#CDC HICPAC

[wat3rm370n]

The Stigma of the Dark Ages.

What they’re talking about here is a society which has moved backwards, and is paying consequences already.

NPR - As the respiratory virus season approaches, where does the vaccination rate stand? November 27, 20244:47 AM ET Heard on Morning Edition By Rob Stein , Rob Schmitz Part of it is the lingering skepticism and outright hostility from the pandemic toward the COVID vaccine specifically and vaccines in general. Another factor is that people tend to underestimate how dangerous both viruses can be while overestimating vaccination risks. There's a lot of misinformation about how well the vaccines work and how safe they are. And finally, a lot of folks are just sick of vaccines because of all the shots they've gotten over the last few years. You know, put it all together and a lot of people are just feeling kind of done with vaccines. I talked about this with Dr. Gregory Poland. He's president of the Atria Academy of Science and Medicine in New York. GREGORY POLAND: “As a society right now, we're in a phase of rejecting expertise, of mistrust of any expert, whether it's science, meteorology, medicine, government - whatever it is.”

This is not unusual, there is no guarantee that society progresses forward. The Dark Ages happened, and that period was not the only time of regression on science.

MedPage Today - Nursing Homes Fell Behind on Vaccinating Patients for COVID — Billing complexities and patient skepticism partially to blame by Sarah Boden, KFF Health News December 5, 2024 Loveland has seen patients and coworkers at the nursing home where she works die from the viral disease. Now she has a new worry: bringing home the coronavirus and unwittingly infecting her infant daughter, Maya, born in May. Loveland's maternity leave ended in late June, when Maya wasn't yet 2 months old. Infants cannot be vaccinated against COVID until they are 6 months old. Children younger than that suffer the highest rates of hospitalization of any age group except people 75 or older. Between her patients' complex medical needs and their close proximity to one another, COVID continues to pose a grave threat to Loveland's nursing home -- and to the 15,000 other certified nursing homes in the U.S. where some 1.2 million people live. Despite this risk, a CDC report published in April found that just four in 10 nursing home residents in the U.S. received an updated COVID vaccine in the winter of 2023-24.

Going forward is a choice.

Public comment to CDC HICPAC committee November 2024 Infection control in healthcare. Chloe Humbert Nov 15, 2024 The Dark Ages was called that because society moved backwards from the technological advances that had come before. The fall of the Roman Empire was marked by elites who only cared about the status quo; they could’ve developed a steam engine as far back as Heron in 15 BC but didn’t bother. Going forward is a choice. In an article in the Journal of Infectious Diseases & Preventive Medicine there’s a description of what happened back then. “In medieval times, hospitals were hazardous places, Epidemic infections killed large numbers of hospital patients during this period. Hospital infection and death rates were high. When a sick person entered a hospital, his or her property was disposed of, and in some regions, a requiem mass was held, as if he or she had already died.” Going backward is a choice.

Stigma is part of a backward slide, and even if people don’t choose to go backward, we are all subject to community level leadership influences.

It’s called STIGMA. - wat3rm370n on tumblr - Oct 4th, 2024 When you hear that “people are tired of it” - that’s also part of stigma. And it’s not necessarily true that people are actually just sick of it - but they keep being told they should be. Informational learned helplessness can do that to us. Stigma is leveraged and reinforced on purpose by big money industry interests who think any reminder of danger at all is bad for business. So it’s to some degree manufactured stigma.

[feminist-space]

"Seminario cited the recent report, “Employer-Reported Workplace Injuries and Illnesses,” that shows that the number of respiratory illnesses in the private health care and social assistance sector increased from 145,300 in 2021 to 199,700 cases in 2022, an increase of 37.5 percent.

...

As an industrial hygienist, Seminario was extremely critical that there were no experts in respiratory protection on the committee nor did it include engineers who developed ventilation guidelines. She believes that the HICPAC committee members are likely so opposed to respirators “because once you are into recommending respiratory protection, with that comes a full respiratory protection program from OSHA,” with penalties for violations.

An epidemiologist and consultant, Michael Olesen, echoed this, believing the changes reflect “pressure to remove liability from hospitals.” He added, “I take a very clear position that we should be having respiratory protection mandates in all healthcare settings right now.”

...

Many patients who spoke at the HICPAC meetings said they had gotten Covid-19 when they went to the hospital and that the new policies were keeping them from getting care.

Given that, Dr. Art Caplan, professor of medical ethics at New York University’s Grossman School of Medicine, previously told me that dropping masking requirements in hospitals is “utterly, completely, irresponsible.” Similarly, staff refusing to mask, even when a patient requests it, is a moral failure. “The first principle is, you must do what is in the best interest of your patient,” he said.

...

Several people were asked why they believe HICPAC is determined to water down protections. Consistently, respondents say, “to reduce liability.” Earlier in the pandemic, hospitals regularly tested patients and staff for Covid-19, and you could often tell where and how you became infected. Since staff are no longer masking and continue working when ill, and patients are not being tested on admission, you can no longer prove who infected you. Hospitals are the only ones who win in this scenario, absolving themselves of responsibility and liability."

[alexythimya]

I don't see posts about this on here so here's a link to the current petition by National Nurses United urging the CDC to reject the recently approved draft by the Healthcare Infection Control Practices Advisory Committee to the CDC to weaken infection control standards.

If these standards go through preventable infections will increase for both patients and healthcare workers, which would be bad enough even if we weren't in the middle of a pandemic.

[covid-safer-hotties]

Also preserved in our archive

By Julia Doubleday

For many disabled and immunocompromised people, hospital settings are a significant threat to health and safety. Since the beginning of the COVID-19 pandemic, nosocomial- or healthcare acquired- SARS-COV-2 infections have been an additional risk for sick and vulnerable people seeking care. As of today, there have still been no updates to national-level guidance to reflect that SARS-COV-2 was determined to be airborne in 2021.

In 2020, such a risk was to be expected; hospitals were overwhelmed with patients, PPE was in short supply, proper isolation wasn’t always possible, and public health guidance about transmission was confusing and, it turns out, incorrect. Early on, the WHO confidently and wrongly asserted that COVID was not airborne; this decision led national health bodies to advise against full airborne precautions in healthcare.

But in the nearly five years since, one might assume that any patient visiting their local hospital could reasonably expect safety from infection with COVID-19. After all, we’ve had five years to study transmission, update guidelines, redesign infrastructure, upgrade ventilation, purchase PPE and train staff, right?

As a matter of fact, the CDC has yet to even issue updated infection control recommendations, much less have we seen implementation. The CDC did ask their infection control advisory body, HICPAC, to update the Guideline to Prevent Transmission of Pathogens in Healthcare Settings, last reviewed and updated in 2007. But when HICPAC submitted a first draft of the updated guidelines in November 2023, it was over loud public objections registering that draft’s inadequacy to control airborne infections.

Now, HICPAC is continuing to insist that surgical-style masks are equivalent to N-95 respirators as it pushes forward with its draft guidelines. This decision is emblematic of its commitment to preserving ineffective droplet-based infection control in spite of new information and evidence. While bizarre from a purely scientific standpoint, it makes more sense from a cultural, political and economic point of view.

I’ve written at length about the political and economic factors that led the WHO to immediately claim that COVID wasn’t airborne without the scientific evidence to do so in Spring 2020. Perhaps just as irresponsible as their early decision to spread this misinformation has been their subsequent reluctance to correct their mistake as loudly as they first made it, and ongoing refusal to unequivocally recommend airborne precautions in the years since.

This year, the WHO released a document that rescinded the previous distinction between “droplet” and “airborne” transmission of viruses. This represents progress, as new data showed that no viruses actually transmit solely via “droplets”- i.e., only via sneezes and coughs.

The evolution of the science was tracked beautifully in this Wired article. It’s astonishing that we had such basic science so wrong, for so long. But it’s critical to note that for decades, there was a large financial incentive against looking too closely at the claim that flus, colds, and other common viral and bacterial infections were being spread only via large “droplets.”

“Droplet” precautions are relatively cheap and easy compared to the more complex and expensive requirements of controlling fully airborne infections. If a virus spreads through coughs and sneezes, how do you prevent transmission? Well, we all remember early pandemic guidance. Loose fitting surgical masks, social distancing and keeping diners (or patients) six feet apart, putting up physical barriers to protect from spit, and simply washing hands and covering coughs and sneezes are all examples of droplet-based infection control measures.

But airborne spread is far more difficult to control. Now we’re talking about viruses spreading well beyond six feet, well beyond the radius of a single cough or sneeze. We’re talking about the virus spreading, not just via coughs and sneezes, but via the simple act of exhaling. And not only that, but because airborne particles are so light, they don’t quickly fall to the ground the way droplets do; instead, they can hang in the air, much like smoke. So now, a waiting room or crowded examining area full of patients with flus, colds and COVID suddenly represents a much more complicated and expensive infection control problem for a hospital.

Proper airborne infection control procedures are expensive, but they are not mysterious. Some changes would be relatively simple; masking with proper respirator-style masks, rather than surgical, is an obvious, necessary upgrade. New ventilation and filtration standards are a simple fix technologically, but require investment. Tools like Far UVC are exciting and could mean drastic leaps forward in both patient outcomes and occupational safety for HCW.

Most likely, in order to save money long term and make airborne infection control sustainable, hospitals themselves would be constructed with airborne infection control, patient isolation, airflow, ventilation, etc. as major priorities in the process of designing the infrastructure.

Airborne infection control would require, rather than tinkering at the edges of existing practices, a top-down rethinking of hospital protocols. How are patients being screened upon entry into the hospital? How can COVID, flu, RSV, etc. positive patients be protected from one another in a waiting room? Why are so many hospitals designed without windows in patient care areas?

Are you beginning to see how the economic incentives align against admitting the need for airborne infection control?

Let’s return to the WHO’s document, the one that rescinded the distinction between airborne and droplet spread. Instead, all viruses which spread through the air are now referred to as “infectious respiratory particles” or IRPs. The document encourages moving “beyond the dichotomy of previous terms known as ‘aerosols’ (generally smaller particles) and ‘droplets’ (generally larger particles).”

But problems arise when the WHO attempts to apply what we’ve learned practically- or rather, doesn’t attempt to apply it. Here, it balks at what would be a massive undertaking. As I reported previously, back in 2020, the WHO had been quick to claim:

“Would there be evidence of significant spread of SARS-CoV-2 as an airborne pathogen outside of the context of AGPs [aerosol-generating procedures], WHO would immediately revise its guidance and extend the recommendation of airborne precautions accordingly”

But in 2024, the WHO, now well aware that SARS-COV-2 is a fully airborne pathogen, adopts a new approach to infection control. It’s one totally unprecedented for any other pathogen in healthcare. They advise:

There is NO suggestion from this consultative process that to mitigate the risk of short-range airborne transmission full ‘airborne precautions’… should be used in all settings, for all pathogens, and by persons with any infection and disease risk levels where this mode of transmission is known or suspected. But conversely, some situations will require ‘airborne precautions’. This would clearly be inappropriate within a risk-based infection prevention approach where the balance of risks, including disease incidence, severity, individual and population immunity and many other factors, need to be considered, inclusive of legal, logistic, operational and financial consequences that have global implications regarding equity and access.

In other words, we shouldn’t always try to control airborne disease. That would be so hard and annoying! The document then goes to state that “risks” have to be balanced and goes on to list a bunch of factors that are never considered when it comes to the spread of other pathogens in healthcare.

When it comes to the spread of norovirus in healthcare, do doctors weigh whether to wash their hands, based on the local levels of diarrhea? When it comes to the spread of bacterial wound infections, do doctors clean surfaces based on how deadly they think the wound will be? I mean, if it’s not going to kill you, why bother, right? When it comes to bloodborne illnesses like HIV, do doctors no longer test for it because it’s now a treatable disease, no longer a death sentence?

Or, when you apply this logic to any other type of infection, is it clear that this is an absurd attempt to continue evading liability for nosocomial airborne infections in healthcare, including SARS-COV-2? People should not be infected with diseases in hospitals. Period. Regardless of disease severity. Of course, SARS-COV-2 is also incredibly severe for hospitalized patients; in Australia, nearly 1 in 10 patients who caught COVID in hospitals in 2022 and 2023 died. And these events are far from rare. Of 206 patients admitted for strokes in a hospital in Japan, 44 were infected with COVID-19. 6 of them - or 13% - died. Globally, we see the same thing over and over again: lack of airborne infection control, high rates of nosocomial infections, high rates of patient death.

The WHO chose to incorporate “balance of risks”, “disease severity”, “immunity,” and the rest of its laundry list of “factors”, not because it expects infection control bodies to do serious risk assessments, but in order to provide cover for them not to do any such thing. Universal airborne infection control would be expensive and disruptive so the WHO simply gives disease control bodies a series of “outs”.

This is the international backdrop against which the US has also been updating infection control guidance. The CDC, like other national public health bodies, does not directly report to the WHO; the WHO does not have enforcement power over the CDC. However, guidance from the WHO is taken seriously at the CDC, and experts at the CDC also influence the WHO.

The WHO’s document constructs a mile-wide loophole for HICPAC to drive through. Although HICPAC provides no evidence whatsoever that the characteristics of SARS-COV-2 (or flu, or RSV for that matter) would justify dropping airborne precautions, the language in the WHO document exists to justify dropping them in the face of the ongoing, global pandemic. Despite SARS-COV-2 being a systemic, multi-organ disease with the potential to cause long-term disability, and highly fatal when contracted by vulnerable patients, culturally and politically, we are treating it like a cold. HICPAC members are not making scientific decisions, but political ones.

The science on disease transmission has advanced tremendously since 2020. In a world that actually wanted to implement what we’ve learned from COVID, this would mean dramatically safer care for patients and healthier workplaces for HCWs. Instead, HICPAC does the opposite, working to ignore the advancements in scientific knowledge and fighting to keep infection control as similar as possible to the outdated droplet model of the pre-pandemic era.

For example, they advise that N95 respirators should be worn for “new and emerging pathogens,” but make an irrational distinction between these and other viruses that are already in circulation. You know, the ones that are actually, currently infecting patients. “Emerging/new” isn’t a type of transmission, so shouldn’t denote a type of infection control.

Even the CDC balked at HICPAC’s initial draft, sending it back with pointed questions about this bizarre distinction and other inadequate protections. It asked for clarification, stating:

Another issue relevant to preventing transmission through air is 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 nor the intent of the draft language. Although masks can provide some level of filtration, the level of filtration is not comparable to NIOSH Approved respirators.

Why would HICPAC equate surgical masks with respirators? HICPAC’s draft was not designed to protect patients; it was designed to protect the status quo and allow hospitals to continue to infect patients with COVID and other airborne diseases. It’s likely that the CDC’s decision to push back on this claim was influenced by the massive outpouring of public outrage at the draft, which was seen in both the public comments submitted and read at HICPAC’s meetings.

Additionally, both OSHA, the Occupational Safety and Health Administration, and NIOSH, the National Institute for Occupational Safety and Health, agree with both the CDC and patients that surgical masks are not sufficient protection. N95s are required to control airborne infections.

However, despite months of pushback, the tears of suffering and scared patients, the word of the experts who design respirators, as well as the input of occupational safety leaders, HICPAC remains unmoved on the subject.

In a series of votes held last month, HICPAC stuck to their guns. Lisa Baum of the New York State Nurses’ Association was the sole dissenting member of the committee, as reported by Judy Stone of Forbes. She not only voted against the anti-science equating of surgical and N95 masks, but also against allowing COVID positive staff to return to work 3 days after a positive test. The 3-day time frame has absolutely no scientific basis, and return to work should be based on negative tests, not on an arbitrary time window or symptoms. Since a quarter of all COVID cases are asymptomatic, staff should also be asymptomatically screened; they aren’t because hospitals don’t want staff taking time off. Again, these are economic, not scientific, decisions.

Putting these two votes together, HICPAC has voted to allow sick, infectious, COVID+ staff to go to work without proper PPE and infect fellow HCW and patients, in hospitals without proper ventilation and filtration. Patients who are infected in hospitals using outdated droplet precautions will have a 10% risk of death. Coworkers- even if fully vaccinated- will have a significant risk of developing a long-term health condition following their acute infection.

At a time when hospitals remain crushed by the ongoing burden of both COVID and post-COVID health problems, failing to protect workers is a particularly short-sighted decision. Studies have already shown that HCWs suffer unusually high rates of Long COVID, with a recent one in the UK finding a whopping 33.6% reporting symptoms, and 7.4% of respondents reporting an official diagnosis.

These decisions not only mean infected doctors and nurses returning to work actively ill; they also mean that hospitals will continue to reinforce false information about how COVID spreads, purposely miseducating doctors and nurses in their employ to save money.

The members of HICPAC understand that surgical masks aren’t really the equivalent of N95s, they simply believe HCWs are more likely to wear surgicals (they’ve explicitly stated such; this is not, incidentally, how infection control decisions should be made). But this reasoning is not shared with patient-care level HCWs. Instead, HCWs are told that surgical masks are a sufficient infection control measure for COVID-19 when infectious. When an informed patient seeking care tries to correct them, they are greeted with condescension; after all, the doctor’s information comes directly from the CDC.

Disabled and immunocompromised people relate stories of medical professionals who believe COVID spreads via droplets, who wear surgical masks instead of N95s, who draw curtains to prevent the spread of COVID and other viruses; in other words, they are continuing to adhere to outdated precautions. This is unsurprising, because they have never received accurate guidance reflecting our updated technical knowledge about how SARS-COV-2 and other common viruses actually spread.

They’ve never received updated information because the medical system does not want to spend money to protect workers or patients.

At the end of the day, this story is not about droplets and airborne particles as much as it is about dollars and cents. What sounds like an in-the-weeds scientific debate, is no more than a common tale of industry greed. We know- and have known- exactly what it would take to protect patients in healthcare settings. Instead, our leaders sit back and watch as day after day, more unnecessary infections and deaths accumulate. As day after day, more healthcare workers acquire illnesses at work which lead to staff shortages, worse patient outcomes, long-term departures, and the loss of talented, highly trained people from the field.

All of us, patients, doctors, nurses, and other healthcare staff alike, deserve medical leadership that will value our rights to safety in these settings. We deserve medical leadership that won’t actively try to slow scientific progress, and instead will welcome its arrival. We deserve to enter a hospital knowing we won’t be infected and killed because HICPAC would rather allow airborne nosocomial infections to continue on its watch than spend money preventing them.

Right now, the biggest factor protecting hospitals as their negligence rolls on into year five is the ignorance of the public. Most people have no idea how COVID and other viruses spread, have no idea that it’s so dangerous to contract COVID as a vulnerable patient (thanks to years of normalizing propaganda), and may themselves believe that social distancing or curtains prevent infections. This public ignorance is a deliberate tool which enables continued public health negligence on multiple fronts. Continuing to educate ourselves and each other is resistance when the state relies on ignorance to tamp down resistance to policies of mass infection and death.

[covidsafecosplay]

The People’s CDC COVID-19 Weather Report: October 28, 2014

The People's CDC has released another updated report on COVID-19 data and action items for the United States of America.

Highlights:

Wastewater and emergency room data indicate covid transmission continues to be under-reported. Get vaccinated and use layers of precaution such as masking and air filtration to defend yourself from infection.

KP.3.1.1 remains the dominant variant.

The CDC has updated guidelines permitting access to twice-annual covid vaccines for adults aged 65 and older, as well as the immunocompromised.

Read the rest of the report here:

Please note that the CovidSafeCosplay blog and its admin are unaffiliated with the People's CDC or its management, and are simply sharing the resource.

Via the People's CDC About page:

The People’s CDC is a coalition of public health practitioners, scientists, healthcare workers, educators, advocates and people from all walks of life working to reduce the harmful impacts of COVID-19.  We provide guidance and policy recommendations to governments and the public on COVID-19, disseminating evidence-based updates that are grounded in equity, public health principles, and the latest scientific literature. Working alongside community organizations, we are building collective power and centering equity as we work together to end the pandemic. The People’s CDC is volunteer-run and independent of partisan political and corporate interests and includes anonymous local health department and other government employees. The People’s CDC is completely volunteer run with infrastructure support being provided by the People’s Science Network

[liminalweirdo]

Please sign this letter from National Nurses United to urge the CDC and HICPAC to fully recognize aerosol transmission of covid.

The Healthcare Infection Control Practices Advisory Committee (HICPAC) to the Centers for Disease Control and Prevention (CDC) recently initiated work to update the CDC’s guidance, Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, last updated in 2007, based on “lessons learned” during the Covid-19 pandemic. This foundational guidance directs infection control practices for a wide range of pathogens in health care settings in the United States and around the world. 

BUT the process is obscured. Working group meetings are closed to the public. Short updates are provided at HICPAC meetings but drafts are not posted. Based on updates provided at HICPAC meetings over the past year in addition to other presentations from CDC staff regarding the guidance updates, there are concerns that the CDC may be headed in the wrong direction on multiple fronts, including failing to fully recognize aerosol transmission, incorporating crisis standards into infection control guidance, and downgrading personal protective equipment for health care workers. Read this document for more details. 

[appnordesteaqui]

REFERENCIAS BIBLIOGRAFICAS

AYLIFFE, G. A. J. et al. Control of hospital infection: a practical handbook. 4th ed. London: Hodder Arnold, 2000.

BRASIL. Agência Nacional de Vigilância Sanitária. Higienização das mãos em serviços de saúde. Brasília, 2007a. Disponível em: <http://www.anvisa.gov.br/hotsite/higienizacao_maos/index.htm>. Acesso em: 10 jun. 2007

CDC (CENTERS FOR DISEASE CONTROL AND PREVENTION). Guideline for hand hygiene in healthcare settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR Recomm Rep, Atlanta, v. 51, n. RR-16, p. 1-45, 2002.

Departamento da Qualidade na Saúde/ Divisão de Segurança do Doente. Circular Normativa

Nº 13 de 04/06/2010. Orientação de Boa Prática para a Higiene das Mãos nas Unidades de Saúde. Acedido em:http://rncci.min-saude.pt/SiteCollctionDocuments/i013069.pdf

DIREÇÃO-GERAL DE SAÚDE. Norma Nº 29/2012 de 28/12/2012. Precauções Básicas do

Controlo da Infeção. (A aguardar aprovação final)

Larson EL.(2004) .A Causal link between handwhashing and risk of infection? Examination of the evidence. Infect Control, v.9,n.1p.28-36.

World Alliance For Patient Safety. (2006). Guidelines on hand hygiene in health care,

(advanced draft). Global Patient Safety Challenge 2005-2006: Clean care is Safer Care. OMS. Genebra. Acedido em:

http://www.who.int/patientsafety/information_centre/Last_April_versionHH_Guidelines%5b3%5d .pdf..

World Alliance For Patient Safety. (2009). Guidelines on hand hygiene in health care. First

Global Patient Safety Challenge: Clean care is Safer Care. OMS. Genebra. Acedido em:

http://whqlibdoc.who.int/publications/2009/9789241597906_eng.p

[gotohoon]

In case you missed it: August HICPAC Public Meeting Recap | Blogs

Posted on September 3, 2024 by Centers for Disease Control and Prevention (CDC) Sydnee Byrd, a contracted CDC program analyst, addresses the group during the August HICPAC meeting. The Healthcare Infection Control Practices Advisory Committee (HICPAC) held a public meeting August 22, 2024, in Atlanta, GA. Official meeting minutes will be available on the HICPAC website soon. Until then, here is…

[anumberofhobbies]

I wonder how much, if anything, has changed since this article was published August 2023?

Hmm, interesting,

Infection Control Today notes that Long COVID is exacerbating worker shortages in all industries, but particularly healthcare. A recent survey from the British Medical Association found that, among doctors who contracted Long COVID, about one in five were no longer able to work due to ill health, and nearly half reported lost income. Three quarters of those surveyed attributed their infection to the workplace; the massive labor rights issues at play here have been largely ignored by most unions, with the notable exception of NNU. The nurses’ union is currently organizing to push the CDC and its infection control advisory body, HICPAC, to fully acknowledge airborne transmission as they consider loosening guidelines even further.

[wat3rm370n]

Public comment to CDC HICPAC committee November 2024

Infection control in healthcare.

My public comment to the CDC HICPAC Committee.

Direct link to my comment in the stream.

Direct link to the start of the whole comment period.

Day 2 of the meeting link, with another session of public comments then the vote.

I’m Chloe Humbert. Semmelweis is known for his campaign for hand washing standards. He was attacked by contrarians until his death. Today he is vindicated yet respiratory hygiene is the science denier flavour of the day.  It’s not okay that doctors and nurses are maskless and breathing directly on patients who then get infected. Now is the chance for those in positions to do so to set a precedent for deserved protection of worker and patient safety. To be on record giving evidence based practitioners something to hang onto.  We are going back.   The only question is how far back people in medical leadership are willing to sign onto. The announced incoming department of defense secretary is someone who said on national tv that he doesn’t wash his hands. We know what can happen because of what has happened before.  In the 1850s Florence Nightingale went to the Crimean War - a hospital in Constantinople. That's Istanbul now, and that situation was no Turkish delight on a moonlit night. She arrived at a British military base ATOP a cesspool where patients lay in their own feces among rodents and more soldiers died from infectious diseases than injuries in battle. Under Nightingale the place was scrubbed and she reduced the facility’s death rate by two thirds. We might go back further.  The Dark Ages was called that because society moved backwards from the technological advances that had come before. The fall of the Roman Eempire was marked by elites who only cared about the status quo; they could’ve developed a steam engine as far back as Heron in 15 BC but didn’t bother.  Going forward is a choice.  In an article in the Journal of Infectious Diseases & Preventive Medicine there’s a description of what happened back then. “In medieval times, hospitals were hazardous places, Epidemic infections killed large numbers of hospital patients during this period. Hospital infection and death rates were high. When a sick person entered a hospital, his or her property was disposed of, and in some regions, a requiem mass was held, as if he or she had already died.” Going backward is a choice.  We know better now. We use surgical gloves, autoclaves, disinfectants, checklists and yes, respirator masks exist. But big healthcare corporations don't wanna pay for that, they lock up PPE, force nurses to work without sick leave at hospitals, and make patients beg for reasonable accommodation.  Going forward is a choice.  Let this not be a case of rearranging deck chairs on the Titanic. But a time when serious healthcare professional leadership takes a stand for sanitary conditions in healthcare, and makes respirator masks and the precautionary principle the standard of care instead doing with masks what would be like calculating whether you should wash your hands after the toilet based on age or health status.

[feminist-space]

"National Nurses United wrote to CDC Director Mandy Cohen on July 10 [2023] expressing concern about HICPAC’s guideline update, and nearly 900 public health experts on July 20 wrote a similar letter to Cohen, about the lack of transparency and the failure to address and protect against aerosol transmission of infectious diseases.

The CDC responded to the second letter on Friday, Aug. 19, but did not provide any indication there would be any traction to meet the requests to open up the process and involve key experts and stakeholders, according to one of the authors, Peg Seminario, an industrial hygienist who served for 30 years as the health and safety director at the AFL-CIO.

“We are deeply dismayed that the CDC response did not address any of our substantive concerns about the weakness of the guidelines,” Seminario said.

No minutes or transcripts of any HICPAC meetings so far in 2023 have been posted to the panel’s website.

Sharan said federal rules give the government three months or 90 days to post meeting minutes, and the June HICPAC minutes will be available within that time frame.

Including Wednesday, it has been 77 days since the June meeting. The deadline to post the minutes is Sept. 5.

Rachel Weintraub, executive director of the Coalition for Sensible Safeguards, urged the federal agency to immediately seek input on the rule proposals from the public, health care workers, unions, engineers with expertise in ventilation and research scientists with expertise in aerosols.

As the guidelines are being written, Weintraub also urged the CDC working group to create a public docket for the guideline’s development, including all meeting minutes, drafts, all scientific evidence used, and public comments submitted.

The Centers for Disease and Control and Prevention did not directly respond to Source NM’s question about whether they intend to create a centralized public docket specifically for the update to the Isolation Precautions Guidance.

“CDC hospital infection control measures are still failing to protect health care workers and patients,” Seminario said. “We need to do more. CDC must develop strong infection control guidelines that fully protect against aerosol transmission, and open up the development process to include necessary experts and members of the public.”"

[kai958531911]

専門家らは、CDCは院内感染予防に関して適切なアドバイスを受けていないと指摘

「エアロゾル科学者、粒子物理学と空気中の分布の原理について専門家から意見を聞く必要がある」

「最新の研究は、新型コロナウイルスのような感染病原体が非常に細かい粒子で空気中を長距離伝播する可能性があることを示しています。」

HICPACガイドラインでは、新型コロナウイルス感染症の感染経路を定義するために「空気」と「接��」という一般用語を使用しているが、専門家らはこれをあまりにも単純すぎて最新の科学とはかけ離れていると分類している。繰り返しになりますが、シャラン氏は、これは臨床分野全体での感染の理解をより合理化するための取り組みであると述べました。

「新型コロナウイルス感染症（COVID-19）のパンデミックは、用語の使用（例：集団によって異なる意味で使用される空気感染などの用語）と、医療における飛沫対空気感染の枠組みの使用に関するいくつかの制限に関する継続的な課題を最前線にもたらした。病原体が空気を介してどのように伝染するかを連続的に説明しています」と彼女は言いました。「ガイダンスの更新により、これらのトピックに対処する機会も提供されます。」

[covid-safer-hotties]

Also preserved in our archive

by Dr. Judy Stone

Last June, an obscure federal advisory committee—the Healthcare Infection Control Advisory Committee to the Centers for Disease Control—first shocked many in the public health community by suggesting that the CDC could loosen infection control practices in hospitals and healthcare settings. Their most controversial recommendation was that surgical masks (aka "baggy blues") could generally be substituted for the more protective N95 respirators. This was despite their own data showing that respirators provide superior protection.

Last fall, the CDC advisory committee sent their formal recommendations for revising infection control in healthcare facilities to the CDC director. During the public comment period, there was considerable pushback from patients and families. Concerns centered around immunocompromised people fearing to seek care because staff refused to mask, people acquiring infections in the hospital, and the issue of masking versus the use of N95 respirators. The CDC did not accept the HICPAC committee's recommendations and sent them back to the committee for revision and comment on several questions relating to transmission and protection.

Months later, the HICPAC met again, but they have not yet resolved the questions or concerns. Here are the issues raised by the CDC.

Are Surgical Masks Enough For Bugs Spread By Air? The first question was whether surgical masks or NIOSH-approved N95 [or higher-level] respirators should be used for pathogens that spread by the air.

Erica Shenoy, MD, PhD, Chief of Infection Control at Mass General Brigham, and a prominent committee voice who has published against masking in healthcare settings, argued that wearing an N95 respirator for initial patient contact was excessive. She told the committee that her practice is to go into a patient's room (without a respirator), ask a few questions, and then determine the level of protection needed. I understand that since I sometimes did the same—but that was long ago, and when I suspected my exposure would be minimal during that brief period.

Times have changed. We now are still in the midst of a COVID-19 pandemic—despite pronouncements to the contrary—with a virus that we know has airborne transmission. Further, long Covid develops in at least 10% of those infected and often has life-changing consequences. These include autoimmune diseases, dysautonomia (autonomic dysfunction causing fainting, pulse and blood pressure swings, and more), and chronic disabilities. Since we know COVID is a disease transmitted through the air, wearing an N95 respirator for the initial patient encounter and then downgrading the precautions when COVID has been ruled out makes sense.

OSHA and NIOSH clearly state that surgical masks provide inadequate protection. OSHA says, "Surgical masks are not designed or certified to prevent the inhalation of small airborne contaminants." NIOSH concurs, concluding a surgical mask "is not considered respiratory protection." Yet HICPAC, with one exception, concluded that they were equivalent.

Wearing an N95 respirator will become even more critical as bird flu becomes more widespread, particularly if/when it mutates to be readily spread person-to-person. Highly pathogenic avian influenza H5N1 can be spread by direct contact with animals or contaminated surfaces, by ingesting milk, or by inhalation. Some data says that airborne transmission of HPAI H5N1 is not very efficient. A significant concern is that influenza viruses mutate readily and might acquire mutations that enhance their ability for airborne transmission. The first case of the bird flu with "no immediate known animal exposure" was in Missouri in September. There is now a critically ill teen with respiratory failure from avian flu in British Columbia, Canada.

Should Healthcare Workers Be Allowed To Wear N95 Masks? Question 2 related to the classification of pathogens and when different types of precautions would apply. Influenza is classified as requiring "standard" and droplet precautions in the 2007 guidelines, which are under revision now. This would mean a surgical mask would be adequate.

There was considerable discussion about whether a health care worker (HCW) should have the flexibility and right to decide what level of respiratory protection they felt necessary, based on their own health and that of family members they might be exposing to disease.

In the non-binding vote, almost all members supported the idea that HCWs should not be given that voluntary right.

Peg Seminario, the director of occupational safety and health for the AFL-CIO from 1990 to 2019, told me employers believe they know best and that workers "don't really know when they should be wearing this respiratory protection. And also, that it upsets patients." Seminario also said, "I think the decision-making reflects the continued domination of the infectious disease professionals who represent healthcare hospital interests," who already feel regulations are too burdensome.

“The reasons they gave were, frankly, very paternalistic,” is how Lisa Baum, an Occupational Health and Safety Specialist with the New York State Nurses Association, described this decision-making process. “They know what's needed in terms of protection, and if they determine that a respirator isn't needed, then a respirator isn't needed, period,” she added.

The HICPAC Membership Doesn’t Meet Its Own Requirements The World Health Network has filed a supplementary complaint to the Health and Human Services Inspector General because their committee is supposed to have fourteen members with diverse backgrounds, but they don't. Experts in airborne transmission are still not voting members. Also, many of the members "are from management positions in hospitals that benefit financially from treating healthcare-associated infections (HAIs)" with "perverse financial incentives that prioritize treatment over prevention." The Isolation Precautions Guideline Workgroup "operates in secrecy, in violation of FACA's requirements for transparency and public involvement."

The fourth question concerns "source control," or whether HCWs, patients, and visitors should mask in hospitals. The HICPAC—again with one dissention—voted that this should be left to local decision-making.

When And Where Can Infected Healthcare Workers Return To Work? Finally, there was discussion in the Infection Control in Healthcare Personnel Working Group as to when HCWs recovering from flu or Covid could return to work. If they're working with people who are at high risk, immunocompromised, other reasons, you know, should there be special places, conditions, where they should not be assigned?

The committee recommended only a 3-day work restriction from the onset of symptoms, even if the HCW is still symptomatic, if they are improved and afebrile—this, despite abundant data that many people shed SARS-CoV2 virus for ten days or more. The HCW should wear a surgical mask for 7 days from onset. There were also no recommendations to restrict ill HCWs from caring for high-risk or immunocompromised patients because "it is not feasible."

Baum was the sole dissenting vote on almost all of these questions. Notably, she was also the only committee member who was masked during the meeting. Baum was particularly disturbed by this decision, as “many employers pressure healthcare workers to come back to work after the number of days that the CDC lists workers should be excluded from work, even if the worker is still feeling too ill to work.”

Opposition To HICPAC Recommendations Before vaccinations, the mortality of patients hospitalized with COVID-19 was close to 30%. The mortality rate of hospital-acquired Covid has decreased with multiple vaccinations, but is still 10% or higher. This is still higher than community-acquired infection. So it makes sense that hospitals should do what they can to prevent transmission within the hospital so prevent these needless and avoidable deaths.

As I noted previously, "More than 900 experts in infectious disease, public health, industrial hygiene, aerosol science and ventilation engineering signed a letter to Mandy Cohen, M.D., the new CDC director, explaining how the new draft guidelines weaken protections for healthcare workers. They state, "Surgical masks cannot be recommended to protect health care personnel against inhalation of infectious aerosols."

Furthermore, as with earlier HICPAC meetings, numerous public comments protested the committee's decision. Many patients are afraid to seek care now, knowing that they risk becoming infected in the hospital or doctor’s office. One commenter, Amanda Finley Diggs (@rubyslippahs) is a Covid long-hauler, ardent masking advocate, and defender of vulnerable patients. She urged HICPAC, “Please step up and fulfill the public mandate in your very name: the Centers for Disease Control **and Prevention.**”

Baum said, “There are still those on HICPAC who refuse to accept that this is happening on a widespread basis, that there is exposure and infection occurring in the healthcare environment.” Neither professional nor public concerns appears to have any impact on HICPAC’s decision-making process.

The HICPAC also seem oblivious that NIH has resumed requiring masking in all patient care areas and testing for SARS-CoV-2, Influenza A, Influenza B, and Respiratory Syncytial Virus (RSV) on inpatients. Sonoma County also requires masking in all hospitals. But #HICPAC thinks masks are unnecessary.

Despite her frustrations, Baum stressed, “We actually strongly support the CDC.” She added, “It is our job to push them to protect patients and staff better and to follow the science better, but we want them empowered to do so.”

Note: You can still submit comments until November 22, 2024 Email HICPAC@cdc.gov if you want to advocate for isolation of infectious staff + ASHRAE 241 indoor air standard + N95s in healthcare.

Note: Dr. Shenoy and the CDC/HICPAC have not yet responded to a request for comment.

[nedsecondline]

Experts say CDC not getting right advice on hospital infection prevention | CIDRAP

The proposed guidance is full of outright errors, she said, such as a slide that states surgical masks are as effective as respirators in preventing transmission of airborne diseases based on a review of 27 studies. “What did we learn from COVID? It seems like nothing, according to HICPAC,” Brosseau said. HICPAC’s proposal does recommend healthcare workers use respirators, but only in the case of…