have been a priority for non-ICU and ER nurses who spent time around infectious patients, even if they weren’t putting tubes in their throats.
Changing the Narrative
The research came out of a new body of evidence that suggests people wearing surgical masks may not be as safe as we once thought when singing in groups, going out to restaurants, or even taking the bus; a simple cough could put everyone in the general proximity at risk.
These guidelines have been controversial in the healthcare industry. International and U.S. nurse leaders have been asking the CDC to update its guidelines for months, so that all nurses with direct contact with patients would have access to the most protective gear.
But their calls went unanswered.
Small changes to the guidelines would change the way we view and measure risk during the pandemic.
For example, the CDC still says that a provider doesn’t qualify as “exposed” to the virus even after caring for an infected patient with just a surgical mask, despite growing evidence that healthcare providers can get sick during routine care, including during intake and diagnosis. This suggests that N95 masks should have been available at all stages of the treatment and care process.
New research from Harvard and Tulane University show that super-spreaders of the virus, around 20% of people who emit 80% of the tiny particles spreading through the air, tend to be older and obese. They tend to live in poorer, non-white communities, which has put black and Latinx providers at more risk.
This information could have helped the lives of those working in nursing homes and long-term care centers, which have become magnets for the virus throughout the pandemic. According to the Centers for Medicaid & Medicare Services, more than 546,000 of these workers have tested positive for COVID-19 and 1,590 have died.
Dr. Donald Milton, a professor at the University of Maryland School of Public Health, says, “The upshot is that it’s inhalation, which means loose-fitting surgical masks are not sufficient.”
On February 10th, the CDC updated its guidelines by deleting a suggestion that it was okay for healthcare workers to wear a surgical mask when caring for COVID-19 patients. The agency now urges providers to wear a N95 or “well-fitting” surgical mask when working near infected patients.
Of the 3,500 providers who have died, many were at the forefront of patient care, performing routine tasks, such as bathing, dressing, feeding, and changing the patient. According to the Kaiser Health Network, around 2 out of 3 were providers of color.
The CDC has since responded to these reports, writing, “We are encouraged by the publication of new studies aiming to address this issue and better identify which procedures in healthcare settings may be aerosol generating. As studies accumulate and findings are replicated, CDC will update its list of which procedures are considered [aerosol-generating procedures].”