‘Long time coming’: California wants weekly COVID-19 screening for all HCP
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The California Department of Public Health “strongly recommends” that as of next Monday, general acute care hospitals in the state begin weekly testing of all health care professionals for COVID-19.
California said its strategy was informed by CDC’s “Interim Guidance on Testing Healthcare Personnel for SARS-CoV-2.” It applies to all health care professionals (HCP) with signs or symptoms consistent with COVID-19, asymptomatic HCP with known or suspected exposure to SARS-CoV-2 and, to assist in early identification, asymptomatic HCP without known or suspected exposure to SARS-CoV-2.
The state of California is also recommending that general acute care hospitals test all patients “prior to admission and monitor all patients for the development of COVID-19 symptoms [and] promptly test any newly symptomatic patients and patients who are exposed to a suspected or confirmed case during their hospital stay.”
The two recommended tasks were contained within a letter the CA Department of Public Health sent all general acute care hospitals on Nov. 25, 2020, that notified the hospitals of a requirement to submit a COVID-19 testing plan to the state by Dec. 7, 2020. A National Union of Healthcare Workers (NUHW) spokesperson told Healio Primary Care that the organization considers the tasks “requirements,” and to treat them as such in “discussions with employers.”
The California Nurses Union/Nurses Union United (CNU/NUU) — who did not respond to a request for comment from Healio Primary Care — stated in a press release that the high number of patients with COVID-19 in hospitals prompted them to fight for the new recommendations.
The authors of an article in the Journal of the American Board of Family Medicine wrote that amid the pandemic, “there has been a great deal of concern about the safety of health care workers,” and the “duration of [SARS-CoV-2] exposure and frequency of exposure” is a risk factor for COVID-19. Findings published in The Lancet Public Health suggested that frontline HCP are at least 3.4 times more likely to test positive for COVID-19.
“This testing requirement has been a long time coming,” Cathy Kennedy, RN, president of CNU and executive vice president of NNU, said in a press release. “Now hospitals in the rest of the country just need to do the same to get this virus under control.”
However, according to NUHW, at least several California hospitals have indicated “they may not comply with the state mandate and view the new rules as merely a recommendation they don’t need to follow.”
Sal Rosselli, president of NUHW, said in a press release that this was ”unconscionable,” citing data indicating that in the last 2 weeks of November, the number of Californians hospitalized with confirmed COVID-19 cases nearly doubled. The surge in COVID-19 cases prompted the governor to order individuals to stay at home except for “permitted work, local shopping, other permitted errands or [those] otherwise authorized.”
As of Dec. 10, ICU availability ranged from 1.9% to 30.3% in various regions of the state, according to California’s official COVID-19 website. A Dec. 3 article in BMC Health Services Research projected that at least 5% of the U.S. population is expected to eventually contract COVID-19 — 15% of these patients will require hospitalization and 5% will require intensive care. In time, there will be five patients with COVID-19 requiring hospitalization for every existing U.S. hospital bed, the researchers said.
“Caregivers are exhausted and fearful of what the next few weeks will bring,” Rosselli said. “[Nurses] don’t want to be called heroes, they want to be tested. If the NFL can test its players every day to protect their health, hospitals should be able to test their workers every week, and if they refuse, they should be harshly punished for ignoring a state order.”
A spokesperson for the California Department of Public Health told Healio Primary Care that “health care workers who decline to take a test may face actions from the facility or its provider,” adding that these measures may vary by location.
References
California Department of Health. Coronavirus disease 2019 (COVID-19) testing recommendations for patients and health care personnel (HCP) at general acute care hospitals (GACHs). https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-88.aspx. Accessed December 8, 2020.
Cowan J and McDermott MT. "California lockdowns go into effect." https://www.nytimes.com/2020/12/07/us/stay-at-home-california.html. Accessed December 8, 2020.
Gouda D, et al. J Am Board Fam Med. 2020; in press.
State of California. About COVID-19 restrictions. https://covid19.ca.gov/stay-home-except-for-essential-needs. Accessed December 8, 2020.
Tonna JE, et al. BMC Health Serv Res. 2020;doi:10.1186/s12913-020-05975-z.
Perspective
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With limited distribution provisos, the more COVID-19 testing we can do, the better. Therefore, this California recommendation is very important.
Health care workers should be tested regularly as very recent California recommendations have indicated. However, some health systems have found more positive test results than expected, creating staffing shortages when we can least afford them.
Fortunately, the CDC has said 14 days of quarantine for those who have been exposed to COVID-19 and are asymptomatic are no longer needed, only 10 days. And if a negative test result can be provided, only 7 days are required.
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