Hayden E. Klein

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As COVID-19 infections and hospitalizations rise in the United States — especially due to the delta variant — groups led by the American Medical Association and the American Nurses Association have 

In a recent interview with Chief Healthcare Executive™ Hilary Babcock, MD, MPH, infectious disease specialist, Washington University and BJC Healthcare in St. Louis, Missouri, discusses a COVID-19 vaccine mandate, as well as other vaccine mandates in healthcare settings. Babcock said healthcare workers signed up to look out for the health of themselves and others, and getting vaccinated is part of that job.

 With the delta variant surging, and new data showing breakthrough cases are increasing, what steps can be taken in healthcare settings to keep the virus at bay among uninfected patients and personnel?

There are a lot of things that healthcare organizations have been doing over the whole past year to protect patients and employees during this COVID pandemic. And a lot of those continue today and need to continue. And those include using our personal protective equipment, doing screening of patients to be sure we identify people who may have COVID quickly so they can be appropriately isolated, screening of our employees to be sure that people aren't coming to work sick. And then the biggest advance in being able to control this spread in healthcare is the same as it was in the community was the availability of these very effective vaccines. So really encouraging and doing everything we can to get high vaccination rates in our communities, and then also among our employees, as well.

 for healthcare personnel part of the “ethical commitment” of healthcare workers to patients. Can you address that and what it means to you?

 As healthcare workers, we all, you know, signed up for a job that was primarily providing care for others and putting others first and looking out for their health and well-being. And so the vaccine is one way that we can protect ourselves. And that serves two purposes. One, it keeps us healthy and safe and able to go to work and continue to do our jobs and be sure that staffing doesn't create safety problems for our patients. And it also protects our colleagues and coworkers and patients, because if we were to come to work with COVID, we would put all of these people at risk. And putting people at risk is not why we went into healthcare. We went into healthcare to keep people safe and to try and make them well.

 Your organization is already requiring COVID-19 vaccinations. When was that decision made and what went into it?

We decided to require COVID vaccination as a condition of employment, probably near the end of May. It was announced in mid June and our deadline for compliance is in September. We already have in place requirements for influenza vaccination every year and for other recommended vaccines for healthcare workers. For us, in many ways, it was just a natural progression for that, here is another vaccine that is recommended for healthcare workers that can protect our patients and our employees. And so we should treat it the same as these other vaccines that we already require.

 What was the reaction from personnel at the hospital and was there any fallout?

In general, I would say most people were not super surprised because we already have this in place for other vaccines. And so it wasn't, you know, out of left field for us to require or recommend a vaccine for our employees. Many of our employees are pleased because they would prefer high vaccination rates in their colleagues and coworkers, and so they were pleased that it would be treated the same way. You know, some employees still had some concerns about the vaccine, still have some worries about the vaccine. A mandate or condition of employment is not just a switch that you can turn on. So it goes along with continued education and outreach. We had a lot of town halls for our whole organization. We've had smaller town halls on request for specific areas where people have concerns. We had a specific town hall focused on women's health and fertility and pregnancy and breastfeeding, and concerns and questions around that with some of our OB-GYN and fertility specialists. We've done a lot of outreach and education and we are now also including, it's an incentive program for people who have been vaccinated get entered into a raffle and could win some money for being vaccinated. So that condition of employment is important. It puts a deadline, it shows our commitment, but it doesn't get us out of having to do all of these other things that we want to do with our employees to be sure that they feel safe and comfortable getting this vaccine.

 It is not uncommon for healthcare organizations to require other vaccinations. How are those typically handled and what is the difference with the COVID-19 vaccine?

 I think the main difference between the other vaccines that we require and this one is that we don't yet really know exactly what the schedule will be. So we don't know for sure whether this is a one-and-done vaccine series or whether we will need boosters. And if we need boosters, when will we need boosters, who will need boosters? So we know that we can require the vaccine of everyone right now with allowances for medical and religious exemptions. But we don't know whether we will have boosters we need to require, whether those will apply to everyone or just to some of our population. So that's a little bit different than the other vaccines that we've required.

 for the vaccines, do you expect or hope to see some of the resistance melt away?

 I'm hopeful that the FDA will provide full licensure soon. I don't think there's any doubt that they're going to license the vaccines. We have really extensive data — they’ve been used in millions of people — we have a lot of safety data, we have a lot of efficacy data. I don't think there's any question that it will be licensed. I think having it fully licensed will be reassuring to some people and so hopefully that will help with some of the concerns. I don't think it will take care of everything. There is a lot of active misinformation that is being put out there for whatever nefarious reasons to try and discourage people from getting these vaccines. And so that's a real barrier and that will not be addressed, I think, by the licensing.

 You coauthored a paper supporting the CMS rule that hospitals must report COVID-19 vaccination coverage among healthcare providers. Why is a similar rule in place for flu vaccines and what is the benefit of enacting it for COVID-19 vaccines?

 Influenza vaccination is reported as a quality and safety measure to the CDC and has been for years. And the goal of that is to encourage healthcare organizations to take seriously the importance of reaching high influenza vaccination coverage rates among their employees to keep, again, their employees, their colleagues, and coworkers, and their patients safe from influenza. And having it publicly reported and using it as a safety measure encourages organizations to really push for those high levels and do whatever it takes to get to high levels of vaccine coverage. Adding the COVID-19 vaccine to that program would have the same effect. So we’ll really show that the government thinks it's important, that the CDC thinks it's important, that it is a quality measure for a healthcare organization to have high levels of COVID vaccine coverage among their employees. And so we’ll really have a similar impact, hopefully, in driving people to do whatever it takes to get high levels of vaccine coverage among their employees.

 Is there anything you would like to add?

 The most important thing that anyone can do to help get us through and out the other side of this pandemic into a more normal life again, is to get vaccinated. Get your friends and family vaccinated, tell all of your acquaintances and colleagues to get vaccinated. Really just whatever we can do to get that vaccination rate up higher will really help us get through this faster.

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Hilary Babcock, MD, MPH, infectious disease specialist at Washington University and BJC Healthcare in St. Louis, Missouri, discusses the COVID-19 vaccine and other vaccine mandates in healthcare settings.

Infectious Disease Expert Dr Hilary Babcock Addresses Vaccine Mandates in Healthcare Settings

Dialysis and kidney care company DaVita and its former CEO Kent Thiry face a two-count indictment for conspiring with competitors not to solicit each other’s senior employees, the U.S. Department of Justice 

DaVita and Thiry are charged with two counts of violating the Sherman Act, which outlaws "every contract, combination, or conspiracy in restraint of trade," and any "monopolization, attempted monopolization, or conspiracy or combination to monopolize,” according to the 

. If convicted, DaVita faces a maximum penalty of a $100 million fine per count, and Thiry faces a maximum penalty of 10 years in prison and a $1 million fine per count.

Count One charges both parties for conspiring with Surgical Care Affiliates LLC and its related entity “to allocate senior-level employees by agreeing not to solicit each other’s senior-level employees from as early as February 2012 until as late as July 2017,” according to a statement.

Similarly, Count Two charges DaVita and Thiry for agreeing with another healthcare company to not solicit DaVita’s employees from as early as April 2017 until as late as June 2019.

“These charges show a disturbing pattern of behavior among health care company executives to conspire to limit the opportunities of workers,” said Assistant Director in Charge Steven M. D’Antuono of the FBI’s Washington Field Office in the news release. “The FBI is dedicated to working with our partners to hold those accountable who would engage in labor market collusion to the detriment of their employees.”

The defendants are scheduled to appear in the U.S. District Court for the District of Colorado on July 20. DaVita is based in Denver.

The maximum fine may be increased to twice the gain derived from the crime or twice the loss suffered by victims if either amount is greater than the statutory maximum.

Karen Crummy, a spokeswoman for Thiry, issued a statement refuting the charges.

“These allegations are false and rely on a radical legal theory about senior executive recruitment without precedent in U.S. history. The government took steps to ignore – and even hide – key evidence. The facts bear it out decisively: No antitrust violations occurred, these companies hired DaVita executives for years, and the companies are not competitors.”

DaVita is one of two large dialysis providers that together account for more than 70% of the US market.

Articles

This indictment is a result of the Antitrust Division’s ongoing investigation of employee allocation agreements within the health care industry.










DaVita, Former CEO Indicted, Charged With Collusion Over Top Employees

Hospitalizations for eating disorders among adolescents increased significantly during the COVID-19 pandemic, according to 

In the first 12 months of the pandemic, the number of hospitalizations among patients ages 10-23 with eating disorders more than doubled at Michigan Medicine. The center admitted 125 patients with eating disorders in that time, compared to an average of 56 per year between 2017 and 2019.

The pandemic may have triggered or worsened symptoms in teens with eating disorders and those who were at risk for eating disorders, according to the authors.

“These findings emphasize how profoundly the pandemic has affected young people, who experienced school closures, cancelled extracurricular activities, and social isolation. Their entire worlds were turned upside down overnight,” said lead author Alana Otto, M.D., M.P.H., an adolescent medicine physician at University of Michigan Health C.S. Mott Children’s Hospital.

The study also suggests that admission rate at Michigan Medicine increased steadily in those 12 months, with the highest rates being between nine and 12 months after the pandemic began. Rates have continued to climb after March 2021. This may be due to delayed care and in-person visits for conditions unrelated to COVID-19, the study said.

This research only reflects a small portion of people with eating disorders during the pandemic, however other studies have found similar trends. “Although our findings reflect the experience of a single institution, they’re in line with emerging reports of the pandemic’s potential to have profound negative effects on the mental and physical health of adolescents across the globe,” Otto wrote.

Other institutions are reporting the pandemic’s profound effects on mental health among teens. Experts at Johns Hopkins Bloomberg School of Public Health 

 on the pandemic’s double whammy on well-being: the disruption of peer-to-peer interactions, and the severing of ties to teaches and coaches who form a “safety net” and are trained to intervene if they see a teenager showing signs of distress.

Otto also mentioned that medical attention is not the end of treatment for adolescents with eating disorders, but the beginning. “Access to care was already limited before the pandemic and now we’re seeing an increased demand for these services. As we see a wave of young people coming to the hospital for urgent medical concerns related to eating disorders, we need to be prepared to continue to care for them after they leave the hospital.”

One study author noted that access to mental health care was already limited before the pandemic, and now demand is increasing.

Hayden E. Klein

Articles

Infectious Disease Expert Dr Hilary Babcock Addresses Vaccine Mandates in Healthcare Settings

DaVita, Former CEO Indicted, Charged With Collusion Over Top Employees

Hospitals See Spike in Adolescent Eating Disorders During Pandemic