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My waiting room was full when I saw the dreaded email from the host of a gathering I’d recently attended. Someone had tested positive for COVID-19. Instructions, passed on from the Department of Health, were clear. I had to leave.
But under Victorian guidelines, I was cleared to return to work the next day.
Sydney’s hospitals are under stress as staff isolate due to COVID restrictions. Credit:Kate Geraghty
With 2000 healthcare workers furloughed, the NSW government is considering easing isolation restrictions for healthcare workers identified as close contacts.
Although it can seem worrisome to allow healthcare workers back into high-risk environments early, with good guidelines and the right testing and PPE, Victoria has shown this can be done safely.
Over many waves of infection in Victoria, guidelines for healthcare workers have changed. We worked the second wave unvaccinated, in surgical masks alone. We saw outbreaks in hospital tea rooms and patients contracted COVID-19 from healthcare workers looking after them. Staff furlough stretched our services, but at least we were never one of those jurisdictions where healthcare workers had to work while actively sick.
Workplace exposures are now less of an issue – PPE and regular asymptomatic screening is mandatory for those working in high-risk environments. But as community cases rise, healthcare workers are also caught up in social exposures and potentially furloughed at rates that impact on safe service delivery.
In Victoria, with all healthcare workers vaccinated, increasingly with three doses, N95 masks freely available and normalised, and Rapid Antigen Tests part of the arsenal, our guidelines around furlough changed several months ago. Published in October in response to the widespread closure of GP clinics and healthcare worker furlough stretching clinical services, these guidelines have allowed healthcare workers to return to work earlier than previously allowed.
That afternoon, 2.5 days after my exposure in a social setting, I joined a priority queue for hospital employees and had my first PCR test within 15 minutes. I called the infection prevention and control (IPAC) department from the car before I drove home to isolate. They asked a comprehensive list of questions: what sort of gathering, how large was the venue, how long had I been there, was the case vaccinated, was I vaccinated and with how many doses, did we wear masks and what sort, was I fit-tested for N95 masks, had I been wearing one to work?
My first PCR test, priority processed, came back negative within hours. According to the Department of Health, I was now freed from isolation. But what to do about working as a healthcare worker in a high-risk setting, potentially with vulnerable patients?
The hospital IPAC nurse called back with a plan, based on these updated Victorian Department of Health guidelines. I could attend work but in a fit-tested mask and eye protection. I was obliged to wear this at all times. To eat or drink, I had to isolate myself, preferably outside. I was given a testing protocol – supervised rapid antigen tests in the hospital on certain days, and then a clearance PCR test at day six.
Although I had the privilege of an IPAC nurse to guide me through this process, these guidelines also apply to GP colleagues and other community-based healthcare workers. They tell me it’s easy to use and allows them to stratify the risk of any exposure, whether it occurred in the health care setting or in the community. Being a household contact is a significant risk and warrants furlough. The risk of being a casual social contact or after a workplace exposure are weighed up with many considerations, reflected in the questions the IPAC nurse asked me.
The various NSW Health Guidelines, published in December 2021, are not so different from the Victorian guidelines. Those working in infection prevention and control in both states have told me there’s always been wiggle room for a common-sense approach.
In NSW, guidelines have already changed in recent weeks to bring healthcare worker furlough in line with what’s already been happening in Victoria, though I’m told some health services in NSW have applied different standards to exposures in a social setting to those in hospital. The proposed changes are likely to standardise the risk assessments for these types of exposures. Further refinements are under discussion but will be consistent with what is happening in my state and with patient safety.
Dr Neela Janakiramanan is a reconstructive plastic surgeon.
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