Tuesday marked the final deadline for Georgia healthcare workers to get their second COVID-19 vaccine dose or a valid exemption to keep their jobs.

Several hospitals reported their employee vaccination levels were as high as 99%. Nursing homes in Georgia reached at least 88%. Under the federal law, health workers in a wide range of fields were required to either get vaccinated or to obtain an employer-approved waiver based on medical or religious reasons.

While public health experts say vaccine requirements are critical to prevent the spread of the virus, the federally imposed mandate created worries that healthcare workers would walk rather than comply. That could leave healthcare facilities — particularly in rural areas, which are often more vaccine-hesitant than metro Atlanta — strained and understaffed.

Neil Pruitt Jr., Chairman and CEO of PruittHealth, said meeting the requirement was not as difficult as feared even though more than 450 staff members were fired for refusing to be vaccinated and failing to qualify for a waiver.

“We were very concerned about the mandate going into it,” he told The Atlanta Journal-Constitution. “We actually had plans to relocate patients because we were concerned about some locations simply refusing to do it, especially in the rural areas... As the deadline came, our partners chose to stick with us by the vast majority and comply with the deadlines.”

PruittHealth, the Norcross-based company operating about 170 nursing home communities across the Southeast, said Tuesday’s deadline was a moot point for them. They imposed a vaccine mandate last year, but the company’s CEO expects other companies to face some workforce losses.

“(Some) providers are scrambling right now,” Pruitt said. “...But from our standpoint, this is a non-event for us.”

The Centers for Medicare and Medicaid Services (CMS), which implemented the vaccine mandate, estimated that nationwide, the mandate covers 17 million workers. The mandate applies to a wide range of health care settings, covering doctors, nurses, technicians, aides, hospital volunteers, nursing home and in-home care agencies, along with other providers that receive funding through Medicare or Medicaid programs.

Across their four-state system, PruittHealth fired 451 employees for refusing to get vaccinated — 258 of those firings were in Georgia. The company currently has more than 12,500 employees, which is about 3,500 short of the company’s pre-pandemic employment levels. During that time, occupancy at PruittHealth’s facilities also dropped to 72.5% from 89%.

Pruitt said staffing has remained a challenge, but he doesn’t attribute it to the required shots. He said many healthcare workers have left nursing home settings due to COVID-19 fears, forcing his company to look outside the U.S. for staffing. He said PruittHealth recently contracted with 1,000 foreign nurses who have met vaccination requirements to plug the gap.

According to CMS data, about 85% of nursing home staff have been fully vaccinated in the U.S. That’s slightly below the 87% of nursing home residents who have been fully vaccinated per facility.

In the general population, about 55% of Georgians are fully vaccinated, while 86% of nursing home residents have received a shot.

With the exception of Children’s Healthcare of Atlanta and Northside, all metro Atlanta hospital systems imposed their own vaccination mandates last year before the Supreme Court upheld the federal vaccine requirement.

On Tuesday, a Northside spokeswoman said more than 99% of its employees were vaccinated, and the remainder received approved exemptions. Questions about whether any employees were noncompliant and could lose their jobs went unanswered.

“We are very pleased with how Northsiders have responded and supported this important effort,” the spokeswoman said in an email.

A Children’s healthcare spokeswoman similarly did not provide any specifics, instead saying the hospital system will enforce the mandate.

Hospitals and healthcare systems have been tight-lipped about the number of religious and medical exemptions they’ve granted employees. Pruitt, who said 97% of his employees are vaccinated, emphasized that they vetted all exemption requests and made several denials.

“We were very stringent on our exemptions,” he said, adding that they checked to see if employees had received other vaccines in the past. If they had, their request for a waiver was rejected.

Georgia was among 24 states with a vaccine deadline Tuesday. Texans are the only healthcare workers in the country who have more time to meet the mandate; their deadline is March 21.

If a hospital doesn’t comply in time, the CMS said it will work to help them boost their vaccination rates before revoking their government insurance privileges.

“CMS’s goal is to bring health care facilities into compliance,” the federal agency said.