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COVID-19 Health Care Staff Vaccination IFC-6
On Friday November 5, 2021, the Centers for Medicare and Medicaid Services (CMS) published a rule requiring all health care facilities certified under Medicare and Medicaid to ensure their staff have received COVID-19 vaccination. The rule is effective immediately. The first compliance deadline is December 6, 2021, and all covered staff must have received all shots for full vaccination by January 4, 2022. CMS has several resources available, including an infographic, a webinar recording and slide deck, and frequently asked questions (FAQs). CHA has provided a summary of the rule for members (member login required). 

Also on November 5, 2021, the Occupational Safety and Health Administration released its COVID-19 Employer Emergency Temporary Standard (OSHA ETS) for facilities with 100 or more employees. In general, if facilities are subject to the CMS rule then that rule takes priority. The CMS FAQs have more information on how the CMS rule interacts with the OSHA ETS and state law requirements.
 

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Actions speak volumes: Doctors' kids at front of line for pediatric COVID vaccine

December 1, 2021

By LISA EISENHAUER

Dr. David Basel, Avera Medical Group vice president of clinical quality, didn't hesitate when it came to getting his 8-year-old immunized for COVID-19.

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Basel

Basel had the system's clinic manager text him when the first shipment of the Pfizer vaccine newly approved for children age 5–11 arrived in early November. He took his daughter in pronto. He says that rush to vaccinate his own child is "probably the strongest piece of evidence I can give you about how I feel about this vaccine."

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Bolton

Dr. Michael Bolton, a pediatric infectious disease doctor with Our Lady of the Lake Children's Hospital, saw that his daughters, age 11 and 8, got vaccinated the first morning the pediatric shots were available in Baton Rouge, Louisiana. The hospital is part of the Franciscan Missionaries of Our Lady Health System.

"There were a few tears for the younger one, but once we went and got donuts right after, they were A-OK," Bolton says.

Both Basel and Bolton have lead roles in overseeing the COVID vaccination process for their systems.

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Dr. Michael Bolton, a pediatric infectious disease doctor with Our Lady of the Lake Children's Hospital in Baton Rouge, Louisiana, got his daughters, 8-year-old Georgia, and 11-year-old Caroline, in for the first of two doses of COVID-19 vaccines as soon as possible. He shared this photo on the hospital's Facebook page in the same post in which the hospital announced that its clinics would be offering inoculation to all children age 5-11.

"I know we don't have millions of kids who have gotten it so far, but judging off the safety on the adult side and the safety that's been studied so far in the older age group of kids, and the studies that have come out so far in this (5–11) age group, I feel very confident in the safety and efficacy of this vaccine," Bolton says.

He says his confidence is based on closely following the vaccine studies and the reports on them from the Centers for Disease Control and Prevention and its affiliated bodies. On Nov. 2, the CDC gave its long-awaited approval for use of the pediatric dose of the Pfizer vaccine in children age 5–11. Children age 12– 15 have been eligible for the adult dose Pfizer vaccine since mid-May. Vaccine safety trials have begun in children age 6 months to 4 years.

Benefits dwarf risks
As with any vaccine, the doctors note, there is a potential for side effects. The most likely are the mild sort — arm soreness and short-lasting flu-like symptoms. The next highest risk is for an allergic reaction.

Of the hundreds of thousands of COVID immunizations Avera has given to teens and adults, Basel is aware of three or four cases of severe allergic reaction. Those patients got a quick shot of epinephrine "and they've been just fine," he says.

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Carrie Farr administers a COVID-19 vaccination to Eliana Genua at Mercy Hospital Springfield in Missouri in early November. The hospital made a video of Eliana and two other children getting their first doses and offering tips to other youngsters about the process. Eliana says: "If you're calm, you won't even feel it after." The hospital shared the video on social media.

Children are monitored for 15 minutes after each injection of the two-dose vaccines, just as teens and adults are, to check for an allergic response. The doses are given at least three weeks apart, for children and adults.

The vaccine carries a slight risk of myocarditis or pericarditis, inflammation of the heart muscle or cardiac sac, in children age 12 and older and young adults, particularly males, according to the CDC. The risk of myocarditis and pericarditis is much lower in children age 5 -11, according to the CDC. A COVID infection also can trigger heart inflammation.

Basel says there have been no documented cases of death from myocarditis associated with the vaccines and all cases have been resolved with treatment. The doctors say the overall benefits of vaccination for COVID far outweigh the risk of going unvaccinated, even for youngsters.

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Stirling

Dr. Jerold Stirling is chair of the pediatrics department at Loyola University Medical Center in suburban Chicago. The academic medical center is affiliated with Trinity Health. Stirling points out that as of early November, more than 25% of all cases of the virus were in those 18 and younger and that unvaccinated children who got COVID had 10 times the hospitalization rate as those who had been immunized.

"Our experience with COVID in children is the majoirity of time they do not experience as serious symptoms, but it is the eighth largest cause of death in children in the United States right now," he notes. As of Nov. 17, the CDC reported that the deaths of 605 children involved COVID.

Anticipating skepticism
Even with scientific evidence of their safety and efficacy and the endorsement of federal health agencies and medical groups, the doctors know the vaccines for young children will be met with skepticism by some parents. The physicians have prepped themselves and their clinician colleagues for those encounters in various ways, including by holding internal town halls for medical staff to get questions and concerns out in the open, sharing FAQ sheets and mailing and texting out synopses of studies.

"I think pediatricians' role is to educate and advocate for parents to do something for their kids to keep them safe and healthy," Bolton says. "This is a vaccine that falls right in line with all the other vaccines that do that."

Listen up
Stirling suggests that doctors hear out vaccine doubters and address their specific concerns. "I think we really need to spend a lot of time talking to our patients' parents, trying to understand their belief systems, where they got their information, and trying to address the information as best we can," he says.

He recalls listening to the concerns of two "extremely dedicated" parents who he knew well and who were struggling over the decision of whether to vaccinate their three developmentally delayed children. He counseled them about how their own COVID risk went up if their children caught the virus.

"I pointed out that if they got sick, there wouldn't be anybody available to take care of their children as well as they are able to do that," he says. "That really turned it around for them. They agreed to the vaccination after I put it that way."

Stirling says he is frustrated by how COVID vaccination has become politicized, despite its clear benefits. He notes that the speed at which scientists were able to develop the medications has been used as fodder for misinformation by some people instead of being embraced as a medical triumph.

"I think we're victims of our own success," he says.

Wide availability
The doctors report that all of their systems have enough supply to meet demand and the shots are widely available in pharmacies, clinics and physicians' offices.

The systems will continue to do vaccine outreach to all eligible age groups in medically underserved communities. Loyola uses its pediatric mobile clinic for pop-up vaccination events in its service area. Franciscan Missionaries of Our Lady arranges vaccination events in partnership with the Baton Rouge mayor's office and various nonprofit groups. It offers shots to students through school-based clinics.

Basel says Avera will continue to collaborate with federally qualified health centers and county health departments to offer vaccine clinics across its footprint in the Upper Midwest. He doubts that the system will be able to do the same scale of outreach that it did when the first COVID vaccines became available.

At that time, the system was just coming off a COVID surge and could shift staffers to focus on vaccination efforts, including phoning patients with chronic conditions and setting up vaccination appointments. With the pandemic dragging on and workers exhausted and new hires hard to find, he notes: "We're just in a difficult spot with staffing right now."

 

Facts about COVID-19 vaccines for age 5–11

  • The Pfizer vaccine, the only one approved for kids so far, is given in two shots at least three weeks apart.
  • The pediatric dose is one-third of the adult dose.
  • The formulation is the same as the adult version except for a different buffer, which allows for a longer shelf life.
  • The vaccine was found in trials to be 90.7% effective in preventing COVID.
  • The dosage in children was tested at 10 micrograms, 20 micrograms and 30 micrograms, which is the adult dosage. The tests showed the same antibody production at all dosages. The decision to go with the lowest dosage makes more of the vaccine available.
  • The vials with children's doses have orange tops; the vials for adult doses have purple tops.
  • The vaccine can be safely administered to kids at the same time as other inoculations, such as for flu or tetanus.
Sources: Dr. David Basel of Avera Health, Centers for Disease Control and Prevention and U.S. Food and Drug Administration

 

Copyright © 2021 by the Catholic Health Association of the United States
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