Are we really going to fire healthcare workers who won’t vaccinate…during a pandemic? Here’s my Alt-Middle take.

Here’s a New York Times article on the subject.
Transcript Below!

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– [Zubin] All right, New York City is about to fire 70,000 frontline healthcare workers because of the mandates. And this is what I think about this. We really need to look at this from an alt-middle perspective, because if we don’t look at all sides of this issue and inhabit them, we’re not gonna be able to come up with something that actually makes sense, that actually saves lives, instead of just throwing stuff at the wall and seeing what sticks, and then having all this unintended harm. So why on earth, if you work in healthcare, especially in a place like New York that’s seen very, very bad COVID disease, you’ve seen all this stuff, you have PTSD from seeing people dying alone on ventilators with stiff, non-compliant, scarred lungs, young people who are otherwise healthy, just unlucky, dying under torture in an ICU of COVID, long COVID, all the other stuff.

Frontline healthcare workers see this. Why wouldn’t they get vaccinated? Right? And this is a common question of people who are really supporting the federal OSHA mandates on hospitals to get all healthcare workers vaccinated. All right, let’s really inhabit this. Okay, imagine you’re a frontline healthcare worker who in the course of your duty, because remember, we didn’t have great PPE, we didn’t have great support. We call them healthcare heroes, send them in the battle with trash bags, remember that? Then Delta surges. A lot of these folks have been infected with coronavirus.

They’ve been through it. They have a positive test. They have positive antibodies. You’re now telling them, okay, on top of that, you gotta get two doses of an mRNA vaccine or one of the J&J in order to keep your job. And during those doses, because they’re gonna act as a booster, you’re gonna have symptoms of fevers, chills, headache, you may be off a couple days. But you gotta do it or lose your job. Well, first of all, that generates mistrust because you’re saying the natural immunity they’ve developed doesn’t count, when there’s a lot of data that says, yeah, it does. Sure, you should probably get one dose of the mRNA vaccines as a booster because natural immunity can be uneven, but still, imagine what that feels like having gone through it, and then having it be completely ignored by the mandates. This is not an immunity mandate. This is a vaccine mandate.

That’s different. So completely ignoring natural immunity, many healthcare workers are like, what? This doesn’t even make scientific sense. And even mentioning natural immunity can get this video tagged as misinformation on TikTok, YouTube, Facebook. Why I mentioned TikTok, they’re a garbage platform, I don’t even know. All right, so that’s one piece of it.

Now the second piece is you gotta remember, many frontline healthcare workers, all right, don’t trust the healthcare system, especially those that are say, not physicians, that are not writing the orders. And the reason is they see very clearly how broken and dysfunctional our system has been. The financial incentives are all backwards. We are paid to do things TO people, not to do things FOR people. You have everything from pharma and insurance companies and everybody pushing to squeeze on the business of medicine, they see this. Then along comes Joe Pfizer who’s like, hey, take my vaccine or else. How are they gonna feel about that? They see the harm caused by those physician orders in the form of side effects, complications, et cetera. Even though it may be medically necessary, they’re seeing the downside at the bedside, right? And so of course, they’re like, .

Already their mistrust is high. They’ve been abused by leadership. They don’t feel valued. They’re burned out from working crazy hours during the pandemic, all of this, stigmatized by society early on because they worked in healthcare. People were afraid they were contagious. And now you’re telling them, take this vaccine. Yeah, it’s FDA approved, but just barely. It’s a new technology, but it’s fine, don’t worry about it. How are they going to feel about that? Now, throw in the third piece. Many, many, many healthcare workers, we assume everyone in healthcare has the same training. They don’t. A housekeeper, someone in health IT, someone working in the back office, a CNA, an MA.

They do not have the same training in looking at primary data sources as a BSN trained nurse, a physician, right? A physician assistant, a nurse practitioner. It’s all a spectrum of hours of training in this stuff. So why are physicians over 90% immunized? Because they’re actually able to look at the data and go, you know what, on balance, I will take the tiny, teeny risk of vaccine over the much bigger risk of COVID any day. Even if I’ve been naturally infected, I’ll at least get a single dose because that’ll be a booster, and the data shows 50% less likely to be reinfected in that setting if I get vaccine on top of natural infection. They’re willing to do it. But would a housekeeper have that capacity? No. So what do they do?

They go online to try to figure out what’s up, and it’s a sea of sense-making disaster. You can’t make sense of any of it. It’s full of misinformation between Robert Malone, Weinstein, the “smart” misinformers, and then everybody else with the crazy conspiracy stuff that’s just off the rails, the “dumb” misinformers. How do you even sort it out? You can’t. And so are you gonna blame them for not having the tools to sort out, just like the general public? It’s very hard to sort out. And now you’re telling them, you must take this, that you’ve read is terrible, and you don’t understand why it might be good, you must take it or be fired.

Okay, emotionally, how’s that gonna sit? Now, here’s another case. Imagine you’re a pregnant nurse, first trimester, first baby. And they’re telling you, you need to get this two doses of this mRNA vaccine that is likely to give you a fever. And by the way, historically, hasn’t fever been associated with bad pregnancy outcomes and so on and so forth? Oh, you want me to do this while I’m pregnant, or I’ll lose my job? By the way, and I need to tell you this, these vaccines, all the data we have says they are safe, effective in pregnancy, they don’t cause miscarriages, they don’t cause fertility problems. All the major medical societies recommend pregnant and breastfeeding mothers take this vaccine, and I am with them on this. But a frontline nurse who’s pregnant herself, whose maternal instincts are kicking in, and is now being forced to do this. That’s a very different feeling than someone who can objectively look at data. It just is.

These are human beings. Take it to the next level. You’ve sacrificed your 20s for healthcare, which is your calling. You’re a nurse or you’re a doctor or whatever it is. You have delayed having kids because you are, you have no choice, you’re dedicated to this profession that is sucking your 20s away. Because it called you. You had no choice. This is who you are, helping other people. So now you’re taking fertility treatments. And after cycle after cycle and thousands of dollars, you finally have conceived. Now they’re telling you, you have to take a vaccine, right now, or lose your job. What does that feel like to the pregnant mother or the spouse of that pregnant mother?

All right, this is who a federal mandate is affecting in healthcare, right? So people who don’t have the training to actually understand the vaccines are safe and effective and a better alternative to COVID. Those who’ve had COVID and have natural immunity and are just like, what? And those who actually have these kind of medical and ethical concerns that aren’t being properly heard. They may not fully be valid based on the data, but they better be heard. Okay, now, what happens when 70,000 healthcare workers in New York get fired? There was a staffing crisis before this pandemic. This will make it an order of magnitude worse. How many people will the mandates actually get to be vaccinated incrementally? According to Vinay Prasad, across the population, it’s probably only 3 to 7% more people will get vaccinated due to mandates. What’s the downside of this healthcare mandate and firing these people?

Now you understaff hospitals, COVID patients don’t get care. Non-COVID patients don’t get care. Elective surgeries don’t happen and then become unelective emergency surgeries. People with appendicitis, people with cancer, a kid with sepsis, those are the people that can suffer when we don’t have enough staff to staff the beds. It’s not that we don’t have the beds. We don’t have the staff for the beds. So what will vaccinating this incremental number of staff actually do? Well, we might, well, we’re gonna talk about the pros in a second, we’ll talk about what it does. This is the side that doesn’t want the vaccine. And I want you to inhabit what that side feels like, how they see the world, why they might see the world that way. Because right now, the pro side of this is like, you’re just a dumbass if you don’t get vaccinated and you work in healthcare. You are killing our patients if you do this, right? That’s how they see it.

That’s not a productive way to talk to people that have these concerns and that are inhabiting this space. The way they feel is, hey, we were wearing all this PPE, and apparently that was enough to keep everybody safe before, why isn’t it now? That’s how they see it, right? So you better sit compassionately and understand this. So what’s the pro side of this? The pro side of this, right, is hey, we’ve had mandates for a lot of things, seatbelts, childhood vaccines, PPD for healthcare workers, MMR for healthcare workers, hepatitis shots for healthcare workers. These things have been part and parcel of this space for years. This is nothing new. These things are probably not illegal to mandate. It’s very reasonable to do that. Now, the con side would say, but these are new vaccines. But the pro side would say Pfizer vaccine is now FDA approved, they’ve looked at all the data. Okay, so mandates aren’t new.

Now, you could argue, well, but those mandates worked over years. We’re trying to make this work over a short period of time. It may not have the same effect. And will the mandate cause more harm than good? Okay, that’s a reasonable counter-complaint. Now, on the pro side also is, hey, these vaccines reduce the risk of infection by fivefold, risk of death and disability and being hospitalized by tenfold in the worst situations like Delta. So if you’re in healthcare, you need to get this vaccine, because first of all, you’re at higher risk just being in the hospital. Second of all, we’re trying to model behavior for our patients. If we have CNAs running around telling patients they’re not getting vaccinated because this thing is experimental, that is very damaging to people who are quite vulnerable. And yes, you can transmit to a patient if you’re unvaccinated and you get even an asymptomatic infection and you slip your mask off for a second, and you transmit to them. So yes, you can hurt patients. So there’s a real care versus harm here thing, right? On the other side, it’s this liberty versus oppression. It’s my bodily autonomy. Here it’s like, well, your bodily autonomy ends when you put others at risk. So we have mandates in hospitals. It’s not unreasonable to ask you to keep patients safe. Now, you can see why there’s nuance here. This is a pandemic, these are new vaccines, and all the reasons I talked about. But inhabit the pro space for a second.

You just have trouble understanding why somebody in healthcare especially would not get vaccinated, especially when there’s a gradient, this is part of the problem, there’s the Dunning-Kruger effect, right? But it’s a continuum. So on the low end, when you don’t have enough training, you overestimate what you know. “Oh, these vaccines are gonna cause spike protein toxicity and ovarian failure.” Okay, wrong. But as you learn more, as you get more training, there’s another cognitive distortion, which is overestimating what other people know. “Oh, well I know these, I’ve looked at the data. Why doesn’t everyone just get the vaccine?” Because they don’t, they can’t, they don’t even have the training to be able to process it the way that you did. So, yeah, 90-plus percent of doctors are vaccinated, and less of nurses, but the higher-educated nurses are more vaccinated, and so on and so on and so on.

So we need education. Right? So on the pro side, we need to understand where are our bias is and how do we overcome them, right? And we also have to understand that there’s nuance. Vaccines are safe, but not perfect. We do have to talk about myocarditis. We do have to continue surveillance for side effects. But you can understand, so now, the question is, what do we do? How do we solve this from an alt-middle perspective? Alt-middle says every perspective is true, but partial. Find the truth, recognize the shadow of that, and integrate it to come up with solutions that are much more holistic and much more encompassing and much more true, but still always partial, ’cause we’re always searching for truth. All right, this is what I think we should do. For people who have natural immunity, we better fricking respect that. Instead of saying this is a vaccine mandate, say this is an immunity requirement.

If you’ve been naturally infected and you can show it by a COVID test or an antibody test, past positive test or an antibody test, then we should respect that, all right? We should still encourage people to get at least a single dose, if not the full series of vaccine, because they will be much more immune by doing that, and it will have some incremental benefit. But if they don’t wanna do that, we should respect natural immunity, because otherwise we’re generating mistrust and we’re not being scientifically valid, right? Even though there’s patchiness in natural immunity because of asymptomatic infections versus severe infections. All right, fine.

The second thing is we still need to mask in the hospital with our patients across the board, because even vaccinated people can technically transmit if they get a case and they’re symptomatic, all right? So everybody should mask. We shouldn’t be punishing unvaccinated people by forcing them to mask in a different way. Everybody should still be masking. Now, in the break rooms and stuff, that’s a different subject, but that’s the subject of a different show. All right, the third thing is in healthcare, we really oughta be just modeling, modeling the correct way to talk about this compassionately, patiently, still encouraging vaccination, but understanding people’s concerns. Now, what if you don’t have natural immunity and you have these concerns that I talked about? Either you don’t understand, you’re poisoned by the misinformation, or you have medical issues that really have got you concerned. At that point, what we need to do is say, hey, before we fire you, here’s an hour, two-hour class that you can take with someone who’s really good at listening, as well as teaching about vaccines. It oughta be a specialty in itself, alt-middle teacher of vaccines.

And that person can then go through the fears, understand the misinformation, listen to the case at hand, and say, you know what, all right, here’s what we can do, here’s what we can learn, here’s what I would advocate. And if that person then elects to get vaccinated, wonderful. If they don’t, then there can be more conversations, and at that point, if there’s a federal mandate, you have no choice, but you tried. You tried compassionately and holistically to kind of look at this person as a person. And that goes a long way to diffusing this liberty vs autonomy moral palate that we have, right? It’s really important to be done with love, respect, and patience, and it’s hard.

But you know what’s harder? Staffing a position that’s now empty. Right? Restoring the harm to a profession where there’s a great deal of resignations now because we’re tired of it, we’re tired of being used as pawns, we’re tired of the moral injury, we’re tired of working in a for-profit system. Even the not-for-profits are for-profit that values dollars over people, and doing stuff to people instead of doing stuff for people. Okay, that would go a long way to changing the dynamic in hospitals. And that’s why I think these one-size-fits-all mandates are a mistake. It’s much more nuanced, like everything. And we can get through it with love. With love, understanding, and compassion. All right. So do me a favor. Share this video. Please don’t take a crap on your colleagues if they’re not vaccinated in healthcare. Talk to them compassionately. I know it’s hard.

And if you haven’t been vaccinated and you’re in healthcare and you haven’t been naturally infected, please consider getting the vaccine. That’s really the… I’ll take everything I’ve learned over this year and a half of pandemic and just say this, I really think you should get vaccinated. I really do. Talk to your doctor, talk to your pediatrician. Whoever you need to talk to. Get vaccinated. All right, guys, I love you so much. And we are out.

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