What Biden’s new COVID-19 plan could mean for employers

Here are some highlights of what the new plan could mean for U.S. employers:

• More access to testing: The administration is doubling down on both at-home and PCR tests, with more genetic sequencing that could help identify the spread of variants earlier, and will continue to promote employer-sponsored insurance coverage of tests, with point-of-sale access without cost sharing.
• Easy access to COVID-19 drugs: Soon the antiviral Paxlovid will become available directly from pharmacists at the point of a positive test through a “test to treat” initiative. The federal government will pay for Paxlovid and has secured 20 million courses of therapy – 3.5 million will be available in March and April. Routine access to effective drugs dramatically lowers the risk of hospitalization and death, even for those who are immunocompromised.
• Increased vaccine manufacturing capacity: More production could help keep vaccine prices affordable when the federal government stops paying for them. Increased manufacturing also allows more shipments to developing countries, which could reduce global risk of dangerous variants. Vaccinations remain the safest and most effective way to prevent severe illness and death.
• Continued support for time off: The administration will revive federal payment of eligible sick leave expenses for employers with fewer than 500 employees.
• Updated guidelines on workplace safety: The Occupational Safety and Health Administration will provide new guidance on workplace safety, including increasing vaccination rates, enhanced ventilation and mask guidelines for the immunocompromised.
• Provide aid to schools: In the event of a new surge, the administration will seek to keep schools open through testing and improved ventilation.
• Develop new monitoring tools: The administration will create improved tools showing current COVID-19 risk in each community, which will allow for geographic-specific guidelines for preventative measures such as masking.
• Create an exposure protocol plan: As effective interventions like Paxlovid and the long-acting monoclonal antibody Evusheld become available, pre-exposure prevention for those who are immunocompromised could ease the burden on employers seeking to keep the workplace safe for vulnerable employees.
• Establish long COVID centers of excellence (COE): To help people suffering from long COVID, the administration will encourage the creation of COEs that could shorten wait times for those who are seeking multidisciplinary programs to address their ongoing symptoms.
• Expansion of wastewater surveillance systems: Some municipalities found that wastewater surveillance provided an early warning system ahead of surges. Such systems could help employers determine changes in workplace policies based on community risk.

COVID-19 cases continue to decline

As the Omicron wave subsides, new cases, new hospitalizations and total hospitalizations have all continued to decline. A new strain of Omicron, BA2, accounts for about 8% of infections in the U.S. but does not appear to be causing large new outbreaks or slowing the decrease in new cases. Additionally, those who have recovered from BA1 appear unlikely to become reinfected with BA2 over the short term.

Daily trends in number of new COVID-19 cases and patients admitted to hospital in the U.S.

Source: Centers for Disease Control and Prevention (CDC), March 2, 2022

Implications for employers:

• Risk of bringing remote workers back to the office continues to decline, although transmission rates remain high in some communities.
• Employers should remain prepared for workplace exposures and infections.
• Workplaces with high vaccination rates face the lowest risk.
• Employers should continue to mitigate risk for immunocompromised employees, customers and visitors.

Decreased screening during the pandemic may have led to later cancer diagnosis

Researchers at the University of California, San Diego published research that demonstrated higher rates of diagnosis of late-stage colon and breast cancer in 2021 compared to previous years. Stage 1 breast cancer was down by about a third over the two-year period, while stage 4 breast cancer was up more than threefold. Consider this data preliminary; it’s from a single institution and a short time period. Still this is worrisome given that cancer screening levels plummeted in 2020 and did not recover in 2021.

Implications for employers:

• Employers can continue to encourage members to complete all recommended preventive care, including vaccinations and cancer screening.
• Here’s an article I co-authored with WTW colleague Gary Shutler last year about using behavioral economic insights to encourage use of preventive care.

Pfizer vaccine effectiveness in children

Two studies over the last week evaluated the effectiveness of the Pfizer COVID-19 vaccination among children ages five to 11. The headlines said that these results were “disappointing,” but the actual results are more nuanced.

The first study, done by the state of New York, showed that children ages 12 to 17 were well protected against hospitalizations even with the Omicron variant (vaccine effectiveness was 51%), but the vaccine was less effective for children ages five to 11. (Vaccine effectiveness preventing cases was just 12%, and preventing hospitalizations was 48%, which did not reach statistical significance.)

The second study, published by the CDC, showed that vaccine efficacy against Omicron waned five months after vaccination for those ages 12 to 17, but was restored in older teens when they had a booster shot. It showed that two doses in children ages five to 11 prevented 51% of emergency department or urgent care visits and 74% of hospitalizations — but there were so few hospitalizations that this 74% protection also fails to reach statistical significance.

While the vaccine’s efficacy didn’t reach statistical significance in children ages five to 11, the vaccine cut emergency department and urgent care visits by half and hospitalizations by three-quarters in these reports.

Implications for employers:

• The Pfizer vaccine for children ages five to 11 has just 10 micrograms of antigen, while the vaccine given to those ages 12 and older has 30 micrograms. It’s possible that a higher dose would lead to better immune response and that boosters will help.
• Hospitalizations are rare for kids with COVID-19, so it’s difficult to show a statistically significant effect.
• Parents should still get their younger children vaccinated. Some protection is better than no protection. Vaccine side effects are mild and it’s likely those who are vaccinated will have milder cases if they get infected. Higher vaccination rates and lower infection rates among children may result in fewer days of work missed for employees with caregiving responsibilities.

Author

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Jeff Levin-Scherz, MD, MBA

Managing Director and Population Health Leader

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.

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