California election results embolden feds on new health rule

Julie Smith/News Tribune
Capital Region Medical Center RN Jackie Wisch prepares a vaccine for distribution Monday as the The Cole County Community Vaccination Site opened at 9 a.m. for registrants and walk-ins. The site is staffed with personnel from Cole County Health Department, Capital Region Medical Center, the Community Health Center of Central Missouri, Jefferson City Medical Group, SSM- St. Mary’s Health Center and the Missouri National Guard. The facility, which is located in the Capital Mall's south side and is open 9 a.m. to 3:30 p.m. with the goal vaccinating 4,000 people per week . No appointment is necessary but you are able to register online to get through the line more quickly. To make a vaccination appointment at this location, please visit https://covidvaccine.mo.gov/navigator/ and register through the COVID-19 Vaccine Navigator provided by the Missouri Department of Health and Senior Services. If internet/computer access is not available, please call 1-877-435-8411 to register and schedule an appointment.
Julie Smith/News Tribune Capital Region Medical Center RN Jackie Wisch prepares a vaccine for distribution Monday as the The Cole County Community Vaccination Site opened at 9 a.m. for registrants and walk-ins. The site is staffed with personnel from Cole County Health Department, Capital Region Medical Center, the Community Health Center of Central Missouri, Jefferson City Medical Group, SSM- St. Mary’s Health Center and the Missouri National Guard. The facility, which is located in the Capital Mall's south side and is open 9 a.m. to 3:30 p.m. with the goal vaccinating 4,000 people per week . No appointment is necessary but you are able to register online to get through the line more quickly. To make a vaccination appointment at this location, please visit https://covidvaccine.mo.gov/navigator/ and register through the COVID-19 Vaccine Navigator provided by the Missouri Department of Health and Senior Services. If internet/computer access is not available, please call 1-877-435-8411 to register and schedule an appointment.

The squeaky wheel normally gets the grease.

And those who oppose vaccination mandates have been squeaking very loudly lately.

However, there are signs a number of Americans would welcome mandates if they help end the COVID-19 pandemic.

Although mandates weren't on the ballot Tuesday in California, Gov. Gavin Newsom, a supporter of mask mandates and vaccine requirements for health care workers, was. Sixty-three percent of voters said Newsom should not be recalled because of his mask policies during the pandemic.

President Joe Biden's administration is praising the victory as a validation for policies that he espouses. On Aug. 18, Biden's administration announced the federal government would require nursing facilities to vaccinate all staff members if they wish to continue receiving Medicare and Medicaid payments. The administration already required all federal employees to get vaccinations.

Biden announced Sept. 9 that all health organizations that receive Medicare or Medicaid are to require staff to be vaccinated or submit to weekly testing.

Biden also announced plans to require all businesses with 100 employees or more to require employee vaccinations or weekly COVID-19 tests.

The Centers for Medicare and Medicaid Services (CMS) is developing an interim final rule concerning mandatory vaccinations for health organizations. It is expected to be released in October. CMS will hold a comment period for the rule.

"There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health," Xavier Becerra, secretary of the U.S. Department of Health and Human Services, said in a news release. "Ensuring safety and access to all patients, regardless of their entry point to the health care system, is essential."

Multiple large U.S. and Missouri health care providers began early this summer to mandate that all their employees receive vaccinations against the virus that causes COVID-19.

In Missouri, SSM Health (the St. Louis-based owner of St. Mary's Hospital), MU Health Care (with whom Capital Region Medical Center has a longstanding relationship), BJC HealthCare (Barnes-Jewish Hospital and others) and Mercy (including Mercy Hospital in Springfield and others) represent a significant number of medical institutions in the state.

Many implemented the mandates in late June. MU Health Care did Aug. 5. CRMC did in late August, after the federal government gave full approval for the vaccine.

The change at CRMC is intended to protect the health and safety of employees, patients and the community, hospital President Gaspare Calvaruso said in a news release.

The health care provider mandate or the employer mandate would affect hospitals, said Mary Becker, Missouri Hospital Association (MHA) senior vice president of strategic partnerships and communications.

No details are available for either, Becker said.

"Everybody's interested to see how this will play out," she continued. "We're all waiting to see what the regulations say."

Following the announcement of the mandate for businesses, business leaders demanded answers to questions surrounding the vaccinations. Is one dose enough? What about double doses? What about boosters? What kinds of tests will be required?

And mostly, Becker said they asked, "Who's paying for those tests?"

The Biden administration has indicated it will support "booster" doses for people who have received vaccinations. Pfizer, whose vaccination requires two doses, released data that show its efficacy declines by about 10 percent over a four-month period. The U.S. Food and Drug Administration said Wednesday the vaccinations are so effective they don't require a booster.

All eyes were on the U.S. Food and Drug Administration on Friday morning, as an advisory panel (the Vaccine and Related Biological Products Advisory Committee) received testimony about the effectiveness of COVID-19 vaccination booster shots.

The Centers for Disease Control and Prevention is only recommending at this point that people with highly compromised immune systems receive booster vaccination shots. The committee weighed whether booster shots for the Pfizer vaccine should be offered to people 16 and older.

Experts provided conflicting data about the efficacy of booster shots that morning, according to the New York Times.

Questions were raised about whether vaccinations have been available long enough to generate accurate data.

The panel came back with a decision (voting 16-2) late Friday afternoon to not recommend booster vaccinations.

In another vote, it approved booster shots for people ages 65 and older, and for people with compromised immune systems.

Meanwhile, hospitals have battled the latest wave of cases, which appears to have peaked in mid- to late August.

SSM Health St. Mary's Hospital had 12 total COVID-19 patients Wednesday, two of whom were on ventilators, said Jessica Royston, SSM Health regional manager of marketing and communications.

"For the most part, our number of COVID-19 patients has been trending down since the beginning of September," Royston said. "We averaged 15 COVID-19 patients per day over the past two weeks."

CRMC also had 12 COVID-19 patients Wednesday, according to crmc.org. The lower numbers of COVID-19 patients seen recently makes staff at CRMC optimistic, said Lindsay Huhman, the hospital's director of marketing and public relations in a Thursday email to the News Tribune.

"Thankfully, over the past couple of weeks, we have seen our number of COVID-19 positive patients decrease from the mid- to upper-teens to around 10," Huhman said. "As of today, there is one ventilator in use."

She encouraged people to seek vaccinations, and added "nearly all patients who have been admitted with COVID-19 have not been vaccinated."

"What we're seeing is that hospitals are exhausted," Becker said. We understand that there is hesitancy. On the hospital side, something has got to bring this pandemic under control.

The annual respiratory illness season is beginning, she continued. Respiratory syncytial virus (RSV) is already rampant, well ahead of its normal time period - in winter.

"You want to treat all patients. If you're full of COVID-19 patients, you can't," Becker said. "We don't know that this is the answer. We want to find an end to the pandemic. It's tough right now because we know so little."

The Missouri House Subcommittee on Health, Mental Health and Social Services convened Tuesday afternoon to discuss the vaccination requirements for nursing facilities. The hearing was scheduled before other mandates came along, so organizers focused on nursing homes.

Nikki Strong, executive director of the Missouri Health Care Association, said nursing facilities support getting vaccinations to everyone in nursing homes but don't believe a mandate is the way to accomplish that goal.

Nursing facilities have gone out of their way to encourage staff members and clients to receive vaccinations, Strong said.

"We've provided education sessions, webinars one-on-one meetings separate. We've offered vaccine clinics on-site at our facilities, not only for our residents, for our staff," Strong said.

She said they've separated people from friends who might have been urging them to refuse vaccinations and offered private vaccinations.

The reality of the situation in many states - including Missouri - is that nursing homes have not been able to overcome vaccine hesitancy in younger staff members, Strong said.

In order to continue providing care for residents, she said, facilities have to remain staffed.

"Prior to COVID-19, we were experiencing extreme staffing shortages across the state in long-term care and in other health care settings," Strong said. "In particular, in long-term care."

It's not easy to work in nursing homes, she said. And added it's easier to work at a fast-food restaurant or convenience store than at nursing homes. Without staff, nursing facilities can't take care of their residents.

"We have lost a tremendous amount of staff due to exhaustion levels, burnout, stress, anxiety," Strong said.

In some cases, people were able to make more money by staying home than going to work in the facilities, she said. Nursing facilities don't have the resources to compete with fast food restaurants, convenience stores or Walmart.

She said 70 percent of nursing home residents are on Medicaid, which sets specific rates that it pays for services.

Staff are leaving nursing homes and going into other sectors, where they can make more money.

"This is real. This is going to have a significant impact. This isn't because people don't care, and don't care about their residents, and don't care about protecting them," Strong said. "This is a real, personal choice that's become very polarizing. It's become very political."

She said the mandate, rather than encouraging people to get vaccinated, has "almost created more resistance to being vaccinated, because someone's going to tell me what I'm going to do with my body."

Strong's testimony raised a lot of questions, said Rep. Peter Merideth, D-St. Louis.

The staffing crisis is very real, and happening without a vaccine requirement being in place, Merideth pointed out. That's true in a lot of sectors of the economy that pay lower wages for jobs, he continued.

"We still want safety protections in place, especially in jobs that are taking care of the vulnerable," Merideth said.

He asked Strong how many residents had died in nursing homes over the past two years.

She responded that she didn't know.

The state already has a staffing crisis, Merideth said.

"What we should be talking about today is how we stem that, not how we make it less safe in nursing homes," he said. "But, how we raise pay and reimbursement rates that have been lagging behind and making it so people are working for less than living wages - and doing one of these difficult jobs in one of the most difficult times in our history."

That's why they're leaving - because they don't get paid enough to respect the work they do, Merideth said.

Another requirement on them might be the straw that broke the camel's back, he said, but the tough job they've done for the past two years for little pay is undoubtedly a bigger factor in staff leaving.