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What have we learned after a full year of COVID-19?

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | March 17, 2021

A year into the pandemic, we reflect not only on how much we’ve lost but also how much we’ve learned.

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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.

Last week we marked the one-year anniversary of when we first recognized just how dangerous and how widespread the COVID-19 pandemic had become, and many of us started working from home. An anniversary is a good time to look back and remind ourselves how much we have lost. COVID-19 has killed at least 2.6 million around the world and 530,000 in the U.S. — and many are still hospitalized. We don’t know how long symptoms will last in those who have long-haul COVID-19 (post-acute COVID-19 syndrome, or PASC). Many children have lost an entire year of school, and our in-person worlds have narrowed.

An anniversary is also a good time to focus on what we’ve learned over the last year.

  • We have proved that we can do business using videoconferencing. We thought we needed to travel an entire day by air to visit in person for an hour with a client but, in many instances, a videoconference is almost as good. A videoconference also means we can be meeting with business partners on the East Coast in the morning and the West Coast in the afternoon without a science fiction supersonic aircraft! I know some business travel will come back and, like many, I’m eager to return to travel recreationally.
  • A pandemic requires response of both government and business. Even those skeptical of the role of government recognize that governmental efforts were necessary to guarantee the market for COVID-19 vaccines and to underwrite research and manufacturing. Even proponents of robust government action recognize the importance of efforts made by private business, including pharmaceutical companies, manufacturers, technology companies and more.
  • Information changes over time. This is a new disease in humans, and experts made some initial conclusions that were dead wrong, like recommending against masks. It’s important to keep our antennae up for new data that show us we have to pivot and change approaches. As our knowledge of COVID-19 increases, the advice we get will continue to improve.
  • Infrastructure is really important. None of us realized how important it would be to have reliable high-speed internet at home. Weather-related power outages caused misery, and overall, both utility companies and telecommunications companies rose to the challenge and kept us connected.
  • Prevention works. Masks, distancing, sanitation and ventilation saved millions of lives worldwide. These were key to reopening economies early in a number of Asian countries and they continue to help suppress the disease worldwide — making it more likely we’ll be able to come out of the pandemic due to vaccination. The public health response to COVID-19 has meant that this year there is, so far, virtually no influenza; hopefully, we can use these learnings to suppress influenza epidemics in future years too.
  • Benefits matter. Most developed countries require sick leave, which encourages workers who feel unwell to stay home from work, preventing infection of colleagues. Many companies added sick leave during the pandemic; hopefully, the spread of sick leave will continue.
  • We learned to better appreciate front-line workers. Many of us were lucky enough to have our groceries delivered during peaks of viral transmission, and all of us were dependent on those who staffed supermarkets, pharmacies, health care facilities, police and fire departments, and others. Many companies gave extra pay to those who served the public during the pandemic, and hopefully our appreciation won’t end as the pandemic winds down.
  • We live in a global world. COVID-19 does not respect country borders and has spread even to the most remote regions. Testing was initially hampered by lack of nasopharyngeal swabs, which were largely manufactured in hard-hit northern Italy. We also have realized that the components for successful vaccines, including vials, stoppers and stabilizing chemicals, are manufactured in various countries, and we need global cooperation to be sure that vaccine is rapidly manufactured. Pockets of people who are not vaccinated will lead to spread of more mutant strains. We will not resolve the worldwide pandemic until vaccination is widespread, which could take years.
  • Misinformation spreads rapidly. Social media can fuel rapid spread of inaccurate information, whether about origins, spread or treatment of COVID-19. News reports suggest that even now Russia is promoting disinformation to discourage use of well-proven, safe, highly effective vaccines, hoping to increase the market for its own vaccine, which has also proven to be safe and highly effective. We need to be careful not to inadvertently give more attention to viral falsehoods and make accurate information available and compelling.

Most of us ache to return to the social interactions that we’ve been missing over the last year, and reopening of our communities is tantalizingly close. Some worry that the U.S. will have a fourth wave of infections, although I’m hopeful that we’ll start to see a decline in cases in the coming weeks. Let’s be sure to prevent as many cases of COVID-19 as we can over the next few months as we get closer to universal vaccine availability, and let’s be sure that we don’t forget what we’ve learned over the last year even as the pandemic winds down.

Although we are all talking about the end of the pandemic, the current reporting continues to show no decrease in new cases. We are at about 65,000 new cases a day, similar to where we were in late July at the mid-summer peak. Note: It’s always best to look at seven-day moving averages. Some states report incompletely on weekends, leading to Monday or Tuesday reporting spikes that reflect infections from a few days earlier.

The seven-day moving average of new cases for March 14, 2021, is 64,867. A steep decline from new cases reported in January of this year.
Daily trends in number of COVID-19 cases in the U.S. reported to the CDC

Yellow line signifies seven-day moving average number.
Data from January 22, 2020 to March 14, 2021.
Source: Centers for Disease Control and Prevention.

Some COVID-19 news to review from the last week:

  • Evidence from schools suggests that mask wearing at three feet of distance might be about as effective as six feet of distance to prevent transmission of COVID-19 in the classroom. This might not be exactly applicable to employers, but it’s good news. This could help many schools reopen, which is critical to educating future workers and to letting parents get fully back to work.
  • The Pfizer vaccine doesn’t need super-cold freezers after all.
  • There is more evidence a single dose of mRNA vaccines gives those who have had COVID-19 in the past a very robust antibody boost.
  • We should remember that for all the talk of “vaccine hesitancy” among people in minority communities, there is also a huge problem of vaccine availability. We need to be sure to make vaccines readily available in communities that historically have had less access to medical care in general.
  • We’re starting to see reports of COVID-19 disability claims and worrisome reports of high frequency of symptoms up to months after even some mild cases of COVID-19. These claims are often difficult to adjudicate because some of the symptoms of long COVID-19 like “brain fog” and fatigue are hard to define objectively. Organizations should expect some increase in disability claims and more appeals of initial denials. Our understanding of long COVID-19 will increase in the coming months and help make determinations clearer.
  • There is more data showing that temperature scanners are less accurate than we thought. Hopefully, in the coming months, we’ll have inexpensive at-home antigen tests employees can use instead. These should be more likely to exclude those who might be contagious from the workplace. Here’s a report of a study that just started at Citigroup.

One year into the pandemic, we’re still not out of the woods, but we are closer.

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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