Firing staff for not being vaccinated....

[dieABRdie]

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Today a couple of therapists were talking about what they would do if they were fired for not being vaccinated. Despite the mandate being held up by the supreme court, they still aren't going to get it.

Our leadership hasn't issued any plans yet. I was just curious what other departments/groups are doing about it. Hopefully without the thread devolving into a political dumpster fire discussion.

People being fired? Testing weekly?

 

[elementaryschooleconomics]

Yes, I would also like to have a discussion about this without devolving into a political dumpster fire. Opinions on whether or not it's right/wrong, constitutional/unconstitutional, based in science/based in policy - those are different matters from day-to-day practical issues.

As far as I have heard, everyone in my department has been vaccinated, consistent with my state and hospital mandate. So I think I am spared this (for now).

I see this going two ways:

1) If your (or my) hospital leadership issues and enforces an edict that you must be vaccinated to be employed, then that's the answer, problem solved.

2) If there is no hospital or state mandate - obviously a little tricky. If I dig way, WAY back into my memory banks, I recall a time where we only required a yearly flu vaccine. Staff who were unwilling/unable to get the yearly flu vaccine were required to wear a mask at all times during flu season (as I recall, I think "just" a surgical mask, not an N95, but that might have varied institution to institution).

At this point in the game, I would be OK with weekly testing and wearing an N95 with eye protection. If they developed any symptoms, stay home. Honestly, in a few years when we're finally in the endemic stage, I bet that's what will happen routinely. Assuming society doesn't crumble first.

As the pandemic has dragged on, hospital leadership has given less and less guidance (at least in my observation). We're an interesting specialty in this situation. We care for immunocompromised/vulnerable patients in an ambulatory setting, with dozens and dozens of people coming in and out daily by the very nature of what we do. I think we need to pay closer attention to these things compared to say, an inpatient unit which can restrict visitors.

 

[TheWallnerus]

We instituted testing weekly or get vaccinated as soon as vaccines were available. I think in healthcare, you really kind of have no choice. However, forcing healthcare workers, or allowing them, to come to work if COVID positive is even stupider than not nudging people toward vaccination.

 

[DoctwoB]

The best solution: Anti-vaxxers bribe doctors for “vaccination” with water, end up with the real vaccine - Keep Talking Greece

Apparently it is not too uncommon for doctors to take a bribe to fake giving a COVID vaccine. Waste the dose and give a vaccine card. Obviously unethical.

But to take the bribe and administer the vaccine anyways? Absolutely brilliant. Who are they going to complain to?

 

[deleted1116990]

It's a total cluster all around. The timing of this is horrible as we were almost there. Omicron is basically functioning as a vaccine against more deadly strains. It was reported yesterday that omicron infection confers a 91% mortality benefit over delta. That's pretty good. So basically everyone will get some immunity one way or the other. The problem is going to be if there is still a push for mandates after it's burned through (I am confident there will be), everyone has gotten sick and recovered, and cases go back down. I think you are going to see a lot more angry protest if that happens, which is frankly understandable. The arguments I have heard for vaccinating those with recovered infections are pretty weak. It basically boils down to "How do we know they are not lying? Vaccinate everyone anyway."

It would be nice to go back to common sense behaviors of not coming to work if you have flu-like symptoms, avoiding people, and covering your cough. But not going back to forcing residents to get IVs, take steroids, and continue to work with 101 degree fevers. It wasn't even that long ago when I was a medical student that calling into your surgery rotation sick was unacceptable. If you had flu like symptoms and a fever, you came anyway. The same doctors now who are screaming about mandates and staff quarantines are the same ones that 15 years ago were bragging about never taking sick days. I remember having to come in with a norovirus infection as a med student. It got so bad that I literally could not function, and the dean would not let me go home and made me go to student health to make sure I wasn't faking it. I actually remember feeling ashamed about it and worried my grade would suffer. I remember a co-intern working through strep throat. Hopefully we don't go back to that. That was always insane.

 

[ramsesthenice]

common sense behaviors

Unfortunately, sense is not common.

 

[Mandelin Rain]

I'm not a big "Mah Rights!" guy to say the least, but the most interesting element of any of this to me is that health care workers can be subject to specific mandates while the rest of the working country is protected from them. I'm sure there's some legalese nonsense to describe why the disparity is okay, but we all understand how we're treated in America.

 

[Ray D. Ayshun]

We instituted testing weekly or get vaccinated as soon as vaccines were available. I think in healthcare, you really kind of have no choice. However, forcing healthcare workers, or allowing them, to come to work if COVID positive is even stupider than not nudging people toward vaccination.

I'm always annoyed when people come to work with the common cold, but it's hard to stay home/take sick days. Seems like this is the common cold now.

 

[Mandelin Rain]

I'm always annoyed when people come to work with the common cold, but it's hard to stay home/take sick days. Seems like this is the common cold now.

Eh. That's going a bit far. Omicron became the dominant variant in mid December. People dying in mid January, are predominantly Omicron people. 2,100 people died yesterday of COVID.

It ain't delta, but it also ain't a common cold.

EDIT: Unless I'm misunderstanding your meaning.

 

[DoctwoB]

I'm not a big "Mah Rights!" guy to say the least, but the most interesting element of any of this to me is that health care workers can be subject to specific mandates while the rest of the working country is protected from them. I'm sure there's some legalese nonsense to describe why the disparity is okay, but we all understand how we're treated in America.

Not a lawyer, but that makes some sense to me. Medicare makes their own rules. Want to accept Medicare? Comply with a mandate. Also note that this doesn't keep employers from having mandates, or that the federal government cant mandate a vaccine, but can't mandate it based on Biden's executive order (i.e. would require congressional action).

FWIW I'm a big fan of mandates and big hater of the current supreme court, but didn't find this decision totally unreasonable..

 

[Ray D. Ayshun]

Eh. That's going a bit far. Omicron became the dominant variant in mid December. People dying in mid January, are predominantly Omicron people. 2,100 people died yesterday of COVID.

It ain't delta, but it also ain't a common cold

More virulent than the common cold. But the risk of death, hospitalization etc is >10 higher for the unvaccinated. At this point, unvaccinated=never will be. It's time to treat this like the common inasmuch as we just stop rearranging the deck chairs. I would also be a fan, though, of giving the hospitals the liberty to turn away the unvaccinated when they present with COVID complications.

 

[temujim]

Today a couple of therapists were talking about what they would do if they were fired for not being vaccinated. Despite the mandate being held up by the supreme court, they still aren't going to get it.

Our leadership hasn't issued any plans yet. I was just curious what other departments/groups are doing about it. Hopefully without the thread devolving into a political dumpster fire discussion.

People being fired? Testing weekly?

The power is in the hands of hospital employees at this stage. If say 10% of your therapists quit instead of vaccinated... easily see your linac schedule collapse. Same with nurses, MAs, janitors, etc. Doctors prob not so much. And there's nothing like damaging the bottom line to get the c-suite in line with accepting "exemptions".

 

[TheWallnerus]

I'm not a big "Mah Rights!" guy to say the least, but the most interesting element of any of this to me is that health care workers can be subject to specific mandates while the rest of the working country is protected from them. I'm sure there's some legalese nonsense to describe why the disparity is okay, but we all understand how we're treated in America.

Once you take a single dollar from Medicare, they (the US govt) write your rules.

 

[temujim]

I'm not a big "Mah Rights!" guy to say the least, but the most interesting element of any of this to me is that health care workers can be subject to specific mandates while the rest of the working country is protected from them. I'm sure there's some legalese nonsense to describe why the disparity is okay, but we all understand how we're treated in America.

If you read the decision, 5-4 supreme court says that this specific regulatory power to mandate vaccines (ensure the health and safety of medicare patients -- something like that) was written into the law by congress whereas not written into the law for OSHA. This isn't the final step -- the stay was voided and case remanded to appeals court for further review.

 

[temujim]

Once you take a single dollar from Medicare, they (the US govt) write your rules.

When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.”

And the golden rule of course states that he who has the gold, makes the rules.

 

[medgator]

Once you take a single dollar from Medicare, they (the US govt) write your rules.

Bingo... I'm guessing that's how SCOTUS threaded that needle

 

[TheWallnerus]

When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.”

And the golden rule of course states that he who has the gold, makes the rules.

Older docs, real late onset boomers, say there was no such thing as a wealthy physician before Medicare.

 

[temujim]

Older docs, real late onset boomers, say there was no such thing as a wealthy physician before Medicare.

At least in radiation oncology the real golden age wasn't IMRT. It was the early 80s when CT planning started and before Medicare started squeezing in any form. Apparently the money was ridiculous. Knew a guy who owned a bank on the side.

 

[medgator]

At least in radiation oncology the real golden age wasn't IMRT. It was the early 80s when CT planning started and before Medicare started squeezing in any form. Apparently the money was ridiculous. Knew a guy who owned a bank on the side.

Really? I thought late 90s/early 00s was the really golden goose with IMRT....

Before then, many ROs had to go to the too l radiology Dept to the Sims from the stories I've heard, so they weren't even collecting CT charges?

 

[TheWallnerus]

At least in radiation oncology the real golden age wasn't IMRT. It was the early 80s when CT planning started and before Medicare started squeezing in any form. Apparently the money was ridiculous. Knew a guy who owned a bank on the side.

Really? I thought late 90s/early 00s was the really golden goose with IMRT....

Before then, many ROs had to go to the too l radiology Dept to the Sims from the stories I've heard, so they weren't even collecting CT charges?

Bogardus used to tell a story about that in the first days of Medicare, you... the doc... would just decide what was the right dollar amount to bill for the patient. And you'd send in the bill, for, say $10K, which was A LOT of money back in the day, and Medicare just paid it. No questions asked.

 

[dieABRdie]

Bogardus used to tell a story about that in the first days of Medicare, you... the doc... would just decide what was the right dollar amount to bill for the patient. And you'd send in the bill, for, say $10K, which was A LOT of money back in the day, and Medicare just paid it. No questions asked.

I know a doc that lived through that era and can concur.

 

[elementaryschooleconomics]

I know a doc that lived through that era and can concur.

I also know a doc who came in at the tail end of that era and has several friends who were from that era, I can also concur.

The phrase "they basically had to back a dump truck up to his house to deliver his money" has been said more than once to me.

 

[SneakyBooger]

As I understand Medicare, @TheWallnerus is correct about "the first days".

To get everyone on board they promised the moon and it worked - all the docs signed up. However, as time went by CMS slowly and continually tightened the screws. Initially, if one charged $100 for $100 of service then CMS paid $100. As time went by, CMS began paying $90, then $80, then $70, and so forth. Docs eventually caught on and started charging $500 to get the fair rate of $100.

Medicare then mandated that if you are going to charge $500 (to provide $100 of services), then you can't charge anyone else any less than you charge CMS. So, the uninsured/underinsured now are charged an artificially inflated price for health care in the US.

Long story short, now one charges $150K to be paid $7500.

 

[SneakyBooger]

Back to the subject at hand.

If one believes "my body = my choice" then the decision to wear a mask or be vaccinated is a choice left to the individual.

I chose to be vaccinated and boosted. I always wear a mask when indoors and have relatively rarely gone out in public for the past 2 years.

Employees can declare a religious exemption if they are not vaccinated.

Patients need healthcare workers.

Now a few little pandemic stories:

An ob/gyn office in my area has an office staff of 18. Last week 14 of those were out with Covid. I can't imagine how difficult it must be trying to run a clinic with 78% of the office staff MIA. Those babies don't stop being born just like cancer doesn't stop growing. 13 of those 14 were vaccinated.

20% of a local hospital staff is unvaccinated. How does one run a hospital with 20% of the staff suddenly gone?

I am certain that such a loss of production in another facility will have an effect on my care for patients. For example, why is it taking so long to get office notes from the referring? Why is it taking 30 minutes to answer their phone? Why can't I get reports from the pathology group?

Speaking of pathology - I recently spoke with one of the pathologists who said they had lost 2 key personnel due to this mandate and that it is having a detrimental effect on their productivity. They commented that this is on top of a significant decline in the amount of work they are doing lately due to outside offices ordering fewer labs and biopsies. My take: this situation has a detrimental effect on patients and health care services, including oncology.

 

[seper]

Vaccines don’t seem to prevent Omicron infections and staff absences.

 

[elementaryschooleconomics]

If one believes "my body = my choice" then the decision to wear a mask or be vaccinated is a choice left to the individual.

I normally try to stay out of this, especially on the internet, but @SneakyBooger has been on a roll this morning with thoughtfully provocative posts, which I appreciate.

You're obviously not the first to make this argument. There are many flavors of it, and, at face value, they sound like they have merit.

It's a false equivalence.

If we break that statement down, and the heuristics it triggers:

America is a two-party political country, with increasing polarization, especially over the last 20 years.

In general, the conservative right are pro-life, and the liberal left are pro-choice. Elective abortion = medicine.

"My body, my choice" is a slogan used by the liberal left when advocating pro-choice policies and legislation.

Again in general, the conservative right are against COVID restrictions and vaccine mandates, while the liberal left are for them. This breaks down somewhat on the extreme left, especially in southern California, but I digress. COVID vaccine = medicine.

In America, most people associate "my body, my choice" with "the liberal left wants the government to not legislate personal medical choices".

By responding with "my body, my choice" to vaccine mandates, you are putting people in a logic prison because of American politics and abortion.

However - pregnancy is not contagious.

There are issues which affect us as individuals, and issues which affect us as a group. The arguments for/against one cannot translate to the other.

We could start using this elsewhere, and arrive at "we need to stop screening blood donors for HIV or hepatitis, my body, my choice".

So no, "my body, my choice" and vaccine mandates are not mutually exclusive. America has built this bizarre ethos where rugged individualism is held up as admirable...within a society. For a society to survive, choices must occasionally be made which benefits society but not necessarily the individual.

And I also don't disagree with a lot of the elegant/eloquent scientific/data arguments against mandatory vaccines (i.e. the Peter Attia stuff). Health policy is more about protecting the group from the weakest link, and this country is too big and disorganized for nuanced policy. The most conservative policy to protect the group is "vaccinate everyone".

Attending Addendum: The blood donation thing is JUST AN EXAMPLE. I know people will latch onto that specifically. It's just meant to illustrate that co-opting "my body, my choice" in other aspects of life is heavy-handed.

 

[temujim]

Back to the subject at hand.

If one believes "my body = my choice" then the decision to wear a mask or be vaccinated is a choice left to the individual.

I chose to be vaccinated and boosted. I always wear a mask when indoors and have relatively rarely gone out in public for the past 2 years.

Employees can declare a religious exemption if they are not vaccinated.

Patients need healthcare workers.

Now a few little pandemic stories:

An ob/gyn office in my area has an office staff of 18. Last week 14 of those were out with Covid. I can't imagine how difficult it must be trying to run a clinic with 78% of the office staff MIA. Those babies don't stop being born just like cancer doesn't stop growing. 13 of those 14 were vaccinated.

20% of a local hospital staff is unvaccinated. How does one run a hospital with 20% of the staff suddenly gone?

I am certain that such a loss of production in another facility will have an effect on my care for patients. For example, why is it taking so long to get office notes from the referring? Why is it taking 30 minutes to answer their phone? Why can't I get reports from the pathology group?

Speaking of pathology - I recently spoke with one of the pathologists who said they had lost 2 key personnel due to this mandate and that it is having a detrimental effect on their productivity. They commented that this is on top of a significant decline in the amount of work they are doing lately due to outside offices ordering fewer labs and biopsies. My take: this situation has a detrimental effect on patients and health care services, including oncology.

Hmmm... I was assured by CMS, etc that staffing shortages due to vaccine mandates would never happen.

https://public-inspection.federalregister.gov/2021-23831.pdf

Most c-suite entities have settled on a very liberal exemption policy having seen the numbers and potential impacts.

 

[temujim]

And I also don't disagree with a lot of the elegant/eloquent scientific/data arguments against mandatory vaccines (i.e. the Peter Attia stuff). Health policy is more about protecting the group from the weakest link, and this country is too big and disorganized for nuanced policy. The most conservative policy to protect the group is "vaccinate everyone".

The thing that bothers a lot of people is the lack of nuance... which is seen in pretty much every other standard vaccine recommendation we have.

 

[BobbyHeenan]

The thing that bothers a lot of people is the lack of nuance... which is seen in pretty much every other standard vaccine recommendation we have.

I don’t understand how a prior infection is completely ignored.

We will allow for hand waiving questionable “religious exemptions” but somehow won’t grant prior infection waivers.

 

[medgator]

Vaccines don’t seem to prevent Omicron infections and staff absences.

Afaik boosted folks were less likely to end up in the hospital with omicron?

There's seems to be a misconception about what vaccines are supposed to do.... They don't prevent infection. Never have. Gardisil won't prevent HPV infection as an example as that was not its intended purpose which is why it is less useful when given an older, sexually active population

 

[elementaryschooleconomics]

I don’t understand how a prior infection is completely ignored.

This is a perfect example!

The data indicates that someone who has been infected and recovered but not vaccinated has similar (or better) protection than someone who has been vaccinated but not infected, yes?

1) Using italics here invokes a sense of "omg how are we missing this" in the reader

2) The data is from May to November 2021 in California, a pre-omicron era in a demographic which might not translate to other states

3) This is a raw "yes/no" rate about hospitalizations for COVID, not indicating severity or outcome

4) While you can spin it as "infected, unvaccinated people were hospitalized 2.5x less"...it's 0.0693% vs 0.0275%

Regardless, I actually completely agree on his point.

So, now I think about humanity, and how this could go wrong:

How can we KNOW someone has been infected and recovered? Serology from a national lab is probably the best answer, which is not practical. So, skipping ahead several steps - namely, people erroneously invoking HIPAA and demanding we take their word for it - there would be a sizable segment of the population who would lie about this to avoid "the government telling me what to do".

We already see this with fake vaccine cards.

If society was filled only with high-health literacy who understood the nuance of the pandemic and cared about the health of the group in aggregate, I would be 100% for exempting previously infected individuals from the vaccine.

We don't live in that society.

Vaccines for all, regardless of whether you claim prior COVID infection, is the most conservative answer.

I will absolutely advocate for nuance down the road, when the dust has settled and this is endemic. We're still in the acute phase. This isn't the time for nuance. Masks and vaccines for everyone, REGARDLESS of the truth of efficacy for either of those things. No mixed messaging or exemptions. Then, when we're back in control, we get nuanced.

If someone with known metastatic cancer comes in with saddle anesthesia and a CT lumbar spine with a new vertebral met, do you wait until you have the MRI confirming cord compression before starting dex? Or do you opt for the most conservative route before tailoring the treatment as more information comes in and you gain control of the situation?

In the COVID cord compression of American society, the MRI total spine has been ordered, but it's pending.

 

[BobbyHeenan]

This is a perfect example!

The data indicates that someone who has been infected and recovered but not vaccinated has similar (or better) protection than someone who has been vaccinated but not infected, yes?

View attachment 348829

1) Using italics here invokes a sense of "omg how are we missing this" in the reader

2) The data is from May to November 2021 in California, a pre-omicron era in a demographic which might not translate to other states

3) This is a raw "yes/no" rate about hospitalizations for COVID, not indicating severity or outcome

4) While you can spin it as "infected, unvaccinated people were hospitalized 2.5x less"...it's 0.0693% vs 0.0275%

Regardless, I actually completely agree on his point.

So, now I think about humanity, and how this could go wrong:

How can we KNOW someone has been infected and recovered? Serology from a national lab is probably the best answer, which is not practical. So, skipping ahead several steps - namely, people erroneously invoking HIPAA and demanding we take their word for it - there would be a sizable segment of the population who would lie about this to avoid "the government telling me what to do".

We already see this with fake vaccine cards.

If society was filled only with high-health literacy who understood the nuance of the pandemic and cared about the health of the group in aggregate, I would be 100% for exempting previously infected individuals from the vaccine.

We don't live in that society.

Vaccines for all, regardless of whether you claim prior COVID infection, is the most conservative answer.

I will absolutely advocate for nuance down the road, when the dust has settled and this is endemic. We're still in the acute phase. This isn't the time for nuance. Masks and vaccines for everyone, REGARDLESS of the truth of efficacy for either of those things. No mixed messaging or exemptions. Then, when we're back in control, we get nuanced.

If someone with known metastatic cancer comes in with saddle anesthesia and a CT lumbar spine with a new vertebral met, do you wait until you have the MRI confirming cord compression before starting dex? Or do you opt for the most conservative route before tailoring the treatment as more information comes in and you gain control of the situation?

In the COVID cord compression of American society, the MRI total spine has been ordered, but it's pending.

Appreciate your thoughts.

I’d say to get your prior infection exemption you would have to provide lab evidence of current antibodies or a prior + test.

No “self attestations” allowed.

Maybe I’m wrong/naive but that doesn’t seem too onerous/cumbersome.

 

[elementaryschooleconomics]

Appreciate your thoughts.

I’d say to get your prior infection exemption you would have to provide lab evidence of current antibodies or a prior + test.

No “self attestations” allowed.

Maybe I’m wrong/naive but that doesn’t seem too onerous/cumbersome.

I definitely would support that in a few years!

Just not right now, while we're still struggling.

 

[TheWallnerus]

As I understand Medicare, @TheWallnerus is correct about "the first days".

To get everyone on board they promised the moon and it worked - all the docs signed up. However, as time went by CMS slowly and continually tightened the screws. Initially, if one charged $100 for $100 of service then CMS paid $100. As time went by, CMS began paying $90, then $80, then $70, and so forth. Docs eventually caught on and started charging $500 to get the fair rate of $100.

Medicare then mandated that if you are going to charge $500 (to provide $100 of services), then you can't charge anyone else any less than you charge CMS. So, the uninsured/underinsured now are charged an artificially inflated price for health care in the US.

Long story short, now one charges $150K to be paid $7500.

But Sneak... they were from the government, and they were there to help.

 

[elementaryschooleconomics]

QuadShot, as always, with the great timing:

Is this why my phone and email blew up about COVID yesterday, in addition to this thread?

Regardless, I look forward to joining the nuance and data train with you all in the future. For now, me and my "Weakest Link" baseball bat will continue to roam the streets.

 

[temujim]

QuadShot, as always, with the great timing:

View attachment 348876

Is this why my phone and email blew up about COVID yesterday, in addition to this thread?

Regardless, I look forward to joining the nuance and data train with you all in the future. For now, me and my "Weakest Link" baseball bat will continue to roam the streets.

CDC doing a modified limited hangout, just in case they want to pivot away from their crappy kentucky MMWR article.

 

[wandering star]

There's seems to be a misconception about what vaccines are supposed to do.... They don't prevent infection. Never have. Gardisil won't prevent HPV infection as an example as that was not its intended purpose which is why it is less useful when given an older, sexually active population

I hear this argument sometimes. I think the question of what vaccines are "supposed" to do has become a Rorschach test on your own values. The smallpox vaccine prevented infection and it did a fantastic job. The truth is that if we had a Covid vaccine that could prevent infection and onwards transmission, we would be able to protect unvaccinated/immunosuppressed individuals even without action on their part, and in so doing could eradicate the disease.

The original trials submitted to FDA had a primary endpoint of symptomatic PCR-confirmed infection, and the regulators wanted to see 50% or better. When vaccines from other countries achieved 50ish% protection against infection but 90% protection against severe disease, most people in the US said, no way dude, give me the mRNA vaccine, it is way way better.

Regardless of the original intent, though, I agree that currently the role of the vaccine is to prevent severe disease. Prior infection will also prevent severe disease, too, possibly better than the vaccine but then with a lot more risk for complications too.