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 COVID-19 pandemic is an enormous tragedy and disaster. The U.S. alone has suffered almost a million deaths, and over 200,000 children have lost a parent or primary caregiver. But the pandemic has also led to the adoption of impressive innovation that can help improve healthcare, the workplace and the world.
Virtual healthcare visits were widely available before the pandemic, but usage was low. Virtual visits peaked at 12.5% of total outpatient visits in April 2020. Moreover, most of these visits were not delivered by virtual-first companies but rather by traditional brick-and-mortar providers faced with dramatic loss of income as patients stayed home to protect themselves. The largest benefit was likely in mental health, where access has long been inadequate.
Virtual care has made culturally matching patients with providers easier and increased the availability of care at convenient times by enabling providers to practice across time zones.
Virtual care can save costs because fewer ancillary procedures like blood tests and imaging are performed. We’ll have to carefully monitor overall cost though, as the convenience of virtual care could lead to overuse. Virtual care can also improve care for people with chronic diseases who may need urgent care or regular visits. In response to this growing demand, health plans and other vendors are rolling out virtual primary care services.
Care in the home is convenient for many people, and the pandemic increased access to “hospital at home,” technology-enabled intensive monitoring. Some cancer centers have also started offering testing and even chemotherapy in the home.
Researchers started working on COVID-19 vaccines as soon as the viral sequence was published, and volunteers received the first COVID-19 vaccines less than a year after the pandemic began. This rapid rollout is credited to the messenger RNA (mRNA) technology, which was in development for over a decade. The pandemic led to accelerated research and deployment.
mRNA is used to introduce bioengineered proteins from a portion of the virus into the body so that the immune system learns to fight the virus, as opposed to older vaccines that generally inject dead or weakened virus particles or proteins. This technology could be useful in creating vaccines to help the immune system fight other diseases including cancer.
The COVID-19 pandemic showed us the extraordinary value of non-physician providers. Pharmacies across the country stepped up and offered vaccinations and tests. This trend will continue with the so-called “test to treat” program, which might enable patients with newly diagnosed COVID-19 to bypass physicians and get antiviral prescriptions directly from pharmacists.
The COVID-19 test to treat program is not the first time pharmacists have treated patients. Previous studies have shown that pharmacists can also effectively manage chronic diseases like diabetes.
The pandemic has shown us we can improve access and quality by increasing the use of advanced-practice clinicians, including nurse practitioners, physician assistants, midwives and pharmacists.
Home testing for COVID-19 got off to a rocky start, with a short supply of expensive tests. But over time the pandemic has shown us that people can effectively test at home. There are many other home tests available, including tests for strep throat and influenza, and even home tests for colon and cervical cancer screening. More are coming too. Home tests can further empower patients and reduce the amount of time people spend in medical settings.
AIDS activists pressured pharmaceutical companies and the Food and Drug Administration to accelerate the pace of research and approval of HIV drugs in the 1990s, and those with long COVID have played a similar role during the pandemic. Many long COVID research teams are now seeking input from patients as they design new studies, which can serve as a model to be sure that research meets the real needs of patients.
Videoconferencing was at the periphery of the world of work for the last decade. But workers still often jetted around the world even for brief meetings and commuters spent billions of hours in traffic on the way to the workplace. This traveling cost money and time, and also increased our carbon footprint.
The pandemic led us to reconsider when travel is necessary and where work gets done. I can now meet with clients on both sides of the country in a single day and be home to eat dinner with my wife. Technology improvements abetted this transition, internet connections became more stable and platform capabilities increased with each passing month.
Remote work protected employees from COVID-19 exposure when the risk was high. But there are other potential health and wellbeing benefits as well as pitfalls. Less time spent commuting has allowed many to commit to more regular exercise, although home offices leave us closer to our refrigerators. Shorter commutes were found to be associated with higher levels of social engagement in the community before the pandemic, but many have replaced their commuting time with more work.
Employers have achieved substantial benefits from this transition. Many have been able to downsize their real estate footprints, can now recruit from a wider geography and maybe even inch closer to being carbon-neutral. Here’s hoping that rush hours will continue to be a bit more endurable, and we will continue to reduce carbon emissions and gain some social benefit from working remotely, at least some of the time.
COVID-19 cases continue to decline in the U.S, along with hospitalizations and deaths. However, the more contagious Omicron BA.2 strain has increased to about three-quarters of all cases, and cases are rising in the Northeast. The virus has definitely not gone away. Broadway shows in New York were canceled when their leading actors tested positive, and there was a large cluster of COVID-19 cases at the Gridiron Dinner in Washington, D.C.
There is data from New York City that I find heartening: While cases are going up, there is no parallel increase in hospitalizations. The best protection against hospitalization from COVID-19 remains vaccination and boosting, although there is now an adequate supply of effective antivirals that can also help prevent hospitalization and death.
Source: New York City Department of Health. Note: previous week hospitalization report is likely incomplete.
Employers can use this period of low COVID-19 infections to develop proactive plans for how to address future localized or general outbreaks of COVID-19 in the coming months.
The New England Journal of Medicine published two studies of a second booster this past week. The first study of over a million participants over age 60 showed that a second booster decreased the risk of hospitalization about fourfold and the risk of infection by about half. (The comparison is to those who had three shots – not to those who were unvaccinated.) The protection against infection waned rapidly, but the extra protection against hospitalization was maintained.
The second study of just 374 healthcare workers showed a decreased incidence of infection with second boosters. The authors concluded that in average, young healthcare workers, the extra booster was only “marginally beneficial.”
Employers should consider the following when thinking about the second booster:
Nature published a comprehensive review of 968 patients who had recovered and found that 10% had long COVID. Of those with symptoms at two months, 85% were still symptomatic a year after initial infection.
The U.K.’s Office of National Statistics reported yesterday that 1.7 million people, about 2.7% of the entire U.K. population, self-reported symptoms of long COVID. Almost half of these reported that some symptoms persisted a full year after their COVID-19 infection.
These studies highlight the importance of continuing research into effective treatment for long COVID, which is likely to be a large cause of disability in the coming years.
BMJ published data showing increased risks of blood clots for over 100 days after recovery in a cohort of over a million Swedes with positive COVID-19 tests. Blood clots were more common in earlier waves and in those who had severe COVID-19 illness, but risk was even increased in those with milder cases.
For more information regarding the likely future increase in medical costs, please check out my recent article Eight reasons why health care cost inflation is likely to escalate in The Hill.
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.