The Double-Edged Sword of Nursing Home Vaccine Mandates
It comes as no surprise that logging, roofing and construction were among the most dangerous jobs in the U.S. in 2020, according to Bureau of Labor Statistics data. But it’s decidedly unexpected that topping them all, with twice the fatality rate of the next highest profession on the list, was nursing-home work—a job that exposes nurses, aides and other staff to all manner of infectious diseases, never more often than during a viral pandemic like we’ve seen these past 18 months.
It was in an effort to protect both workers and residents that President Joe Biden, on Aug. 18, announced that nursing homes must vaccinate all staffers or risk losing Medicare and Medicaid funding. As my colleague Tara Law reports, the ruling—which effectively amounted to a vaccine mandate given how heavily reliant most nursing homes are on government reimbursement—seemed badly needed, with 39% of nursing home staffers unvaccinated at the time, according to data from the U.S. Centers for Disease Control and Prevention.
But nursing home workers who haven’t yet been vaccinated are no more persuadable than the rest of the vaccine-hesitant population in the U.S., and that presents a problem. The only way for nursing homes to enforce the new rules is to threaten non-compliant employees with dismissal—which might bring some of them in line but could cause others to walk. That would exacerbate an existing problem: according to the American Health Care Association and the National Center for Assisted Living survey of 616 nursing facilities released in June, 94% of nursing homes already report a staffing shortage.
So, nursing homes are now forced to choose between two poor alternatives: either tolerate a certain number of unvaccinated staffers or worsen the chronic staffing shortages. To some, the choice seems clear.
“Understaffing may make the facility dirtier, and it may make the residents wait longer for their meals. Un-vaccination makes them dead,” says Arthur Caplan, a professor of bioethics at New York University School of Medicine.
But there’s yet another wrench in the machinery here: many staffers who quit one nursing home are likely to seek new employment in another, according to Charlene Harrington, professor emeritus at the UCSF School of Nursing, moving the shortages around, but not adding to them—nor removing high-risk virus vectors from the health care system. Caught in the middle are nursing home residents—among the most vulnerable members of the population, made all the more so as COVID-19 continues to rage.
About 443.7 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this afternoon, of which some 371.3 million doses have been administered thus far, according to TIME's vaccine tracker. About 52.6% of Americans have been completely vaccinated.
More than 218.4 million people around the world had been diagnosed with COVID-19 as of 1 a.m. E.T. today, and more than 4.5 million people have died. On September 1, there were 722,859 new cases and 12,448 new deaths confirmed globally.
Here's how the world as a whole is currently trending:
Here's where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
And here's every country that has reported over 4 million cases:
The U.S. had recorded nearly 39.4 million coronavirus cases as of 1 a.m. E.T. today. More than 642,000 people have died. On September 1, there were 198,025 new cases and 1,973 new deaths confirmed in the U.S.
Here's how the country as a whole is currently trending:
Here's where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:
All numbers unless otherwise specified are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of Sept. 2, 1 a.m. E.T. To see larger, interactive versions of these maps and charts, click here.
WHAT ELSE YOU SHOULD KNOW
The U.S. Department of Labor yesterday reported that jobless claims for the past week numbered just 340,000, a pandemic-era low. The figure represented a 14,000 drop from the previous week, and a steep decline since early January when claims topped 900,000. Rising vaccination rates—resulting in more workplaces opening up and bars and restaurants welcoming more customers—are contributing to the improved outlook, the Associated Press reports . That said, jobless claims still significantly exceed the 220,000-weekly figure from just before the pandemic hit in March 2020.
The U.S. yesterday began shipping doses of the Moderna vaccine to Kenya and Ghana,Reuters reports. The allocation of shots is being coordinated by the COVAX global distribution program. Over 2 million doses will be sent in the latest shipment, with about 900,000 going to Kenya and about 1.2 million to Ghana. Just 1.5% of the population of Kenya is currently fully vaccinated, and 1.3% in Ghana, according to Our World in Data.
The U.S. Food and Drug Administration has just scheduled a meeting on coronavirus boosters with a panel of outside advisers for Sept. 17—just three days before the Biden Administration plans to begin a campaign for the third shots, reports the Washington Post. The purpose of the meeting is to review data on the efficacy of booster shots with the Pfizer-BioNTech vaccine, but the recommendations of the panel are not binding, and the campaign is set to begin regardless of the conclusion the advisers reach. Still, the meeting will be open to the public and could at least provide some transparency into the government’s decision-making behind vaccines.
Breakthrough infections appear to be rare among the vaccinated, according to a new study in the Lancet. The study, which relied on a massive sample group of 1.2 million UK-based users of the COVID Symptom Study mobile app found that just 0.5% of people who had received a single dose and 0.3% who had received both doses were subsequently diagnosed with the virus. Severity is also reduced: among those in the study who did suffer a breakthrough infection, vaccines were associated with lower rate of hospitalization, fewer symptoms in the first week of infection and a reduced risk of symptoms persisting for 28 days or more.
Hospitals in Hawaii are facing a severe oxygen shortage as wards fill up with COVID-19 patients, reports the New York Times. With the seven-day hospitalization average peaking at 427 on Monday, the state has seen the demand for oxygen surge by 250% since August, and is now shipping in additional supplies from the continental U.S. But transport is slow: oxygen is shipped in highly flammable liquid form, considered too dangerous to carry by plane, and carrying it across the Pacific by boat can take up to a month.
The World Health Organization is eyeing the emergence of a new variant, called Mu, reports the Jerusalem Post. Mu currently accounts for less than 0.1% of cases worldwide according to the WHO, but it is surging in Colombia, where it emerged, and currently accounts for 39% of all cases in the country. In neighboring Ecuador, the figure is 13%. The WHO has currently identified three mutations unique to the Mu variant, two of which may help it evade immune system defenses, and one which may make it more infectious in the first place. Work is still underway to determine if any of the forms of Mu are resistant to existing vaccines.
Thanks for reading. We hope you find the Coronavirus Brief newsletter to be a helpful tool to navigate this very complex situation, and welcome feedback at coronavirus.brief@time.com. If you have specific questions you'd like us to answer, please send them to covidquestions@time.com.
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Today's newsletter was written by Jeffrey Kluger and edited by Elijah Wolfson.
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