Many of the nation’s leading medical groups are calling for the Occupational Safety and Health Administration (OSHA) to delay its Emergency Temporary Standard (ETS) on COVID-19 by at least six months and to extend the comment period.

OSHA’s ETS to protect healthcare workers from COVID-19 became effective with publication in the Federal Register on June 21, 2021.1 That means that employers must comply with most provisions within 14 days, but can take up to 30 days for requirements involving physical barriers, ventilation, and training. (See Hospital Infection Control & Prevention, July 2021). The ETS is in effect for six months, and OSHA requested comments by July 21, 2021, on whether it should become a final rule after that period.

Comments gleaned from the OSHA docket show few making that argument, with private citizens and prestigious organizations alike essentially saying OSHA was late in intervening and now demands immediate compliance from those regulated.

“Healthcare facilities need time to thoughtfully review this rule and understand the requirements and to request and receive clarification where needed,” said the Association of American Medical Colleges (AAMC).

Asking for a six-month delay and an extension of the comment period for 30 days, AAMC stated, “As our members continue to respond on the front lines of the COVID-19 pandemic, we are concerned that it will take significant effort and divert resources for teaching hospitals to review this complex ETS, provide meaningful feedback to OSHA on provisions, … and make any necessary changes to comply.”

A non-profit group, the AAMC represents all 155 accredited U.S. medical schools. It is affiliated with more than 400 teaching hospitals and health systems, including those in the Department of Veterans Affairs.

“Compliance with this rule will require academic medical centers, and all healthcare facilities, to make modifications to their hospital policies and procedures, and undertake structural changes to their facilities, such as creating physical barriers,” the AAMC stated.

Increased Risk?

The American Hospital Association (AHA), representing about 5,000 facilities, made a similar request, saying “changes in hospital policies and procedures are not simply a matter of changing words on paper; they require careful analysis and planning, the acquisition of needed materials and tools, and the retraining of personnel. For organizations that are already busy caring for their communities’ ill and injured, it will take time to accomplish all of these required changes.”

The AHA cited ETS requirements that actually could increase risk, including barrier requirements that could impede airflow.

“Our members also are unsure how they will implement the provisions in the mini respiratory protection standard that permit employees who are not required to wear respirators to bring their own into the hospital,” the AHA said. “Moreover, this provision will allow employers to provide respirators to employees who are not required to wear them, and without the benefit of fit testing, medical evaluation, or a written program. Many of our members have noted that these requirements, which contradict OSHA’s own PPE (personal protective equipment) and respiratory protection standards, raise huge liability exposures for the employer and put these employees at additional risk.”

The National Association for Behavioral Healthcare (NABH) echoed the other requests, saying mental health facilities and addiction treatment centers have been hit hard by the pandemic.

“[They] continue to experience increased need for their services as indicated by the dramatic increase in drug overdose deaths over the past year and continued elevated levels of anxiety and depression and suicidal ideation,” the NABH said. “In addition, behavioral healthcare providers across the United States are struggling to hire staff to address this increased need for treatment services. Shortages of behavioral healthcare providers were already widespread before the pandemic. Nearly one-third of the U.S. population lives in mental health provider shortage areas.”

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 14,500 nonprofit and proprietary skilled nursing facilities and skilled assisted living communities.

“Long-term care has been hit extremely hard by this pandemic and continues to confront substantial staffing challenges,” the AHCA/NCAL said. “While many of these standards are already in place in our provider’s communities, some of the new standards require a level of resources that many centers do not currently have available and will take extended time to fully implement. For example, designating a COVID-19 workplace safety coordinator is challenging for small or independent facilities with limited resources staffing-wise as well as financially due to census impacts from COVID-19.”


  1. 86 Fed Reg 32376 (June 21, 2021).