VA Mandates That Health Care Providers be Vaccinated

As President Biden weighs the pros and cons of mandating that federal employees must get the COVID-19 vaccine, one federal agency decided to not wait for a presidential directive. The Department of Veterans Affairs is telling its health care professionals that they must be vaccinated within the next two months.

VA Secretary Denis McDonough said in a press release Monday that “we’re mandating vaccines for Title 38 employees because it’s the best way to keep Veterans safe, especially as the Delta variant spreads across the country. Whenever a Veteran or VA employee sets foot in a VA facility, they deserve to know that we have done everything in our power to protect them from COVID-19. With this mandate, we can once again make—and keep—that fundamental promise.”

Title 38 refers to doctors, nurses, and other health care providers who interact with patients. The VA’s move comes in the same week when the Centers for Disease Control and Prevention (CDC) revised masking guidelines, saying that fully vaccinated individuals should begin wearing masks again when indoors in public settings in parts of the US with substantial to high transmission. CDC Director Rochelle Walensky, MD, in a press conference yesterday also cited the Delta variant, which is fueling a new wave of infection in some parts of the country, as the reason for revising guidelines. According to the CDC, about 50% of the US population is fully vaccinated, which is nowhere near the 70% to 80% that health care experts say would lead to herd immunity.

“I have seen new scientific data from recent outbreak investigations showing that the Delta variant behaves uniquely differently from past strains of the virus that cause COVID-19,” Walensky said at the press conference. “Information on the Delta variant from several states and other countries indicate that in rare occasions, some vaccinated people infected with the Delta variant after vaccination may be contagious and spread the virus to others. This new science is worrisome and unfortunately warrants an update to our recommendations.”

Kevin Kavanagh, MD, a member of Infection Control Today^®’s Editorial Advisory Board, warns that “this virus is about one or two iterations away from completely avoiding the vaccine.”

About the VA’s mandate, Kavanagh says that “it is becoming increasingly apparent to even the most conservative policymakers that we are in this pandemic for the long term. One of our most pressing needs is for a nationally integrated and coordinated public health care system. I believe this would fit well into the Department of Veterans Affairs fourth mission which is to respond and aid the United States in health emergencies. The VA has both the infrastructure and knowledge to implement this strategy.”

Former CDC Director Tom Frieden, MD, tells CNN that the US could see about 200,000 new cases of COVID-19 in the next month or so, a number that was last seen in the COVID surge in January. Frieden added that the country will not see the “horrific death tolls” of those earlier surges thanks to the vaccines, but avoidable deaths will occur.

Leana Wen, MD, an emergency room physician and a visiting professor of health policy and management at George Washington University, tweeted that “the vaccinated are currently paying a price for the unvaccinated. #covid19 is surging again, with spillover to the vaccinated. Masks are coming back, because the honor system isn’t working.”

At yesterday’s press conference, Walensky said that in areas of high COVID-19 transmission, the fully vaccinated should “wear masks in public indoor settings to help prevent the spread of the Delta variant and protect others. This includes schools. CDC recommends that everyone in K-12 schools wear a mask indoors, including teachers, staff, students, and visitors, regardless of vaccination status.”

The CDC monitors COVID-19 spread in US counties.

The press release the VA issued Monday states that 4 VA health professionals have died in recent weeks, all of them unvaccinated and “at least three of those employees died because of the increasingly prevalent Delta variant. There has also been an outbreak among unvaccinated employees and trainees at a VA Law Enforcement Training Center, the third such outbreak during the pandemic.”

An article posted Monday on Infection Control Today^®’s website examined the problem of compassion fatigue among health care professionals as they have to care for patients who refuse to get the COVID-19 vaccine.

One of the experts ICT^® reached out to was Robbie Hilliard, MSN, RN, CIC, the infection control coordinator for Carl Vinson VAMC in Dublin, Georgia. (Hilliard recently wrote an article for ICT^® about how VA nurses tackle infections.)

Hilliard said that there’s a danger that compassion fatigue could set in when it comes to treating unvaccinated COVID-19 patients, but tries not to simply dismiss the concerns of the unvaccinated.

“As a nurse, I am vaccinated for COVID-19, but I still have co-workers who are not, which just emphasizes the importance of understanding and accepting people’s personal choices,” Hilliard told ICT^®. “Most of these providers are very educated individuals, who are compassionate, but continue to feel that not enough research on side effects, etc., was done for a vaccine released on an emergency basis.”

Hilliard added that compassion fatigue comes with a provider’s job “and I am sure, at times, compassion fatigue creeps in with COVID patients, but most of us understand the fear associated with the unknown/new pharmaceutical treatments that have long-term unknown effects.”