Strategies for safe business travel during COVID-19

The U.S. COVID-19 infection rate is stuck at over 75,000 new cases a day, and we continue to have an average of 1,200 deaths a day. While this remains far better than during our peaks last winter or in late August, we are at over 750,000 deaths now and are on track to reach a million total deaths by March, 2022 according to the Institute of Health Metrics Evaluation.

Daily trends in COVID-19 cases and incident of death in the U.S. as reported to the CDC

Rates of new COVID-19 cases and deaths remain about the same. Source: CDC

The good news here is that death rates continue to decline, although hospitalization rates are also stuck at around 5,000 new hospitalizations a day, which has led to shortages of ICU beds and nurses in areas with high rates of infection.

Four percent fewer counties have a high rate of community transmission, although 86% of counties have high (100 new cases per 100,000 residents) or substantial (50 new cases per 100,000 residents) rates of community transmission.

Implications for employers:

• Fully vaccinated employees are at dramatically lower risk of hospitalization than those who are not vaccinated. The case for booster doses continues to get stronger.
• Employers should continue to monitor local conditions to determine when and how employees return to work.
• The Centers for Disease Control and Prevention (CDC) continues to recommend indoor mask wearing for unvaccinated people across the U.S. and for the vaccinated in communities with substantial and high rates of transmission.

Addressing the risks of business travel

The U.S. recently allowed recreational and business travel from many other countries, and state and local authorities have eliminated or loosened their restrictions on indoor gatherings. Many companies are considering returning to business travel, and many conferences that had been canceled or postponed are returning. Willis Towers Watson co-hosted the Employee Healthcare Conference Board meeting in New York last month and in San Diego this month.

What can employers do to help increase the safety of their employees when they are traveling for business? Here are a few of my thoughts:

1. Carefully consider whether the goals of the in-person meeting could be accomplished without travel.
   Each time an employee travels there is risk of exposure in transit or at a meeting, which leads to the risk that the employee might need to quarantine away from home if they are infected or exposed. We’ve learned through the pandemic that many things we thought required face-to-face meetings can be well addressed virtually.
2. Require that traveling employees are vaccinated.
   Vaccinated employees are more than 10 times less likely to be hospitalized – and the overwhelming majority of cases in those who are fully vaccinated are mild. There is good evidence that those who are vaccinated are also less likely to spread COVID-19 to others.
3. Strongly urge employees who travel to get a booster shot at least two weeks before travel, if they are eligible.
   Booster shots increase antibody levels substantially and reduce the risk of breakthrough infection. Current CDC guidelines allow adults with a broad range of risks to get booster shots, and strongly recommend those age 50 and over with risks of complicated infection get booster shots.
4. Instruct employees not to begin business travel if they feel sick.
   A minor runny nose or a scratchy throat can indicate a COVID-19 infection, but even if an employee tests negative for COVID-19, other upper respiratory viral infections are highly transmissible. Employees who are feeling sick should not endanger others or themselves by traveling. Employees who have had a recent COVID-19 exposure should also not travel until they have had a negative PCR test at least three to five days after the exposure.
5. Employers should have back-up plans for business travel.
   Employees might become sick at their travel destination or need to cancel travel last-minute out of an abundance of caution. Thus, it’s critical that there be a company approach to meet business needs while supporting individual employees.
6. Encourage employees to turn on "exposure notification" on their iPhone or Android mobile. This program allows users to self-report positive tests, which triggers a warning to those who they might have exposed.
7. Remind employees to mask while in transit.
   Those boarding planes, trains and buses are required by federal regulation to wear masks. Employees can also reduce their risk of exposure by masking while in taxis or hired cars, and opening windows to increase ventilation. The Delta variant is very contagious, and masking and distancing reduce risk even for those who are vaccinated.
8. Require employees to mask when attending business meetings.
   I know, masks can be uncomfortable and don’t help facial recognition, either! But masks are a well-proven way to diminish the spread of airborne viruses like the coronavirus. Even if the community transmission rate is low or moderate where the business meeting is held, there may be attendees from communities with higher rates of transmission. Multiple studies have shown that those wearing masks are less likely to be infected from an exposure. Employees should choose their mask based on their perception of risk. N95 and KN95 masks are the most effective. Surgical masks are more effective than cloth masks, and masks that fit tightly around the nose are better than those which are loose.
9. Encourage employees to test when they return from business travel.
   Anyone with upper respiratory symptoms should be tested, as many cases of COVID-19 in vaccinated people are quite mild. Employees returning from business travel can also consider testing themselves three to five days after they return.

Evidence of vaccine efficacy from Texas

Countries around Europe are reporting that new surges in COVID-19 infections are “a pandemic of the unvaccinated.” Germany, the U.K. and Canada are experiencing an increase in cases among the unvaccinated.

Texas released data this week showing that from January to October, the risk of infection was, on average, 45 times higher for those who were unvaccinated. Those who are vaccinated might have also been more vigorous in other “layers of protection,” including masking and avoiding locations like bars and restaurants, where the risk of being exposed to COVID-19 is higher.

Texas: Risk of infection by age for the unvaccinated, Jan 15, 2021 to Oct 1, 2021

Source: Texas Department of State Health Services

Implications for employers:

• Vaccination is still the most important way to protect the workforce
• Vaccine mandates so far have been very effective at increasing employee vaccination rates, and employers can move forward with these regardless of continuing legal squabbles over the Occupational Safety and Health Administration’s Emergency Temporary Standards.

Another vaccine prevents some cancers

I’ve written earlier about how vaccines have rescued us from epidemics of infectious disease such as measles and polio. Many fear that a decrease in preventive services during the pandemic could leave us vulnerable to these diseases.

Human papillomavirus (HPV) not only causes warts, it can also cause cervical cancer in young women, and head and neck cancers in those middle-aged and beyond. The Lancet published research earlier this month showing that the HPV vaccine has virtually eliminated cervical cancer in the U.K. The vaccine prevented 97% of cancers when administered from age 12 to 13, 75% when administered from age 14 to 16, and 39% when administered to those age 16 to 18. Earlier research suggested that Australia will also be able to virtually eliminate cervical cancer through its vaccination program. In the U.S., over a third of young women and almost half of young men have not yet had this vaccination.

Implications for employers:

• Encourage employees to check to confirm that their children are current on vaccinations.
• Pediatric vaccinations are covered without member cost sharing as preventive services.

Author

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Jeff Levin-Scherz, MD

Population Health Leader, Health and Benefits, North America

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.

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