2021, Vol. 1 (S5) 15-17 https://doi.org/10.47488/dhrp.v1iS5.39 http://dhrproceedings.org 15 © DHR Health Institute for Research and Development COMMENTARY Growing Shortage of Healthcare Workers Poses an Existential Threat to the Public Health System Strategies to Mitigate this Challenge in the Face of COVID-19 Pandemic Sohail Rao, MD, MA, DPhil1, 2 and Manish Singh, MD, FACS3 1 Executive Vice President, DHR Health, 5501 S. McColl Road, Edinburg, Texas 78539 and President & Chief Executive Officer, DHR Health Institute for Research & Development, 5323 S. McColl Road, Edinburg, Texas 78539. ORCID: https://orcid.org/0000-0001-5027-9992 2 Correspondence should be addressed to: Sohail Rao, MD, MA, DPhil., DHR Health Institute for Research & Development, 5323 S. McColl Road, Edinburg, Texas 78539. Tel: (956) 362-2387. E-mail: s.rao@dhr-rgv.com 3 Chief Executive Officer, DHR Health, 5501 S. McColl Road, Edinburg Tx 78539 and DHR Health Bariatric & Metabolic Institute, 5500 Raphael Drive, Edinburg, TX 79539 ORCID: Manish Singh: https://orcid.org/0000-0003-4146-3282 Received 12/27/2021 Accepted for publication 12/29/2021 Published 12/29/2021 Keywords: COVID-19; SARS-CoV-2; Omicron variant; CDC: Centers for Disease Control and Prevention; FDA: U.S. Food and Drug Administration; EVUSHELDTM The growing shortage of essential healthcare workers has been a chronic challenge worldwide. The COVID-19 pandemic has exacerbated this challenge and has undermined the ability of many health systems to continue to offer optimal and timely clinical care to its patients. Many factors are responsible for this outcome not to mention the aging healthcare workforce, early retirements due to the COVID-19 pandemic, mental and physical exhaustion, lack of strategic planning for workforce retention, and national and international mobility (1-3). Collectively, these factors have created an ambiguous future and a precarious disproportion between the demand and supply of essential healthcare workers. The burgeoning primary and breakthrough infections with Omicron variant of SARS-CoV-2 has placed yet additional burden on the healthcare system and its frontline workforce. Recognizing this advancing catastrophe, the Centers for Disease Control and Prevention (CDC) recently forwarded some guidelines to help assuage the same (4). At the core of these guidelines was the understanding that healthcare organization will:  Ensure any COVID-19 vaccine requirements for HCP are followed, and where none are applicable, encourage vaccination, including booster dose, as recommended by the CDC (5)  Understand their normal staffing needs and the minimum number of staff needed to provide a safe work environment and safe patient care under normal circumstances https://orcid.org/0000-0001-5027-9992 mailto:s.rao@dhr-rgv.com https://orcid.org/0000-0003-4146-3282 DHRP, 2021, Vol. 1 (S5) 15-17 Shortage of Healthcare Workers: Strategies to Mitigate this Challenge http://dhrproceedings.org 16 © DHR Health Institute for Research and Development  Understand the local epidemiology of COVID-19- related indicators (e.g., community transmission levels)  Communicate with local healthcare coalitions and federal, state, and local public health partners (e.g., public health emergency preparedness and response staff) to identify additional healthcare personnel (e.g., hiring additional healthcare personnel, recruiting retired healthcare personnel, using students or volunteers), when needed Under these revised CDC guidelines, healthcare workers who either have asymptomatic SARS-CoV-2 infection and/or higher-risk exposure (6) are allowed to return to onsite work as long as there is strict screening and surveillance protocol in place (Table 1). If fully implemented these measures are predicted to have some impact on mitigating the shortage of healthcare workers. However, it is undetermined at this stage if the healthcare workers, members of their families, co- workers, patients, and caregivers would be willing to accept the inherent risk associated with this significant structural change in policy. Table 1: CDC Guidelines for Work Restrictions for Frontline Healthcare Workers with SARS-CoV-2 Infections and Exposures* *https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff- shortages.html It is abundantly clear that the need to protect the healthcare workers and the environment in which they practice is quintessential to mitigate this crisis. It is also imperative that to continue to retain public trust in our healthcare system, we adopt policies that are widely accepted and easily implemented. It is also perturbing that we have arbitrarily and conveniently segregated healthcare workers into those at high risk of exposure and otherwise. The reality on the ground is that ALL healthcare workers are at an equally high risk of exposure and therefore must be treated accordingly. However, it is understandable that to gain maximum benefit, we may need to prioritize the implementation and distribution of limited resources. Fortunately, we have the tools to accomplish these outcomes without placing undue risk on both the patients and the providers. Our recommendations are outlined in Figure 1 and briefly iterated herein. In most institutions, the healthcare workforce is vaccinated with at least the two-dose primary vaccination. This followed the mandatory ruling by the Centers for Medicare and Medicaid Services requiring that all Medicare and Medicaid-certified providers and suppliers must be vaccinated, and they must meet this requirement to continue to participate in the Medicare and Medicaid programs (7). For symptomatic and/or asymptomatic COVID-19 positive healthcare workers, we recommend that we follow the recently published CDC guidelines (Table 1). On the contrary, every attempt should be made to protect those healthcare workers who are COVID-19 negative and prevent breakthrough SARS-CoV-2 infections in this cohort. In an attempt to accomplish this outcome, we are recommending that the immunity against SARS-CoV-2 in frontline healthcare workers who are actively engaged in patient care must be passively enhanced by treating them with the recently authorized monoclonal antibody – EVUSHELD TM (8). Given the observed long-acting benefit of treatment with this monoclonal antibody, it is postulated that its use would minimize the risk of getting infected with SARS-CoV-2 (9). Additionally, with waning immunity, we are advocating that ALL healthcare workers must be considered for a 4th dose (or 2nd booster dose) of mRNA vaccine at least 90-days after their last booster dose. While still awaiting approval from the Ministry of Health, the Israel’s Pandemic Response Team has already recommended this later protocol providing 4th dose of mRNA COVID-19 vaccine to all healthcare workers; at-risk people; and those who are >60 years of age (10). Figure 1: Proposed Interventions to Mitigate the Prevailing Shortage of Healthcare Workers This is a watershed moment in the history of healthcare industry, and it demands that we think innovatively in an attempt to moderate this nascent crisis. The focus of this manuscript was to underscore the impact of COVID-19 pandemic on healthcare industry and to propose innovative solutions to mitigate the shortage of healthcare workers. https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html DHRP, 2021, Vol. 1 (S5) 15-17 Shortage of Healthcare Workers: Strategies to Mitigate this Challenge http://dhrproceedings.org 17 © DHR Health Institute for Research and Development Nevertheless, we must continue to address other intractable challenges that are more impactful in developing a long-term sustainable strategy to overcome the burgeoning shortage of frontline healthcare workers. Diclosures SR declares no conflicts of interest. MS declares no conflicts of interest. References 1. Hall H. The effect of the COVID-19 pandemic on healthcare workers' mental health. JAAPA. 2020 Jul;33(7):45-48. doi: 10.1097/01.JAA.0000669772.78848.8c. PMID: 32590533. 2. Turale S, Meechamnan C, Kunaviktikul W. Challenging times: ethics, nursing, and the COVID-19 pandemic. Int Nurs Rev. 2020 Jun;67(2):164-167. doi: 10.1111/inr.12598. PMID: 32578249; PMCID: PMC7361611. 3. Nyashanu M, Pfende F, Ekpenyong M. Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK. J Interprof Care. 2020 Sep-Oct;34(5):655-661. doi: 10.1080/13561820.2020.1792425. Epub 2020 Jul 17. PMID: 32674701. 4. Strategies to Mitigate Healthcare Personnel Staffing Shortages. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019- ncov/hcp/mitigating-staff-shortages.html (Accessed December 25, 2021; 00:06 hrs CST) 5. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/covid- 19/clinical-considerations/covid-19-vaccines-us.html. (Accessed December 25, 2021; 00:26 hrs CST) 6. Interim Guidance for Managing Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS- CoV-2. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019- ncov/hcp/guidance-risk-assesment-hcp.html. (Accessed December 25, 2021; 10:17 hrs CST). 7. Medicare and Medicaid Programs; Omnibus COVID-19 Health Care Staff Vaccination. A Rule by the Centers for Medicare & Medicaid Services on 11/05/2021. https://www.federalregister.gov/documents/2021/11/05/ 2021-23831/medicare-and-medicaid-programs-omnibus- covid-19-health-care-staff-vaccination 8. Coronavirus (COVID-19) Update: FDA Authorizes New Long-Acting Monoclonal Antibodies for Pre-exposure Prevention of COVID-19 in Certain Individuals. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press- announcements/coronavirus-covid-19-update-fda- authorizes-new-long-acting-monoclonal-antibodies-pre- exposure. (Accessed December 25, 2021; 11:53 hrs CST) 9. Fact Sheet for Healthcare Providers: Emergency Use Authorization for EVUSHELD™ (Tixagevimab co- packaged with Cilgavimab). s://www.fda.gov/media/154701/download. (Accessed December 25, 2021; 11:57 hrs CST) 10. Israel to offer fourth COVID-19 booster dose. Al- Monitor. 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