As COVID-19 cases continued to rise across California, Gov. Gavin Newsom took action in July to require all state workers and workers in health care and high-risk congregate settings to either show proof of full vaccination or be tested at least once per week. On Oct. 1, Newsom added another mandate, that eligible kids in California schools must be vaccinated against COVID-19 once age groups are approved by the FDA.
In a report to the Mountain Communities Healthcare District Board of Directors, Hospital CEO Aaron Rogers said that because of a shortage of health care workers, the mandate could eliminate hospitals in local communities. Asked later to elaborate, Rogers said the shortage of doctors, nurses, lab techs, radiology techs, respiratory therapists, medical assistants and others specially affects California.
“Anything that threatens to eliminate significant staff and inhibit MCHD’s ability to hire replacements are a huge threat to the hospital having the staff to stay open,” he said in an email response. “As you look down main street in Trinity County or any other town, significant numbers of businesses are unsuccessfully looking to hire help.”
Rogers said the mandate threatens to force termination of anyone unwilling to get vaccinated, and inhibits the hospital’s ability to hire new, unvaccinated staff at a time when hiring is already difficult.
“This is not just a Trinity County or rural issue, this threatens health care in all of California,” Rogers wrote. “A question was asked, where will all the nurses go that don’t want to be vaccinated? A nurse can pretty much get a job in any city in any state, plus, don’t forget all the nurses and other medical staff that came out of retirement to help through COVID. We need every one of them to keep up with demand and mandates certainly threaten keeping everyone.”
How it’s going
The governor’s mandate requires that those who do not wish to be vaccinated must submit to regular COVID testing. Asked how that’s been playing out at the hospital, Rogers said it’s been going OK.
“Every employee has either been vaccinated or has signed an exemption according to the state mandate,” he wrote. “It is still brutally tough to recruit and retain staff, and the mandate makes it significantly tougher. Employees continue to get vaccinated as they get more comfortable with whatever their concerns may be. Our clinics constantly offer vaccines to staff if needed/wanted.”
He said that in the first week of October, 68 percent of hospital staff are vaccinated and that all staff, regardless of vaccination status, are complying with mandates regarding personal protective equipment (mask) use.
“Many people in town have tested positive for COVID, including MCHD staff,” he wrote. “The hospital and clinics are where sick people come to get medical treatment, so staff has tested positive and we follow the CDPH and TCPH requirements for quarantine.
“Our medical staff has spent thousands of hours over the past year and a half meeting, strategizing, educating, and leading the MCHD staff with regards to COVID,” he wrote. “Specifically, Dr. Harwood (chief of staff), Dr. Shipsey (vice chief of staff), Dr. Krouse, Dr. Meredith, Dr. Williams, and Dr. Mooney have all done amazing work leading MCHD during COVID.”
Treatment questions answered
When it comes to treating those who come to MCHD’s Trinity Hospital for COVID or symptoms, Rogers said each patient is assessed and cared for according to their medical needs. Some are transferred to other hospitals, but Rogers said it’s getting more difficult to find a tertiary hospital to transfer to.
“Hospitals with an ICU and negative pressure rooms are more equipped to handle severely ill patients,” he wrote. “We transfer those patients out just as we do for non-COVID patients. If a patient’s chance of survival improves by being transferred, we try to facilitate that in all cases.”
He said that while most big hospitals have beds, they may not have adequate staff to care for the same number of patients.
“Hospital capacity is rarely physical beds available, it is almost always staffing shortages,” Rogers explained. “For instance, MCHD has 25 beds available, but only enough staff, specifically nursing staff, to care for 10 patients. So, our bed capacity is 25 but our staff capacity is 10, and we have been at capacity for most of the past year and a half. I would hire 10-15 [registered nurses] right now if I could get qualified applicants.”
Asked for his personal opinion of the governor’s mandate, Rogers said he’s not a fan. He said it could potentially eliminate quality staff from being available if the community becomes ill and needs care.
“Health care workers, active and retired, worked through this pandemic for a year before a vaccine was available,” he wrote. “They were the Healthcare Heroes. They cared for patients even though the risk seemed great and now they are at risk of having to move to another state or go back into retirement because they are inclined to not be vaccinated for a pandemic that they helped save the world from before the vaccine was available. We need all we have and more, so anything that inhibits that from happening, concerns me.”
Asked for a closing statement, Rogers said he is proud of the hospital staff, both medical and non-medical, who continue to work through an unprecedented health pandemic. He added that there are many openings at the hospital for medical and non-medical positions.
Governor Newsom’s mandate makes California the first state in the country to require vaccinations for school children and adds COVID vaccines to the list of long-required vaccinations.
“Our schools already require vaccines for measles, mumps and more,” Newsom wrote on Twitter following the announcement. “Why? Because vaccines work.” At a conference in San Francisco later, Newsom added that California leads the country in preventing school closures and has the lowest case rates.
“We encourage other states to follow our lead to keep our kids safe and prevent the spread of COVID-19,” he said.
“In order to further protect students and staff and continue supporting a safe return to in-person instruction for all students, the Governor directed the California Department of Public Health to follow the procedures established by the Legislature to add the COVID-19 vaccine to other vaccinations required for in-person school attendance — such as measles, mumps, and rubella — pursuant to the Health and Safety Code,” according to a report from Newsom’s Office last week. “COVID-19 vaccine requirements will be phased-in by grade span, which will also promote smoother implementation.”
The rollout will take effect at the full FDA approval of each grade, defined as Jan. 1 or July 1, 2022, whichever comes first. “However, local health jurisdictions and local education agencies are encouraged to implement requirements ahead of a statewide requirement based on their local circumstances,” the report said.
The local effect
In Trinity County, school officials are working with Public Health regarding all the vaccines needed for a student to enter school, according to Trinity County Office of Education Superintendent Sarah Supahan.
“Our TCOE Director of Health Services works in concert with Trinity Public Health to schedule vaccinations at school sites whenever possible,” Supahan wrote in an email response to questions. “At this point, we do not know what the COVID vaccinate mandate will look like in Trinity County or how Trinity Public Health will respond to that mandate, nor what funding they may be given to follow that mandate. We will, however, be required to follow the mandate as with all state mandates that involve the educational system.”
Asked how the mandate will materialize in Trinity County Schools, Supahan said the answers are not clear in the Oct. 1 mandate.
“Since these are early days, I’m sure we will be hearing details such as these as the year progresses, especially if the Legislature supports the mandate with legislation of their own,” she wrote. “Please note, however, an important clause in the mandate, namely: Health and Safety Code Section 120338 says that while further immunizations can be added to the list of those required for school admission, exceptions for medical reasons and personal beliefs must be permitted. I think this is crucial for parents and students to know.”
Asked if efforts have been made to inform students about the known benefits and risks of vaccination, Supahan said information is available on the district website, TCOEk12.org but the district must follow the directives of Trinity County Public Health.
“I’m not aware of all the efforts that may be taking place in all nine districts in Trinity County or within the 25 schools in those districts to further educate students,” Supahan wrote. “However, this is really also under the purview of Public Health. They have put in a lot of effort to educate the community about these issues. Remember, we are educators, not health care workers.”
Some students have been posting on social media that a protest to the mandate was being organized for Oct. 18. Supahan said the district was aware of the Oct. 18 protest but had not heard of any others.
“We are a democracy and there are democratic processes to protest dissatisfaction or register disagreements with mandates and laws. We support that right. Of course, TCOE doesn’t have any say in what the state has mandated regarding COVID-19, nor does our local public health department, and nor do the nine different school boards in our county. Schools must be compliant. However, as part of our democratic and civil processes, school boards can consider resolutions to send to lawmakers, letters can be written, or peaceful protests can be held, and in the end, votes can be cast for those lawmakers — and their stance on the issues — that each person supports.”
Those who wish to claim that a personal belief exemption allows them to turn down a vaccine may want to examine California’s SB 277. Following a measles outbreak in 2014, Senate Bill 277 removed personal belief exemptions for a number of vaccine-treatable diseases, including measles, chickenpox, whooping cough, diphtheria, hepatitis B, mumps and even polio. The law was passed in 2015. It also removed personal belief as a reason for an exemption from the vaccination requirements for entry to private or public elementary or secondary schools in California, as well as day care centers.
However, since SB 277 does not expressly name COVID-19, it’s uncertain if it can legally be applied specifically to the governor’s mandate. However, SB 277 also includes “any other disease deemed appropriate by the department, taking into consideration the recommendations of the Advisory Committee on Immunization Practices of the United States Department of Health and Human Services, the American Academy of Pediatrics, and the American Academy of Family Physicians.”
Health and Safety Code Section 120338, passed in 2016, states “any immunizations deemed appropriate by the department … may be mandated before a pupil’s first admission to any private or public elementary or secondary school, childcare center, day nursery, nursery school, family day care home, or development center, only if exemptions are allowed for both medical reasons and personal beliefs.”
It’s yet to be seen if or how the Legislature will address discrepancies or additions regarding exemptions.
SB 276, introduced in 2019, defines medical exemption requirements, but has been referred to the State Assembly since July 2019, where the appropriations committee has been reviewing it.
The full text of SB 277 can be found at https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277.