COVID-19: What Now?

Numbers of new cases of COVID-19 infections are at the lowest they have been in months. In fact, many states, as well as counties, are easing restrictions such as mask mandates indoors. These decisions are based on new tools created by the CDC to reduce risk of exposure and possibly infection and to reduce the burden this pandemic has placed on especially the hospital system. This comes as a welcomed relief for many but may be a source of confusion for those in healthcare because the recommendations included in this new tool do NOT apply to healthcare facilities. Discussed below are the two different tools designed to be used to reduce risk of exposure and possibly infection and to reduce the burden this pandemic has placed on especially the hospital system. There are two different tools available.

Community Transmission: Applies to all healthcare entities
Community Levels: Applies to the general population

Community Transmission
Community transmission is based on the numbers of new COVID-19 cases and communities positivity testing rate. When there is evidence of community transmission, the likelihood of coming into contact with an individual who is either asymptomatic or pre-symptomatic is increased. This situation leads to an increased risk of being exposed to the virus and possible infection.

Each practice or facility should continue to follow the existing CDC infection control guidance based on their county’s level of community transmission. The CDC’s COVID-19 Data Tracker tool should be checked on a weekly basis to identify the level of community transmission in your area. Some infection control measures could be adjusted based on the transmission level. For instance, when performing aerosol generating procedures in an area with substantial to high levels of community transmission, an N-95 respirator should be used. Once the transmission levels fall below substantial, a decision may be made to move forward with the procedures with a surgical mask and eye protection.

TMC has received numerous questions about masking in general, as the guidance can be confusing. To be honest this is no simple Yes of No answer on whether to wear a mask. The current infection control guidance includes universal masking except in very limited areas of the facility where only staff congregate. As part of assessing the hazard of this activity, it would be important to review current data about community transmission, the vaccination rate of employees, as well as the number of employees who have had COVID-19 in the past 90 days. In short, each practice must be in constant assessment mode to determine how they can best protect their workers and the patients receiving care.

On the other hand, Federal OSHA has been very direct. They have withdrawn the COVID-19 Healthcare Emergency Temporary Standard. Most state OSHA programs have either withdrawn or are in the process of withdrawing their standards. This means for the most part there are no “laws” outlining safeguards which must be in place to protect workers against exposure to this virus. Employers must still be aware of the risk, evaluate their situation and provide safety measures in the workplace referencing the requirements of the General Duty Clause and creating a safe workspace.

Community Levels
In late February the CDC created the Community Levels tool to provide g direction for the general public to avoid COVID-19 infection or re-infection. Currently the CDC new COVID-19 Community Levels recommendations do NOT apply to healthcare and does NOT change any of the infection control recommendations.

This new tool assigns risk levels, which can be low, medium, or high by looking at the following data:

Hospital beds being used
Hospital admissions
Total number of new COVID-19 cases

Focusing on these three data points and implementing additional measure IF community levels increase can prevent strain to local health care systems which has been a continuing issue since the beginning of the pandemic.

Recommended Prevention Strategies Based on Community Level

Low	Medium	High
Stay up to date with COVID-19 vaccines Get tested if you have symptoms	If you are at high risk for severe illness, talk to your healthcare provider about whether you need to wear a mask and take other precautions Stay up to date with COVID-19 vaccines Get tested if you have symptoms	Wear a mask indoors in public Stay up to date with COVID-19 vaccines Get tested if you have symptoms Additional precautions may be needed for people at high risk for severe illness
People may choose to mask at any time. People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask.

https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html

In reviewing the recommended actions, you will see that mask use indoors is only included when the community level is considered high for most individuals. This change does allow for fewer masking restrictions in many areas of the country, but again, these masking recommendations do not apply to those providing healthcare services.

It has been a very long two years with many challenges. While communities move to what would be a more normal way of life, it is still important to remain diligent in the mundane. Assessment of workers and patients, the appropriate use of personal protective equipment, handwashing and clear concise communication of expectations will all work together for the safety of workers and patients.