6 new developments in Biden administration's plan to fight COVID-19

The Biden administration announced a new plan to address the pandemic, centered around executive orders and mandates on employers to require vaccination. These plans will likely be subject to litigation; however, employers should be prepared to implement a series of required actions based on the following points:

1. The Department of Labor (DOL) will enact emergency temporary standards through the Occupational Safety and Health Administration (OSHA) to require all employers with over 100 employees to require vaccination or weekly testing. OSHA will also require employers with over 100 employees to offer paid time off for vaccination.
   
   
2. All federal workers and federal contractors that do business with the federal government will be required to mandate vaccines or weekly testing. Many companies are federal contractors, so this mandate is expansive.
   
   
3. Biden announced that the federal government will coordinate administration of booster shots when they have been approved by the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC). Employer-based health insurance will continue to be responsible for administration fees billed by vaccine providers.
   
   
4. The Biden administration will provide funding to school districts to address the costs of safe opening, including covering the costs of state aid withheld over disputes about mandatory mask requirements. He also promised extra resources to the FDA to review vaccines for those under 12 years of age, announced requirements for vaccination for teachers paid by the federal government, and promoted testing of students and teachers.
   
   Employees have been challenged to balance watching over children who are home from school and meeting the requirements of their jobs. Effective efforts to keep schools open provide educational benefits to children and support full productivity, which benefits employers.
   
   
5. Biden announced more funding and use of the Defense Production Act to increase production of rapid tests. Antigen tests could be a boon to employment-based testing systems as they are much less expensive, give results rapidly and can be performed at home so no one who has COVID-19 goes into the workplace. These tests have been hard to find for consumers and employers alike over recent weeks, so many employers have delayed instituting testing programs or delayed transition from PCR testing, which is more expensive and doesn’t provide immediate results. He announced an increase in free testing at 10,000 community pharmacies. Employer-sponsored health insurance continues to be required to cover COVID-19 tests ordered by providers, although tests required for employment are technically not eligible for such coverage. Most employers will pay for compulsory testing, which is not required by federal law but is required by many states.
   
   
6. Monoclonal antibody treatment is effective in preventing hospitalization and respiratory failure for those who are not yet hospitalized, but they have been underutilized in most of the country. Biden announced additional federal purchases of these medicines and a push to have more providers, including pharmacists, administer them. Employer-sponsored health insurance would not pay for the cost of the medication but would likely be responsible for the cost of intravenous administration. This could save lives and lower costs as it could reduce COVID-19 hospitalizations and intensive care stays.

The requirement for employers to mandate vaccinations or weekly testing will have an enormous impact on U.S. employers, who have increasingly been recognizing that communication, time off and incentives help increase vaccination somewhat, but aren’t going to get us to near-universal vaccination. Employers recognize that unvaccinated employees represent a risk to their organizations — both a risk that they will bring COVID-19 into the workplace and infect fellow employees, or customers or clients, and a risk that if there is a workplace exposure there could be business interruption as many employees require quarantine.

Many employers will greet this news with at least a bit of a sigh of relief. Mandates are the most effective way to increase population vaccination, and if all employers have such a mandate, employers need not worry that employees will leave because of the mandate. This could also create national consistency, so employers don’t face different rules on vaccine and testing mandates from state to state.

But few employers welcome additional regulation and oversight, and some object to mandates on principle. The DOL must still write the rules to implement these executive orders. As opponents go to court, there is some danger that the uncertainty around these requirements could encourage some ambivalent employers to delay vaccination mandates until the litigation is resolved.

Note: For additional information, please see our article “Should Your Company Implement a Vaccine Mandate” in Harvard Business Review, last week.

Delta surge might have peaked

We saw a decrease in the average daily cases from about 150,000 last week to about 140,000 this week. Hospitalizations and deaths, which usually lag cases, are also down. Other countries have found that viral waves subside after two to three months — possibly due to increased vaccination, more natural immunity or increased masking, distancing and immunization by those concerned with infection rates.

The return to school and huge gatherings with no distancing or masking could interrupt the decline in cases. In the U.S., we are clearly going into the fall with a much higher rate of community transmission than we had last year.

Still we’re up to 75% of adults with a single vaccination, and we had 14 million new people get their first vaccinations in August — up from just 10 million in July. Notably, two mRNA vaccines are more effective against Delta than a single shot, although a single shot might be effective for those who have previously had COVID-19. We are not likely to have the type of devastating wave this winter that we had in 2020 because of our higher levels of immunity from vaccinations and natural infections.

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

The seven-day moving average was 135,749 on September 10, 2021.
Source: CDC

Delta in children

The American Academy of Pediatrics published new data showing that pediatric cases of COVID-19 continue to rise. Five million children have been diagnosed with COVID-19 since April 2020, with a little under 20,000 hospitalizations and 444 deaths. Kids represent 15% of diagnosed COVID-19 cases, 2.4% of hospitalizations and 0.08% of total deaths from COVID-19.

The New York Times reported last week that the increase in pediatric COVID-19 hospitalizations is higher in the 10 states with the lowest vaccination rates, while there appears to be no increase in pediatric COVID-19 hospitalizations in the 10 states with the highest vaccination rates.

Clearly the reopening of schools represents a time of opportunity and danger. We’re excited that children will gain the academic and social advantages of in-person education. But we’re worried about the potential for outbreaks associated with schools. And we should worry. There were over 90,000 students quarantined for COVID-19 exposure in late August, even though most school districts were still on summer break.

We have the tools to decrease this risk substantially, by vaccinating teachers, staff and children age 12 and older who are now eligible for vaccination. Hopefully, we will see the first emergency use authorization for a vaccination for kids under 12 in mid-fall. Improved ventilation, masks and distancing can all help decrease risk too. Masking also means that fewer children will need to quarantine when there are cases in schools.

Employers will be watching schools carefully. Hopefully, we can limit school-related outbreaks so that parents will not have to return to supervising their children during school days, and we can learn how to reduce risk in the workplace from the efforts made in schools.

Author

---

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.

email Email

---