Policy-Based Evidence Making w/ Jane Thomason (03/14/24)
Death Panel podcast host Beatrice Adler-Bolton speaks with Jane Thomason of National Nurses United (NNU) about the CDC’s recent abrupt decision to drop its 5-day covid isolation guidance and the latest developments in the campaign to stop the CDC from dramatically weakening infection control practices in healthcare settings.
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Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts or visit her website)
Jane Thomason 0:01
This core idea of what the CDC just did for public health guidance for COVID, that idea is also showing up in the HICPAC process, right, we're seeing it really become pervasive -- this idea of trying to link COVID with the flu and really equalize the risks and therefore equalize the measures that we put in place to respond.
[intro music]
Beatrice Adler-Bolton 0:51
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I'm here today with returning guest, Jane Thomason. Jane is the lead Industrial Hygienist for National Nurses United, known as NNU. And for those who are not familiar, NNU is the largest union and professional association of registered nurses in the United States. Now, Jane has been on the show a few times to discuss the work that NNU has been doing around workplace safety, infection control and COVID. And this is an effort that many listeners of the show have also helped out with, pushing back against attempts by CDC and its advisory committee on infection control in healthcare, known as HICPAC, to weaken infection control guidance for healthcare settings. And I'm really, really, really glad to have Jane back on the show today to talk about some recent updates on this guidance, and on the isolation guidance, which we'll get to later on in the show. With all that said, Jane, welcome back to the Death Panel. It's always so nice to have you on the show.
Jane Thomason 2:30
Thank you so much for having me. It's great to be back. And I'm really excited to share some of the things that we have been able to win because of that action, because of that solidarity.
Beatrice Adler-Bolton 2:40
And you know, as we said, today, we're going to talk through the latest with what's happening with the CDC and HICPAC proposed guidance changes for healthcare settings. And after that, we will talk about a second, separate change, news of which was initially leaked in The Washington Post in February and then suddenly announced right at the beginning of March, which is the CDC's change to isolation guidance for people sick with COVID, which unlike the first thing that we're going to talk about, which applies to healthcare settings, the second recommendation applies to the general public. So these are two separate things, but they're related. As I said, there are some parallel logics at play in both that we're going to highlight today. For example, both the proposed CDC HICPAC guidance about infection control in healthcare settings that we'll discuss first, and the CDC's isolation guidance for the general public, are in part justified by the idea that COVID is just like the flu, a point which is unsubstantiated by the data unless you read weak evidence in a very particular way. So of course, when pressed on these points, you start to see the real defenses of these policy shifts show themselves for what they are, which is economic reasoning and cost benefit analysis that weighs the lives, health, and economic security of workers and non-workers alike against the economy writ large. The term that social scientists and policy researchers actually use for this is called "policy-based evidence making," that science and data are marshaled to essentially just support predetermined policy goals. So Jane, for folks who might not be caught up, can you just walk through what's happened so far, and then get us right into the update?
Jane Thomason 4:15
Okay, so just really briefly, the CDC has infection control guidance for healthcare settings that was last updated in 2007. In 2022, they initiated a process to update this guidance, to make it more user friendly. That was the reasoning. They tasked their HICPAC, the Healthcare Infection Control Practices Advisory Committee, with developing these updates. HICPAC created a workgroup that was meeting behind closed doors. It wasn't until last June of 2023, that we really got a good picture of what the workgroup was working on, what they were developing, and that picture was very bad. So NNU, we raised the red flag, a lot of allies including many folks who listen to this podcast -- thank you -- provided comments at public meetings, submitted written comments, signed petitions, sent letters. All of those actions together, I think, have resulted in a number of different changes. There were some transparency issues, obviously, with the process, some of which have been remedied. For example, HICPAC used to vote before they heard public comment, at every one of their meetings -- you can look at their minutes -- until last August, when they switched the order, and they hear from the public before they vote. You know, I think a very important thing for a federal advisory committee to do, right. So that happened because of our advocacy. That's just one example. And I know we have talked about some of the other examples in the past. So fast forward to November, HICPAC heard the workgroup's draft officially. The workgroup presented their draft to HICPAC. And HICPAC voted unanimously to send that draft to the CDC for further review. They said, great, we like what the workgroup put together, which is not a good thing. The workgroup's draft was so bad, it was really astonishing. And I would add that we didn't get to see it, the public didn't get to see this draft until the morning of the HICPAC meeting. So there was not a lot of time for engagement. But having looked at it in great detail, just to name a couple of the big issues here, right. One is that they are looking to shift the focus and responsibility of infection prevention onto individual healthcare workers and away from employers. And this is actually something that really was a talking point that was developed at that November meeting where HICPAC discussed the draft. Erica Shenoy from Massachusetts really pushed this line during the November meeting, that this draft is aimed at individual healthcare workers, not employers. And we've seen the CDC pick up that line since. And they're using that as a reason for why they are not including recommendations on ventilation. They're not including recommendations on staffing levels, which we know are directly related to patient infection rates. There's a lot of research on that. And they're not including a lot of other -- they're not including robust recommendations on a lot of other prevention measures, like screening patients or isolating patients. They're really focused on PPE, on personal protective equipment, right, the things that individual healthcare workers are "responsible" for. And even within the PPE sections of the draft, there are a lot of big issues where HICPAC is equating respirators and surgical masks, right? They're saying healthcare workers, if you're exposed to a pathogen that transmits through the air, you can wear a surgical mask to protect you, you don't really need a respirator, like an N95. And that is not -- that's just not true. That's not, that's not the science. [laughing] We can get into the details, but that's just -- that's not reality, right? A surgical mask does not protect you from breathing in, from inhaling a hazard in the air. They just don't do that. They're loose fitting, they're not made out of good filter materials, you have to have a respirator. So that's, I think, another big issue with the draft. And then the last issue that I'll highlight is that for novel pathogens, they're saying we no longer need to use an airborne infection isolation room. That's a room that has specialized ventilation that prevents any infectious aerosols, any infectious virus in the air from going into like the corridors, hallways, other rooms, other areas of the facility, like it isolates that and then it's got a special exhaust. They're saying in the next pandemic, we are not going to use airborne infection isolation rooms, even if we don't know exactly how the pathogen transmits, we're not going to use these things, right. It's just [Beatrice sighs] -- it's a huge step backwards from past practice. Like it makes no sense scientifically, and it's weakening what we've done for the past however long. So bad ideas, all bad ideas. You know, this draft would really -- would really materially increase the infection risk for anyone who walks into a healthcare setting - staff, patients, visitors, anyone who walks in.
Beatrice Adler-Bolton 9:15
Contractors who are going to deliver supplies and then go into all sorts of other workplaces, you know, in the course of their jobs. These things don't stay in healthcare settings too, absolutely.
Jane Thomason 9:27
Yes, yes. And so after that November meeting, when this draft was finally released, and it was clear that the CDC and HICPAC, even though we've been sharing our concerns with a lot of these proposals since June, that they hadn't responded to them. It was clear that the CDC was, you know, full steam ahead, like let's go on this draft. So NNU and a lot of our allies urged the CDC to reject HICPAC's draft. Mandy Cohen had that option. We made a big push, you know, it was against all the odds. The CDC usually rubber stamps what it gets from HICPAC, If you look at some of the history there. And we were successful. On January 23rd of 2024, the CDC released an announcement sending the draft back to HICPAC for more work, specifically calling out some of our core issues, not all of them, but specifically calling out some of our core issues that we've all been raising as advocates about HICPAC's draft. And the CDC is saying to HICPAC, you have to do more work around these issues, around respiratory protection, around source control, around whether source control recommendations should be expanded for healthcare settings in this draft. And that has all happened because of -- because of us, right, because of our solidarity. And so that was really exciting to see. And I hope everyone, you know, takes a moment to pat themselves on the back, give themselves a hug, celebrate that win. We really -- you know, it's a big, I think, a big shift in how the CDC has operated in the past.
Beatrice Adler-Bolton 11:05
Absolutely. And I mean, when we have discussed this in the past, one of the things that we've talked about is how the guidance that was being voted on and discussed in November, the one that was sent back for more work, that essentially this was not only going to not recognize and meet the needs of what the pandemic demands of the healthcare workforce, right, to protect patients, and healthcare workers, and everyone that all of those people come in contact with outside of the workplace, right, because an infection you get at work doesn't stay at work, you take it home. And one of the things that we've talked about is how, you know, these recommendations not only are not necessarily going to reflect the reality, right, but that we're going to roll back and actually take steps backward, right? That this is going to be not just a loss with regard to COVID, but in terms of workers' rights in general for workers who work in healthcare settings, or you know, any of the people that come in contact with them in their lives. And ultimately, you know, I think what's really important here is sort of like, well, what happens next, right? What happens when this draft goes back to HICPAC, because it's absolutely fantastic to have gotten to this point, and essentially prevented that harm from just being rubber stamped and passed through immediately, right. And this is going to be one of those victories where it's not like you win something, but you win the absence of something. And that's important, right. And so what happens next? Now that this is going back to HICPAC, what are your concerns moving forward? What are we looking at in terms of sort of what becomes of these recommendations from this point forward? I mean, this isn't necessarily something that's happened before, from what I can tell.
Jane Thomason 12:47
Yeah. So I think that is the question, right. So the other piece of what's been happening I think that is important to understand for what happens next is who has been on HICPAC, and specifically who is on the workgroup that is now going to be answering these questions, responding to the CDC's questions. And it has been industry, right. When you look at the roster on HICPAC's website, everyone pretty much is an infection prevention manager at a large healthcare system or at a university system. And part of the CDC's announcement -- so this is something that we've been calling attention to this whole time, right? That's a huge issue. Basically, the CDC is enabling industry in writing its own standards, which is unacceptable. And one of the other big pieces of the CDC's announcement from this January is that they made a commitment to expand the scope of technical expertise -- that's the language they used -- on both HICPAC and this workgroup. I think that is also a really significant win, right? HICPAC has, since it was created, really been an industry mouthpiece, right? HICPAC has had these issues for a long time. And to have the CDC make this commitment that they're going to expand it is really, really big. Now, they haven't made public who they are adding to the workgroup yet. We know they have not yet added labor, which is a major piece of the puzzle, right? We need to have -- you can't write infection prevention guidance that's going to be protective and implementable without the people who are going to be implementing it being part of the process to write it, right. And when you look at the hospital setting especially, but when you also look at like clinics and other outpatient settings, which workers are the ones who are carrying out a lot of the infection prevention measures? It's the nurses, right. So we know that they have not added that perspective to either HICPAC or the workgroup yet. We also know they need to add the patient perspective and that has not been present on the workgroup. And they need to also expand the experts. So they have a lot of infection prevention people, and that's an important perspective here. But they also need to make sure that there is industrial hygienists, ventilation engineers, respiratory protection experts, occupational health experts, right. They need to have folks from a lot of different disciplines, because there's all these perspectives and all of this research, all this evidence that needs to be weighed, that hasn't been up to this point, in actually crafting guidance that's going to be protective for both patients and healthcare workers. We do you have a new petition out, calling on the CDC to make sure that they get the right people added to the workgroup, and HICPAC. If you go to NationalNursesUnited.org/CDC, you can sign that petition and join us in our big push. And so I really -- you know, I think, Beatrice, you asked about kind of what's next. And I think that that is a really important piece of what comes next, right? Because the workgroup is going to be hashing out how they're going to change the draft to match, or to respond to what the CDC is asking them to work on. And if it's just the same people who wrote the first draft in that room, then they're going to come up with the same things, right? They're not going to adjust what needs to be adjusted. It really is going to come down to, is the CDC going to make sure the right people are a part of that conversation, that that's going to determine how that works out.
Beatrice Adler-Bolton 16:27
I mean, one thing I do want to make sure to spend some time on is to talk about some of these dynamics that are involved. But before we go further, I do want to sort of address the expertise point a little bit for a second, because I'm just trying to anticipate criticism in some sense, which is like, people are like, well, maybe you know, someone whose job title is Infection Control Manager, maybe that is relevant expertise, right. Can you speak to some of the specifics of the way that expertise was limited in the inclusion in this working group, its sort of limitations in general with regard to HICPAC, and also sort of what the resulting limitations were in terms of the data that they were using to back up this document? Because before we get into any of these other points, I think it's really important to sort of talk about, you know, what the problems with these recommendations are, but also what the problem with the sort of justification for the recommendations were as well.
Jane Thomason 17:24
Yeah, so infection prevention folks should be part of this conversation, right? So the infection preventionists are the ones who are, you know, if you think about a hospital, there's a program for infection prevention at that hospital. There is someone who is tracking data on patient infections, there's someone who is tracking data on worker infections, and they are in charge of typically making sure that the right PPE is going places and they're in charge of making sure that the right signs are on the right doors and that the signs are clear on like what precautions the patient needs, because they have a C. diff infection, or they have measles, right, that there are different levels of precautions that need to be put in place, and that all staff who are around, and visitors, right, and other patients know what PPE you need to put on, what kind of room they need to be in, right? All the different pieces that go into that. And so that is one important perspective. But it's also important to recognize that those infection prevention managers, they're part of management. And so they have a budget, and they are making decisions on a daily basis about what is important enough to spend money on? And so that's their framing that they're coming in with. They have important expertise, right, but they're also coming in with that management orientation. And when you think about the evidence that really needs to go into, like how do we understand how infections -- infectious diseases are transmitted, right? Because there's been all of this clarity about how our current understanding, or our past understanding depending on where you're at in your process of updating it, this droplet/airborne contact paradigm for labeling how infection, infectious diseases are transmitted -- it's wrong, right? There's been all these articles, there's been all this historical research, clearly finding that it was based on an error decades ago, and has just been reiterated as truth because it's been repeated as the truth, and that we have to update that paradigm. And that's important because the way that infectious disease is transmitted determines what protections you get, right? A droplet transmitted disease gets different protections from an airborne transmitted disease, even though we now know that there's not actually a difference. There's not actually a distinct dividing line between droplet and airborne.
Beatrice Adler-Bolton 19:49
Can you actually -- do you mind elaborating also the transmission, because one of the big aspects that sort of we've been dealing with here is essentially the CDC is refusing to acknowledge airborne transmission in the way that the recommendations were delivered initially. And that's kind of one of the points that we're pushing on. And so I just want to make sure that if anyone's like new to this and hearing about this for the first time, that they're coming away super clear about what we mean when we say, you know, that the sort of paradigm and the understanding has changed?
Jane Thomason 20:19
Yes, definitely. So in the existing paradigm at the CDC, they understand pathogens that can transmit either through contact, right, where you touch a surface that's contaminated, and then you rub your eyes and then you can get infected with something, or droplets versus airborne. Droplet transmitted diseases the CDC understands to be transmitted through large respiratory droplets that you create when you sneeze or cough. And that those only travel up to three to six feet, you can wear a surgical mask, and that will be enough to protect you because it's only the large stuff. You're not really breathing it in. It's like, it's really kind of understood more as a form of contact transmission. It's like if someone sneezes in your face, then you're gonna get infected with whatever they have. You know, that's kind of the understanding of droplet. Versus airborne, which is really this like select category in the CDC's understanding, where only a few specific organisms are included. Things like measles, chicken pox, tuberculosis, where there has been extensive evidence showing what the CDC refers to as long range transmission where, you know, the famous study that really clarified for the CDC that TB, tuberculosis, is airborne, there was a hospital where researchers -- there was a TB ward. They put a cage of guinea pigs on top of the hospital and built special air ducts to duct air directly from the TB ward to the guinea pigs to expose them to that air, that contaminated air. And then they had other guinea pigs where the air was treated with UV, so they called it clean air. And they found that the guinea pigs exposed to the contaminated air from the TB ward got TB, and the guinea pigs that had the clean air didn't get TB. And so the CDC says oh, well, TB is airborne, you have to have a lot more precautions in place, you have to put a patient who has tuberculosis or measles in an airborne infection isolation room, that specialized ventilation that we talked about. Any staff that goes in has to wear a respirator. A surgical mask is not enough. You have to have a tight fitting respirator that is made to filter out any of those tiny particles that could be carrying infectious virus that you might be able to breathe in and that would lead to infection. And so that's really -- you know, that's how the CDC understands infectious disease transmission, and they divide --, there's really only select pathogens that get that airborne category, and everything else, so like all your respiratory infections -- influenza, RSV, your adenoviruses, your common colds, those all get put in the droplets protections, except that that's not actually based on the science. There are literally decades of research that have found that this idea of large versus small droplets, it just -- that's not reality. When someone sneezes, when they cough, actually, when they breathe, every time someone takes a breath, if they're infected with say influenza, or RSV, or COVID, that virus, that infectious virus is coming out in their breath. And is actually present in a wide range of particle sizes, both really, really tiny and really, really big. And you're like maybe thinking, well, why does the particle size matter? It matters because the smaller the particle, the farther it travels through the air, and the longer it stays airborne. And therefore, the more likely it is for someone else to come in contact with it. You know, of course, depending on a lot of other factors, like how good is your ventilation system, is the other person wearing a respirator, right, like all those other factors. And so when we understand that, right, there's this continuum, that means that -- really, it means that we need to drop this idea of droplet versus airborne and think of just one aerosol transmission category or transmission through the air. And that's actually an update that HICPAC is proposing, right? They're proposing to drop this droplet/airborne language and replace it with just one category of through the air transmission. But when it comes time to like, what are the prevention measures, what are the categories of precautions that are being recommended by HICPAC? That's where there's a breakdown. And we talked about this, I think, in the past, right? There's these three categories that they are newly proposing -- routine air precautions, which basically just tracks onto droplet, where they're saying, you know, we're recognizing that these pathogens transmit through the air, but a healthcare worker should wear a surgical mask to protect them, which is like -- it just does not -- that doesn't make any sense, right? If you're recognizing that something is an airborne hazard, then you need a respirator. That's the simple math of that.
Beatrice Adler-Bolton 24:58
Yeah. Surgical mask doesn't really help to block anything that's like floating around in the air, so.
Jane Thomason 25:04
It's not even manufactured to block very much. Most -- you know, there's a wide variety, but a lot of surgical masks, the filter material is only 20%, 30%, 50% filtration efficiency. And that is separate -- that's a separate measure from how tightly it fits to your face. Surgical masks are baggy, no matter how much you have looped the loops and tied the knots to make it fit your face better, it's still not going to have the face seal that an N95 or other types of respirators would have. And that is really -- you know, the air is going to go the easiest way around, which is around.
Beatrice Adler-Bolton 25:41
Mhm, absolutely.
Jane Thomason 25:42
Path of least resistance. And you asked about the data that kind of limits -- that HICPAC is relying on and sort of how that overlaps with the kind of understanding how the paradigm needs to be updated. And just to really briefly say that HICPAC asked CDC staff to conduct an evidence review for them. And this is actually dating back to 2022 when they started this workgroup. And they asked for that evidence review to look at the use of N95 respirators compared to surgical masks for protecting healthcare workers from respiratory infections at work. And when you look at that evidence review, it concluded that there was no difference between surgical masks and N95 respirators in protecting healthcare workers. But when you look at the actual like methodologies for the evidence review, when you look at the studies that they decided to include, and the studies that they decided to not include -- to exclude -- there are a lot of issues, right? They really -- they cherry picked the studies that didn't find a difference. They left out the studies that did find a difference. And there's not a lot of clarity from the CDC on exactly why they chose which studies they chose. There's just this general statement that they are prioritizing "real world evidence." But then they're not contextualizing that real world evidence with the fact that a lot of these employers -- you know, these studies that were conducted earlier in the COVID pandemic, right, 2020, 2021, there were a couple of studies, I think Loeb is the famous one, right, where he did a randomized controlled trial, where healthcare workers got surgical masks versus healthcare workers who got N95s, but then didn't really look at the issues around reuse of N95 respirators, the decontamination methods that employers were piloting at that time to reprocess used N95s and reuse them, you know? And the fact that like healthcare workers were not all fit tested for N95s, and that is a huge piece of making sure that an N95 is actually protecting you. And that, you know, OSHA requires respirators to be used within a respiratory protection program, which has a lot of different pieces to it to make sure that healthcare workers are trained on how to put on and take off respirators so that they fit appropriately, so that they protect them, and to know when a respirator is failing. And like none of that was really taken into account by the CDC as they were weighing this evidence. And we know that there were significant issues at the same time that a lot of their evidence was gathered, that likely impacted the effectiveness of the N95s, the protection that healthcare workers got. And so what the CDC is doing, right, is they're looking at this really messy data and they're saying it's the N95s that aren't working, instead of what they should be looking at is that the N95s weren't being used correctly. And so that's why they didn't see an impact.
Beatrice Adler-Bolton 28:44
Yeah.
Jane Thomason 28:45
Right. And so like, you know, I think it relates to what you were talking about earlier, you know, this I think intentional use of data to support what is clear from the workgroup meeting minutes, that they started with this orientation of trying to use N95 respirators less often in healthcare settings. That was one of their goals dating back. And we -- you know, we have those meeting summaries because of -- because of our advocacy, right, so hopefully that helps answer your question.
Beatrice Adler-Bolton 29:17
That was just so beautifully laid out. I really so appreciate it, Jane, I mean, just a wealth of information for people who are longtime COVID sickos and those who are new to this life, because I think one of the things that's really clear here is that the framework that we've been talking about now, and across three episodes, we've been pushing back on essentially the idea that the obligation to protect someone from COVID, right, sort of begins and originates in the self and it has no impact on the employer. And this is something we've covered on the show from actually a lot of different angles. We've gone in depth on this framing, on the CDC HICPAC guidance. For years, we've talked about the discourse around school reopenings and the ways that in that instance, you know, teachers unions were basically having their health bargained away, right? We had commitments to cleaning the air that were not fulfilled, and people were sent back to work anyways, right. And ultimately, we're looking at a very similar dynamic here to things that have been much more formal, like the legal decisions that we've covered out of the state of California where you have really high level court decisions weighing in on who should be liable if someone gets COVID at work and takes it home, infects someone at home and kills them, right? Like, can you actually hold the employer liable for that, for what they call a take home COVID infection. And in all of these instances, we're seeing a very similar shift, actually, even in the removal and the end of mask mandates. And one of the studies that wasn't included in the CDC's picture that they painted for HICPAC in this data, right, was stuff like Ellie Murray's study, that we've talked about with Murray twice on the show, which looked at not looking at the use of masking, but what happens when mask mandates end and masking is not only ended, but the language around the recommendations changes. And it goes from masks required to masks encouraged, and that that alone, the encouraged framework is not sufficient to achieve like the same level of benefit from masking, right. And part of that is about, you know, ultimately having a kind of majority of people reducing the amount of virus that they're either transmitting or breathing in. Because ultimately, as you were talking about Jane, you know, with masking, we're talking about not just like a -- it's not like a shield in a video game and nothing's getting in, right? Like, it's about dosage. It's about how much virus are you breathing in. Your immune system works the same way. There are thousands of viruses in every one of us right now, right? It's about what is the balance between how many virus cells are floating around and what is going on in your immune system, and does your immune system have sufficient numbers on its side to keep that under control. And the more virus you take in, the more likely it's going to go from having a lot of COVID virus in your system to becoming sick with COVID, right. And that's how we get sick. It's not like a kind of one time instance, like a sperm fertilizing an egg or something. This is about cumulative risk in terms of what air we're sharing, what we're breathing in, and how much virus is being released into that air. And what we're seeing over and over is essentially these moves being pushed further and further from the precautionary principle and further and further towards this very kind of individualistic framework of saying, you know, your employer's not responsible, your health is on you, you do you. And this is the sort of moment of individual choice and freedom. And it's one thing to frame that as autonomy, which it's questionable if that qualifies, right. But the -- you know, because of the ways that it excludes and sort of removes autonomy and choice from so many other people who would want to protect themselves. But, you know, ultimately, what is also going on is that this is about costs and burdens and benefits, right, and economic calculations in which every time workers and non-workers are losing out to managers, to the flow of capital, and to these kinds of ways that we've justified these things by looking very selectively at only certain evidence that's going to back up our desire to shift the pandemic response from a collective response to an individual one.
Jane Thomason 33:40
Yeah. And I think that that -- I think that's a really important point, that HICPAC and the CDC are really looking in this guidance to shift that responsibility for protections, right, for safety, from the employer, right, who owns and operates and controls the healthcare facility to those individual healthcare workers. And that that's just -- like, not only is that not appropriate, but it benefits the employers' profit, right, at the expense of those patients and those healthcare workers.
Beatrice Adler-Bolton 34:17
Absolutely. And I mean, I want to bring in real quick, there's actually a test that's been made by social scientists to test if something is policy-based evidence making, and I thought we could run through what those are really quickly and talk about how that maps on to these HICPAC recommendations as being an instance of what's called policy-based evidence making, which again is the idea of sort of marshaling research in support of predetermined policy goals. And this comes from a paper by Stephen McMillan that was in Journal of Policy Practice in 2012. And so these are -- these are six questions broken into two groups of three. And it's sort of, these are questions to test for policy-based evidence making. So the first one is -- the first three are concerned with policymaking like structure and context. So the first question is, how authoritarian is the policymaking structure? Now, do you feel like the CDC/HICPAC situation qualifies here? [Jane laughing] I mean, let's just think of things you've mentioned so far in this conversation. Oh, we know this because we hit them with information requests, you know, through the process, and now we know the minutes. And you know, this is a classic example of the kind of authoritarian policymaking structure.
Jane Thomason 35:40
Well, and they rejected our initial requests. We only got them to fulfill our requests because of public pressure. They initially rejected both our request under the Federal Advisory Committees Act and under FOIA initially. And yeah, the workgroup continues to be behind closed doors, right. To participate in a HICPAC meeting used to be -- well, I don't know, like you had to know the special spell to get in, and password, right? Like you had to sign up --
Beatrice Adler-Bolton 36:09
Yeah, it's private.
Jane Thomason 36:10
You had to sign up weeks ahead of -- this is a federal advisory committee, it's supposed to be public under the Federal Advisory Committees Act. You had to sign up weeks in advance. The deadline to register to comment was a week or two ahead of the meeting. And the agenda wasn't released until a day or two beforehand. You had to register to get the link to attend the meeting. And then you had to attend the meeting to get the meeting presentations. You couldn't get them afterwards. They were never posted anywhere, right. Like that used to be the case. Now, of course, because we have advocated here, the meetings are being live streamed and recorded and recordings are posted. And yes, I -- simple answer, yes, to question number one.
Beatrice Adler-Bolton 36:54
Alright, well, one of six.
Jane Thomason 36:55
I think HICPAC's process is very authoritarian [Jane and Beatrice laughing] -- or it has been. Has been. I think it's changing, right?
Beatrice Adler-Bolton 37:01
And alright, so we're one of six. Number two, in this policymaking context, are appeals made to politics as a rationale to do or not do something?
Jane Thomason 37:11
Are appeals made to politics?
Beatrice Adler-Bolton 37:14
Mhm, as a rationale to do or not do something. Now, in some ways, this question, I think, is really kind of pointing to guidance changes that are less about this HICPAC one, but more things that relate to probably interpersonal things within the workplace for nurses, right, where you have the sort of social pressure and the worries from employers that nurses are going to quit, right. And so we've seen some of these implications that because people have become so anti-mask, that in order to help people comply with recommendations, we need to simplify them. And that is used as a kind of stand in for what really becomes rolling back protections for the entire group of workers.
Jane Thomason 37:59
Yeah. Well, and I would actually say that CDC staff have been clear from the beginning that this was a political project. You know, they wouldn't use that language for it, but what they said as the reasoning for why they wanted to update the guidance was that they wanted it to be more user friendly, and they felt like they needed to have more flexibility and less rigid restrictions in their guidance in order to allow employers to be more responsive to conditions in the facilities. That was their reasoning from the very beginning. Not let's change the guidance to fix the problems that happened earlier on during the COVID pandemic response. Not to update based on decades of scientific research that have indicated that there are issues with the existing guidance and how it understands infectious disease transmission. It was about giving employers more flexibility and less rigid requirements.
Beatrice Adler-Bolton 38:59
Well, there you go. Alright, two of six. The third one is, in this policymaking context, are appeals made to time as a rationale to do something right away or to stop doing something right away. I mean, this is a classic when it comes to COVID. Because one of the frames that we see so often with regard to all sorts of guidance changes is, this is a different time in the pandemic. We're at a different time, and this time in the pandemic calls for X kind of response. Now, here's an example of that from defense of the COVID isolation guidelines that we're about to talk about, by Ashish Jha, Dean of Public Health at Brown University and former COVID-19 Response Coordinator for the White House. And in his defense of these guideline changes for not healthcare settings, but for the general public, which we're about to get into, he writes "Public health guidance has been confusing during the pandemic. It feels like it keeps changing, leading people to ask, is the science changing? Sometimes yes, our scientific understanding does change as we learn new things, but that's not the only thing that should drive our guidance. As population immunity grows, the benefits of avoiding infection by taking on high burdens wanes. And as the pandemic progresses, our guidance should change to reflect not just new science, but new realities of burdens and benefits." Which, you know, is essentially Ashish Jha saying, well, you know, we've gotten to this point where the costs of treating COVID as a problem that needs to be addressed via collective response no longer outweigh the benefits of that, being protecting people from infection. And ultimately, what goes unsaid and what I think is wonderful about this instance of the HICPAC recommendations, and the work especially that has been done to put pressure on them, which has resulted in even more concrete support for the fact that what we see here in the HICPAC guidance is really explicit concerns with the duration of the costs on the employer in this instance, and in a way that is forward looking, as you mentioned, you know, this is not just really kind of applying to COVID in the current landscape of diseases that we're talking about, there's also changes in this guidance that apply in a forward looking way, like we have to make this change now in case another novel pathogen comes that would require us to suddenly invest in more of these negative pressure isolation rooms, for example.
Jane Thomason 41:28
Yeah, and I think we've seen that kind of same rhetoric show up in HICPAC discussions. Their proposals last summer distinguished between pandemic phase viruses and seasonal or endemic phase viruses, specifically referring to influenza and coronaviruses - COVID. And saying that pandemic phase COVID should have an N95 respirator, whereas seasonal or endemic phase COVID should have a surgical mask for healthcare workers caring for patients with that infection. And so I think kind of that sense of -- you know, kind of arbitrary sense of time and risk has been at play here as well. Nothing changes about the science, nothing changes about how COVID transmits, whether we classify it as seasonal or pandemic phase, right. That's just rhetoric.
Beatrice Adler-Bolton 42:27
Right. What changes is who's responsible when you get sick.
Jane Thomason 42:31
Mhm.
Beatrice Adler-Bolton 42:32
Alright, so we're at three of six. The second domain of questions are about scientific evidence frameworks, and the sort of structure of scientific evidence. So the first one -- or so, question four is, do the policy question and empirical method chosen to investigate the policy question logically match one another? We were, in a way, just addressing this in terms of the RCT mention when we were talking about masking, but we didn't necessarily get into that totally explicitly. Can you talk about some of the mismatch that was going on in terms of what this preference for so-called real world evidence ultimately like works out in terms of influencing the kind of dynamics of where the citations are going, what's being cherry picked, and why?
Jane Thomason 43:16
Yeah. So we've seen this pop up in so many places, this like focus on "real world evidence". And I really, I don't know what they mean by that exactly because -- I mean, I do know what they mean, but like studies done in the lab are in the real world, like they have evidence that applies to us. Anyways, sorry, that's an aside. But yeah, so the CDC has been focused on what they're calling real world evidence. And what they are really focused on is limiting the body of evidence that they are obligated at evaluating to really just randomized controlled trials that are done in practice, like in healthcare settings and workplaces, in the field, right, like in "real life" and not having to look at -- and they're trying to not have to look at lab based studies, other kinds of methodologies that are not randomized controlled trials, that all of which can offer I think a lot of clarity, when you're trying to dig in and get an assessment of the whole body of scientific literature, it's important to actually have a lot of different types of studies to really help you get out what is the truth, what is background information, background noise, what is actually -- how is this effect actually tied to the variables that we're studying. Yeah, and when it comes to what HICPAC is really focused on, right, they started out with this -- and you can see it in the meeting minutes, right, they started out with this goal of using N95 respirators less often in healthcare, and delinking the use of N95 respirators from airborne infection isolation rooms. And when you look at the evidence, you know, we talked a little bit about the evidence review that the CDC did that HICPAC is looking at around N95 respirators and surgical masks, but you'll note that we haven't talked about an evidence review around say, the use of airborne infection isolation rooms, or the use of really ventilation as an important control measure in healthcare settings, right? We haven't talked about that. And that's because there hasn't been one. And so you know, HICPAC in their work group really made this decision from the beginning to not deal with ventilation. And that is not based on any evidence that they looked at. And I would say that that is a big piece of this question, like do the methods match the evidence reviewed? And no, right, because, really, we need to be looking at the evidence for multiple control measures, not just at the evidence for PPE. We need to be looking at the evidence from multiple control measures when we're creating this guidance. And I think that that is part of why -- sorry, just to go back to that kind of overall point on like what's next on HICPAC, I think that's an important part of why there needs to be more than just infection prevention perspectives in the room. That's why they need to have the ventilation engineers and the respiratory protection experts and the industrial hygienists, and you know, a couple of other types of public health experts in the room, because those folks can help understand what types of evidence need to be weighed, and how we need to weigh it so that we're actually ending up with guidance that's based on the best available science and that is protective.
Beatrice Adler-Bolton 46:42
So well put. And you know, ironically, you actually just answered the next two questions, which are essentially about sort of like, does the evidence that is needed to actually answer this policy questions support the policy? And is the evidence that's used and specified to support the policy, is that credible evidence to support it, which as we've just run through for the last, you know, the entire conversation now, ultimately what we have here is in the CDC/HICPAC isolation guidance, just a classic example of the policy leading the evidence and the harms that come to everyday people as a result of the priorities that get played out here.
Jane Thomason 47:28
Yeah. [laughing] It's just -- it's hard to use words to describe exactly how HICPAC is going about these updates. But we won, right? We got the draft sent back and I think that there is, you know, hope around what can come next. There's a lot of work to be done to make sure that what comes next is the right thing. But I think that there is some actual hope here.
Beatrice Adler-Bolton 47:57
Absolutely. And just again, for folks, do you mind us naming the link again, for this latest CDC letter on the NNU website,
Jane Thomason 48:06
Totally. So you can sign our petition to the isolation precautions workgroup, to make sure that what comes next is the right thing. You can sign that petition at NationalNursesUnited.org/CDC.
Beatrice Adler-Bolton 48:19
And now I want to move us on to our next topic, which again, you know, this is a separate piece of guidance that applies to a different arena, and that is the CDC guidance on isolation for people sick with COVID. On Friday, March 1st, the CDC abruptly announced an end to their recommendation that people isolate for five days after testing positive for COVID-19. Now, back in December of 2021, this guidance was cut from 10 days of isolation down to five days of isolation. So this is the second change to this policy. And back when the first change was made, the reasoning -- which was plainly stated by multiple administration officials at the time, the reasoning behind the shift from 10 to five days was not new scientific information, but was growing concern that so many people were becoming sick with COVID that it would impact the functioning of the economy to have this many people out of work at once.
Computer Generated Voice Over (UK Daniel) 49:20
NIH director Anthony Fauci, December 29th, 2021.
Clipped Audio, Anthony Fauci 49:25
The purpose of it was, is that given the wave, the extraordinary unprecedented wave of infections that we are experiencing now, and we'll certainly experience more of in the next few weeks, that there is the danger that there will be so many people who are being isolated who are asymptomatic for the full 10 days, that you could have a major negative impact on our ability to keep society running. So the decision was made, although it's not completely risk free, of saying let's get that cut in half.
Computer Generated Voice Over (UK Daniel) 50:01
CDC Director, Rochelle Walensky, that same day.
Clipped Audio, Rochelle Walensky 50:06
And then finally the behavioral science, what will people actually do when people need to get back to work? What is it that they will actually do? And if we can get them to isolate, we do want to make sure that they're isolating in those first five days when they're maximally infectious.
Speaker 1 50:18
So from what you're saying, it sounds like this decision had just as much to do with business as it did with the science.
Clipped Audio, Rochelle Walensky 50:24
[pause] Well, so, it --
Beatrice Adler-Bolton 50:27
And so the solution was to shift this policy from 10 days to five, which resulted, you know, ultimately, in a lot of people being pressured to go back to work sick, without the CDC guidance of the 10 days of isolation to back them up. That is, of course, if they had sick leave to begin with. And the lack of sick leave in the United States, where one in five people have no paid time off for illness at their job, was also a part of this and a part of the justification. So quite sickly, you know, it was even framed as a move by some people for equity. Since low wage workers tend to not have sick leave, some supporters of this change smugly insisted that this was about workers' rights, and, you know, the right to send low wage workers to work sick basically was what it was. And now we have, again, the second rollback of the very same isolation guidelines, which again, came down as a surprise basically, on March 1st. It had been initially reported in February, as I mentioned at the very top of the episode, by the Washington Post that this was being discussed as a change. And in that reporting was a really important detail. There were very few details that emerged, but one of the things that we did know was that the recommendations were being discussed for coming out in April. And it was stated that there was likely going to be that the plan was -- the plan was to have a period of public comment. Now, when this broke, it appears from follow up reporting that leadership at the CDC was pretty pissed. And then suddenly, on March 1st, with no comment period, a month early, surprise, here is the new recommendation, which is that they went from five days basically down to nothing. The official policy is now that someone who has been fever free without medication for 24 hours, and whose symptoms are improving, not gone, but improving, may return to school or work. The guidance also says that people who've returned to their regular activities should wear a mask for five days and basically puts this in line with RSV and the flu. Now, some reporting has referred to this also as a pan-respiratory guidance, which we'll get into hopefully. And NNU has come out condemning these recommendations and calling for similar transparency to be introduced into the process of these recommendations, like what we're seeing sort of in the HICPAC situation. So can you talk about, first, can you set this guidance apart from the one we've just been talking about, the difference between the isolation guidance, and essentially sort of this infection control guidance and sort of what are we talking about in terms of where these things apply? Because there's been a lot of confusion about, for example, if ending the isolation guidance is going to mean that now health care workers, for example, are going to be back at work with no time off for COVID?
Jane Thomason 53:21
Yeah, so thanks for asking that question. I think it's really important to distinguish these things. So what we were just talking about, HICPAC, right, the infection control guidance, that is about like infection control programs overall for a facility. So it's sort of disease agnostic, but also applies to all diseases. It's like how do you -- how do you place patients, how do you screen patients? Like it's really kind of big picture stuff. So it has impacts on COVID, but it's not just about COVID. Now, what the CDC did earlier this month, right, applies to public settings, and it actually doesn't apply to healthcare. So the healthcare COVID guidance is still in place. So if you have a healthcare worker who is exposed to COVID, they're infected with COVID, they still have to be out of work for 10 days. Or if they test negative by day seven, then they can go back to work wearing an N95. Patients in healthcare settings still have to be isolated for at least 10 days. And if patients are immunocompromised or have severe illness, then that can be a longer period, like 20 or more days, and there's special considerations for those situations. So you know, I think that if someone is concerned or asking the question, will this new CDC guidance from March mean that when I go to the doctor, the nurse who's coming in might have COVID or is going to be more likely to have COVID? The answer to that is no, right, because there are still these other longer timeframes in place for healthcare, for right now. And I would put an emphasis on for right now, right? Because, right, this -- kind of this core idea of what the CDC just did for public health guidance for COVID, to really try to link COVID with the flu and RSV, and other respiratory viruses, which is so misplaced, but we can talk about that in a moment, but that idea is also showing up in the HICPAC process, right? We're seeing it really become pervasive, this idea of trying to link COVID with the flu, and really equalize the risks, and therefore equalize the measures that we put in place to respond when someone has that infection. We're seeing it come up in both places. And so I do think that it is possibly a matter of time before we see a lot more of that idea of showing up in healthcare. And that's part of why we're really focused on this HICPAC fight is because we know we need to win it there in order to win it kind of across the board.
Beatrice Adler-Bolton 56:03
Absolutely. I really appreciate the way you set that up. And this is part of why I wanted to talk about this with you in particular, because what I think we're looking at is ultimately this HICPAC fight and many other fights around COVID are right now going to need to like spend a lot of energy resisting the normalization of the collapsing of COVID and the flu. As we've been talking about, this conflation has played a role in the kind of construction of the justification for these HICPAC changes for structural applications within hospitals, right? Controlling and shifting the ways that healthcare workplaces treat infectious diseases to reflect this conflation, right. And now what we're talking about in terms of these guidelines for isolation precautions, when someone tests positive for COVID, how many days do they need to stay home from work? This is really, I think, telling to compare and contrast what are the isolation precautions for healthcare workers? And also, what are healthcare workers doing in terms of how long they're isolating patients for when they're positive with COVID, right? To compare that with what workers in the general population, so to speak, who are in other industries, who are not in healthcare settings, and to see sort of through some of the justification for these isolation precautions in that comparison, right, because what we've been told in terms of the justification for the isolation change is that this is coming at a time when COVID related hospitalizations and deaths are trending down, they're making references to there being wide treatments available, there being a certain level of hybrid immunity, that Long COVID is decreasing, though there is not evidence of that, there is in fact evidence to the contrary of that, and that there's evidence -- for example, there's something that I was posting about this specific example on Twitter just earlier this week, you know, in the Long COVID section, which is two paragraphs, there is a claim made where they're essentially saying we've got evidence that Long COVID is prevented by vaccinations. And if you click through the citation there, the authors not only say in the conclusion to this study that the study should be used only for the purposes of trying to educate unvaccinated people as to the benefits of vaccination. And the study also details the fact that the evidence that it was looking at, it's a meta analysis, that the evidence, many of the sort of things that claim to be a meta analysis of COVID, Long COVID incidence and vaccination, to sort of look through those things, that they are compiling insufficient evidence, that at best they're not reliable and need to be confirmed, right. And so here we see again the kind of disconnect and the false assurance that's being delivered in the framing of the justifications, right, that ultimately covers over what we can see if you dig a little bit deeper to be quite clear and obvious, rather sloppy in certain cases, clear and obvious cherry picking, again, to sort of fulfill these prefigured policy goals by finding science that they feel like they can stretch to back this up.
Jane Thomason 59:38
And we've seen that happen so many times throughout the pandemic.
Beatrice Adler-Bolton 59:43
Well, and part of the justification is sort of that guidance needs to be simplified. And that's why the conflation is being made between COVID, RSV and the flu. Can we sort of talk through or maybe talk against, rather, that comparison and sort of, do you mind explaining for listeners why in particular this is not only wrong, but a dangerous precedent that's being set right now.
Jane Thomason 1:00:06
Sure. I think COVID -- we often talk about COVID as a respiratory virus, but it's not actually a respiratory virus, right? It comes with respiratory symptoms, but it's really a vascular virus. And there's a lot of scientists who have really tried to reframe our understanding of COVID as a vascular virus. It causes a lot of changes in many different organ systems in a way that other viruses like flu don't. They just don't. And I think for that reason alone, it is -- it's unscientific to really put -- try to put COVID in this respiratory viruses category. But even beyond that, you know, I think if you kind of look at the data, there is still higher mortality with COVID than with flu. Yes, COVID mortality is lower than it once was. But it's still really significant. Amongst people who are hospitalized, COVID carries a 60% higher risk of death than the flu. If you look at the general population, in 2022 to 2023, the flu season, which the CDC generally says runs from October to May, the CDC estimated that there were 21,000 deaths from flu in 2022 to 2023, versus 75,000 deaths from COVID during that same time period. You know, the CDC's data shows that COVID hospitalizations are still higher than the flu. And I think the really big piece for me is the issue of Long COVID. Flu can carry some post infection -- like long-term post infection impacts, but it is nothing compared to the issue of Long COVID. And I think the number of people who continue to experience really significant impacts in multiple different ways, right? If you think about having new onset diabetes after having a COVID infection, if you think about having a stroke after having a COVID infection, and you know, just thinking about that impact, we should not be equating COVID with the common cold, right? There are just so many risks that come with this virus, and so many risks that are elevated, that are escalated when you have more than one infection, that trying to equate the risk of COVID with the risk of flu is just -- is so misplaced, in terms of protecting public health and in terms of protecting individual health. If you want to take kind of the medicalized approach to public health that the CDC takes, it doesn't even make sense under that -- under that purview.
Beatrice Adler-Bolton 1:02:50
Absolutely. I mean, one of the things that I'd love to sort of maybe just touch on before we wrap out is that there's a comment from CDC director, Mandy Cohen, that during this process, that people who were immunocompromised, older adults and people who are disabled were "top of mind when we were putting together this guidance." She says "There are special considerations for those groups to help them protect themselves, and additional steps that we can take." Now, what do you feel like is really top of mind in a guidance change like this? Because from a base perspective, right, the changes that have been made have only made life more difficult for immunocompromised people, for older people, for people who are disabled, you know, this is again, sort of has compounding effects that layers on top of itself when we're talking about Long COVID, because we also know that, you know, study after study is showing that the more times you're infected with COVID, the higher likelihood it is that you're going to get Long COVID, the worse your Long COVID can become, the worse your other illness might become. People are being diagnosed with diabetes in significantly large numbers after COVID infections. I know a lot of people who have had issues with their thyroid after COVID infections, who have had heart attacks, who have had myocarditis. We're talking about yes, a slight reduction in the number of cases of MIS-C that we've seen in children. However, we're still talking about a significant number of children, in particular very young children and babies getting sick with COVID, being hospitalized, and some of them dying, right. And these kinds of burdens of disease, as they compound in particular in people who are considered medically vulnerable, it's very hard to imagine that any of these decisions had disabled people, immunocompromised people, older people, at top of mind. It did not have workers at top of mind. What, in your sort of -- from your perspective, do you feel like is really the sort of priority behind changes like this?
Jane Thomason 1:05:07
I mean, I think it seems pretty clear that corporate profits are the main concern behind changes like this. I think the CDC, when Mandy Cohen said that people who are immunocompromised, people who are over 65 years old were top of mind, she's referring to the fact that the guidance -- you know, they reorganized the guidance and have like all these different pages, right, where it's like, you know, steps you can take to protect people around you, like, if you do have COVID, or you think you might have COVID, test before you're around people who are at high risk, or wear a mask if you're going to be around people who are at high risk if you have COVID, or make sure you open the windows and have good ventilation if you're going to be around people who are at high risk. And that is -- I've heard people call that like a harm reduction approach. And I just -- I think that adopting that framework here is so misplaced, right? That like --
Beatrice Adler-Bolton 1:06:04
Offensive, yeah.
Jane Thomason 1:06:05
Right. Like you just -- you don't understand what harm reduction is. Like harm reduction is so important, like separate conversation, that is not a framework to apply here. Like you cannot reduce the harm from COVID. It is not -- it is not possible. Like if someone is infected with COVID, their body has changed forever. And we don't actually know what the long-term impacts of having one, two, five, ten COVID infections are going to be. We do know that we continue to see new variants popping up every few months, every few weeks, and that those new variants are not being recognized by our immune systems, right? We know that this virus has a high propensity for mutations to evade immune detection. And that means that we're going to continue dealing with it. And we don't know what the long-term impacts are. You know, there was a really great study that came out, I think, earlier this year that tied some conditions like Parkinson's to previous viral infections decades prior, right. And I think that that study just really underlines that we don't actually understand very much about how this virus is going to impact our health in the long term. And what we do understand, what we are coming to understand about it, how it impacts our health in the short term, over a year to three years, is not a good picture. And really not just in healthcare settings, but in public health, I think stronger protections are the way to go, because we need to keep protecting people from this virus. Not just people who are, you know, in a category that has already been found to be -- maybe a better way to say this is that anyone who has had a previous COVID infection should be in a category that is like medically vulnerable, is high risk for future -- for long-term impacts. Does that make sense?
Beatrice Adler-Bolton 1:07:59
Mhm.
Jane Thomason 1:07:59
I'm not sure I said that -- I said that super clearly, but --
Beatrice Adler-Bolton 1:08:06
No, absolutely.
Jane Thomason 1:08:03
We just need to shift our understanding of like who is actually at high risk here. And it's like, basically, it's what -- 95% of the population?
Beatrice Adler-Bolton 1:08:11
Yeah, I mean, I think that ultimately, what we've seen is a couple of sort of baseline, underlying assumptions that really drive a lot of these recommendations, right, which is that one, you know, high risk people aren't everywhere, that everyone who's high risk knows they're high risk, that the only people who are high risk are the people who already know they're high risk. That, for example, infections are benign, that in some cases, infections are good for you. You have people out there talking about building your immune system like a muscle, which is wrong. Let me tell you, as someone with an autoimmune disease, absolutely so fucking wrong. But you know, ultimately, what we're really seeing is this translation, again, of COVID into an individual problem. And I think, as you point out, ultimately, when we're talking about the effects of COVID, the unknowns with COVID, the fact that COVID has helped reinforce what should have changed decades ago with things like SARS and MERS, which started to provide some really interesting data on aerosol transmission and things like that, but COVID has really changed the game in terms of what we understand about disease spreading through shared air, through sociality, through the conditions of work, through sick buildings, right, buildings that don't have adequate ventilation, right. These are really important and powerful changes that all, most importantly, I think, if they were to be implemented, offer workers power. And what we're sort of seeing here is a very deep and desperate attempt to avoid anything other than a return to the kind of status quo, which ultimately, under the conditions that we are living under, in the circumstances of COVID absolutely need to change. But that status quo before normalized tens of thousands of deaths a year from the flu that weren't necessary, right, that normalizes rampant levels of in hospital infections, right. So we're talking about the demands that COVID places on us to respect the precautionary principle, to operate in response to the unknowns, not with that bias of saying, well no data means that we're good to go, right, that informs things like environmental policy often in the United States, where you see chemicals going out, because they're like, oh, we don't have data yet saying it gives people cancer, right. So you know, what we're really seeing is that ultimately, what COVID demands, right, would shift the status quo of how we thought about, how we prepared for, how we treat, how we behave when we encounter infectious diseases. And that's ultimately what's at stake in all of these recommendations is what is the responsibility that we have for one another? What is the responsibility that the state has for anyone's health at the end of the day?
Jane Thomason 1:11:12
Yeah, I think those are all really important points, that we should not just accept that a certain level of death due to infections is normal or acceptable. That, you know, I think, by pushing back on things like the HICPAC process and pushing back on other places where we see policy that is -- what did you say, policy-based evidence making? [laughing]
Beatrice Adler-Bolton 1:12:47
Yeah.
Jane Thomason 1:11:44
That that is how we can shift that, that that is really important to shifting this dynamic where, you know, in real -- in reality, like what is happening, not to put too fine a point on it, is that like our health, our lives are being sacrificed so that corporations can make larger profits. And really, that's what is happening in healthcare settings is that patients and healthcare workers, their lives and their health are being sacrificed. When an employer decides not to give N95 respirators, or when the CDC decides that you don't need an N95 respirator, you just need a surgical mask for COVID, that's what is happening. That employer is saving money on PPE. And it's the nurses, the other healthcare workers and the patients and their families who are paying the price. And ultimately, it's all of us, right? Because as you said earlier, Beatrice, those infections don't just stay in the hospital, don't just stay in the clinics. They also get carried out into the community.
Beatrice Adler-Bolton 1:12:48
Yeah, absolutely. And Jane, I so appreciate you coming back on to talk through all of this. This has been such a wonderful discussion, and I appreciate the work that you've been doing. And it's been so nice getting to know each other through such a frustrating situation. But I think it is so important to kind of always be refocusing on what is the -- what is the bottom line here. I don't think there is too fine a point that we can put on COVID, because ultimately, you know, what we're talking about is a long struggle that would benefit from more collaboration between nurses and patients, but that's happening in a beautiful way. And we're looking at this strategy that I think it's important to say, will not work, right? Like that the -- what they're trading our life and our health and our working conditions for, ultimately will not even achieve the goals that they want, right, which is to pretend like everything is normal and keep the economy running. The staffing shortages that are facing nurses, the staffing shortages that make care worse, right, that make work harder, that impacts everything else, right, these things are not solved by sending people to work sick, and what they're trying to do will not work. It's going to make things worse, ultimately, and I think that that's -- you know, at the end of the day, it's been -- it's been wonderful to see that enough pressure can actually force that point to make it into the conversation in such a closed black box like HICPAC.
Jane Thomason 1:14:13
Yeah. And I think -- I think you're exactly right, that it's when nurses and patients come together, it's when labor and community comes together, right, that we're actually able to make these really, really big wins. And that's what has happened at HICPAC. And I'm really optimistic about what we will be able to do next, because we are able to work together on these issues that impact all of us.
Beatrice Adler-Bolton 1:14:40
Well, to many more months of giving them hell.
Jane Thomason 1:14:43
[laughing] Awesome.
Beatrice Adler-Bolton 1:14:46
Jane, thank you so much. I really appreciate you taking the time to come back on. And I think that's a great place to leave it today. Again, my guest today was Jane Thomason. Jane is the lead Industrial Hygienist for National Nurses United,. And patrons, thank you so much for supporting the show. We'll catch you Monday in the Patreon feed. To support the show, become a patron at patreon.com/deathpanelpod. We are entirely funded by our Patreon support and couldn't do any of this without the amazing people who believe in us. So thank you all. And if you'd like to become a patron and get access to that weekly bonus episode that comes out on Mondays and the entire back catalogue of bonus episodes as a thank you for your support, you can go to 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 copies of Health Communism and A Short History of Trans Misogyny at your local bookstore, or request them at your local library, and follow us @deathpanel_. As always, Medicare for All now, solidarity forever. Stay alive another week.
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