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OSHA issues COVID-19 guidelines for employers’ reopening, more contagious variant to become dominant

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | June 22, 2021

Although U.S. COVID-19 numbers are headed in the right direction, the more contagious and deadly Delta variant concerns health authorities.

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About our “The COVID-19 Crisis” series

“The COVID-19 Crisis” series is a weekly update by Dr. Jeff Levin-Scherz covering the latest developments related to the COVID-19 pandemic in the U.S. Explore the entire blog series.

The rate of new COVID-19 infections continues to decline in the United States. According to the Centers for Disease Control and Prevention (CDC): We're down to under 12,000 new cases per day, and about 2,000 new hospitalizations per day. We are at under 300 deaths per day (seven-day moving average). The U.S. has administered 315 million vaccine doses, and continues to average 1.3 million per day. More vaccines are better, but this continues to be a vigorous pace and will continue to provide us with more protection as a population.

Even as the pandemic winds down, there's a lot of COVID-19 related news.

  1. 01

    OSHA issues new guidelines for employers

    The Occupational Safety and Health Administration (OSHA) issued new guidelines for employers, which make it clear that employers can and should have different policies and procedures for vaccinated compared to unvaccinated workers. Key elements of the OSHA guidelines recommend:

    • Providing time off for employees to get vaccinated
    • Requiring workers who are infected and those who are exposed and unvaccinated to stay home
    • Maintaining physical distancing and masking for unvaccinated and at-risk workers in the workplace
    • Providing worker education
    • Asking that unvaccinated visitors use masks
    • Improving ventilation
    • Routine cleaning and disinfecting (as opposed to deep cleaning in absence of workplace infections)
    • Full reporting of occupational COVID-19 infections and deaths
    • Allowing anonymous reporting of employee concerns and protecting against retaliation

    This guidance will help employers determine their practices to maintain safe workplaces, although they will need to continue to follow any state or local guidelines that are more strict.

  2. 02

    Medical claim data shows that medical utilization continues after recovery from COVID-19

    Fair Health studied medical claims from almost two million people who recovered from COVID-19. They found that 23% had claims for symptoms related to COVID-19 30 days after the initial infection; this rose to 50% among those who had been hospitalized. The most common symptoms included pain, breathing difficulties, malaise and fatigue, and hypertension. Depression and anxiety were common, too. One half percent of those who were discharged from the hospital with a diagnosis of COVID-19 died 30 days or more after diagnosis, 46 times higher than expected.

    The Fair Health researchers also say that 55% of those with COVID-19 were asymptomatic, but I would be cautious about this conclusion. This is a claims study, and clinicians code imperfectly when they do medical billing. Some busy clinicians might not have coded for COVID-19 symptoms, and some symptomatic diagnoses might be misattributed to post-COVID-19. Providers often code for a disease when it is being "ruled out," which could artificially elevate the apparent portion of asymptomatic cases.

  3. 03

    A hit and a miss on new vaccines

    Novavax reported its Phase 3 trial results for a new vaccine that uses nanoparticles to deliver the spike protein to trigger the body to produce antibodies. The trial included about 30,000 adults, and the vaccine showed a 90.4% efficacy against symptomatic COVID-19 and 100% efficacy against moderate or severe COVID-19. The vaccine was 91% effective in preventing symptomatic disease in elderly and high-risk volunteers.

    Novavax’s efficacy is essentially equivalent to those of the mRNA vaccines from Pfizer and Moderna, which were tested before the current more-contagious variants emerged. We don't know its efficacy against the Delta variant (B.1.617, first seen in India), which was rare in the U.S. when this was tested, but is expected to be the dominant variant in the U.S.

    The Novavax vaccine requires two injections three weeks apart and requires only refrigeration — no freezing. This is super news. Although we have enough vaccine in the U.S. without Novavax doses, this vaccine can help us vaccinate globally, which will decrease variants and make us all safer. This vaccine is a new technology, which might well help us combat other viral diseases beyond COVID-19.

    Curevac, a German biopharma company, announced preliminary data showing that its mRNA vaccine is 47% effective against symptomatic COVID-19. This is disappointing, and it's unlikely that completion of this trial will increase apparent efficacy. I'm amazed at how many of the vaccines have proven to be highly effective, and with two mRNA vaccines that are dramatically more effective, this vaccine is likely to be abandoned.

  4. 04

    Delta variant continues to be a threat

    New evidence shows that the delta variant (B.1.617, initially identified in India) is 60% more infectious and twice as likely to lead to hospitalization compared to the alpha variant (B.1.1.7, initially identified in the U.K.). The delta virus now represents over 90% of the infections in the U.K., which has postponed easing its final stage of lockdown due to a new surge of infections. This is especially worrisome given the high rate of vaccination in the U.K., where 55% of the adult population is fully vaccinated.

    Vaccines remain very effective against the delta variant (Pfizer is 88% effective at preventing symptomatic infection, and 96% effective at preventing hospitalization.) This variant's increased infectivity and severity make it all the more important for the U.S. to continue to aggressively promote vaccination.

  5. 05

    Multisystem inflammatory syndrome in children

    CDC researchers reported in JAMA Network Open that one in 3,200 children who had COVID-19 got multisystem inflammatory syndrome. Symptoms include persistent fever, gastrointestinal symptoms, rash, headache, confusion, swelling, decreased cardiac function, respiratory failure, and kidney and liver injuries.

    Most children recover — but this is a terrible disease and the incidence is higher than expected. This is a compelling reason for parents to get their children vaccinated as soon as they are eligible. The eligibility age is now 12 and will hopefully be five or six before the end of the year.

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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