Looming deadlines keep COVID vaccine mandates in the hot seat

Issues related to mandatory COVID-19 vaccination continue to roil employment settings in many parts of the nation, as deadlines approach and courts weigh in on requirements.

In other developments, a large multistate study based on data from the Centers for Disease Control and Prevention (CDC) and several health systems found that mRNA vaccines were less effective at preventing hospitalization in immunocompromised people when compared with their peers who don't have underlying health conditions.

Mandate issues come to a head

A deadline for COVID-19 vaccination for New York City's municipal workers arrived yesterday, and nearly 9,000 were placed on unpaid leave for not complying, according to the New York Times. About 12,000 have applied for religious or medical exemptions.

On Twitter today, Mayor Bill De Blasio said 92% of the city's workforce is vaccinated.

In related developments, a Cook County judge today suspended a Dec 31 deadline for Chicago police officer to be vaccinated, but he didn't weigh in on the requirement that they be regularly tested, according to the Associated Press.

Meanwhile, the White House yesterday released guidance that said federal contractors can use their discretion in managing employees who refuse COVID-19 vaccination, according to Roll Call. In September, the Biden administration announced a requirement that federal contractors need to be vaccinated by Dec 8. In general, for those who refuse vaccination, the new guidance suggests counseling and education, followed by more disciplinary measures, as needed, which could include firing.

The guidance said government contractor employees must still follow other COVID-19 protocols, such as masking and added that contractors have leeway in determining the legitimacy of exemption requests.

Lower vaccine protection in immunocompromised

Those with weakened immune systems are known to mount a less robust response to vaccination, and today the authors of a large multistate study detailed a drop in protection against severe COVID-19 outcomes in immunocompromised people who had received two doses of mRNA vaccine.

The group published its findings today in an early online edition of Morbidity and Mortality Weekly Report (MMWR).

The data they looked at came from nine states that are part of the VISION Network, a collaboration between the CDC and seven health systems and research institutions that was developed to gauge the effectiveness of COVID-19 vaccines. The analysis included about 89,000 adults who were hospitalized for COVID-19 from Jan 17 to Sep 5.

For immunocompromised patients, vaccine effectiveness (VE) was lower, at 77%, compared with 90% in those who didn't have weakened immune systems.

VE was lower in certain immunocompromised groups, such as solid-organ and stem-cell transplant recipients. VE estimates ranged from 59% in those two groups to 81% in patients who had rheumatologic or inflammatory disorders.

The group said the findings support the CDC recommendation that immunocompromised people receive three mRNA vaccine doses, plus a booster 6 months after the third dose, use nonpharmacological interventions such as masking, and, if infected, be monitored closely to avoid severe complications.

More US headlines

  • With the CDC expected to formally recommend COVID-19 vaccination for younger children this week, states with high adult coverage are planning more robust measures to get kids immunized than in states where vaccine hesitancy levels are higher, according to Reuters.

  • The pace of COVID-19 hospitalizations in older Americans has dropped significantly since vaccination started, federal data show, according to Axios. Some parts of the Medicare population, however—such as those in nursing homes and those with kidney failure—are still more susceptible to severe disease and hospitalization.

  • Amazon announced that employees no longer need to wear masks in company warehouses if they are fully vaccinated, unless federal, state, or local laws require them, according to the Wall Street Journal.

  • The US 7-day average is 75,203 cases a day, with 1,331 daily deaths, according to the Washington Post.

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