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About the series
All signs point to a substantial decline in COVID-19 infections in the U.S. Our rate of new cases is down to under 500,000 per day, and new hospitalizations are down to under 17,000 per day. Deaths continue to be high (almost 4,000 reported on February 1), but deaths peak and fall later than new cases or hospitalizations. Test positivity rates (PCR) are down from 30% to 17%. Only about 5% of counties have hospitals that are at capacity or forecast to reach capacity now, compared to well over half of counties just two weeks ago.
Source: CDC
Implications for employers:
The U.S. Food and Drug Administration (FDA) gave full approval to the Moderna Vaccine (Spikevax) for adults. Moderna is expected to report on its large-scale trial in children next month and announced that it is working on an Omicron-specific vaccine. So far, no variant-specific vaccines have been widely used because vaccines developed against the original strain of COVID-19 have continued to be so effective against hospitalization and severe illness, and the variant targeted has often been supplanted by a new variant by the time studies are completed.
The FDA solicited an emergency use authorization application from Pfizer for its vaccine (Comirnaty) for children ages six months to five years. This vaccine appeared safe for all ages tested, but only produced protective levels of antibodies for children between six months and two years of age. Researchers (and parents) were disappointed that the small dose did not induce adequate antibody response in children between three and five years of age.
The FDA faces hard choices regarding children five and under. Pfizer is testing a third dose for children two to five years old, and that data is not yet available. If the FDA approves this for just children ages six months to two years, physicians could be confused by the vaccine being unavailable for those age two to five. If they approve this for kids two to five, many will say they are “not following the science.” But if three doses will be necessary and effective, some parents may want to start now, rather than waiting for the studies. More to come on this.
Novavax, which has previously reported that its nanoprotein vaccine is about 90% effective, obtained emergency use authorization in the U.K. and applied formally to the FDA for emergency use authorization in the U.S. There are suggestions that the Novavax vaccine might be more effective against Omicron, and might have fewer systemic side effects like fatigue and muscle aches. It does not require freezing and is similar to other widely used vaccines, so it may be preferable to some who have been hesitant to receive mRNA vaccines.
The CDC released research recently showing that those who were fully vaccinated and boosted were 97 times less likely to die of COVID-19 than those who were unvaccinated.
Source: CDC, January 28, 2022
Implications for employers:
The Omicron BA.2 variant, which has become the dominant strain in India, South Africa, Denmark and the U.K., appears to be more transmissible than the original BA.1 strain. There are conflicting reports about its ability to evade immunity from vaccination or previous infection. The U.K. reported that vaccines were a bit more effective against the new strain, while a Danish study showed more household transmission. Researchers generally believe that this variant could prolong the Omicron wave but it is not likely to lead to a large new wave of infections.
Implications for employers: Employers need to be agile and able to pivot their workplace protection programs if there is a new spike in community transmission.
Many report continued symptoms weeks or even months after an acute COVID-19 infection, which may indicate long COVID. The Brookings Institution published research suggesting that as many as 1.1 million U.S. workers might be off the job and an additional 2.1 million might be working reduced hours due to long COVID. This would represent 15% of the estimated 10 million currently unfilled jobs.
Implications for employers:
The U.S. currently stands out as the developed country with the highest rates of hospitalizations and deaths from COVID-19. There are likely many structural reasons for this, including access to care, demographics and underlying disease. But generally, countries that are further ahead in vaccinations have escaped some of the pandemic’s toll.
Source: Our World in Data
What’s most striking is how far we’ve fallen behind in vaccination compared to other countries.
Source: Our World in Data
The U.S. lags even further behind on booster shots (except for Japan, which began boosters for the general population only last month).
Source: Our World in Data
There is substantial randomness in viral transmission, and we can’t know that lower vaccination rates alone are the cause of our high rates of hospitalization and death. But our low vaccination and booster rates are likely part of the cause, and therefore we should continue to work to increase vaccination rates. After the current wave of infections passes, we remain under-protected against future COVID-19 waves compared to other countries. This puts us at risk for more illness, death and economic dislocation.
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.
