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Comment by Nov 6 on HICPAC Infection Control Changes - It’s still urgent to send comments
Resources for writing a comment, selected comments from the HICPAC meeting, and our November 2nd protest.
It’s urgent to submit comments to help stop the CDC HICPAC steamroller! Deadline is 11:59 PM on Mon. Nov. 6, 2023 [EASTERN STANDARD TIME].
Although HICPAC voted, their draft must go through several further steps before CDC standards actually get revised. So it’s still vital to let CDC, the media, the healthcare industry, Congress and others know we’re watching – and, through each step of this process, to continue to voice our grave concerns about why the proposed guidelines are weak and dangerous.
⬇️ CONTENTS - See below! ⬇️
▶️ Some details on the HICPAC meeting and proposed changes.
▶️ Timeline: Nov. 6th deadline and beyond.
▶️ How to submit a comment to HICPAC.
▶️ Suggested points for your 1-page comment and more resources.
▶️ Some highlights from the public comments (video and text).
▶️ Some notes about our People’s Meeting Protest on 11/2. ❤️
➡️ The meeting and proposed guidelines
On Friday 11/3, ignoring the growing outcry from patients, healthcare workers, and public health experts, CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) voted to approve draft proposals to revise CDC guidance in numerous ways that would undermine long-standing infection control standards for hospitals, nursing homes, and all US healthcare settings. The draft guidelines would give employers great latitude on whether and when to implement or allow protections, and what type, saying, for example:
“During periods of higher levels of community respiratory virus transmission, facilities should consider implementing one of the tiers of source control…” [Emphasis added.]
HICPAC also ignored glaring evidence that COVID is infecting people in healthcare settings – including multiple cases described by those permitted to provide oral “public comment” during the HICPAC meeting. (Recordings of the 2-day meeting are on CDC’s Youtube channel for Thursday Nov 2, and Friday Nov 3.)
This great after-meeting overview from National Nurses United “urges the CDC to reject HICPAC’s draft” and start over, actively seeking input from health care workers, their unions, patients, and a much broader array of public health/science experts.
➡️ Timeline: Nov. 6th deadline and beyond
CDC is accepting written public comments through 11:59 pm [EASTERN STANDARD TIME] on November 6, 2023
The draft that HICPAC just approved is now being submitted to CDC for review. According to the HICPAC general review process, that “first” draft could soon (possibly very soon) be posted to the Federal Register for 60 days of public comments, including industry input. NOTE: If it is posted soon, much of the 60-day comment period would be during the busy holiday season when many people’s minds would be elsewhere – so we all need to keep a close watch and prepare to continue voicing our concerns again at every stage.
➡️ How to Write Your Public Comment
It is best to submit a personalized comment, possibly noting why this issue is important to you. When you have written your statement, email it to HICPAC at HICPAC@CDC.GOV. Per CDC, “All requests must contain the name, address, and organizational affiliation of the speaker, as well as the topic being addressed. Written comments should not exceed one single-spaced typed page in length.“
To add to your personal comment, feel free also to draw on / borrow from
some of the suggested points listed below
our previous recommendations for CDC / HICPAC
After you send it to HICPAC, please also consider sharing your comment to our People’s Register using our public comment form. HICPAC is taking comments by email instead of the traditional comment posting site, thus hiding public objection to the threatened changes. The number and content of so-called “public” comments won’t be public until the HICPAC meeting minutes are published. As a rejection of that practice, we will again post your comments on our People’s Register (Link is also available to share at linktr.ee/peoplescdc )
➡️ Suggested points to include in comments to HICPAC:
NOTE: The draft of revised healthcare infection control guidelines (24 pages) that HICPAC posted on 11/2, just before their meeting (and the 93-page HICPAC slide deck about it that the meeting focused on), do NOT reflect the edits made during the 11/2-3 meeting. Those changes can only be seen in the videos of the meeting. (The 2 documents are on this HICPAC page.)
If you’d like to make broad comments on preventing transmission:
The guidelines must fully recognize aerosol transmission of SARS-CoV-2 and establish rigorous protocols for preventing “transmission by air.”
Protocols must account for the science showing that each infection control measure is most effective when other infection control measures are also implemented in a layered approach to reducing transmission risk.
Much transmission is asymptomatic. Therefore, all precautions must be universally practiced at all times.
Healthcare settings are where high risk, disabled, and seniors will mingle with infected patients, visitors, and staff. Therefore, healthcare facilities and personnel should employ all precautionary strategies at all times.
The draft guidelines aim to maximize flexibility for healthcare employers, not protections for healthcare workers and patients. They allow employers broad discretion to choose, implement or restrict, their own infection control plans, which may be based on profit considerations or on prioritizing seeing “smiles” rather than infection control.
Healthcare providers complain of the cost of protective measures to stop transmission, but the US Dept. of Health and Human Services in 2016 deemed an intervention cost-effective if it cost less than $9.6 million per life saved [see, for example, pages 20 and 22 of the PDF file] – and does not weigh that cost against profits, nor should CDC.
The proposed guidelines currently call for varying levels of protection that depend on the level of “community transmission” of a pathogen, but for COVID in particular, those levels are largely unknown because there is now very little testing, wastewater monitoring, and tracking and reporting of cases and other data.
The HICPAC draft inappropriately shifts responsibility and risk to individual workers, focusing almost entirely on what should be the last layer of protection – personal protective equipment – while failing to set strong standards for other crucial tools such as ventilation, testing of patients and staff, and isolation.
Nosocomial COVID (transmitted in hospitals) has a 10 percent mortality rate – so it has proven deadlier and more dangerous than community-acquired COVID.
Letting COVID-19 infections run rampant will be more costly in the long run than providing N95s, fit testing, rapid molecular testing, ventilation, and isolation because widespread and repeated infections will disable countless workers in healthcare as well as other fields. Millions of Americans already suffer from Long COVID.
If you’d like to comment on specific layers of protection:
Universal masking is necessary to make healthcare settings safer for all, and more accessible to people especially at risk.
HICPAC’s deceptively-named “Enhanced Barrier Precautions” scheme would radically weaken barrier precaution standards for nursing homes and potentially other health care settings, letting patients with Candida auris or MRSA interact with other vulnerable patients without restriction, and letting un-gowned staff work with infected patients and thus the staff could then spread dangerous pathogens widely.
Surgical masks are not adequate to protect against airborne pathogens, including SARS-CoV-2. N95 respirators or better should be the standard of care, and healthcare employers must not prohibit workers or patients from using them.
All healthcare personnel should be tested for COVID-19 regularly and for RSV and flu regularly during peak season.
Personnel who are infectious must be supported with paid leave, or where appropriate, remote work, and allowed to stay home until symptoms improve and testing is negative.
Facilities should implement minimum indoor air quality standards that have been set by The American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) to control infectious aerosols in all healthcare settings.
HICPAC’s proposal would reduce use of an essential tool – negative pressure rooms – for MERS, SARS-1, and SARS-CoV-2, though all are very serious airborne infections.
Vaccines reduce BUT DO NOT STOP transmission of aerosol-transmitted infectious diseases.
Hospitals and healthcare systems should provide free vaccination and boosters for staff, patients, and visitors.
Hospitals and healthcare systems should require staff to be up to date on vaccinations (based on ACIP schedules) for all aerosol-transmitted infectious diseases.
If you’d like to comment on HICPAC process for updating guidelines:
As the nurses union is urging, CDC should reject HICPAC’s draft and “actively engage the input of frontline health care workers, patients, and public health experts in developing a new draft” including holding public meetings (in a process similar to the meetings held in 1992 to help develop guidelines on control of multidrug-resistant TB).
HICPAC cannot develop appropriate guidance now, as it has no members expert in several crucial fields such as occupational health and safety, engineering for clean air, aerosol science, industrial hygiene, and respiratory protection. It needs such members.
HICPAC made a show of accepting public comment on 11/2-3, but only posted its preliminary draft online on the morning of 11/2. It must make any draft guidelines available for the public for much more extended review before submission to the CDC.
CDC and HICPAC should make the process for updating guidelines fully open and transparent.
Final guidelines should include an attachment that lists the public’s comments, and why each one was or was not adopted, with references to scientific evidence.
When you finish submitting your comment, please encourage your friends, colleagues and relatives to comment as well.
Thank you for working to help make healthcare safer for everyone.
➡️ ADDITIONAL RESOURCES
HAVE YOU WRITTEN OFFICIALS WITH THESE RELATED LETTER CAMPAIGNS? Do it often!
A FEW RELATED MEDIA ITEMS:
Nurses union (11/3, after HICPAC vote): National Nurses United (NNU) condemns CDC committee for voting to finalize draft infection control guidance for health care settings
CNN story (11/2): Under cloud of scrutiny, CDC advisers meet to revise infection protections for health care workers - “Dr. David Michaels, an epidemiologist and professor at [GWU] School of Public Health, said the new guidelines should have benefited from all the knowledge about the transmission of respiratory infections gleaned during the pandemic. Instead, he said, ‘this is going backwards.’”
Dr. Judy Stone in Forbes (9/30), on masking (and ventilation) in hospitals
➡️ The Public Comments
ORAL PUBLIC COMMENTS AT 11/2-3 HICPAC MEETING
CDC HICPAC Meeting November 2 2023 - YOUTUBE LIVESTREAM (public comments start around 6:13:00)
CDC HICPAC Meeting, November 3 2023 - YOUTUBE LIVESTREAM (public comments start around 1:44:00)
Kevin Kavanagh, MD, MS - Health Watch USA
“This week’s CDC decision regarding new infection control guidelines will be nothing short of life changing for those who work in or frequent a healthcare facility. Granted the guideline needs to be published in the Federal Register, but if the CDC does not change course after the deluge of common-sense criticisms, it is doubtful the CDC will after publication.
The current CDC draft guidance appears to be conflicting and in some places in error: -- The CDC is giving approval for the use of Surgical Masks to prevent the spread of Airborne Pathogens such as seasonal influenza and coronaviruses. Surgical masks are not designed to stop airborne infections. -- The CDC is not routinely recommending the use of negative pressure rooms for MERS, SARS-1 or, SARS-CoV-2. -- And with Enhanced Barrier Precautions the CDC is allowing those with Candida auris to wander around a facility and at the same time the CDC is warning of dangerous outbreaks of Candida auris. There is also lack of provisions for air quality standards, such as ASHRAE Standard 241 for the “Control of Infectious Aerosols," and a lack of provisions for screening of these pathogens.
The back peddling of standards has often been justified by the imposed “burden” preventive strategies would place on facilities. However, the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, considers an intervention cost effective, if the cost is less than 9.6 million dollars per life saved. The Office does not measure burden in relationship to C-Suite and CEO salaries, or investor profits, nor should the CDC.
The proposed standards will also place the safety of immunocompromised individuals in healthcare settings at grave risk. This concern was further underscored by the findings of the recent INFORM and EPOCH research initiatives. The EPOCH study concluded that “Immunocompromised populations appear to be at substantial risk of severe COVID-19 outcomes” and that “Effective prophylactic options are still needed for these high-risk populations.”
For the immunocompromised the status quo is unacceptable, and weak[en]ing current regulations will result in a “direct threat to their safety and wellbeing and does not maintain accessible features for safe and adequate access to a facility as required by the Americans with Disabilities Act. The CDC must be “mindful of the provisions of the ADA and the impact their recommendations will have on vulnerable individuals and healthcare workers, along with patients who are experiencing reduced access to healthcare because of unsafe healthcare environments.”
Mary Jirmanus Saba
“I am a political economist and member of the People’s CDC. Before today’s meeting, HICPAC got 600 pages of written comment on proposed changes to infection control guidance. The drafts you are voting on do not reflect any of that feedback, and thus you must postpone today’s vote. Much of the public comment describes jarring and unsafe experiences of healthcare workers and patients, and actual harm – patients who sought healing at a healthcare appointment but instead contracted COVID or RSV. Patients whose healthcare providers denied reasonable accommodations requests and refused to mask. The People’s CDC, a volunteer-run CDC watchdog and public health advocacy group, has received dozens of such complaints. Some said their healthcare employers even refused to allow them to wear N95 masks to protect themselves. Many complaints came from patients and workers at Massachusetts General Hospital, Dr. Shenoy’s employer – people stating that their federally guaranteed right to safe medical care is being violated. This situation stands to get drastically worse if you continue with these weakened recommendations.
American Hospital Association reports hospitals are experiencing “crushing financial challenges,” In a brief, Sourav Bose, Serena Dasani from Penn’s Leonard Davis Institute of Health Economics, demonstrated that hospitals lost a lot of money due to postponed elective procedures for covid positive patients while hospitals were still required to test patients on admission. The April 5 Boston Globe reported Massachusetts hospital administrators lobbied the DPH to get rid of masks. So, before the CDC changed guidance on masking in healthcare last year, did hospital administrators email Rochelle Walensky just like the CEO of Delta and say “hospitals are losing money — please loosen the rules on preventing Covid and other aerosol transmitted viruses in healthcare? In making these new recommendations, are HICPAC and CDC prioritizing hospital profits over our safety?
Whatever is happening, the consequences of continuing down this path are dire: they empower anti public health forces. Just this past week, the US Senate passed a resolution to ban mask mandates on public transport. Several democrats supported it. If it becomes law, and if we get another novel deadly virus aerosol-transmitted, states cannot mandate masks. Are they going to ban healthcare masks next? You can still do the right thing: delay the vote. Incorporate our comments and base your recommendations on peer-reviewed evidence rather than vague and undefined “expert opinion” which conveniently overlaps with healthcare management priorities. Recognize aerosol transmission and recommend n95 respirators or better for healthcare workers accordingly, recommend upgraded standard ventilation and core control isolation protocols. Make universal masking the new standard of care year-round. Include occupational safety, healthcare union representatives and patient safety groups as voting members of HICPAC. You can still do the right thing, and do no harm. You can and must control and prevent disease. It’s literally the CDC’s mandate.”
Note: The letter to Walensky mentioned above is the letter from Delta Airlines to the CDC Director in December 2021 that immediately preceded the CDC’s announcement of shortened isolation guidelines.
“Why is it that I have to continually ask about safety precautions when I need healthcare? I’m continually hit with the canned answer from healthcare providers saying that oh, they follow recommendations and guidelines, and then basically say they don’t have to prevent infection or protect me, but hey you can mask if you wanna. I wrote to the CEO of Geisinger requesting ADA accommodation, and in his response he seemed more concerned with quote “patient experience” than he was about infection control. The response from the patient liaison also just repeated that they follow federal law and guidelines and that people who are actively sick are required to wear a mask.
The message I’m getting is that they’re not gonna do anything to stop transmission unless forced. The whole point of healthcare is to stop disease. I don’t want to get covid FROM going to the doctors. So is it about the money and the healthcare corporations wanting to just half ass it on the cheap? Because I can’t help but notice that the HICPAC committee has fancy people from highfalutin corporate executive positions, and NO PATIENT ADVOCATES. It’s been suggested this isn’t legal and might even render the committee’s recommendations null and void.
I can’t believe in 2023 we’re being forced into infection because the CDC has decided to adopt Brownstone Institute dark money connected people putting out PR publications that they call a meta study - a study that’s been widely debunked and lambasted. And this seems in order to not protect workers or patients. Right-wing anti-mask covid contrarian think tanks shouldn’t be dictating my healthcare and the working conditions of healthcare workers. The American people voted out the maga scott atlas great barrington declaration herd immunity garbage. I expected better from the Biden administration.
This whole process needs revamping because the so called experts involved are bizarrely disconnected from reality.
And I am not alone in these frustrations. Today I went to an impromptu online demonstration announced just last night about covid transmission in healthcare. This event attracted a couple hundred people at noon on a Thursday. And several people who spoke at this event repeated the same experiences and concerns that I’m running up against and that you’ve heard in previous comments to this committee. Healthcare providers putting them in danger and giving them covid, it’s unacceptable. We are not alone. Read the room. People want masks in healthcare settings.”
❤️ VIRTUAL PEOPLE’S MEETING ON NOV. 2 ❤️
Thanks to all who joined our Nov. 2 virtual protest about HICPAC on just a day’s notice – and apologies to many of the ~250 registrants who could not get in! You can watch the recording here. We hope our widely-shared grave concerns expressed there, and the resources above, help inspire more people to submit a comment (or an additional comment), to encourage others to do so, and to follow this process closely.
This virtual protest was a response to the Nov. 2-3 HICPAC meeting.These meetings are supposed to be publicly accessible and open to public feedback. The HICPAC meeting from June was broadcast on zoom with an open question and answer period. The meeting in August was broadcast on zoom, but restricted commentary to 14 individuals. The Nov. 2-3 meeting was viewable only on youtube live, with no public Q and A access, and HICPAC only allowed oral comments from a few pre-selected individuals who submitted requests to comment in advance.
One sign of HICPAC members’ lack of true interest in outside input is that they ended their discussions Nov. 3rd BEFORE the oral public comment period. Similarly, they scheduled the Nov. 3rd vote to send draft guidelines to CDC for review only 1 day after the discussion draft was posted online, and only 2 days after they began accepting written public comments.
Note that though CDC announced that the HICPAC meeting would be teleconference only, the HICPAC members were all seated in person in a location that was not disclosed or open to the public for in-person comments. This strategy was presumably to dissuade protest of their increasing hindrance of oversight.
We hope the widely-shared and very serious concerns expressed at our virtual “People’s Meeting” help inspire more patients and concerned family members, healthcare workers, public health experts and others to submit comments (even a 2nd comment!) and to encourage others to comment – and to follow this process closely in coming months.