What does Governor Inslee’s emergency proclamation mean for health care personnel who work in Washington? #
Governor Inslee’s emergency proclamation means that health care personnel who work in Washington need to be fully vaccinated by October 18, 2021, with limited exemptions for medical or sincerely held religious beliefs, or they will be prohibited from working.
“Fully vaccinated” (under Section 6 definitions of the proclamation) means that nurses will need to have received their second Moderna or Pfizer COVID-19 vaccine or will have received the Johnson & Johnson vaccine on or by October 4, 2021, in order to be considered fully vaccinated by October 18, 2021, as a condition of further employment. In other words, nurses will have to have a second Moderna or Pfizer vaccine, or a Johnson & Johnson vaccine, on or by October 4 or risk being prohibited from working.
Is it legal to mandate a vaccine that does not have full FDA approval? #
Yes. First, the FDA granted full approval to the Pfizer-BioNTech vaccine on August 23, 2021. Beyond that, the Governor’s proclamation carries the full force of law and is granted as part of the emergency powers afforded in the Washington State Constitution. In addition, the Department of Justice has ruled that mandating vaccines subject to an Emergency Use Authorization is legal. In case law, there is precedent for employer-mandated vaccine mandates, most recently in the Texas lawsuit filed against Houston Methodist. This lawsuit, brought by terminated employees, was dismissed by a federal court.
- Whether Section 564 of the Food, Drug, and Cosmetic Act Prohibits Entities from Requiring the Use of a Vaccine Subject to an Emergency Use Authorization
- Federal Court Affirms Hospital’s Mandatory COVID-19 Vaccination Policy
- PROCLAMATION BY THE GOVERNOR AMENDING PROCLAMATIONS 20 – 05 and 20 – 14
What if a health care worker refuses to get vaccinated and does not have an exemption in place, can my employer prohibit me from working? #
Yes, under Gov. Inslee’s emergency proclamation, employers are prohibited from permitting health care workers who are not fully vaccinated by October 18, 2021, to continue to work.
What happens if I have a valid medical or religious exemption, will I be prohibited from working? #
If you have a valid medical or religious exemption, the health care worker should be allowed to continue to work with a reasonable accommodation.
- Link to Full Proclamation
- COVID-19 Vaccination Requirement (Proclamation 21 – 14) for health care providers, workers and settings
If an employee refuses to get vaccinated and is not allowed to work by the employer, is the employee entitled to unemployment benefits? #
When an employee’s separation is the result of failure to comply with an employer’s requirement to become vaccinated, the Employment Security Department will examine a number of factors. These factors may include when the employer adopted the requirement, whether the employee is otherwise eligible for benefits, the specific terms of the vaccine policy including allowable exemptions, and the reason why the employee did not comply with the vaccine requirement.
For example, if the employee does not qualify for an exemption and does not comply with the vaccine requirement, a claim would likely be denied. However, some individuals may still qualify based on their own unique circumstances. ESD will evaluate each case on its own merit.
- Washington State Employment Security Department and the Washington Attorney General
- If your employer fires you because you won’t get the COVID vaccine, don’t expect to collect unemployment
Is there an option for frequent testing in lieu of vaccination? #
No. The proclamation does not allow for testing instead of vaccination. Affected workers must either be fully vaccinated or receive a religious or medical exemption.
- COVID-19 Vaccination Requirement (Proclamation 21 – 14) for health care providers, workers and settings
I am planning to be vaccinated outside of the United Stated with the AstraZeneca/or another vaccine. Is this acceptable according to the Washington state proclamation? #
Fully vaccinated is defined under section 6e of the proclamation (8/9/2021), stating that the vaccine must be under EUA, licensed or otherwise approved by the FDA. As such, vaccinations that are accepted are Moderna, Pfizer, and Johnson & Johnson.
What is the evidence regarding the safety of the COVID-19 vaccine? #
COVID-19 vaccines are safe and effective. Millions of people in the United States have received COVID-19 vaccines under the most intense safety monitoring in U.S. history. The CDC recommends that eligible individuals get a COVID-19 vaccine as soon as possible. Steps taken to make sure COVID-19 vaccines are safe:
- Careful testing — All vaccines go through clinical trials to test safety and effectiveness. For the COVID-19 vaccine, the FDA set high safety standards for vaccine developers to meet.
- The FDA granted full approval to the Pfizer-BioNTech vaccine on August 23, 2021.
- Authorization for Emergency Use — If a vaccine or medicine is needed to address an emergency situation such as the coronavirus pandemic, once it is shown to be safe and effective, the FDA can grant it an emergency use authorization, or EUA. An EUA allows a vaccine, treatment, or medication to be used before the formal FDA approval.
- Continuous monitoring for problems and side effects — Once a vaccine gets an EUA and is being given to people, the FDA and the U.S. Centers for Disease Control and Prevention (CDC) continue to watch carefully to make sure no problems arise. Data on the vaccine’s safety record accumulates over time when more and more people who receive it report on their experience and any side effects they experience. One important way to report any adverse events after vaccination is through the Vaccine Adverse Events Reporting System (VAERS).
- You can learn more from the CDC about the safety steps for the COVID-19 vaccine.
- Safety of COVID-19 Vaccines
- The long view on COVID-19 vaccine safety and efficacy
- Is the COVID-19 Vaccine Safe?
- Development and Licensure of Vaccines to Prevent COVID-19 — Guidance for Industry
How effective are COVID-19 vaccines? #
All authorized vaccines are very good at preventing severe infection, hospitalization, and death from COVID-19. The testing methods for the vaccines are not all alike, which makes it difficult to compare them. Johns Hopkins Medicine considers them to be equally effective.
Is the COVID-19 vaccine experimental? #
The FDA granted full approval to the Pfizer-BioNTech vaccine on August 23, 2021. The J&J and Moderna vaccines are FDA approved under an emergency use authorization. They are past the experimental phase. While data is still being collected on adverse vaccine events, this is very common with all vaccines and medications that require FDA approval. This specific process is called post-marketing surveillance, otherwise known as a Stage 4 trial.
How was the COVID-19 vaccine developed so quickly? #
In the past, vaccines have taken many years to develop. However, the relatively quick development of this vaccine does not mean safety measures were skipped. There are several reasons why the COVID-19 vaccines were developed faster than other vaccines:
- The technologies used to develop the COVID-19 vaccines have been years in development to prepare for outbreaks of infectious viruses. The manufacturing processes were ready very early in the pandemic.
- Countries shared genetic information about the SARS-CoV‑2 coronavirus when it was available, which gave vaccine developers an early start at finding a vaccine.
- The testing processes for the vaccines didn’t skip any steps, but the vaccine developers conducted some stages of the process simultaneously to gather as much data as quickly as possible.
- Governments gave money to vaccine developers in advance, so the companies had resources they needed.
- Some types of COVID-19 vaccines were created using messenger RNA (mRNA), a new technology that allows a faster approach than the traditional way vaccines are made.
- Social media enabled companies to reach out to and enroll study volunteers, and plenty of people wanted to help, so there were enough research participants to test the COVID-19 vaccines.
- Because the SARS-CoV‑2 coronavirus is so contagious and widespread, many volunteers who got the vaccine were exposed to the virus, and with so many exposures, the trials took a shorter time to see if the vaccine worked.
- Companies began manufacturing vaccines ahead of their authorization or approval so some supplies would be ready if authorization occurred.
What does the evidence say about the COVID-19 vaccine and pregnancy, lactation, and future consideration of becoming pregnant? #
The Centers for Disease Control and Prevention (CDC) issued this statement: “COVID-19 vaccination is recommended for all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Pregnant and recently pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people. Getting a COVID-19 vaccine can protect you from severe illness from COVID-19.”
In addition to the CDC, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend COVID-19 vaccination for pregnant, lactating, those (eligible) that are considering becoming pregnant or who may consider future pregnancy. Pregnancy testing is not required prior to receiving Food and Drug Administration EUA-approved COVID-19 vaccine. Claims linking COVID-19 vaccines to infertility are unfounded and have no scientific evidence supporting them. COVID-19 vaccines may be administered simultaneously with other vaccines, including within 14 days of receipt of another vaccine and vaccines routinely administered during pregnancy, such as influenza and Tdap.
- COVID-19 Vaccination Considerations for Obstetric – Gynecologic Care
- SMFM: Provider Considerations for Engaging in COVID-19 Vaccine Counseling With Pregnant and Lactating Patients
- COVID-19 Vaccines While Pregnant or Breastfeeding
- Vaccinating During Pregnancy Has Become Even More Urgent As ICU Beds Fill Up
Do mRNA vaccines alter DNA? #
No. Vaccines of any type do not alter DNA. Coronaviruses and mRNA have been studied for decades. Coronaviruses cause SARS, MERS, and the common cold, and cause severe illness in endangered big cats. This early, preliminary research allowed scientists to build upon existing studies when creating the COVID-19 vaccine. Research into mRNA has been ongoing for decades. Both the Pfizer and Moderna vaccines utilize mRNA. The Johnson & Johnson vaccine uses viral vector technology, the same technology used by other FDA-approved vaccines.
If an employee takes the COVID-19 vaccination and has side effects, is the employer required to pay the worker for sick time without tapping into the health care worker’s sick time/accrual hours? #
The Proclamation does not require this. Any provision like this would have to be negotiated and agreed to by the employer.
Once vaccinated, is it possible to transmit COVID-19 to others? #
Infections happen in only a small proportion of people who are fully vaccinated, even with the Delta variant. However, preliminary evidence suggests that fully vaccinated people who do become infected with the Delta variant can spread the virus to others. To reduce their risk of becoming infected with the Delta variant and potentially spreading it to others CDC recommends that fully vaccinated people:
- Wear a mask in public indoor settings if they are in an area of substantial or high transmission.
Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated. People who are at increased risk for severe disease include older adults and those who have certain medical conditions, such as diabetes, overweight or obesity, and heart conditions.
- Get tested if experiencing COVID-19 symptoms.
- If you came into close contact with someone with COVID-19 get tested 3 – 5 days after the date of your exposure and wear a mask in public indoor settings for 14 days after exposure or until a negative test result.
- Isolate if they have tested positive for COVID-19 in the prior 10 days or are experiencing COVID-19 symptoms.
- Follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.
- Interim Public Health Recommendations for Fully Vaccinated People (Updated July 27, 2021)
- Fully vaccinated people who get a Covid-19 breakthrough infection can transmit the virus, CDC chief says (August 6, 2021)
If I have had COVID-19, is it necessary to take the vaccine? #
Yes. If you’ve been infected with COVID-19, you have some protection. But that immunity has limits. The biggest limit is that it doesn’t last as long as we would like it to. Studies have shown that people who have been infected can benefit significantly from vaccination. It gives them a strong, lasting immunity boost. After receiving the first dose of the Pfizer or Moderna vaccine, vaccine recipients have immunity levels comparable to those of uninfected people who have received their second dose.
The CDC states: The COVID-19 vaccine is necessary for those who contracted the COVID-19 infection. New CDC Study: Vaccination Offers Higher Protection than Previous COVID-19 Infection. This study of COVID-19 infections in Kentucky among people who were previously infected with SAR-CoV‑2 shows that unvaccinated individuals are more than twice as likely to be reinfected with COVID-19 than those who were fully vaccinated after initially contracting the virus. These data further indicate that COVID-19 vaccines offer better protection than natural immunity alone and that vaccines, even after prior infection, help prevent reinfections.
“If you have had COVID-19 before, still get vaccinated,” said CDC Director Dr. Rochelle Walensky. “This study shows you are twice as likely to get infected again if you are unvaccinated. Getting the vaccine is the best way to protect yourself and others around you, especially as the more contagious Delta variant spreads around the country.”
- New CDC Study: Vaccination Offers Higher Protection than Previous COVID-19 Infection
- Back to School: Vaccinating Kids and Teens
Who should receive a third vaccine dose? #
Currently, the CDC recommends a third dose for moderate to severely immunocompromised persons who have received either the Pfizer or Moderna vaccines. There is not enough data at this time to determine if a second dose of the Johnson and Johnson vaccine would produce an improved antibody response in immunocompromised persons. Someone who qualifies for a third dose should receive the same brand of vaccine as their first two doses. Conditions causing moderate to severe immune compromise include but are not limited to high doses of corticosteroids, recent cancer treatment for tumors or cancers of the blood, organ or stem cell transplant within the last two years or are taking medicine to suppress the immune system, advanced or untreated HIV infection, and moderate or severe primary immunodeficiency. People should consult their healthcare provider to see if they qualify for a third vaccine dose based on their medical condition.
Are there plans to administer booster vaccine doses to the general population? #
On August 18, 2021, the US Department of Health and Human Services released a statement outlining a plan to offer booster doses of the Pfizer and Moderna vaccines to people who received those vaccine brands for their first two doses. After FDA and ACIP approval, this booster vaccine dose would be available to all persons beginning no earlier than September 20, 2021. More data is needed to determine the appropriateness of a booster dose for those who received the Johnson & Johnson vaccine. Distribution and prioritization plans of booster vaccines are still being developed.
Is Hydroxychloroquine an alternative to taking the COVID 19 vaccine? #
The World Health Organization does not recommend hydroxychloroquine to prevent COVID-19. This recommendation is based on six trials with more than 6000 participants who did not have COVID-19 and received hydroxychloroquine. Using hydroxychloroquine for prevention had little or no effect on preventing illness, hospitalization, or death from COVID-19. Taking hydroxychloroquine to prevent COVID-19 may increase the risk of diarrhea, nausea, abdominal pain, drowsiness, and headache. More information can be found here.
However, hydroxychloroquine and chloroquine are safe for use in patients with autoimmune diseases or malaria (not COVID-19).
Can Ivermectin be used for prevention or treatment of COVID-19? #
Ivermectin is an anti-parasitic drug used to treat certain abdominal and topical parasite infestations in humans. It is also approved for the prevention and treatment of heartworm and other parasites in large animals, such as horses. Ivermectin is not FDA-approved for the prevention or treatment of COVID-19 in humans. Initial studies are underway to assess the efficacy of Ivermectin as a treatment for COVID-19. It is important to note that Ivermectin preparations for animals differ than those for humans, and humans should not ingest any medications that are manufactured for animals.
What supplements/vitamins prevent or reduce the risk of contracting COVID-19? #
No supplements/vitamins have been shown to reduce the risk of contracting or treating COVID-19.
At present, there is no known agent that can be administered before exposure to SARS-CoV‑2 (COVID-19) to prevent infection. Clinical trials are investigating supplements such as zinc, vitamin C, and vitamin D.
- Vitamin D
- Debunking COVID-19 (coronavirus) myths (Mayo Clinic, July 29, 2021)
- Coronavirus Resource Center
- Prevention and Prophylaxis of SARS-CoV‑2 Infection
What happens if a health care worker tests positive for COVID-19? #
Specific CDC guidelines are available with nuanced instructions depending on investigations findings/circumstances related to the individual case.
- Clinical Questions about COVID-19: Questions and Answers (Infection Control)
- Healthcare Workers: Information on COVID-19
If someone has been vaccinated, should they still be tested for COVID if they have symptoms? #
Yes. While the COVID vaccine (like other vaccines) does not guarantee 100% immunity, it does significantly decrease the likelihood that a fully vaccinated person will be hospitalized or die from COVID-19. While vaccine breakthrough cases are rare, persons with COVID-like symptoms should be tested and should follow public health guidelines.
What should someone do if they feel they have been injured by a vaccine? #
Injuries from vaccines (including the COVID-19 vaccines) are rare. If individuals feel they have been injured by a COVID-19 vaccine, they should first contact their healthcare provider. Vaccine injuries are reported through the Vaccine Adverse Event Reporting System.
- Vaccine Adverse Event Reporting System (VAERS)
- Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Pfizer-BioNTech COVID-19 Vaccine
- Countermeasures Injury Compensation Program (CICP)
Where can I learn more about the COVID-19 vaccines from the Food and Drug Administration (FDA)? #
The FDA website provides evidence for each COVID-19 vaccine and the reasoning behind the FDA’s emergency use authorizations. Each vaccine has a fact sheet with a list of frequently asked questions.
- Learn More About COVID-19 Vaccines From the FDA (main consumer website)
- Pfizer COVID-19 Vaccine:
Pfizer Fact Sheet
Pfizer Frequently Asked Questions
- Moderna COVID-19 Vaccine:
Moderna Fact Sheet
Moderna Frequently Asked Questions
- Johnson & Johnson COVID-19 Vaccine:
Johnson & Johnson Fact Sheet
Johnson & Johnson Frequently Asked Questions
What other resources are available to nurses to learn more about COVID-19 vaccines? #
The American Nurses Association (ANA) has several resources for nurses regarding COVID-19, vaccines, treatments, and other information. Nurses do not need to be a member of ANA to access these resources.
- COVID-19 Vaccines (42-minute ANA webinar)
- COVID-19 Vaccines (ANA — Find out about the science, principles, and best practices for Covid-19 vaccination. Information you can trust, for the “most trusted profession”)
- COVID-19 Vaccine FAQs (ANA — Answers to the most frequently asked questions on Covid-19 vaccines, from the American Nurses Association and the American Society of Health-System Pharmacists)
- Guiding Principles for Nurses and the COVID-19 Vaccines (ANA)