The Houston Methodist Hospital System mandated Covid vaccinations for all of their hospital staff. Although they have achieved an extraordinarily high rate of vaccinations among their staff, there are some people that are adamantly holding out. Failure to get vaccinated can result in job termination. A group of approximately 117 employees are suing the hospital over this policy–charging wrongful termination and violating a federal law “that where a medical product is unimproved then no one may be mandated to take it.” Hospitals mandate many things for their employees. Most commonly related to this case is that we are required to get an annual influenza vaccine. Many public health experts consider the Covid vaccine to be as safe and effective as the flu vaccine. In reality, it’s probably much more effective than the flu vaccine. The Equal Employment Opportunity Commission, (EEOC) has said that employers may legally require the Covid vaccine for all employees physically entering the workplace. There are some caveats but in general most employees would fall into this category. While I do not consider the vaccine to be experimental at this point, both the Pfizer and Moderna vaccines are still under the EUA (emergency use authorization) category. Getting full FDA approval will take the ”experimental” argument off the table and help hospitals as well as other employers mandate the vaccine, which I believe is in the best interest of the company and their customers/patients. There will be more to come on this as other employers and schools mandate the vaccine. So far, it appears to be lawful (EEOC says so) but we’ll see what the courts say.
There were a couple of interesting little nuggets in our emergency department data this week. For starters, the number of patients that we classified as “symptomatic” for testing was lower than previous weeks. This does not surprise me as we’re seeing less COVID than earlier in the year. However, the percent positive rate for this group was much higher than it has been over the last several weeks. And the total number of patients that we diagnosed as having COVID based on our testing, increased for the first time in several weeks. While the percent increase is considerable, the total number of new cases was not particularly concerning to me compared to a month or two ago. Our overall percent positivity rate was up a touch as well. Neither the total number of new cases nor the percent positivity are high enough to be waving red flags it may, but the increase in both certainly means we need to continue to follow the data for the next several weeks. Around the country, certainly the percentage of people being vaccinated continues to increase and the number of weekly new cases and hospitalizations is generally declining. The 7-day daily average of new Covid cases has declined from 31,000 weeks ago to approximately 17,000 now. This is the first time our 7-day average has been under 20,000/day since March 2020. Daily deaths are also declining. With the majority of adults in the US population now having received at least 1 dose of the vaccine, I frequently think to myself how fortunate we are to be here. There are many countries around the world that have not had our vaccination success. Japan comes to mind as the Olympics are less than two months away and the vaccination rate is <5% of the population. The US is 42% for comparison.
Consistent with the decreasing numbers of positive tests in the symptomatic patient category, we also used less “Covid isolation” compared to previous weeks. We had about a 30% reduction in the number of patients who required Covid isolation this past week compared to previous weeks. The admission rate for this subgroup of patients remains fairly constant.
Although things are looking better in the US, COVID-19 infections are increasing in the United Kingdom. They are now seeing daily new case numbers similar to what they saw in March. This is in large part due to the Delta variant B.1.617.2, first found in India. This variant is now the dominant strain in England and it is believed to be more contagious than previous strains. They are seeing outbreaks in communities and in schools and there is discussion about delaying the countries reopening till later in June. The UK has more than 50% of its adult population fully vaccinated which is similar to the US. Fortunately, it does appear that the vaccines are effective against this variant.
In other vaccine news:Israeli health officials reported that they do believe there is a link between the Pfizer vaccine and dozens of cases of heart inflammation that occurred after people received the first or second dose of the vaccine. Primarily, this was seen in young man ages 16-19, and about half the patients had a pre-existing medical condition. Heart inflammation cases such as myocarditis were still very rare. There were only 275 cases of myocarditis identified out of the 5 million people who received the vaccine. About 54% of the cases occurred within 1 month of receiving the vaccine. The risk of contracting coronavirus is still higher than the risk of getting a complication from the vaccine, particularly considering that the majority of myocarditis patients recovered with no complications. Please also keep in mind that no direct link has been identified.
Scientists continue to be optimistic that the immunity derived from the initial vaccination process may last longer than initially expected and may not require frequent booster shots. Immunologist are using expressions like “the immune response is quite impressive.” There are multiple layers to our immune system, and while many scientists believe we will need a booster down the line, they are working to identify the proper time interval. There will be much more to come on this, but the current thinking is that the vaccine produces an excellent and perhaps long lasting response.
The CDC released a statement saying that fully vaccinated asymptomatic people don’t need to be regularly tested or quarantined, even after being exposed to someone who is sick. It will be interesting to see how this plays out for international travel (which often requires proof of vaccination and a negative to enter another country and return ) and places like colleges which did a lot of regular testing over the spring. Currently, the CDC is still saying those returning from international travel require a negative test to reenter the country. Asymptomatic fully vaccinated people who are exposed should self-monitor for symptoms for 14 days.
As we all get back to normal, and based on my traffic and increasing commute times, I think most of the DMV is in normal mode, I hope that the news around Covid declines. Each week I feel like I am digging a little bit more into the weeds than what my “Friday night update from the ER” was ever intended to be. With that in mind, if you have questions or thoughts about life in the ER you would like me to address, put them in the comments and I will tackle them in the future additions. I am not sure when I am going to stop these posts, but I do hope we get to the place one day where people are not interested in Covid updates.
Science matters. Get vaccinated. Wear a mask when you’re supposed to. We’re almost there.