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About our “The COVID-19 Crisis” series
COVID-19 rates continue to decline throughout the U.S., and decline is greatest in the areas that had the worst outbreaks a few weeks ago. This is typical of the coronavirus, where severe outbreaks lead to more natural immunity as well as increased uptake of vaccine — which eventually causes a decline in cases. Hospitalizations remain high in states with low vaccination rates though, and we still see hospital systems in severe stress in many states in the South and West.
Source: CDC, October 1, 2021
| State | Full Vaccination Rate, 18+ | Hospitalizations (per 100K) |
|---|---|---|
| Vermont | 80% | 7 |
| Massachusetts | 79% | 8 |
| Connecticut | 80% | 9 |
| Louisiana | 56% | 20 |
| Alabama | 52% | 37 |
| Mississippi | 54% | 26 |
Source: Becker’s Hospital Review, September 30, 2021; New York Times, October 2, 2021.
The vast majority of the country continues to still have a high risk of community transmission (>100 cases per 100,000 per week), so many employers will continue to delay return to the workplace for remote employees. Employers and employees should remain vigilant to prevent workplace exposures.
Employers increasingly recognize that unvaccinated employees represent a business risk that they are looking to mitigate.
The business risks of unvaccinated employees include:
Some employers have expressed worry about workforce attrition if they mandate vaccination. So far, few workers have actually left their jobs due to vaccine mandates — far fewer than those who reported they would leave their jobs. For instance, United Airlines has achieved a 99.5% vaccination rate. So have many hospital systems (Houston Methodist 0.6% noncompliance; Medical University of South Carolina, 0.003% of employees or 5 of 17,000 terminated) and universities (Harvard, Yale, Princeton, Stanford, and many others have vaccination rates of well over 90%).
New York State was concerned about loss of health care workers when its mandate took effect, yet the compliance with the mandate was well over 90%. National news outlets reported that “dozens” of Massachusetts state troopers had resigned over the mask mandate; only a single resignation has been confirmed.
Employers should continue to make it easy for employees to get vaccinated — including flexible scheduling, onsite vaccinations and time off to deal with vaccinations and adverse effects. But making it easy and offering financial incentives is not as effective as a mandate. The real-world evidence is that mandates are getting many employers to well over 90% vaccination rates without causing substantial workforce attrition. United Airlines has even said that they have seen an uptick in new applications since the mandate went into effect.
Vaccinations have proven to be more effective than expected against the coronavirus, but so far our drug treatments for people already infected have been disappointing. For those who already have respiratory failure in an intensive care unit, the generic steroid dexamethasone reduces ventilator treatment and death. For those who are a bit less sick, remdesivir (Veklury) is approved in the U.S. to reduce complication rates, but it requires intravenous administration, and a large World Health Organization study didn’t confirm its effectiveness.
The New England Journal published a study last week of the monoclonal antibody “cocktail” REGEN-COV showing that it reduced the risk of hospitalization or death from COVID-19 by 73%, which is great news. The drug was given intravenously, although the medication can be given by subcutaneous injection. The FDA previously gave an emergency use authorization to REGEN-COV for prevention in high risk individuals after exposure and for treatment of mild to moderate COVID-19. REGEN-COV is expensive (over $2,000 a dose) and decreased symptoms on average by four days (from 14 days to 10 days).
Merck just announced that it would seek approval for the first oral medication, molnupiravir, to treat COVID-19. Its unpublished data showed that the drug, given as four capsules twice daily for five days, decreased risk of hospitalization or death by half. No word on the price of this medication. It might initially only be available to high risk patients. Pfizer also has Phase 3 trials of oral medications to treat and prevent COVID-19.
Availability of drugs that are easy to administer to treat cases of COVID-19 could help us emerge fully from the pandemic and help allow those who are especially cautious or who have suppressed immune systems to return to their pre-pandemic activities. These medications will likely carry prices appropriate for their high value and will probably be an unanticipated cost in employer-sponsored health plans, which will be partially offset by decreased inpatient spending.
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.
