It seems to be better for the well-being of residents to allow nursing home employees with mild Covid symptoms to work with a mask than to furlough infected employees.

In a simulated scenario, the missed tasks outweighed the increased harm from Covid transmission, according to a study published Monday morning in JAMA Network Open. Understaffing was associated with missed tasks, resident hospitalizations and deaths, and cost an estimated $1.07 million per 100-bed facility; another $247,090 was lost due to furloughed staff, based on data from the Centers for Medicare & Medicaid Services (CMS).

Most of these losses were averted by allowing 75% of nursing home staff who had mild Covid to continue working, the study found, saving about $85,470 without any worsening of staff or residents’ situations due to Covid.

The model study was a simulation of a 100-bed nursing home. The aim was to examine short-time work policies for employees in connection with Covid-19. Ultimately, it was found that significant direct medical and societal costs could be saved by allowing employees to work despite mild symptoms.

“Given the current situation of extreme understaffing in nursing homes, the ability to keep people with mild COVID-19 illnesses working may prevent greater harm from staff shortages and missed care tasks and ultimately save significant costs,” the study’s authors said.

They said basic care needs in nursing homes are currently limited by widespread staff shortages and that simulations at current average staffing levels showed an annual deficit rate of 22.1% in nursing tasks.

Simulations suggest that mandatory leave of absence for staff due to Covid illness may have exacerbated current staff shortages through missed care tasks, the study found. It was also associated with additional non-Covid-related hospitalizations – and potentially one additional death per year, considering a 100-bed facility.

“In contrast, 73% of missed care tasks could be completed if staff with mild (Covid) illnesses work with masks, at the expense of a small number of additional (Covid) illnesses and minimal (Covid)-related hospitalizations of staff or residents,” the authors say.

Policies requiring leave for staff with Covid were an early precaution against the pandemic, when the incidence, severity and long-term effects were much greater, they said. Now, vaccinations and pre-existing conditions have reduced the severe effects. This likely tipped the balance between the benefits of mandatory leave and the unintended consequences for resident care, the study said.

Employee burnout was likely made worse by the forced leave.

“All of this does not mean that nursing home staff should be encouraged to work despite being sick with a contagious pathogen. Rather, our work underscores the fact that developing appropriate nursing home staffing policies involves trade-offs,” the authors noted in the study.

Simulation studies like this one, published in JAMA, could help evaluate such trade-offs, they added. Vaccines, a general acceptance of masks in the workplace and adaptations to Covid strains are all factors that mitigate the harm from Covid exposure compared with worse harms resulting from mandatory Covid-related reduced hours for employees.

“This study provides an important example of how infection control decisions should consider broader and downstream impacts across the system and how systemic approaches can clarify these impacts,” the study authors said.

Of course, a significant increase in nursing home staff would offer greater scope for short-time work strategies and the containment of the spread of pathogens, according to the study, which also briefly refers to upcoming nationwide minimum standards for staffing.