Like Smoking In Public

But the unvaccinated may be breathing out Covid-19, not secondhand smoke.

In They Don’t Want the Shot. They Don’t Want Colleagues to Know., Sydney Ember and Coral Murphy Marcos talked with a variety of unvaccinated people about walking the line around vaccination at work:

A growing number of companies are mandating vaccines as a condition of employment, leaving unvaccinated workers at risk of being fired. CNN, which has required full vaccinations for all employees working in its offices and in the field, said on Thursday that it had fired three people who went into the office unvaccinated. Many others are adopting less sweeping — but perhaps more conspicuous — approaches, including mask mandates for unvaccinated workers or the requirement that they work remotely.

For employers, keeping workers safe while being equitable is one of the thorniest workplace challenges of the pandemic to date. In addition to potential legal ramifications if any of their policies are viewed as discriminatory, many companies are concerned that implementing separate protocols for unvaccinated workers could lead some of them to quit amid an already tight labor market. As of Aug. 5, roughly 39 percent of Americans ages 18 and over were not fully vaccinated, representing a large pool of people who could be in close contact with others at their jobs.

However, there is the question of liability: if contact tracing suggests a deceased worker got Covid-19 at work, and the business does not require vaccination to enter the building, is the business at fault?

Meanwhile, some of the unvaccinated believe others should not ask their vaccination status:

Though her employer did not require her to be vaccinated, Ashley Williams, 25, said she felt her colleagues were crossing boundaries when they asked her if she was.

A licensed practical nurse in Bridgeport, Conn., Ms. Williams said she was constantly reading about vaccine development, but wasn’t confident enough in the information she gathered to get the shot. She said she believed that she would avoid getting infected by using personal protective equipment and hand sanitizer.

“Every time you tell someone you’re not vaccinated, people assume you’re a conspiracy theorist or you think the government is trying to poison you,” said Ms. Williams, who left her job at a mental health residential facility last month. “Now it’s a normal thing to go up to someone and ask if you’re vaccinated. This is personal information. Then there’s the judgment behind it.”

Yes, I admit that I am judgmental about her belief that hand sanitizer and PPE would stop her from a/ getting Covid-19, and b/ (more importantly) spreading Covid-19. While those precautions certainly help, in the age of Delta (which is 50% more contagious than the Alpha strain, and as contagious as chicken pox) masks and sanitizer may be ineffective.

Yale Medicine reports on Delta:

The CDC has labeled Delta “a variant of concern,” using a designation also given to the Alpha strain that first appeared in Great Britain, the Beta strain that first surfaced in South Africa, and the Gamma strain identified in Brazil. (The new naming conventions for the variants were established by the WHO as an alternative to numerical names.)

“It’s actually quite dramatic how the growth rate will change,” says Dr. Wilson, commenting on Delta's spread in the U.S. in June. Delta was spreading 50% faster than Alpha, which was 50% more contagious than the original strain of SARS-CoV-2, he says. “In a completely unmitigated environment—where no one is vaccinated or wearing masks—it’s estimated that the average person infected with the original coronavirus strain will infect 2.5 other people,” Dr. Wilson says. “In the same environment, Delta would spread from one person to maybe 3.5 or 4 other people.”

“Because of the math, it grows exponentially and more quickly,” he says. “So, what seems like a fairly modest rate of infectivity can cause a virus to dominate very quickly.”

And it seems that while masks will work to slow the spread of the Delta variant, a better class of masks is essential, as discussed in this NPR interview by Rob Stein with Linsey Marr of Virginia Tech University, who studies virus transmission:

LINSEY MARR: Delta transmits in the same way as the other variants that we've seen so far. It's just that people who are infected seem to release a lot more virus into the air. So masks still work, but with delta, we need better-performing masks.

STEIN: So Marr says everyone should take a good look at their mask to make sure it's good enough. A mask that filters out, say, 75% of viral particles might've been good enough before delta, but with delta, you really need a mask that's going to filter out something more like 90%.

SIMON: So what kind of mask would that be? Because a lot of people have gotten very used to using cloth masks or maybe surgical masks. Do they need to switch to something more like the N95?

STEIN: Well, those are the gold standard, and so are similar masks, like those KN95s. But Marr says cloth masks can still do the trick as long as they fit really well and they're made out of the right stuff.

MARR: Which means something that has a dedicated filter layer and that fits really well with no leaks.

STEIN: So it can't fit loosely, you know, leaving gaps on your cheeks or under your chin where the virus could sneak in, and it should pinch tight over your nose. And if you're wearing a cloth mask, it should have a layer made out of special filter material, not just regular cloth. If you're not sure, you can hold your mask up to the light to see if you can see pinpricks of light through it. If you can, then it's probably not good enough. Or, you know, another thing you can do is spray water through it in front of a mirror. If water gets through to the mirror, not good enough. Buy a better mask or buy filters to insert between the cloth layers. And if you really want to protect yourself, you could consider double masking.



So, it is not enough for businesses to require 'masks'. They should require -- or provide -- masks with the characteristics that virologists say will work to counter transmission of Delta. This would require really knowledgeable people checking masks at the entrance to a company's office. Not just a simple observation of a mask, but a real inspection. Or, as I said, providing approved masks to those entering. Otherwise, going to work could just become a superspreader event. And those masks have to be used correctly, not just as a vaccine theater prop.


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Note in the image above, the guy checking IDs is wearing a surgical mask, which won’t do the job against Delta. And the woman who is entering has a mask that doesn’t fit well and may also be one of the wrong kind. As I said, it’s going to be hard to tell.

As many companies are acknowledging, requiring vaccinations plus effective masking is really the only way to make sure people are safe. Or at least as safe as we can make going to the workplace ‘safe’ during a pandemic. The ‘weekly testing’ half measure is bad science because an unvaccinated person with an ill-fitting mask could be spewing the virus for a week before testing positive.

The economist Richard Thaler believes we have gone past the point where 'nudges' are sufficient to coax people to get vaccinated. He rules out a government mandate, which we are told by constitutional law experts would lead to a Supreme Court challenge, at the very least. It is clear that U.S. states have the right to mandate vaccinations for school children (and therefore maybe for everybody), and many countries require travelers to prove they've been vaccinated against various diseases before entry. But leave that constitutional question to the side, like the Biden administration is doing.

Thaler thinks we've moved into 'pushing and shoving' territory:

Although vaccines are readily available and free for everyone over age 12 in the United States, there are many holdouts. About 40 percent of the adult population has not been fully vaccinated, and about a third has not yet gotten even one dose. It is time to get serious.

Of course, information campaigns must continue to stress the safety and efficacy of the vaccines, but it is important to target the messages at the most hesitant groups. It would help if the F.D.A. gave the vaccines its full approval rather than the current emergency use designation. Full approval for the Pfizer drug may come as soon as Labor Day, but the process for the other vaccines is much further behind.

[...]

Many universities and businesses like Walmart, Disney, Google and Uber are requiring employees to be vaccinated before returning to campus or the office. New York City will require vaccinations for indoor restaurants, gyms and other activities. But carrying out such policies is unnecessarily difficult because of the archaic state of vaccination records.

As anyone who has been vaccinated knows, the card you receive to document your shots looks like a handwritten 1950s library card, and is too big to fit in a wallet. It is jarring to use that piece of paper as documentation for vaccines created with 21st-century science.

California and New York State (and many countries) have shown that there is a better way. The basic idea is to turn the information on that card into a digital Covid vaccine record. Specifically, the record contains your name, birth date and vaccination history. That information is captured in a QR code that can be scanned easily. The QR code can be stored on a smartphone or printed.

It is important to stress that New York State and California have made this digital record an option for their residents — they did not require that anyone get it. Furthermore, the information captured by the QR code is merely what is already on that card. No one’s rights or privacy is at stake.

There have been inevitable start-up glitches, but these states have been leading the way. Nevertheless, it’s reasonable to expect the federal government to play at least a facilitating role in making this happen. Many people have gotten shots in two states or in one other than the state in which they live. Without federal coordination, creating reliable electronic documentation across jurisdictions will be a major database management problem.

We should expect the Biden administration to at least create a national vaccine 'passport' of the sort Thaler describes so that their hand-off policy -- leaving it to businesses and municipalities to decide what vaccination requirements to mandate -- could at least be possible.

Thaler closes with this:

Being unvaccinated in 2021 is similar to smoking in public, though it is more immediately hazardous. The unvaccinated are endangering themselves and those with whom they come into contact. It would be good public policy if those who refuse to be vaccinated are compelled to spend more time alone.

Am I reading too much into that evocative 'time alone'? Is he hinting at quarantining the unvaccinated? Make those that don't want to be vaccinated stay home? That would be quite a shove.