Vaccine photo by Anne Wernikoff, CalMatters

Vaccine requirements are in place for state employees, school staff and health care workers. But now hospitals are concerned about both staffing and the spread of the delta variant.

Ever since the delta variant started increasing Covid-19 cases across the state, health officials started cracking down on universal mask mandates and ramping up vaccinations.

On July 26, Gov. Gavin Newsom announced that health care workers and state workers must show proof of vaccination or opt for weekly testing. On Aug. 5, the California Department of Public Health announced that health care workers will be required to be fully vaccinated by Sept. 30, without the option for weekly testing. And just this week, teachers and other school employees were given the weekly testing options as well. The measure is aimed at protecting the most vulnerable individuals while protecting workers in these settings, the department stated.

The state is paying for testing of state employees and is working out details on implementation. Health plans are obligated to cover the cost of Covid-19 testing in health care and other congregate settings, said the California Department of Public Health.

In the case of Visalia-based Kaweah Health, the health plan is self-insured. Therefore the cost will fall on the health system for increased Covid-19 testing for employees as well as visitors, per state guidelines.

Will they stay or will they go?

Hospitals are worried about whether staff will resign, or if they will have to lay off or terminate workers should they choose not to receive the vaccine. The health care labor shortage is already a concern, so potentially losing staff in this way creates many questions.

“Given the suddenness of the Governor’s unexpected vaccination mandate, we don’t know the answer to this question. We will look at traditional approaches like hiring travelers (if they are even available), offering extra shift bonuses to staff, asking the State for permission to work short-staffed and out of compliance with State-mandated staffing ratios,” said Kaweah Health CEO Gary Herbst.

But he said all of these solutions are unsustainable in the long run and will just further add to employee burnout, he said. These solutions are also dependent on hospital finances — not the state.

“We also may have to consider temporarily closing non-critical or non-emergency services to redeploy staff to areas we have the greatest staffing shortfalls,” Herbst said.

Beverly Hayden Pugh, Valley Children’s Hospital senior vice president and chief nursing officer, said, “As a health care organization, we are well-prepared to deal with unforeseen circumstances like those we have experienced during Covid-19, including unexpected patient surges and staff shortages. Our plans and preparation have been well-tested from the start of the pandemic. We will continue to provide the best care for the kids and families who need us — directly and through regional partnerships.”

Staff remains concerned with the potential for increased Covid-19 transmission because of the delta variant, which is more contagious especially among the unvaccinated.

“A vaccinated workforce is a key piece of slowing the transmission and in keeping our kids and families safe. Above all else, that is our priority. We will continue to focus on reducing rates of community transmission of Covid-19 for kids, as well as treating any who need our expertise,” said Hayden Pugh.

Vaccination is the key

Kaweah Health currently has 55% of its workforce vaccinated, and Community Health System has 60%.

“We will make every effort to encourage unvaccinated staff to receive the vaccination or obtain an accommodation. But ultimately, as with all California Department of Public Health orders and mandates, we are required to comply.  We also continue to remain focused on our recruitment and staffing efforts,” said Dr. Tom Utecht, senior vice president and system chief medical officer at Community Health System.

Utecht said the health care system expects to work through challenges over the next few months, but believes that vaccination is the only way to eradicate the spread of Covid-19.

“While providers are definitely worried about a shortage of workers, we don’t have any insights as to what hospitals’ plans are/concerns about handling workers who choose to go unvaccinated,” said David Bacci, regional vice president for the California Hospital Council, in an email.

Hospitals in the Central Valley are preparing for another surge this fall, but visitors will also be affected by the state’s mandate. Visitors must demonstrate proof of vaccination or receive a negative Covid-19 test within 72 hours in advance of stepping foot in the facility.

Until the state mandate is in full effect at the end of September, Valley Children’s Hospital will conduct weekly testing beginning Aug. 23. Those with a medical or religious exemption will continue to be tested weekly.

“Visitors who are visiting a patient in critical condition, when death may be imminent, are exempt from the vaccination and testing requirements of this order. They must, however, comply with mask, personal protective equipment, and physical distancing requirements,” said the California Department of Public Health.

Balancing act

The department did not say whether workers who refuse the vaccine will be terminated.

“Keeping both workers and patients safe is our top priority and the purpose of this order. We do not believe it will take staff away from already busy hospitals,” said the department.

California’s requirement for its health care workers comes after Trinity Health System, parent company of Saint Agnes Medical Center in Fresno, implemented a vaccine mandate.

The hospital did not say how it would navigate terminating employees, but said it has pledged to protect the most vulnerable.

“We understand this decision may not resonate with all of our colleagues, but after careful consideration we know this is the right decision,” said Chief Medical Officer Dr. Walter E. Egerton for Saint Agnes Medical Center.

Regardless, it does present operational challenges to pivot according to new health ordinances. Hospitals have to develop their own plans to implement guidance for visitors, which includes Covid-19 testing. Some may require the visitor to come with a complete test, and others may offer testing on-site.

“As a general rule, each time a Public Health Order of this type is issued it does present at a minimum an operational challenge for a hospital.  Throughout this entire pandemic resources have been stretched thin. However, our hospitals stand ready to care for our community, and will take the necessary steps to comply with all Public Health Orders,” said Bacci.

Shots are up

The rates of vaccination across the state are increasing. First time vaccinations increased by 315,121 from July 26 to Aug. 1 – up 16.9% from the previous week when 269,629 doses were administered. Compared to July 12 to July 18, which brought in 222,299 new doses, the first-time vaccinations were up 41.8%.

Though vaccinations are increasing across the state, the Central Valley is projected to see a surge through September, said Dr. Rais Vohra, interim health officer for the Fresno County Department of Public Health.

Covid-19 cases are rising fastest among the non-vaccinated, Vohra said.

“The vaccinated breakthrough infections are relatively benign, and they’re not landing people in the hospital. So while it does happen, that’s not what’s driving the surge and that’s not why we’re so worried that our health care system is once again under strain,” he said.