Rethinking the rules: How organizations are changing protocols for unvaccinated employees

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While many employees at health systems have been vaccinated for COVID-19 in recent months, other workers do not ever plan to get inoculated or are still considering it. 

A survey encompassing 276 hospitals, published by USA Today June 3, found that fully vaccinated rates among employees at nine hospital networks ranged from 53 percent to 72 percent. Additionally, 15 percent of the public hospital respondents reported rates that ranged from 51 percent to 91 percent. 

To boost vaccination among their workforces, organizations have focused on education about the shots. Some also have vaccination mandates and incentives for those who are inoculated. 

Now, health systems are also thinking about how their protocols could change for those who remain unvaccinated. 


At Cleveland-based MetroHealth, employees who are not vaccinated against COVID-19 will be required to undergo weekly COVID-19 testing, effective July 1. The requirement is based on maintaining patient safety and the safety of workers, spokesperson Mike Tobin told Becker's.

"A dedicated email address and phone number have been set up to answer medical questions from employees about safety and potential side effects," Mr. Tobin said. "Employees are encouraged to get vaccinated, since the vaccines have proven to be safe, effective and our best hope to returning to normal."

As of May 13, about 72 percent of MetroHealth's approximately 7,800 employees had received at least one dose, and about 70 percent were fully vaccinated.

Christus Health 

Sam Bagchi, MD, executive vice president and chief clinical officer of Irving, Texas-based Christus Health, said his health system is not requiring systematic testing for unvaccinated workers and is working to engage employees who have questions about the vaccines. 

"We do think it's important. We do want our workforce to be protected. And we want to send the right message to the communities we serve that vaccines are important and a big part of the winding down of the pandemic," said Dr. Bagchi. 

As of May 28, about 61 percent of the health system's more than 31,000 U.S. employees had been vaccinated. That does not include its employees in Latin America. Employees are tested when they have exposure to COVID-19 or if they have related symptoms, regardless of vaccine status. 

Christus Health also has deployed a surveillance program for antibody testing to detect potentially asymptomatic spread in its workforce and continues to periodically do that testing.

"That's something we're evaluating and will continue to think about because we know our vaccinated workforce is likely to test positive because of the test we're using. On the other hand, we found some people, even after being vaccinated, don't develop antibodies, so that's something we're thinking through," said Dr. Bagchi. "We're not sure that means they're not protected. We believe they still have some protection because they've been fully vaccinated, but in other conditions where we would test for antibodies, like with hepatitis B, we would revaccinate people until they demonstrated an antibody response, so that's something we're waiting on guidance from the CDC on."

Meanwhile, effective June 7, Christus will allow vaccinated employees who work in its corporate administrative office to unmask in the workplace, based on CDC guidance.  

"We're going to be using the honor system for that, and we expect our unvaccinated workforce to act with integrity and honesty. And really, they would be protecting themselves more than they would be protecting others given that only vaccinated people will be unmasked," Dr. Bagchi said. 

He said Christus is hoping this new guideline encourages a few more people to get vaccinated, but it also doesn't want to force people to mask unnecessarily when they're protected.    

Novant Health 

Like Christus, Charlotte, N.C.-based Novant Health is not requiring systematic testing for unvaccinated workers. However, it is monitoring its COVID-19 vaccination acceptance rate among employees, including those who have received a dose or are fully vaccinated and those who have scheduled vaccinations. 

Alen Brcic, vice president of people and culture operational excellence, said data is lagging since all new hires don't reveal whether they have been vaccinated outside of Novant. 

But with lagging data, the health system had a roughly 64 percent acceptance rate as of May 26. 

The health system also has universal masking protocols in place for employees, as well as a prescreening process for clinical and nonclinical employees who come on-site. 

"We are screening those who are reporting COVID-19-related symptoms, and we are following screening and return-to-work algorithms that are continuously changing based on CDC guidance and guidance around vaccinations," said Mr. Brcic. "In addition, different units at different facilities have different PPE guidelines that are being continuously reviewed by infection prevention teams to ensure workers are protected."

He said Novant is exploring opportunities to affirm vaccinated employees in a different way and continuously reviewing what is occurring in and outside of healthcare related to the pandemic. 

Still, right now, workers, regardless of vaccine status, are tested if they report COVID-19 symptoms and are taken away from work because of those symptoms, or if they travel internationally.

"While we won't test week over week for unvaccinated workers, we are closely monitoring what other health systems are doing and aligning it in terms of how we serve and support our team members in the best way to care for our communities," said Mr. Brcic. 

For now, Novant is encouraging voluntary vaccination of employees, through pop-up events, as well as standard weekly events at specific locations. Mr. Brcic said the health system also is administering vaccines to employees during later shifts via a mobile cart and bringing in experts to share their vaccination stories and debunk myths related to the shots. 

"We're hopeful all of these efforts will continue to increase our vaccination rates," he said. 

Neither Christus nor Novant require employees to get vaccinated. 

Houston Methodist; Indianapolis-based Indiana University Health; Philadelphia-based University of Pennsylvania Health System; West Orange, N.J.-based RWJBarnabas Health; Great Falls, Mont.-based Benefis Health System; and University of Louisville (Ky.) Health have announced vaccination mandates. 

Other health systems have decided not to mandate the vaccine for employees while the shots are only FDA-approved for emergency use. 


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