What You Should Know about the New Federal Covid 19 Vaccine Mandate

In my December 17, 2020 blog “Should a Covid 19 Vaccine be Mandatory?, I wrote that “it seems unlikely that there will be a federal mandate for the Covid 19 vaccine.”

But on September 9, 2021 and in a televised speech, President Joe Biden announced a federal Covid 19 vaccination mandate affecting as many as 100 million Americans “in an all-out effort to increase COVID-19 vaccinations and curb the surging delta variant.”

Calling Covid 19 “a pandemic of the unvaccinated” and that “our patience is wearing thin” with the estimated 80 million Americans who have not been vaccinated, President Biden announced new rules that:

“mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated.”

and signed

“an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers.”

However, it turns out that some groups of people are not required to get the Covid 19 vaccine, including the US Congress and people illegally crossing our southern border.

Even worse and back in an August, 2021, an NBC News article titled “18 percent of migrant families leaving Border Patrol custody tested positive for Covid” stated that:

“More than 18 percent of migrant families and 20 percent of unaccompanied minors who recently crossed the U.S. border tested positive for Covid on leaving Border Patrol custody over the past two to three weeks, according to a document prepared this week for a Thursday briefing with President Joe Biden. (Emphasis added)

MORE POTENTIAL PROBLEMS WITH THE COVID 19 VACCINE MANDATE

Some hospitals are now telling healthcare workers to get vaccinated or lose their jobs. And in New York, there are now worries that a vaccine mandate “will exacerbate staffing shortages dogging medical facilities.”

And although some U.S. businesses welcome President Biden’s COVID-19 vaccination mandate for firms with 100 or more employees, some small businesses are bristling, saying that the order “imposes yet another burden that could intensify historic worker shortages and supply-chain bottlenecks.

Already, legal challenges are looming for the covid 19 vaccine mandate.

WHY VACCINE HESITATION OR REFUSAL?

From the start of the Covid 19 pandemic, the rules seemed to keep changing: first gloves and no mask, then lockdown, mask and social distancing. Different states had different rules about opening and closing businesses and schools.

It was frustrating when the scientific data behind the changing rules was often lacking or contradictory. And some people are concerned about some of the reported rare side effects of the vaccines as well.

However, experts say that few people are medically exempt from getting the Covid 19 vaccine.

Now, there is an emphasis on providing booster Covid 19 vaccines for the fully vaccinated. However, it is concerning to now read in the Business Insider that “18 leading scientists, including 2 outgoing FDA officials, say COVID-19 booster shots lack evidence and shouldn’t yet be given to the general public”.

CONCLUSION

My husband and I received our Covid 19 vaccinations in March without any problems and recommended the vaccinations to our children with the caveat that they check with their doctors first, especially since some of our children and grandchildren have special situations.

We are open to receiving the Covid 19 vaccine booster shot but we would like to see more scientific data and hopefully a consensus among the experts.

Covid 19 Vaccine Refusal?

Last December, I wrote the blog Should a Covid 19 Vaccine be Mandatory? and concluded that:

“It is more likely that only certain groups of people may be required to take the vaccine like healthcare workers, universities and some employers. Even then, the Civil Rights Act of 1964 may help people who have a religious objection to a vaccine as well as anti-discrimination laws and exemptions for medical reasons. An employer would have to make a reasonable accommodation as long as it’s not too costly for the business.

It is also possible that airlines, stores and stadiums could also make vaccination a condition of doing business with a person.”

In March 2021, a Monmouth University poll showed that 25% of those polled would refuse the vaccine.

VACCINE REFUSAL NOW

After a concerted public effort to encourage Covid 19 vaccination, about 67 percent of Americans 18 and older had received at least one dose of a vaccine by July 4.

So far, the CDC (Centers for Disease Control and Prevention) recommends that everyone 12 years and older should get a Covid 19 vaccination but has not issued guidance on COVID-19 vaccines for children under 12.

But even though there is no federal requirement for Covid 19 vaccination, there are many colleges that require students have the Covid 19 vaccinations before arriving on campus.

However, according to CNN:

“at least seven states– Alabama, Arkansas, Florida, Indiana, Montana, Oklahoma and Utah — have enacted legislation this year that would restrict public schools from requiring either coronavirus vaccinations or documentation of vaccination status

and

“(a)s of June 22, at least 34 states had introduced bills that would limit requiring someone to demonstrate their vaccination status or immunity against Covid-19″

with

At least 13 states — Alabama, Arkansas, Florida, Indiana, Iowa, Kansas, Missouri, Montana, North Dakota, Oklahoma, Tennessee, Texas and Utah — have passed them into law.” (All emphasis added)

In addition, more than 150 staff members at Houston Methodist Hospital were fired or resigned in June after refusing to get vaccinated for COVID-19. They are now appealing a judge’s ruling that sided with the hospital’s right to terminate their employment.

According to an April 27, 2021 American Academy of Family Physicians article, four reasons for some health care workers’ hesitancy to get the vaccine are safety and efficacy concerns, preference for physiological immunity, distrust in government and health organizations and autonomy/ personal freedom.

Some people say they are worried about the reported side effects and adverse events on sites like VAERS (Vaccine Adverse Event Reporting System) included on the CDC (Centers for Disease Control) website as “an early warning system used to monitor adverse events that happen after vaccination” and “one of several systems CDC and the US Food and Drug Administration (FDA) use to help ensure all vaccines, including COVID-19 vaccines, are safe.” (VAERS’ reported adverse events can be found at Open VAERS.)

LEGAL CONSIDERATIONS

The March 5, 2021 National Law Review article Declining a Shot in the Arm: What Employers Should Do When Employees Refuse Vaccines regarding health care workers points out that:

“Remember that we are still under the vaccines’ Emergency Use Authorization (EUA) period. The EEOC has indicated that employers can require that employees get vaccinated, but the EUA statute contains some language saying that people have a right to refuse any vaccine during the EUA period. Courts have not yet decided the issue. So, there’s some legal risk for employers that choose to mandate that employees get vaccinated.

Most health care employers have decided to strongly encourage – but not require – employees to get vaccinated, partly out of concern that mandating the vaccine might lead to staffing shortages if enough employees refuse to get vaccinated and quit or are fired.”

The article also discusses religious and medical exemptions.

CONCLUSION

My husband and I received our Covid 19 vaccinations in March without any problems and recommended the vaccinations to our children with the caveat that they check with their doctors first, especially since some of our children and grandchildren have special situations.

Some received the vaccinations and some didn’t but we ultimately had to leave the decision up to them.

I am pleased that Covid 19 infections appear to be waning and that our family is healthy at present but I know that this is no time for any of us to be complacent about our health or our rights.

A Light at the End of the (Covid 19)Tunnel?

My husband and I just returned from a trip to Florida where we were happily surprised to find the closest place to normal since the Covid 19 pandemic started. Everyone wore masks (except one young man we saw at a distance) and everyone was careful about social distancing. Hand sanitizers were everywhere.

Best of all, people seemed happy and we saw very few stores closed.

When we returned home, we both finally received the first of our 2 Covid 19 vaccination doses.

Is it possible that there is a light at the end of the Covid tunnel?

I am cautiously optimistic but aware that Covid 19 may still be a problem in the long term, especially since some younger family members-including children-contracted Covid despite precautions. Thankfully, they all had mild cases with no hospitalizations. My husband and I will continue to follow Missouri’s guidelines of masks, social distancing, etc. even after we receive our next dose of vaccine.

IS FLORIDA A HARBINGER OF GOOD NEWS?

Florida was among the last states to go into lockdown and one of the first states to ease restrictions.

Florida’s Governor Ron DeSantis was vilified by many of the media for adopting something similar to Sweden’s strategy of protecting the vulnerable while keeping businesses and schools open but a year after the pandemic hit the US, that strategy seems to be working.

Despite having the second largest number of elderly people by state, Florida’s Covid death rate numbers are better than New York’s and California’s. And, unlike so many other states, Florida’s economy is thriving.

Now, Governor Abbott of Texas and Governor Reeves of Mississippi have announced that they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates.

WHAT HAPPENED?

It has been almost a year since the U.S. went on lockdown for Covid 19 when President Trump declared Covid 19 a national emergency on March 13, 2020.

At first, the lockdown was only supposed to be for a few weeks to “flatten the curve” of infections and prevent hospitals from being overwhelmed by Covid patients.

However, as the lockdowns wore on for months, some doctors and other experts started warning about the emotional and health damage occurring.

Although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter also stated that:

“Keeping schools and universities closed is incalculably detrimental for children, teenager and young adults for decades to come.”

Then on October 4, 2020, the Great Barrington Declaration was written and released and eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly, stating:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

Unfortunately, Covid 19 rules and lockdowns have become a political football in many states, especially with school and small business reopenings.

CONCLUSION

We know a lot more about Covid 19 now than when the pandemic started, especially from watching U.S. states and other countries use various strategies to try to contain the virus. And now, of course, it appears we have several promising vaccines.

Although there is much more to learn, we indeed might be seeing a light at the end of the Covid 19 tunnel.

When Can We End Lockdowns for Covid 19?

When the Covid 19 pandemic hit the U.S. early last year, little was known about this new infection.

But as the highly contagious Covid 19 virus was spreading around the world, President Trump issued a proclamation on March 13, 2020 declaring a national emergency with “preventive and proactive measures to slow the spread of the virus and treat those affected” and state lockdowns began.

Regular healthcare became virtually suspended as states went to lockdown with rules to shelter in place except for essential errands or work. Schools and many businesses were closed. 

On March 18, the Centers for Medicare and Medicaid Services recommended that hospitals cancel all elective surgeries and nonessential medical, surgical and dental procedures to prepare for the expected deluge of patients with Covid 19 and the health system complied.

Then, although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

The doctors’ letter stated that:

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties: “150,000 Americans per month who would have had new cancer detected through routine screening.”

“Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

“The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” (All emphasis added)

Then on October 4, 2020, the Great Barrington Declaration was written and released by three public health experts from Harvard, Stanford, and Oxford. The Declaration was eventually signed by thousands of doctors and experts from around the world. The Declaration encouraged governments to lift lockdown restrictions on young and healthy people while focusing protection measures on the elderly.

These experts surmised that this would allow COVID-19 to spread in a population where it is less likely to be deadly, encouraging widespread immunity that is not dependent on a vaccine.

The Declaration stated:

“Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice. “

The Declaration was swiftly met with intense criticism from other medical experts who called the plan “practically impossible and highly unethical”.

As the numbers of people with Covid 19 and who died from Covid 19 went up and down over the months, various U.S. states and counties ordered different degrees of lockdown and now many states seem to be guided more by politics than science when it comes to lockdowns.

HOPE ON THE HORIZON

We now have more people with Covid 19 surviving and leaving the hospital sooner due to a better understanding of what treatments work best in comparison to what was known when the pandemic started in the US.

And although seemingly impossible at first, new vaccines have been developed for Covid 19 and began being distributed in December 2021 due to Operation Warp Speed. Despite the controversy about some Covid 19 vaccines, it is hoped that the widespread use of vaccines may help the U.S. end the lockdowns.

In addition, the FDA (food and Drug Administration) approved the use of several rapid Covid 19 tests, some that can even be done at home. This can be a gamechanger with some experts saying that the massive distribution of rapid self-tests for use in homes, schools, offices, and other public places could replace harmful sweeping lockdowns with knowledge.

CONCLUSION

Lockdowns have caused enormous economic, physical, social and mental upheaval in the US.

When lockdowns are intermittent in intensity and duration in some states without clear scientific evidence that the lockdowns are working, it seems we need a reevaluation of their usefulness as we evaluate other measures to help end the Covid 19 pandemic.

Should a Covid 19 Vaccine be Mandatory?

As the first Americans are receiving a Covid 19 vaccine, a December 5 2020 Gallup poll reports that 63% of Americans say they are willing to take the vaccine. 37% are less willing, including some groups like non-white people and Americans age 45-64. But the percentage of Americans currently willing to get vaccinated may still be below where public health experts want it.

Now, there is a proposed bill in New York to make getting the vaccine mandatory to get sufficient immunity if not enough people are voluntarily getting them.

Why are some people unwilling to get the vaccine?

As I wrote in my last blog “Ethics and the Production of Covid 19 Vaccines”, many people are concerned about the use of aborted fetal cells in some vaccines. I also included two lists of vaccines and whether or not such fetal cells were involved in their production. One list is from the Charlotte Lozier Institute and one is from the Children of God for Life organization. (The Charlotte Lozier Institute does disagree with the Children of God for Life organization on the Moderna vaccine.)

Other potential concerns are about the safety, side effects and the effectiveness of the vaccines.

EFFECTIVENESS AND SAFETY

A December 3, 2020 MedPage investigative article “Want to Know More About mRNA Before Your COVID Jab? states that “While an mRNA vaccine has never been on the market anywhere in the world, mRNA vaccines have been tested in humans before, for at least four infectious diseases: rabies, influenza, cytomegalovirus, and Zika.”

The Covid 19 vaccines use a synthetic mRNA, which is genetic information used to make the SARS-CoV-2 spike protein. When injected, the body produces a strong response to that protein to produce an immune response.

How long that response lasts is still unknown.

But, especially for certain groups of people, there are also concerns about safety.

According to the CDC (the U.S. Center for Disease Control) regarding immunocompromised patients such as those with HIV or who take immunosuppressive medications or therapies may take the vaccine but should be counseled about:

“– Unknown vaccine safety and efficacy profiles in immunocompromised persons
– Potential for reduced immune responses
– Need to continue to follow all current guidance to protect themselves against COVID-19″

Also according to the CDC, “There are no data on the safety of Covid 19 vaccines in pregnant women” but “Animal developmental and reproductive toxicity (DART) studies are ongoing” and more studies are planned.

Regarding breastfeeding, the CDC states that “There are no data on the safety of COVID-19 vaccines in lactating women or the effects of mRNA vaccines on the breastfed infant or milk production/excretion”

SIDE EFFECTS

In a Nov. 23, 2020 CNBC article “Doctors say CDC should warn people the side effects from Covid vaccine shots won’t be ‘a walk in the park, a group of doctors told the CDC to warn people that the Covid 19 vaccine shots now being rolled out may have “some rough side effects so they know what to expect and aren’t scared away from getting the second dose.”

And a December 9, 2020 article in the Wall Street Journal “Covid-19 Vaccines Pose Potential Side Effects, Doctors Say” reported that “U.K. authorities warn people with severe allergies against receiving the Pfizer-BioNTech shots, after two Britons experience allergic reactions.”

But a STAT news article a few days later on December 13, 2020, now reports that the CDC has changed its position from Persons who have had a severe allergic reaction to any vaccine or injectable therapy (intramuscular, intravenous, or subcutaneous) should not receive the Pfizer-BioNTech vaccine at this time(emphasis added) to that people who had “severe reactions to prior vaccines or injectable drugs can still get the Pfizer/BioNTech vaccine for Covid-19, but should discuss the risks with their doctors and be monitored for 30 minutes afterward”.

Another concern is that although states rely on the percentage of positive Covid 19 tests for lockdown and other orders, there are many kinds of tests and both false positive and false negative results have been reported.

No wonder many people are confused and anxious!

SHOULD COVID 19 VACCINES BE MANDATORY?

Now we are seeing Covid 19 vaccines being rapidly distributed and more Covid 19 vaccines are coming, including a Johnson and Johnson single dose Covid 19 vaccine that is in testing and the results may be known by January.

Currently, the health care workers and residents and staff of long-term care facilities have first priority for a Covid 19 vaccine.

Although states have the authority to regulate public health and they have in the past mandated vaccines for diseases like smallpox and some mandatory vaccines are required by states before children can attend school, it seems unlikely that there will be a federal mandate for the Covid 19 vaccine.

It is more likely that only certain groups of people may be required to take the vaccine like healthcare workers, universities and some employers. Even then, the Civil Rights Act of 1964 may help people who have a religious objection to a vaccine as well as anti-discrimination laws and exemptions for medical reasons. An employer would have to make a reasonable accommodation as long as it’s not too costly for the business.

It is also possible that airlines, stores, stadiums could also make vaccination a condition of doing business with a person.

CONCLUSION

The Covid 19 pandemic has taken a serious toll on everyone and we will not get back to “normal life” anytime soon, even with the Covid 19 vaccine.

But we still must make sure that any Covid 19 vaccines we take are ethical, effective and safe.

Ethics and the Production of Covid 19 Vaccines

I am hopeful that the new Covid 19 vaccines that are being approved soon will help stop Covid 19 but, like many people, I only want to take a vaccine that does not use cell lines from aborted babies.

But that information can be hard to find, confusing and the facts are sometimes disputed.

For example, a November 18, 2020 article from the Associated Press titled “Lung tissue from aborted fetus not used in AstraZeneca vaccine development” disputes an online video that claims tissue from an aborted baby was used. I discovered later that this AP headline was inaccurate.

And there are disputes even in Catholic and other religious circles.

For example, some Catholic bishops and priests questioned the use of some vaccines before Archbishop Naumann and Bishop Rhoades from the USCCB (the US Catholic bishops conference) wrote a memo citing three Vatican documents and stating that:

“Neither the Pfizer nor the Moderna vaccine involved the use of cell lines that originated in fetal tissue taken from the body of an aborted baby at any level of design, development or production. They are not completely free from any connection to abortion, however, as both Pfizer and Moderna use of a tainted cell line for one of the confirmatory lab tests of their products.”

“There is thus a connection, but it is relatively remote,” they continued. “Some are asserting that if a vaccine is connected in any way with tainted cell lines, then it is immoral to be vaccinated with them. This is an inaccurate portrayal of Catholic moral teaching.”

and

“Most importantly, they all make it clear that, at the level of the recipient, it is morally permissible to accept vaccination when there are no alternatives and there is a serious risk to health.”

However, other articles like the National Catholic Register’s Nov. 25, 2020 Measuring Moderna’s COVID-19 Vaccine: Now’s the Time to Press Hard for Ethical Options” by Stacy Trasancos, PhD, MA and Children of God for Life’s Nov. 16, 2020 article “Moderna Covid-19 Vaccine – Facts – Not Fiction say that kidney cells from aborted babies were used in the development of the Moderna Vaccine but also adds that there are plenty of other ethical vaccines being developed.

CONCLUSION

After weeks of investigation, I found the simplest explanation of the vaccine production process and its’ potential problems at The Charlotte Lozier Institute website.

I also found the most expansive list of current potential vaccines at the Institute’s Update: COVID-19A Vaccine Candidates and Abortion-Derived Cell Lines. (The Institute does disagree with Dr. Trasancos and the Children of God for Life organization on the Moderna vaccine.)

For myself, I do want the Covid 19 vaccine when it is available but I will make sure that I am given one of the ethically uncontroversial vaccines. I will also insist on adequate information on the safety of such vaccines before I take the vaccine.

ADDENDUM:

I am adding this addendum to my latest blog after I discovering some new information from both a medical and a pro-life website (LifeSiteNews December 4, 2020 article “Pfizer COVID jab warning: “No breastfeeding, avoid pregnancy for 2 months, unknown fertility impacts” about the possible effects of the Pfizer Covid 19 vaccine on pregnant and breastfeeding moms.

This disturbing news and another link from a blog reader made me realize that we must have confidence that any Covid 19 vaccine will be safe as well as ethically produced.

Therefore, I have added a final line to my blog:  “I will also insist on adequate information on the safety of such vaccines before I take the vaccine.”

Nancy Valko, RN ALNC

Home Health Care and Safety in the Age of Covid 19

In the 1990s, I reluctantly had to leave my hospital position in oncology after an  operation on my right foot surgery that left me unable to stand on my feet for even just a few hours. I decided to go into home health  to support my children and possibly help my foot heal.

Surprisingly, I found that I loved home health nursing and I learned a lot that even helped my patients when I was finally able to resume hospital nursing some years later.

Home health nursing wasn’t an easy job even back then. I drove up to 200 miles some days to care for just about every kind of patient from medical patients just needing blood work to hospice patients and even a young man unable to move below his neck after a diving accident. But I loved the independence and really getting to know my patients and helping them in their own environment.

In May, I wrote a blog “Covid 19 and Nursing Homes” about friends of mine who refused to go to extended care nursing facilities because of the outbreaks of Covid 19 which are especially dangerous to the elderly. Instead, these friends chose to stay home with help from home health caregivers, family and/or friends.

I wondered how home health nursing was now coping with the pandemic.

HOW COVID 19 IS CHANGING HOME HEALTH CARE

A May 18, 2020 article written by 3 geriatricians and titled “How coronavirus could forever change home health care, leaving vulnerable older adults without care and overburdening caregivers” reveals how Covid 19 is now changing a sector of health care that has received little attention during the pandemic.

According to the article, over 5 million people in the US are currently receiving paid home care from personal care assistants, home health aides, nurses and therapists. But even before Covid 19, there were not enough of these health care workers.

As the geriatricians write:

 “(N)ow, not only must home care continue for older adults, and for those with disabilities, but many people with COVID-19 will need it too”.

While home health care reduces the stress on hospital systems, Covid 19 means that home health care is facing new challenges.  Because home health workers travel to multiple homes and people, this increases the risk of possible Covid 19 transmission both for the workers and their often frail and older patients. How can health care workers and their patients both stay safe during the pandemic?

The geriatricians researched the problem and came up with 10 recommendations to  deal with Covid 19 and also improve home health care.

These recommendations include access to personal protective equipment (PPE), regular COVID-19 testing for both staff and patients,  Centers for Medicare and Medicaid Services (CMS) expanding the definitions of “home health” and “homebound” to include “personal care” to help more patients, as well as increasing federal funding for community health workers.

They also recommend more flexibility using options like telehealth which has been particularly useful for one of my older friends.

ONE BIG REASON WHY I LEFT HOME HEALTH NURSING

Although this article did not address this issue, one of the big reasons I finally left home health when my foot improved was the danger of working in a large city like St. Louis that has several high-risk areas as well as the roving packs of wild dogs  that were a problem at the time.

I often saw patients in these areas and sometimes even during the night when I was on call for the agency. On occasion, even the police stopped some of us nurses when were going in to see a patient in these high-risk areas and they offered to wait outside until we returned. I especially appreciated this because as a single mother, I was concerned about what could happen to my children if anything happened to me.

Personally, I saw guns in some households, was cut off by some young men trying to stop my car, dealt with some suddenly psychotic patients, tried to mitigate domestic disturbances, etc. Some areas were so high-risk that I took the fire escape for safety reasons rather than use the elevator to get to my patients’  apartments.

It took many attempts before we nurses finally got our agency to help us get pepper spray and provide a security person to accompany us nurses to high-risk areas when we felt it was necessary.

But sadly, I could never consider going back to home health now with the protests, riots and escalating violence we are seeing in many cities like St. Louis and other areas.

I fervently hope and pray that the important issues that are tearing our country apart will soon be resolved for the safety of all of us.

Especially because I am a nurse, I do know how much every life matters.

Sweden and Covid 19: Families Complain That “Palliative Care” Instead of Treatment Is Being Given to the Elderly

A June 18, 2020 article in the Wall Street Journal titled “Coronavirus is taking a high toll on Sweden’s elderly. Families blame the government”  starts with a disturbing story:

“When 81-year-old Jan Andersson fell ill with Covid-19 at a nursing home in the Swedish town of Märsta, a doctor consulted by phone ordered palliative care, including morphine, instead of trying to help him fend off the infection.

Mr. Andersson’s son, Thomas Andersson, says he was told his father was too frail for other treatment. The younger man disagreed and, after arguing with the physician, summoned journalists and insisted his father be given lifesaving care. Mr. Andersson has since recovered.

The county that runs Mr. Andersson’s nursing home said all decisions on medical treatment for the residents were made by doctors employed by a company that provides medical services. (All emphasis added)

The Wall Street Journal reports that cases like this have sparked a public outcry from not only relatives but also from some doctors and nurses. There is now an investigation by Swedish national health-care authorities into the treatment of older patients in nursing homes and Stockholm hospitals. There are now 5,041 people in Sweden who have died from Covid 19 with about half being nursing home residents.

“Many people have died unnecessarily,” said Yngve Gustafson, a geriatric-medicine specialist in Sweden, who looked into more than 200 cases in which people were denied care. He said that doctors were too quick to put patients on palliative care. He also said that he believed many would have survived and lived year longer had they been provided basic care.

Furthermore, a June 12, 2020 British Medical Journal article “Has Sweden’s controversial covid-19 strategy been successful?” stated that Dr. Gustafson also spoke to the Svebsja Dagbladet newspaper and “expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes.

He also was quoted as saying:

“Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” … “It’s active euthanasia, to say the least.”

Thomas Linden, chief medical officer of Sweden’s National Board of Health and Welfare, said the triage guidelines for Covid 19 were developed to prepare the health-care system for a potential crisis while ensuring best-possible treatment for all patients.

However, the Wall Street Journal article reports that Swedish critics say these guidelines have too often resulted in older patients being denied treatment, even when hospitals were operating below capacity.

“Dr. Cecilia Söderberg-Nauclér, a physician at Karolinska University Hospital in Stockholm, said that “the ICU wards were comparatively empty “because elderly people were not taken to hospitals—they are given sedatives but not oxygen or basic care.”

The Wall Street Journal article also notes that “About 90% of nursing-home residents who succumbed to Covid-19 in Sweden were never admitted to a hospital, according to official estimates. ” (Emphasis added)

Most poignantly, Latifa Löfvenberg, a nurse  for a company providing medical services to several nursing homes, said she sought treatment for residents with Covid-19 and was told by company physicians to administer morphine and a sedative.

She  described what happened:

People suffocated, it was horrible to watch. One patient asked me what I was giving him when I gave him the morphine injection, and I lied to him,” said Ms. Löfvenberg, who is now working at a hospital in the Swedish capital. “Many died before their time. It was very, very difficult.” (Emphasis added)

COULD-OR HAS-THIS HAPPENED IN THE US?

As I wrote in my May 20, 2020 blog “Covid 19 and the Culture of Death” about the dangerous and unethical responses to Covid 19 in the US:

“(T)he National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the “ethical allocation of scarce medical resources during a disaster” that:

‘provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life saving care during an emergency event or disaster and which ones will not.’ With the event of the COVID-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care.” (Emphasis added)

However, access to the actual crisis standards is restricted to NHPCO members only.

But transparency is not the only  problem.

Unfortunately, I have also personally and professionally seen cases of deliberate overdose sedation. I have written about this, most recently in my 2019 blog When Palliative Care goes Horribly Wrong”.

CONCLUSION

While Sweden has not yet legalized physician-assisted suicide, Sweden’s National Board of Health and Welfare did authorize passive euthanasia in 2010, whereby “patients may request the termination of their treatment knowing that this will lead to their death”. This ruling came in response to a request by a 32 year old woman who was totally paralyzed and dependent on a ventilator since the age of six. She requested it be shut off when she was asleep. Whether or not she received a “palliative cocktail” beforehand is unknown.

Now, Swedish officials seem to have forgotten the part about “patient request” when it comes to Covid 19 and the elderly.

In the US, we started down a similar path when “right to die” groups focused on “living wills” and withdrawal of even basic treatment before outrightly promoting physician-assisted suicide.

The bottom line for any country is that we must not lethally discriminate against anyone, regardless of age or condition like Covid 19 and we must hold palliative care to the high standards set by the late Dame Cicely Saunders,  founder of hospice movement (1918 – 2005) who said:

“You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.” (Emphasis added)

 

 

 

Over 600 Doctors Send Powerful Letter to President Trump Calling the Covid 19 Lockdown a “Mass Casualty Incident”

Although it received little media notice, a May 19, 2020 letter to President Trump signed by over 600 doctors detailed the physical and mental impact of the lockdown in the US due to Covid 19, calling it a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non-COVID patients. 

As the highly contagious Covid 19 virus was spreading around the world, President Trump issued a proclamation on March 12, 2020 declaring a national emergency with “preventive and proactive measures to slow the spread of the virus and treat those affected”.

On March 18, the Centers for Medicare and Medicaid Services recommended that hospitals cancel all elective surgeries and nonessential medical, surgical and dental procedures to prepare for the expected deluge of patients with Covid 19 and the health system complied.

Regular healthcare became virtually suspended as states went to lockdown with rules to shelter in place except for essential errands or work. Schools and many businesses were closed. 

Ironically,  except for New York and other hotspots that received massive federal help including ventilators and emergency field hospitals, US hospitals wound up with many empty beds and even emergency room visits dramatically declined

Many hospitals are now facing a financial crisis and health care professionals are being furloughed.

THE IMPACT OF THE LOCKDOWN ON AMERICANS’ PHYSICIAL AND MENTAL HEALTH

The doctors’ letter to President Trump focused on the devastating impact on Americans’ physical and mental health of the lockdown and why the months-long lockdowns should be ending. 

Here are some excerpts:

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties: “150,000 Americans per month who would have had new cancer detected through routine screening.”

“Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

“The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people. Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” (All emphasis added)

But while nearly all 50 states are starting to relax lockdown rules to some extent, some officials are threatening to keep many businesses closed and other draconian measures in place until August or even later. Many schools and universities now say they may remain closed for the remainder of 2020.

But as Dr. Marilyn Singleton, a California anesthesiologist and one of the signer of the letter said, “Ending the lockdowns are not about Wall Street or disregard for people’s lives; it’s about saving lives.” (Emphasis added)

CONCLUSION

We know a lot more about Covid 19 now. The US Center for Disease Control’s new ‘best estimate’ implies a COVID-19 Infection fatality rate below 0.3% with an estimated 35% of people with Covid 19 never having symptoms. 

States have rescinded orders that forced long term care facilities with our most vulnerable people to admit Covid 19 patients after hospital discharge resulting in lethal outbreaks.

But as more states are slowly opening, Grace-Marie Turner of the Galen Institute writes:

“Will patients come back? COVID-phobia is deathly real.

Patients still are fearful about going to hospitals for heart attacks and even for broken bones and deep lacerations. Despite heroic efforts by physicians to deeply sanitize their offices, millions have cancelled appointments and are missing infusion therapies and even chemotherapy treatments. This deferred care is expected to lead to patients who are sicker when they do come in for care and more deaths from patients not receiving care for stroke, heart attacks, etc.”

While still observing social distancing, sanitizing and other common sense measures to protect ourselves and others, it is my opinion that the more than 600 doctors writing to President Trump are right when they urge ending the Covid 19 shutdown as soon as possible for all Americans’ physical and mental health.

 

 

 

 

 

 

 

Covid 19 and the Culture of Death

“Ironically, the Covid 19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of  respecting every life to the dangerous notion that some lives are expendable-even our own.”

I have written about how the Covid 19 pandemic has resulted in dangerous and unethical responses like ventilator rationing,  unilateral DNRs, and some states ordering nursing homes and other long-term care facilities to accept coronavirus patients discharged from hospitals.

But now,  the Covid 19 crisis has also spawned new ideas such as the American Clinicians Academy On Medical Aid in Dying’s policy recommendations on medically assisted suicide requests by telemedicine in the context of Covid 19  and Covid 19 advance directives aimed at refusing potentially life-saving treatment.

Compassion and Choices, the former Hemlock Society that promotes assisted suicide, voluntary stopping of eating and drinking (VSED) and terminal sedation, now has a Covid 19 toolkit with a special Covid 19 addendum  to add to an existing advance directive to refuse care if a person gets Covid 19. The addendum even contains the question:

“Do you want your healthcare proxy to have the ability to override any of these orders if he or she believes you have a reasonable chance of living a life consistent with your values and priorities based on the information provided by the doctor? Or, do you want these orders followed no matter what?” (Emphasis added)

Another organization “Save Other Souls”, headed by an MD and an ethicist, has an “altruistic” advance directive for Covid 19 that states:

“In the event of shortages during the period of a declared emergency related to COVID-19, and in order to direct resources to others, I am willing to receive palliative care instead of: Critical medical equipment (ventilator, ECMO, etc.), Medication (other than palliative), Placement in a hospital care unit that provides critical care.” (Emphasis added)

Even more disturbing, the National Hospice and Palliative Care Organization (NHPCO) has a new resource for Crisis Standards of Care for the “ethical allocation of scarce medical resources during a disaster” that:

“provides a framework for healthcare professionals to utilize a predetermined framework to determine which individuals will receive life saving care during an emergency event or disaster and which ones will not. With the event of the COVID-19 Public Health Emergency (PHE), it is important for palliative and hospice care providers to be familiar with Crisis Standards of Care.” (Emphasis added)

The National Hospice and Palliative Care Organization (NHPCO), founded in 1978, is the nation’s largest membership organization for providers and professionals who care for people affected by serious and life-limiting illness”. NHPCO states that it “represents the interests of its members and the general public with legislative advocacy that helps to enhance and expand access to care that addresses holistic health and the well-being of communities.” (Emphasis added)

Not surprisingly, the NHPCO has supported  the problematic Palliative Care and Hospice Education and Training Act, currently still in the US Congress awaiting passage.

CONCLUSION

The Covid 19 pandemic is especially terrifying to many people but we must realize that just like any other serious or terminal illness, we must act responsibly and ethically in caring for people with Covid 19.

While medical treatment that is medically futile or unduly burdensome to the person can be ethically refused or withdrawn, refusing or removing ordinary medical treatment or deliberately oversedating a person in order to cause or hasten death is unethical. Even when we think it may help another person get care.

We need to know the difference, especially when it comes to making out living wills” or other advance directives.

Ironically, the Covid 19 pandemic has pulled back the curtain on how far our healthcare ethics has fallen from the ideal of  respecting every life to the dangerous notion that some lives are expendable-including our own.