Employers may end mask and distancing rules as case and hospitalization rates continue to decline

We continue to see a decline in new cases of COVID-19, and the total number of Americans hospitalized with COVID-19 is down by almost a third in the last two weeks. Infection rates are down across the country, although virtually every county continues to have a “high risk” of community transmission, with more than 100 cases per 100,000 per week. Some public health officials are recommending continued mask wearing and distancing, while governors of most of the states that had statewide mask mandates plan to cancel them.

New cases and hospitalizations (seven-day average)

Source: CDC, February 13, 2022

We are indeed in a much better place than a month ago. We have far higher immunity – both from vaccination and infection. Access to treatment for COVID-19 is improving since many hospitals have improved capacity. The access to more effective drugs, including Paxlovid and molnupiravir, as well as home COVID-19 tests is increasing.

But there is room to increase our protection. Our primary vaccination rate is stalled, and less than half of eligible adults have had booster shots. Fewer than a quarter of children ages five to 11 have been vaccinated. Since we are likely to see a future wave of COVID-19, we’d be wise to use this relative lull in cases to increase vaccination and boosting rates.

Pretty much everyone is tired of the pandemic and pandemic-related restrictions, and most of us would like to go back to life as “normal” before we wore masks, stayed six feet away from others, avoided restaurants and movie theaters, and stopped traveling. Some want to pivot right back to pre-pandemic behaviors, while others remain nervous. People’s point of view is often not well-correlated with their risk, either.

An Axios/Ipsos poll from last week sums up the wide array of preferred approaches at this point.

How should the U.S. handle COVID-19 at this time?

Survey of 1,049 adults, conducted between February 4 – 7, 2022.
Source: Axios/Ipsos Poll

More Americans would like us to move away from current precautions (50%), although most of those favor continuing some precautions. About one in five want more restrictions. The only category above without a strong partisan divide is “move toward opening up with precautions.”

The WTW Global Benefits Attitudes Survey, with 9,000 respondents surveyed from December 1, 2021 to January 3, 2022, shows similar ambivalence. The majority supported employer vaccine mandates (58% versus 23% opposed). Even here there is polarization, though. Employees already subject to vaccine mandates support mandates (72% support with 10% opposed); those who work at companies without pandemic restrictions oppose vaccine mandates (36% support and 46% oppose).

The coronavirus pandemic has changed what normal means. Even when we reach endemicity – and we are not yet there – we will continue to be exposed to an evolving virus that is highly contagious, affects many different organ systems and is deadly for high-risk populations. In our new normal, new variants will appear and immunity will wane over time.

We need to acknowledge both that the risk of COVID-19 is dramatically lower than it was a month or a year ago and that residual risk remains. What makes this period especially challenging is that this risk will likely increase and decrease at different times and in different places, in ways we can’t yet predict.

Implications for employers:

• Many employers are reluctant to have workplace restrictions beyond those required by local or state authorities. This means that many mask or distancing mandates are likely to end soon, and many remote workers may return to the workplace.
• Improved ventilation and filtration can continue to protect all workers from COVID-19, influenza and other respiratory diseases. This can help decrease illness in those with asthma, too.
• The risk for most healthy, vaccinated workers is low as the rate of community transmission goes down, and few healthy people under age 65 with up-to-date vaccination (including boosters) are hospitalized when they get infected.
• Employers should be sure that employees feel comfortable to wear a mask when not required and should support employees who choose to follow extra precautions to protect themselves and their families.
• Employers should also support those employees who wish to continue videoconferencing to avoid business travel and clearly instruct employees who feel ill not to come to the workplace.
• This new phase of the pandemic, hopefully the off-ramp, will require enormous flexibility. Employers who deploy what WTW’s John Bremen calls elastic innovation (simultaneously managing short-term disruption while making progress on long-term goals and strategies) will gain a competitive advantage.

Influenza infections on the way down

Another piece of good news is that influenza infections are down more quickly than during most pre-COVID-19 flu seasons. This is a relief, as co-infection with influenza and COVID-19 leads to higher mortality, and hospitals are just starting to get relief from the Omicron wave of COVID-19 infections, which disproportionately affected the unvaccinated.

Summary of influenza positive tests reported to CDC

Results of tests performed by clinical U.S. laboratories.
Source: CDC

Implications for employers:

• Pandemic restrictions probably helped tamp down influenza this winter, although employers should continue to be watchful for an upswing as more employees shed masks.
• Influenza is often seen as late as May or June, so employees can still gain some benefit from flu shots, especially if case rates rise again.

COVID-19 causes heart complications for a full year after recovery

Researchers at the Veterans Administration matched over 150,000 patients who recovered from COVID-19 with over 5 million who had not had COVID-19 to look at the incidence of various cardiovascular complications in the year after initial diagnosis. The excess risk of cardiac events was large in the 12 months after infection: a 69% increased risk of any cardiovascular event, a 55% increased risk of a major cardiovascular event and a 52% increase in the risk of stroke. Many have talked about the myocarditis risk of vaccinations (which is small, concentrated in teenage boys and young men, and can be lowered by a longer interval between the first and second shots). The cardiac risk of COVID-19 is dramatically higher than the cardiac risk due to the vaccination.

Next were pulmonary embolism (2.93) and cardiac arrest (2.45).

Relative risk of cardiac event 12 months post-COVID-19 recovery

Source: Nature Medicine

Implications for employers:

• We should continue to promote vaccination to prevent these cardiac consequences.
• The impact on the employed population is probably somewhat lower than the impact on the Veterans Administration population, which is older and generally has a higher underlying rate of illness.

COVID-19 causes worse pregnancy outcomes

Pregnant women continue to be vaccinated at lower rates than age-matched adults, leading to bad pregnancy outcomes. JAMA published a study this week of over 14,000 births at 17 hospitals across the U.S., showing that the 5% of pregnant women who had moderate to severe COVID-19 were twice as likely to lose their fetus, almost three times as likely to have severe hypertension, almost 50% more likely to have a cesarean section, and 13 times more likely to need intensive care. Earlier research showed that COVID-19 also increases the risk of stillbirth more than twofold. Researchers recently identified that the virus attacks the placenta, decreasing oxygen available to the fetus.

For example, intensive care admission rises from 1% (no COVID) to 13% (mild to moderate COVID) and risk of hemorrhage is more than double.

Pregnancy complications of COVID-19

Source: JAMA Network, “Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications”

Implications for employers:

• COVID-19 vaccination for pregnant women is strongly recommended by the CDC, the American College of Obstetrics and Gynecology, and the Maternal and Fetal Medical Society.
• Employers with vaccine mandates should use this information when assessing requests for medical exemptions for pregnancy.

The pandemic has caused substantial excess mortality among those of working age

The COVID-19 pandemic has led to substantial excess deaths in the working-age population. Some life insurers are reporting unexpected payouts, and are raising insurance rates especially in geographies with low vaccination rates.

Below is the CDC data. The pink lines show the weekly death rate from 2015 – 2019, and an increase of about 60% for ages 25 to 44, and an increase of 30% (2020) and 50% (2021) for those 45 to 64 from the 2015 – 2019 baseline. For the 45 to 64 age group, the death rates are 13% higher (2020) and 24% higher (2021) compared to the 2015 – 2019 baseline. This represents 109,000 excess deaths among those 25 to 44, and 208,000 excess deaths among those 45 to 64.

Weekly counts of deaths by age group

Source: CDC February 10, 2022

Implications for employers:

• We should continue to be respectful of the dangers of COVID-19. Although deaths are concentrated in the elderly and the sick, these pandemic years have led to substantial excess deaths among those in the prime of working age.
• Historians have noted high mortality and substantial business disruption during the final wave of pandemics, which often happens after people stop paying attention.

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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