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How the Delta variant is changing employers’ plans

By Jeff Levin-Scherz, MD, MBA | August 17, 2021

Amid the surge of COVID-19 infections, many employers are delaying returning employees to the office.
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Risque de pandémie

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update by Dr. Jeff Levin-Scherz covering the latest developments related to the COVID-19 pandemic in the U.S. Explore the entire blog series.

Every state in the U.S. saw an increase in COVID-19 infection rate over the last two weeks, despite a decrease in the total number of tests performed. The Delta variant represents over 90% of new infections in the U.S. at this point, and the Centers for Disease Control and Prevention (CDC) suggests that it is more than twice as infectious as the previous dominant strain.

The seven-day moving average has risen sharply over the past month. For August 13, it was 119,523.
Daily trends in number of COVID-19 cases in the U.S. reported to the CDC

The seven-day moving average for August 13, 2021, was 119,523. Source: CDC

The rate of community transmission is highly correlated with the level of unvaccinated people. The graphic below illustrates the dramatic difference in infection rates between the states with the lowest rates of vaccination (LA, MS, AL) and those with the highest (CT, VT, MA).

States with high vaccination rates (above 70%) have far fewer new cases of COVID-19 per 100,000 than those with rates below 50%. Alabama’s number of new cases was 120 vs Vermont with 12.
Correlation of infection rates and vaccination rates among states with lowest and highest vaccination rates

Source: CDC cases and vaccination rates, August 12, 2021.

Implications for employers: Many employers have delayed returning remote employees to the workplace and are restricting business travel amid the recent surge in new infections. We don’t want employees to get sick anywhere, but we especially don’t want them to get sick far from home. Efforts to decrease infections (vaccinations, masking, physical distancing) will require time to reduce infection rates, so most delays of return for remote workers will be long-lasting. Some companies have already announced that a return to the workplace will wait until 2022, and others have not yet announced a new date.

Schools can open safely, but vaccines and masks and distancing matter

2020 – 2021 was another challenging academic year. Most children were limited to remote learning for a substantial portion of the year, and math and language proficiencies fell significantly. Children missed school lunches and socialization, and parents had to deal with their full-time jobs and providing care for children who needed help with homework, technology and coping. We saw parents, especially moms, leave the workforce due to lack of in-person education for their children. This has been hardest on lower-income families, where parents often have to work multiple jobs and tend to have fewer opportunities to work remotely.

Pediatricians and public health experts overwhelmingly recommend a return to school, which will help to make sure our children don’t fall further behind and allow parents to have fewer distractions from their jobs. What does that mean in an era of the Delta variant, where vaccinations have only been approved for those 12 and over?

The Annals of Internal Medicine published a simulation model projecting that increased adherence to masks and distancing could substantially lower transmission of COVID-19 at school; weekly testing, isolating those with symptoms, quarantining affected classrooms and mandatory teacher vaccination all helped too. Nonetheless, there are likely to be outbreaks, especially in high schools in communities with low vaccination rates. Nine districts in Mississippi have moved to remote learning already, and one district in Arkansas reported quarantining over 800 students and teachers.

Parents and employers should be prepared for intermittent interruptions to in-person school attendance this fall.

Vaccines continue to provide robust protection against serious illness

There has been a lot of reporting about breakthrough infections, and the Delta variant seems much more likely to infect those who have been vaccinated compared to previous strains of the virus. But keep in mind these two facts:

  • The overwhelming majority of those who have gotten seriously ill with COVID-19 are unvaccinated.
  • The overwhelming majority of those who are vaccinated and who get COVID-19 have mild illnesses.

Massachusetts recently reported that three-quarters of those who were fully vaccinated and died of COVID-19 had serious underlying medical conditions and their median age was 82.5.

The Delta surge has been described as a “pandemic of the unvaccinated.” That’s true, but even those who are vaccinated should take notice of the increased risk posed by the Delta strain. The 2.7% of the population that is immunocompromised (those who received transplants, chemotherapy or use various drugs) might be at as much risk as those who are not vaccinated. And even those who have had vigorous immune responses might not have as robust protection as we perceived a few months ago.

A few additional vaccine notes:

  • Those who were previously infected but are unvaccinated are more likely to be reinfected: The CDC reported that those who had already recovered from COVID-19 and remained unvaccinated were twice as likely to have a second infection as those who were vaccinated.
  • The one-dose Johnson & Johnson (J&J) vaccine is also effective against the Delta variant. Data from South Africa showed that the J&J vaccine was highly effective at preventing Delta variant infection: 71% effective at preventing hospitalization and 95% effective at preventing death in a study of 480,000 healthcare workers. A laboratory study suggested that the J&J vaccine produced lower levels of neutralizing antibody — but real-world evidence is more compelling than a test tube study.
  • The effectiveness of the Pfizer and Moderna vaccines decreases over time: The Mayo Clinic reported that from January to July 2021, both the Pfizer and Moderna vaccines were highly effective at preventing COVID-19 infections (Pfizer 76%, Moderna 86%) and hospitalization (Pfizer 85%, Moderna 92%). Subsequent analysis of July data, when Delta peaked, showed a worrisome decrease in efficacy in preventing infection by both vaccines: Pfizer (42%) and Moderna (76%).
  • The CDC strongly recommended vaccination of pregnant women this week. Vaccination does not increase risk of miscarriage and transfers maternal antibodies to the fetus, giving newborns some protection from the virus. The vaccine is also safe and recommended for women who are breastfeeding.
  • The FDA gave emergency use authorization for a third mRNA booster shot for those with compromised immune systems such as those who have had transplants or chemotherapy. Those who are generally in good health but are not clear if they should get booster shots should check with their clinicians.

Implications for employers: Getting employees vaccinated is even more important now, given the increased contagiousness of the Delta variant. Employers should not put in place limitations on payment of the administrative fee for a third vaccination. We’ve heard that a number of employers are considering premium surcharges, but these have significant disadvantages, and there are likely better ways to increase employee vaccination rates. My colleague Julie Stone and I coauthored an article, “Employers should think twice about using premium surcharges to boost vaccination” in

Employers are increasingly mandating COVID-19 vaccination

There is a growing move by employers to mandate vaccinations. The federal government has led the way; federal workers will be required to be vaccinated or undergo frequent COVID-19 testing by the fall, and the Department of Defense has announced that its employees will be required to be vaccinated after the FDA offers full approval to the first vaccine. The federal government is seeking to expand this mandate to contractors. The largest teachers union endorsed vaccine mandates for teachers, and the most influential healthcare organizations have encouraged vaccine mandates for healthcare workers. One airline (United) has announced a vaccine mandate and another (Delta) will require mandates for new hires.

Implications for employers: With the upcoming FDA full approval of at least one of the mRNA vaccines, we will see more vaccine mandates over the coming weeks and months. Religious and medical exemptions will usually be offered, and many will be required to test frequently if they are not vaccinated.

Masks work

Vaccinations alone looked like enough protection from COVID-19 in May when the CDC recommended that vaccinated people could remove their masks indoors in public spaces. A variant that is far more contagious means that we need to layer on additional approaches to maximize protection.

The severity of a COVID-19 infection is also likely related to how much viral material is taken into the respiratory system. Those who are masked when exposed to COVID-19 are less likely to get infected and are less likely to get especially sick from COVID-19. A better-fitting mask provides more protection than an ill-fitting mask. A mask on the chin provides no protection at all. For those who have compromised immune systems, N95 masks are now available to the general public, and KN95 masks provide more protection than simple surgical masks, which themselves provide more protection than cloth masks without filters.

A review of the efficacy of masks from the Proceedings of the National Academy of Sciences earlier this year concluded that “…nonmedical masks have been effective in reducing transmission of respiratory viruses; and places and time periods where mask usage is required or widespread have shown substantially lower community transmission.”

The CDC still recommends mask wearing in areas of high community spread, but most are unaware of infection rates in their areas. With the Delta variant still on the rise, it is prudent to wear a mask indoors.


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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