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As COVID-19 cases plummet, employers can learn from schools about reopening

Health and Benefits|Bienestar integral
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | February 23, 2021

Amid falling hospitalizations and new infections, employers are thinking about how to reopen and whether to mandate vaccination.

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update from Dr. Jeff Levin-Scherz, Population Health Leader and Health Management Practice Co-Leader, Health and Benefits, North America.

It’s been another week of continuing declines in COVID-19 new cases and deaths, pretty uniformly across the U.S. and much of the world. U.S. hospitalizations are down to half of their peak (from over 130,000 to under 64,000), and deaths per day are below 2,400.

COVID-19-related testing, new cases, hospitalizations and deaths are declining.
Nationwide COVID-19 metrics since April 1, 2020

Data show declines in all categories.
Source: COVID-19 Tracking Project

Still, there is a lot of pain. The Centers for Disease Control and Prevention reported this week that average life expectancy decreased by an entire year in the first half of 2020 and will likely decrease further when we analyze the last half of 2020, which is when the death toll was the highest. Loss of life expectancy disproportionately affected Black people, where life expectancy decreased by 2.7 years.

Between 2019 and the first half of 2020, - Description below

Between 2019 and the first half of 2020

  • life expectancy decreased 2.7 years for the non-Hispanic Black population,
  • 1.9 years for the Hispanic population and
  • 0.8 year for the non-Hispanic white population.
Life expectancy at birth by Hispanic origin and race in the U.S.

Between 2019 and the first half of 2020, life expectancy decreased 2.7 years for the non-Hispanic Black population.
Source: CDC

We continue to see exceptionally good news on the vaccine front, too. A study of over 7,000 Israeli hospital workers showed a decrease of 85% in infection rate two weeks after the first vaccine dose.

Weather-related issues over the last few days have decreased the number of doses given in the U.S., but systems for booking appointments are working far better in most states, and we’ll be receiving up to 3.2 million doses from Pfizer and Moderna within five weeks. We also expect Food and Drug Administration (FDA) emergency use authorization for the Johnson & Johnson (J&J) vaccine in the very near future. This single-dose vaccine also prevented 100% of hospitalizations and deaths in clinical trials and is much better suited to potential employer onsite vaccination clinics.

Vaccination as a condition of employment?

I’ve been worried that employers might hastily mandate that employees get vaccinated as a condition of employment. I’m not alone; the head of the Business Roundtable warned against “hectoring” workers to get vaccinated. Premature mandates could force many who want to “wait and see” about getting the vaccine to declare their opposition and could paradoxically decrease vaccination rates. We recently saw the first report of a restaurant employee in Brooklyn, N.Y., fired for refusing the vaccine. I was heartened that our “Emerging From the Pandemic” survey, which included about 500 employers representing over 6 million employees, showed that very few were mandating vaccination at this point.

Although few employers currently mandate vaccines, over 30% of employers are considering a policy that will mandate vaccination for all employees at some point.
Currently, few employers have mandated vaccinations to return to work or maintain employment

Many employers are considering a policy that, at some point in the future, will require proof of vaccination for employees.
Source: Willis Towers Watson survey, February, 2021

I’ve also been thinking about the importance of how we frame the discussion when communicating to employees about COVID-19 and vaccination. Here are a few examples:

  • Let’s talk about “increasing vaccine confidence” rather than “decreased vaccine hesitancy.” The number of people who said they would definitely be vaccinated as soon as possible swelled by 40% from December to January according to a Kaiser Family Foundation poll.
  • The J&J vaccine, which requires only one dose and requires no freezing, is the most likely to be available for onsite employer-sponsored vaccine clinics. Here’s a good way to frame the effectiveness of the J&J vaccine: “This vaccine, like those available from Pfizer and Moderna, has proven 100% effective in preventing hospitalization and death from COVID-19.”

There are already unfortunate reports that some are refusing the Astra Zeneca vaccine in Europe because of early reports of lower effectiveness against mild disease. We should stop talking about the relative efficacy of vaccines in preventing minor illness. Individuals are most likely to avoid hospitalization, death and even mild infections by getting the first vaccine that’s available, rather than waiting a month or more for a vaccine with “higher efficacy.”

  • There are many reports of vaccination rates in the U.S. military, and the best way to frame this is that with no mandate two-thirds of active military members got the vaccine in the first round. I’m disappointed with headlines highlighting those who have not yet gotten the vaccine.

A few words about schools

Employers are already closely watching efforts across the country to reopen (or keep open) schools. Many employees cannot be fully productive while they are supervising Zoom school sessions for their children, and many employees must remain remote as long as their children’s schools are not having in-person classes.

Here’s another reason why employers should carefully watch plans to make education in-person and safe. Education can show us the path to opening and keeping open workplaces that have been shuttered due to the pandemic. Education can also show us pitfalls to avoid.

  1. There is no zero risk option in a world with COVID-19.
    There is widespread agreement that we should open schools — and credible studies that show not just economic loss but increased premature death from keeping schools closed. But bringing together groups of people in the pandemic is about reducing risk; it’s not about eliminating risk altogether. Some teachers and students will be exposed and get sick at school, despite the best planning. Employers face a similar challenge. They must do everything possible to protect employees and the community, but there is no zero risk option other than remaining closed.
  2. Public health recommendations — masking, distancing and ventilation — save lives.
    Schools that have been strict about mask wearing have far greater success keeping students, staff and teachers from harm. The same will be true of workplaces that reopen.
  3. The amount of COVID-19 transmission in the community matters.
    Schools in Europe were closed when community spread was high and were able to reopen when the rate of community spread declined.
  4. Make contingency plans.
    Schools that reopen should have a plan for what threshold would make them return to remote learning. Likewise, employers that reopen should have contingency plans to return to remote work if there is a new surge, which is certainly possible as the U.K. mutant strain becomes dominant in the U.S.
  5. Testing can help.
    Our testing has been deeply flawed: So far in the U.S., tests have been highly accurate, but they’ve been expensive and long turnaround times have too often rendered them unhelpful. Schools that are reopening are often doing some degree of testing — and in many geographies are doing pooled testing. I’m hopeful we’ll have a ready supply of do-it-yourself inexpensive antigen tests over the coming months, allowing workers to test at home a few times a week before leaving for work. These tests are not as sensitive in picking up tiny traces of virus in the nose, but they are excellent at identifying who is likely to be contagious.
  6. Create a comprehensive and effective communication plan.
    Schools have to clearly explain their reopening plan and rationale to all stakeholders and re-explain as the situation changes. The same goes for employers. Those who communicate positively and effectively will have the smoothest return to the workplace and will earn the trust and loyalty of their employees.

We are by no means out of the woods. Most of the U.S. remains at very high risk, with more than 160 new COVID-19 cases per 100,000 population in the past two weeks or more than 10% of tests positive. Indoor activities remain dangerous, and we should still avoid nonessential travel. But the rates of infection will continue to decline, and vaccinations will help suppress the virus further. The road back to the workplace for many of the 56% of employees in the U.S. who remain remote will follow a trail blazed by our schools.

Author

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led Willis Towers Watson’s clinical response to COVID-19. 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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