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COVID-19 reverses gains in cardiovascular disease

By Jeff Levin-Scherz, MD, MBA | March 30, 2022

Employers can lower cardiovascular risk of their employees by offering and promoting tobacco cessation programs and programs to better treat high-blood pressure and high cholesterol.
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.

Case rates continue to decline in the U.S. We are now around 30,000 new cases daily, and the number of new hospitalizations and total number of people in the hospital (about 20,000) has declined to the lowest rate in the pandemic. Another positive sign, wastewater reporting, an early signal of community transmission, continues to show more communities with a decrease than an increase in viral particles.

The Omicron strain BA.2 continues to represent a growing portion of cases in the U.S. BA.2 is more contagious than the previous Omicron strains (BA.1 and B.1.1.529), but it does not cause more severe illness. Much of Europe and Asia continue to have large increases in cases associated with BA.2 resulting in changes in pandemic restrictions.

In the U.K. cases have tripled over the last month. The situation in the U.K. is worth monitoring, because typically the U.S. has a wave of infections about three weeks after the U.K. Furthermore, our rates of vaccination and boosting is less than those of the U.K. However, the arrival of warmer spring weather across the country may help break the cycle or reduce the next wave’s impact as people can move social gatherings outside where risk of infection is reduced.

Implications for employers

Current status of pediatric COVID-19 vaccines

Moderna released data on its clinical trial for children ages six months to six years old. The vaccine significantly decreased the likelihood children would get symptomatic COVID-19 by 44% (for ages six months to two years) and 38% (for ages two years to under six years). The vaccine had no more adverse effects than in adolescents and adults and induced substantial antibody production. There were no hospitalizations or deaths among the group that received either vaccine or placebo. There were no cases of heart inflammation among those children vaccinated. The vaccine trial included 11,700 children in the U.S. and Canada.

While these effectiveness rates don’t compare to the reports of 90% effectiveness of the mRNA vaccines in adults in 2020 and 2021, these new trials were assessed during the Omicron wave, and Omicron is more immune evasive than prior strains.

Vaccines approved and in trial for children age six months to 17 years

Note: Information in bold represents approved vaccine/dose.

Age group Pfizer Moderna
6 months to <5 years 3 ug, 2 doses
Testing third dose
Seeking EUA
6 months to <6 years N/A 25 ug, 2 doses
Seeking EUA
5 to <12 years 10 ug, 2 doses, Approved N/A
6 to <12 years N/A 50 ug, 2 doses
Seeking EUA
12 to 17 years 30 ug, 2 doses Approved
Booster for ages 16 to 17 approved
100 ug, 2 doses Seeking EUA

While the FDA is evaluating vaccination for those in preschool, only 27% of children ages five to 11 in the U.S. have so far been vaccinated against COVID-19.

Implications for employers

  • Vaccination of young children will help decrease child-to-parent transmission and decrease school interruptions.
  • This can lead to fewer employees missing work due to caring for their children.

COVID-19 is exceptionally dangerous for pregnant women and their unborn babies

Two new research papers published this week add to our understanding of the impact of COVID-19 infections on pregnancy.

The first, published in JAMA Network Open, reviewed outcomes of almost 44,000 pregnancies in Northern California, and found 1,332 pregnancies were complicated by acute COVID-19 infections. Those women who had COVID-19 in pregnancy were 2.5 times more likely to have severe maternal mortality, 2.1 times more likely to have preterm birth and 3.1 times more likely to have blood clots. Seventy-six (5.7%) were hospitalized for COVID-19.

The second study, also published in JAMA Network Open, demonstrated that SARS CoV2, the virus that causes COVID-19, can cause severe inflammation of the placenta and multiple blood clots. Many of the placentas examined in this pathology study were from stillbirths.

When infected with COVID while pregnant, woman are two to three times as likely to suffer from preterm birth, blood clots or maternal morbidity.
Complications associated with COVID-19 infection during pregnancy

Source: JAMA Internal Medicine, March 21 2022

Pregnant women remain less likely to be vaccinated (69%) than all U.S. adults (72%).

Implications for employers

  • Employers should publish targeted communications to pregnant women and women of childbearing age about the importance of vaccination and boosting.

New study shows substantial increase in U.S. cardiovascular deaths with large racial disparities

When I was in training in the late 1980s, I routinely saw people in their forties with heart attacks that would change or end their lives. Things have gotten much better since then. Far fewer Americans smoke tobacco, inexpensive statin drugs that effectively control high cholesterol are widely available, and we are getting better at controlling high blood pressure. Interventional cardiologists and radiologists have also gotten better at intervening during acute heart attacks and strokes to save lives and protect heart and brain tissue.

Age-adjusted deaths from heart disease decreased and stroke decreased substantially from 2011 to 2019, but much of this gain was reversed with the pandemic in 2019 and 2020. (Of note, total number of deaths increased as the population aged, but the average age of those dying of cardiovascular causes was higher.)

From 2011 to 2019, the incident of heart disease and stroke had decreased. Post 2019, they have both increased by over 4% (heart disease) and 5% (stroke).
Age-adjusted risk of cardiovascular death

Source: JAMA Network Open March 23, 2022

This was not uniform across the population. Increases in age-adjusted risk of death from heart disease and stroke rose over five times higher for Black and Hispanic compared to white people and increases in age-adjusted risk of death from stroke increased more than twice as much.

Implications for employers

  • Employers can continue to set expectations with carriers that they will collect and report data on race, ethnicity and language to better identify and address disparities in medical care.
  • Employers can lower cardiovascular risk of their members by offering and promoting tobacco cessation programs and programs to better treat high-blood pressure and high cholesterol.

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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