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Businesses need to keep COVID-19 plans up to date to ensure resilience

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD and Patricia Toro, MD | March 23, 2022

This moment of relative peace offers employers the opportunity to plan for a possible future wave of COVID-19. While no one wants to plan for another surge, the time to prepare for one is now.

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About the series

Dr. Jeff Levin-Scherz provides regular updates on the latest COVID-19 developments with a focus on the implications for employers and guidance on how they can tackle pandemic-related challenges to keep their workplaces safe. Explore the series.

The news from the U.S. on COVID-19 cases, hospitalizations and deaths continues to be good. We are down to 30,000 new cases a day, with 25,000 currently hospitalized and 4,500 in ICUs, and deaths per day are below 1,300. All these numbers are down over a third in the past two weeks.

There is concerning news from Europe, where we see substantial increases in cases across the continent and increases in hospitalizations in the U.K., France, the Netherlands and Austria. Cases in a number of Asian countries, including China (especially Hong Kong), South Korea and Singapore, are also on the rise. The Omicron sub-strain BA.2, which is 79% more contagious than Omicron BA.1, is partially responsible – and decreasing pandemic protective measures likely plays a role. Past European spikes have predicted a U.S. spike weeks later, and there is no reason for us to believe this time will be different. Further, our rate of booster shots is lower than those of most European countries.

Implications for employers:

  • Remain vigilant and continue efforts to encourage employee vaccination and boosting and to provide good ventilation.
  • See the next section for suggestions on employer pandemic preparedness.

Employers should make plans now for addressing future outbreaks

In response to the improving COVID-19 situation, many employers are loosening their pandemic restrictions while starting to bring their employees back to the workplace. This moment of (relative) peace offers employers the opportunity to plan for a future wave of cases. While no one wants to plan for another future surge, here is why now is the time to do so:

  • Omicron BA.2 is more contagious than the previous strain.
  • For any future variant of concern to take over the globe, it will need to be more contagious than Omicron. In other words, when a wholly new variant of concern spreads it may take over quickly.
  • Case numbers are increasing in Europe, Asia and Africa, including in many countries with higher vaccination rates than in the U.S. The increase in new cases is likely partly due to BA.2 but also to an earlier discontinuation of all pandemic restrictions. It’s likely the U.S. will see something similar in the coming weeks.

What should employers be doing at this time?

  • Determine what pandemic measures your organization will maintain, including promoting vaccination and improving ventilation. Successful communication of these efforts can help reassure employees and build trust.
  • When removing current pandemic safety protocols (masking, distancing, testing, vaccination requirements), determine which metrics would lead to reinstating such measures.
  • Decide which data will guide specific pandemic protection actions. Will your organization use the CDC community transmission levels or some other rubric? Which pandemic protection measures (masking, partial remote, full remote) will be put in place?

Once employers have completed this planning, any future outbreaks will be less likely to distract them from their business priorities. This approach will enable organizations to respond efficiently and quickly to any changes in local situations, which could happen rapidly and sooner than any of us want.

The future of “Test to Treat”

The Biden administration announced last month that part of returning to normal will be to make COVID-19 testing widely available at pharmacies and have all people with positive tests leave the pharmacy with a prescription in hand. This is important because the available drugs (Paxlovid and molnupiravir) must be given three to five days after symptoms begin. Additionally, these drugs reduce infectiousness, so better to get them into the hands of patients before they feel well enough to forget about filling them. Also the U.S. has the lowest portion of people who have a relationship with a primary care physician among developed countries, so requiring a physician visit will be hard for many, will certainly create additional costs and take up valuable physician visits that might address other important concerns.

So far things are not going well for this plan. Congress hasn’t supported the billions the Biden administration proposes to spend for vaccinations and therapeutics, which means that these products will likely be funded through employer-sponsored health plans in the next few months. The American Medical Association opposed allowing pharmacists to prescribe these medications, although less than 10% of pharmacies around the country have a nurse practitioner or other prescriber on premises.

Implications for employers:

  • Employer-sponsored insurance costs will increase if the federal funding for COVID-19 vaccinations and therapeutics ends. This is likely during the 2022 calendar year.
  • Pharmacist prescribing could lower the cost and increase access to these medications.

COVID-19 and diabetes

The Lancet published data from a large record review at the U.S. Veterans Administration showing a 40% increased risk of diabetes in those who had been diagnosed with COVID-19. Although, recent evidence shows that good control of Type 2 diabetes is associated with decreased risk of severe complications or death from COVID-19. The graph below shows the mortality risk for adults from a series of almost 40,000 diabetics cared for at 35 different centers in the U.S.

Keeping blood sugar levels (HBA1C levels) low and under control, at 7 or below, can greatly decrease mortality risk in diabetes patients.
COVID-19 mortality risk by HBA1C

Note: “HBA1C” is a marker of long-term blood sugar levels; lower is better.
Source: American Diabetes Association

Not only do diabetics do better with COVID-19 if their diabetes is under good control, but children are less likely to be diagnosed with diabetes if they don’t get COVID-19.

Researchers reviewed two sets of claims records for children under age 18. One showed that diabetes rates increased by 166%; the other showed new diabetes rates increasing by 31%. Both of these findings are highly statistically significant. Previous reports of increased rates of diabetes came from the U.K. and Romania, and there are also reports that more children with new-onset diabetes have presented with life-threatening diabetic ketoacidosis during the pandemic. A large registry in Germany showed a significant increase in Type 1 diabetes in children, which began about three months after the start of the pandemic.

Implications for employers:

  • Programs to encourage better diabetes control, including value-based pharmacy design and diabetes virtual care programs, can lead to better COVID-19 outcomes.
  • Vaccinating children ages five and over decreases the risk of COVID-19 infection and may decrease the incidence of new-onset diabetes.

COVID-19 and young children

Young children have always been less likely to become severely ill with COVID-19, but there were more hospitalizations of young children during the Omicron wave than at any point earlier in the pandemic.

Rates of hospitalizations in children under age five peaked at over 1,400,000 in mid-January 2022, amid the Omicron wave.
Hospitalizations per 100,000 in children age five and under

Source: Centers for Disease Control and Prevention

Both Pfizer and Moderna are expected to provide further data on their studies of COVID-19 vaccination in children, and many parents will continue to anxiously await approval of a vaccine for preschoolers. In the meantime, the U.S. has only vaccinated 27% of children ages five to 11, and 58% of children ages 12 to 17.

Risk of myocarditis increases 145.2% in patients age 12 to 30 after a COVID diagnosis. For this same age group, it increases 8.6% after receiving a COVID vaccination.
Risk of myocarditis in patients ages 12 to 30

The 30-day risk of myocarditis in patients ages 12 to 30 after a COVID-19 diagnosis is much higher than either historical (pre-pandemic) incidence or risk after receiving a COVID-19 vaccine.
Source: Epic Health Research Network

Implications for employers:

Pfizer and Moderna have both now requested FDA authorization for second boosters for adults. Second boosters are currently only recommended for those in the U.S. who are immunocompromised. More on this next week.

Authors

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led WTW’s clinical response to COVID-19. 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.


Senior Director, Health Management Practice, Health and Benefits

Patricia is a physician and infectious disease specialist who consults with employers to improve the quality and cost-effectiveness of health care delivery. She has guest lectured at Harvard Medical School and currently develops pandemic responses and programs to address chronic conditions.


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