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About the series
The news from the U.S. on COVID-19 cases, hospitalizations and deaths continues to be good. We are down to 30,000 new cases a day, with 25,000 currently hospitalized and 4,500 in ICUs, and deaths per day are below 1,300. All these numbers are down over a third in the past two weeks.
There is concerning news from Europe, where we see substantial increases in cases across the continent and increases in hospitalizations in the U.K., France, the Netherlands and Austria. Cases in a number of Asian countries, including China (especially Hong Kong), South Korea and Singapore, are also on the rise. The Omicron sub-strain BA.2, which is 79% more contagious than Omicron BA.1, is partially responsible – and decreasing pandemic protective measures likely plays a role. Past European spikes have predicted a U.S. spike weeks later, and there is no reason for us to believe this time will be different. Further, our rate of booster shots is lower than those of most European countries.
Implications for employers:
In response to the improving COVID-19 situation, many employers are loosening their pandemic restrictions while starting to bring their employees back to the workplace. This moment of (relative) peace offers employers the opportunity to plan for a future wave of cases. While no one wants to plan for another future surge, here is why now is the time to do so:
What should employers be doing at this time?
Once employers have completed this planning, any future outbreaks will be less likely to distract them from their business priorities. This approach will enable organizations to respond efficiently and quickly to any changes in local situations, which could happen rapidly and sooner than any of us want.
The Biden administration announced last month that part of returning to normal will be to make COVID-19 testing widely available at pharmacies and have all people with positive tests leave the pharmacy with a prescription in hand. This is important because the available drugs (Paxlovid and molnupiravir) must be given three to five days after symptoms begin. Additionally, these drugs reduce infectiousness, so better to get them into the hands of patients before they feel well enough to forget about filling them. Also the U.S. has the lowest portion of people who have a relationship with a primary care physician among developed countries, so requiring a physician visit will be hard for many, will certainly create additional costs and take up valuable physician visits that might address other important concerns.
So far things are not going well for this plan. Congress hasn’t supported the billions the Biden administration proposes to spend for vaccinations and therapeutics, which means that these products will likely be funded through employer-sponsored health plans in the next few months. The American Medical Association opposed allowing pharmacists to prescribe these medications, although less than 10% of pharmacies around the country have a nurse practitioner or other prescriber on premises.
Implications for employers:
The Lancet published data from a large record review at the U.S. Veterans Administration showing a 40% increased risk of diabetes in those who had been diagnosed with COVID-19. Although, recent evidence shows that good control of Type 2 diabetes is associated with decreased risk of severe complications or death from COVID-19. The graph below shows the mortality risk for adults from a series of almost 40,000 diabetics cared for at 35 different centers in the U.S.
Note: “HBA1C” is a marker of long-term blood sugar levels; lower is better.
Source: American Diabetes Association
Not only do diabetics do better with COVID-19 if their diabetes is under good control, but children are less likely to be diagnosed with diabetes if they don’t get COVID-19.
Researchers reviewed two sets of claims records for children under age 18. One showed that diabetes rates increased by 166%; the other showed new diabetes rates increasing by 31%. Both of these findings are highly statistically significant. Previous reports of increased rates of diabetes came from the U.K. and Romania, and there are also reports that more children with new-onset diabetes have presented with life-threatening diabetic ketoacidosis during the pandemic. A large registry in Germany showed a significant increase in Type 1 diabetes in children, which began about three months after the start of the pandemic.
Implications for employers:
Young children have always been less likely to become severely ill with COVID-19, but there were more hospitalizations of young children during the Omicron wave than at any point earlier in the pandemic.
Both Pfizer and Moderna are expected to provide further data on their studies of COVID-19 vaccination in children, and many parents will continue to anxiously await approval of a vaccine for preschoolers. In the meantime, the U.S. has only vaccinated 27% of children ages five to 11, and 58% of children ages 12 to 17.
The 30-day risk of myocarditis in patients ages 12 to 30 after a COVID-19 diagnosis is much higher than either historical (pre-pandemic) incidence or risk after receiving a COVID-19 vaccine.
Source: Epic Health Research Network
Implications for employers:
Pfizer and Moderna have both now requested FDA authorization for second boosters for adults. Second boosters are currently only recommended for those in the U.S. who are immunocompromised. More on this next week.
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.
Patricia is a physician and infectious disease specialist who consults with employers to improve the quality and cost-effectiveness of health care delivery. She has guest lectured at Harvard Medical School and currently develops pandemic responses and programs to address chronic conditions.
