Lack of a Vaccine Mandate Becomes Competitive Advantage in Hospital Staffing Wars

Yves here. We had warned that efforts to impose Covid vaccine mandates, as the Biden Administration has announced for nursing homes receiving Medicare and Medicaid funds, was certain to exacerbate existing staffing shortages. Hospitals have already suffered resignations of nurses and doctors due to burnout and their own fears of contracting Covid. One of our aides quit her job in a local hospital last month. Her floor supposedly had a specialized role, but she said the facility was fabulously disorganized so they got all kinds of patients.

Her floor was converted to a Covid floor: “Two cases the first day. Four the second, Eight the next. I could see where this was going. I resigned.”

This article is frustratingly misleading by omission on several issues. First it does not acknowledge weak efficacy of the existing vaccines against Delta infections, particularly after a few months (the vaccines do still appear to offer solid protection against hospitalizations until they start to wane, which again appears to be much sooner against Delta than the officialdom wants to admit). Second is that the CDC has stated that vaccinated Covid positive cases carry similar amounts of virus in their nasal passages. Viral loads for Delta are so high that later papers trying to argue the the virus in vaccinated patients is somehow less potent did not impress our GM: “Yeah, it got 2x more contagious, the vaccinated are only 1.8x more contagious, we are winning…”

That is a long-winded way of saying that having hospital staff vaccinated is a good idea…for them! Adequate staffing, high grade PPE, and negative pressure rooms are oddly being downplayed as important patient protections in these discussions. And hazard pay. Many hospitals are paying huge amounts for traveling nurses, when bonuses for working a certain number of days a month would keep at least some staffers from leaving.

And why is this article silent on why nurses, who by virtue of seeing how devastating Covid can be, should be in the front of the line to volunteer for getting vaccinated yet many still haven’t? This is a huge CDC failure and the article going soft by being complicit isn’t helping.

We reviewed in our post on the Biden Administration nursing home mandate why some staffers still have not gotten vaccinated. Recall that nurses and other support staff, like cooks and cleaners, are the backbone of hospitals, and they skew female and young. As we wrote:

Let’s look at a few of the cohorts that are on the vaccine hesitant to anti-vax spectrum that have good odds of quitting:

Reproductive age women who’ve heard of cases menstrual period disruption post vaccination. The CDC has simply ignored this issue, which doesn’t engender confidence in women who’ve heard about these problems. The lack of interest reeks of gender and class bias. Well off women could store their eggs before getting a shot and then get IVF later. Or they could afford a fertility doctor if they had issues, whether or not due to the vaccination. Lower income women don’t have these fallbacks.

And these changes are frequent enough to not be “rare” (like the roughly one in a million J&J blood clots) even if not common. And they are in many case alarming. From WBRC last month:

Katharine Lee noticed changes in her menstrual cycle not long after getting her COVID-19 vaccine….

“When we were going through ethics approval, Katie and I had a discussion about how many people we anticipated would participate and the number we put in was 500 and that was being optimistic,” said Kate Clancy, PhD, Director of Graduate Studies, Associate Professor of Anthropology, University of Illinois. “We hit 500 I think in the first couple of hours and in fact, were in the thousands within 24 hours.”

Their research survey launched a few weeks ago and has nearly 130,000 replies from women sharing their menstrual experiences after vaccination…

Among those people, just broadly what we can say, is for the most part their experience is that their period is heavier, but we do also see some people with lighter periods, and really the most important finding for us, is not just looking at the experiences of people who are currently menstruating, but looking at people who are not currently menstruating.”

Clancy said women who are on-long active contraceptives or women who are postmenopausal are reporting breakthrough bleeding.

Some experts (of course men!) have tried to depict these results as stress-driven, but stress if anything leads to late and/or light periods, not early and heavy ones. And since when do post menopausal women have heavy breakthrough periods?

Even some of our male readers have heard about this syndrome. From Isotope_C14:

With the quality of data being collected by CDC and VAERS I don’t know how any person could hang a flag to either side…

Anecdotally, all the girls that run the bar that I shouldn’t go to have incredibly whacked long-term symptoms. All of them are under 30. Most of them are having bizzare menstrual problems. One, who is utterly adorable and reminds me of a young Terry Farrell hasn’t had her time of the month in 55 days.

He also mentioned how odd it was to have women who were just a bit over half his age tell him about their periods, which he took as an indicator of how much it was on their minds.

Back to the current post. We’ve since heard of two cases who haven’t menstruated in months post vaccination. Their specialists don’t know what to do since their hormones look fine. Anecdata like that gets around.

The CDC should have gotten on top of this issue immediately and gathered data on prevalence, in particular how often this was happening and how quickly the irregular periods resolved, and how many had continuing issues. The CDC then could easily have put up comparative data on the odds of this result versus the odds of bad outcomes from getting Covid, not just death but all of the other types of damage, starting with long Covid, which appears to hit women more often then men.

Pretending that this isn’t happening only feeds distrust. As one hospital worker put it: “Most people who want to have kids will gladly tell the boss to take the job and shove it – and they are.”

By Lauren Weber, correspondent for Kaiser Health News, a former health policy reporter for HuffPost, and a 2017 USC Annenberg Health Journalism National Fellow. Originally published at Kaiser Health News

In the rural northeastern corner of Missouri, Scotland County Hospital has been so low on staff that it sometimes had to turn away patients amid a surge in covid-19 cases.

The national covid staffing crunch means CEO Dr. Randy Tobler has hired more travel nurses to fill the gaps. And the prices are steep — what he called “crazy” rates of $200 an hour or more, which Tobler said his small rural hospital cannot afford.

A little over 60% of his staff is fully vaccinated. Even as covid cases rise, though, a vaccine mandate is out of the question.

“If that becomes our differential advantage, we probably won’t have one until we’re forced to have one,” Tobler said. “Maybe that’s the thing that will keep nurses here.”

As of Thursday, about 39% of U.S. hospitals had announced vaccine mandates, said Colin Milligan, a spokesperson for the American Hospital Association. Across Missouri and the nation, hospitals are weighing more than patient and caregiver health in deciding whether to mandate covid vaccines for staffers.

The market for health care labor, strained by more than a year and a half of coping with the pandemic, continues to be pinched. While urban hospitals with deeper pockets for shoring up staff have implemented vaccine mandates, and may even use them as a selling point to recruit staffers and patients, their rural and regional counterparts are left with hard choices as cases surge again.

“Obviously, it’s going to be a real challenge for these small, rural hospitals to mandate a vaccine when they’re already facing such significant workforce shortages,” said Alan Morgan, head of the National Rural Health Association.

Without vaccine mandates, this could lead to a desperate cycle: Areas with fewer vaccinated residents likely have fewer vaccinated hospital workers, too, making them more likely to be hard hit by the delta variant sweeping America. In the short term, mandates might drive away some workers. But the surge could also squeeze the hospital workforce further as patients flood in and staffers take sick days.

Rural covid mortality rates were almost 70% higher on average than urban ones for the week ending Aug. 15, according to the Rural Policy Research Institute.

Despite the scientific knowledge that covid vaccinations sharply lower the risk of infection, hospitalization and death, the lack of a vaccine mandate can serve as a hospital recruiting tool. In Nebraska, the state veterans affairs’ agency prominently displays the lack of a vaccine requirement for nurses on its job site, The Associated Press reported.

It all comes back to workforce shortages, especially in more vaccine-hesitant communities, said Jacy Warrell, executive director of the Rural Health Association of Tennessee. She pointed out that some regional health care systems don’t qualify for staffing assistance from the National Guard as they have fewer than 200 beds. A potential vaccine mandate further endangers their staffing numbers, she said.

“They’re going to have to think twice about it,” Warrell said. “They’re going to have to weigh the risk and benefit there.”

The mandates are having ripple effects throughout the health care industry. The federal government has mandated that all nursing homes require covid vaccinations or risk losing Medicare and Medicaid reimbursements, and industry groups have warned that workers may jump to other health care settings. Meanwhile, Montana has banned vaccine mandates altogether, and the Montana Hospital Association has gotten one call from a health care worker interested in working in the state because of it, said spokesperson Katy Peterson.

It’s not just nurses at stake with vaccine mandates. Respiratory techs, nursing assistants, food service employees, billing staff and other health care workers are already in short supply. According to the latest KFF/The Washington Post Frontline Health Care Workers Survey, released in April, at least one-third of health care workerswho assist with patient care and administrative tasks have considered leaving the workforce.

The combination of burnout and added stress of people leaving their jobs has worn down the health care workers the public often forgets about, said interventional radiology tech Joseph Brown, who works at Sutter Roseville Medical Center outside Sacramento, California.

This has a domino effect, Brown said: More of his co-workers are going on stress and medical leave as their numbers dwindle and while hospitals run out of beds. He said nurses’ aides already doing backbreaking work are suddenly forced to care for more patients.

“Explain to me how you get 15 people up to a toilet, do the vitals, change the beds, provide the care you’re supposed to provide for 15 people in an eight-hour shift and not injure yourself,” he said.

In Missouri, Tobler said his wife, Heliene, is training to be a volunteer certified medical assistant to help fill the gap in the hospital’s rural health clinic.

Tobler is waiting to see if the larger St. Louis hospitals lose staff in the coming weeks as their vaccine mandates go into effect, and what impact that could have throughout the state.

In the hard-hit southwestern corner of Missouri, CoxHealth president and CEO Steve Edwards said his health system headquartered in Springfield is upping its minimum wage to $15.25 an hour to compete for workers.

While the estimated $25 million price tag of such a salary boost will take away about half the hospital system’s bottom line, Edwards said, the investment is necessary to keep up with the competitive labor market and cushion the blow of the potential loss of staffers to the hospital’s upcoming Oct. 15 vaccine mandate.

“We’re asking people to take bedpans and work all night and do really difficult work and maybe put themselves in harm’s way,” he said. “It seems like a much harder job than some of these 9-to-5 jobs in an Amazon distribution center.”

Two of his employees died from covid. In July alone, Edwards said 500 staffers were out, predominantly due to the virus. The vaccine mandate could keep that from happening, Edwards said.

“You may have the finest neurosurgeon, but if you don’t have a registration person everything stops,” he said. “We’re all interdependent on each other.”

But California’s Brown, who is vaccinated, said he worries about his colleagues who may lose their jobs because they are unwilling to comply with vaccine mandates.

California has mandated that health care workers complete their covid vaccination shots by the end of September. The state is already seeing traveling nurses turn down assignments there because they do not want to be vaccinated, CalMatters reported.

Since the mandate applies statewide, workers cannot go work at another hospital without vaccine requirements nearby. Brown is frustrated that hospital administrators and lawmakers, who have “zero covid exposure,” are the ones making those decisions.

“Hospitals across the country posted signs that said ‘Health care heroes work here.’ Where is the reward for our heroes?” he asked. “Right now, the hospitals are telling us the reward for the heroes: ‘If you don’t get the vaccine, you’re fired.’”