Should I still insist that clients be vaccinated?
October 13, 2022 9:39 PM Subscribe
In the early days of the COVID vaccine, people who were vaccinated were much less likely to get COVID and less likely to pass it along. So I only saw ciients in-person if they were vaccinated, otherwise we worked via video. I am now on-boarding new clients for the first time in many months. How much of a difference does it makes to my COVID risk if I allow unvaccinated clients? (Assume we are wearing masks and there is a HEPA filter in the room.)
In my circle, almost everyone is vaccinated and has gotten a varying number of boosters. I recently reopened to new clients for the first time in many months and I will seeing some new clients in person starting next week. At the time, I made the appointments it didn't occur to me to ask if they were vaccinated. I'm trying to figure out if I should go back and ask. If they say no, I will tell them that we will need to switch to video only. (These are recurring clients that I see for maybe an hour per week for a number weeks so repeated exposures.)
Given that omicron is so contagious, even if vaccinated and that I assume most unvaccinated people have had COVID at least once, I'm wondering if there is still much of a difference between the risk of getting covid from person who is vaccinated (at least with the original two shots) and someone who is unvaccinated. I would appreciate pointers to any data that would help me estimate how much additional risk I would taking on for myself if I allowed us to meet in person.
In my circle, almost everyone is vaccinated and has gotten a varying number of boosters. I recently reopened to new clients for the first time in many months and I will seeing some new clients in person starting next week. At the time, I made the appointments it didn't occur to me to ask if they were vaccinated. I'm trying to figure out if I should go back and ask. If they say no, I will tell them that we will need to switch to video only. (These are recurring clients that I see for maybe an hour per week for a number weeks so repeated exposures.)
Given that omicron is so contagious, even if vaccinated and that I assume most unvaccinated people have had COVID at least once, I'm wondering if there is still much of a difference between the risk of getting covid from person who is vaccinated (at least with the original two shots) and someone who is unvaccinated. I would appreciate pointers to any data that would help me estimate how much additional risk I would taking on for myself if I allowed us to meet in person.
Best answer: You may have already seen this Nature news story. I suspect it's as firm as any data you're likely to see in the near future.
The evidence remains that there is a significant drop in infection rate, even if not as dramatic as we'd like: Someone fully vaccinated with a recent booster might be 40-50% less likely to infect someone in that study of close contacts (cellmates in prison). But there's uncertainty and protection wanes over time.
posted by mark k at 10:32 PM on October 13, 2022 [4 favorites]
The evidence remains that there is a significant drop in infection rate, even if not as dramatic as we'd like: Someone fully vaccinated with a recent booster might be 40-50% less likely to infect someone in that study of close contacts (cellmates in prison). But there's uncertainty and protection wanes over time.
posted by mark k at 10:32 PM on October 13, 2022 [4 favorites]
I'm an epidemiologist. I cannot think of a single reason to avoid Covid vaccination(s), or for businesses that conduct in-person activities to stop recommending if not requiring them. My org, for instance, very flatly requires anyone working outside of a home office to have the most current vaccination available to them.
posted by late afternoon dreaming hotel at 11:41 PM on October 13, 2022 [30 favorites]
posted by late afternoon dreaming hotel at 11:41 PM on October 13, 2022 [30 favorites]
The hope is that the bivalent boosters will do a better job than the original vaccines have been able to do in blocking omicron infection. I don’t think we have clinical efficacy data on these yet, but if I understand right antibody responses are pretty good. In my mind you’re doing the community a service in trying to shore up this norm, too.
posted by eirias at 2:30 AM on October 14, 2022 [8 favorites]
posted by eirias at 2:30 AM on October 14, 2022 [8 favorites]
In addition to the reduced infection rate, vaccination acts as a useful proxy for who cares about you, and is more likely to cancel an appointment if they feel a bit sniffly because they don't want to get you sick. I would guess that is a fair risk for you in particular.
posted by Dashy at 5:14 AM on October 14, 2022 [21 favorites]
posted by Dashy at 5:14 AM on October 14, 2022 [21 favorites]
I've had my three shots, and will be getting the bivalent booster soon as well.
But ive also tested positive for covid several times, and luckily only had minor symptoms.
The vaccine unfortunately doesnt prevent covid entirely, but does cut down the death rate.
My point is, your clients can be covid positive despite showing vax cards. So you have to decide are you just virtue signaling, or what you are actually trying to accomplish. No one has asked me for my vax card in a long time, but i care about my health so i will be getting the new booster anyway.
posted by TheAdamist at 6:00 AM on October 14, 2022 [1 favorite]
But ive also tested positive for covid several times, and luckily only had minor symptoms.
The vaccine unfortunately doesnt prevent covid entirely, but does cut down the death rate.
My point is, your clients can be covid positive despite showing vax cards. So you have to decide are you just virtue signaling, or what you are actually trying to accomplish. No one has asked me for my vax card in a long time, but i care about my health so i will be getting the new booster anyway.
posted by TheAdamist at 6:00 AM on October 14, 2022 [1 favorite]
So you have to decide are you just virtue signaling, or what you are actually trying to accomplish.
The vaccine significantly reduces the likelihood that someone who has been exposed to COVID will transmit it to someone else.
Saying that a company requiring visitors to be vaccinated is virtue signaling is an asinine statement.
posted by NotMyselfRightNow at 6:41 AM on October 14, 2022 [68 favorites]
The vaccine significantly reduces the likelihood that someone who has been exposed to COVID will transmit it to someone else.
Saying that a company requiring visitors to be vaccinated is virtue signaling is an asinine statement.
posted by NotMyselfRightNow at 6:41 AM on October 14, 2022 [68 favorites]
One of the worst things about our pandemic response is our inability to keep more than one strategy in mind. Assuming the vaccine does all the work is bound to disappoint, but that doesn’t mean it does none of the work. The nice thing about a vaccine is once you have it, it’s always “on” — by reducing a customer’s risk of getting it in every setting you reduce the risk they bring it into yours. That’s different from a mask, which does a good job preventing transmission in your space but will not prevent a client bringing a virus in if they are not masking elsewhere. That’s okay! That’s why we should keep more than one thing in mind at a time, which it sounds like the OP is.
Really coming to hate the phrase “virtue signaling” in general. Yes, part of what we are doing when we choose a behavior that has ethical implications is helping to shape the norms in our group. That is extremely normal for a social creature and it is a good thing. We are also accomplishing whatever good the behavior accomplishes on its own. One chain of transmission interrupted is a win, just as is one person housed or one life saved. Again: we get nowhere if we can only keep one thing in mind at a time.
posted by eirias at 6:53 AM on October 14, 2022 [37 favorites]
Really coming to hate the phrase “virtue signaling” in general. Yes, part of what we are doing when we choose a behavior that has ethical implications is helping to shape the norms in our group. That is extremely normal for a social creature and it is a good thing. We are also accomplishing whatever good the behavior accomplishes on its own. One chain of transmission interrupted is a win, just as is one person housed or one life saved. Again: we get nowhere if we can only keep one thing in mind at a time.
posted by eirias at 6:53 AM on October 14, 2022 [37 favorites]
The vaccine is only one layer of a multi-layer approach to avoiding covid and the potential with each infection that your body will not handle it as well, resulting in death or permanent disability.
Layered in with testing, masking, distancing, filtering, airflow, and limited exposure to large groups, it’s a very responsible requirement.
Speak to whomever you need to about establishing the requirements for patients to have and maintain “proof of recent vaccination” and a “before you come in tomorrow illness checklist”. And telehealth anyone who isn’t feeling well for at least the next month’s worth of appointments, or all appointments for folks who won’t vax.
Virtue signaling? That’s just snake oil grifter talk. If fucking keeping people alive is virtue signaling, then you probably don’t need them as a customer.
As someone who is kind of fond of staying alive, I sincerely appreciate providers who actually have an ounce of sense, and aren’t afraid of nattering dimbulbs who plaster over their soul-deep existential fear of their own death with mockery of attempts to keep people alive.
posted by tilde at 7:04 AM on October 14, 2022 [19 favorites]
Layered in with testing, masking, distancing, filtering, airflow, and limited exposure to large groups, it’s a very responsible requirement.
Speak to whomever you need to about establishing the requirements for patients to have and maintain “proof of recent vaccination” and a “before you come in tomorrow illness checklist”. And telehealth anyone who isn’t feeling well for at least the next month’s worth of appointments, or all appointments for folks who won’t vax.
Virtue signaling? That’s just snake oil grifter talk. If fucking keeping people alive is virtue signaling, then you probably don’t need them as a customer.
As someone who is kind of fond of staying alive, I sincerely appreciate providers who actually have an ounce of sense, and aren’t afraid of nattering dimbulbs who plaster over their soul-deep existential fear of their own death with mockery of attempts to keep people alive.
posted by tilde at 7:04 AM on October 14, 2022 [19 favorites]
I think it's fair to assume that people who aren't vaccinated are less likely to take other preventive measures.
posted by theora55 at 7:11 AM on October 14, 2022 [21 favorites]
posted by theora55 at 7:11 AM on October 14, 2022 [21 favorites]
Would you be requiring the booster shot specifically? If they are fully vaccinated but had their last shot a year ago, I don't think it would be helpful (though I agree that they're probably more likely to be cautious than an anti-vaxer).
posted by pinochiette at 8:02 AM on October 14, 2022
posted by pinochiette at 8:02 AM on October 14, 2022
My workplace requires 2 shots + 1 booster. One reason to not force people to get the bivalent booster is that it's my understanding (happy to be corrected) that if you've recently had COVID, you've most certainly had Omicron, and so it makes more sense to wait a few months post-infection to get a booster. So I'd provide that option for people.
posted by coffeecat at 9:18 AM on October 14, 2022 [1 favorite]
posted by coffeecat at 9:18 AM on October 14, 2022 [1 favorite]
How much of a difference does it makes to my COVID risk if I allow unvaccinated clients?
As everyone has said, it would reduce your risk. But how much depends on what else you do with your time. Think of it this way: suppose in a month's time you get COVID. Are you going to be able to confidently attribute it to a client meeting, or will it be difficult to say how you got it, because you do lots of things other than see clients?
If you literally never see any other people, the marginal value to your safety of insisting your clients be vaccinated is very large.
If between clients you go to restaurants and parties, and take local transit and flights (during which you are surrounded by people you don't know, who are not wearing masks, and many of whom are unvaccinated), then the marginal value of insisting your clients be vaccinated is ... well it's not zero, but it's not a lot.
In other words, there is not information for anyone to answer your specific question (which was specifically about the implications for your personal safety of insisting on vaccination) except in the most general terms of "I think people should get vaccinated because it would be good for public health", which we all agree on, but is not an answer to the question posed.
posted by caek at 2:01 PM on October 14, 2022 [3 favorites]
As everyone has said, it would reduce your risk. But how much depends on what else you do with your time. Think of it this way: suppose in a month's time you get COVID. Are you going to be able to confidently attribute it to a client meeting, or will it be difficult to say how you got it, because you do lots of things other than see clients?
If you literally never see any other people, the marginal value to your safety of insisting your clients be vaccinated is very large.
If between clients you go to restaurants and parties, and take local transit and flights (during which you are surrounded by people you don't know, who are not wearing masks, and many of whom are unvaccinated), then the marginal value of insisting your clients be vaccinated is ... well it's not zero, but it's not a lot.
In other words, there is not information for anyone to answer your specific question (which was specifically about the implications for your personal safety of insisting on vaccination) except in the most general terms of "I think people should get vaccinated because it would be good for public health", which we all agree on, but is not an answer to the question posed.
posted by caek at 2:01 PM on October 14, 2022 [3 favorites]
By the way, if you find yourself about to write "virtue signalling", consider whether you mean "sending a signal about the behavior expected from others". If that's the case, just say "setting a good example". If you mean something else when you say "virtue signalling" then you're probably using the term in bad faith, or you're going to fail to get your message across because other people will assume you're using the term in bad faith. See above.
posted by caek at 2:12 PM on October 14, 2022 [9 favorites]
posted by caek at 2:12 PM on October 14, 2022 [9 favorites]
I ran some sample numbers through microCOVID (for my location, so they won't be the same as yours and I won't quote them). Testing it with surgical masks on both faces in a close proximity for an hour: if they are vaccinated or unvaccinated, it makes no difference to your risk. However, if they are unvaccinated it seems to roughly quadruple their risk. (The numbers are way under 100 microcovids both ways around, so not super high, but if you had, say, 20 meetings a week it would build up.) you can obviously run the numbers yourself, and I recommend you do it from both perspectives as I did.
That site is not a panacea, but it is evidence backed; and even if the numbers are not spot on I'd like to think that the relative sizes are good enough to inform your decision.
posted by How much is that froggie in the window at 2:34 PM on October 14, 2022
That site is not a panacea, but it is evidence backed; and even if the numbers are not spot on I'd like to think that the relative sizes are good enough to inform your decision.
posted by How much is that froggie in the window at 2:34 PM on October 14, 2022
To reduce my own risk and the risk of me passing COVID to others, I'd request all in-person clients wear a well-fitted N95/equivalent mask and also be bivalent boosted. If you're also offering virtual services, I don't think these two things are a big ask. With how the numbers are looking in Europe right now and also the possibility of the XBB variant arriving, being very strict with in-person criteria makes a lot of sense.
posted by quince at 2:59 PM on October 14, 2022
posted by quince at 2:59 PM on October 14, 2022
Assume we are wearing masks
I think it is ultimately irrelevant because nobody who has refused to be vaccinated for this long will be willing to wear an n95 or equivalent or better that is properly fitted and actually sealed to their faces for every second they are around you. if you announce that unvaccinated clients are permitted so long as they exhibit absolutely correct mask usage, such clients will simply not prevent themselves. or they will be so obviously and immediately noncompliant that you will have to have them emergently removed before your professional association with them gets off the ground.
there are exceptions to everything so I am sure there are one or two exceptions to this. but the odds that the exceptions will turn up in your office seem very low.
posted by queenofbithynia at 4:10 PM on October 14, 2022 [3 favorites]
I think it is ultimately irrelevant because nobody who has refused to be vaccinated for this long will be willing to wear an n95 or equivalent or better that is properly fitted and actually sealed to their faces for every second they are around you. if you announce that unvaccinated clients are permitted so long as they exhibit absolutely correct mask usage, such clients will simply not prevent themselves. or they will be so obviously and immediately noncompliant that you will have to have them emergently removed before your professional association with them gets off the ground.
there are exceptions to everything so I am sure there are one or two exceptions to this. but the odds that the exceptions will turn up in your office seem very low.
posted by queenofbithynia at 4:10 PM on October 14, 2022 [3 favorites]
I’d consider that there is a big racial/economic gap in vaccination, so your policy will have a disparate impact based on race. Personally there would have to be a pretty important justification for me to enact such a policy. If you’re average risk and boosted the additional protection of a vaccination policy might not really justify the discrimination. A policy requiring a recent booster shot would probably be more effective, but that’s going to exclude a lot of people who haven’t gotten around to it for various reasons.
posted by haptic_avenger at 9:08 PM on October 14, 2022 [1 favorite]
posted by haptic_avenger at 9:08 PM on October 14, 2022 [1 favorite]
at the time, I made the appointments it didn't occur to me to ask if they were vaccinated. I'm trying to figure out if I should go back and ask.
as an additional practical thing: if you provide any kind of health or health-adjacent care service, the way to do this is not to ask deferentially or in a way that makes it sound like you totally forgot to bring it up at the right time (because you did forget & don't have a clear policy, and that creates a bad impression.) instead, whenever you send out your pre-appointment reminder text or email, just include a big bold message telling them to bring their vaccination card with them for their first appointment. if they do not have one, they will have to be the one making the explanations and the big fuss.
you should also bear in mind that if you are a provider of some health-related service, OR if you are not but if you have clients coming into the same room one after another all day to breathe the same air without any significant pause, your less antisocial clients may eventually discover that you don't require all clients to be vaccinated as a matter of course and flip right out about it. as always, both having safety standards and not having safety standards will lose you some number of people.
and yes, as long as you're thinking about this at all, consider making the updated booster the standard.
posted by queenofbithynia at 9:30 AM on October 15, 2022 [1 favorite]
as an additional practical thing: if you provide any kind of health or health-adjacent care service, the way to do this is not to ask deferentially or in a way that makes it sound like you totally forgot to bring it up at the right time (because you did forget & don't have a clear policy, and that creates a bad impression.) instead, whenever you send out your pre-appointment reminder text or email, just include a big bold message telling them to bring their vaccination card with them for their first appointment. if they do not have one, they will have to be the one making the explanations and the big fuss.
you should also bear in mind that if you are a provider of some health-related service, OR if you are not but if you have clients coming into the same room one after another all day to breathe the same air without any significant pause, your less antisocial clients may eventually discover that you don't require all clients to be vaccinated as a matter of course and flip right out about it. as always, both having safety standards and not having safety standards will lose you some number of people.
and yes, as long as you're thinking about this at all, consider making the updated booster the standard.
posted by queenofbithynia at 9:30 AM on October 15, 2022 [1 favorite]
Response by poster: The article in Nature linked by mark k was absolutely on target for my question. For close contacts (people who shared a prison cell) "Unvaccinated people had a 36% chance of transmitting the virus to close contacts but prisoners who were [both] vaccinated and had had a previous infection still had a 20% risk of spreading the infection." Every exposure (vaccine, booster, previous infection) improves the protection but it wears off over time (dropping 6% every 5 weeks).
So yes, vaccination makes a difference but so boosters and past infections so unless I want to require up-to-date boosters as prerequisite for in-person sessions, I would need to take a full COVID history to figure out comparable risks.
In terms of next steps, after I posted this question, I realized that I could send an email asking people if they were vaccinated without having to discuss my policies just yet. In a county where 87% of the total population (including children) are vaccinated, I shouldn't be surprised that all four people reported that they were vaccinated so I can just keep to my current policy for now.
However, this conversation made me realize the value of boosters. I've decided to check in with everyone about where they are with boosters and to encourage people, as appropriate, to make a plan to get the new bivalent booster if they haven't already. I'm hopeful that, for some people, that kind of gentle conversation might just enough to push them into taking an action that benefits themselves and everyone else.
posted by metahawk at 4:24 PM on October 16, 2022 [5 favorites]
So yes, vaccination makes a difference but so boosters and past infections so unless I want to require up-to-date boosters as prerequisite for in-person sessions, I would need to take a full COVID history to figure out comparable risks.
In terms of next steps, after I posted this question, I realized that I could send an email asking people if they were vaccinated without having to discuss my policies just yet. In a county where 87% of the total population (including children) are vaccinated, I shouldn't be surprised that all four people reported that they were vaccinated so I can just keep to my current policy for now.
However, this conversation made me realize the value of boosters. I've decided to check in with everyone about where they are with boosters and to encourage people, as appropriate, to make a plan to get the new bivalent booster if they haven't already. I'm hopeful that, for some people, that kind of gentle conversation might just enough to push them into taking an action that benefits themselves and everyone else.
posted by metahawk at 4:24 PM on October 16, 2022 [5 favorites]
I think it is ultimately irrelevant because nobody who has refused to be vaccinated for this long will be willing to wear an n95 or equivalent or better that is properly fitted and actually sealed to their faces for every second they are around you
Vaccinated people aren’t doing this either. In fact, I’ve seen approximately zero people doing it at all. Maybe 2-3 since vaccines were rolled out. Most people, even the quadvaxxed, are clueless about masks and wear them completely improperly. Maybe <1% of the population (the scrupulous) know what they’re doing and are really taking true precautions, and that’s an estimate based on observation from a very vaccinated place. Otherwise it’s a jungle out there.
posted by stoneandstar at 1:52 PM on October 18, 2022
Vaccinated people aren’t doing this either. In fact, I’ve seen approximately zero people doing it at all. Maybe 2-3 since vaccines were rolled out. Most people, even the quadvaxxed, are clueless about masks and wear them completely improperly. Maybe <1% of the population (the scrupulous) know what they’re doing and are really taking true precautions, and that’s an estimate based on observation from a very vaccinated place. Otherwise it’s a jungle out there.
posted by stoneandstar at 1:52 PM on October 18, 2022
This thread is closed to new comments.
posted by aramaic at 10:11 PM on October 13, 2022