Although health workers constitute about 3% of the population in most countries, they comprise 14% of COVID-19 cases reported to the World Health Organization (WHO), and in some countries account for up to 35% of COVID cases. WHO Director-General Tedros Adhanom Ghebreyesus noted this in a September 17 statement and added, “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives.” As “one of the keys to keeping patients safe is keeping health workers safe,” on Thursday the Director-General issued a 5-point charter on healthcare worker safety in conjunction with Patient Safety Day.
The 5-point WHO charter urges its partner countries to:
1. Develop and implement national programs for the occupational health and safety of health workers
WHO recommends that education and training programs for health workers at all levels include health and safety skills in personal and patient safety and that healthcare licensing and accreditation standards incorporate requirements for staff and patient safety. Member countries should also review and upgrade national regulations and laws for occupational health and safety to ensure that all staff members have regulatory protection of their health and safety at work.
2. Protect health workers from violence in the workplace
Promote a culture of zero tolerance to violence against health workers. Labor laws, policies, and regulations need to be strengthened, and all healthcare workers should have access to ombudspersons and helplines to enable free and confidential reporting and support for any health worker facing violence.
3. Improve the mental health and psychological well-being of healthcare workers
Healthcare facilities must establish and maintain safe staffing levels, and ensure fair duration of deployments, working hours, and rest breaks. Mental and social support services, including advice on work-life balance, risk assessment, and mitigation should be readily available to all staff.
4. Protect healthcare staff from physical and biological hazards
Health care systems must implement patient safety, infection prevention and control, and occupational safety standards in all health care facilities. Facilities need to ensure availability of personal protective equipment (PPE), adequate quantity, appropriate fit, and acceptable quality. All facilities should maintain an adequate, locally held, buffer stock of PPE and provide workers with adequate training on appropriate use and safety precautions. Further, at-risk healthcare staff should receive vaccinations against all vaccine-preventable infections, and in the context of emergency response, be given priority access to newly licensed and available vaccines.
5. Connect the dots between policies on patient safety and healthcare worker safety
Institutions should integrate staff safety and patient safety incident reporting and learning systems, and define the linkages between occupational health and safety, patient safety, quality improvement, and infection prevention and control programs.
Regarding the latter point, the charter states that “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe.”
For more details on the charter see the WHO announcement, “Keep Health Workers Safe to Keep Patients Safe.”
Enterprise High School students refused to allow anti-mask protesters to disrupt the start of the new school year. Senior Dalee Cobb, a cheerleader and javelin thrower, declared, “I feel like the opinion of parents and adults in general right now are just a big part of that problem.” Prior to a football game in late August, Cobb and other student athletes at the Utah school urged their community to take a stand against a growing anti-mask movement that threatened to postpone local school reopenings: “We, of all people, know that wearing a mask is not fun, “Cobb said. “Neither is wearing a seat belt or a life jacket or pads for football, but we do all these things so we have a future.” (As of September 1, there have been over 52,000 COVID-19 cases in the state).
As the public becomes accustomed to the ebb and flow of COVID outbreaks, a resurgence of protests against the state mask-wearing mandate came into conflict with the reopening of Utah’s public schools. Students became alarmed when hundreds of parents demonstrated outside the school district administration office and circulated threats to engage in a #NoMaskMonday. Enterprise students decided to use the football game as a platform to take action to protect their own health—and persude parents to send their kids to school in masks so they would be able to resume classes. “We ask that you put your mask on so we can get our game on,” Cobb said, as she urged local football fans to look out for the best interests of their community.
That weekend, Enterprise students also made use of social media to counter parents attempting to organize a #NoMaskMonday protest. Cobb told the Deseret News, “It’s sad to say, but the parents that are doing this, they aren’t us.” School Principal Calvin Holt supported students’ efforts and remarked, “[Students] were concerned about what a rebellion against masks was going to do to their opportunities for school and other activities.”
When schools did open, according to Deseret News, “Most students complied with the mask order, though the school district received some phone calls from concerned parents who got calls or messages from their children that not all students were wearing their masks all the time inside school buildings.” By the end of the first day, the local school district reported that no more than six students had been sent home for refusing to wear masks.
Anti-mask protesters cite a variety of reasons for their refusal to wear a mask. Some refer to the mixed messages that prevailed in the early stages of the pandemic; some are vehemently opposed to statewide mask mandates (at present 34 states require that masks be worn in many public settings); others say that they are still dubious about the severity of COVID-19 and have adopted various conspiracy theories promulgated on social media; a large contingent of anti-mask protesters, of course, use all of these arguments.
When it seems hard to persuade people in the grip of a pandemic to wear masks, it is understandable if you sigh at the prospect of reminding them to get vaccinated for this year’s flu viruses. Amid all the changes in our world, flu remains a constant. We can expect it to arrive on schedule, and as usual, it will take thousands of lives between fall and spring.
To reduce the burden of flu cases during the pandemic, public health officials are emphasizing the importance of vaccinating this year. At an August 20 livestream with JAMA (the Journal of the American Medical Association), CDC Director Robert Redfield said, “This fall and winter could be one of the most complicated public health times we have… This is a critical year for us to try to take flu as much off the table as we can. Our hospital capacity could get strained.”
Manufacturers are preparing 194-198 million doses of flu vaccine for the 2020-21 season, and a nationwide media blitz is encouraging people to make use of those doses. According to the CDC, even the fairly mild 2019-2020 season led to over 410,000 hospitalizations and took at least 24,000 lives. While it is hoped that social distancing may reduce this year’s numbers, bypassing vaccination is a particularly dangerous gamble in a year when flu cases will be competing with COVID-19 for hospital beds. Sadly, it is an uphill battle to vaccinate even half of the population. In the 2018-2019 season, only 45.3% of American adults over age 18 got their shots, and a substantial majority were senior citizens.
Getting Vaccinated: Who Needs a Shot and When They Should Get One
It takes about two weeks for vaccine antibodies to become fully active and start protecting the body from the flu virus. The flu season usually peaks between December and February, but vaccines are already available. However, the CDC suggests that August is too early for vaccination as this can leave people with less protection later in the season. Seniors should get their shots in September or October, but even being vaccinated as late as January can prevent infections.
While everyone from the age of six months and upward should get vaccinated, many public officials agree with Redfield’s view that 2020-21 is “a critical year.” The state of Massachusetts has even taken the decisive step of making flu shots mandatory for all children attending child care, pre-school, kindergarten, K-12, and colleges and universities.
What if someone has COVID-19? The CDC recommends that patients with COVID-19 delay getting their influenza vaccine to ensure others in the healthcare setting are not exposed unnecessarily. All patients coming in for flu shots should be screened for COVID-19 symptoms before and during the visit.
The CDC also suggests that providers work to ensure certain adults at higher risk from COVID-19 get their flu shot, including:
- Staff and residents of long-term care facilities
- Adults with underlying illnesses
- African Americans and Hispanics
- Adults who are part of “critical infrastructure
Although no states have implemented a legal requirement for seniors to get flu shots, as members of the largest at-risk population most people over 65 should consider vaccination imperative. Because they are so vulnerable to serious complications, seniors constitute 70-85% of flu deaths and 50-70% of hospitalizations during an average flu season. Owing to the added dangers of contending with flu, most seniors receive special vaccine compounds. The most common form is the high-dose vaccine, which contains four times the amount of antigen as a standard flu shot. In a recent study, the incidence of flu among seniors receiving a high-dose shot was 24% lower than it was among those who had received a standard shot. A more recent compound for seniors is the adjuvanted flu vaccine, which creates a stronger immune response than the standard vaccine. Side effects are somewhat more likely to occur with the senior formulations, but reducing the danger of flu usually makes the risk of minor pain at the injection site, headache, muscle ache, and/or fatigue for one to three days seem negligible.
Where to Get Vaccinated
Locating a vaccine provider is easy. Those with internet access can go to VaccineFinder.org and enter their location and the type of vaccine they need (children, adults over age 18, and seniors receive different formulations, as do people with egg allergies as most vaccines are egg-based).
For the millions of newly unemployed whose jobs had provided their health insurance, getting vaccinated can pose a financial challenge. Public health departments in many larger cities offer free vaccinations, but in areas that lack this service, the price for vaccination varies. Non-seniors who live near a Costco can get a shot for less than $20.00, but most drug store chains charge around $40.00. See here for an overview of vaccination sources and prices.
But Will People Get Vaccinated?
While there are undeniable reasons to be concerned about vaccine hesitancy and past failures to vaccinate even 50% of the population, it is possible that more Americans will get their flu shots this season. Findings in the 2020 United Healthcare Wellness Checkup Survey indicated a heightened awareness of health concerns spurred by the pandemic and 30% of the surveyed respondents said they are more likely to receive a flu shot this fall.
Vilified, threatened with violence or in some cases suffering from burnout, dozens of state and local public health officials around the U.S. have resigned or have been fired amid the coronavirus outbreak, a testament to how politically combustible masks, lockdowns, and infection data have become.
One of the latest departures came on August 9, when California’s public health director, Dr. Sonia Angell, was ousted following a technical glitch that caused a delay in reporting virus test results — information used to make decisions about reopening businesses and schools.
Last week, New York City’s health commissioner was replaced after months of friction with the police department and City Hall.
A review by KHN and The Associated Press finds at least 49 state and local public health leaders have resigned, retired or been fired since April across 23 states. The list has grown by more than 20 people since the AP and KHN started keeping track in June.
Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention, called the numbers stunning. He said they reflect burnout, as well as attacks on public health experts and institutions from the highest levels of government, including from President Donald Trump, who has sidelined the CDC during the pandemic.
“The overall tone toward public health in the U.S. is so hostile that it has kind of emboldened people to make these attacks,” Frieden said.
The past few months have been “frustrating and tiring and disheartening” for public health officials, said former West Virginia public health commissioner Dr. Cathy Slemp, who was forced to resign by Republican Gov. Jim Justice in June.
“You care about community, and you’re committed to the work you do and societal role that you’re given. You feel a duty to serve, and yet it’s really hard in the current environment,” Slemp said in an August 10 interview.
The departures come at a time when public health expertise is needed more than ever, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
“We’re moving at breakneck speed here to stop a pandemic, and you can’t afford to hit the pause button and say, ‘We’re going to change the leadership around here and we’ll get back to you after we hire somebody,’” Freeman said.
As of August 10, confirmed infections in the United States stood at over 5 million, with deaths topping 163,000, the highest in the world, according to the count kept by Johns Hopkins University researchers. The confirmed number of coronavirus cases worldwide topped 20 million.
Many of the firings and resignations have to do with conflicts over mask orders or shutdowns to enforce social distancing, Freeman said. Despite the scientific evidence that such measures help prevent transmission of the coronavirus, many politicians and others have argued they are not needed, no matter what health experts tell them.
“It’s not a health divide; it’s a political divide,” Freeman said.
Some health officials said they were stepping down for family reasons, and some left for jobs at other agencies, such as the CDC. Some, like Angell, were ousted because of what higher-ups said was poor leadership or a failure to do their job.
Others have complained that they were overworked, underpaid, unappreciated or thrust into a pressure-cooker environment.
“To me, a lot of the divisiveness and the stress and the resignations that are happening right and left are the consequence of the lack of a real national response plan,” said Dr. Matt Willis, health officer for Marin County in Northern California. “And we’re all left scrambling at the local and state level to extract resources and improvise solutions.”
Public health leaders from Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, down to officials in small communities have reported death threats and intimidation. Some have seen their home addresses published or been the subject of sexist attacks on social media. Fauci has said his wife and daughters have received threats.
In Ohio, the state’s health director, Dr. Amy Acton, resigned in June after months of pressure during which Republican lawmakers tried to strip her of her authority and armed protesters showed up at her house.
It was on Acton’s advice that GOP Gov. Mike DeWine became the first governor to shut down schools statewide. Acton also called off the state’s presidential primary in March just hours before polls were to open, angering those who saw it as an overreaction.
The executive director of Las Animas-Huerfano Counties District Health Department in Colorado, Kim Gonzales, found her car vandalized twice, and a group called Colorado Counties for Freedom ran a radio ad demanding that her authority be reduced. Gonzales has remained on the job.
In West Virginia, the governor forced Slemp’s resignation over what he said were discrepancies in the data. Slemp said the department’s work had been hurt by outdated technology like fax machines and slow computer networks. Tom Inglesby, director of the UPMC Center for Health Security at Johns Hopkins, said the issue amounted to a clerical error easily fixed.
Inglesby said it was deeply concerning that public health officials who told “uncomfortable truths” to political leaders had been removed.
“That’s terrible for the national response because what we need for getting through this, first of all, is the truth. We need data, and we need people to interpret the data and help political leaders make good judgments,” Inglesby said.
Since 2010, spending on state public health departments has dropped 16% per capita, and the amount devoted to local health departments has fallen 18%, according to a KHN and AP analysis. At least 38,000 state and local public health jobs have disappeared since the 2008 recession, leaving a skeleton workforce for what was once viewed as one of the world’s top public health systems.
Another sudden departure came Monday along the Texas border. Dr. Jose Vazquez, the Starr County health authority, resigned after a proposal to increase his pay from $500 to $10,000 a month was rejected by county commissioners.
Starr County Judge Eloy Vera, a county commissioner who supported the raise, said Vazquez had been working 60 hours per week in the county, one of the poorest in the U.S. and recently one of those hit hardest by the virus.
“He felt it was an insult,” Vera said.
In Oklahoma, both the state health commissioner and state epidemiologist have been replaced since the outbreak began in March.
In rural Colorado, Emily Brown was fired in late May as director of the Rio Grande County Public Health Department after clashing with county commissioners over reopening recommendations. The person who replaced her resigned July 9.
The months of nonstop and often unappreciated work are prompting many public health workers to leave, said Theresa Anselmo of the Colorado Association of Local Public Health Officials.
“It will certainly slow down the pandemic response and become less coordinated,” she said. “Who’s going to want to take on this career if you’re confronted with the kinds of political issues that are coming up?”
Weber reported from St. Louis. Associated Press writers Paul Weber, Sean Murphy and Janie Har and California Healthline senior correspondent Anna Maria Barry-Jester contributed reporting.
This story is a collaboration between KHN and The Associated Press. Published courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. KHN is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
In an interview with Florida International University’s FIU
Magazine, alumnus Cliff Morrison recounted the battle to treat AIDS
patients with care and humanity in a time filled with widespread fear and
misconceptions about the illness.
As described in the Johnson & Johnson nursing newsletter, “the stigma around the disease wasn’t limited to the general public, it also permeated healthcare systems around the world. Many healthcare workers were afraid to touch patients diagnosed with AIDS, sometimes refusing to provide treatment. Even as more information about the virus was discovered, patients were often isolated at their last stages of life, receiving reluctant treatment by healthcare professionals who hid behind layers of protective clinical uniforms.” As a clinical nurse specialist at San Francisco General Hospital, Morrison noticed—and was disturbed by—numerous instances of mistreatment owing to ignorance about how AIDS was spread. “I began to think, there are a number of people here who agree with me—nurses that I consider my allies, doctors of infectious diseases that I had worked with. So [I thought], maybe we should have an AIDS unit,” but instead of isolating patients, Morrison’s intention was to “develop the expertise and develop a standard of care.”
So, armed with evidence-based data from University of
California-San Francisco and medical experts at San Francisco General Hospital,
in 1983 Morrison founded San Francisco General’s Ward 5B for the care of AIDS
patients. In Ward 5B, according to FIU Magazine, “Nurses embraced their
patients, held their hands and even ate lunch with them when their friends and
family had abandoned them.” As Johnson & Johnson (which sponsored a
documentary on Ward 5B) puts it, “Nurses showed that you didn’t have to hide
behind heavy clinical gear while treating AIDS patients or burn their beds when
they passed away… By pushing back against stigma, the Ward 5B nurses showed the
world the power of compassionate care and exemplified the profound impact
nurses have on transforming human health.”
Morrison continued his crusade for the humane treatment of
AIDS patients and went on to administer the Robert Wood Johnson Foundation AIDS
health services program in 12 states. He attributes his advocacy to “a
combination of things: the family values that I was taught growing up, the fact
that I grew up with a religious foundation. I went into nursing, and all of
those things complemented each other greatly. My work matched where I was as a
person, and I stayed true to myself.”
The documentary on the revolutionary ward at San Francisco
General Hospital, Ward 5B, can be viewed on a variety of video streaming
The San Antonio, Texas nurse known as “Nurse Shelly” was keeping a sharp eye on COVID-19 from the start, but it still came as a surprise when the virus entered her hospital—and her own body.
ER Nurse Shelly—who is known for her popular Twitter account—started following the progress of COVID-19 shortly after the initial outbreak in Wuhan. Perusing medical publications as well as the news media, she suspected that COVID would soon reach the US. In a recent Houston Public Media “Houston Matters” podcast, Shelly recalled, “In February, when research started coming out in The Lancet, I was reading the research and passing it on to my hospital administrators…. I tried to tell my administrators that we needed to stock up on PPE and get policies and procedures in place to protect our healthcare workers and our patients… Um, and that really didn’t go over well with them,” she admits. “Because I guess I was a little too loud.” The administrators also suggested that the risk in San Antonio was not as great as it was in densely populated cities such as Wuhan.
In January through March, Nurse Shelly’s ER was receiving “a lot of flu cases,” but as yet hospital officials seemed to feel little sense of alarm over COVID. From her research on the Wuhan epidemic, though, Shelly was already worried that the new coronavirus could pose a serious danger to the public, and she was frustrated by the CDC-imposed limitations upon testing—at the time, COVID-19 tests could only be administered to patients who had recently travelled in China. As cases mounted and PPE grew scarce, she also formed a non-profit project with a friend to obtain N-95 masks for hard-pressed healthcare workers. She and her friend managed to ship N-95s to hotspot areas such as New York, New Jersey, and Chicago.
In March, Shelly herself fell ill. Ineligible for COVID-19 testing, she was prescribed a variety of ineffectual medications for flu and other ailments. As she remained at home, her condition worsened until she was not only bedridden, but unable to walk. At that point Shelly called 911. Doctors placed her in an isolation ward, but “the CDC [still] wouldn’t test me! [Officials] were lying to the country, telling us everything was good—and I felt like I was in the Twilight Zone,” she recalls.
Her condition had improved enough by April 16 for her to take part in a phone conference with Texas senator John Cornyn’s office (the senator himself was represent ted by one of his assistants). Shelly, who took careful notes, said “There were nurses from El Paso, Corpus Christi, Houston; nurses in San Antonio… nurses from pretty much all parts of Texas on this call.” She remarks, “We were pleading for help at this point.” Remembering one caller who spoke of the shortage of PPE and described her experience intubating and placing a fellow nurse on a ventilator, Shelly mused, “just think of it: you’re having to care for your nurse co-worker on a ventilator, and they may not make it.”
Of her personal experience with the virus, she says, “It’s been a really long recovery, but I’m finally feeling better and am ready to get back into the ER.” However, she is still trying to come to grips with the severity of her ordeal: “I’m a healthy 33-year-old nurse… [and] this had me bedridden for months…” As the virus surges through Texas, Florida, and other states, Shelly is still urging officials to take action. At present, “my main concern is… Do we have enough nurses? Do we have enough travel nurses when we have hot zones all over the country?”
To listen to the full interview with Nurse Shelley, visit the special “Houston Matters” podcast on the Houston Public Media site.