How employers are responding to Omicron

It’s been two weeks since my last note, and while many of us were on holiday break, Omicron has become the dominant COVID-19 variant in the U.S., and infection rates are shockingly high. The U.S., Canada, the U.K. and the European Union have all seen sharp spikes in infections over the past several weeks.

I live in the Boston area, where our water authority has tracked COVID-19 through viral DNA in wastewater since the beginning of the pandemic. The amount of viral material detected now is so high that the “y” axis was reset, dwarfing last winter’s surge.

As of January 3, 2022, levels were more than three times that amount (over 16,000 copies/ml).

COVID-19 wastewater tracking 2020 – 2022, Boston, Massachusetts

Source: Massachusetts Water Resources Authority, January 3, 2022.

There are worrisome reports of hospital staffing and bed shortages in a number of states, but this surge may be different from previous ones, for several reasons:

1. Omicron spreads even more quickly. People with Omicron can be contagious earlier, and it can spread with far less contact. This has led to dramatic increases in case rates. We see earlier decline in case counts in South Africa, which is promising. It’s early though, and South Africa has a younger population and it’s now summer there.
2. Omicron appears to cause less severe disease – perhaps because it isn’t as effective at binding to cells in the lungs. The rate of patients being hospitalized, needing oxygen ventilation and dying appears substantially lower than previous COVID-19 waves. Still, a virus that infects more people can overwhelm hospitals even if a smaller portion of those infected require intensive care.
3. Many more people have immunity either through vaccination or previous infection. While neutralizing antibodies from previous infection or vaccination appear less effective against Omicron, T-cells continue to vigorously fight this variant. Those who have immunity are much less likely to be hospitalized or die. Those without immunity are likely to be contagious for longer than those with immunity.
4. We better understand the airborne spread of SARS-CoV-2, so we can concentrate on mitigation efforts likely to be successful like high-filtration masks, ventilation and decreased density of people — rather than be distracted by deep cleaning and plexiglass barriers. (We should still wash our hands as part of basic hygiene, but this virus is rarely spread through surfaces.)
5. We are not leveraging “nonpharmacologic measures” to blunt the impact of the Omicron surge. Beyond some localities requiring indoor masking, few local or state public health agencies are discussing using effective non-pharmacological interventions (like restrictions on gatherings) to blunt the impact of this Omicron surge.

The Omicron variant surge has caused substantial disruption of air travel over the holidays, and this disruption is likely to continue over the next few weeks as more people, including those who are vaccinated, get sick and test positive.

What Omicron means for employers

Here’s what employers should consider as we start the new year:

• We are likely to have at least a number of weeks of high infection rates, so employers should expect business interruptions including:
  • Workers will be out sick or in quarantine. This has led to thousands of flight cancellations over the holidays. Note: Quarantine for up-to-date vaccinated workers is now only five days, although the CDC is considering adding testing at the end of five days in order to end quarantine.
  • We could see additional supply chain challenges, again due to worker shortages during the Omicron surge.
• Most employers will put plans to return remote workers to the workplace or resume business travel on hold temporarily.
• Vaccinations are even more important, as those who are vaccinated are over 80% less likely to be hospitalized. Those who are vaccinated are getting COVID-19 in high numbers but, for the most part, they are not getting seriously ill.
• This remains a very hazardous time for those with compromised immune systems – about 3% of U.S. adults. Immunocompromised employees often have little response to vaccination, and are more likely to get sick, be hospitalized and die of COVID-19.
• Employers can protect their employees through increasing vaccination rates, but that’s not enough. They can also increase worker safety by:
  • Decreasing the density of workers, so that fewer people are close together for shorter times. Omicron doesn’t respect the rule of “six feet apart for less than 15 minutes,” and there have been reports of people getting infected through hotel hallway doors opened only briefly in quarantine hotels.
  • Requiring indoor high-quality masks
  • Increasing ventilation or increasing air filtration
  • Implementing testing to decrease the chance of spread from infected employees who have few symptoms
  • Continue to offer paid sick leave to discourage those who feel ill from coming to work
• Some employers, including Goldman Sachs, the state of New Mexico and a number of universities are mandating COVID-19 booster shots.
• The new quarantine guidance noted above (for five days) is for individuals who had their primary vaccine series in the last six months. Individuals who had their primary series more than six months ago are being treated for the purposes of exposure management as if they are not vaccinated.

Reasons to avoid getting COVID-19 now

Some have remarked, “We'll all get COVID-19 anyway, so why bother avoiding it now?” Even if the virus is endemic and we will all have exposure, those who have high amounts of immunity are likely to fair better in the long term. There are excellent reasons to avoid getting COVID-19 now:

1. It’s best not to get sick when there is a surge of hospitalizations. Full intensive care units could lead to tens of thousands of preventable deaths, not just of those infected with COVID-19.
2. Avoiding getting COVID-19 now helps break the transmission chain and can protect those at high risk, including the elderly, children under five who are not eligible to be vaccinated and those whose immune systems don’t work well.
3. Medical treatment of COVID-19 keeps improving, and there will soon be available oral antiviral drugs that will further decrease the risk of getting severely ill.
4. The only way to avoid getting long COVID-19, also known as Post-Acute Sequalae of SARS-CoV-2 or PASC, is to not get infected with COVID-19!

Personally, I now use and reuse N95 masks for indoor shopping, and I’m avoiding indoor restaurants or movie theaters until there is substantially less community spread.

If you cannot avoid contact with others outside of your household (because of your work or if you are caring for a loved one) then try to consistently wear a high-filtration mask (KF94, KN95 or N95) when you are with others, limit your time indoors with others to the extent you are able and use antigen tests (when you can purchase them). Moreover, it’s important that you be vaccinated and get a booster as soon as you are eligible.

Despite high infection rates, Omicron appears to be far less severe

I was talking to my brother, who lives in Brooklyn, N.Y., just before New Year's Eve. New York City was the epicenter of COVID-19 in spring 2020, and it is again the epicenter now. It was a warm late December afternoon, and he was sitting on his porch. He told me that he knew more friends who had COVID-19 right now than he did during any of the previous waves. He also told me “in spring, 2020, there would have been the constant shriek of ambulance sirens.” When we spoke, the streets were quiet.

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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