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About the series
We continue to see a decline in new cases of COVID-19, and the total number of Americans hospitalized with COVID-19 is down by almost a third in the last two weeks. Infection rates are down across the country, although virtually every county continues to have a “high risk” of community transmission, with more than 100 cases per 100,000 per week. Some public health officials are recommending continued mask wearing and distancing, while governors of most of the states that had statewide mask mandates plan to cancel them.
Source: CDC, February 13, 2022
We are indeed in a much better place than a month ago. We have far higher immunity – both from vaccination and infection. Access to treatment for COVID-19 is improving since many hospitals have improved capacity. The access to more effective drugs, including Paxlovid and molnupiravir, as well as home COVID-19 tests is increasing.
But there is room to increase our protection. Our primary vaccination rate is stalled, and less than half of eligible adults have had booster shots. Fewer than a quarter of children ages five to 11 have been vaccinated. Since we are likely to see a future wave of COVID-19, we’d be wise to use this relative lull in cases to increase vaccination and boosting rates.
Pretty much everyone is tired of the pandemic and pandemic-related restrictions, and most of us would like to go back to life as “normal” before we wore masks, stayed six feet away from others, avoided restaurants and movie theaters, and stopped traveling. Some want to pivot right back to pre-pandemic behaviors, while others remain nervous. People’s point of view is often not well-correlated with their risk, either.
An Axios/Ipsos poll from last week sums up the wide array of preferred approaches at this point.
Survey of 1,049 adults, conducted between February 4 – 7, 2022.
Source: Axios/Ipsos Poll
More Americans would like us to move away from current precautions (50%), although most of those favor continuing some precautions. About one in five want more restrictions. The only category above without a strong partisan divide is “move toward opening up with precautions.”
The WTW Global Benefits Attitudes Survey, with 9,000 respondents surveyed from December 1, 2021 to January 3, 2022, shows similar ambivalence. The majority supported employer vaccine mandates (58% versus 23% opposed). Even here there is polarization, though. Employees already subject to vaccine mandates support mandates (72% support with 10% opposed); those who work at companies without pandemic restrictions oppose vaccine mandates (36% support and 46% oppose).
The coronavirus pandemic has changed what normal means. Even when we reach endemicity – and we are not yet there – we will continue to be exposed to an evolving virus that is highly contagious, affects many different organ systems and is deadly for high-risk populations. In our new normal, new variants will appear and immunity will wane over time.
We need to acknowledge both that the risk of COVID-19 is dramatically lower than it was a month or a year ago and that residual risk remains. What makes this period especially challenging is that this risk will likely increase and decrease at different times and in different places, in ways we can’t yet predict.
Implications for employers:
Another piece of good news is that influenza infections are down more quickly than during most pre-COVID-19 flu seasons. This is a relief, as co-infection with influenza and COVID-19 leads to higher mortality, and hospitals are just starting to get relief from the Omicron wave of COVID-19 infections, which disproportionately affected the unvaccinated.
Results of tests performed by clinical U.S. laboratories.
Source: CDC
Implications for employers:
Researchers at the Veterans Administration matched over 150,000 patients who recovered from COVID-19 with over 5 million who had not had COVID-19 to look at the incidence of various cardiovascular complications in the year after initial diagnosis. The excess risk of cardiac events was large in the 12 months after infection: a 69% increased risk of any cardiovascular event, a 55% increased risk of a major cardiovascular event and a 52% increase in the risk of stroke. Many have talked about the myocarditis risk of vaccinations (which is small, concentrated in teenage boys and young men, and can be lowered by a longer interval between the first and second shots). The cardiac risk of COVID-19 is dramatically higher than the cardiac risk due to the vaccination.
Source: Nature Medicine
Implications for employers:
Pregnant women continue to be vaccinated at lower rates than age-matched adults, leading to bad pregnancy outcomes. JAMA published a study this week of over 14,000 births at 17 hospitals across the U.S., showing that the 5% of pregnant women who had moderate to severe COVID-19 were twice as likely to lose their fetus, almost three times as likely to have severe hypertension, almost 50% more likely to have a cesarean section, and 13 times more likely to need intensive care. Earlier research showed that COVID-19 also increases the risk of stillbirth more than twofold. Researchers recently identified that the virus attacks the placenta, decreasing oxygen available to the fetus.
Source: JAMA Network, “Association of SARS-CoV-2 Infection With Serious Maternal Morbidity and Mortality From Obstetric Complications”
Implications for employers:
The COVID-19 pandemic has led to substantial excess deaths in the working-age population. Some life insurers are reporting unexpected payouts, and are raising insurance rates especially in geographies with low vaccination rates.
Below is the CDC data. The pink lines show the weekly death rate from 2015 – 2019, and an increase of about 60% for ages 25 to 44, and an increase of 30% (2020) and 50% (2021) for those 45 to 64 from the 2015 – 2019 baseline. For the 45 to 64 age group, the death rates are 13% higher (2020) and 24% higher (2021) compared to the 2015 – 2019 baseline. This represents 109,000 excess deaths among those 25 to 44, and 208,000 excess deaths among those 45 to 64.
Source: CDC February 10, 2022
Implications for employers:
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.
