Becker's Clinical Quality & Infection Control

24 PATIENT & CAREGIVER EXPERIENCE Why some don't want to confirm their COVID-19 diagnosis By Erica Carbajal S ome physicians say they're seeing more patients who want to avoid polymerase chain reaction testing for COVID-19 out of fear of the potential dis- ruptions it could cause to their livelihoods, NPR reported Feb. 1. Lab-based PCR tests are reported to health officials, while the results of at-home rapid tests are not. And with at-home test kits hard to come by, some people worry about the implications a positive lab result could have on their lives. "It's easy to take a moral stand and say, 'You should always do the right thing,'" Cristina San Martin told NPR. "But if I knew that my job was on the line, I don't know if I would've gotten tested, because anyone could say, 'Oh, this is a cold,' or 'I just have the flu,'" said San Martin, who identifies as nonbinary. e dog grooming salon where San Martin worked fired them aer they received a confirmed COVID-19 diagnosis, they told NPR. Similar concerns are behind the reason many patients opt for rapid tests, Shantanu Nundy, MD, who treats mostly low-income patients at a federally funded clinic in Ar- lington, Va., told NPR. e physician said many of his patients ask: "Hey, can you test me? But can you test me, you know, [with] the rapid tests so that it's not part of my record?" Dr. Nundy continued, "e patients and fam- ilies who are the most marginalized people — who don't have steady employment, receive benefits, have limited child care and home support — are those who are most likely to not test, and who are probably the ones who we need to test the most" because they're also the most exposed to the virus, he told the news outlet. e rise of at-home testing alters how well the virus can be tracked, said Hugh Guster- son, an anthropologist who teaches the culture of science at the University of British Columbia in Vancouver and George Wash- ington University in Washington, D.C. Essentially, the true number of COVID-19 cases will be harder to measure as more peo- ple make their own decisions about whether to report their results, Mr. Gusterson said. n License wait periods reach crisis levels for healthcare workers By Molly Gamble L icensing agencies were understaffed and used antiquated workflows pre-pandemic. Now, facing an influx of applicants, the delays are affecting health- care workers' ability to get to work and patients' access to care, NBC News reported Feb. 12. Healthcare workers, from Wisconsin nurses to New York psychologists, said they are waiting months more than usual for approval to work. In New Jersey, some social workers have been waiting more than 18 months. NBC News spoke to leaders with nine healthcare profession- al organizations in three states who said wait times for licenses are worse than they've ever been. Regardless of position or state, licensing and health- care leaders say the solution is increased staffing at licensing agencies. In Wisconsin, healthcare workers say licensing delays have reached a crisis level. The state's Department of Safety and Professional Services licenses more than 200 professions. It was understaffed and overwhelmed before the pandemic and has since fallen further behind on applications, struggled to upgrade to an electronic processing system and struggled to retain staff, which the Post-Crescent first reported. The Wisconsin Council on Mental Health has sent two letters to the state Legislature pleading for increased staffing at the department. "There is an obvious and immediate solution to this: Add necessary positions and pay market wages to attract new candidates and retain talent," Jennifer Garrett, spokes- person for the Department of Safety and Professional Services, told NBC News. At the Wisconsin licensing agency, staffing is so lean that one worker's illness or parental leave curbs productivity. Entry-level salaries start around $17 an hour. Licensing wait times are an upstream contributor to workforce constraints that public health and healthcare organizations are experiencing and patients' wait times downstream. In New Jersey, for example, social workers are still waiting for licenses they applied for in 2020. "We hear from different organizations — whether they be mental health or domestic violence providers — across the board that because they can't get people who are li- censed, there are wait times for services that can be three to five months," Jennifer Thompson, executive director of the New Jersey Chapter of the National Association of Social Workers, told NBC News. n "Because they can't get people who are licensed, there are wait times for services that can be three to five months." Jennifer Thompson, executive director, New Jersey Chapter of the National Association of Social Workers

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