Clark assumed everyone in the dentist's office, because they worked in health care, was vaccinated. But when the topic came up during the appointment, Clark discovered an employee caring for her was not.
"There I was sitting there, very vulnerable with my mouth open, and I'm thinking 'Oh great. I'm just relying on her mask and my vaccination status to protect me,'" said Clark, of Lake Saint Louis, Mo.
Clark is one of many who, because of age or medical conditions, are at higher risk of complications with COVID-19. They also may not experience the same level of protection from vaccination as a healthy person would.
Getting vaccinated greatly reduces the likelihood of infection or ending up in the hospital, but still about 30 percent of COVID-19 patients in St. Louis-area hospitals are fully vaccinated, according to the latest data from the St. Louis Metropolitan Pandemic Task Force. Nearly all are compromised by other health conditions, hospital officials have said.
Like more than two-thirds of the country, Missouri is identified as having high levels of community transmission of the coronavirus by the U.S. Centers for Disease Control and Prevention.
That prompts people like Clark, who want to protect their health, to seek out service providers who are vaccinated against COVID-19 — especially those with whom they'll be in close contact, such as dentists, therapists or stylists.
Finding those providers isn't easy. Many providers don't advertise their vaccination status. And medical privacy laws leave customers confused about what they can ask and employers walking a fine line between protecting their employees' personal health information and being transparent with customers.
Even vaccine mandates for employees in hospital systems or companies like United Airlines are no guarantee for concerned patients or customers, because accommodations must be made for those whose religion or medical condition prevents them from getting vaccinated.
The major hospital systems in the St. Louis area — BJC HealthCare, SSM Health, Mercy and St. Luke's Hospital — declined to reveal what percentage of their staff has received religious or medical exemptions.
The politicalization of the vaccine has also made employers even more cautious and left clients feeling uncomfortable or awkward bringing up their concerns.
While employers are barred from revealing personal health information about their workers, customers can ask employees directly about their vaccination status.
"It is such a polarized topic that sometimes, in some settings, asking someone might feel kind of fraught, unfortunately," said Pauline Kim, a law professor at Washington University School of Law. "That's why the employer can't reveal that information about somebody else because an employee might very well not want to share their own decision as to whether they got vaccinated or not."
Clark is now sure to ask her health care providers if they are vaccinated. She also makes sure the piano tuners, painters, kitchen remodelers and other workers who spend time with her and her husband in their home are vaccinated.
There's been little drama, she said, other than once when a company agreed to send a vaccinated worker but mistakenly sent someone who wasn't. She asked the worker about his vaccination status while he was on his way over the phone.
"I say, 'Are your workers vaccinated? We are high risk.' That is pretty much it. I usually get a straight answer," Clark said. "They will often say, 'Well, we will make sure the one who comes out is vaccinated.' And I even say, I will check their card."
Saying Too Much or Not Enough
Dr. Homer Sedighi was happy to learn that his entire staff at his pediatric dental practice in Chesterfield had all become vaccinated against COVID-19. He shared what he saw as the good news in an email to patient families in the middle of October, adding that he'd try to maintain the achievement by hiring only vaccinated employees.
"I just wanted the parents to know that my office is a safe environment for their children, and I wanted them to feel comfortable and feel safe," Sedighi said. "That is all, nothing more than that."
Questions from families about whether his staff was vaccinated had also waned as the vaccine became more available, so Sedighi wanted to be forthcoming: "There's no doubt in my mind a lot of parents they assume that the dental offices — I mean they are in their mouths, there's a lot of aerosol, there's a lot of splashing going on — that every assistant or hygienist has been vaccinated."
While the responses were overwhelmingly positive, he said, about 20 percent were not. Sedighi did not want to comment about what pushback he faced. It might have stemmed from a misunderstanding about the letter.
"Nobody lost any jobs in my office," he said.
Parents of patients with conditions such as autism or who have other fragile family members were especially thankful for the information, Sedighi said.
"I have patients who have gone through organ transplants. They have finished their chemotherapy and cancer therapy. They are Type 1 diabetic," he said. "They are medically compromised patients, and if they are not, they might have grandparents who are going through cancer treatments and don't want kids carrying anything with them when they go visit."
Dr. Greg Luerding, who has operated Brevco Family Dentistry for close to 40 years in Lake Saint Louis, has patients who are 100 years old and many who are medically compromised. Luerding said patients frequently ask if the staff is fully vaccinated.
"Our standard line is to say, 'I can't discuss the health conditions of the employees, but I can tell you that you will not be seen by someone who is not vaccinated,'" he said.
Luerding says even though he has his employees' permission to share their vaccination status, he chooses to stick to an across-the-board rule of not sharing any kind of health information about staff.
"I just think this is so politicized, and I want to keep it out of that realm," he said. "If you tell them that everybody is vaccinated, they will be very upset, they'll say 'why do you make them do that?' I don't. Then they don't believe me, or the opposite. So, I just kind of steer clear of that."
Luerding also encourages patients to share their concerns with their providers. "We've had close to a dozen patients who have passed away from it (COVID-19), and I've had have family members who have, so I don't take it lightly."
Dr. Guy Deyton is a practicing dentist in the Kansas City area. He also serves as the director of the Office of Dental Health within the Missouri Department of Health and Senior Services, where part of his job has entailed informing providers about how to talk with concerned patients and share their disease mitigation strategies.
"We've encouraged them to be good listeners and to be very, very transparent — and to accept that there are going to be people that have some anxiety about getting care or even just going out into the world and interacting at this juncture," Deyton said.
Deyton also encouraged patients to not be shy about asking questions they need answered in order to feel safe.
"Simply ask, 'Could you tell me if the staff is completely vaccinated?' And if not, 'Would it be possible for me to have my care delivered by staff that have been fully vaccinated?'" Deyton said. "I think everybody would be forthcoming with that information."
Not many want to advertise their efforts, however. Deyton approached two dentists whom he knew mandated COVID-19 vaccinations for all staff, but they told him they did not want to be interviewed or mentioned in a news article.
Patients can find assurance, Deyton said, in surveys from late summer that showed about 90 percent of dentists and 80 percent of hygienists are vaccinated. The percentage among dental assistants (who can polish teeth), however, is unknown.
"Patients need to be encouraged to speak up and ask questions and feel that not only is it right for them, but it's right for other people too," Deyton said. "Once everybody can accept that this is the right thing to do, then we can get right to sharing answers transparently."
Safe Way to Share Information
Kim, the law professor, said while employers cannot reveal medical information about individual employees including vaccination status, consumers can ask businesses about their general procedures to prevent the spread of disease. Employees are also free to share medical information about themselves, and they can also grant permission to their employer to share their vaccination status, Kim said.
"I think everybody is sort of navigating some level of uncertainty, and all you can do is try to understand the policies and protocols of the businesses you are interacting with and assess your own risk and make your best judgment," Kim said.
To help, Amy Rhoades, 42, of O'Fallon, Missouri, started a Facebook group called Missouri COVID-19 Safe Businesses where people can feel comfortable sharing and seeking information about businesses who comply with CDC-recommended mitigation strategies.
When Rhoades started the group in December 2020, it was limited to St. Charles County businesses. The county did not have a mask mandate and people used the group to share names of businesses where staff and customers were wearing masks.
Around the start of the school year, Rhoades said, she expanded the group after more people across the state began seeking recommendations for services. At the time, cases of COVID-19 had greatly increased among children, people had grown lax about mask-wearing and vaccination rates had stagnated.
"It's kind of a safe way to share information. People are all on the same page," Rhoades said. "I think there are a lot of things that make it (taking to employers or employees) uncomfortable. I think there's a misunderstanding of HIPPA and what protections that actually provides, and it feels rude maybe just asking people."
The Health Insurance Portability and Accountability Act of 1996 applies only to health-related entities such as medical and insurance providers and protects health information that could be used to identify a person.
One member of the Facebook group created a Google form that members can fill out about businesses, so others can search for certain services they may need, Rhoades said. People have used the group to find dance or gymnastics studios for their children, exercise facilities and "any business that you'd have to spend a lot time there."
"We have people in our group who have a lot of medical vulnerabilities — either they do, or their kids do or another loved one," she said. "So for them it's almost a life-or-death thing if they don't find a provider that's willing to be vaccinated and keep them safe, and they don't really know where else to turn."
Clark has the point-of-view as both a concerned consumer because of her age and medical conditions, as well as a conscientious service provider as a piano teacher, providing lessons to customers in her home.
She tells her families that she is vaccinated. She requires a symptom checklist before coming, allows only one person in her house at a time and disinfects between lessons. Those who are unvaccinated must wear a mask.
"I want everyone to be safe. I don't ever want to be responsible for somebody getting COVID. I would just feel horrible," Clark said. "I take that as my business responsibility and my freedom to do so."
(c)2021 the St. Louis Post-Dispatch. Distributed by Tribune Content Agency, LLC.
Related Articles
