States must step up to protect health workers
The federal government’s response to COVID-19 has been haphazard, mismanaged and ultimately deadly. Yet the Trump administration is trumpeting the country’s “success” against the pandemic, with the vice president recently declaring that the U.S. response to COVID-19 is “cause for celebration.”
As doctors, we are not celebrating. With more than 125,000 people in the United States dead from COVID-19 and new cases climbing in a majority of states, this is no time to let down our guard. And while the issue may have faded from the headlines, health workers in many parts of the country still lack personal protective equipment. Doctors’ and nurses’ pleas for masks and gloves may no longer be trending on social media, but the nationwide PPE crisis persists.
We have seen colleagues and friends forced to make impossible decisions — putting their own lives at risk to care for COVID-19 patients because they didn’t have the proper protective equipment. Some health workers have lost their jobs for speaking out about these shortages. The danger is real: At least 939 health workers have died of COVID-19 in the U.S., according to National Nurses United, and this is likely an undercount. These deaths were largely preventable.
Whether we’re still in the first wave of COVID-19 infections or preparing for the second, this much is true: We cannot abandon medical workers again by not providing the protective equipment they need. But to date, the federal Occupational Safety and Health Administration (OSHA) has only issued voluntary worker-protection standards in health care settings. This leaves these standards unenforceable. Many complaints about potentially life-threatening safety issues have gone unaddressed.
With the Trump administration attempting to simply wish away the pandemic, it’s again up to the states to shape the next phase of our response to COVID-19. Crucially, this includes a responsibility to protect the health workers on the front lines in the weeks and months ahead.
This is why thousands of health professionals, including our organization, Physicians for Human Rights, are calling on governors in all 50 states to exercise their authority to protect front-line health workers during the pandemic. That means setting clear and enforceable workplace safety standards and mandating the provision of personal protective equipment. Governors should also enact clear standards for social distancing and hygiene measures, and enhance whistleblower protections.
This week, Virginia proposed the country’s first-ever pandemic emergency workplace safety standards — the clearest signal yet of OSHA’s neglect of its duty to protect health workers. The new state regulations are expected to include mandatory guidelines for PPE, sanitation and other workplace safety guidance, as well as protections from retaliation for health workers who speak out about safety concerns. This is an encouraging development, but whether it will save lives depends largely on the state’s enforcement practices.
Some states, including Maryland and New York, have OSHA-approved state plans that meet or exceed national standards. That means they can impose stricter safety rules in public health care facilities and in some cases, private ones, too. In places where there is no state plan, governors and state legislatures must step in and institute emergency standards for worker safety and enforcement that go beyond OSHA’s voluntary measures. OSHA’s nonenforceable standards currently set a very low bar for health worker safety during a pandemic. The states aiming higher will save lives.
Given these gaps, it is crucial that Maryland Gov. Larry Hogan, a Republican, and New York Gov. Andrew Cuomo, a Democrat, the chairman and vice-chairman, respectively, of the National Governors Association, exercise their leadership to push for universal protections for health care workers across the nation. States can look to the California model, where there are standards set and generally enforced by the state for social distancing, face masks, hand sanitizing, washing and gloves. California also boasts regular workplace disinfection, increased ventilation and notification of infections.
Beyond passing new standards, it is essential that states enforce them. Once issued, relevant state agencies should be mandated to enforce standards under their own authority. States’ attorneys general should likewise be mandated to enforce these standards through the courts. States should also not overlook the critical importance of protecting health workers from discrimination or dismissal for speaking out in the face of dangerous conditions. Likewise, health workers should not face retribution for bringing additional personal protection to their jobs when employers are unable to provide adequate PPE.
As physicians, we know the U.S. is still facing the biggest public health emergency in our lifetimes. The leadership of governors across the country has been vital in mitigating an even deadlier disaster. As we enter the fifth month of the coronavirus crisis, state-level leaders must rise to meet the moment. That means protecting the health workers who protect all of us.
Michele Heisler is medical director at Physicians for Human Rights and a professor of internal medicine and public health at the University of Michigan. Ranit Mishori is senior medical adviser at Physicians for Human Rights and a professor of family medicine at Georgetown University. This was first published by Bloomberg Opinion.