The Volokh Conspiracy
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Health Care Worker Vaccine Mandate Reaches the Supreme Court
The Biden Administration is seeking to stay lower court injunctions against the mandate.
As predicted, the vaccine mandate for health care workers is the first of the Biden Administration's vaccine mandates to reach the Supreme Court. Today the Department of Justice asked the Supreme Court to stay the lower court injunctions against the mandate, citing (among other things) a circuit split on the question.
In November, at the White House's direction, the Center for Medicare and Medicaid Services (CMS) promulgated an interim final rule mandating that Medicare and Medicaid service providers require their workers to obtain COVID-19 vaccines. Several states filed suits against the rule, and sought preliminary injunctions against its enforcement pending rulings on the merits.
The two circuit courts of appeals to consider injunctions against the CMS mandate reached opposite conclusions. As I noted here, the U.S. Court of Appeals for the Eleventh Circuit refused to enjoin the rule, concluding that the challenge was unlikely to succeed on the merits. This week, the U.S. Court of Appeals for the Fifth Circuit reached the opposite conclusion, while also refusing to uphold a nationwide injunction against the rule. This division in authority, and the existence of injunctions against the rule covering multiple states, make a Supreme Court response reasonably likely.
It is interesting that the CMS mandate is reaching the Court prior to the higher-profile OSHA Emergency Temporary Standard, currently under consideration in the U.S. Court of Appeals for the Sixth Circuit. It also presents slightly different issues. The policy arguments in support of mandating vaccination of health care workers is greater than that for employees at larger firms, but the CMS rule is also significantly more stringent than the OSHA rule, as it does not allow a testing alternative. The CMS rule is also being imposed as a condition on the receipt of federal spending (through participation in Medicare or Medicaid), rather than as direct federal regulation. That said, in both cases the challengers stress the unprecedented nature of the vaccine requirement and question whether Congress clearly authorized the imposition of such a requirement.
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A friend of mine recently changed jobs. She used to be the administrator of a nursing some and had simply had enough. She can’t believe that there are health care workers who refuse to get vaccinated. Unfortunately due to the internet and right-wing media, a large percentage of Americans are living in a fever swamp of misinformation and conspiracy theories. This did not used to happen, folks. In the old days we had cranks complaining about fluoridation, etc. but they were on the fringe.
Obligatory fluoridation video: https://www.youtube.com/watch?v=Qr2bSL5VQgM
Might as well include one of the most iconic film scenes in the history of film: https://www.youtube.com/watch?v=Sfpe28mv9n0
There is at least a grain (alcohol) of truth there, in that Russians do drink a lot of vodka. There is not as much truth in the objections to vaccination.
These health care workers are the same ones who make sure the seniors in their care take a number of medications and precautions that, had they first been recommended now, they would be objecting to also.
there are two bucket of objections to the vaccines
The first bucket consists of the religious objection and it will change the DNA, its untested, emeregency use approval, etc. Of those, the religious exemption is only valid for a small segment of the population,
The second bucket consists of those who the risk of adverse result from catching covid is low and those who recognize that naturally aquired immunity is much stronger and longer lasting than the immunity acquired from the vaccine. Those individuals typically have made a rational assessment of the risks.
A good example irrational overassessment of the risk is the demand to vaccinate children. Other than those with other significant health issues, there is little rational basis to get children vaccinated since their risk of adverse consequences is extremely low and naturally acquired immunity is so much stronger and longer lasting.
"Those individuals typically have made a rational assessment of the risks."
Yeah, sure...they got all the data, read official medical peer reviews, and consulted with medical officials - and then made their "rational" assessment.
Or cock-sucked Facebook crap.
apedad
December.17.2021 at 8:25 am
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"Those individuals typically have made a rational assessment of the risks."
Yeah, sure...they got all the data, read official medical peer reviews, and consulted with medical officials - and then made their "rational" assessment."
As of early November, 2021 Its well established in the studies that natural immunity is much stronger and longer lasting than immunity from vaccines. That is no longer subject to debate by an informed person. As far individual risk assessment, the data for who is at risk , hositalization and death data by age and other subgroups, by underlyng conditions, etc is widely available. So yes, data is available to make a rational assessment of the risks.
No longer a reason to base the assessment on someone else's assessment of their risk.
But with a virus, the assessment isn't someone's individual risk. America treats it like that, but that is factually not what the risk is.
Not quite right S_0.
There are two risks to consider. The individual's risk may be significant. That is one of the things that the ADA is about.
Once the vaccine became widely available, the proper assessment is someone's individual* risk. If you are vaccinated, then your risk from my decisions is negligible. And if you still haven't gotten vaccinated, by now it's your own damn fault.
* Yes, there are a tiny minority of people with compromised systems who want to get vaccinated but cannot. My vaccination choices do affect that minority. However, we have had that minority for every disease in history. That minority's problems, while tragic, are not justification for abrogating the rights of others.
The other exception being the vaccinated person you have a breaththrough infection to, because of a choice not to vaccinate, brought it home and spread it to someone who couldn't get vaccinated.
Your perspective seems to be "If I spread a deadly disease to someone because I don't give a fuck, that's on them, not me."
Do I detect a bit of homophobia there?
No, unless you want to.
Any sex and/or gender can be a cock sucker.
" Or cock-sucked Facebook crap. "
For a moment there, I feared you had used the term c_p succ_r and would be censored by this blog (even if the censorship in your case might be imposed solely for consistency).
(If this blog would like me to stop referring to this blog's repeated, partisan, viewpoint-driven censorship, a good start would be to rescind the ban on "sl_ck-j_wed," rescind the ban on "c_p succ_r," and acknowledge that the partisan censorship was series of a mistakes.)
(Can anyone identify the reason that song was chosen?)
The first bucket is complete nonsense, mostly though not entirely falsifiable.
The second combines separate categories: 1) risk-adversity and medical contraindications and 2) covid-recovered with immunity not recognized in the US.
Don - I agree that the first bucket is nonsense (other than the religious exemption which I disagree, but do understand the reason - at least for those who have a valid religious belief)
I also agree with your comment on the second bucket (other than your spelling of contrarians.)
Covid recovered immunity is shorter lived than vaccines and its strength varies depending on the strength of the original infection. So people with mild cases don't really get much protection at all. The data on re-infection versus vaccine breakthrough cases illustrates this pretty cleanly.
Repeating this based on one un-peer-reviewed study you almost certainly haven't even read does not make it true.
Don - I keep repeating it because there are numerous studies, not just one that the rebuttals keep claiming.
Posting links here dont work -
go to healthy skeptic with kevin roche,
he links to several studies , 10-15 at this point - look at his daily summaries.
Capt,
You would be honest if you would acknowledge that there is a not insignificant number of people taking essential medications and treatments for who most if not all of the vaccines are strongly contraindicated.
Yes but that is not the argument being made.
These folks are not making an individualized showing. In such a case accommodations can always be made.
Worse than that we still haven't gotten to the bottom of the Rainbow Sprinkler Conspiracy: https://www.youtube.com/watch?v=_c6HsiixFS8
https://www.politico.com/news/2020/09/05/kamala-harris-trump-coronavirus-vaccine-409320
Your friend sounds stupid. My primary care physician apparently isn't a big fan of vaccines generally and specifically not the COVID vaccine. It's not an unreasonable position by any means.
Your doctor is incompetent and unqualified.
Please tell me:
1. the reasons he doesn't like the Covid vaccine
2. the reasons he opposes vaccines generally
Are you also opposed to the polio vaccine? Are you old enough to remember when seeing people walk around in braces was a common occurrence? Do you have children? Did you refuse to have them take the measles vaccine? Diphtheria? Tetanus?
There is a huge difference in the effectiveness of those vaccines. Polio, measles have near lifetime immunity, tetanus - nearly full ten years - though kinda rare that someone gets booster shots for tetanus.
Covid vaccine - barely meets the definition of a vaccine. generally less than 50% effective after 6 months, likely much less after 9-10 months. Currently requiring boosters after 6 months to have any effectiveness over 80%.
Its well established that Natural immunity has much longer and stronger immunity .
While somewhat disputable, there is a rational basis to forgo the vaccine, at least for healthy individuals. You are basing your demand for others to get vaxed based on your fears instead of a rational assessment of the risks for that individual
Booster shots for tetanus are recommended. I have observed that doctors don't push them as much as they push flu shots. I asked because I get my legs scratched by brambles or my fingers bitten by squirrels more than most people. (Ask your doctor if W53.21XA is right for you.)
The official CDC recommendation is tetanus booster (1) every 10 years, (2) each pregnancy, (3) for "wound management".
I concur that some doctors push tetanus boosters and its not on the radar for docs - last time a doc pushed tetanus booster for me was the 1980's.
The point being is that there is a huge difference in a vaccine that works for 10 years or one that works for nearly a lifetime vs one that only works for 6 months. Natural immunity for covid is so much stronger than the vaccines (at least the current vaccines) and if your are not in the at risk groups, it is an entirely rational decision to assume the risk.
"Natural immunity for covid is so much stronger"
A wee bit of exaggeration Tom.
Currently reinfections are running about 1% of cases vs 40%_ 45% of cases for breakthroughs
50m cases / 330m population x 1% = .066 vs 70% of population vexed / 40%= .57
That’s about 8x greater infection risk with vaccine vs prior infection
I also posted 4 other studies that are in moderation
Tom, are you insisting that vaccine immunity confers no benefit against contagion? Take the vaccine and you remain just as likely to become infected with Covid, and pass it on, as if you had not taken the vaccine?
Stephen Lathrop
December.17.2021 at 4:00 pm
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Tom, are you insisting that vaccine immunity confers no benefit against contagion? Take the vaccine and you remain just as likely to become infected with Covid, and pass it on, as if you had not taken the vaccine?
No that is not what I am stating
The vaccines provide a meaningful reduction in severity of disease , viral loads, risks of transmission to others and severity of illness for the first 6 or so months . After 6 months, the effectiveness of the vaccines drop off , precipitiously in some cases. In other words, for the first six months, vaccines are great, after 6 months - meh.
For those at risk, vaccines and repetitive boosters are a good idea. For those not at risk, especially children, vaccines become a very ineffective long term solution.
Anybody got the shingles vax?
My next door neighbor got shingles and .... ouch.
I'm at "that age" so have been wondering if I should get it.
A coworker got the shot and she said she was knocked out (headache, nausea, etc.) for a weekend.
Get it.
I recently had a mild case of shingles. I wouldn't wish that on anyone.
I got it the day after I was eligible. My dad got shingles, and it was a horrible, miserable, awful experience. I pushed the shingles vaccine to my friends harder than for anything else medicine related. Please do get it.
If by "well established" you mean that you saw a TikTok video asserting that.
David Nieporent
December.17.2021 at 12:47 pm
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Its well established that Natural immunity has much longer and stronger immunity .
If by "well established" you mean that you saw a TikTok video asserting that."
David - Two things are wells established
1) that natural immunity is much stronger than vaxed immunity, and
2) you have made an intentional effort to be uninformed on the subject. _ at this point in time there is no debate - except by those who have actively chosen to remain uninformed. See titles to studies below.
Why mute Nieporent? He wasn't being abusive or obscene. He was only disagreeing with you. You just can't deal with that. Back to your echo chamber.
captcrisis
December.17.2021 at 5:51 pm
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Why mute Nieporent? He wasn't being abusive or obscene. He was only disagreeing with you. You just can't deal with that. Back to your echo chamber."
Neibort is not agreeing with me only because he refuses to stay current on the data.
It's not "well established." The science is still mid-stream. The most recent study from Israel, which is not peer reviewed yet, only covers 90 days. Other studies, similarly fresh and untested, are saying the strength of the initial infection is important regarding strength of acquired immunity.
More interestingly, another recent study suggests that a single dose of vaccine *after* acquired immunity is more effective.
Again, would be more honest and not so arrogant if you acknowledged that there is a not insignificant number of people taking essential medications and treatments for who most if not all of the vaccines are strongly contraindicated.
I'm not sure why you keep bringing up this irrelevancy. In a country of 330 million people, even a tiny percentage will amount to a "not insignificant number of people," but they are in fact a tiny percentage, and not who anyone in the debate is talking about. 100% of people on both sides agree that there are some people for whom the vaccines are truthfully¹ medically contraindicated, and that those people ought to be (and are) exempt from mandates, and that those people are not stupid for not being vaccinated. But they make up a tiny fraction of the non-vaccinated.
¹I'm quite sure that a large number of people claiming this are making it up, though.
I'm not opposed to vaccines generally. But vaccine safety and testing is important. Did you know that the first polio vaccine paralyzed and killed a bunch of kids and had to be stopped?
As far as polio, modern sanitation technology and practices did more to stop polio than any vaccine.
Some say polio wasn't eradicated either, but was renamed with names such as Guillain Barre, transverse myelitis, coxsackie, MS, and cerebral palsy.
I don't know the answer to your questions as I haven't seen the doc myself, but I intend to ask. But I didn't say he opposes vaccines generally, I said he's not the biggest fan, it sounds like he has a more nuanced view.
But your friend used to be a "nursing home administrator" and can't believe that anyone in healthcare wouldn't want to get a brand new COVID vaccine, when many thousands of doctors feel that way not to mention other healthcare workers who know more than she does. That's why she sounds stupid.
"many thousands of doctors feel that way not to mention other healthcare workers who know more than she does."
Not true, and not true.
You, sir, are a menace to public health. I hope you don't venture outside.
"health care workers... right-wing media"
You realize that many health care workers are black and vote for liberal democrats. Its not "right-wing media" that influences the heads of major urban hospitals like the Cleveland Clinic to rescind their mandates.
I live in a mostly black area (obviously you don't) and everyone is masked and has no hesitation showing proof of vaccination.
But, according to Democrats, those same folks are incapable of getting photo ID and, thus, photo ID for voting is racist.
Weird.
It should also be noted that all the made up "there are lots of studies, but I can only keep citing the same one over and over again" claims are a red herring anyway.
Whether, after the fact, natural immunity is more robust than vaccine acquired immunity does not change the fact that vaccination is a good thing. Because while having acquired natural immunity is good, the process of acquiring it is not. No intelligent person says, "I want to get sick because if I recover I'll have more immunity."
Moreover, vaccination does seem to provide a boost of immunity even if one has already recovered.
David Nieporent
December.17.2021 at 1:10 pm
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It should also be noted that all the made up "there are lots of studies, but I can only keep citing the same one over and over again" claims are a red herring anyway.
David quit denying the numerous studies
As I have said, Volokh puts my links into moderation
go to healthy skeptic dot com - kevin Roche
Real-life protection provided by vaccination, booster doses and previous infection against covid-19 infection, hospitalisation or death over time in the Czech Republic: a whole country retrospective view
Incidence of COVID-19 reinfection: an analysis of outpatient-based data in the United States of America
Viral Dynamics of SARS-CoV-2 Variants in Vaccinated and Unvaccinated Persons
Increased risk of infection with SARS-CoV-2 Beta, Gamma, and Delta variant compared to Alpha variant in vaccinated individuals
"No intelligent person says, "I want to get sick because if I recover I'll have more immunity.""
Setting COVID aside, were all of the people doing measles parties in the 60s and chicken pox parties in the 90s unintelligent? Genuine question.
Chicken pox deaths per year prior to the vaccine in the US were about 100 per year. COVID is currently killing over 1100 per day.
And Chicken Pox parties, as someone who was forced to attend one as a child, weren't about acquiring immunity. They were about having all the children in a household get the disease at the same time so the parents didn't have to go through the effort repeatedly. My mother would have gotten me the vaccine had it existed then.
Measles parties? That was a thing? You would have been pretty badly informed to get measles on purpose if you could otherwise take a vaccine.
I had a pretty good case of measles in the early 60s. Dentists today can look in my mouth and tell me about it. Ophthalmologists can do the same for my eyes.
"No intelligent person says, "I want to get sick because if I recover I'll have more immunity.""
Does this also apply to countless people right now who say that they are OK with having a few days of sick/downtime from mild vaccine side effects because they'll have more immunity after?
I think it's because "I'm less likely to die or worse, go bankrupt due to the US's sub-standard medical system."