COVID-19 infections spike in U.S. though deaths remain low

It’s been an unexpectedly tough few weeks on the COVID-19 front. The Delta variant is now responsible for four out of five infections in the U.S., and our daily rate of reported infections is up fourfold from the end of June. We’re still giving over a half million vaccines daily, but if we continued at this rate, it would take nine more months to get 75% of the population fully vaccinated. The relatively good news: Daily deaths remain at just over 200. Yet because the elderly have higher vaccination rates we’re likely seeing a decrease in the average age of those hospitalized and dying from COVID-19.

Daily trends in number of COVID-19 cases in the U.S. reported to the CDC

The seven-day moving average was 47,455 for July 23, 2021. Source: CDC

Key points for employers regarding the recent increase in COVID-19 cases:

• The risk of workplace transmission is highly related to the risk of community infection. The risk over a month that someone with COVID-19 will enter a worksite with 100 employees in mid-July is only about 10% in Boston, MA (2.4 cases per 100), but is about 76% in Springfield, MO (79.6 cases per 100). Thanks to Joe Allbright for help with these (rough) calculations.
• Employers can pivot to remote work and flexible and staggered schedules to allow social distancing for workplaces in communities with high rates of transmission.
• Employers can reduce the risk of transmission primarily by increasing ventilation in the workplace. Temperature screening, deep disinfection and ultraviolet lights have not been shown to be necessary to protect workers.
• Vaccination remains the best way to prevent workplace exposure to COVID-19. The vaccines remain very effective against the variants (more on this below), and employers can continue their efforts to encourage vaccination and make it easy for employees to get vaccinated.
• The CDC recommends that all unvaccinated people wear masks indoors — which includes workplaces.
  • About 3% of the population has immunosuppression. These employees should wear masks to protect themselves even if they are vaccinated.
  • Many localities have extended mask mandates to those who are vaccinated.
  • Many who are fully vaccinated will choose to wear masks when they are in public places with those who are unvaccinated or whose vaccination status is unknown.
• All employers with onsite workers should be prepared for workplace exposures. They should have policies and procedures in place to notify employees of exposures while maintaining the medical privacy of those who are infected.
• I expect more employers will consider testing given that we’re likely to continue to have sporadic outbreaks.

Patricia Toro, M.D., M.P.H. and I have a piece on this topic featured on ChiefExecutive’s website: Seven Tips for Returning Employees Safely to the Workplace.

Vaccines continue to be effective against COVID-19 variants

There have been reports that the available COVID-19 vaccines have lower effectiveness against the variants — and a huge amount of press attention on “breakthrough” infections in those who are fully vaccinated. The “real world” reality is that the mRNA vaccines (Pfizer and Moderna) and the adenovirus vaccines (J&J, AstraZeneca) continue to provide excellent protection against the Delta variant. The AstraZeneca vaccine is not especially effective against the Beta variant (B.1.351, initially identified in South Africa). But this vaccine is not in use in the U.S., and the Beta variant represents less than 1% of current infections in the U.S.

One challenge is that breakthrough infections become a higher and higher portion of total infections in communities with high vaccination rates. Los Angeles reported that 20% of its infections were in those who were vaccinated — but 53.4% of residents there are fully vaccinated. This means the vaccine decreases risk of infection by over 60% (1-[.20/.534]).

Many of the reports suggesting that the vaccines might not be effective against variants come from laboratory studies showing lower effectiveness of vaccine antibodies against the variants in test tubes. The vaccine antibody titers are quite high though, and a decrease in neutralizing capability in the test tube doesn’t mean that people aren’t protected. The vaccine induces additional types of immunity — so even those with very low antibody levels might still be protected.

Israel recently reported that the vaccine is 91% effective at preventing severe illness; in the U.S. over 97% of hospitalizations are in those who are unvaccinated.

Vaccine effectiveness

Israel data on protection percentages provided by the Pfizer vaccine. Source: Israel Ministry of Health

The Delta variant is far more contagious than earlier strains. This variant has already made some employers push back their return-to-work dates, and I’m hopeful this threat will motivate many who have been waiting to get vaccinated now!

Life expectancy falls and drug overdose rates soar

Life expectancy in the U.S. has tumbled by a staggering 1.5 years in 2020, largely due to the COVID-19 pandemic. Disparities persist; loss of life expectancy decreased three years for Hispanic people, 2.9 years for Black people and 1.2 years for white people.

U.S. life expectancy at birth by race

Notes: Life expectancies for 2019 by Hispanic origin and race are not final estimates. Estimates are based on provisional data for 2020. Source: National Center for Health Statistics and the CDC.

In addition to COVID-19, there were also increases in deaths from injuries, homicide, diabetes and liver disease. Interestingly, death rates from cancer and lung disease were down substantially, and suicide deaths decreased, although I fear this is likely to be reversed in the coming years.

Contribution to loss of life expectancy for 2020

Source: CDC July 21, 202. Note: residual is “all other.”

The CDC also just reported that there were about 93,000 deaths from drug overdoses during 2020, a 30% increase over 2019. Mental health issues have worsened in general during the pandemic, and many have had a difficult time gaining access to professional help and especially getting access to medication-assisted treatment. Employers play an important role in making this life-saving therapy available to employees and their dependents.

Provisional counts of drug overdose deaths in the U.S.

Source: CDC

Author

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Jeff Levin-Scherz, MD

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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