Death Panel podcast co-host Beatrice Adler-Bolton speaks with Jane Thomason of National Nurses United (NNU) about troubling new guidance changes the CDC is considering that would further weaken infection control in healthcare settings, and NNU's campaign to stop it.

Jane Thomason 0:01

What HICPAC and CDC are doing right now, they are wanting to adopt that same "flexible approach" with the crisis and contingency standards that they took in COVID for all of infection control. This guidance will impact so many people, and they're keeping the draft behind closed doors.

[Intro music]

Beatrice Adler-Bolton 0:46

Welcome to the Death Panel. To support the show, become a patron at patreon.com/deathpanelpod. You'll get access to our second weekly bonus episode and entire back catalogue of bonus episodes. Now, I know that we announced last week that we were taking a week off from releasing new recordings so that we could spend the week working on research and development for the fall and getting some really great episodes together for you all. But, as is habit here at Death Panel, we tried to take off and then, you know, we released an episode anyways. [ Laughs ]. So again, if you'd like to support our work, and the over 100 deeply researched hour-plus-long episodes that we put out a year, you can support us at patreon.com/deathpanelpod. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism at your local bookstore or request it at your local library and follow us at @deathpanel_. So, today I am joined by a fantastic guest, who is here to talk about why the CDC is trying to weaken infection control guidance in healthcare settings and the organizing that is happening against it. My guest today is Jane Thomason. Jane is the lead Industrial Hygienist for National Nurses United, known as NNU, which has been leading a fight to resist this and who needs your help urging the CDC to fully recognize aerosol transmission, and help keep everyone who uses healthcare facilities, from workers to patients, safe from respiratory infections. Jane, welcome to the Death Panel. And thank you so much for coming on the show.

Jane Thomason 2:21

Hi, thank you so much for having me.

Beatrice Adler-Bolton 2:23

So just to start us off, can you start us at the beginning here, some people may have seen this campaign mentioned or that there's an upcoming meeting or that there's proposed changes to infection control guidelines, but just so everyone is on the same page and folks listening have sort of context for what's going on, you know, what is happening right now and what is NNU asking folks to do?

Jane Thomason 2:46

Okay, so this is a little bit wonky of a process, but the CDC, the CDC has an advisory committee called the Healthcare Infection Control Practices Advisory Committee. It's a mouthful, so we all just know it as HICPAC. H-I-C-P-A-C. And so HICPAC has written, over the last several decades, a number of guidance documents that the CDC relies on to tell health care facilities how they should protect patients and workers from infectious diseases. We're talking about tuberculosis, MRSA, influenza, measles, ebola, COVID, everything. The last time that HICPAC updated this guidance was in 2007. So, it's past time that we do another update. There's been a lot of scientific research over the last few decades. And that's what they're doing now is they're updating that foundational guidance. Many of us call it "the bible of infection control" for healthcare settings. So that gives you kind of a sense of, like, this is what everyone goes to. Regulatory agencies incorporate it by reference. So it—it has a pretty broad-ranging impact, this guidance. So HICPAC is in the process of updating this guidance. And they're trying to make it more user friendly. That's what they're saying. It's about 200 pages right now, they want to get it down to 10 to 15. The problem—

Beatrice Adler-Bolton 4:02

Okay. [ laughs ]

Jane Thomason 4:03

[ laughs ] The problem is that this process has been completely behind closed doors. They're going out of their way, really, to make it inaccessible to the public. HICPAC is pretty much exclusively infectious disease clinicians, and hospital industry, health care industry representatives. So those are the people who are doing this. They're writing it, they're making decisions, they're doing research, they're deciding what needs to be done around infection control in nursing homes and hospitals and clinics across the country. So I've been following this process for the last—actually it's been over a year now. And we finally have enough information that's been made public that we're very concerned about what they are planning to do in these updates. And why we're talking about this right now, why we're taking action right now, is that there's a vote coming up at a meeting that's happening this next Tuesday, August 22nd 2023, where HICPAC will be voting officially on sending their guidance updates to the CDC to finalize the process. So that's why we're intervening now is because we've gotten information that they're headed in the wrong direction, that they're going to weaken protections for patients and healthcare workers. And we have this meeting coming up, where they're going to make a vote.

Beatrice Adler-Bolton 4:10

Now, I went through that 200-plus page document, recently—

Jane Thomason 5:11

Good for you!

Beatrice Adler-Bolton 5:22

—you know, we're thorough here at Death Panel. And the thought of reducing that to 10 to 15 pages after having spent hours going through it with a fine tooth comb is, frankly, terrifying. There is so much detail in the recommendations. And a lot of these recommendations were, you know, changed and updated in 2007, in response to the 2003 SARS outbreak. And what's really, I think, difficult and frustrating is to imagine both the kind of impact that this could have immediately to care, but also just the space and duration between these updates, and the kind of information that's going to get lost in the simplification of this document into something shorter and more, quote unquote, "user friendly," like I understand that impulse. But it is very worrying, especially considering a lot of the other recent changes we've seen, or even just changes we've seen to COVID guidelines or frameworks in the last, you know, two, two and a half years or so. But also, if this guideline gets rolled back, it could be in place for quite a while. And, now your expertise specifically is in industrial hygiene, which gives you very special insight into how workplaces become important vectors of the spread of diseases, especially in a respiratory pandemic, like COVID, where you have folks who are coming to the hospital, they're coming maybe with relatives or caregivers who may not have symptoms, but could be asymptomatic, you know, you're really dealing with like a very complex infection environment. And if you look at the 2007 guidelines, you know, it appears that if you're following those guidelines, then out of an abundance of precaution, the thing to do is to have mask mandates in healthcare. And actually sort of holding up the rollback of mask mandates that we've seen—I think Los Angeles County ended mask mandates in healthcare settings this week, even—you know, to hold that up against the current guidelines it, you know, makes sense why there is a concerted effort by the kind of constituencies that you mentioned, being really key to this sort of pushing it away from that standard. But this is also potentially, you know, an opportunity to kind of recognize some of the disease pathways and ways that COVID is transmitted, but also the ways that COVID impacts work, right? And so I think a really important part of the campaign that NNU is doing that I'd love for us to talk about for a second is that, you know, your background is all about identifying and mitigating the things at work that can make people sick. And you would think that it would be an obvious point, to see sort of what COVID has done to the US, quote unquote, health care system in the last three years and say, okay, this infection guidance needs to reflect the fact that COVID is transmitted through aerosols, through the air, that it is a, you know, airborne virus. But NNU's very concerned that we're actually not going to see that acknowledgement reproduced in these new guidelines, as well.

Jane Thomason 8:32

Yeah. So I think one of the things that became clear when the working group did a presentation at the June 2023 HICPAC meeting, that's a public meeting, is that they are planning on updating the scientific paradigm on infectious disease transmission by name only, but that they're still continuing this like failure to actually comprehend and grapple with all of the research on aerosol transmission of infectious diseases, just like you said. Like we have—and it was before COVID—we will have decades of research on this topic. And COVID only drove home, we shouldn't have had to live through the mortality and morbidity that we have and that we continue to live with around the world, but especially in the United States. We had the information we needed before the pandemic started. It's just that the CDC caved to industry pressure to weaken their guidance. The CDC actually, if you look back and think back to January through March of 2020, the CDC actually started with a precautionary approach. They started by saying you need at least an N95 respirator if you're a healthcare worker caring for a patient who might have COVID and that patient needs to be in an airborne infection isolation room, which is a room that has specialized ventilation set up so that there's no chance for airborne virus to transmit through the facility outside of that patient's room. That's what the CDC started with, and then a weakened it after the hospital industry said, hey, we need you to give a cover because we're not going to do that.

Beatrice Adler-Bolton 8:32

Right. What is it like in practice right now for nurses and for healthcare workers? You know, what kind of protections do they actually have at the moment?

Jane Thomason 10:18

I think things are in a really bad situation for a lot of healthcare workers. And that is squarely on the shoulders of the healthcare industry, of the employers. You know, I think everyone's aware of the staffing crisis in healthcare, that there are many nurses and other health care workers who are leaving the bedside or leaving the profession entirely. And that's happening because healthcare employers have not protected them.

Beatrice Adler-Bolton 10:44

Yeah.

Jane Thomason 10:44

Because they have intentionally shortstaffed units. And that has led to really dangerous working conditions for patients and for healthcare workers. There was this complete abandonment of health care workers, right, we saw employers at the beginning of the pandemic, literally walk—we saw managers walk through units, gathering up all of the PPE and locking it away and telling nurses that they weren't allowed to access it, even when they have known COVID positive patients that they were caring for. Right? Just that whole abandonment and disregard for nurses' safety as they were on the frontlines of this crisis, and the moral distress that comes from that. And that comes from seeing so much death and so much sickness, without any of those supports from your employer has led to just these astronomical rates of moral distress, this harm to health care workers across the country. And so it's not surprising that we're seeing a lot of them say, you know what? I can't do this anymore. And on top of all of that, as if that wasn't enough, we're seeing many employers continue to keep these "crisis standards" in place. So: keep these lean staffing levels in place, keep lean resourcing plans in place so that there's like not always supplies that you need, because the employer is trying to save a dollar on not having enough inventory, right? Things like that are happening. And that's just causing this huge crisis for healthcare workers.

Beatrice Adler-Bolton 12:18

Yeah, I mean, it's probably really difficult to sum up kind of the scale of frustration and misery that folks are experiencing right now. We have a lot of listeners who are healthcare workers, we hear from folks all the time, you know, stories that I wish I could share on air, but you know, it's off the record, on background, and there are so many moments where patients have been put in really, really, really dangerous situations in the last three years directly as a result of the organized abandonment that, you know, COVID kind of initiated, but that hasn't necessarily been justified. Like as you're saying these kinds of crisis framings of saying, okay, well, there's a supply chain issue, and we can't get 500 bags of saline anymore. You know, the kind of shift during COVID has been very much like what happens after a big natural disaster. If a big concentration of medical storage or medical supplies manufacturers are hit by a hurricane, like for example, Hurricane Maria in Puerto Rico caused devastation in Puerto Rico and then caused resulting shortages in medical supplies and medications as a result of the way that the kind of extractive medical industries exist and concentrate a lot of storage facilities in Puerto Rico that then lost power, right? So you have all these kinds of moments where, let's say in response to a crisis, decisions are made and working conditions are shifted. Maybe staffing ratios are changed, maybe the kind of supplies that you use are changed. But what you're saying, and what I hear from so many people is that the crisis, even when the supply chain crises have ended, and as COVID has continued to be a problem, and their employers have started talking about COVID in the past tense, right? They're talking about COVID in the past tense, they're putting patients in danger, and they're rolling back all sorts of workplace protections even further than they were already refusing to protect employees and workers before that. And then on top of it, you know, you've have this kind of weird, contradictory framing where they're saying, oh and, because of the ongoing crisis of COVID, like, you know, we're still going to maintain these razor thin margins where you're like on a ward and you've got maybe 50 patients, and it's just you and one other person, and you're like that for six hours. You know, like really just, you know, we hear from folks who staff ICUs who are like, "people died last night because of the staffing ratios and I can't say anything about it." And these are the kinds of sort of compounding harms, the negative social and structural determinants of health that come downstream from the kinds of ethical and moral breaches and decision making that has to happen when your employer is forcing these kinds of conditions on you. And we so rarely talk about the harms of what it's like to live and work through that. And I think that's also sort of part of what the focus is here, right, is that if healthcare is losing workers, then this is kind of also something that has to be addressed in order to kind of keep the health system running from a structural standpoint is it not?

Jane Thomason 15:32

Exactly, I agree with you entirely. And I think there's another piece that I would add to what you just said, is that when nurses call their employers on these dangerous working conditions, like not having the PPE they need with COVID patients, or whatever the situation is, the employer just says "well I'm following CDC guidance."

Beatrice Adler-Bolton 15:55

Mhm.

Jane Thomason 15:56

Because the CDC has adopted these crisis and contingency standards that say, well, you know, if you're having a staffing situation, if you can't actually follow safe staffing, then it's okay to return COVID-positive asymptomatic healthcare workers to work. Which—that's a really unsafe situation for everyone involved. But healthcare workers have done it. And they say, well, we're following CDC guidance. And that matters for this conversation that we're having about what HICPAC is—and CDC—are doing right now, because they are wanting to adopt that same flexible approach with the crisis and contingency standards that they took in COVID, for all of infection control. So they have said they want these updates, this new version of the infection control guidance for healthcare, to say: here's a minimal standard. And then you guys decide—employers—you decide what you do in addition to this, based on your own assessment of your patient population—

Beatrice Adler-Bolton 16:58

Mm.

Jane Thomason 16:58

—maybe you have a more or less vulnerable patient population, so you do more or less infection control. Maybe you have a more or less vulnerable healthcare worker population, maybe you have staffing considerations that go into what level of infection controls to do. That is what they are trying to change all of infection control to be, instead of: you have this virus? Here are the precautions you need to keep everyone safe.

Beatrice Adler-Bolton 17:26

What did the current guidelines say that are relevant here? And sort of what are the changes that are expected based on some of these leaks that got out? And I guess, if you don't mind—if you can talk about—sort of how the information came to light, because as you mentioned, this is sort of a notorious blackbox processes, not, you know, publicly transparent. You know, I'd also be really curious to sort of hear how and what it may have taken to actually even come by the information as to what these guidelines might become.

Jane Thomason 17:58

Yes. So, what is happening? The way the process works is that HICPAC has this working group comprised of a subset of HICPAC members, and some CDC staff. And the working group is actually, like, they're working on a draft, and they're making decisions about what the updates are gonna include. And every meeting that HICPAC has—they meet about every quarter. So this is like the full federal advisory committee, they're governed by FACA, the Federal Advisory Committee Act. HICPAC hears an update every time they meet from the working group that's actually actually doing the work. So we don't have any access to what the working group is doing. We actually submitted both requests under FACA, under the Federal Advisory Committee Act, and an official request under FOIA, for more information about what the working group is working on, and we were refused both times. They replied—they refused our FACA request entirely. And our FOIA came back completely redacted.

Beatrice Adler-Bolton 18:59

Gosh. [ sighs ] [ laughs ]

Jane Thomason 19:00

So, we don't have detailed information about what the working group is doing but do you have the presentations that the workgroup has made to HICPAC. And that is where we're actually getting this information. So this has been announced at a public meeting. This is a presentation that was made at a public meeting about where they're planning on going.

Beatrice Adler-Bolton 19:17

So can you walk through sort of where they're planning on going based on the product of the working group? Because again, these sort of deliberations, as you're saying, this is not something that is accessible, but they have, you know, this proposal that's going to be voted on on the 22nd.

Jane Thomason 19:32

Right. And no one outside of the CDC has seen the full proposal. Which is like a huge part of the issue here, right? That like—this guidance will impact so many people, and they're keeping the draft behind closed doors. But from what we know, from the June meeting, is that there's really three major issues that we have with the content, concerns that we have about the content about where they're headed. One is that it's become clear that, like I said earlier, they're going to update the scientific paradigm on infectious disease transmission by name only. But they're not going to actually follow through on recognizing the vast body of research we have on aerosol transmission.

Beatrice Adler-Bolton 20:17

So specifically, what do you mean about that? Can you get into some detail there? Do you mean that they're going to just sort of add COVID to a list of respiratory diseases, or that it's sort of like a specific shift in the way aerosol transmission is discussed in general?

Jane Thomason 20:33

So, right now we have airborne / droplet / contact. Those are the three main ways that infectious diseases transmit. That's what the CDC has said, that's what we all learn in school, right? Everyone knows these words now: airborne / droplet / contact, those are the categories of transmission. They are replacing that—which is a good thing, I want to be clear, they're replacing that with two categories: "by air" and "by touch."

Beatrice Adler-Bolton 20:58

Mm. Okay.

Jane Thomason 20:59

And that's a good thing, because this dichotomy between droplet and airborne, this idea that some respiratory and other pathogens that spread through respiratory aerosols, or any other kind of aerosols, only transmit three feet versus farther than six feet, that's—that's a whole false dichotomy. Have you all talked about and looked at that?

Beatrice Adler-Bolton 21:21

Yes.

Jane Thomason 21:21

That piece of this? Okay.

Beatrice Adler-Bolton 21:22

Yeah, we've talked extensively about that. I was just thinking to myself, when you mentioned, okay, they're gonna shift it to two, "by air" and "by touch," I was like, wow, if that had happened prior to COVID we would have saved hours and hours of discussion over, you know, two and a half years of basically saying no, no, no, droplet means in the air, too. Droplets in the air, and the three to six foot—ugh, gosh, I mean, it's—it's so frustrating, because as you're saying, this is not necessarily a bad thing. But the way that it's being done is not good.

Jane Thomason 21:56

Yeah. So let's keep going. So first glance? Great. This is progress. But, let's keep going. So they—what became clear in June is that in the "by air" category, they're now going to propose three subcategories. And this is where they're making recommendations about, like, precautions.

Beatrice Adler-Bolton 22:16

Is it mild, milder, and mildest?

Jane Thomason 22:19

[ laughs ] Basically.

Beatrice Adler-Bolton 22:20

Sorry, I had to.

Jane Thomason 22:21

[ laughing ] So—so they are going to say, there's routine air precautions, novel air precautions, and extended air precautions. Okay, so—

Beatrice Adler-Bolton 22:35

I don't like this already.

Jane Thomason 22:37

For routine air precautions, they say healthcare workers should have a medical or surgical face mask. Which is an issue—a huge issue—unto itself, that the CDC is going to say, there are pathogens spread through the air. And healthcare recruits should be protected with face masks, a surgical mask or a medical mask. Those devices are not respiratory protection, in no circumstances does a surgical mask or a medical mask or a cloth mask protect you from hazardous aerosols. That's not what they're designed to do. They're designed to be protection against splashes and sprays. They're designed to prevent your emissions from contaminating a surgical field, a sterile field. But really, if you have something that's transmitted through the air, you have to have a respirator.

Beatrice Adler-Bolton 23:27

Mm hmm. I mean, that's really worrying. That's—

Jane Thomason 23:30

Yes.

Beatrice Adler-Bolton 23:31

Yeah. I mean, I think, oftentimes—just to just to note for listeners, oftentimes, you know, we use [the term] "masks" on the show, because it's like a broad, you know, kind of colloquial reference to "masking and a high quality respirator," right? Masking as a kind of cultural practice. But you have to remember, these are very specific guidelines, and they're going to be used by hospital administrators to their advantage, which is going to mean, I'm sure, potentially supplying only, you know, regular blue disposable procedure masks, or something like that, because they're much cheaper than respirators, you don't have to do the fit testing. This is really, in effect, a kind of privatization of COVID protection for health care workers just in a simple, like, language omission. It's very, very insidious.

Jane Thomason 24:21

And they're doing this based on an evidence review that CDC staff conducted for the workgroup that concluded that there was no difference between N95 respirators and surgical masks for protecting healthcare workers from respiratory viruses. This evidence review is—[ laughs ]—is trash.

Beatrice Adler-Bolton 24:41

Mhm.

Jane Thomason 24:42

I'll just go ahead and say it. It's trash. They cherry picked data from the studies they did include, they left out other studies that they should have included but didn't and no one knows why. And people have asked them and they've said we can't tell you—

Beatrice Adler-Bolton 24:57

Well. We know why. [ laughs ] Right? We all know why. But, yes.

Jane Thomason 25:01

Yes. Yes. They also—they only looked at randomized control trials, which is not what you use when you're looking at worker protections. That's—randomized controlled trials are held up as the gold standard when you're doing, like, clinical evaluations of treatments. But it's not what you use when you would look at workers. It's really not an ethical way to look at workplace protections. When you think that something might be protective, you can't then have an arm of workers that are not protected intentionally. There's a whole body of work—decades, literally decades, longer than I've been alive, longer than you've been alive—of research on respiratory protection and how it protects workers from aerosolized hazards in a variety of industries in a variety of settings. And they didn't look at any of that.

Beatrice Adler-Bolton 25:44

Mhm. Of course not.

Jane Thomason 25:45

So that is how they're, you know, they're getting to this. They're doing bad science, in large part—

Beatrice Adler-Bolton 25:51

Looking only where they want. Yeah.

Jane Thomason 25:52

Exactly. In large part because they're leaving out all of these experts, these groups of experts, that should be part of the process, industrial hygienists, occupational physicians and nurses, aerosol scientists, respiratory protection scientists, they're leaving all of them out of this whole process. And they're just doing it themselves. "They" being, the infection control clinicians and hospital industry, healthcare industry representatives.

Beatrice Adler-Bolton 26:19

Now, so that was just sort of the "routine" air precautions. Now we have the "novel" air precautions. So I'm assuming, in some capacity, that, you know, the idea being: okay, you can just say "masks" for this, because if something like COVID "comes back"—ugh—then you have the "novel" one that can kick in, which obviously plays into the idea that the pandemic is over when it absolutely isn't. Is that sort of where they're going with this? That this is, like, under normal times employers have to spend X amount of money. And we can pretend that COVID doesn't exist, and then it's your problem to pay for those respirators. Once the—you know, "once a new virus comes through, then they'll pay." Is that kind of where they're going in this framework?

Jane Thomason 27:06

I'm impressed. Yes, that was very astute. So for novel air precautions, these are—the example pathogens they list are MERS SARS-CoV-1, and "pandemic phase respiratory viruses" such as influenza and SARS-CoV-2—

Beatrice Adler-Bolton 27:19

[ laughs] "Pandemic phase"!

Jane Thomason 27:21

Yeah. So, let's keep going because there's more to unpack there. So, for "novel" air precautions, they say N95 respirator, but: no airborne infection isolation room. So they are saying, newly—and this a change from current practice. If you look at CDC guidance on MERS, SARS-CoV-1, SARS-CoV-2—COVID—even H1N1 they said "airborne infection isolation room," like, initially. Right?

Beatrice Adler-Bolton 27:45

Yeah, no, I mean, it's all over that 200 page document. This is a—that's a significant departure from the current standards.

Jane Thomason 27:51

Right. So this is a huge setback in terms of protections for everyone. And this is—like I want to emphasize this. This is not—airborne infection isolation rooms are for protecting everyone. They keep any infectious virus that a patient emits in that room and then it gets filtered through a HEPA filter, or exhausted outside. So it protects everyone who's not in that room. And then of course, when you have healthcare workers entering that room, they need PPE. And so they're saying an N95 respirator for those categories. But so this—the other thing to unpack here is, right, that you honed in on. Is "pandemic phase" respiratory viruses such as influenza and SARS-CoV-2. When you look at the example pathogens for the "routine" air precautions, it says "seasonal Coronavirus," "seasonal influenza."

Beatrice Adler-Bolton 28:40

Oh gosh.

Jane Thomason 28:41

So we now have this new distinction between "seasonal" and "pandemic phase" for the same pathogen having different levels of protections. So the CDC is saying, like, there's some magical thing that happens with this pathogen, when we call it something different. Not to put too fine a point on it. But that's essentially what they're doing here. Right? It just doesn't—it, scientifically, practically, it doesn't make any sense to have different precautions for the same pathogen. So we can see where they're headed here.

Beatrice Adler-Bolton 29:17

It only makes sense from—yeah, it only makes sense from the perspective that COVID morbidity and mortality is being translated into a quote unquote "expected impairment" for workplace injury purposes, essentially. And at the same time, as also we've seen—I mean, you're in the state of California. I'm sure you're familiar with the decision that just happened in the California State Supreme Court where you have essentially the state Supreme Court saying actually employers really don't have a duty of care in terms of protecting their workers from catching COVID at work because COVID is everywhere. You know, it's this kind of terrifying, almost mirror of what we really saw early on in the pandemic, with things like nursing home liabilities, where you saw lawmakers hustling to pass liability protections for nursing home owners. And then at the same time, they were also shifting the triage standards and shifting the transfer standards and saying, you know, you can discharge patients that are still positive with COVID, back to the nursing home and the nursing home's protected from liability, you know, it is a complete kind of mirror of that same almost nonsense framing in terms of like the infection, you know, oh, is it quote unquote, "endemic" COVID? Or is it "a novel variant that's so infectious that it justifies going back" that never seems to come across the horizon, but is always pointed to as the reason why what they're doing is not awful, even when it absolutely is.

Jane Thomason 30:51

Yes, [ laughs ] I agree with you. So, you know, these changes are concerning. And just to complete the description here for extended air precautions. This was for pathogens that are treated as airborne right now. So tuberculosis, measles, varicella are the example pathogens that they give. And they are saying, still an N95 respirator and airborne infection isolation room. So there's not much changing on that front. And essentially, you know, these categories track onto the existing "droplet" and "airborne." So that's why I'm saying they're updating the language, their terminology without actually making any changes.

Beatrice Adler-Bolton 31:28

Absolutely. I mean, it's very worrying. It's very worrying to see the fact that what should be a change that reflects the severity of COVID and its widespread and ongoing impact is actually part of the process of kind of sociologically producing the end of the pandemic, even though it continues on, right? You know, whether that's the "endemicity' frame that we've seen, you know—my co-host, Abby, who's an epidemiologist, Abby Cartus, she's done a lot of work, just sort of looking at the ways that the framework of "endemicity" has been imposed during the pandemic, not as a declaration of fact, a reflection of the sort of actual spread of COVID going on, but a ideological commitment towards sort of moving towards a different phase of the pandemic. And what these guidelines should reflect is that, you know, COVID should be added to the isolation room guidance, right? But what we're seeing is the kind of "mild COVID," "COVID as the flu," "COVID is no big deal," actually being reinforced and reinscribed as kind of natural reality through these very guidelines. Framed as like making it accessible and simplifying it and making the quote unquote, "infection bible"—you know, as you said people call it, to make it simpler and easier to use, right? Because we all have to use it more often now! Which—whatever—but like, you know, this is kind of the the difficult and, frankly, kind of insidious way that we've seen people say like, oh, we've got to "trust the science," we have to rely on the data, as you said, this was constructed using cherry picked evidence, omitting things, and this is going to shape the understanding of COVID moving forward, if it's allowed to proceed and be, you know, adopted as is.

Jane Thomason 33:21

Right,well and it's not just COVID that we need to be concerned about what these guidance updates, it's literally everything.

Beatrice Adler-Bolton 33:27

Absolutely.

Jane Thomason 33:27

Every infectious disease is going to be governed by this new—these updates. And this, I mean, the the way that they're treating the science, I agree with you entirely, with what you just said. On top of this, like, the reframing that we talked about earlier, to be more flexible to have kind of minimal standards, and then leave it up to employers to decide what they do is going to result, like it did during the [ongoing] COVID pandemic in a race to the bottom for everything. So any patients, any visitor, any health care worker, after these guidelines are in effect, when you go to a health care facility? You're going to be at higher risk for tuberculosis, you're going to be at higher risk for getting MRSA or influenza or COVID, or measles or, you know, any of those kinds of diseases that people end up in the hospital with or for. And that's.. that—we don't want that to happen! That's why we're here, right? We're fighting back.

Beatrice Adler-Bolton 34:26

Absolutely. Now, one of the other settings that's specifically being addressed in this update, that also is really worrying is nursing homes, too. You know, we've we've sort of mentioned hospitals by name a lot, but I want to talk specifically about the "enhanced barrier precautions" that have been proposed for nursing homes and how they have been proposed, you know, like what the recommendations would be changed to to deal with certain healthcare acquired infections like Candida infections are the kinds of—what is it—like MRSA, Staph, whatever, you know, the kinds of things where everyone's like, oh, you know, you got to be really worried about all of the healthcare errors and the individual hygenic mistakes being made by individual people that are causing all these infections, couldn't possibly be anything about the workplace policies or the infection controls, [ laughs ] it's definitely, you know, "individual behavior." We sort of have that framework, right? And what they're doing also in these recommendations is making it easier for some of these really difficult to treat infections and different things that you can pick up in congregate settings, whether that's a hospital, the prison, but especially a nursing home, that can be really, really deadly quite quickly and spread quite quickly. They're also really weakening, or it seems like they might weaken, those protections as well, as part of this update.

Jane Thomason 35:47

Yeah, so I'll just preface this by saying most of my experience and expertise is around hospitals and clinics and home health. But certainly, I can talk about what the CDC has proposed here around nursing homes and some of the implications. I think there's also always a concern that they'll introduce this into nursing homes and then expand it to other facilities as well.

Beatrice Adler-Bolton 36:10

Mm. Mhm.

Jane Thomason 36:12

But what HICPAC has proposed, at the June 2023 meeting, is that for skilled nursing facilities, enhanced barrier precautions will be implemented, which is where gown and glove use is only during, quote, "high contact patient care activities." That's not defined in this document that they shared. But basically, they're saying, you can either do it as a pathogen based method. So if you have a resident with a particular infection or colonization with a particular organism, or if you have residents with wounds or indwelling medical devices, who are at particularly high risk of getting an infection, then you implement enhanced barrier precautions, and that they're not going to require cleaning or disinfecting of equipment between residents. Residents won't be like isolated, they won't be confined to their rooms, they'll be allowed to mix with other patients to eat in the dining hall, go to activities. And the example pathogens they give for enhanced barrier precautions include CRE and Candida auris. I just want to point out, Candida auris, the rates of Candida auris—Candida is a fungal pathogen that's resistant to a lot of the drugs that are used to treat it. And it's exploded over the last few years in the United States. And there was a study that came out recently that found that the mortality rate of patients with Candida auris was about one third. These are patients who are hospitalized. And so, you know, I think that kind of underlines—that particular statistic—underlines the risk of a nursing home patient becoming colonized or infected with Candida auris. And that, like that—that's not okay. Right? To put them at higher risk of that kind of infection is really concerning. For them and for others in the facility. And then the guidance. Just one more point. The guidance then says you would use "contact precautions," which is when you use a gown or gloves—gowns and gloves—for any activity interacting with that patient or entering the room at all. If, for specific pathogens that are time limited, like norovirus, C. diff, scabies, where it's a time limited infection, and during outbreaks. So basically what this proposal says is that we should wait to put in place precautions that we know work to prevent transmission of infectious diseases until there's an outbreak. In nursing homes.

Beatrice Adler-Bolton 38:53

[ sighs ] For listeners that might not be aware why I'm taking such a deep sigh. Can you talk about why these decisions that we're talking about are going to make workplaces so much more dangerous, make care so much more dangerous? And who this benefits? I know these are, you know, obvious points. We have that shared context. But you never know when someone's first episode of a podcast is, right? So let's say maybe we have a person who's brand new to the show, and they might not even realize that COVID still a problem. I mean, let's be real, like, based on what your media consumption is, you might think of it as over, right? Like that is a person—that's a guy that exists. We don't have to make him up. Right? So for folks that, you know, maybe don't kind of see what this does to, let's say, in particular, hospitals, which is, as you said, your particular area of expertise, but a particularly great place to pick up an infection from another patient, from another worker. What do these proposed changes do to the working environment?

Jane Thomason 40:03

That's a great question. So if you think about the things that I've talked about, they're all oriented towards less protection. They're rolling back to a surgical mask rather than an N95. They're not using an airborne infection isolation room. This whole idea of the "flexible approach." The only person that that benefits is the employer. Because they save money. They don't have to pay for N95s, they don't have to pay for, say, PAPRs and elastomerics, which are types of respirators that are even more protective than an N95. That we really should use more often. They don't have to pay for ventilation. They don't have to pay to—when there's a surge in COVID patients or a surge in patients with an unknown respiratory infection, they don't have to pay to convert rooms into negative pressure rooms, to protect folks. And what that means is that everyone who's present in that environment is going to be at higher risk. It's the—we've talked about, I feel like I've talked about the "Swiss cheese model" of risk reduction so many times through the pandemic, I'm sure you all have talked about it too. But for those who are not familiar—

Beatrice Adler-Bolton 41:13

It always bears repeating.

Jane Thomason 41:14

Always bears repeating. It's a really important and simple model to think about this. There's a guy named James Reason who came up with this model in, I believe, the 80s. That when you're working in a complex system, when there's a lot of factors at play, and you want to prevent harm from happening, the more measures you have in place, the less likely that harm is to happen. And if you envision each measure that you could put in place—so like, we're talking about COVID, each protective measure, ventilation, respirator, environmental cleaning, paid sick leave, just to name a few examples. If you think about each of those measures as a slice of Swiss cheese, it's got holes in it, not one of those is going to be perfect. You can't just give people respirators and say, great, we're done. That's not how it works, right? But the more measures you have in place, the more likely it is that you prevent the harm from happening. And so that's the whole orientation to preventing COVID. Like, that's what we've been calling for, what nurses have been calling for, since the beginning of the pandemic. And that is the opposite of what the CDC is working towards.

Beatrice Adler-Bolton 42:23

Right. And that's presumably the point of infection control guidelines for health care settings. One would think, right?

Jane Thomason 42:31

Yes.

Beatrice Adler-Bolton 42:30

You know, that—[ laughs ]—and that's the thing that can be really frustrating, right, is that, as you mentioned much earlier, you know, when we were talking about, you know, things that you and I have heard from folks who are working in healthcare settings that oftentimes this is justified by pointing to it and saying, well, "CDC says that we don't have to protect you." "CDC says that it's okay to abandon you." "CDC says that it's not our problem, if you want to protect yourself from COVID. It's your problem." You know? And really sort of what is going on here is that this is a major challenge and hurdle that is being introduced intentionally into healthcare workplaces. And that is coming at the same time as the messaging and the language about why we need to make these changes, and why we need to do these things that are, again, going to make people sick, kill people, make work worse, harder, more dangerous, and more emotionally draining for all of the health care workers, make things much more dangerous for patients. No one comes out better from this, as you mentioned, other than the employers themselves. And all of this, right, is being justified by the fact that, oh, well, we have to do these things. Otherwise the health care system will collapse. It's—ugh—so, you know, nurses are being thrown into the grinder, patients are being thrown into the grinder, transport workers are being thrown into the grinder, just the folks working in the cafeteria or, you know, checking insurance—anyone in the vicinity of the hospital, the places these people go in their private lives, when they leave work. Their families, their neighbors, their—people they're next to on the subway, on the bus, whatever. This has, you know, an impact and a reverberation beyond these individual moments of transmission, right? Between one person and another in one healthcare setting. It doesn't stay in the healthcare setting. And the way that these guidelines kind of pretend that healthcare settings are not a part of the community is very strange to me, and I'm sure it's really frustrating to you as well.

Jane Thomason 44:43

It is and, you know, I think on the flip side, we see that argument thrown at health care workers as a reason to not protect them! Right? Like we see employers say, I mean, they've said for years now that health care workers are more likely to get infected in the community than in the workplace. And that's not true! Anywhere that you've seen an employer put forward data to supposedly support those points, it's been poorly gathered. They haven't tested asymptomatic healthcare workers who were exposed, or, the—I think the example that is clearest on this point is the Cleveland Clinic. They put out an article that was claiming that their health care workers were more likely to get infected in the community than in the workplace. And then it came out a few months later that during the period of their study they had been giving their health care workers counterfeit N95s that didn't protect them.

Beatrice Adler-Bolton 45:37

Oh, my god.

Jane Thomason 45:38

Right. So that's, you know, that's a clear example, right, of how employers have done this. And it's—there's no recognition of the need to protect healthcare workers, as you said, as just what employers are obligated to do in this country based upon a decades long fight to win the Occupational Safety and Health Act, to establish workers' right to a safe workplace in this country. People fought and died for that over many, many years. And employers are ignoring that obligation, except where, of course, workers and especially unions organize to force them to recognize that right and take measures to protect workers. But there's also this lack of awareness and.. not even a lack of awareness. It's lack of recognition on the part of employers and, I would say, the CDC, too, about—exactly what you said—about how workers are not just workers. They're people. And they exist in these complex webs of social connection, and that it really matters how we protect workers for what happens to public health writ large. And I think the COVID pandemic made that super clear to a lot of people. And it is—it's not just disappointing. It's.. I don't know what word is good here.

Beatrice Adler-Bolton 46:59

Radicalizing?

Jane Thomason 46:59

Infuriating? It's infuriating that the CDC is not recognizing this, right? It is—it has been radicalizing, for a lot of people, you're right. But for the CDC to not recognize this fact, after what we all just lived through and continue to live through? Is.. it's a travesty. It shouldn't be happening.

Beatrice Adler-Bolton 46:59

Yeah. And it tracks with, you know, all the previous guideline changes that we've seen all this—you know, all the statements—

Jane Thomason 47:26

Mhm.

Beatrice Adler-Bolton 47:27

And we've been talking a lot about, for lack of a better word, "individually mediated" workplace protections. But another thing that's addressed here, and done so poorly, and that will be sort of affected by these changes, if they go into place and are adopted, is the kind of structural workplace protections as well. This includes some sort of shifts in the discussion of not just like, individually ventilated rooms for isolating patients, but just sort of the ventilation systems and HVAC in general, right?

Jane Thomason 48:00

Mhm. Yeah, I think it's totally unclear, based on what has been made public, how or if the updates will address kind of the multiple measures approach to infection control. So things like ventilation, things like screening and isolation, things like safe staffing, right, these structural pieces that you're talking about. I would say on top of that, that there was another meeting that—for a group that I sit on, I can give you the specifics, if you want. But the short—why it's important, is that Dr. Mike Bell, who is staff within CDC that staffs HICPAC, he works on and for HICPAC—he told us in that meeting that they are not planning on incorporating ventilation, or other respiratory protective devices like PAPRs and elastomerics in this guidance update. And you know, that could change, the guidance is still ongoing, the develop—the process to develop the guidance is still ongoing. Right? We are pushing really hard. That could change. Hopefully it will change. But it might not change. And for that to be, you know, an explicit message—and that happened in March of 2023, that I heard that from Dr. Bell. For that to be an explicit decision that had been made, in March at least, that they weren't going to talk about ventilation, it's super concerning.

Beatrice Adler-Bolton 49:29

Yeah. Yeah, absolutely. I mean, it's—I'd love if you want to get into more detail about that ventilation piece. One of the kind of frustrating things that often folks who are advocating for layered protections, for the Swiss cheese model, who have been, for so long, you know. Oftentimes, whatever it is that's being held up is treated as a silver bullet. And there sometimes is a kind of debate just sort of between the promise of ventilation, right, like the many ways that ventilation and HVAC upgrades can potentially mitigate COVID, and the way that's talked about, and then the realization and the actuality of how that exists in the world, right? Where, for example, you'll see often the Biden administration, kind of tout and champion, the fact that HVAC upgrades have been made in some public schools, in some plac,es, in some parts of the United States, right? And that is kind of spoken about in a very selective way that runs cover for, you know, the fact that not all children have a safe place to learn right now. In fact, most of them don't, you know, explicitly. And COVID is just one of many reasons why it's unsafe, and ventilation could help with a lot of them, right? But one thing that's really, I think, particularly interesting is, you know, to not even really kind of go there, here, too, right? And it shows you how important the differences between the idea of ventilation as it exists as a kind of silver bullet, right, which is really just the idea that ventilation upgrades can stand in for other layered protections. And that's obviously dangerous for all of the reasons we've been discussing for like the last hour. But, you know, the, the sort of exclusion of ventilation here, for example, is really important because employers would be beholden to actually making those changes, were they to be included. Correct? And that exclusion of them, I think, shows us the reality of the public kind of lip service that's paid to ventilation as a mitigation for COVID, versus how ventilation has actually been implemented for COVID in real world environments.

Jane Thomason 51:52

Mhm. I think that's spot on. I mean, for those who are maybe—of your listeners who are maybe not as familiar with, like, what we're talking about with, like why ventilation matters, would it be helpful to walk through that briefly?

Beatrice Adler-Bolton 52:04

Absolutely. Yeah, definitely.

Jane Thomason 52:06

So if you think about how COVID is transmitted, and this is something that actually applies not just to COVID, but a lot of other diseases, including influenza, and RSV, just for the record. But I'll talk about COVID specifically, since that's kind of a lot of the focus of our conversation. You have a person, they're infected. Maybe they know it, maybe they don't, right? Because actually, for all three of these diseases, COVID, influenza, and RSV, there is a lot of transmission that happens before people develop symptoms. If you think about every breath that they take, every word that they speak, every sneeze, cough, laugh, singing, all of that, anytime they use the respiratory tract do anything, there are infectious viral particles that are emitted. And they're emitted in respiratory secretions. They're emitted in little tiny bits of mucus, water, proteins, it's all kind of mixed together. And those—we call the particles or aerosols, particles suspended in the air, those aerosols are in a wide range of sizes. Almost exclusively microscopic, right? You can't really see it when you're just talking to someone in a room. But they can stay suspended in the air and travel long distances. And where ventilation becomes important is that if you have someone who's in a room, and there's no ventilation at all, very quickly, that room will become filled, those infectious particles will become very concentrated, if you have someone who's infected in that room. And where ventilation can be helpful is decreasing that concentration. So if you think about someone else being in that room, and there's ventilation that's pulling the air out that has infectious particles in it, and bringing in filtered air that's cleaner, or outside air that doesn't have infectious particles in it, you're going to keep that concentration at a lower level, which means that the other person who's not infected yet has a lower chance of breathing in enough infectious particles to become infected.

And so you can see the ways that ventilation by itself is not going to fix the problem. Right? That other person is probably going to breathe some infectious virus in, especially if they're close by the person who's infectious. Because there's, you know, it's a gradient, right. But it's not guaranteed that it—just because you're six or twelve or twenty feet away that you're not going to get infected. And so that's where we need to have these other measures, like screening patients who come into a facility, like wearing masks, or better yet, wearing an N95, like having people be able to stay home when they're feeling sick, or be able to stay home when they know they've been exposed. And all the other measures that we could be talking about. That—does that help?

Beatrice Adler-Bolton 54:54

Absolutely. No, I—beautiful, laying that out. Really appreciate that. And I think it speaks to also, again, these guidelines should reflect the fact that health care facilities are part of the regular world that we all live in, right? So if there's no paid sick leave for restaurant workers, and they have to go to work sick with COVID, that's also, you know, if they were—if the CDC was really committed to, you know, keeping America, like, "economically productive" and safe from COVID—you know, adequately, as they say that they are—what you would need to do to actually reduce the burden, so to speak, on the healthcare workforce, or the healthcare system of COVID is to give everyone the ability to stay home when they are sick. And to make sure they have health care, right? Like the kind of guidelines themselves, they—in a way, they kind of individuate infections and put them—it's kind of in this very specific context of like, one worker, one health care facility.

And so obviously even, you know, the guidelines, if they were best right would still be happening in a world where most people don't have sick leave. But you would think that it would be advantageous in some capacity towards their stated goals to have robust layered protections in place in health care settings. And I think it's evidence that their commitment to their stated goals is insincere, when you look at what some of these guideline changes that are potentially going to be adopted at next week's meeting are. Can you talk about what the demands are? What are the demands that NNU has put forward specifically regarding these changes?

Jane Thomason 56:45

Yeah, so specifically, we want to see the process opened up and made transparent. We want the draft to be made public, we want there to be clear input from healthcare workers and unions, as well as other experts who have expertise germane to these updates, aerosol scientists, respiratory protection experts, ventilation experts, occupational health, industrial hygiene right, that whole range of people need to actually be part of developing the draft. Not just—so, when we say this to the CDC, the CDC says back, well, there will be a Federal Register posting down the line. You can make public comment then.

Beatrice Adler-Bolton 57:24

[ laughs ] Ok.

Jane Thomason 57:24

Well, by then all of the decisions have been made. We really need the process to be open and transparent and engaged with the public now.

Beatrice Adler-Bolton 57:33

Mhm.

Jane Thomason 57:34

The other things that we are asking for are for them to not adopt the, quote, "flexible" or the "crisis standards" approach. We need clear and explicit guidance for what employers need to be doing to [protect] healthcare workers and patients in all these different situations. We need them to adopt the multiple measures approach and maintain the precautionary principle. So that means clearly talking about ventilation, engineering controls, PPE, staffing, patient screening, and isolation, exposure notification, vaccines, the whole shebang needs to still be part of this. It's part—it's actually part of the 2007 guidance and needs to not be cut out. We need the whole multiple measures approach.

And then the third thing that we're asking them, or I guess the fourth thing that we're asking them for, is to make strong recommendations, particularly on respiratory protection, where that's needed to protect healthcare workers and patients. They need to fully recognize the science on aerosol transmission, and really keep strong protections—strong recommendations on respiratory protection. So in a nutshell, those are the things that we're asking for right now.

Beatrice Adler-Bolton 58:36

Thank you for running through it. I really appreciate that. And I'm sure you know, folks, listening to this right now are probably now wondering, you know, as we mentioned at the top, like, we have an ask of people today. Can we talk through, if people want to get involved in the work that NNU is doing around this specifically, or just, you know, help out or participate in the organizing, whether that's sort of signing on to something, or testimony, research help, sort of, can you talk about, you know, any and all ways that folks might be able to help out towards trying to get those four points across to the CDC and to HICPAC?

Jane Thomason 59:17

Yeah. So a super easy thing that every single listener can do is to go to nnu.org/cdc. And sign our petition. It makes those four points that I talked about, that were the asks that we're making of the CDC. So, really simple. We really want people to sign that in the next couple of days ahead of the meeting that's happening next Tuesday, but, you know, if you're busy and you're listening to the podcast after August 22, go ahead and sign it. We'll still include you in our efforts. So that would be the biggest piece that folks can do.

Beatrice Adler-Bolton 59:56

Alright folks, before the 22nd—today's the 17th, the day this episode comes out, so you should have plenty of time to take like five seconds and at least do that over the weekend. Hopefully, please, if you can. If folks want to sign on and they're in the EU or Canada that, I'm assuming is—is that helpful? Or is that not? For international listeners?

Jane Thomason 1:00:20

No, please, go ahead.

Beatrice Adler-Bolton 1:00:22

Okay.

Jane Thomason 1:00:22

We recognize that the guidance that HICPAC and CDC put out has international implications. There are other agencies, there are employers, there are associations internationally that looked to the CDC. So, yes, please join us wherever you are in the world.

Beatrice Adler-Bolton 1:00:37

And if folks want to get involved beyond that, how can people plug in and help?

Jane Thomason 1:00:43

So the other thing that people can do, if they're interested, is sign up to comment at the meeting that's happening on Tuesday, August 22. It's scheduled from noon to 2:30pm eastern time, it's virtual, it's on Zoom. There is a link in the episode description that will take you to a Google form. Fill that out, and then I will make sure that you get the link to register for the meeting, as well as talking points. And that would be a huge help, we want to make sure that there's a group—a strong group—of people at that meeting sharing these points that we talked about, the need to, for more transparency, the need to protect patients and healthcare workers by issuing strong guidance, we want to make sure that there's a lot of folks speaking at that meeting. So if you're free and available on August 22, from noon to 2:30pm, eastern time, there's a link in the episode description for more information.

Beatrice Adler-Bolton 1:01:34

Mhm. Artie and I are gonna be there. We cleared our calendar for Tuesday. So we'll actually be—

Jane Thomason 1:01:38

Amazing!

Beatrice Adler-Bolton 1:01:39

And we'll put links to both that, and where you can sign on, in the episode description. Sometimes it's episode notes, if you can't find it, email us, DM us, bother me, whatever, we'll make sure that you can get plugged into this however you need. Now, there's another thing that we're going to link to in the episode description, which is really helpful if people want to just sort of do some more digging, read up on this, maybe get prepared for Tuesday. Can we talk a little bit about the letter that was addressed to Mandy Cohen and sent in late July, which laid out a lot of the things that we've been talking about today?

Jane Thomason 1:02:17

Yeah, so a group of experts got together and wrote this letter, it was signed by nearly nine hundred people with expertise in public health, occupational health, ventilation, respiratory protection, aerosol science, health care, infection control a whole range of experts who should be a part of this process, but are not being included by the CDC. And that letter laid out concerns about the content of the draft proposals as well as concerns about HICPAC's lack of transparency in how they're making these updates.

Beatrice Adler-Bolton 1:02:50

And has Dr. Cohen responded yet? Or has she publicly made comment on these guidelines that are maybe going to be updated?

Jane Thomason 1:03:00

No. We got a very brief "thank you for the email." And then there's been nothing in the last several weeks.

Beatrice Adler-Bolton 1:03:06

So you know, listeners who are D.C. health beat reporters, you heard that. You've got something to ask Mandy right now. [ laughs ] Sorry, Jane. Just had to do that. No, and this letter is really detailed. I think the sign on section I particularly love, it's a beautiful touch, you know, 60 page letter, almost, it's 900 people, it's an airtight sort of case, it makes these new guidelines look like a joke.

You know, it's really important work if you're looking for a sort of standard for also kind of like how to produce the kind of knowledge production and work that needs to go into like resisting changes to guidelines and policy, you know, whether it's in the framework of implementation or policy design, things like that. This is like a master class in sort of putting together a background document and also showing just the immense amount of solidarity behind this issue. And also the support that is sort of behind these critiques of the CDC. And the implications of these guidelines are very serious. I think, particularly what worries me the most is these nursing home guidelines.

And as you said, you know, there is—it's not inconceivable that things that sort of are stood up now in nursing homes or, you know, undone in terms of protections now in these rehab facilities or other congregate facilities like that, that that could become the new norm for just healthcare settings writ large. The disability scholar—late disability scholar—Marta Russell, when she was theorizing her money model of disability, one of the things she said is that the nursing home industry is like the canary in the coal mine for what is going to become of American medical care systems, right? So when we look at some of the innovations, both in terms of the way that workers are extracted from, but also that patients are extracted from and abstracted from, you know, a human being with dignity into an object or a bed where the kind of occupation of a bed is more valuable than them as a person.

And that's where the kind of money model of disability comes from, is looking at how, in particular, what happens to patients, the abandonment that happens in particular to patients and people in nursing homes, right? That that also goes on to structure not just the experience of other patients in other parts of the healthcare system, but that it's a major form of labor discipline, and the way that we, you know, are forcing workers to treat patients and extracting from them, you know, what we see in nursing homes, is the discipline to come to future health care workers in other sectors of healthcare industry, which is why you know, Marta's work is so salient. And you know, it's really important to also just take a moment, if you just have like, five minutes, you've got four days before that meeting, just sign on to the letter. Again, that's, what? NNU forward slash CDC, or—

Jane Thomason 1:06:21

nnu.org/cdc

Beatrice Adler-Bolton 1:06:23

Exactly. And Jane, and I really appreciate you taking the time today. I know we've been going for a while, I don't want to steal more of your time. But on a final note, what would actually good protections for health care workers look like?

Jane Thomason 1:06:40

It would look like good protection—it would look like—it would look like stronger protections. You know, I think the conversation that we had today about the staffing crisis, the ways that healthcare workers have been disregarded and treated during the COVID pandemic, by their employers, and by the CDC and government agencies. I think really, to rebuild that trust, there needs to be stronger protections, there needs to be, first of all, engagement with health care workers to create those protections, to create that guidance. But to make healthcare a safe place to work, there really needs to be more protection, there needs to be good ventilation, there needs to be strong respiratory protection and personal protective equipment, there needs to be really thorough contact tracing, and exposure notification there needs to be paid sick leave that's generous and recognizes that importance of that measure.

And, you know, I think that if we can course correct the CDC on this front, it will have major implications in a positive way for health care workers being able to do their jobs without having to worry about infecting their patients or having to worry about infecting their other patients because they have a load where—they have an assignment—where one patient is infected, but the others are not. Or worrying about themselves being infected and taking it home to their families. And I think that that will have a huge impact on retention of nurses at the bedside, and will have a major impact on our health care system as a whole, and really our society as a whole. That where we can lead with that care for workers and that care for what they need to do their jobs, that that will be transformative in many ways.

Beatrice Adler-Bolton 1:08:41

Jane, I really appreciate you taking the time today. Again, my guest today is Jane Thomason. Jane is the lead Industrial Hygienist for National Nurses United. All those links will be in the description. And patrons, as always, we will see you Monday in the Patreon feed. Everyone else we will hopefully see you Tuesday in that meeting and then in the main feed at the end of the week, like usual. To support the show become a patron at patreon.com/deathpanelpod, you'll get access to our second weekly bonus episode and entire back catalogue of bonus episodes. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, pick up a copy of Health Communism or request it at your local library, and follow us @deathpanel_. As always, Medicare for All now. Solidarity forever. Stay alive another week.

[Outro Music]

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Sign on to NNU's letter here.

Sign up to give public testimony on August 22nd here.

Read NNU's letter to CDC Director Mandy Cohen here.