William Miller, MD
We Are Living in Interesting Times
There is an old saying, “May you live in interesting times.” Some people consider this to be a curse, suggesting that life during uninteresting times is better. I disagree. While I certainly want this pandemic to be over and for our lives to return to normal, I think that how we overcome life’s challenges is what gives our lives greater meaning.
As a country, we are now engaged in many monumental debates and are becoming increasingly divided. Perhaps we can find ways to work through the differences and come back together. How we go about doing that will, in the end, tell much about who we are as a nation and will either leave us stronger or weaker for it.
One interesting debate going on right now is around vaccination mandates. As you probably know, the state health department mandated that all healthcare workers in California must be vaccinated against COVID by September 30th or have received an exemption based on health or religious reasons. Those that are unvaccinated and not given an exemption may not work. Those that are unvaccinated and do have an exemption may work, but will need to be tested regularly for COVID.
Mandating vaccinations is not new to COVID. Healthcare workers already must show proof of vaccination or immunity for many things including hepatitis B, influenza, mumps, measles, rubella, and varicella. Every year, healthcare workers must also get a PPD, which is a skin test in which a foreign protein from tuberculosis is injected to see if there is a reaction indicating an exposure. So, mandating injections of foreign antigens is nothing new.
However, sentiments are running high on both sides in favor or against mandated vaccines. Many people decry that mandating vaccinations is an infringement upon personal liberty. Some feel that hospitals should not require vaccination at all. Further, that if we do, we should accept proof of prior COVID infection in leu of vaccination. Meanwhile, others come down on the side of insisting that we should require all staff to be vaccinated and not provide any waivers at all. Some people in this group also feel that if staff are given a waiver, then we should notify patients of which staff are vaccinated and which are not.
I can see both points of view. None of us like being told by authorities what to do, especially when it comes to what goes into our own bodies. At the same time, there is mounting frustration at the folks who are unvaccinated for not participating in the vaccination effort to halt the spread of the disease.
Here is the reality for hospitals and clinics. On August 5th, the California Department of Public Health (CDPH) issued an order to all healthcare facilities in the state requiring full COVID vaccination of all staff by September 30th. This is a broad order and includes all types of healthcare facilities from skilled nursing homes and dialysis centers to private dentist’s and doctor’s offices. It also extends to all staff in those facilities, not just clinical staff. Affective August 23rd, all these facilities had to start performing testing of staff who are not vaccinated; weekly in the out-patient setting and twice weekly for in-patient settings. Such regular testing had already been implemented a year ago for all the state’s nursing homes.
The CDPH order also requires that each facility have a mechanism for staff to apply for an exception based on either medical grounds or for religious beliefs. Some folks in the community have already complained that they think we are granting religious exemptions too easily. To that, I would say that it is easy to make such comments when you are not the one having to make the determinations. This great country is based on principles of freedom and especially around religious freedom. I would be hard pressed to have to judge the “authenticity” of another person’s religious beliefs.
As for requiring staff to indicate whether they are vaccinated, there are other legal requirements that employers must hold in confidence medical related information about their employees. So, it isn’t as simple as people may think. We should also keep in mind that masking, handwashing, and social distancing is effective at holding the Delta variant at bay, just as it was before with other variants. So, it is hard to make an argument that there is justification for breaking confidentiality and giving out such private information to patients.
Another very important consideration in all of this is that we are facing a serious healthcare staffing shortage locally as well as nationally. This was going on before COVID, but has been made much more acute. Our three hospitals in Mendocino county have been at full capacity for several weeks now. We need every nurse and support staff we have. If we loose any because they do not get vaccinated or resign out of protest, and several already have, then it makes it all the more difficult to continue to care for our community.
So, it is an interesting time trying to find the right balance between protecting personal liberty and meeting the needs of the larger community. It is a challenge that is not all that easy to solve. As of today, on the Coast, we have about 320 staff at the hospital and clinic. A month ago, about 120 of those staff fell into the unvaccinated group. We have worked with them by providing education and support while encouraging them to get vaccinated. We have also processed their exemption requests. As of this writing, a little over 60 have gone ahead and gotten vaccinated. We have given 27 religious waivers and 6 medical exemptions. Eighteen staff remain undecided and 6 have resigned in protest.
Of the 65 physicians and mid-level providers on staff, all but one are fully vaccinated. An exemption was given for the one who is unvaccinated.