California Nurses Know Your Rights: Protections at Work for COVID-19

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COVID-19 cases have risen in California over the past few weeks and now community transmission is occurring. It is of the utmost importance that hospitals and other health care facilities take immediate action now to ensure all precautions and protections are in place to prevent further spread.
 
It’s the Law: Your Employer Must Protect You
 
California law requires that hospitals and other health care employers have the following protections in place for COVID-19:*
  • Screening protocols to identify patients who may have COVID-19 infections.
  • Plans to ensure prompt isolation of patients with suspected or confirmed COVID-19 infections in negative pressure isolation rooms.
  • Protective PPE for nurses and other health care workers providing care to patients with suspected or confirmed COVID-19 infections. Cal/OSHA is clear that airborne and contact precautions are required for patients with suspected and confirmed COVID-19.
  • If a nurse or other health care worker is exposed to COVID-19, the employer must notify the employee in a timely fashion and ensure precautionary leave for at least 14 days (paid).
  • And more: See the full Aerosol Transmissible Diseases (ATD) standard here.
* These requirements are in Cal/OSHA’s Aerosol Transmissible Diseases Standard. See Cal/OSHA’s guidance on COVID-19 at https://www.dir.ca.gov/dosh/Coronavirus-info.html. Full standard at https://www.dir.ca.gov/title8/5199.html.
 

How to Understand the COVID-19 Tests… and Using the Nurses’ Precautionary Case Definition

There have been many reports of issues with COVID-19 testing, including delays in testing for nurses and other health care workers who have been occupationally exposed (read the statement by a quarantined nurse)
 
Here are three things you need to know about the COVID-19 test:
 
1. The test for COVID-19 is an RT-PCR test (that’s a reverse transcription-polymerase chain reaction test). It tells you whether there are enough viral particles present in a sample to register as a positive result. And the Centers for Disease Control and Prevention (CDC) has not yet released the necessary information (sensitivity and specificity) for us to understand how well this test works.
 
2. A negative result does not necessarily mean an individual does not have COVID-19. A recent study found that 48% of patients with a negative COVID-19 PCR test were considered highly likely cases based on chest CT findings.i See this article for a report of a patient who tested negative twice before a third test later recorded a positive result.
 
3. A more protective way to implement precautions is to use the nurses’ precautionary case definition, based on the precautionary principle:
 
The following case definition is proposed. This definition would be more protective than the CDC’s current case definition.
 
Suspected: Any patient with symptoms of respiratory illness should be considered a suspected COVID-19 case.
 
Probable: If the patient tests negative for influenza and other respiratory viruses, s/he should be considered a probable COVID-19 case.
 
If the patient has clinical symptoms that match the characteristics of COVID-19 cases, s/he should be considered a probable COVID-19 case regardless of test results.
 
Confirmed: If the patient tests positive for COVID-19.
 
Any suspected COVID-19 case should be investigated further, and all protections and precautions taken until ruled out.
 
All protections should be implemented for any probable or confirmed COVID-19 case. This also means that precautionary leave (minimum of 14 days) should be implemented for any nurse exposed to a probable or confirmed COVID-19 case. For more information visit: https://www.nationalnursesunited.org/covid-19
 
i Ai, Tao, Zhenlu Yang, et al. “Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases.” Radiology, Feb 26, 2020. https://pubs.rsna.org/doi/full/10.1148/radiol.2020200642