Omicron causing strain on employers and hospitals despite being less dangerous

Rates of new cases of COVID-19 have increased rapidly, and in 36 states there is not enough hospital capacity or a threat of running out of hospital capacity due to this wave of COVID-19 infections.

The Centers for Disease Control and Prevention (CDC) chart below shows the problem (blue line is the seven-day moving average of cases, yellow line is hospitalizations).

New daily cases and new daily hospitalizations

Source: CDC, January 7, 2022.

The good news is that the ratio of new cases to hospitalizations is three times lower compared to the peak of January 9, 2021. The bad news is that we have about three times as many newly diagnosed cases, so we see the same 16,500 new hospitalizations this January as we saw last January. Neither new cases nor hospitalizations seem to have peaked yet, so in the healthcare delivery system conditions will continue to get worse over the next few weeks, after which we will hopefully see a decline in new Omicron cases.

The problem of healthcare system capacity is not limited to hospitals. At one community health center in Boston, a quarter of the staff are out with COVID-19. This means a limit to urgent care and well-child visits, so vaccinations will again decline. Many hospitals around the country are postponing elective surgery. This includes surgery to remove cancer and surgery to address serious orthopedic injuries – so this delay will certainly worry patients and could also worsen outcomes and costs later this year.

Thousands of schools across the country have moved to remote sessions, either due to high rates of infection of students or shortages of staff due to employee illness or quarantining.

Implications for employers

• The high rate of infections will likely continue to cause widespread business disruptions; we’ll need to be more flexible.
• Telemedicine continues to be critical to address employee and family immediate needs and is especially helpful for those with compromised immune systems.
• Claim costs will likely decrease during the peak of Omicron as non-COVID-19 treatment is delayed, but much of this will come back after this wave has passed.
• Parents will need continued support as they balance work and childcare.
• Mental health needs from the pandemic are likely to increase.

Evidence grows that Omicron leads to less severe disease

Studies continue to show that those who are infected with Omicron are likely to be less sick than those who were infected during previous waves of COVID-19. It appears that this variant is better at evading immunity and replicates even more rapidly in the upper airway leading to increased transmissibility. But it replicates less effectively in the lungs, leading to less respiratory failure.

The Journal of the American Medical Association published data from the recent Omicron wave in South Africa based on 17,200 patients seen in emergency departments of a 49-hospital system. The study showed that fewer patients were admitted with acute respiratory conditions during Omicron than during the first three waves of COVID-19.

This percentage is less than half of those admitted with respiratory distress during South Africa’s three previous waves.

South Africa: Admissions and respiratory status

Caroline Maslo, MD, PhD, et al, Characteristics and Outcomes of Hospitalized Patients in South Africa During the COVID-19 Omicron Wave Compared With Previous Waves, JAMA, December 30, 2021.

Data from a preprint (not yet peer reviewed) study of over 575,000 newly diagnosed cases of COVID-19 across multiple healthcare systems in the U.S. show that Delta was far more likely to cause emergency room visits, hospitalizations, intensive care stays and mechanical ventilation. The data also show that the difference extends to those under five years of age, who are not yet eligible for vaccination.

and hospitalization rates were half the amount occurring with Delta.

Omicron and Delta: Three-day outcomes

Source: Wang, et al, Comparison of outcomes from COVID infection in pediatric and adult patients before and after the emergence of Omicron, MedRxIV, December 30, 2021.

Implications for employers

• While many more employees and family members will get Omicron, a smaller portion of them will become exceptionally ill.
• Still, as noted above, we’ll see many more employees on sick leave but hopefully for shorter periods of time.
• We don’t know whether this wave of infections will have a similar rate of long COVID-19 compared to earlier waves. This could have a large impact on future disability claims and worker turnover.

Oral COVID-19 medications are slowly becoming available

The Omicron variant evades immunity offered by two previously available monoclonal antibodies, REGEN-COV (Regeneron), and bamlanivimab and etesevimab (Lilly). The monoclonal antibody that remains effective, soltrovimab (Glaxo Smith Kline), is in short supply. The two promising oral drugs, molnuprivir (Merck) and paxlovid (Pfizer), are slowly becoming available at pharmacies, but are still in limited supply. They are indicated for treatment of those with laboratory-diagnosed COVID-19 who are at high risk for complications and must be given within three to five days of symptoms.

Implications for employers

• The federal government has purchased all supplies of these medications at this point, and employer-sponsored health insurance pays for administration only – not ingredient cost.
• Supplies are severely limited and only available in select pharmacies. Supplies are expected to expand significantly by the spring.
• Pharmacy benefit managers have instituted pharmacy administration or program fees and will implement age and dispensing limitations.

New CDC recommendations on vaccines

The CDC now recommends booster shots when eligible for all those age 12 and up. Booster eligibility begins at five months (Pfizer and Moderna) and two months (Johnson & Johnson) after the primary series. The agency also recommends an additional dose for both children over age five and adults who are immunocompromised.

CDC vaccine recommendations

Implications for employers

• If the OSHA emergency temporary standard is upheld, employer mandates will be for “full vaccination” rather than for “up to date on vaccination.”
  Note: The definition of “fully vaccinated” is still a single J&J vaccine or two Pfizer or Moderna vaccinations, although the definition of “up to date on vaccination” now includes getting booster shots, if eligible.
• Nonetheless, employers should track booster shots, which adds substantially to employee protection and might be required by regulations at some point.
• Some universities, hospitals, financial services companies and states have announced booster-shot mandates.
• A simulation model from Yale School of Public Health and the Commonwealth Fund shows that doubling rate of booster shots could prevent 14 million COVID-19 cases, 400,000 hospitalizations and 41,000 deaths by this May.

New CDC recommendations on quarantine and isolation

Quarantine (for those exposed to COVID-19, whether in the workplace or elsewhere):

• Those who are up to date (i.e., boosted, if eligible) on vaccination or had a positive COVID-19 test result in the last 90 days should carefully wear a high-quality mask when indoors with others.
  • Those with symptoms should be tested with a PCR test.
• Those who are unvaccinated or have not gotten a booster and are eligible for one should quarantine for five days. If available, they should do a rapid test at five days and, if positive, quarantine for another five days. In any event, they should wear a well-fitting, high-quality mask for the full 10 days.

Isolation (for those diagnosed with COVID-19):

• For the first five days, those diagnosed with COVID-19 should stay at home and wear a well-fitting, high-quality mask around others at home.
• After five days, they can end isolation if they don’t have a fever and symptoms and can do a rapid test, if available. They should wear a well-fitting, high-quality mask for a total of 10 days. They should not travel for a full 10 days after exposure and should avoid places with high-risk people (nursing homes) and avoid places where you cannot wear a mask (restaurants, gyms) for the full 10 days even if they have no symptoms.
• Immunocompromised people might need longer isolation – and should talk to their healthcare providers.

Implications for employers

• Shorter isolation periods can help decrease business interruptions.
• Those who are exposed or who have recovered from COVID-19 should wear masks for at least 10 days, regardless of their test status.
• The CDC specifies well-fitting masks, but many public health experts would go further and say they should wear high-filtration masks (KN95, KF94 or N95), as some with COVID-19 may be infectious for longer than five days, and some who are exposed to COVID-19 might get sick more than five days after their exposure. Los Angeles will require employers to provide high-quality masks to employees as of mid-January.

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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