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About our “The COVID-19 Crisis” series
Every state in the U.S. saw an increase in COVID-19 infection rate over the last two weeks, despite a decrease in the total number of tests performed. The Delta variant represents over 90% of new infections in the U.S. at this point, and the Centers for Disease Control and Prevention (CDC) suggests that it is more than twice as infectious as the previous dominant strain.
The seven-day moving average for August 13, 2021, was 119,523. Source: CDC
The rate of community transmission is highly correlated with the level of unvaccinated people. The graphic below illustrates the dramatic difference in infection rates between the states with the lowest rates of vaccination (LA, MS, AL) and those with the highest (CT, VT, MA).
Source: CDC cases and vaccination rates, August 12, 2021.
Implications for employers: Many employers have delayed returning remote employees to the workplace and are restricting business travel amid the recent surge in new infections. We don’t want employees to get sick anywhere, but we especially don’t want them to get sick far from home. Efforts to decrease infections (vaccinations, masking, physical distancing) will require time to reduce infection rates, so most delays of return for remote workers will be long-lasting. Some companies have already announced that a return to the workplace will wait until 2022, and others have not yet announced a new date.
2020 – 2021 was another challenging academic year. Most children were limited to remote learning for a substantial portion of the year, and math and language proficiencies fell significantly. Children missed school lunches and socialization, and parents had to deal with their full-time jobs and providing care for children who needed help with homework, technology and coping. We saw parents, especially moms, leave the workforce due to lack of in-person education for their children. This has been hardest on lower-income families, where parents often have to work multiple jobs and tend to have fewer opportunities to work remotely.
Pediatricians and public health experts overwhelmingly recommend a return to school, which will help to make sure our children don’t fall further behind and allow parents to have fewer distractions from their jobs. What does that mean in an era of the Delta variant, where vaccinations have only been approved for those 12 and over?
The Annals of Internal Medicine published a simulation model projecting that increased adherence to masks and distancing could substantially lower transmission of COVID-19 at school; weekly testing, isolating those with symptoms, quarantining affected classrooms and mandatory teacher vaccination all helped too. Nonetheless, there are likely to be outbreaks, especially in high schools in communities with low vaccination rates. Nine districts in Mississippi have moved to remote learning already, and one district in Arkansas reported quarantining over 800 students and teachers.
Parents and employers should be prepared for intermittent interruptions to in-person school attendance this fall.
There has been a lot of reporting about breakthrough infections, and the Delta variant seems much more likely to infect those who have been vaccinated compared to previous strains of the virus. But keep in mind these two facts:
Massachusetts recently reported that three-quarters of those who were fully vaccinated and died of COVID-19 had serious underlying medical conditions and their median age was 82.5.
The Delta surge has been described as a “pandemic of the unvaccinated.” That’s true, but even those who are vaccinated should take notice of the increased risk posed by the Delta strain. The 2.7% of the population that is immunocompromised (those who received transplants, chemotherapy or use various drugs) might be at as much risk as those who are not vaccinated. And even those who have had vigorous immune responses might not have as robust protection as we perceived a few months ago.
A few additional vaccine notes:
Implications for employers: Getting employees vaccinated is even more important now, given the increased contagiousness of the Delta variant. Employers should not put in place limitations on payment of the administrative fee for a third vaccination. We’ve heard that a number of employers are considering premium surcharges, but these have significant disadvantages, and there are likely better ways to increase employee vaccination rates. My colleague Julie Stone and I coauthored an article, “Employers should think twice about using premium surcharges to boost vaccination” in ChiefExecutive.net.
There is a growing move by employers to mandate vaccinations. The federal government has led the way; federal workers will be required to be vaccinated or undergo frequent COVID-19 testing by the fall, and the Department of Defense has announced that its employees will be required to be vaccinated after the FDA offers full approval to the first vaccine. The federal government is seeking to expand this mandate to contractors. The largest teachers union endorsed vaccine mandates for teachers, and the most influential healthcare organizations have encouraged vaccine mandates for healthcare workers. One airline (United) has announced a vaccine mandate and another (Delta) will require mandates for new hires.
Implications for employers: With the upcoming FDA full approval of at least one of the mRNA vaccines, we will see more vaccine mandates over the coming weeks and months. Religious and medical exemptions will usually be offered, and many will be required to test frequently if they are not vaccinated.
Vaccinations alone looked like enough protection from COVID-19 in May when the CDC recommended that vaccinated people could remove their masks indoors in public spaces. A variant that is far more contagious means that we need to layer on additional approaches to maximize protection.
The severity of a COVID-19 infection is also likely related to how much viral material is taken into the respiratory system. Those who are masked when exposed to COVID-19 are less likely to get infected and are less likely to get especially sick from COVID-19. A better-fitting mask provides more protection than an ill-fitting mask. A mask on the chin provides no protection at all. For those who have compromised immune systems, N95 masks are now available to the general public, and KN95 masks provide more protection than simple surgical masks, which themselves provide more protection than cloth masks without filters.
A review of the efficacy of masks from the Proceedings of the National Academy of Sciences earlier this year concluded that “…nonmedical masks have been effective in reducing transmission of respiratory viruses; and places and time periods where mask usage is required or widespread have shown substantially lower community transmission.”
The CDC still recommends mask wearing in areas of high community spread, but most are unaware of infection rates in their areas. With the Delta variant still on the rise, it is prudent to wear a mask indoors.
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.
