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About the series
There are two totally opposite narratives going on now about where we are in this pandemic. Some are saying “Omicron cases are falling, and this is the end of the pandemic. Throw off your masks, and let’s move on!” Others are saying, “The hospitals are still jammed; there might be other variants just around the corner and we should be prepared to hunker down for the undefinable future.”
The answer is probably somewhere in between these two viewpoints.
Case counts in the U.S. have started to decline, but this is the sum of case counts in each local area, so some geographies will continue to have increased cases. Most estimates suggest that the reported cases (755,000 average daily cases during the last week) dramatically understate the actual cases, since many are diagnosing themselves with rapid tests and these results are not reported to public health authorities. This is consistent with my experience; none of those in my extended family who have had COVID-19 infections in the last month have been included in The Centers for Disease Control and Prevention (CDC) reporting.
Hospitalizations continue to increase, and there are now about 21,000 new hospitalizations daily. People are usually hospitalized well over a week after their first symptoms, so we could see a continued increase in hospitalizations over the coming weeks. About a third of counties’ hospitals in the country are already or projected to be at or over capacity, so as Surgeon General Vivek Murthy has stated, “The next few weeks will be tough.”
But we are reaching a point where we should begin to prepare for a world where most of us go about our daily lives without COVID-19 being top of mind. Increasing immunity, from both vaccinations and infections, coupled with better therapies mean that most people should soon be able to spend time indoors with others without a large risk of severe illness or death. I am waiting until both community transmission rates and hospitalizations ebb before going to indoor restaurants, but I think that will come soon.
Those who are elderly and those who have compromised immune systems (about 3% of adults in the U.S.) will remain at higher risk. Even when we achieve low rates of community transmission, these individuals will likely need to continue to be more vigilant, and many will continue to wear high-quality masks when in crowded indoor spaces.
There is a monoclonal antibody (evusheld, AstraZeneca) that provides six months of protection against COVID-19. This is in short supply but could be valuable to protect the most vulnerable in the future. Oral medications (paxlovid and molnupiravir) are also currently in short supply, but in the future could be used much as anti-influenza drugs are now used to prevent severe illness, hospitalization and death in those exposed or recently infected.
The coronavirus has thrown us a lot of curves over the last two years, and there could be more to come. There are likely to be future variants, some of which could lead to more severe disease or be more infectious than Omicron. Even when we achieve low community transmission rates of COVID-19, the world likely will not look just as it did in the fall of 2019.
Implications for employers:
Seventy-three percent of all U.S. adults are fully vaccinated, but only 42% of pregnant women are fully vaccinated. There have been over 160,000 cases of COVID-19 in pregnancy, and 263 deaths, and research shows that the risk to pregnant moms and their unborn babies is high.
Research from electronic medical records in the U.S. shows an eight times higher rate of stillbirth in women who had positive COVID-19 tests in pregnancy; the greatest danger was in the third trimester. Researchers also found a 30% increased rate of babies who were small for gestational age, which predisposes them to developmental delays. Data from Scotland shows that the fully vaccinated were about 10 times less likely to be hospitalized, and about 30 times less likely to be treated in intensive care units compared to the overall population. All the stillbirths in this study were in the unvaccinated group.
Antibodies from vaccination are created by the immune system, and these natural antibodies pass through the placenta and provide some protection to newborns after delivery, too. Vaccination doesn’t interfere with fertility, and the Centers for Disease Control and Prevention, the American College of Obstetrics and Gynecology, and the Society for Maternal and Fetal Medicine all recommend that women who are pregnant or considering pregnancy get fully vaccinated as soon as possible.
Implications for employers:
Omicron might have infected as much as a quarter of the U.S. population over the last few weeks, and all of us know many people who had COVID-19 infections even though they were fully vaccinated and boosted. Omicron has a high ability to infect those with previous immunity from vaccination or infection – although most who were fully vaccinated, and especially those who were boosted, had relatively mild symptoms.
Evidence is now pouring in that the vaccinated continue to have dramatically lower risk of being hospitalized, treated in intensive care and dying. The CDC released data for December, when Omicron was already prevalent, showing that the unvaccinated were 16 times more likely to be hospitalized than those who were vaccinated.
Source: CDC January 20, 2022
The United Kingdom’s National Health Service also released data last week showing that the protection from two doses of vaccines wanes to just 44% by six months but is restored by booster shots.
Source: U.K. Health Security, January 14, 2022
Switzerland has published data on the impact of vaccination and boosting on mortality. Those who are unvaccinated are nine times more likely to die than those who have two shots, and 48 times more likely to die than those who are boosted.
Death rates are calculated as the number of deaths in each group, divided by the total number of people in this group (per 100,000 people) Source: Our World in Data, Creative Commons License January 21, 2022
Implications for employers:
We’re all familiar with the placebo effect, where people have improved symptoms when they expect to get better, even if they are being treated with no active ingredients. The “nocebo” effect, where people have an adverse side effect of a placebo, is less well known, but also powerful.
Researchers performed a meta-analysis of 12 studies of various COVID-19 vaccines with over 45,000 participants and discovered that about a third of those who were not given active vaccinations nonetheless had systemic adverse effects.
Source: Haas, et al JAMA Network Open January 18, 2022
The most common systemic adverse effects among those who did not receive the active ingredients were headaches (19% first dose, 16% second dose) and fatigue (17% first dose, 15% second dose). The researchers point out that these “nocebo” effects represent about three-fourths of systemic adverse effects for the first dose, and half for the second dose. They conclude that “informing the public about the potential for nocebo responses may help reduce worries about COVID-19 vaccination, which might decrease vaccination hesitancy.”
Implications for employers: We can be reassured that at least some portion of systemic adverse effects being attributed to COVID-19 vaccinations do not represent physical manifestations of the vaccines. Nonetheless, these symptoms are quite real to those who have them.
Researchers have observed that the major symptoms from Omicron are not the same as Delta’s and previous variants of SARS CoV2. Researchers in the U.K. found that sore throat was twice as common with Omicron, while loss of taste or smell was about 80% less likely. A crowdsourced project showed similar results: Sore throat, runny noses and sneezing were more common; headaches and fatigue were similarly common, but cough, loss of sense of smell and shortness of breath were less common.
Source: Insider January 14, 2021 and Zoe Project January 6, 2021
Implications for employers:
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.
