Weekly Review: Ethics, Law & Policy – Staff, Stuff, Space & Systems – September 28, 2020

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Weekly Review: Ethics, Law & Policy – Staff, Stuff, Space & Systems – September 28, 2020

Weekly Review: Ethics, Law & Policy – Staff, Stuff, Space & Systems – September 28, 2020

Testing

This CDC MMWR analysis provides data on the impact of preemptive testing of residents and staff members in long-term care facilities (LTCFs) to prevent COVID-19 outbreak. LTCF residents have been and remain at especially high risk during the pandemic due to age and prevalence of comorbidities, as well as frequent contact with health care providers. This analysis focuses on the timing of COVID-19 testing and its ability to identify asymptomatic and presymptomatic infections. In the county studied, 15 LTCFs performed facility-wide testing following identification of a case and found high prevalence of additional cases among residents (28.0%) and staff (7.4%). In comparison, 13 LTCFs conducted testing prior to identification of a specific case and found significantly lower prevalence among residents (0.5%) and staff (1.0%), indicating that facility-wide preemptive testing may help prevent potential outbreaks by enabling earlier discovery of asymptomatic or presymptomatic individuals and facilitating additional control measures and strict adherence to prevention and control recommendations.

Health Care Workforce

This article by Johnson et al. addresses the intersections of health equity and the nurse practitioner workforce, with a particular focus on awareness of and action to respond to the disproportionate impact of the pandemic on Black Americans. The article draws attention to the role of implicit racial bias among health care providers in perpetuating health disparities through poor quality of care and calls for frontline NPs and other health care professionals to approach practice with a health equity perspective. The authors offer several specific recommendations at the individual and organizational level. Individually, they recommend that NPs address and mitigate their own bias, look for and eliminate bias in documentation, and incorporate concepts in preceptorship. Organizationally, they recommend significant bias and structural competency work, institutional policy development, workforce diversification, and patient education and empowerment.

This CDC MMWR update tracks the characteristics of health care personnel (HCP) with COVID-19. According to the data, HCP cases overall were most frequently reported among females and those working in nursing and residential care facilities. HCP with ultimately fatal cases were more likely to be male, be over age 65, report race as Asian or Black, or have an underlying medical condition among those on the report form (e.g., cardiovascular disease, chronic lung disease, or diabetes mellitus). These data generally support the importance of continued surveillance of essential health care workers and the necessity of providing appropriate access to PPE, and they are helpful in assessing plans for continued testing protocols and future vaccination allocation strategies. These data should also be interpreted in light of other indications that asymptomatic and pre-symptomatic transmission is a significant contributor to transmission, including among health care workers, as discussed in this article by Stock, et al.

Disparities

This CDC MMWR data from Utah adds to the substantial body of evidence that COVID-19 continues to disproportionately affect socially disadvantaged groups. In addition to disparate impacts on racial and ethnic minority populations and among those in roles as essential workers, this data points to additional and intersecting inequities due to geographic social and economic deprivation. In these data, odds of infection were two times greater in high-deprivation areas and three times greater in very high-deprivation areas, and odds of hospitalization also increased with level of deprivation (though to a lesser extent). Indicating the intersections of these sources of inequity, these areas also tended to be characterized by a larger proportion of Hispanic and non-white residents, persons working in manual, essential, and public-facing sectors, more crowded housing, and persons with food and health care insecurity. Mitigation strategies and resource allocation plans must account for these disparities to ensure that those who are disproportionately affected by the pandemic receive fair allocation of resources to address its impact.

|2020-09-28T08:22:21-04:00September 28th, 2020|COVID-19 Literature|0 Comments

About the Author: Daniel Orenstein

Daniel Orenstein
Daniel G. Orenstein, JD, MPH, is Visiting Assistant Professor of Law at the Indiana University Robert H. McKinney School of Law in Indianapolis. He teaches in the areas of administrative law, public health law, and health care law and policy. His research focuses on public health law, policy, and ethics, and he was previously Deputy Director of the Network for Public Health Law Western Region, where much of his work centered on emergency preparedness and response, including resource allocation and government authority during declared emergencies, as well as vaccination policy.

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