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7 business risk associated with unvaccinated employees

Health and Benefits|Wellbeing
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | October 5, 2021

As COVID-19 rates begin to decline and mandates increase, employers recognize that unvaccinated workers represent a business risk.

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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.

COVID-19 rates continue to decline throughout the U.S., and decline is greatest in the areas that had the worst outbreaks a few weeks ago. This is typical of the coronavirus, where severe outbreaks lead to more natural immunity as well as increased uptake of vaccine — which eventually causes a decline in cases. Hospitalizations remain high in states with low vaccination rates though, and we still see hospital systems in severe stress in many states in the South and West.

Per 100,000 people, the seven-day moving average for cases:103,422; for death rate: 3.17 as of October 1, 2021.
Daily trends in number of COVID-19 cases and cumulative incident rate of deaths in the U.S.

Source: CDC, October 1, 2021

Six states’ COVID-19 vaccination and hospitalization rates

The table illustrates hospitalization rates in the three states with the highest vaccination rates (VT, MA, CT) and the three states with the lowest vaccination rates (LA, AL, MS).
State Full Vaccination Rate, 18+ Hospitalizations (per 100K)
Vermont 80% 7
Massachusetts 79% 8
Connecticut 80% 9
Louisiana 56% 20
Alabama 52% 37
Mississippi 54% 26

Source: Becker’s Hospital Review, September 30, 2021; New York Times, October 2, 2021.

Implications for employers

The vast majority of the country continues to still have a high risk of community transmission (>100 cases per 100,000 per week), so many employers will continue to delay return to the workplace for remote employees. Employers and employees should remain vigilant to prevent workplace exposures.

Business risks of unvaccinated employees

Employers increasingly recognize that unvaccinated employees represent a business risk that they are looking to mitigate.

The business risks of unvaccinated employees include:

  1. Employees could get sick — if they are hospitalized the expense can be from $75,000 to up to $300,000 if they are treated in the intensive care unit. Those with COVID-19 must miss at least 10 days of work.
  2. Infected employees, even those without symptoms, can expose others in the workplace.
  3. Unvaccinated employees must quarantine for 14 days after an exposure, while vaccinated employees face no such quarantine requirement.
  4. Those who get COVID-19 could have long-term disabilities from long COVID-19. Some might need workplace accommodations, while others might not be able to return to the workforce.
  5. Employees, customers and clients might be more wary about coming to a workplace with lower rates of employee vaccination.
  6. Employees who have immunosuppression could feel unsafe and could file complaints for violation of the Americans with Disability Act. Employers should be careful not to suggest that such employees could work remotely, which could be considered discriminatory.
  7. Companies with workplaces that are identified as the cause of a community outbreak face reputational risk.

Some employers have expressed worry about workforce attrition if they mandate vaccination. So far, few workers have actually left their jobs due to vaccine mandates — far fewer than those who reported they would leave their jobs. For instance, United Airlines has achieved a 99.5% vaccination rate. So have many hospital systems (Houston Methodist 0.6% noncompliance; Medical University of South Carolina, 0.003% of employees or 5 of 17,000 terminated) and universities (Harvard, Yale, Princeton, Stanford, and many others have vaccination rates of well over 90%).

New York State was concerned about loss of health care workers when its mandate took effect, yet the compliance with the mandate was well over 90%. National news outlets reported that “dozens” of Massachusetts state troopers had resigned over the mask mandate; only a single resignation has been confirmed.

Implications for employers

Employers should continue to make it easy for employees to get vaccinated — including flexible scheduling, onsite vaccinations and time off to deal with vaccinations and adverse effects. But making it easy and offering financial incentives is not as effective as a mandate. The real-world evidence is that mandates are getting many employers to well over 90% vaccination rates without causing substantial workforce attrition. United Airlines has even said that they have seen an uptick in new applications since the mandate went into effect.

Drug treatments for COVID-19

Vaccinations have proven to be more effective than expected against the coronavirus, but so far our drug treatments for people already infected have been disappointing. For those who already have respiratory failure in an intensive care unit, the generic steroid dexamethasone reduces ventilator treatment and death. For those who are a bit less sick, remdesivir (Veklury) is approved in the U.S. to reduce complication rates, but it requires intravenous administration, and a large World Health Organization study didn’t confirm its effectiveness.

The New England Journal published a study last week of the monoclonal antibody “cocktail” REGEN-COV showing that it reduced the risk of hospitalization or death from COVID-19 by 73%, which is great news. The drug was given intravenously, although the medication can be given by subcutaneous injection. The FDA previously gave an emergency use authorization to REGEN-COV for prevention in high risk individuals after exposure and for treatment of mild to moderate COVID-19. REGEN-COV is expensive (over $2,000 a dose) and decreased symptoms on average by four days (from 14 days to 10 days).

Merck just announced that it would seek approval for the first oral medication, molnupiravir, to treat COVID-19. Its unpublished data showed that the drug, given as four capsules twice daily for five days, decreased risk of hospitalization or death by half. No word on the price of this medication. It might initially only be available to high risk patients. Pfizer also has Phase 3 trials of oral medications to treat and prevent COVID-19.

Implications for employers

Availability of drugs that are easy to administer to treat cases of COVID-19 could help us emerge fully from the pandemic and help allow those who are especially cautious or who have suppressed immune systems to return to their pre-pandemic activities. These medications will likely carry prices appropriate for their high value and will probably be an unanticipated cost in employer-sponsored health plans, which will be partially offset by decreased inpatient spending.

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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