Don't assume CDC HICPAC will recommend controlling infection in hospitals

[Chloe Humbert:] I'm Chloe Humbert, and I'm recording this the day after the CDC HICPAC meeting. That's the Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee. That was on August 22nd, 2024. And... Well, it's very concerning. There's supposed to be, I believe, an open comment period, but the information on that is not yet posted. I signed up, but I was not chosen to give public comments. I really hope... that there's been a misunderstanding, but I think they actually voted that healthcare workers can work with an active CMV infection now. Like that's what they're going to put in the guidelines, and that just seems... way out of the norm. I mean, as I understand it, like, for example, in a labor and delivery department, nurses aren't supposed to even work with a case of diarrhea, just in case it's, you know, something that can threaten… people lose pregnancies from CMV infections. So like, I'm not sure what's going on here. But I did publish a blog post about, you know, my concerns, and I'll go over them here. First of all, National Nurses United report about the CDC HICPAC committee said that, “multiple members of the group remain focused on maintaining and even expanding the use of surgical masks as protective equipment for healthcare workers exposed to infectious diseases.” I've had reports from people who are immunocompromised, disabled high risk, otherwise asking for healthcare workers that see them to wear respirator N95s. And in some cases being told that they have to like go and find them, or they need to order them. And that seems like really unprepared. Even if there was no current problem, which there is a current problem, there's a COVID surge going on. But even if there wasn't, that seems very unprepared and problematic that hospitals would not have these readily available. I think we should be asking hard questions about this - about the preparedness for other outbreaks. And it sounds like we're just going to go back to an even worse spot than we were in 2020 when there was shortages of PPE. This doesn't make any sense. Hospitals and labs are already relying on like flimsy surgical masks. And I recently got blood work at a Geisinger lab locally and asked for the technician to be masked. And they had to go look for a surgical mask somewhere in the office. So that's not a good situation. Especially with, you know, COVID spreading, there's flu, RSV, we have possible other infectious diseases. They should be ready. Okay, and so CDC HICPAC committee knew in 2020 about the precautionary principle when it comes to infectious disease. In January 2020, they issued guidance for use of N95s for COVID. And the CDC HICPAC meeting in March 2020, they specifically mentioned that a surgical mask, “isn't as good of a device. The fact that there's a half inch gap on either side of your face really doesn't protect against inhalation.” So that's the whole reason there was a debacle about N95 shortages early in the pandemic. And it turns out that, of course, the health care corporations were the ones doing it to their own employees and withholding PPE, even after shortages were no longer even a thing. There was some shitty behavior by the Trump administration, too. And they also were basically allowing a boondoggle where a company was going to make money on cleaning N95s. So the bottom line is it's the same disease now. It's more contagious. It still transmits and it's still circulating. And N95s could prevent that. So why hospitals would not be having them in stock even for ADA accommodation requests, seems very wrong and peculiar even. And I've even heard stories of people at hospitals being forced to remove their own N95 mask and put on a flimsy surgical mask instead. So here's the thing, is if CDC HICPAC issues guidance where they say use surgical masks and don't use N95s. So the health care companies can then be telling their workers, well, you can't have N95s. You can't have better PPE. And what's next? COVID is a really bad disease and it has high levels of risk. So I would expect that they would have healthcare workers work with Ebola and TB and anything else with less expensive gear. I think that's where they're going with this. Bird flu has a high mortality rate. And I think it's wrong that farm workers are being denied PPE with this risk. They could be unwittingly, you know, even taking it home to more vulnerable family members, or their cats for that matter. A lot of cats have died from bird flu now. I would not assume this laissez-faire attitude is confined to COVID contrarianism. Hospital resistance to infectious disease mitigation appears to be financially motivated. And it's underneath all COVID mitigation resistance. Like, that financial motivation has been proven since the start of the pandemic. Walker Bragman has an article from December of 2021, and it's titled “How the Koch Network Hijacked the War on Covid” - And it lays it out. You just follow the money. So it's wrong to think of this as a cultural issue. It's not. It’s politicized, but it's more of a cognitive warfare issue. And the result of PR blitzes, pushing propaganda by industry interests. And they use manufacturing mild and manufacturing consent. And moral disengagement. These are known tactics for PR. So I was at a recent National Nurses United webinar on the use of AI in healthcare. And someone told the story about an automated shift change report that just makes a sheet with no human to human handoff, like there's no giving report anymore between shifts. That's a problem within itself for all sorts of reasons. to just have a sheet. In this case, the automated sheet failed to show that the person coming into the hospital and waiting for a room had no immune system. That's what they said. The patient had no immune system. And the nurse wouldn't have known that if they had not checked the patient's chart on purpose to look further into the patient's condition. They would have put, and this is what they said, they said they would have put this immunocompromised person in with a patient who had COVID and flu. Now, in this case, the problem could have been avoided by properly isolating COVID and flu patients from other patients, because, I'm sorry, but even people with working immune systems shouldn't be deliberately sickened at the hospital. That's preventable harm. They know how to prevent this. Hospitals shouldn't be giving people COVID. Like that's on purpose if you know you can prevent it, you isolate COVID and flu patients. You don't put uninfected patients in with infected patients, which I feel like if they're doing that with COVID, what else are they doing that with? Like, what else will they do that with? You know, if they're allowed to. And, you know, of course, also, getting rid of shift change reports just seems just obviously bad and going to lead to all kinds of other patient safety issues. And all to just, I guess, save money. Another story at the NNU webinar was that the automated system failed to alert the health care worker that the patient had COVID and the health care worker would go into the room of the COVID patient without any mask. In this case, universal masking in the healthcare settings would have actually prevented the problem caused by the automated system and is, in my opinion, another argument in favor of universal usage of respiratory PPE in healthcare settings. So even if a patient hasn't yet tested for COVID, the patient could have COVID. I don't know why this is still a mystery. You don't suddenly become contagious the minute your test result shows the positive line. That's not how infection works. You're already infectious if your test comes back positive, like you were already infected when you were taking the test and, you know, for some period before that. This is just how reality works. So, and this is a point made by the People’s CDC in October ‘22, they made the point by saying, “because approximately 40% of COVID cases are asymptomatic and many people may be infectious before they develop symptoms, it is utterly inadequate to require masks only for symptomatic people.” And the People's CDC in August 2024 said, “many aerosol transmitted pathogens are transmissible without symptoms and without predictable seasonality. Diagnosis and isolation may be delayed, leading to exposures that could have been prevented by universal masking.” Especially in hospitals where they're clearly doing little to prevent the spread of anything anymore, you know, to cut costs. So it's not unlikely that a healthcare worker might actually have undiagnosed or unsymptomatic COVID and should be wearing a mask for source control to prevent them spreading it to patients. National Nurses United also reported that Andrew Levinson, Director of OSHA Directorate of Standards and Guidance, attended a CDC HICPAC committee meeting as a guest to discuss current regulations. Okay, so I'm old enough to remember when OSHA issued a pretty decent guidance for workplaces in March 2020. I was so excited when I saw that in March 2020. I was like, oh, help is coming. Little did I know. It called for engineering controls, such as high efficiency air filters and increasing ventilation rates in the work environment. And also encouraging sick workers to stay home. Frankly, this was unexpected and a competent move made by a federal agency early in the pandemic under the Trump administration. I was frankly shocked at the quality of the guide. And with the swift release, they were doing their job. Workplaces locally to me actually did the guidance. And I mean, that might have been me sending it to all my reps. Sigh. You know, in a more sensible timeline, MAGA would be campaigning on this point when criticized for mishandling the pandemic. But nobody on the right can campaign on, like, they can't even campaign on the vaccine Operation Warp Speed because, you know, the Republicans are all now fully committed to anti-vax disinformation. So they let Joe Biden take that win, even though our vaccination campaigns have been kind of dismal, confused, sometimes nonsensical, or even contrary to actually getting people vaccinated. I'm sure it doesn't help that they have at least one Great Barrington Feclaration signer on the FDA committee for vaccines. And he's actually mentioned natural herd immunity at vaccine meetings. But back to OSHA, there was an OSHA hearing in 2022. I've not heard anything about what's came of that since about developing standards. I worry that they're waiting for CDC HICPAC, and CDC has no regulatory power itself, and it's not set up to enforce safety rules to protect workers, protect patients, or anybody else. It's strictly a public health messaging and data collection agency. And it doesn't even do that right. At the OSHA hearing in April 2022, Dr. David Michaels, epidemiologist and longest serving OSHA head from 2009 to 2017, he testified. [Dr. David Michaels:] “ Beyond that, of course, we have this problem. that they've really clung to this, what we call the droplet dogma, that clearly has been shown to be incorrect, certainly by the research by several of the people on this panel, who've done remarkable work, as you heard from Dr. Prather and Dr. Milton in particular. It's disappointing. I think the whole country is disappointed by them. You know, employers need to know exactly what to do or how to at least process the challenge that they face to protect workers. And OSHA standards tell employers how to do that. They say, this is what we expect you to do. We expect you to develop a plan. The plan has to take your situation into account, but also has to ensure that you're looking at the hierarchy of controls. You're thinking about engineering controls first. All of those things are missing from CDC recommendations. And finally, I think I talked about this in my testimony, OSHA has a statutory responsibility, statutory requirement to have an open and transparent process like we are having today to determine what the standard should be. CDC is a black box. We have no idea how these recommendations are determined, unfortunately, until there are Freedom of Information Act requests or congressional inquiries. So given all those things, it's really incumbent upon OSHA to develop standards and to say, these are the standards that every employer covered by the standard must follow.” [Chloe Humbert:] That the CDC is a black box wasn't a revelation to me because of how my FOIA request to the CDC in 2021 came back completely redacted. Because they're allowed to keep the deliberative process secret. So they don't have to tell us. Even with the FOIA request, you don't get to know how they came up with their reasoning. It could be anything. It could be my brother-in-law's cousins left whatever. You get my… They could just be using whatever. We don't know. I don't know if anybody will ever be able to know. CDC has been deleting emails they weren't supposed to delete because they agreed to keep them for seven years and they were deleting them after people left the agency employment. So who knows what they're doing there. We just don't know. We don't have a way to know. OSHA actually has to develop actual standards and CMS can actually enforce data collection. And that's actually what they're going to be doing on COVID. But the CDC is just there ostensibly to cajole the public and often with ill-considered social media. And they can collect data, but only if they feel like it. And the agency is, it's quite obviously easily directly swayed by industry. In December 2021, Delta Airlines sent a letter to the CDC complaining that the 10-day isolation guidelines were interfering with their operations because of people being off sick too often. Instead of better infection control, stopping the spread among staff, or hiring more staff to cover the new normal of everyone getting COVID on the job all the time, they instead asked the CDC to reduce the isolation time recommended. A week after this Delta Airlines letter to the CDC, the CDC changed the isolation guideline down to five days. That's a big coincidence. Yeah. National Nurses United also reported that Andrew Levinson of OSHA said, “OSHA saw healthcare employers prohibiting respiratory protection because they were afraid it could scare patients.” This is the second time I'm reminded of this story I heard on the Bloomberg Big Take podcast, which was about the poor training for some nurse practitioners and healthcare companies who deploy them in questionable roles they're not really trained for in order to cut costs. The podcast recounted a story where a nurse practitioner didn't want to scare a patient who was on vacation. So they didn't tell them to go to the hospital because they didn't want to scare the patient. The patient wound up dying of an ectopic pregnancy as a result. Something that was completely preventable. Because they didn't want to scare the patient. The patient's now dead. I think most people would prefer to be temporarily scared than permanently ignorant six feet under. It's the most nonsensical, inexplicable, illogical reasoning, unless you understand that the priority motivation of the healthcare system, it's ingrained into every system and every choice that's incentivized by everybody involved. It's not to save lives, but to spin perceptions and keep the revenue coming in and the C-suite salaries satiated. Disaster researchers call this elite panic. People with power have different priorities, chiefly maintaining their own power. In a documentary from 2002 called “Toxic Sludge is Good for You”, it described it this way, “Whenever something bad happens to a corporation, often its first move is not to deal with the actual problem, but to manage the negative perception caused by that problem.” And in this context, COVID, patient deaths, worker illness, all of these are problems to be managed by PR and lobbying the government to make it at least officially okay. So then it makes it harder to sue them or hold them to any standards or for unions to negotiate for safety or whatever. National Nurses United also reported that Andrew Levinson of OSHA also shared, “that health care employers felt that voluntary use by one health care worker, when not required, could make other health care workers nervous and question the determination of the employer that the respirator was not required." Yeah. So they're basically saying they can't let the high risk or the older nurse wear an N95 to protect themselves from possible COVID or other infectious diseases. They can't allow that because it might give other health care workers ideas that maybe the employer is lying to them by saying that it's not necessary because they just don't want to pay for the PPE. Of course. Of course. And of course, this sounds like one of the many tricky kind of forms of union busting that corporations do to undermine workers organizing, you know, by pitting them against each other. It has big Metropolis vibes. That's the silent film from the 1920s that's still relevant, unfortunately. It's totally believable that hospital management figures most of their workers get ideas from troublemakers and the like. So they're going to see workers as largely mindless replaceable widgets, and they resent people who actually... you know, know their job and want to protect themselves or know their immunocompromised status and, you know, need ADA accommodation, but they don't want to do that. So I wouldn't be surprised if... I don't know. I just... Heaven only knows what's happening in these hospitals. So it does track also that administrative executives are worried about not having complete totalitarian control over their staff. They want to decide who can prevent the harm on the job. Like, you know, because we know most of these high level people in health care, they might talk a careless game, but they're they don't risk themselves easily. And I think about David Rubin, the director of Policy Lab at CHOP, the Children's Hospital of Philadelphia. He specializes in high-risk children. He was the lead investigator on CHOP's Policy Lab's COVID-19 forecasting model. Policy Lab started putting out anti-mitigation statements reminiscent of the ideology of the Great Barrington Declaration. Invoking, for example, the idea of focused protection for high-risk individuals. Those people can alter the routines, but the medical professionals responsible for their care and others should not have to. Because, you know, there's room at the hospital, after all. They literally... They literally said that. Policy Lab at CHOP actually had a tweet in April of 2022 that said, “it is important for those living in the north to anticipate some increased transmission over the next couple of weeks so high-risk individuals can alter their routines and mask. But our team advises against requiring masking given that hospital capacity is good.” Their message was that spreading disease in schools is fine because there's room at Children's Hospital. Seemingly unaware that people don't want to get sick and need the hospital. People don't want their kids in the hospital. People don't want their kids in the hospital. At the same time, CHOP itself, the hospital was still recommending quarantines and precautions, by the way. So, you know, the hospital itself wasn't like saying, yes, fill us up. But Dr. David Rubin himself directly contradicted the Policylab official public stance of promoting COVID to be fine, because he said, he literally said, “I don't think right now I would walk into a crowded venue of the week that we were at 20% of individuals who are infected with COVID”. This is what he told NPR in January 2022. So it comes down to money. They don't want to spend the money for the rank and file healthcare workers to protect themselves. But, you know, the executives, of course, protect themselves. So is it any wonder I saw a headline in MedPage Today that said trust in doctors crashed and remains low? In a recent survey, they said, “putting financial motives over patient care was the top reason for patient mistrust.” Well, isn't that a surprise?