Healthcare Vaccine Mandate Remains As Some Push For An End

By David A. Lieb and Kavish Harjai Associated Press

At Truman Lake Manor in rural Missouri, every day begins the same way for every employee entering the nursing home’s doors - with a swab up the nose, a swirl of testing solution and a brief wait to see whether a thin red line appears indicating a positive COVID-19 case.

Only the healthy are allowed in to care for virus-free residents.

Despite those precautions, a coronavirus outbreak swept through the facility late last year. An inspector subsequently cited it for violating the federal government’s COVID-19 vaccination requirement for health care facilities.

Truman Lake Manor is one of about 750 nursing homes and 110 hospitals nationwide written up for violating federal staff vaccination rules during the past year, according to an Associated Press analysis of data from the Centers for Medicare & Medicaid Services. Most were given a bureaucratic nudge to do better - though some nursing homes also received fines, especially when they had multiple other problems.

One year after it began being enforced nationwide on Feb. 20, 2022, the vaccination requirement affecting an estimated 10 million health care workers is the last remaining major mandate from President Joe Biden’s sweeping attempt to boost national vaccination rates. Similar requirements for large employers, military members and federal contractors all have been struck down, repealed or partially blocked.

The health care vaccination mandate is scheduled to run until November 2024. But some contend it’s time to stop now, citing fewer severe COVID-19 cases, health care staffing shortages and the impending May

11 expiration of a national public health emergency that has been in place since January 2020.

``Their regulations are making it harder to give care - not easier,`` said Tim Corbin, the administrator of Truman Lake Manor who also doubles as a nurse, adding that ``the mandates need to end.’’

CMS said in a statement to the AP that ``the requirement for staff to be fully vaccinated has been a critical step in responding to the pandemic’’ and ``has saved Americans from countless infections, hospitalizations, and death.’’

The policy requires workers, contractors and volunteers at facilities receiving Medicare or Medicaid payments to have the full primary dosage of an original COVID19 vaccine, with exemptions for medical or religious reasons. Though nursing homes can be fined for violations, CMS generally gave violating facilities additional time to update their policies and come into compliance.

The Republican-led U.S. House recently passed legislation that would halt the mandate, but the bill is unlikely to pass in the Democratic-led Senate. Meanwhile, the requirement continues with mixed results and - in some cases - widespread exceptions.

It’s hard to find workers willing to be vaccinated, Corbin said, because many local residents remain opposed to the vaccine or doubt its effectiveness. Just 42% of adults in St. Clair County are vaccinated against COVID-19 - a rate barely half the national average.

See HEALTHCARE page 16

SAN DIEGO COUNTY COVID-19 STATUS

TOTAL CONFIRMED CASES 981,076

REPORTED TESTS

13,314,451

ICU

2,492

HOSPITALIZED

38,913

SOURCE: County of San Diego as of 2/23/23

Everyone is at risk for becoming ill with COVID-19, but some people are more vulnerable to serious illness due to age or underlying health conditions. San Diego County is currently subject to a declared local health emergency and a proclaimed local emergency due to the COVID-19 pandemic, and the Governor of the State of California proclaimed a state of emergency. In order to slow the spread of COVID19, and prevent the healthcare system in San Diego County from being overwhelmed, it is necessary for the Health Officer of the County of San Diego (Health Officer) to require the quarantine of persons exposed to COVID-19.

Household contacts, intimate partners, caregivers, and any other person who have been in close contact with a person either diagnosed with COVID-19, or likely to have COVID-19 (COVID-19 Patient), are subject to this Order unless a specific exception applies. A “close contact” is someone sharing the same indoor airspace (i.e., home, clinic waiting room, or airplane), for a cumulative total of 15 minutes or more over 24 hours (e.g., exposed to three infected individuals, three 5-minute exposures, for a total of 15 minutes), during an infected person’s laboratoryconfirmed or clinically diagnosed infectious period.

This order requires persons to follow the quarantine periods and measures applicable to their unique situation. The length of the quarantine, and the measure to be taken, may be different based on factors such as vaccination status, health conditions, COVID-19 symptoms, workplace setting, or school setting. Since these requirements may change based on new data, this Order incorporates detailed quarantine criteria and measures in the hyperlinks below. If the documents linked below are updated, those updates will automatically be part of this Order.

This Order does not prevent an employer, school, facility, the California Department of Public Health (CDPH), or a licensing agency from imposing more stringent quarantine requirements.

The Health Officer therefore ORDERS pursuant to California Health and Safety Code sections, 101040, 101030, 120175, 120215, 120220, and 120225: a) Members of the general public who are close contacts shall follow all applicable quarantine measures identified in the California Department of Public Health’s most recent Guidance for Local Health Jurisdictions on Isolation and Quarantine of the General Public The currentversion is available here, and may be subsequently amended: https://www.cdph.ca.gov/ Programs/CID/DCDC/Pages/ COVID-19/Guidance-onIsolation-and-Quarantine-forCOVID-19-Contact-Tracing. aspx b) Qualifying health care personnel shall comply with the most recent California Department of Public Health’s Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19, the current version is available here, and may be subsequently amended: https:// www.cdph.ca.gov/Programs/ CHCQ/LCP/Pages/AFL-21-08. aspx. c) Schools may follow the quarantine guidance set forth in the most recent COVID-19 Public Health Guidance for K-12 Schools in California, 2021-22 School Year. The current version is available here, and may be subsequently amended: https://www.cdph.ca.gov/ Programs/CID/DCDC/Pages/ COVID-19/K-12-Guidance2021-22-School-Year.aspx.

1. All Persons who are “close contacts” as stated above shall comply with the applicable quarantine measures set forth below.

2. During critical staffing shortages, employers may use alternative quarantine/work exclusion guidance for their workforce or facility where specifically permitted by CDPH or an applicable State licensing agency (e.g., waiver from Cal/OSHA from the return- to-work requirements of the Emergency Temporary Standards).

3. For the purpose of meeting the negative COVID-19 test requirement to end quarantine, any US Food and Drug Administration (FDA) approved/authorized COVID-19 diagnostic viral test, including nucleic acid amplification (NAAT) tests (e.g., lab-based PCR, loop mediated amplification [LAMP] tests) or antigen test, is sufficient for all settings including workplace settings.

4. Additional updates to quarantine periods, measures to be taken, and exceptions, may occur subsequent to the date of this Order. These updates will be posted adjacent to the section labeled “Quarantine Order” on the following County webpage: https://www.sandiegocounty. gov/content/sdc/hhsa/programs/ phs/community_epidemiology/ dc/2019-nCoV/health-order. html. Any such updates posted on this webpage will automatically become part of this Order, and will take precedence over any inconstant provision included in the sections above. Any person subject to this Order should regularly check this webpage for updates.

Home Quarantine Guidance for COVID-19 Close Contacts should be followed by those on home quarantine, because of exposure to a COVID-19 Patient. Guidance is found here: https://www.sandiegocounty.gov/content/dam/sdc/ hhsa/programs/phs/Epidemiology/ COVID-19%20Home%20

Quarantine%20Guidance.pdf

Unless otherwise authorized by this Order, or an applicable quarantine protocol incorporated into this Order, a person under quarantine may not come within 6 feet of any person, excluding a treating medi cal professional, a law enforcement officer enforcing this Order, a repre sentative of the Health Officer, any other person specifically authorized by the Health Officer, or a caretaker.

If you develop symptoms, please contact your medical provider. Signs and symptoms that are consistent with COVID-19 include cough, shortness of breath or trouble breathing, fatigue, fever or chills, muscle or body aches, headache, sore throat, new loss of taste or smell, congestion or runny nose, nausea orvomiting, or diarrhea. Based on guidance from your medical provider, you may need to isolate and get tested for COVID19. Public Health Officer’s Isolation Order is accessible through the following County webpage: https:// www.sandiegocounty.gov/content/ sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/ health-order.html.

Violation of, or failure to comply with, this Order is a misdemeanor punishable by imprisonment, fine, or both (California Health and Safety Code sections 120275 and 120295). This Order may be enforced by any law enforcement officer within an area subject to their jurisdiction for the purpose of preventing the spread of a contagious, infectious, or communicable disease (California Government Code sections 26602 and 41601, and California Health and Safety Code section 101029).