Gov. Mills’ decision to mandate COVID vaccines for healthcare workers is a welcome development for long term care facilities, since the majority of Maine facilities were considering vaccine mandates but were concerned about staffing issues. The state mandate levels the playing field for facilities and sets the same standard for all. This decision should not be considered controversial since 72.8 percent of Mainers already voted last year in to remove the philosophical and religious exemptions to mandatory vaccinations for other communicable diseases. (The law takes effect on Sep. 1). The federal government is also reported to roll out a nursing home staff vaccination mandate soon.
In nursing homes we have the unique element of the residents often not being aware of the dangers and unable to exercise their right to refuse care by unvaccinated staff. This amplifies the professional moral duty to vaccinate and the need to mandate those who refuse to vaccinate. The vast majority of healthcare workers already vaccinated will also breath a sigh of relief as working with unvaccinated co-workers carries a higher risk of getting COVID.
The Maine vaccine mandate, however, still leaves some gaps for long term care facilities. The medical exemption provision is too broad and only requires a generic letter from a healthcare provider exempting a staff member from the COVID vaccine. There is not even a requirement that the letter state the reason for the exemption.
It is expected that those who are opposed to vaccines for philosophical or religious reasons would instead seek a medical exemption as the only avenue available to them. Medical directors in long term care facilities should be empowered to swift through these exemptions and deny any inappropriate ones.
Medical directors are responsible for the well-being of all residents in their facility, and in pandemic conditions employee health is intertwined with the health of the residents in the facility. The state mandate doesn’t go far enough to protect against abuse of the medical exemption process. Heart disease, pregnancy, breast feeding, infertility, immune compromised state and other conditions are often cited as contraindication by AntiVaxx websites, but the data doesn’t support that. In fact, some of the conditions cited as contraindications are in fact reasons to get vaccinated.
Another issue is the matter of timing of the vaccines. As of today, the state requires 30 days separation between flu and COVID shots. In the COVID vaccine studies they kept two weeks separation from other vaccines to ensure that there is no unintended interactions. Under normal times it makes sense to be conservative, but during a delta surge every day counts and 30 days is a long time to wait. Medical directors should have the flexibility to shorten the waiting period between different vaccines based on science on a case by case basis.
Facilities administrating the COVID vaccine after the surge may miss the window of opportunity to mitigate against unnecessary nursing home infections and deaths. As they plan their first mandatory vaccination dates, facilities should consider how many more lives would potentially be saved if they vaccinate within days rather than weeks.
Last but not least, the state mandate does not cover visitors to long term care facilities. Unvaccinated family members who visit long term care residents can be a source of infection for those residents, just like unvaccinated staff.
Currently visitors to nursing homes are not required to be vaccinated or be fitted with N95 masks to prevent airborne viral transmission. The only break nursing homed are getting is that the warm weather is allowing for outside visits.
Mandating vaccines for nursing home visitors could create conflict in our polarized atmosphere and would carry a political price. It is, however, a necessary step if we are to protect nursing home residents from unvaccinated virus transmission, and is as necessary as the healthcare workers mandate.
It only takes one case to cause an outbreak in a facility, and the outcome can be disastrous regardless of the source.
— Special to the Press Herald
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