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Most public health measures to reduce COVID-19 should continue

Health and Benefits|Wellbeing
COVID 19 Coronavirus

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

With the current risk of COVID-19 infection higher than it was a month ago, layers of protection are as important now as they were in late summer when the Delta variant wave began.

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About the series

Dr. Jeff Levin-Scherz provides regular updates on the latest COVID-19 developments with a focus on the implications for employers and guidance on how they can tackle pandemic-related challenges to keep their workplaces safe. Explore the series.

New cases of COVID-19 are on the rise nationally as we head into the Thanksgiving and Christmas holiday seasons, raising concerns that we might have another wave of infections this winter. We are at 85,000 new cases per day, almost a third higher than a month ago. Infection rates are up across geographic regions, and the infection rate in Michigan (83 per 100,000 residents) is especially high.

New hospitalizations are up 5% over last week, stressing hospital workers who have seen an unimaginable amount of suffering and death during the pandemic. Some hospitals are reporting severe staff shortages, and decreased morale is leading to an exodus of senior experienced nurses, physicians and other staff.

The seven-day moving average number of new cases was 92,852 and the death rate was 2.21 on November 19, 2021.
Daily trends in number of COVID-19 cases and rate of deaths in the U.S. as reported to the CDC

Source: Centers for Disease Control and Prevention

Factors that might be driving the increases in cases and hospitalizations

  1. Our vaccination rates continue to lag. Forty-one percent of the population is not fully vaccinated. Almost everyone in intensive care for COVID-19 at this point is unvaccinated.
  2. Immunity from vaccines is waning for those who received their last dose over six months ago. We’ve administered 31 million boosters, a small portion of those who are now eligible.
  3. Immunity from previous COVID-19 infection is waning too — and likely decreases more quickly than immunity from vaccinations.
  4. We’re spending more time inside, especially with colder weather in the North.
  5. We are getting tired of pandemic-related restrictions. See below for some new information about effectiveness of public health measures.

Implications for employers:

  • The risk of COVID-19 infection is higher now than a month ago. Vaccination, masking, distancing and better ventilation are as important now as they have been since the late summer when the Delta variant wave began.

Layers of protection

The BMJ (formerly the British Medical Journal) just published a meta-analysis of studies examining various public health measures at preventing COVID-19 infections. The results:

  • Mask wearing decreased the risk of COVID-19 infections by 53% (95% confidence interval of 25% to 71%). This was based on six studies with almost 400,000 people.
  • Physical distancing decreased the risk by 25% (95% confidence interval of 5% to 41%). This was based on five studies with about 109,000 people.

The authors also looked at studies of handwashing, which did not show a statistically significant decrease in COVID-19 infections. That’s no surprise, as there is not significant evidence of COVID-19 spreading via surfaces. Good handwashing, of course, is still a good idea.

The BMJ study did not analyze data on workplace testing. More employers are instituting testing as an alternative to vaccine mandates or an accommodation for those with exemptions. Rapid antigen tests, which are now becoming more available, are exceptionally sensitive at detecting people who are likely to be contagious and can provide an additional layer of protection.

Implications for employers:

  • The Centers for Disease Control and Prevention (CDC) continues to recommend masks indoors in communities with substantial (>50 cases per 100,000 residents) and high (>100 cases per 100,000 residents) transmission rates.
  • Vaccination lowers risk substantially, but in the era of the super-contagious Delta variant, additional layers or protection are often necessary.
  • Hopefully we will see a decline in community transmission and continued increase in vaccination and boosters over the coming months, which will allow us to ease up on these additional layers of protection.

Boosters and the importance of primary vaccination series

On November 19, 2021, the Food and Drug Administration and the CDC approved boosters for all adults who are six months past their last mRNA vaccine or two months past the Johnson & Johnson vaccine. Most adults are already eligible for boosters based on illness or body mass index, and most pharmacies or other providers are simply administering booster vaccines on demand.

The evidence for boosters is clearly growing. Israel’s Delta wave subsided when the country offered boosters to all those over age 12, and the country has seen a number of days without a single COVID-19 death. Booster shots confer antibody levels that are higher than after the primary vaccination. Booster shots protect the person being boosted and also protect the community around them, including kids under five years old and immunocompromised adults who get imperfect protection from their own vaccination.

But getting the unvaccinated their primary vaccinations remains the most important way to prevent hospitalizations and deaths and to tamp down the pandemic. Sixty health care groups issued a joint statement encouraging employers to implement vaccine mandates regardless of the court outcome of the Occupational Safety and Health Administration’s (OSHA) Emergency Temporary Standard. Signatories include the American Medical Association, the American Academy of Pediatrics, the American College of Physicians, the American Public Health Association and multiple nursing organizations.

Implications for employers:

  • Employers can encourage booster vaccines with scheduling flexibility and time off, although mandates should continue to focus on primary vaccination.
  • Employers should track booster shots when they set up documentation for vaccine mandates, as boosters may become a requirement to be considered fully vaccinated in the future — as they are for influenza vaccines.
  • Employers can implement vaccine mandates to improve workplace safety regardless of the outcome of court challenges to the OSHA Emergency Temporary Standard.

COVID-19 and influenza: A deadly combo

The CDC is investigating the first big influenza outbreaks of the fall, including a cluster of over 500 cases at the University of Michigan. Data from the U.K. suggests that those who get influenza and COVID-19 at the same time are twice as likely to die.

So get your flu shot this fall if you haven’t already.

Lancet Respiratory Medicine published a report this week which showed excellent immune response when influenza and COVID-19 vaccines are given at the same time. This year, people who are eligible for COVID-19 vaccine boosters should get a flu shot at the same time if they haven’t already gotten one.

Implications for employers:

  • Keep up the effort to encourage employees to get their flu shots this fall.

Tips for a safe and happy Thanksgiving

This is our second pandemic Thanksgiving, and I’m grateful that the situation is dramatically better than last year. We have safe, effective vaccines that are widely available, and we’re on the cusp of having effective and scalable oral medications to treat early COVID-19. Furthermore, our economy is proving more resilient than many would have predicted.

Sadly, many people have lost friends and loved ones this year, and many are still suffering from long COVID-19 or organ damage from severe cases of COVID-19.

Many families will gather together this year, a sign we are getting closer to a post-pandemic normal. However, most Americans live in areas that have high rates of community COVID-19 transmission, and actions that keep workplaces safer can also protect us during family gatherings. Family members who are fully vaccinated are least likely to bring COVID-19 into a family gathering, and no one should attend if they don’t feel well. Here are a few additional tips on how you can make this Thanksgiving a little safer:

  • Cracking windows open can increase ventilation dramatically.
  • HEPA filters also decrease risk of transmission, although they are expensive and can be noisy.
  • Consider asking attendees to do a rapid antigen test just before coming to the family gathering, especially if you have family members attending who have compromised immune systems and young children or others who are not vaccinated.

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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