Ottawa’s largest hospitals say they may call in symptomatic health-care workers with COVID-19 to work should their staffing crisis become dire — a policy move that hospitals across the continent are making amid the Omicron surge, say experts.
An internal document by The Ottawa Hospital dated Jan. 5 outlines its decision-making process for when health-care workers are allowed to work should they be exposed to or have COVID-19.
The hospital states that “if exceptionally critical to operations,” workers who’ve tested positive for COVID-19 may be asked to come into work whether they’re symptomatic or asymptomatic.
If approved on a case-by-case basis, staff must work under its “work self-isolation” measure, which means they’ll have to get tested daily and self-isolate at and outside of work — like eating meals and taking breaks away from colleagues and family, travelling to and from work in a private vehicle or wearing PPE on public transit and staying two metres away from everyone “except when providing direct care.”
“Work self isolation is not a staffing option and should only be used as a last resort when there is a clear risk to patient care (i.e. the risk of the staff member not returning outweighs the risk of potentially exposing patients),” says the document.
Nurses who CBC spoke to expressed concern over this policy, as they could risk infecting vulnerable patients should it become a reality.
“It just goes against everything that we do as nurses,” said one nurse at The Ottawa Hospital, who CBC agreed not to name because of their concern their job could be at risk if they speak publicly.
“Our whole job is to protect the public and we don’t get to do that anymore … we can’t safely take care of patients.
“We’re just going to show up to work and it’s like roulette.”
As of last week, hundreds of Ottawa health-care workers were off work as a result of COVID-19 infections or exposure. The hospital said 125 staff are off work because they’ve tested positive for COVID-19.
“I don’t know if I could live with myself if I got someone sick, if it came back that I took care of them, then they got sick, and then they ended up in ICU,” said the nurse. “I’m not sure if I would want to be a nurse after that.”
They also asked what legal protection will they have should they infect a patient while working.
Only in ‘extreme circumstances,’ hospital says
A spokesperson for The Ottawa Hospital (TOH) said in an email that this decision would only be made in “extreme circumstances” when the risk to the patient by not having health-care workers is greater than the risk of the infected worker exposing them to COVID-19.
“It is important to note that TOH has not had to bring in any COVID-19 positive staff,” the spokesperson said.
CBC has contacted all of Ottawa’s major hospitals and asked if they are implementing a similar policy.
Montfort Hospital’s spokesperson said it also has measures in place that “allows for COVID-19 positive staff to be called back to work,” but hasn’t had to resort to it yet.
“That said, if it becomes necessary to maintain essential activities, it is an approach that could be considered,” said the hospital in an email.
Queensway Carleton, CHEO and Bruyère hospitals confirmed they also have a similar policy.
Quebec announced in late December that it will allow infected health-care workers to work to protect hospital capacity.
Across the border, health-care workers in the U.S. with COVID-19 and mild cold-like symptoms are also allowed to work, as the Centre for Disease Control updated its guidelines late last month on how to mitigate staff shortages amid Omicron.
Policy ‘unusual’ but necessary, says expert
“This is so new,” said Doug Angus, a health-care policy and management expert and University of Ottawa professor.
He said these policies are unprecedented in the health-care system as a result of the COVID-19 pandemic, and doesn’t see any other solution in the short run if hospitals can’t provide care because of staff shortages.
“It’s not normal. The situation has arisen just because of absolute necessity,” he said. “It’s the traditional ‘between a rock and a hard place’ and I think the health-care system … is trying to do best it could possibly do.”
Angus said as hospitals transition into calling in sick workers, they must provide “absolutely the best equipment they can wear and use” so the odds of transmitting COVID-19 becomes fewer.
“It’s not 100 per cent fool proof, but … under the circumstances, it’s a risk that pretty well has to be taken.”
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Susy Hota, the medical director of infection prevention control at the University Health Network in Toronto, says these policies aren’t unique to Ottawa hospitals but are “crisis-type interventions” likely being implemented in hospitals across the country.
“Things are pretty dire,” she said, noting these measures that were once theoretical and only on paper are becoming a reality.
Hota said having no health-care workers in hospitals may be a greater risk than transmission.
“It really is about weighing the risks and benefits of something that seems a bit unusual compared to the alternative of not having people around to care for patients who need it — which is probably the greater risk in this scenario,” she said.
“While it might sound frightening in some ways maybe for people, and a bit shocking, I think we all have to recognize the reality we’re in and how these [decisions] aren’t being taken lightly.”
‘Bad Band-Aid solution,’ says union
Rachel Muir, a nurse at The Ottawa Hospital and president of the local bargaining unit of the Ontario Nurses Association, says she already knows of a handful of nurses who are working under work self-isolation because of exposure to COVID-19.
“Work self-isolation is a bad Band-Aid solution to a critical situation that we should never have been in if people have listened to us,” said Muir.
Alhough no grievances have been filed about work self-isolation, Muir said the issue has been on her radar. She’s worried about the impact working while sick will have on nurses.
“Personally, I don’t like it. I don’t like the fact that we’ve come to this point, and it all circles back to the fact that we are so chronically short-staffed,” she said.
“We’re in trouble.”
Policy in line with Ontario’s guidelines
According to an Ontario government guideline published on Dec. 30, the province outlined expedited return to work scenarios for health-care workers during staff shortages.
“Staff who are cases (i.e. have tested positive or symptomatic) should be considered only in the critical staffing shortage situation,” the government said.
“The fewest number of high-risk exposed health-care workers should be returned to work to allow for business continuity.”
It says in that situation, health-care staff who are symptomatic or test positive may return under work self-isolation if they are asymptomatic, among other requirements like being fully vaccinated, and wear fit-tested, seal-checked N95 respirators at all times during work.
They should avoid working with immunocompromised patients, the province said.
CBC has asked the Ministry of Health for clarification on its guidance and is waiting for a response.