Should Vaccinated Health Care Workers Reinfected with COVID-19 be Quarantined?

Vaccines work. They ward off severe illness and death. But they do not make health care workers invulnerable to breakthrough infections, according to a research letter in JAMA Open Network.

Articles about COVID-19 vaccines these days could all begin the same way: Vaccines work. That could be the lead of an article about a research letter in JAMA Open Network that looks at breakthrough infections among health care workers. However, while vaccines do work, they do not make the vaccinated invulnerable to SARS-CoV-2. That last part might be a sticking point to the vaccine hesitant, including vaccine hesitant health care workers.

Only about 54% of Americans eligible to get vaccinated have gotten both doses of the vaccines, according to the Centers for Disease Control and Prevention (CDC). It’s possible that individuals tend to take from news about the vaccines information that bolsters their preconceived notions. For instance, reports of the waning of vaccine effectiveness, the need for booster shots, other COVID-19 variants waiting in the wings such as lambda and mu that initial un-peer-reviewed research indicates might be able to elude vaccines, and the CDC study released last week showing that the Moderna vaccine is more effective than the other vaccines on the market could make the vaccine hesitant shrug and ask: “What’s the use?”

Never mind that the CDC also released a study last week that says that the unvaccinated are 11 times more likely to die from COVID-19 than the vaccinated, and that collectively, the 3 vaccines are 86.8% effective in preventing hospitalizations.

The vaccine hesitancy found among the public can also be seen in health care professionals, as experts have been telling Infection Control Today® (ICT®) for months.

Rebecca Leach, RN, BSN, MPH, CIC, a member of ICT®’s Editorial Advisory Board, (EAB) said in the Q&A in February, that “there’s a large number of people in the general community who are wary of vaccines. And so why would there be any difference with health care workers? Some of the reasons that they are concerned about it are the same reasons that other people are too, including concerns about safety or side effects and other things.”

Another ICT® EAB member, Kevin Kavanagh, MD, minced no words in discussing vaccine hesitancy among health care workers in an article in April. “If you work in a health care facility, you need to be vaccinated against SARS-CoV-2. If you choose not to become vaccinated, then you should choose not to be working in a health care setting.” The headline: “Viewpoint: Health Care Professionals—Get Vaccinated or Get Out.”

Unfortunately, many health care professionals choose the latter, and that could cause a critical shortage in the health care workforce at time when the delta variant surges and every available body is needed. Lewis County General Hospital in Lowville, N.Y, has had to halt delivering babies because of the exodus, as NPR reports. And this reaction isn’t limited to the United States. Reuters reports on a nursing home in France that struggles to continue operating because many staff have quit over the vaccine mandate.

Does vaccine hesitancy among health care professionals feed into vaccine hesitancy among the public? The most trusted sources of information about COVID-19 vaccines among the public are pediatricians and an individual’s doctor, according to the Kaiser Family Foundation’s COVID-19 Vaccine Monitor.

Health care providers can also be a bulwark against inaccurate information, such as pushing ivermectin as a plausible treatment for COVID-19. Prescriptions for ivermectin have risen dramatically in recent months, forcing the CDC to issue a health advisory about the problem on August 26.

What will be the reaction of vaccinated health care workers who are told that because of a breakthrough infection they must be quarantined?

In the JAMA Open Network research letter, Investigators looked at data from 5312 fully vaccinated and 690 unvaccinated health care workers at the Hadassah-Hebrew University Medical Center in Jerusalem. The vaccinated workers received 2 doses of the Pfizer/BioNTech vaccine. The results reinforce the main message health care officials want the public to hear: Vaccines work. Investigators found that 27 of the fully vaccinated staff became reinfected with COVID-19 (0.5%), while 69 of the unvaccinated staff did (10%). Contact tracing for the breakthrough infections found that 15 of the 27 vaccinated staff who experienced breakthrough infections became infected by a member of their households.

“This case-control study found that exposure to SARS-CoV-2–positive household members was a risk factor associated with infection among vaccinated HCWs,” the research letter states. “Household exposure is usually longer and closer than casual exposure or exposure at work and does not include masking or distancing, thus exposing one to a higher infectious dose and being more contagious.”

Investigators argue that their findings suggest that people exposed to someone in their household who’s tested positive for COVID-19 be quarantined.

“The findings of this case-control study suggest reconsideration of quarantining vaccinated people who have had significant exposure to household members who are positive for SARS-CoV-2 infection,” the research letter states. “This policy has already been implemented successfully in our hospital. Coupled with the current emergence of the SARS-CoV-2 delta variant in Israel and worldwide, our proposal should apply not only to HCWs but to the general population.”

Yonatan Oster, MD, a researcher in the department of clinical microbiology and infectious diseases at Hadassah-Hebrew University Medical Center, tells ICT®’s sister publication Contagion® that “the findings of this case-control study suggest reconsideration of quarantining vaccinated people who have had significant exposure to household members who are positive for SARS-CoV-2 infection. This policy has already been implemented successfully in our hospital. Coupled with the current emergence of the SARS-CoV-2 delta variant in Israel and worldwide, our proposal should apply not only to HCWs but to the general population.”