Nurses care for COVID-19 patient in the intensive care unit at the la Timone hospital in Marseille, southern France, in December. Credit: Daniel Cole / AP

While new federal guidelines allow employees who have tested positive for COVID-19 to work in hospitals when they’re short on employees, most hospitals across Maine are not allowing that practice as omicron spreads across the state.

Hundreds of hospital employees across the state are missing work as COVID-19 sidelines them either because they have tested positive or been exposed to the virus. Only one Maine hospital is known to have allowed those who have tested positive to work, but that could change as the omicron variant continues to drive up cases and hospitalizations across the state, hospital officials and experts say.

The U.S. Centers for Disease Control and Prevention recently introduced guidelines for hospital workers in late December that allow employees who have tested positive for COVID-19 to work during a staffing crisis. In those situations, the CDC recommends that they only allow asymptomatic or mildly symptomatic employees to work.

While the practice has occurred elsewhere in the U.S., St. Mary’s Regional Medical Center in Lewiston  is the only hospital in Maine known to be under crisis conditions and to have allowed infected employees to work.

Such guidelines are meant for when coronavirus infections prevent a hospital from having enough staff to remain functional. St. Mary’s Health System Chief Medical Officer Doug Smith told WGME that about 70 employees had been out due to COVID each day in the last week.

The new guidelines could lay the groundwork for an extraordinary new step for Maine hospitals as they face record-high hospitalizations and staffing shortages, and as the highly contagious omicron variant spreads. The CDC’s previous guidelines did not provide for any situation in which an employee with COVID could work.

The practice could become far more common as cases of the omicron variant rapidly increase in Maine, Maine Hospital Association President Steven Michaud said.

“Nobody wants to do it,” Michaud said. “But the way this is headed, I can see more incidents where you reach crisis mode, and you have to bring somebody back.”

It is up to individual hospitals to determine where they fall among the U.S. CDC’s three designations for staffing situations, according to Michaud — conventional, contingency and crisis.

Only crisis staffing allows COVID-positive employees to work without any restrictions, although contingency staffing allows for shorter isolation (five days) and does not require that an employee produce a negative test to return to work.

None of the 10 hospitals in the Northern Light Health system are currently in crisis staffing, spokesperson Suzanne Spruce said. Some fall under the “conventional” designation while others fall under “contingent,” she said, though the designations can change hourly.

None of the system’s hospitals has ever knowingly put a COVID-positive worker on the schedule, she said.

“We hope we never need to consider doing so,” Spruce said.

A shift to crisis staffing would be widely communicated to staff and patients, Spruce said.

MaineHealth, which operates the state’s largest hospital, Maine Medical Center in Portland, has never allowed an employee it knew to have COVID to report to work, spokesperson John Porter said.

“There’s no one on our care team testing positive and coming to work for us,” Porter said. “We’ve not put any plans in place to go down that path.”

Most of MaineHealth’s hospitals, which are located along Maine’s coast and in western Maine, are operating under contingency plans, which are a step below crisis and allow employees to return to work five days after testing positive or showing COVID-19 symptoms as long as they are asymptomatic or only mildly symptomatic.

MaineHealth is also requiring that employees test negative in a rapid test before returning, though the U.S. CDC does not require that step in its guidelines. It’s an extra safeguard to make sure patients are safe, Porter said.

Augusta-based MaineGeneral Health also does not allow employees who have recently tested positive to work and has not done so in the past, spokesperson Joy McKenna said.

The leadership at Mount Desert Island Hospital is aware of the new guidelines, but hasn’t faced a situation in which it would need to call COVID-positive employees to work, hospital spokesperson Oka Hutchins said.

“It isn’t anything that we need to do at this time, and we are grateful for that,” Hutchins said.

Asked if an infected employee can work or has ever worked at any of Lewiston-based Central Maine Healthcare’s three hospitals, the system said its staffing plans strictly follow state and federal guidelines. They take into account the type of work a staff member could perform, if the employee is “well enough and willing,” and other infection control measures, said Dr. John Alexander, the system’s chief medical officer.

Michaud noted there are risks that COVID-positive workers could spread the virus to patients. However, there are also protections in place — namely the protective equipment that all health care workers have to wear inside hospitals.

Hospitals would also likely only put asymptomatic or mildly symptomatic people on the floor during crisis staffing, as the U.S. CDC guidelines recommend, Michaud noted.

Maine health care workers are also required to be vaccinated against COVID-19, and recent research points to vaccinated individuals being less likely to spread the virus.

While Maine is seeing fewer daily cases per capita than any other state, many health officials and experts fear that the worst of the state’s COVID surge is yet to come. For many hospitals, it could mean making decisions previously unthinkable.

“I don’t think anyone thinks we’ve peaked yet,” Michaud said. “We’re in for a heck of a ride in the next four to six weeks. There’s no question about it.”