COVID-19 testing and vaccinations

Last COVID-19 mandate falls with Murphy order

Credit: (Rich Hundley, The Trentonian)
April 15, 2020: That was then … in the early days of the COVID-19 pandemic, Gov. Phil Murphy gave a briefing in Trenton on the crisis.

With COVID-19 cases and hospitalizations declining statewide and treatment readily available, New Jersey has rescinded one of its last remaining pandemic mandates, impacting vaccination requirements for more than 500,000 employees in high-risk settings like hospitals, nursing homes and prisons.

Gov. Phil Murphy signed an executive order Monday that ended a mandate that unvaccinated workers at doctors’ offices, hospitals and behavioral health programs be routinely testing for COVID-19. These employees must still prove they are up to date on vaccinations under federal and state requirements, the order notes, but those who are granted religious or medical exemptions will no longer need to be regularly screened for the coronavirus.

Murphy’s action also ends the state mandate for staff in so-called congregate settings like prisons, day programs and group homes to be immunized or regularly screened for the virus. The changes, which largely follow federal guidance, took effect the same day, quietly ending what had been a controversial measure late in the pandemic.

“With vaccines and treatments available to help combat the effects of this virus and our state maintaining lower rates of key metrics, New Jersey can continue to take steps to responsibly lift COVID-19 mitigation protocols,” Murphy said. “In line with federal recommendations, today’s executive order will keep certain safety measures in place to protect vulnerable individuals in health care settings while lifting others in recognition of the progress we have made in combating this virus since the height of the pandemic.”

New Jersey’s public health emergency ended on March 4, 2022, two years after Murphy first declared the public health crisis, although a separate state of emergency initiated at the start of the pandemic continues; his office said the latter is now being reviewed. The federal public health emergency is set to end in mid-May.

Big decline in infections, hospitalizations

COVID-19 daily diagnoses and hospitalizations in New Jersey have declined more than 80% since late December 2022, and measures of viral spread are fairly stable, according to state data tracked by NJ Spotlight News. However, the  reported diagnoses and hospitalizations are likely a fraction of the real total, given the popularity of home-testing, whose results largely go unreported.

Over time, Murphy has rolled back almost all the state’s original pandemic restrictions, including masking and social-distancing requirements and vaccination mandates that applied to state workers as well as transit and school employees. Public concern about the pandemic has largely diminished and, while almost all New Jersey residents have received at least one dose of COVID-19 vaccine, only about 16% have had the new, more effective bivalent booster — similar to booster uptake nationwide.

Alexandra Altman, Murphy’s deputy communications director, said the only statewide COVID-19 requirement that remains is the vaccination mandate for health care workers.

“However, there are regulatory actions, rule waivers, and directives from state departments that are still in place,” she said, including orders based on federal guidance that workers in health care facilities continue to wear masks.

Former state epidemiologist Dr. Eddy Bresnitz, who previously advised the state on its COVID-19 strategies, agreed it makes sense for the state to eliminate the testing requirement for unvaccinated health care workers now, given the limited threat posed by COVID-19 and because of herd immunity due to vaccination or acquired via COVID-19 infection. But he said how officials define “up to date” on vaccinations is important, given that it’s been nearly two years since the first shots were available and protection wanes over time.

Key decision-making shifts from state to facilities

“Testing people if they’re not symptomatic is a low-gain answer for these institutions” like hospitals and nursing homes, Bresnitz said. “So I think that’s the right thing to do, from a government-mandate perspective,” he said, noting that facilities can always go beyond what regulations require.

Bresnitz said ending the requirement could have a greater public health impact on prisons and group homes, congregate settings that are not required by state or federal regulations to ensure staff are vaccinated. “Ultimately, the state is now placing decision-making for infection prevention and control on the facilities, based on the facilities’ assessment of risk to their patients or their residents, their staff and visitors,” he said. “It’s really up to these individual organizations to make the determination of their testing policies and their vaccination.”

‘You’re never going to get to the point where there are zero deaths in long-term care’ from COVID-19 or other causes. — Andy Aronson, Health Care Association of New Jersey

Monday’s order was good news to nursing home providers, whose facilities were especially hard-hit by COVID-19; residents at these sites comprised roughly one in four of the state’s 36,000 related fatalities. More than 200 long-term care facilities have active outbreaks as of this week, according to state reports. Operators say the testing requirement took employees’ time away from bedside care and other duties and created further strain in an industry that has long struggled with staffing shortages.

“It’s just a real positive development,” Andy Aronson, president and CEO of the Health Care Association of New Jersey, which represents nursing homes, said of Murphy’s new order. “I know the facilities feel great about any positive development, like a step forward, back to normal.”

Better equipped

Nursing homes are now better equipped to control the virus, Aronson said, and proactively test anyone who shows symptoms of sickness. Facilities have also provided booster clinics for residents and staff, he said, noting “everybody has the ability to protect themselves.”

Given that nursing homes generally serve a frail, older population, some of whom refuse invasive lifesaving procedures, Aronson said fatalities will continue. “You’re never going to get to the point where there are zero deaths in long-term care” from COVID-19 or other reasons, he said. “But the vast, vast majority of people who test positive are treated and do very well.”

Murphy’s latest order builds on a long line of executive actions that date to March 2020, including orders that shuttered businesses and public spaces, required people to wear masks in indoor venues — including classrooms — and shifted voting from in-person to a mail-in ballot system. Vaccinations first became available in late 2021.

While the state began to roll back aspects of its pandemic response in the spring of 2021, the explosion of new, more deadly strains of COVID-19 — and vaccine hesitancy among some employees — led Murphy to issue new vaccine-or-test mandates. Workers in health care, prisons and other settings were required to provide proof of immunization or be tested at least every two weeks, starting in early September 2021. State workers, school staff and transit employees would soon face similar requirements. Murphy added a booster mandate in early 2022, after cases again surged.

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