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Employers continue workplace safety efforts as employees return and COVID-19 still threatens

By Jeff Levin-Scherz, MD, MBA | February 1, 2022

Omicron cases are down, but we continue to have hospitals under severe stress and the long COVID-19 threat persists.
Health and Benefits|Benessere integrato
Risque de pandémie

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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 U.S. Omicron wave continues to trend down. Over the last two weeks, new cases have decreased 13%, but there are 5% more people in the hospital (over 153,000). Deaths are up too; we’ve had multiple days where over 3,000 deaths were recorded. Reports from Europe suggest that a subset of Omicron (the BA.2 variant) is “outcompeting” the original strain (BA.1). This might be why the “tail” of the Omicron wave is decreasing at a slower rate in the U.K. and Northern Europe than modelers originally forecast.

You might hear this new variant, which has already been reported globally, including in the U.S, called the “stealth” Omicron – because it often appears different than BA.1 on some PCR tests. PCR and rapid antigen tests, though, continue to be accurate in diagnosing this variant. BA.2 is likely to be more contagious but does not appear to cause more severe symptoms.

Daily case and death rate on January 28, 2022, were 543,013 and 4.78%, respectively.
Daily trends in number of cases and seven-day cumulative rate of COVID-19 death in the U.S.

Source: Centers for Disease Control and Prevention (CDC)

Implications for employers:

  • We will likely see much lower rates of community transmission a few weeks from now, although we should keep our eyes on this new Omicron strain.
  • The contagiousness of the new Omicron variant will be another reason to use well-fitting, high-quality masks when the rate of community transmission is substantial or high.
  • Employers should continue to make plans to improve safety in the workplace as employees return. Improvements in ventilation help prevent transmission of all respiratory viruses, including coronavirus and influenza.

Even 'incidental' COVID-19 infections stress hospitals

Many people who have been hospitalized in recent weeks were incidentally found to have COVID-19, as opposed to being hospitalized because of respiratory or other symptoms from COVID-19. Here is data from Massachusetts, where almost half of all COVID-19 admissions were “incidental” rather than “primary.”

State data show nearly half of COVID-19 recent hospitalizations in Massachusetts are incidental cases, not primary.
COVID-19 hospitalizations – Massachusetts

Patients hospitalized due to COVID-19 (primary) and patients reported as testing positive for COVID-19 while hospitalized for other reasons (incidental). Source: Boston Globe

This is good news because it means fewer people on ventilators and less death. But in some patients, COVID-19 may have exacerbated a chronic illness like asthma or diabetes and might still be the underlying cause of the admission. Treating people with an abdominal complaint or an orthopedic injury is more complicated if they have COVID-19; they need to be in a private room and all hospital staff must wear extra personal protective equipment when caring for them. Additionally, room turnover takes longer due to enhanced disinfection.

Hospitals are also under severe stress due to staff illness and isolation/quarantine. Some hospitals are so short-staffed they have asked infected employees to return to work before the isolation period is complete. Some are unable to discharge recovering patients to skilled nursing facilities, which have been hit hard by staff shortages. Hospital bed shortages mean that sick patients, including those with COVID-19, may be cared for in the emergency departments for days.

Implications for employers:

  • We will continue to see delays in treatment of nonemergency medical conditions, including cancer, which cause stress for members and can lead to worse outcomes.
  • We are likely to see higher medical costs for treatment of COVID-19 during the Omicron wave, offset in part by a decrease in elective surgery and procedures, much of which will be performed later this winter or in the spring.
  • Employers should be aware that utilization and cost reporting from their health plans is likely to continue to be distorted by the impact of the pandemic.

Patients who survive COVID-19 ICU stays continue to have symptoms and have difficulty working

COVID-19 clearly causes disability in some who have survived, and mechanical ventilation in an intensive care unit (ICU) setting often leads to problems in physical and mental health for survivors. Researchers in the Netherlands did follow-up a year after 246 patients (71% male, average age 62) were discharged after being treated in an ICU for COVID-19.

They found that about three-quarters reported physical ailments and a quarter reported mental health concerns. Of those who were working before their illness, over half reported trouble with working, including disability, reduced hours or reduced capabilities.

74.3% reported physical symptoms, 26.2% reported mental symptoms and 16.2% reported cognitive symptoms.
Symptoms a year after COVID-19 ICU discharge

Source: JAMA Network January 24, 2022

A study from the U.K. published in Lancet Infectious Disease earlier this month similarly showed that those who had two shots of the COVID-19 vaccination were less likely to be hospitalized, more likely to have asymptomatic infections and less likely to have symptoms 28 days later compared to those who were unvaccinated.

Implications for employers:

  • COVID-19 survivors who have required intensive care are more likely to have physical and mental illness after recovery.
  • The pandemic will likely require additional consideration of disability and accommodation policies for many employers.

Vaccination reduces risk of long COVID-19

Vaccination primarily keeps people from getting long COVID-19 by preventing them from being infected with COVID-19 altogether. But those who were vaccinated and got COVID-19 anyway were still substantially less likely to have long COVID-19 symptoms 12 weeks after their infection. The unvaccinated were 53% more likely to have symptoms of long COVID-19 than those who were vaccinated, and 58% more likely to have symptoms that limited their day-to-day activities.

14.6% of unvaccinated reported long COVID symptoms, 9.5% of fully vaccinated reported long COVID symptoms.
Relationship between full vaccination and long COVID-19 symptoms

Source: U.K. Office of National Statistics, January 26, 2022. Note: Groups were propensity adjusted.

Implications for employers: Employers that achieve higher vaccination rates among their employees are likely to face less disability in their workforce.


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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