For more than a year and a half, California healthcare workers and their patients have been the canaries in the coal mine of COVID-19. As of August 12, 2021, there have been at least 118,000 COVID infections among California healthcare workers and 483 deaths.
Testing and isolating and protective equipment failed to contain the spread among the vulnerable—and the fact is that even the vaccinated are becoming infected and contagious. Nurses in particular have been exasperated by being forced to re-use equipment meant to be disposable and left unprotected when Cal-OSHA aerosolized disease regulations failed to be enforced at the very moment they were most needed.
My colleagues were first told that they could only be tested if they had specific symptoms so many were then suspicious when testing became mandatory.
Now hospital administrators and Federal and State governments are increasingly imposing mandatory vaccination on an exhausted workforce. Some are balking and want to “compromise” by allowing testing instead. That would be a huge mistake because it has not worked.
The rapid tests are not sufficiently sensitive and the “gold standard” PCR test may detect the infection too late, as it may miss the most infectious period of the disease process before symptoms. To see how mandates work, one has to look no further than the screening for tuberculosis and universal precautions when handling bodily fluids. As a nurse, I was infected with tuberculosis and took medicine to stop the development of active TB that could sicken my family and community. I lost so many co-workers to HIV but have lived to see treatment that can help people to survive and medications that prevent transmission.
There is no medication developed that can prevent people from becoming infected with COVID-19 and precious few that slow disease progression. But the struggle to contain the current pandemic has something that TB and HIV control efforts lack: several safe, well-tolerated, highly effective vaccines.
Yes, it has to be a condition of employment or healthcare workers will continue to sicken and die while infecting their colleagues, their patients, and their families.
TB is spread just as COVID 19 is: by breathing in microscopic particles exhaled by people already infected with their respective microbes. Every nurse is screened for tuberculosis, and those who have a positive test must be evaluated to determine if they have an active disease that could be spread to their co-workers and patients. I have yet to meet the nurse or doctor who has complained about the mandate to not work with active tuberculosis.
Testing and masking are necessary but insufficient measures for control of COVID-19. My workplace provides evidence of why this is the case.
Laguna Honda Hospital is San Francisco’s public nursing home and therefore an early epicenter of the COVID outbreak. In addition to a stringent lockdown that prevented all but patients and staff from entering, masks have been required as well as testing of all staff and residents once or twice a week. The vaccine became available to staff and residents at the very end of December during the worst surge in California. Within a month, there were virtually zero infections.
And then the Delta variant arrived, and staff infections are increasing again.
Mandatory anything is upsetting to everyone. I am asked to consent to have my nose swabbed twice a week and if I decline, I can’t work.
Some of my colleagues expressed reservations about being required to have a COVID vaccination as a “slippery slope.” The nurse who swabbed me agreed but said “we have to go down that slippery slope and put in guard rails.”
Instead of focusing on mandates and conditions of employment, it should be addressed the way blood-borne diseases are: universal precautions. This means using gloves and devices engineered to reduce needle-stick injuries for all patients, not only those who have HIV or hepatitis. As long as there is community contagion of an airborne virus then there must be universal masking, testing, ventilation, and vaccination.
Different diseases have different routes of transmission and different methods of prevention. The vaccine for tuberculosis is very rarely used in the US because it has poor efficacy and for a very short time. There is no vaccine for HIV—but there are medications that can prevent it and safer devices that have been required thanks to the work of union healthcare workers whose efforts have saved countless lives from occupationally acquired HIV and Hepatitis B.
Nurses and patients must very quickly put aside the fears and embrace the best chance we have of ameliorating this pandemic: universal vaccination, masking, ventilation, and testing and supporting one another. It is disappointing that some union leaders are not listening to the majority of nurses who know what works.
Nurses must remind their unions of the radical slogan that very much applies to COVID-19: An injury to one, is an injury to all.
Sasha Cuttler RN PhD works for the San Francisco Department of Public Health and is the RN Chair for the Service Employees International Union Local 1021. The views expressed in this piece are Cuttler’s alone.