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Employers face uncertainty around mandates, Omicron variant and new ruling on at-home testing costs

By Jeff Levin-Scherz, MD, MBA | December 7, 2021

COVID-19 cases are down, but we could see an increase after holiday gatherings.
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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 Centers for Disease Control and Prevention (CDC) reported that new cases of COVID-19 are down over the last two weeks. We are now at 80,000 new cases daily, down from 95,000 new cases a week ago. However, many states are behind on reporting due to the Thanksgiving holiday, and some experts predict a bump from holiday gatherings. New hospital admissions are up 5%, which reflects the higher rate of infection in past weeks. Average deaths per day have dipped below 1,000.

Seven-day moving average number of new COVID-19 cases was 106,132 on December 3, 2021.
Daily trends in number of COVID-19 cases in the U.S. reported to the CDC

Source: CDC, December 3, 2021.

Implications for employers:

  • Most counties continue to have high rates of community transmission of COVID-19, and this might get worse with the spread of Omicron.
  • Most companies will monitor infection rates carefully and make changes in remote working based on reporting in the coming weeks.

Omicron identified in the U.S.

The first cases of Omicron were identified in the U.S. While some patients had recently traveled in southern Africa, many appear to have been infected in the U.S., including infections that happened before the Omicron variant was reported to the World Health Organization. Many of the cases were in people who had been vaccinated. The rate of genetic surveillance of positive PCR tests in the U.S. is low and the timing is slow. The U.S. does genetic sequencing of just under 3% of samples and reports results in an average of 28 days, compared to the U.K., which does sequencing of 11.5% of samples and reports results in an average of 10 days. Omicron is likely already spreading in many U.S. communities.

We still don’t know whether Omicron will outcompete the Delta variant and become dominant, and we don’t know how well Omicron will overcome the immunity already in the population. Some early reports from Europe suggest that Omicron might cause less serious illness, but the number of cases remains small, and we should be cautious in interpreting this since those who have recently completed international travel are more likely to be vaccinated than the general population.

Implications for employers:

  • Vaccinations are likely to continue to protect against severe disease, even if they are less effective in preventing mild disease. Increasing employee vaccination rates protect workers, the community and decreases business risk.
  • Many employers are maintaining or reimposing travel restrictions and are delaying planned returns to the workplace.
  • Stay tuned. We will learn much more about Omicron’s contagiousness, ability to evade immunity and the severity of illness over the next few weeks.

New federal rules require employer-sponsored health plans to cover at-home COVID-19 testing

Rapid antigen tests are able to detect Omicron as well as other variants and remain much less expensive than PCR tests. The rapid at-home tests are not as sensitive to low levels of virus in the nose, but they are exceptionally good at detecting people who are currently infectious. My entire extended family used at-home antigen tests before our Thanksgiving gathering. These tests can help reduce community spread.

The Biden administration announced that at-home testing would be free, either through coverage by employer-sponsored health insurance or through federally purchased tests distributed at community sites. Regulations have not yet been established, and insurers will establish processes for member reimbursement for home tests. These tests are less expensive than PCR tests done in laboratories, but are likely to be used far more often, so this is a new unexpected cost for health plans. The operational hassles for members and the administrative costs for health plans will be significant. I hope we’ll see federal purchase and distribution of antigen tests as a public health measure, as opposed to driving up the cost and future premiums of health insurance.

Implications for employers:

  • Insurance reimbursement for home tests is a new expense for plans, although higher use of at-home testing could decrease infections and therefore offset some of the cost.

Survey shows employers are waiting to mandate vaccinations

The Willis Towers Watson Fall Vaccination and Return to the Workplace Survey, fielded in November 2021, had 543 employer responses from companies that have a total of 5.2 million employees. The survey report gives insights on several top issues.

  • 57% of respondents will have vaccine mandates if federal requirements are upheld in court.
    • Only 18% of respondents have a vaccine mandate in place now, and 7% intend to implement one regardless of the outcome of litigation.
    • 32% will introduce a vaccine mandate if the Occupational Safety and Health Administration Emergency Temporary Standard is upheld.
  • The remainder would likely offer a choice of vaccine or weekly testing.
  • Vaccine mandates do not appear to play a large role in recruitment and retention.
    • 13% said mandates led to at least some employees resigning, but 13% reported they helped with recruitment or retention of at least some employees.
  • 90% of employers reported they will have mask mandates.
    • 58% reported mask mandates for all employees regardless of vaccination status.
    • 70% reported mask mandates for all locations.
  • 84% of employers will offer regular testing.
    • Of those with regular testing, 32% will cover the cost, 25% will require employees to pay, and the rest are undecided.
  • 19% will offer testing to vaccinated employees.
Returning to the workplace
  • 83% said some (56%) or all (27%) remote-capable workers had returned to the workplace, up from 73% this summer.
  • Respondents reported on average that 34% of their workers were remote and projected this percentage would decline to 27% by Q1, 2022.
Vaccination rates
  • About a fifth of respondents (19%) reported that their employee vaccination rate is under 50%.
  • A third (33%) reported that their employee vaccination rate was 75% or more.
Financial incentives
  • Very few employers reported they had in place health insurance premium surcharges for the unvaccinated (2%) or health insurance premium reductions for the vaccinated (2%).
  • 25% offered some financial incentive for vaccination at some point, but over half of these (14%) have or will discontinue the program.

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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