Hospitals could certainly walk and chew gum at the same time when it comes to infection control given the right incentives and management.
A piece from CIDRAP about a HHS report makes it sound like dealing with covid is the cause of the spread of other infectious disease in the hospitals, rather than lack of mitigation of covid, and other infectious disease, being to blame. Sadly the framing in the piece and the report feeds a harmful narrative that’s all too familiar.
The real solution to infectious diseases, like covid, of course is controlling them in healthcare settings especially, but also in the community, so that it doesn’t take over hospitals and cause “disruption” of other protocols. And it would help if hospitals actually had adequate staffing typically , but we know that they don’t because nurses unions report that’s the case and some go on strike because of dangerous levels of understaffing — the most common thing to hear about why there’s a nurses strike.
CIDRAP – Report highlights how COVID hindered the fight against antimicrobial resistance Chris Dall, MA January 15, 2025 “The year 2020 marked an unprecedented time for hospitals, many of which were faced with extraordinary circumstances of increased patient caseload, staffing challenges, and other operational changes that limited the implementation and effectiveness of standard infection prevention practices,” the CDC wrote. Case reports on AMR-related hospital outbreaks during the pandemic have also cited lapses in IPC protocols. But the ASPE report suggests hospital ASPs were also heavily affected, with some severely scaled back and others stopped completely. “We had a 100% suspension of ASP activities,” said another ASP physician interviewed for the report. “Everything switched to COVID.” Even at hospitals at which ASPs had strong support and were maintained, physicians and pharmacists had less time for stewardship activities because of increase pandemic-related duties.
The astonishingly disappointing part of this article is that nothing and nobody quoted in the article seems to acknowledge that solutions like adequate staffing or controlling covid in the community would hit the root causes of the lapses in controlling antimicrobial resistance. They only suggest “being prepared” for the hospitals to get overloaded while understaffed in a horrendous status quo. Also some stuff hand waving at “stewardship” something something. The piece uncritically quotes the report claiming that the pandemic is over and that covid is no longer an issue while simultaneously referencing ongoing problems: “Published literature and stakeholder meeting participants observed that, even in the post-pandemic period, patients remain sicker than before the pandemic.” You don’t say?
If you want to know who “stakeholders” are in these scenarios, then one must know about “clientelism” to understand how this crap happens in our government under “normal” conditions and in federal agencies under a Dem presidential administration like Joe Biden’s. And under the new Trump administration, as with the last time, we can expect not just clientelism, but outright corruption as well.
Corruption vs. Clientelism in the Democratic Primary – Feb 22, 2016 Author Jeffrey Feldman “Clientelism” is a bit different because it is a system whereby patrons and clients act in ways that are mutually beneficial to both–without the explicit quid pro quo, without the smudged brown envelope of sweaty cash. The big difference between corruption and clientelism is the explicit demand for a political act from the person or entity who wants to influence government. In “corruption” you are paid and then you do what you are asked. In clientism, the politician acts in favor of a powerful interest or entity and then, subsequently, is rewarded. Now–there are many shades of gray in these two definitions. I have simplified them for the purposes of discussion. And, obviously, clientelism can be rife with acts of corruption, as can corruption give rise to clientelism. But those are the two definitions I want to introduce as a strategy for helping us see a problem that has taken shape in the Democratic primary.
People invited into these “stakeholder meetings” are typically not ordinary people. They are people with connections. They are “business leaders” and corporate actors. They are people who are part of well-funded organizations – which could be something like a union, but also a non-profit organization that gets money from heaven knows where. But again, even the business people and organizations need to have some network connection to get invited to these things, or have people willing to lobby hard for it.
An example is a campaign to pressure the CDC to accept someone, anyone, from a nurses union into the committee and workgroup for the CDC HICPAC. The Biden administration had to be lobbied hard by the largest nurses union of RNs in the US, including getting documents via a FOIA request, in order to get a seat at the table on actual hospital guidelines that would directly affect their job and the safety of their patients. These efforts were bolstered by multiple public health and patient safety organizations and the support of so many precaution advocates who have submitted public comments.
And in fact, there is a lot of public support for measures to protect patients, and yet officials continue to worry about public panicking if they so much as do some form of mitigation or even admit there is a problem. This mindset is a problem. Just do the job. Have common sense rules and enough staff to implement them. That should be obvious.
But we certainly can’t expect any common sense from federal public agencies now. The situation is considerably much worse going forward.