COVID-19 risk diminishes amid increased immunity, better treatments, lower severity

New cases of COVID-19 continue to decline; we’re now at a level approaching that of last summer. We’re also seeing a continuing decrease in hospitalizations, and there are only two states currently at risk for shortage of hospital beds.

One note of caution is that the U.K., which eliminated all of its COVID-19 community protection guidelines last month, has had a 50% increase in new cases and a 10% increase in hospitalizations over the last 10 days. The new Omicron strain (BA.2) is more contagious than BA.1 and now represents about one in eight new cases in the U.S.

New COVID-19 cases and hospitalizations

Source: Centers for Disease Control and Prevention (CDC)

Implications for employers:

• Risks of employees contracting COVID-19 either in the community or the workplace have declined substantially.
• This lull in cases is an ideal time for employers to develop plans to address any future waves of infection. More on this next week.

Increased immunity, better treatment and lower severity mean that for most, COVID-19 is less deadly than influenza

Each winter before the COVID-19 pandemic, we saw a wave of influenza infections, which often led to as many as 30,000 to 50,000 deaths a year. New data from the U.K. suggests that the combination of immunity (from both vaccines and prior infections), better treatment and the decreased severity of Omicron has meant the case fatality rate for COVID-19 is now substantially lower than for influenza for those under age 60 and about the same for those over age 60.

A few important caveats to this:

• COVID-19 is substantially more transmissible than influenza, so we continue to see a higher rate of total deaths even though the case fatality rate is lower.
• The average case fatality rate obscures substantial differences from person to person.
  • The case fatality rate is higher for those with compromised immune systems, for those with underlying illness and for those who are not vaccinated.

Implications for employers:

• This is heartening, although employers should be aware that the risk of severe illness among those who are unvaccinated and those who are immunocompromised remains substantially higher with COVID-19 than with influenza.
• Employers should continue to work to lower and mitigate COVID-19 risks, although it’s impossible to eliminate all risk.
• Vaccination remains the best defense against illness or death due to the coronavirus.

New information on long COVID

A new study from the U.K., which followed about 500 people with documented COVID-19 without hospitalization, showed that one in six continued to have symptoms six months after infection. Of these, more than half missed work for a median of 12 days. While death was the cause of most quality adjusted life years lost for those over age 45, these symptoms of long COVID were the main cause of lost quality adjusted life years in those under age 45.

A small study of patients with neurologic symptoms showed abnormalities in nerve biopsies. Another small study showed that those who eventually got long COVID were more likely to have abnormal spinal taps, suggesting that inflammation might be the cause of ongoing symptoms. Either of these findings could pave the way for new treatments and make it easier for those with long COVID to obtain disability benefits. 

Implications for employers:

• Long COVID will continue to be a major cause of disability and worker absenteeism.
• Those with objective findings of long COVID will more easily qualify for disability benefits.
• Manager training can help reduce stigma faced by some with long COVID whose complaints might otherwise not be believed.

Low-wage workers missed more work due to COVID-19 and often lost pay

The Kaiser Family Foundation published data confirming that the Omicron surge led to a large number of days away from work and many of these, especially for lower-wage workers, were unpaid. One in three low-wage workers reported going to work even when they felt ill or had been exposed to COVID-19.

Employees who missed work in the last three months due to COVID-19

Three in 10 lower-income workers report going to work amid COVID-19 concerns because they couldn’t afford to miss work

Source: Kaiser Family Foundation Vaccine Monitor

Implications for employers:

• Paid sick leave helps to encourage workers to stay home when they are ill.
• Employers need to plan for staffing needs for potential future waves of infection.

Employers can decrease risk for immunocompromised employees

Employers are seeking to protect their immunocompromised employees who return to the workplace as states and localities remove mask mandates and more employees return to the workplace. About 3% of adults are on medications that reduce immune function.

Potential employer interventions:

• Vaccination: may offer those with compromised immune systems some protection. Additionally, vaccinating as many other employees as possible reduces potential for workplace exposures for immunocompromised employees.
• Ventilation: reduces the risk of transmission of all respiratory viruses.
• Masks: especially well-fitting high-quality masks (N96 and KN95) provide protection to the wearer even if others are unmasked.
• Monoclonal antibodies (MAbs): There is one Mab, Evusheld, that offers six months of protection for those who are immunocompromised. MAbs might not be effective for future variants, although new MAbs will likely be developed. The federal government is now paying for these drugs, but that coverage will likely end later this year.
• Oral antivirals: (such as Paxlovid) are not currently approved for prevention, but early treatment with these medicines can reduce risk of severe COVID-19 in those who are immunosuppressed.
• Distancing and remote work: might be an option for those with compromised immune systems if a community has a high rate of transmission in the future.

For children – boosters decrease Omicron infections by 47% and vaccines reduce hospitalization

The New England Journal of Medicine published data from Qatar showing that for at least the first month, a booster shot decreased symptomatic infection by 47% (from 4.5% to 2.4% for the Pfizer vaccine, and from 1.9% to 1% for the Moderna vaccine).

The CDC’s Morbidity and Mortality Weekly Report showed that vaccination continues to be highly effective at preventing hospitalizations in children. While the Pfizer vaccination is less effective at preventing infection altogether in those under age 12, it is far more protective than not being vaccinated. As I mentioned last week, virtually all children severely ill with COVID-19 in large studies were unvaccinated.

Vaccine effectiveness against hospitalization

Source: CDC, Morbidity and Mortality Weekly Report, March 4, 2022

Implications for employers:

• Employers can continue to lower the overall risk of their workforce by promoting booster shots.
• Evidence continues to support vaccinating children age five and older. Hopefully, we will see additional research findings on children age six months to five years from both Pfizer and Moderna in the next few weeks.

Author

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Jeff Levin-Scherz, MD

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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