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About the series
Cases continue to fall throughout the U.S., down by about two-thirds over the last two weeks with hospitalizations down over 40%. Deaths per day are finally below 2,000, and under 2% of counties currently appear to be at risk of hospital-bed shortages.
Source: Centers for Disease Control and Prevention (CDC)
Implications for employers:
The CDC published data showing that maternal deaths in 2020 were higher than in previous years. The mortality among developed countries and the pandemic has worsened the situation. This could be from COVID-19 as well as decreased access to prenatal care. Closure of more rural hospitals, leading to longer distances to care, hasn’t helped. Increases in death rates were higher among Black and Hispanic people than among whites. The pandemic only affected nine months of 2020, so the statistics for 2021 may look even worse. Vaccination protects against severe complications of COVID-19, but we have low vaccination rates among pregnant women in the U.S.
Among Blacks: 37.3 in 2018 to 55.3 in 2020; Hispanics 11.2 in 2018 to 18.2 in 2020.
Implications for employers:
Many governors have announced plans to discontinue mask mandates, and the CDC has published data supporting mask effectiveness at preventing COVID-19 transmission.
A study released by the CDC, showed that those who reported they regularly wore respirators (N95 or KN95 masks) were dramatically less likely to contract COVID-19 than those who remained largely unmasked. Cloth masks were much less helpful, and the study had a small number of participants using respirators. Real-world studies of mask usage like this are always fraught, because those who report regularly using masks might be more cautious in other ways. Nonetheless, the evidence of effectiveness of masks remains good.
Mask | Decreased risk of COVID-19 |
---|---|
Cloth | 46% |
Surgical mask | 53% |
Respirator (KN95/N95) | 83% |
Another study, from an economist affiliated with Johns Hopkins, concludes that “lockdowns” (defined broadly as regulations enforcing almost any pandemic protection, including mask requirements, social distancing and vaccine requirements) did not decrease COVID-19 infections. This paper has been widely criticized because it looked for impact on COVID-19 case counts from the moment the restriction was put in place, rather than two to four weeks later.
The CDC recently issued new mask guidelines.
The CDC will now assess geographic risk based on rate of new community infections, portion of hospital beds occupied by people with COVID-19 and number of new COVID-19 hospital admissions each week.
This places about a third of the country at low risk (indoor masks not recommended), medium risk (indoor masks recommended for those who are immunocompromised) and high risk (indoor well-fitting masks recommended for all, and respirators [KN-95 or N-95] recommended for those who are immunocompromised). The new guidance emphasizes that people can wear a mask in communities with any level of risk based on personal preference informed by personal level of risk, and that those with symptoms, a positive test or exposure to COVID-19 should wear a mask.
Implications for employers:
Sanofi and GSK announced results of their protein-based COVID-19 vaccination, which was highly effective at preventing severe cases and hospitalizations from COVID-19. They plan to seek emergency use authorization for primary and booster vaccinations. This vaccine doesn’t use mRNA. It is based on a more common, traditional approach, an engineered protein, which is similar to how Novavax’s vaccine works.
The mRNA vaccines are exceptionally safe and effective, but perhaps some of those who have opposed the currently available vaccines will decide to proceed with one of these new vaccines after they are authorized.
The CDC also quietly changed recommendations for the primary series of COVID-19 mRNA vaccines; the new recommendation is an interval of eight weeks between the first and second shot. This could decrease the already small risk of heart inflammation after the second dose.
Implications for employers:
Data from Nature Medicine show that those who have had three doses of mRNA vaccine provides less protection against Omicron than previous variants, as expected. Nonetheless, three shots of vaccine prevented more than 99% of hospitalizations. This study covered over 26,000 cases of COVID-19.
A separate study published in the New England Journal of Medicine showed that two doses of mRNA vaccine were over 99% effective at preventing hospitalizations among those ages 12 to 17. Those who were hospitalized despite vaccination were four times less likely to land in intensive care, and all seven deaths in the study were in unvaccinated teens.
Implications for employers:
The New England Journal of Medicine published data earlier this month showing the effectiveness of Paxlovid in decreasing hospitalization risk by 89%. We knew this number from a Pfizer press release last fall, but it’s reassuring to see the full report. Effective antiviral drugs lower the viral load, so they might decrease risk of long COVID, too.
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.