Does CDC HICPAC want to make a mockery of infection control in healthcare?

The things I’m concerned about are talked about and documented - so reasonable concerns about CDC HICPAC.

Note: there is a podcast version of mostly the same information, including a transcript.

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CDC HICPAC (The Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee)

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• National Nurses United (NNU) report about 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 health care workers exposed to infectious diseases.”

  • Hospitals are already relying heavily on flimsy paper surgical masks while multiple aerosol transmitted viruses (covid, flu, rsv, etc) are being allowed to spread freely in healthcare settings where often nobody is masked at all. 

  • CDC HICPAC committee knew in 2020 about the precautionary principal when it comes to infectious disease, and in January 2020 issued guidance for covid for use of N95s. At 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”.

  • It’s the whole reason for the debacle about N95 shortages early in the pandemic and concerns about the public buying up N95s and leaving healthcare workers in a pinch. As it turns out it’s the healthcare corporations who were doing it to their own employees after all and even withholding PPE after shortages were no longer even a thing, and some shitty behaviour by the Trump administration who also allowed a boondoggle where a company was going to make money on cleaning N95s. Bottom line is - it’s the same disease now, and more contagious. 

  • I’ve heard so many times stories of patients at hospitals being forced to remove their N95 mask and put on a flimsy paper surgical mask. Including when they wear adhesive Readimask N95s which are NIOSH approved and contain no metal which would only really be a problem with certain types of tests and procedures.

  • Once they ban NIOSH N95s from healthcare workers for covid, what’s next? Covid is a really bad disease with a high level of risks. So I would expect that they would have healthcare workers work with ebola and TB with less expensive gear, to hell with the consequences? Bird flu has a high mortality rate for humans, and I feel bad for the farm workers and healthcare workers who are denied PPE with this risk, and who may be unwittingly taking it home to sicken their families or even their cats. I would not assume this laissez faire attitude is confined to covid contrarianism, as hospital resistance to infectious disease mitigation appears to be financially motivated - just as underneath it all covid mitigation resistance has been financially motivated since the beginning of the pandemic. (It’s wrong to think of this as a cultural issue, it’s a cognitive warfare issue, and the result of many PR blitzes pushing propaganda by industry interests using well-worn tactics.)

• At a recent NNU webinar on the use of AI in healthcare, someone told the story about an automated shift change report that just makes a sheet with no human to human handoff between actual healthcare workers. In this case the automated sheet failed to show that the person coming into the hospital had “no immune system” and had the nurse not made the extra step of checking the patient’s chart, they would’ve put the immune compromised person in with the patient who had covid and flu. 

  • In this case the problem could’ve been avoided by properly isolating covid & flu patients from other patients. Even people with working immune systems shouldn’t be deliberately sickened at the hospital. That’s a preventable harm that they know how to prevent. Hospitals shouldn’t be giving people covid.

  • Getting rid of nurse to nurse shift change reports and replacing them with a chatbot generated summary sheet is obviously a bad idea and is going to lead to patient safety issues generally. And what, just to save money on staff?

• Another story told at the NNU webinar was that the automated system failed to alert the healthcare worker that the patient had covid, and the healthcare worker would go into the room of the patient without any mask. 

  • In this case universal masking in healthcare settings would’ve actually prevented the problem caused by the automated system, and is another argument in favour of universal usage of respiratory PPE in healthcare settings. 

  • Even if a patient hasn’t yet tested for covid, the patient could have covid! This is a point made by People’s CDC in August 2024, saying: “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.” and People’s CDC in October 2022 made that point too 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.”

  • Especially in hospitals where they’re clearly doing little effort to prevent the spread of covid right in the hospital, it’s not unlikely that the healthcare worker might have as yet undiagnosed covid, and should be wearing a mask for source control to prevent them spreading it to patients.

• NNU 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.

  • I’m old enough to remember when OSHA issued pretty decent guidance for workplaces in March 2020, which called for engineering controls such as “Installing high-efficiency air filters.” and “Increasing ventilation rates in the work environment.” and “Encouraging sick workers to stay at home.” Frankly this was an unexpected and 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 a swift release. Word spread fast and quite a few workplaces local to me I know actually did things in the guidance. In a more sensible timeline, MAGA would be campaigning on this point when criticized for the mishandling of the pandemic. But nobody on the right can even campaign on Operation Warp Speed because the Republicans are all committed to anti-vax disinformation now. They let Joe Biden take that win, even though frankly our vaccination campaigns all along have been dismal and confused, nonsensical, or at times counter to actually vaccinating anyone, and I’m sure it doesn’t help that they have at least one Great Barrington Declaration signer on the FDA VRBPAC committee who invokes natural herd immunity talking points at the vaccine meetings.

  • There was an OSHA hearing in 2022. And I’ve not heard anything about what came of this since. I worry that they’re just going to base worker protections on CDC HICPAC which has no regulatory power itself and is not set up to enforce safety rules to protect workers or even patients or anyone else. It’s strictly a public health messaging and data collection agency, and it doesn’t even do that right!

  • Dr David Michaels, epidemiologist, and longest serving OSHA head from 2009 to 2017, testified at the OSHA hearing on April 28, 2022, saying: “OSHA has a statutory responsibility, statutory requirement to have an open and transparent process like we are having today to just 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.” 

    • 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 — they’re allowed to keep the deliberative process secret.

    • OSHA has to develop actual standards, and CMS can actually enforce data collection. But the CDC is just there ostensibly to cajole the public, often with ill-considered social media, and collect data but only if they feel like it… with more pandemics on the way. And the agency is even quite obviously easily directly swayed by industry interests.

• NNU reported that Andrew Levinson of OSHA said: “OSHA saw health care employers prohibiting respiratory protection because they were afraid it could scare patients.”

  • This is the second time I’m reminded of this story told on 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 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 by telling them to go to the hospital, and the patient wound up dying of an ectopic pregnancy as a result. 

  • 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, ingrained into every system and every choice incentivized, is not to save lies, 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 was described 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… are all problems that are to be managed by PR and lobbying the government to make it at least officially ok, so that it makes it harder to sue or hold them to any standards.

• NNU 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 a respirator was not required.”

  • This sounds like one of the many tricky, and more insulting, forms of union busting that corporations do to undermine workers organizing. It has big Metropolis vibes - the silent film from the 1920s is relevant to this day. It’s totally believable that hospital management figures most of their workers “get ideas” from “troublemakers” and the like. They see workers as largely mindless replaceable widget automatons.

  • It tracks that healthcare company administrative executives are worried about not having complete totalitarian control over which staff are allowed to protect themselves from preventable harm on the job. (Most of the high level people in healthcare who might talk a careless game don’t actually want to risk themselves as easily.) Most of these corporate leaders really resent having any standards at all for patients or workers. They want to run facilities like infection distribution centers of the 1400s while making 2020s money. So they lobby. But often they don’t have to because their executives are appointed to committees at state and federal agencies that make the regs.

And then is it any wonder that “trust in doctors crashed and remains low”? As it is reported in an article in MedPage Today recently about a survey where “putting financial motives over patient care was the top reason for patient mistrust”. Well isn’t that a surprise!

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This is my letter to representatives, feel free to use it yourself, or this form:

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The government needs to require hospitals to implement infection prevention, and stop sickening patients with a preventable disease. Healthcare workers need to wear N95 / respirator masks which should be provided to healthcare workers and patients. Patients should never be required to unmask needlessly, or forced to downgrade their mask just because the hospital doesn’t want to provide effective PPE to their staff. Covid patients need to be isolated from uninfected patients. Common sense has been abandoned in many hospitals. Unmasked nurses entering the rooms of covid positive patients. Healthcare workers working while sick with covid or flu. Cancer units without mask requirements. Hospitals that mix covid patients with other patients. All of this is preventable harm, and should be prevented. CDC HICPAC should not place hospital profits over people. Public safety depends on this. 

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