HAMILTON — For the first time in the pandemic, Hamilton Health Sciences has transferred patients to facilities outside the area because it is overwhelmed with COVID-19. Despite the Omicron surge, the hospital network has terminated 178 employees (slightly more than 1 per cent of its roughly 13,300 staff) who had not complied with its vaccination policy.
Most Ontario hospitals have similar mandates, which are intended to prevent transmission and apply to workers who’ve failed to receive at least two doses of vaccine. But, as staffing shortages mount, should unvaccinated workers be terminated?
Niagara Health doesn't think so: it has deferred its vaccine mandate until a “later time to be determined,” says Flo Paladino, one of the hospital network’s executive vice-presidents, in an email.
In the interim, she added, unvaccinated workers will be required to undergo regular rapid testing. As of January 27, Niagara Health had 123 staff and physicians in COVID-19 isolation and was caring for 118 patients who have contracted the virus. Of those with COVID-19, 26 are in intensive care. Earlier this month, the infectious-diseases and pandemic preparedness lead for Niagara Health said the hospitals were in “survival mode.”
Agenda segment, January 18, 2022: What should we do about the unvaxxed?
Zubin Austin, a professor at the University of Toronto and an expert in health-care staffing, says a hospital’s ability to cope with the current surge is “entirely dependent on local geographical issues.” He says hospitals can address workforce shortages in a number of ways, such as by using students at various levels in their education, bringing back retired workers, and redeploying existing ones.
But these tactics tend to work better in densely populated areas with large pools of talent to draw from, he says: “There are real-world limitations that we’re starting to see, especially in more fragile systems like Niagara, where there just simply isn’t the capacity to undertake redeployment as it’s been used in past.” He says that, while a vaccine mandate is essential and lets health-care workers set a positive example for the public, it does also “hit the hard rocks of reality.”
TVO.org asked Niagara Health how its leadership weighed the risks and benefits of deferring its mandate but did not receive specific answers. A spokesperson for HHS, however, says, “The anticipated impact of [non-compliance] terminations has been planned for, and impact on clinical operations is low” at that hospital network. And Ontario Hospital Association CEO Anthony Dale tells TVO.org in an emailed statement that mandatory vaccination policies “have not materially affected health human resource (HHR) capacity, access to services, or quality of patient care.” On the contrary, he says, “a vaccinated health care worker protects the health and safety of patients and staff.”
But Rafael Gomez, a professor of employment relations at U of T, says terminating unvaccinated workers could harm staff morale as well as the health system’s ability to provide adequate care: “I’m just baffled by all of this. When you think pragmatically about a health-care system, what it needs is staff.”
In a January 12, 2022 Agenda segment, Hamilton nurse Sara Fung responds to a question about reneging on vaccine mandates.
Doris Grinspun sees things differently: the CEO of the Registered Nurses’ Association of Ontario says workers (and patients) feel safer in organizations that have a mandate. “Other nurses and other colleagues from other disciplines do not want to work with people who are not fully vaccinated. And, by fully, I mean three [doses],” she says.
Sara Fung, a registered nurse in Hamilton and co-host of The Gritty Nurse Podcast, works for a Toronto-based home- and community-care organization that has a vaccine mandate. “If that were to change, I would feel like I might be at risk of contracting COVID because [I could be] working side-by-side with someone that’s unvaccinated that could be spreading it to me,” she says.
Austin notes that hospitals could limit risk by placing unvaccinated workers in roles that aren’t patient-facing, while epidemiologist Raywat Deonandan says regularly testing unvaccinated workers is another option — although he would prefer not to “accommodate the unvaccinated in their desire to remain unvaccinated.” Testing, he says, “is a scarce resource.”
In October, the Ontario COVID-19 Science Advisory Table noted that “early media reports from Ontario and data from the United States and globally suggests that across a range of hospital settings, the number of healthcare workers who actually leave the workforce to avoid vaccination is small.”
Agenda segment, January 21, 2022: Trucking, supply chains, and vaccine mandates
But Ontario’s vaccine mandates were developed prior to the advent of the more infectious Omicron variant. While a two-dose regimen still protects against severe illness and hospitalization, it is less effective at preventing Omicron infection, according to data from Public Health Ontario. The head of the advisory table, Peter Jüni, says that “fully vaccinated” should mean three jabs, as that level of immunization has been shown to increase short-term protection against Omicron infection.
Does that mean hospital mandates should be updated? “If it’s not three doses, but two, that kind of takes the wind out of the mandates’ sails,” Deonandan says. “It pains me to say that.”
He believes three doses should be the standard, especially for higher-risk people, although Premier Doug Ford has said that the government is not currently intending to change how it defines full vaccination. “The point of three doses isn't to protect against hospitalization,” Deonandan says, “because two doses does that. The point of three doses is to protect against initial infection and transmission.”
The hospitals in Hamilton and Niagara do not share data on the percentage of staff that have received three doses. An HHS spokesperson told TVO.org that, “while our staff and physicians are encouraged to report their booster, at this time it is not a requirement … HHS will continue to follow provincial guidance and direction on this matter.” Paladino says Niagara Health still considers someone to be fully vaccinated 14 days after having received their second dose of an approved vaccine.
In addition to its short-term benefits, Deonandan says vaccination may help reduce the number of people who get long COVID — which could affect the hospital system for years to come. “A proportion of people who become infected will suffer long-term disability issues,” he says. “Health-care workers should be sensitive to that possibility.”
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