As the delta variant leads to coronavirus case spikes — and deaths — nationwide, workplaces, health care entities and even some schools are issuing vaccine mandates, which provide a sense of safety for some but draw the ire of others.
Nationwide, over 56% of the population is fully vaccinated, compared to around 54% in Wisconsin and nearly 60% in La Crosse County. Vaccination requirements have led to an increase in inoculation rates, with a White House Report released Oct. 7 stating mandates have increased rates by over 20 percentage points, putting some institutions at over 90%.
When President Biden announced the first vaccination requirement for the federal government in late July, 95 million U.S. residents who were eligible for vaccination had not gotten the shots. That number is now 67 million. The Biden Administration’s vaccine requirements apply to around two thirds of U.S. employees. Business with over 100 employees will be required to enforce vaccination or weekly COVID testing.
The White House report states over 3,500 organizations nationwide have already issue vaccine requirements, including 25% of businesses and 40% of hospitals. In Wisconsin, Gundersen Health System, Mayo Clinic Health System, UW Health, Medical College of Wisconsin, Prevea Health and Marshfield Clinic are among those with mandates or requirements. Facilities which receive Medicare or Medicaid funding must have fully inoculated staff in order to continue receiving funds.
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Report: Mandates not hurting hospital staffing
Among the health care organizations in support of mandatory vaccination are the American Medical Association, American Hospital Association, American Nurses Association, and American Academy of Pediatricians, and some hospitals have already achieved up to 98% vaccination. While inoculation requirements have led some to believe mass firings or resignations will occur, the White House Report shows there has been minimal impact on staffing, with an under 1% loss at each of the institutions with provided data in the report.
The pandemic has led to widespread worker shortages, greatly affecting the health care, food, retail and hospitality industries — unemployment is currently two percentage points higher than before the pandemic, with 5.7 million additional people out of work.
Many of those who haven’t been laid off are stretched thin at their jobs. In health care settings, patient levels have increased due to coronavirus cases and resumption of previously delayed appointments and procedures. Burnout is real, with many working long hours in high stress situations, often while donning layers of PPE and with limited ability to interact with co-workers for a morale boost. In addition, many staff have been required to quarantine due to exposure to COVID, being infected themselves, or having to stay home with an infected family member. The White House report notes in the month of September, 4.6 million people nationwide were out of work because they or someone they cared for had COVID.
Vaccine requirements, the report indicates, will have a positive impact on the economy, citing a Goldman Sachs analysis which anticipates that “an increase in vaccination and almost full vaccination at workplaces should encourage many of the 5 million workers that have left the labor force since the start of the pandemic to return.”
Opposition among local hospital staffs
Some local health care workers have been vocal in their dispute of vaccine mandates, among their reasons staff shortages. David Anderson, RN, who works in Gundersen’s behavioral health unit, has been a leader in protests of the mandate and says the facility is lacking adequate staff in many departments. Anderson believes the mandate will exacerbate the issue, but with Gundersen staff at present having until Nov. 1 to be inoculated any current shortages cannot be attributed to the impending requirement.
Job openings in health care, including at local hospitals, are plentiful. A link shared on a website run by the Coulee Region Healthcare Workers Against Covid Vaccine Mandates, of which Anderson is a founder and consisting of a self described group of “hundreds of health care workers from around the Coulee region (of) a variety of political, religious, and racial backgrounds,” shows over 500 current job openings at Gundersen sites while Mayo, the smaller of the two entities, has around 100.
It is not uncommon for health care settings during the pandemic to offer staff to work additional positions for extra pay. Mayo last fall shared some workers took on additional shifts in departments outside their usual, and Gundersen, Anderson says, has been looking for staff to fill cleaning shifts.
Even prior to the pandemic, the United States Registered Nurse Workforce Report Card and Shortage Forecast predicted a shortage of 154,000 registered nurses by 2020, and the study “Projecting US Primary Care Physician Workforce Needs” from the Annals of Family Medicine anticipates a shortage of 52,000 primary care physicians by 2025.
Mayo, which issued its vaccine “required participation program” in July, with a deadline of Sept. 17, offered a declination process and some exemptions. As of Sept. 29, 98% of Mayo Clinic enterprise physicians were vaccinated, with an overall staff rate of 87%. Mayo declined to share the number of exemptions or declinations given, but noted a new mandatory vaccination program will be implemented in the following weeks. A Mayo representative did not yet have information on whether the more stringent policy would affect those who previously completed declination or received exemptions.
“Mayo Clinic Health System hasn’t seen any indications of issues arising at this time pertaining to the vaccine requirement,” Mayo said, noting staff inoculation rates increased following the requirement.
At last share, Gundersen had an 85% inoculation rate, which has increased but an exact number was not disclosed by the hospital. Staff still have around three weeks to complete their shots.
Gundersen declined to comment on staffing shortages, whether due to the pandemic or vaccine requirement. Mayo issued the following statement:
“Medical facilities like Mayo Clinic Health System have not been exempt from the pandemic related staffing shortages being experienced by other businesses and industries. Unfortunately, health care overall began experiencing staffing shortages in roles and skill levels ‘across the board’ prior to the pandemic. Certain roles in health care including nursing, radiology, respiratory care, environmental services and other areas have been impacted due to the increase in workloads because of the pandemic.
Mayo Clinic Health System continues working with local educational institutions and other regional organizations to promote careers in the medical field. Mayo Clinic Health System also utilizes regional and national searches to recruit the brightest and most talented to make the La Crosse region home.”
Mayo’s upcoming mandate may potentially be as strict as Gundersens. Anderson notes that at present, Pfizer employees have the option to be tested weekly in place of vaccination, and the anti-mandate website states government agencies allow exemption or testing options. However, on Sept. 9 President Biden announced all executive branch federal employees and contractors would no longer have a testing alternative to inoculation.
Anderson stresses that the anti-mandate group does not oppose vaccination or discourage it, but believes it should be a personal decision. The staff in protest would like to continue at their jobs and providing care for patients, though the website notes the workplace is currently in a “toxic situation.”
“Last year, before the vaccines, frontline workers were told that to prevent the spread of Covid, we simply had to follow PPE guidelines: appropriate masks, goggles, and hand hygiene. This year, there is no cohesive message,” the website states. “Natural immunity is ignored. To ensure hospitals have adequate staffing, hospital leadership will fire unvaccinated staff. There are some dizzying mental gymnastics happening here, and the end result is truly unfortunate: loss of trust by staff, loss of trust by the community, and staffing shortages that negatively impact patient care. Logic and evidence are discarded in favor of rhetoric.”
As an alternative to vaccination, Anderson would like to see exemptions given, no questions asked, for medical, philosophical or religious reasons, or if the staff member has natural immunity. The latter has been a subject of debate, with a study out of Israel concluding natural immunity offers longer lasting and and stronger protection against infection and hospitalization caused by the Delta variant compared to an mRNA vaccine. But a study from Kentucky found those who were not vaccinated had 2.34 times the odds of reinfection compared with those who were fully vaccinated.
The anti-mandate groups stresses its position is not about a misunderstanding of science — “Our belief in science is why we are taking this stand” — but believe “this particular vaccine is not right for us at this time. We believe in evidence-based practice, individualized patient care, and informed consent. Vaccine mandates undermine all these core values.”
The group further notes they have factored their “health history, chronic conditions, pregnancy/fertility status, age, beliefs, natural immunity status” and more into their decision, iterating, “Where there is risk, there must be choice.” Of note, studies have shown the vaccine does not increase risk of miscarriage or cause infertility. In addition, severe side effects related to the vaccines are minimal. As of Oct. 4, the Vaccine Adverse Event Reporting System had received 8,390 reports of death, the equivalent of 0.0021%, among those who received a COVID-19 vaccine. The CDC notes not all of these deaths are in fact due to the vaccine.
The group disputes that their stance is “selfish” or “uneducated,” and that they want to remain in their jobs because they care about the wellbeing of patients. Without enough staff, they say, services may be closed down and quality of care may suffer.
Gundersen and Mayo assert that staff vaccination is necessary for the health and wellness of patients, with Mayo noting the hospital is requiring shots “to ensure the safest possible environment for our patients, visitors, staff and community.”
Gundersen in its statement to the Tribune said “We have a mission to ensure health, safety, and well-being for everyone in our care. The system vaccine requirement supports this mission, and we stand by it. We must use every option to end the pandemic, protect everyone, and deliver quality care to those we serve. Vaccination is the best option to defend against COVID-19.”
Studies: Vaccination preventing infections, deaths
The anti-mandate group states that fully vaccinated health care workers are testing positive for COVID on a “regular basis,” and that the vaccines “do not prevent transmission.” Data from global and national health organizations proves otherwise. The CDC shows the infection rate among the unvaccinated is five times greater. Per DHS data, in the month of August, the most recent month with published data, infections among the unvaccinated or partially vaccinated were at a rate of 1,413.7 per 100,000, with hospitalizations 98.5 per 100,000 and deaths 11.7 per 100,000. For those fully vaccinated, those rates were 360.7 per 100,000; 11.5 per 100,000; and 1.1 per 100,000, respectively.
A study published in Health Affairs in August estimates that between December 2020 to May 2021, as many as 140,000 COVID deaths and three million infections in the U.S. were prevented due to vaccination.
A report released Oct. 5 from the U.S. Department of Health and Human Services (HHS) shows COVID-19 vaccinations giving January through May 2021 may have helped prevent around 5,500 new infections and 700 deaths among seniors in Wisconsin. On a national level, among Medicaid beneficiaries during the same time period those numbers were around 265,000 and 39,000, respectively. In addition, 107,000 hospitalizations in the U.S. were prevented in that age group.
Nationally, in the first nine months of the pandemic, over 352,000 died from COVID, with nearly 80% of deaths among those 65 and older. When vaccine distribution rates from January through May rose from 1% to 47% among those age 18 to 64, and 1% to 80% among seniors, there was an 11-12% reduction in the number of weekly coronavirus hospitalizations and deaths among Medicare recipients per 10% rise in county inoculation rates.
In contrast, coronavirus deaths as of Friday had reached 711,020 nationally, 8,107 statewide and 104 in La Crosse County. The Guardian reports that through April 2021, 3,067 health care workers died of COVID.
More mandates on the horizon?
The White House report states “In the days and weeks ahead, it is anticipated that additional organizations will announce vaccination requirements or the results of requirements currently in progress.” Federal contractors have until Dec. 8 to enforce staff vaccination, and the Department of Labor and OSHA are finalizing the vaccination order for companies with 100 or more employees.
Currently, the Wisconsin Department of Administration is enforcing weekly testing for non-vaccinated staff starting Oct. 18. Around 70% of executive branch employees had received one or both doses of the vaccine as of Sept. 10. The Milwaukee school district will enforce staff vaccination, with some exemptions or a bi-weekly testing option, starting next month, and Madison schools may follow.
Polls indicate the majority are in favor of vaccination requirements, with a Gallup survey finding about 60% of adults agreeing with requirements for federal government workers, employees of large companies and staff at hospitals that receive federal health care funds. An American Nurses Association (ANA) survey of nurses nationwide found 58% agree with vaccine mandates.
“By getting vaccinated themselves, supporting vaccine mandates, and ensuring that their patients have the most accurate and reliable information possible about the COVID-19 vaccines, nurses nationwide are fulfilling their professional and ethical obligations,” said ANA President Ernest Grant, PhD, RN, FAAN. “We continue to urge the public to follow nurses’ example and get vaccinated to reduce the risk of further hospitalizations and deaths to end this pandemic.”
Emily Pyrek can be reached at [email protected].