Covid Infections Rise as OSHA Health-Care Inspections, Rule Lag

OSHA inspections of health-care facilities dropped by about 84% so far this year, returning to pre-pandemic levels as Covid-19 hospitalizations tripled over the summer and infections quadrupled among nursing-home workers.

From January through August 2023, the Occupational Safety and Health Administration inspected 159 nursing homes and 99 hospitals, according to agency data analyzed by Bloomberg Law. In the same period last year, the agency probed 915 nursing homes and 664 hospitals.

The decrease in inspections is compounded by the continued absence of a permanent Covid safety rule for health-care workers that OSHA can enforce. That rule, which has been stalled at the White House for nine months, could have mandated employers to have infection prevention programs for workers.

“Now that we’re seeing an uptick of Covid on top of surges in flu and RSV, that need gets greater every day,” Randi Weingarten, president of the American Federation of Teachers, which also represents nurses, said about OSHA’s delayed rule.

Covid Admissions, Illnesses Up

Covid cases among nursing home staff members have increased 397% from the year’s low point—1,644 cases the week of June 10—to 8,171 cases for the week of Sept. 10, according to the Centers for Disease Control and Prevention.

While the CDC doesn’t track Covid infection among hospital workers, it does report Covid hospital admissions. During the week of Sept. 2, 18,871 people with the virus were admitted to hospitals, up 200% from the record low of 6,315 set during the week of June 24. The record high was 150,674 the week of Jan. 15, 2022.

There hasn’t been a parallel boost in OSHA inspections.

Agency enforcement data show inspection numbers for nursing homes and general hospitals have returned to pre-Covid levels following a boost of inspections in the wake of the Omicron variant.

From June to August this summer, OSHA averaged about nine hospital inspections each month and 21 nursing home checks. Last year, it inspected an average of 47 hospitals and 51 nursing homes in each of those months.

In a written statement, OSHA said Covid continues to be a priority and that its national Covid emphasis program remains in effect.

“OSHA Area Offices continue conducting investigations in response to Covid-19-related complaints, referrals, and fatalities, and OSHA continues to require Covid-19-related recordkeeping and reporting in covered health-care industries,” the agency said.

OSHA inspections trailed off in 2022 after the Omicron variant faded as a health threat, and the agency finished reinspecting workplaces it had earlier checked. Attorneys representing employers generally saw the change as OSHA returning to its pre-pandemic inspection patterns.

The agency also had fewer Covid complaints to track down. For February 2022, the last month for which data is currently available, OSHA listed just three Covid complaints for all of New York and New Jersey, states that were the focus of its early pandemic inspections.

Worker advocates said OSHA need to do more.

“Without a Covid-specific standard or an infectious disease standard to protect them, OSHA should be using all other tools in its toolbox: targeted and ramped up enforcement of existing standards and getting into workplaces to see what’s not being done,” said Rebecca Reindel, safety director of the AFL-CIO labor federation.

Promises, Delays

The lack of an OSHA Covid rule has frustrated health-care workers.

“We need a standard to protect workers. We don’t know what is around the corner,” said Cokie Giles, a vice president with National Nurses United and an outpatient nurse at Northern Light Eastern Maine Medical Center in Bangor, Maine.

OSHA and the White House’s Office of Information and Regulatory Affairs declined to discuss the Covid rule.

The standard is meant to be the permanent follow-up to OSHA’s emergency temporary Covid standard for health care. The agency stopped enforcing most of the measure in December 2021 after missing a deadline to enact a permanent standard.

OSHA submitted the permanent rule last December to the White House’s regulatory office (RIN:1218-AD36). Since then, OSHA’s only update was an acknowledgment that it has reviewed the rule’s requirements in light of the Biden administration’s May declaration ending the Covid public health emergency as well as subsequent changes to CDC policy.

If the standard follows the outline of the temporary rule, it could require facilities likely to care for Covid-19 patients to have infection protection programs and track workers’ Covid-19 cases. The standard wouldn’t require Covid vaccinations.

Another possibility is that the rule would reference CDC guidance, allowing facilities in compliance with CDC recommendations to also satisfy OSHA requirements.

The long-term Covid rule, if finalized, could eventually be replaced by a broader OSHA infectious disease standard that would cover a wide-range of illnesses such as tuberculosis, measles, and methicillin-resistant staphylococcus aureus (MRSA), in addition to Covid-19 (RIN:1218-AC46).

OSHA is aiming for a March 2024 release of a notice of proposed rulemaking that would outline the rule’s options and invite comments. However, that goal could be delayed as agency’s staff also draft heat stress and health-care workplace violence regulations.

Health-care industry groups believe an OSHA rule isn’t needed because CDC guidelines and Centers for Medicare and Medicaid Services regulations already address Covid and other infectious diseases in their workplaces.

“Hospitals use CDC guidance, including during the Covid-19 public health emergency, to direct their infection control efforts and CDC’s guidance continues to be applicable even with the recent, slight increase in cases and hospitalizations,” said Roslyne Schulman, the American Hospital Association’s director of policy development.