Health Workers Fear It’s Profits Before Protection as CDC Revisits Airborne Transmission

Yves here. It’s revealing, if a bit overdue, that the orthodox KFF Health News is headlining how the CDC is expected to ignore Covid airborne transmission in its updated guidelines. The article is pointed in also presenting the class warfare issue, that this is among other things a workplace safety, and that it’s not just the nurses and cleaners at risk, but every bit as much the MDs. Yet trained and essential professionals take second place to business interests, as the article makes clear. This has been the public policy preference here in the US from early in the pandemic, with the Covid vaccines used as the pretext for getting back to some semblance of the old normal, and the authorities fixating on ending masking as critical. In Asia, masking is seen as polite and not burdensome. The fact that the CDC has promoted the idea that masks are a hardship is simply inexcusable.

The article describes how health worker pushback forced the CDC to retreat from its draft guidance to revisit its position on airborne transmission and what to do about it. However, informed commentators outline some ways the agency, aligned with stingy employers, could issue more strict-sounding guidance that could be largely ignored by hospitals and other corporatized providers.

By Amy Maxmen. Originally published at KFF Health News

Four years after hospitals in New York City overflowed with covid-19 patients, emergency physician Sonya Stokes remains shaken by how unprepared and misguided the American health system was.

Hospital leadership instructed health workers to forgo protective N95 masks in the early months of 2020, as covid cases mounted. “We were watching patients die,” Stokes said, “and being told we didn’t need a high level of protection from people who were not taking these risks.”

Droves of front-line workers fell sick as they tried to save lives without proper face masks and other protective measures. More than 3,600 died in the first year. “Nurses were going home to their elderly parents, transmitting covid to their families,” Stokes recalled. “It was awful.”

Across the country, hospital leadership cited advice from the Centers for Disease Control and Prevention on the limits of airborne transmission. The agency’s early statements backed employers’ insistence that N95 masks, or respirators, were needed only during certain medical procedures conducted at extremely close distances.

Such policies were at odds with doctors’ observations, and they conflicted with advice from scientists who study airborne viral transmission. Their research suggested that people could get covid after inhaling SARS-CoV-2 viruses suspended in teeny-tiny droplets in the air as infected patients breathed.

But this research was inconvenient at a time when N95s were in short supply and expensive.

Optical methods show how air flows between two men conversing. (Tang et al. / PLoS ONE)

Now, Stokes and many others worry that the CDC is repeating past mistakes as it develops a crucial set of guidelines that hospitals, nursing homes, prisons, and other facilities that provide health care will apply to control the spread of infectious diseases. The guidelines update those established nearly two decades ago. They will be used to establish protocols and procedures for years to come.

“This is the foundational document,” said Peg Seminario, an occupational health expert and a former director at the American Federation of Labor and Congress of Industrial Organizations, which represents some 12 million active and retired workers. “It becomes gospel for dealing with infectious pathogens.”

Late last year, the committee advising the CDC on the guidelines pushed forward its final draft for the agency’s consideration. Unions, aerosol scientists, and workplace safety experts warned it left room for employers to make unsafe decisions on protection against airborne infections.

“If we applied these draft guidelines at the start of this pandemic, there would have been even less protection than there is now — and it’s pretty bad now,” Seminario said.

In an unusual move in January, the CDC acknowledged the outcry and returned the controversial draft to its committee so that it could clarify points on airborne transmission. The director of the CDC’s National Institute for Occupational Safety and Health asked the group to “make sure that a draft set of recommendations cannot be misread to suggest equivalency between facemasks and NIOSH Approved respirators, which is not scientifically correct.”

The CDC also announced it would expand the range of experts informing their process. Critics had complained that most members of last year’s Healthcare Infection Control Practices Advisory Committee represent large hospital systems. And about a third of them had published editorials arguing against masks in various circumstances. For example, committee member Erica Shenoy, the infection control director at Massachusetts General Hospital, wrote in May 2020, “We know that wearing a mask outside health care facilities offers little, if any, protection from infection.”

Although critics are glad to see last year’s draft reconsidered, they remain concerned. “The CDC needs to make sure that this guidance doesn’t give employers leeway to prioritize profits over protection,” said Jane Thomason, the lead industrial hygienist at the union National Nurses United.

She’s part of a growing coalition of experts from unions, the American Public Health Association, and other organizations putting together an outside statement on elements that ought to be included in the CDC’s guidelines, such as the importance of air filtration and N95 masks.

But that input may not be taken into consideration.

The CDC has not publicly announced the names of experts it added this year. It also hasn’t said whether those experts will be able to vote on the committee’s next draft — or merely provide advice. The group has met this year, but members are barred from discussing the proceedings. The CDC did not respond to questions and interview requests from KFF Health News.

A key point of contention in the draft guidance is that it recommends different approaches for airborne viruses that “spread predominantly over short distances” versus those that “spread efficiently over long distances.” In 2020, this logic allowed employers to withhold protective gear from many workers.

For example, medical assistants at a large hospital system in California, Sutter Health, weren’t given N95 masks when they accompanied patients who appeared to have covid through clinics. After receiving a citation from California’s occupational safety and health agency, Sutter appealed by pointing to the CDC’s statements suggesting that the virus spreads mainly over short distances.

A distinction based on distance reflects a lack of scientific understanding, explained Don Milton, a University of Maryland researcher who specializes in the aerobiology of respiratory viruses. In general, people may be infected by viruses contained in someone’s saliva, snot, or sweat — within droplets too heavy to go far. But people can also inhale viruses riding on teeny-tiny, lighter droplets that travel farther through the air. What matters is which route most often infects people, the concentration of virus-laden droplets, and the consequences of getting exposed to them, Milton said. “By focusing on distance, the CDC will obscure what is known and make bad decisions.”

Front-line workers were acutely aware they were being exposed to high levels of the coronavirus in hospitals and nursing homes. Some have since filed lawsuits, alleging that employers caused illness, distress, and death by failing to provide personal protective equipment.

One class-action suit brought by staff was against Soldiers’ Home, a state-owned veterans’ center in Holyoke, Massachusetts, where at least 76 veterans died from covid and 83 employees were sickened by the coronavirus in early 2020.

“Even at the end of March, when the Home was averaging five deaths a day, the Soldiers’ Home Defendants were still discouraging employees from wearing PPE,” according to the complaint.

It details the experiences of staff members, including a nursing assistant who said six veterans died in her arms. “She remembers that during this time in late March, she always smelled like death. When she went home, she would vomit continuously.”

Researchers have repeatedly criticized the CDC for its reluctance to address airborne transmission during the pandemic. According to a new analysis, “The CDC has only used the words ‘COVID’ and ‘airborne’ together in one tweet, in October 2020, which mentioned the potential for airborne spread.’”

It’s unclear why infection control specialists on the CDC’s committee take a less cautious position on airborne transmission than other experts, industrial hygienist Deborah Gold said. “I think these may be honest beliefs,” she suggested, “reinforced by the fact that respirators triple in price whenever they’re needed.”

Critics fear that if the final guidelines don’t clearly state a need for N95 masks, hospitals won’t adequately stockpile them, paving the way for shortages in a future health emergency. And if the document isn’t revised to emphasize ventilation and air filtration, health facilities won’t invest in upgrades.

“If the CDC doesn’t prioritize the safety of health providers, health systems will err on the side of doing less, especially in an economic downturn,” Stokes said. “The people in charge of these decisions should be the ones forced to take those risks.”

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  1. Druid in Uruguay

    I seem to remember when “The Science” told us that masks do not stop the spread of viruses, then he said they do, then we learned that they don’t from authoritative medically related individuals. This article seems to be preparing the ground for the next (planned?) release of a pandemic pathogen, by demanding that ineffective masks be sold to the public again. Why? What is this about?

    1. Yves Smith Post author

      Please no conspiracy theories.

      The CDC was in the process of issuing weak guidance, which would at odds with your position. The public and in particular medical workers sent in lots of negative feedback forcing the CDC to at least go through the motions of implementing a more serious policy.

      If masks don’t stop viruses, no one could work with toxic materials that have even smaller particle sizes than viruses.

      There was a study which I won’t dignify by naming it that blared masking did not work. It was debunked as statistically bogus but it got plenty of headlines when released so the false idea was widely touted.

      The issue with masks are:

      1. Anything less than an N95 when very highly transmissible Omicron hit is pretty useless.

      2. The N95 needs to be pretty well fitted.

      3. I see way too many people obviously wearing masks incorrectly, like pulled below their nose. I also see people pulling off their masks when talking to others, so not wearing a mask when engaged in a highly virus-spreading activity.

    2. Gus

      Contrary to what the propagandists of the right claim, governments and corporations wanted nothing more from covid than for it to go away and stop interfering with the operation of the markets and capital accumulation. If the germ theory of disease needs to be changed to align with the demands of the market, such as claiming that no one needs masks or other PPE, then that is what the CDC and other health authorities will claim. Because in the end profit runs the world.

      1. Paris

        That’s absolutely not correct. The Covid pandemic was a great social experiment for governments – even if we concede that it wasn’t on purpose, they never let a good opportunity go to waste. Now, do we know for sure how the virus came to be?

  2. DavidZ

    I think healthcare workers are also not making an attempt to stay safe from Covid.

    My Clinic – has signs saying – wear a mask; not one of the nurses, staff or doctor’s wear masks. Those who do wear the blue baggy surgical masks. Not one N95 mask on.

    Dental Office – non-medical staff not wearing masks, dentist and dental assistant wearing blue baggy medical mask. They do have a BlueAire HEPA filter air purifier running, though that would hardly protect the dentist/assistant from breathing in covid or for a patient from breathing in covid from the doctor/assistant (though it would help between patients depending on how long it takes the Air Purifier to clean the 15ft x 10 ft room).

    When I said why aren’t you wearing a N95 mask:
    – covid is not as high anymore (in Jan/Feb 2024 covid rates were the highest since summer 2022)
    – I double mask (double masking with a blue baggy doesn’t work)
    – I’ll wear a face shield (doesn’t protect either of us from covid)

    I see absolutely no interest on the part of healthcare workers, staff, doctors and even less so administration to actually do anything or enforce rules that protect everyone.

    This is in NYC and has a high proportion of patients who are immune compromised.

    I sent a message via the patient portal, asking my doctor to forward to administration – specifically asking what measures the facility was taking to protect staff, doctors and patients – not a chirp

  3. J.

    This is going to get interesting soon, given that

    1. We are about to have a measles epidemic, and measles is known to be airborne.
    2. Many people who were vaccinated against measles have had immunity wane, either naturally or from covid-caused lymphopenia (covid immune damage happens even in mild cases). That means a lot of adults who thought they were immune to measles are wrong.
    3. About 1/5th of measles patients need to be hospitalized.
    4. A measles infection resets your immune system to where the only thing you are immune to is measles.

    I predict the hospitals will have to bring back n95 masks if they want to have functioning staff.

  4. JonnyJames

    This is interesting in light of that SARS 2 CoV19, was very likely, or almost certainly engineered by US gov agencies and apparently, accidentally released. It is no secret that the US has been involved in biological weapons, and bio-warfare research for many decades, so this would not come as any surprise.

    However to my surprise, Jeffrey Sachs has been on a roll lately, helping to expose the BS about Russia/Ukraine and the virus. This was posted a few days ago

    Because of Sachs’ background, I ignored him for years. Thanks to Yves setting me straight, I now read his newer material.

  5. ChrisPacific

    I’m not sure what studies or evidence support the CDC’s position that Covid is an airborne virus that “spreads predominantly over short distances”. Is there any evidence for it, or is it just leftover dogma?

    I’m thinking for example of the super spreader case in Norway, where the air in a poorly-ventilated bar became so saturated with Covid that it infected not only everyone present at the time, but most of the party that used the space hours afterward. That sure doesn’t sound like short distance transmission to me. There was a similar case in NZ that slipped through the net of proximity based infection controls during the zero Covid phase, involving transmission between two people who had never met due to shared air in an elevator.

    All the transmission in the initial spread phase in New Zealand (prior to elimination) was completely contact traced and mapped. Well over 90% of it, including all the super spreader events, was associated with large, crowded indoor gatherings in situations with poor ventilation. The second largest (a high school) was an exception for a while, mysteriously since no other schools suffered the same fate, but then we learned that there had been a large indoor cultural festival attended by most of the school just a few days earlier. There was minimal evidence of proximity based transmission outside of high risk settings in comparison.

    On the plus side, this is a good article. It’s nice to hear there are people out there making reality based critiques.

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