Wednesday, August 25, 2021

Mandatory Vaccines For Health Care Workers -- Yes or No?

 


Your right to individual medical freedom, your right to hold a fist and punch, ends when you start hurting someone else. And that’s what we are dealing with. We are not dealing with someone’s individual choice of whether they want to do something. We are dealing with them coming into the workplace with a communicable, spreadable disease and hurting other people.”

    Sarah Jodka, who testified for the Ohio Chamber of Commerce against the bill to ban mandatory vaccines

The Ohio House Health committee heard more than four hours of testimony from both opponents and supporters of a bill, which could ban all mandatory vaccines such as those against childhood diseases and meningitis.

A bill to ban vaccines that don't have full FDA approval goes into effect in October, aimed at COVID shots. But if this bill pass, the Pfizer COVID shot would be included in the ban on all vaccines, since it’s been given full FDA approval and can now be required in Ohio. Mainstream medical groups oppose the bill.

(Jo Ingles. “Marathon Hearing On Ohio Bill To Ban Mandatory Vaccines Brings Out Hundreds.” The Statehouse News Bureau. August 25, 2021.)

The Question

To what extent can a state legitimately restrict the liberties of its citizens in order to serve the common good? Furthermore, to what extent has the protection of the public's welfare been a pretext for governments to curtail or erode fundamental rights?

The COVID-19 pandemic has brought the tension between individual rights and the public good to the forefront of the national discourse. Many pandemic response measures – such as stay-at-home orders, mandatory business closures or restrictions, and mask mandates – have evoked vocal opposition by individuals who feel these measures infringe on their freedom.

Mandating the Vaccine

Federal guidance issued in December 2020 allows employers to require that their workers get COVID-19 vaccines, although they must accommodate employees' religious objections and also make sure vaccine requirements don't discriminate against employees with disabilities.

Accommodating a religious objection could involve changing an unvaccinated worker's job duties to maintain a safe workplace. For instance, employers could ask workers who refuse immunization to work remotely or wear protective gear.

Before the pandemic, most businesses didn’t require workers to get immunized. The exceptions included some hospitals and health care settings that serve people with weak immune systems – such as newborns, cancer patients or older adults – for whom an infection could be fatal.

(Sophie Quinton. “Bills to Block Mandatory Worker Vaccines Falter in the States.” Stateline Article. Pew. February 23, 2021.)

With the emergence and spread of the Delta variant, it is clear that we are in a long-term coronavirus war with no quick victories.

Unfortunately, when it comes to COVID-19 vaccination rates, health care workers seem to reflect the country. Vaccination rates vary greatly, with 96% of physicians but 55% of nursing home staff, fewer than 50% of nurses, and just 26% of home health aides being fully vaccinated.

(Ezekiel J. Emanuel, MD, PhD abd David J. Skorton, MD. “Mandating COVID-19 Vaccination for Health Care Workers.” Annals of Internal Medicine. July 30, 2021.)

To prevent the ravages of COVID-19, many more people living in the United States need to be vaccinated. The facts are clear: The U.S. Food and Drug Administration (FDA) – authorized vaccines have been administered to hundreds of millions of people and have been found to prevent severe disease and death. It is imperative that all 17 million health care workers in the United States be vaccinated

To induce employers to require vaccines, health care professional societies and organizations endorse this requirement. As of July 29, 2021, 88 organizations had signed, representing all facets of health care: physicians, nurses, pharmacists, physician assistants, nurse practitioners, epidemiologists, public health workers, and long-term care workers.

The rationale for requiring vaccines for health care workers is 3-fold:

First, like any person, health care workers have a general ethical duty to protect others, especially when there is minimal threat to their own well-being, and the vaccines have so few adverse effects that there is little risk to a vaccinated person's health.

Second, beyond this general ethical duty, health care workers have a special ethical and professional responsibility to protect others. The objective of the health care professions is to promote the health and well-being of patients and their families, residents of long-term care facilities, and the broader community. Getting vaccinated is one way to achieve this professional objective and protect the health of all of these parties.

This responsibility holds not only for physicians, nurses, respiratory therapists, and other health care professionals who take professional oaths or pledges but also for the dietitians, environmental workers, safety officers, clerks, and other support staff at health care facilities. All who choose to work in health care settings—hospitals, urgent care settings, long-term care facilities, physicians' offices—must be committed to putting patients first. During their usual activities, health care workers are likely to interact with patients who are vulnerable to COVID-19, namely elderly adults, children younger than 12 years, and immunocompromised persons. Their work setting confers a special responsibility to not endanger the health of other people.

Third, requiring COVID-19 vaccines for health care workers is not new but is merely an extension of well-established practices and policies. Many health care facilities have long required their workers to be vaccinated against influenza, hepatitis B, and other infectious diseases. As a result, health care workers have historically been role models of good health behaviors, particularly vaccination. All of us working shoulder-to-shoulder in health care can embody health practices for the public. Part of our opportunity to have a positive effect is to show the importance of receiving the COVID-19 vaccine—and, indeed, all vaccines.”

(Ezekiel J. Emanuel, MD, PhD abd David J. Skorton, MD. “Mandating COVID-19 Vaccination for Health Care Workers.” Annals of Internal Medicine. July 30, 2021.)

The Bottom Line

I get it. The opposition to mandatory vaccinations for health care workers is primarily based on the fact that U.S. citizens don’t want the government dictating their behavior. Many Americans feel betrayed – by the government, by the marketplace, and by all whom they consider to be political opponents bent on limiting their rights.

There is now a never-ending culture war. The non-vaxxers have grown to distrust everything and everybody, so they reject authorities and even science. They see the world with moral outrage, and they fear disconnection with public institutions in which they once held a sacred trust.

Never before has so much doubt led to such widespread fear. And, with this fear comes an honest horror and accompanying agitation of losing control. Thus, many people want so much to believe in a return to something they once knew as normalcy that they grasp onto any idea that offers an escape to happier days of the past – to times less bridled with responsibility and thoughtful consideration.

Nevertheless, during the pandemic, we live in a time in which it is of prime importance to help bear one another's burdens. That charge includes the accountability of health care workers to take every measure to stop the spread of the disease. Unvaccinated individuals are more susceptible to infection and more likely to spread the virus. Getting shots saves lives and prevents the mutation of more virulent coronavirus strains.

Lawmakers and courts will likely continue to argue the constitutionality of mandating vaccines. Still, precedent exists for the government, public-private entities, and private businesses to impose all sorts of socially beneficial restrictions – including basic public health and safety measures – before people access institutions or avail themselves of services. Consider airlines, public schools, and even restaurants – “No shirt, no shoes, no service.”

And, hey, consider that service members in the U.S. Armed Forces will be required to get vaccinated against the coronavirus by mid-September. Uncle Sam says, “It's the right thing to do.”


Tuesday, August 24, 2021

Southern Ohio Medical Center Employees and COVID-19 Vaccinations

 


A new dichotomy has begun dogging the pandemic discourse. With the rise of the über-transmissible Delta variant, experts are saying you’re either going to get vaccinated, or going to get the coronavirus.

For some people – a decent number of us, actually – it’s going to be both.”

Katherine J. Wu, Science Staff Writer at The Atlantic

At one time no, one dreamed of living in a world racked by a global pandemic. Now, that nightmare has become a daily threat to our way of life and our very existence. We all must take precautions and follow important measures to insure our safety and the safety of innocent others. Even with vaccines, we must continue to mitigate and prevent the spread of COVID-19.

The local hospital, Southern Ohio Medical Center recently announced after recommendations from 56 health care organizations including the Ohio Hospital Association, American Medical Association and American Nurses Association – as well as local medical and scientific experts – that it was requiring all employees to be fully vaccinated against COVID-19.

While the policy does have exceptions, many employees and other community members do not think it should be mandated and are currently protesting the requirement. Even offered a $500 bonus incentive for vaccination, these protesters refused the mandate citing “freedom of choice” as their major objection. They seem unwilling to compromise as they also disagree with SOMC's stipulation that “employees with medical, religious or strongly held belief objections will be eligible for exemptions, but must be tested for COVID-19 twice a week until the virus is no longer considered a cause for concern.”

Causing quite a stir on social media, the vaccine requirement was questioned by those who explained that even vaccinated individuals could get the virus. They held this belief as proof of the ineffectiveness of the shots.

Let's examine the TRUTH about vaccines and the protection they offer.

Yes, CDC's National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases reports some people who are fully vaccinated will get COVID-19. Breakthrough infections are expected. COVID-19 vaccines are not 100% effective.

Coronavirus infections are happening among vaccinated people. Since we are not close to defeating the virus, they are going to keep happening. Katherine Wu calls post-vaccination infections “an arithmetic inevitability.” The CDC confirms that “because vaccines are not 100% effective, as the number of people who are fully vaccinated goes up, the number of breakthrough infections will also increase.”

However …

As post-vaccination infections might occasionally turn symptomatic, they aren’t aberrant. And, they aren’t proof that the shots are failing.

These cases are, on average, gentler and less symptomatic; faster-resolving, with less virus lingering – and, it appears, less likely to pass the pathogen on …

A breakthrough, despite what it might seem, does not cause our defenses to crumble or even break; it does not erase the protection that’s already been built. Rather than setting up fragile and penetrable shields, vaccines reinforce the defenses we already have, so that we can encounter the virus safely and potentially build further upon that protection.”

(Katherine J. Wu. “Your Vaccinated Immune System Is Ready for Breakthroughs.” The Atlantic. July 26, 2021.)

Read Wu's entire article: https://www.theatlantic.com/science/archive/2021/07/anatomy-of-a-vaccine-breakthrough/619562/

The CDC confirms that fully vaccinated people with a breakthrough infection are less likely to develop serious illness than those who are unvaccinated and get COVID-19. This means they are much less likely to be hospitalized or die than people who are not vaccinated.

According to CDC data, vaccinated individuals are:

  • 8 times less likely to get COVID-19

  • 25 times less likely to be hospitalized with COVID-19

  • 25 times less likely to die of COVID-19

(Katie McCallum. “5 Things Vaccinated People Need to Know About Breakthrough Infection.” HoustonMethodist.org. August 17, 2021.)

The analogy of the human body as a castle can be used to describe a breakthrough case. Deepta Bhattacharya, an immunologist at the University of Arizona, compares immunization to reinforcing such a stronghold against assault.

Bhattacharya explains …

Without vaccination, the castle’s defenders have no idea an attack is coming. They might have stationed a few aggressive guard dogs outside, but these mutts aren’t terribly discerning: They’re the system’s innate defenders, fast-acting and brutal, but short-lived and woefully imprecise. They’ll sink their teeth into anything they don’t recognize, and are easily duped by stealthier invaders. If only quarrelsome canines stand between the virus and the castle’s treasures, that’s a pretty flimsy first line of defense. But it’s essentially the situation that many uninoculated people are in.

Other fighters, who operate with more precision and punch – the body’s adaptive cells – will eventually be roused. Without prior warning, though, they’ll come out in full force only after a weeks-long delay, by which time the virus may have run roughshod over everything it can. At that point, the fight may, quite literally, be at a fever pitch, fueling worsening symptoms.

Vaccination completely rewrites the beginning, middle, and end of this story. COVID-19 shots act as confidential informants, who pass around intel on the pathogen within the castle walls. With that info, defensive cells can patrol the building’s borders, keeping an eye out for a now-familiar foe. When the virus attempts to force its way in, it will hit “backup layer after backup layer” of defense.”

(Katherine J. Wu. “Your Vaccinated Immune System Is Ready for Breakthroughs.” The Atlantic. July 26, 2021.)

The analogy continues …

Prepped by a vaccine, immune reinforcements will be marshaled to the fore much faster – within days of an invasion, sometimes much less. Adaptive cells called B cells, which produce antibodies, and T cells, which kill virus-infected cells, will have had time to study the pathogen’s features, and sharpen their weapons against it. While the guard dogs are pouncing, archers trained to recognize the virus will be shooting it down; the few microbes that make their way deeper inside will be gutted by sword-wielding assassins lurking in the shadows. Each stage it has to get past takes a bigger chunk out of the virus. Even if a couple particles eke past every hurdle, their ranks are fewer, weaker, and less damaging.”

(Katherine J. Wu. “Your Vaccinated Immune System Is Ready for Breakthroughs.” The Atlantic. July 26, 2021.)

The virus may be instantly annihilated by the immune cells and antibodies, preventing any infection at all. But, unfortunately, some people’s immune cells might “keep their weapons holstered for too long” – especially true among the elderly and immunocompromised.

Laura Su, an immunologist at the University of Pennsylvania, says, “Even as the virus is raising a ruckus, immune cells and molecules will be attempting to hold their ground, regain their edge, and knock the pathogen back down. Those late-arriving efforts might not halt an infection entirely, but they will still curb the pathogen’s opportunities to move throughout the body, cause symptoms, and spread to someone else. The inhospitality of the vaccinated body to SARS-CoV-2 is what’s given many researchers hope that long COVID, too, will be rarer among the immunized.

The choice isn’t about getting vaccinated or getting infected. It’s about bolstering our defenses so that we are ready to fight an infection from the best position possible – “with our defensive wits about us, and well-armored bodies in tow.”

(Katherine J. Wu. “Your Vaccinated Immune System Is Ready for Breakthroughs.” The Atlantic. July 26, 2021.)

Those who are highly immunocompromised and received either Pfizer or Moderna during their primary vaccine series are also now eligible to receive a third dose of either Pfizer or Moderna.

The hope is that a third shot will increase antibody protection in immunocompromised people,

In addition, everyone should be more cautious when around someone who is immunocompromised, even if the entire group or household is fully vaccinated. Opting to wear a mask and keep your distance is critical. You can never be too careful when it comes to protecting those who are most vulnerable."

(Katie McCallum. “5 Things Vaccinated People Need to Know About Breakthrough Infection.” HoustonMethodist.org. August 17, 2021.)

Those seeking the truth about the need for continued vaccination and the reality of protection offered by the vaccines must strip excuses and unfounded beliefs from reality. Despite their belief in “freedom of choice” and their adamant refusal to vaccinate because contraction of the virus is not fully prevented by vaccination, anti-vaxxers risk threats to themselves and to other vulnerable immunocompromised people. Science clearly outlines risks and rewards.

Research shows that the FDA-authorized vaccines offer protection against severe disease, hospitalization, and death against currently circulating variants in the United States.

The Delta variant is more contagious than previous variants of the virus that causes COVID-19. However, studies indicate that the vaccines used in the United States work well against the Delta variant, particularly in preventing severe disease and hospitalization. Overall, if there are more infections with SARS-CoV-2 (the virus that causes COVID-19) there will be more vaccine breakthrough infections. However, the risk of infection, hospitalization, and death are all much lower in vaccinated compared to unvaccinated people.

To close, Healthcare institutions like Southern Ohio Medical Center have a legal and ethical obligation to ensure a safe environment for patients, healthcare workers, and visitors. Vaccination reduces viral transmission and thereby promotes health, enhances patient safety, and provides a sense of security. Healthcare workers have an ethical/moral obligation to provide care for patients and to do no harm; vaccination limits the spread of COVID-19 infection.

Mandating universal vaccination is morally justified because of the consequences: community protection and reduction in virus transmission, resulting in lower rates of infections, hospitalizations, and deaths.

Finally, SOMC employees DO HAVE freedom of choice. Here are their options by September 17 as the requirement stands:

  1. They can be fully vaccinated.

  2. They can agree to be tested for COVID-19 twice a week until the virus is no longer considered a cause for concern.

  3. They can be subject to disciplinary action by the hospital for refusing the requirement.

  4. They can resign.