California allowing COVID-positive health care workers to treat patients

With the highly infectious omicron variant continuing to surge, California is taking an unprecedented step to try to avoid an overwhelmed health care system: allowing doctors and nurses who test positive for the virus to return to treating patients immediately, so long as they are asymptomatic and masked up.

The move has drawn pushback from nurses’ unions, who staged rallies Thursday at Bay Area hospitals to demand more staffing and safer working conditions. Hospitals have said they will bring in COVID-positive workers only if absolutely necessary, and it appeared Thursday that few if any have taken that drastic step. But that time could come sooner rather than later.

The roughly 51,000 people in hospital beds across California right now — including about 13,000 with COVID — has swelled to about what it was during last winter’s surge and could rise by the end of January to 40% beyond last year’s peak, Carmela Coyle, president of the California Hospital Association, said during a call Thursday with reporters.

But unlike last year, the problem isn’t about having enough space and supplies for patients, Coyle said. Instead it’s about having enough hospital staff. As with restaurants and retail and other industries, even fully vaccinated and boosted health care workers are coming down with the virus.

And while there is evidence omicron is causing milder illness than previous versions of the coronavirus, hospitals continue to see a sharp rise in COVID patients, especially among the medically vulnerable, because so many people are becoming infected. Some patients come in for other issues and then test positive for COVID, but those patients still require isolation and extra care.

The problem is compounded by the fact that some burned-out health care workers have quit or retired in the last year amid a pandemic that will not let up.

The upshot, Coyle said, is California’s health care system now “finds itself on the precipice of the most challenging time of the pandemic.” And, if current projections hold, she said, hospitals could be overwhelmed. “Our capabilities may soon be eclipsed.”

It’s not just doctors and nurses calling in sick, but janitors, clerks, cooks and others who keep the hospitals running.

In the highly vaccinated Bay Area, many hospitals — including Stanford, UCSF, John Muir Health, Santa Clara County’s three-hospital system, and El Camino Health — said they have not yet had to resort to asking workers who test positive to return immediately.

Two of the region’s major health systems were less clear about their current practices. Sutter Health said “we are not implementing this option systemwide at this time,” while Kaiser Permanente did not respond to multiple requests for comment.

“If push comes to shove, some may do this on a case-by-case basis,” Coyle said, “but I think that really is a last-resort option. The health care leaders — hospital leaders — we’ve heard from have said they do not intend to implement that policy.”

The record surge of cases in California continues to climb but is showing signs of slowing down. On Thursday, the state’s seven-day average for new daily cases rose to an all-time high of over 110,000, after a slight dip earlier this week.

There is no real-time database tracking exactly how many health care workers in California are out sick. But in a bid to make sure California’s sickest patients receive the care they need, many hospitals are limiting some procedures and appointments.

Stanford Health Care, with about 5% of its total workforce out because of illness or quarantine, is delaying some non-emergency procedures this week and next. John Muir, which is also canceling some surgeries, and UCSF, which is pausing scheduling new elective surgeries and procedures, are moving to video visits where possible. Both places are also moving workers to fill vacancies where needed.

“We are looking at a very, very difficult four to six weeks,” Coyle said. “We are all going to have to buckle up.”

The state has dispatched emergency help to some hard-hit areas, and Coyle said the Biden administration could send in military medical resources if things get dire. Earlier in the pandemic, the state converted convention centers into makeshift medical facilities and readied Navy hospital ships to accept COVID patients, but that’s not part of the plan now.

On Thursday, members of the California Nurses Association/National Nurses United (NNU) and the Caregiver Healthcare Employees Union who gathered in front of hospitals across the Bay Area pushed back at the idea that the omicron surge is to blame for the current staffing challenges, suggesting the problem has been years in the making.

“Employers have prioritized profits over safe patient care,” said NNU President Zenei Triunfo-Cortez. “They have cut corners on safe staffing since long before COVID, and with the pandemic still in full swing, they are driving desperately needed nurses away from the profession.”