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Health Care Workers on Front Lines of COVID-19 Outbreak Lack Key Protections

The lack of protections could create shortages of caregivers and undermine efforts to control the coronavirus.

Nurses protest the Center for Disease Control's (CDC) weak response to the COVID-19 pandemic on March 11, 2020, outside the UCLA Medical Center in Los Angeles, California.

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Across the country, health care and domestic workers lack key health and workplace protections as COVID-19 continues to spread. Advocates and nurse unions said this puts people working on the front lines of the effort to contain the COVID-19 outbreak in danger of contracting the novel strain of coronavirus, which could create shortages of caregivers and contribute to the spread of disease.

Based on recent surveys of nurses working in hospitals nationwide, National Nurses United has been warning for weeks that hospitals are not adequately prepared to protect workers and respond effectively to the growing outbreak of COVID-19. Nurses continue to report that hospital managers are not communicating clearly with employees about safety protocols and the presence of confirmed or suspected cases of COVID-19 at their facilities.

If nurses and health care workers are not protected from COVID-19, experts and advocates say, then the public is not protected.

“The response so far that we’ve all seen to COVID-19 has obviously not been a success,” said Bonnie Castillo, a registered nurse and executive director of National Nurses United, during a nationwide call with thousands of nurses on Thursday.

Last Tuesday, the Centers for Disease Control (CDC) further weakened a guidance for hospitals responding to COVID-19 due in part to shortages of N95 face masks and other protective equipment. The guidance lays out standards for isolating patients and providing protective gear to nurses and health care workers at risk of exposure. Last week, a coalition of unions warned the CDC that weakening the guidance would decrease the level of protection for health care workers and encourage the spread of COVID-19. Nurses held protests across the country on Wednesday.

“This rollback is completely outrageous,” Castillo said.

For many health care workers and domestic caregivers, particularly those who are not union members and live in parts of the country with few labor protections, exposure to or contracting COVID-19 could result in quarantine without paid sick leave. This creates an incentive for workers to continue working even if they suspect they may have been exposed to or contracted COVID-19.

On Saturday, the House Democrats reached a deal with the White House and passed emergency legislation that would require smaller businesses to provide paid family and sick leave to workers affected by coronavirus at no less than two-thirds of their pay and reimburse employers with a tax credit. However, thanks to GOP haggling, companies with more than 500 employees are exempt and small business with less than 50 employees can apply for hardship exemptions, according to reports. This could leave up to 20 million workers uncovered, including many nurses and other workers employed by large health care providers and domestic workers employed by individual families.

The bill — which would also strengthen unemployment insurance, provide free COVID-19 testing and temporarily boost funding for nutritional assistance and other safety net programs — will be sent to the Senate as early as Monday, where Republican majority leader Mitch McConnel recently panned the bill as an “ideological wish list.” While the Senate GOP will be under intense public pressure to pass the bill, it remains unclear whether and how soon the COVID-19 relief package will take effect.

The current lack of guaranteed paid sick leave in many parts of the country could contribute to the spread of the disease, particularly because the virus can be easily transmitted by people who display mild or no symptoms and will continue to work, according to Jane Thomason, an industrial hygienist at National Nurses United. Thomason said paid sick leave for all health care workers is absolutely vital for containing the pandemic.

Castillo added that nurses “can and do care for our patients in the toughest situations if we — and that’s a big if — if we have the right protections.”

“During what the World Health Organization is now calling a pandemic, nurses should not have to make impossible decisions, like, ‘Should I keep working despite being exposed to a [potential] or positive COVID-19 patient?” Castillo said.

Domestic workers, including home care providers who care for the elderly and people with disabilities, are particularly vulnerable during an economic and public health crisis. Domestic workers are often paid low wages and 82 percent are not given paid sick days by their employers, forcing workers to decide between going to work or losing financial stability if they get sick, according to the Domestic Workers Alliance.

“Every day, this workforce shows up to ensure the safety and well-being of the people most vulnerable to illness, including older people and people with chronic illnesses,” said Ai-jen Poo, executive director of the alliance, in a statement urging Congress to pass the relief legislation. “They do this crucial work largely without affordable healthcare, job security or paid time off.”

The group said 25 percent of domestic workers who lost jobs report being fired for requesting time off, 22 percent were fired for actually taking time off, and 20 percent were discharged for missing work to care for themselves or a family member. Many domestic workers are immigrants, and the Trump administration’s attacks on lower-income immigrants’ ability to access health care and social safety net programs are already having a chilling effect, with immigrants reporting that they may not seek medical treatment for COVID-19.

“For those without a safety net, a lost paycheck may mean missing rent or being unable to put food on the table,” Poo said. “As we watch the current public health crisis unfold, it is clear that ensuring all workers have the ability to take paid sick leave, whether or not there is a pandemic on the horizon, is absolutely essential.”

In California and a few other states, laws pushed by unions cap the number of patients a nurse can care for at one time, which protects nurses from burnout and fatigue and generally increases the quality of care. California is also one the only states with strong standards for protecting health care workers for illnesses such as COVID-19 that may spread by coughing and sneezing. Many nurses in California have access to paid sick leave, either under local laws or contracts negotiated by unions.

However, many states and localities do not have such standards on the books. One such place is southern Louisiana, where many nurses and health care workers are not unionized and labor protections are notoriously lax.

A nurse in southern Louisiana who spoke to Truthout on the condition of anonymity said the hospital where she works was already understaffed when cases of COVID-19 were first reported in the New Orleans metro area. COVID-19 test kits only recently arrived, and access to N95 masks is tightly controlled due to a lack of supply. Patients suffering from COVID-19 were not immediately placed in negative pressure rooms that prevent the airborne spread of disease, and nurses were unsure which patients were confirmed or suspected to be sick from the virus.

The nurse said the hospital does not offer paid sick leave to nurses — unless they come in contact with a COVID-19 patient without wearing protective gear and also develop a fever. Such a policy is likely reflect concerns over staffing shortages, because COVID-19 can be transmitted before patients develop a fever. Some nurses are wearing surgical masks because they are sick but working anyway.

Thomason said there scientists still do not fully understand how the novel strain of coronavirus is transmitted. Until more information comes to light, hospitals should adhere to the “precautionary principle,” which states that health care providers should not wait until scientists know for sure how the virus spreads to implement measures protecting health care workers. This means all suspected COVID-19 patients must be kept in functioning negative pressure rooms and those caring for them must be provided with and trained to use the highest level of protective equipment, include coveralls and air-purifying respirators.

On Friday, public health groups renewed calls for the U.S. Occupational Safety and Health Administration to grant a petition filed by unions and advocacy groups and establish emergency protective standards for health care workers nationwide. Currently, no such standards exist.

“It is a no-brainer to use the best tools available to safeguard the workers at the forefront of exposure to the coronavirus, especially health care workers and first responders,” said Dr. Michael Carome, director or Public Citizen’s Health Research Group, in a statement. “The coronavirus pandemic could become a public health catastrophe unless we adequately protect such workers from this infection.”

Note: This article has been corrected to clarify that the House vote on the emergency legislation occurred on March 14.

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