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The COVID-19 public health emergency is ending. Now what for HR?

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Jeffrey Levin-Scherz and Patricia Toro
Patricia Toro, MD, MPH, is a Senior Director in the Health, Equity and Wellbeing practice of WTW. She is trained in infectious diseases and works with payors, providers and employers to improve the quality and outcomes of healthcare delivery. Jeff Levin-Scherz, MD, MBA, is a Managing Director and Population Health Leader of the North American Health and Benefits practice at WTW. He is an assistant professor at the Harvard TH Chan School of Public Health.

Three years after COVID-19 first emerged, we have an increased understanding of the virus, better tools to prevent and treat COVID-19 and more protective immunity across the population. The situation has changed enough that the Biden administration has announced the end of the pandemic Public Health emergency as of May 2023. Yet, while the worst of the hospitalizations, deaths and countless disruptions to business may be behind us, the virus is still present. As conditions evolve, so must employers’ strategies to address the pandemic.

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The situation today is quite different from even a year ago, both in the U.S. and internationally. Approximately five out of six American adults have some level of immunity to COVID-19, either through vaccination or previous infection. Individuals are feeling safer, and travel and attendance at public events have returned to pre-pandemic levels. Efforts to prevent infection have declined, though. Less than one in seven eligible Americans have received the latest bivalent booster, despite widespread availability and no out-of-pocket cost. Moreover, mask use has declined, as public venues such as houses of worship, stores, public transportation and libraries have removed mask requirements.

But there are still reasons to be concerned about ongoing viral transmission. Businesses still face disruption due to work absences or intermittent remote working due to employee or family illness. Some employees are more vulnerable than others. For instance, about 3% of American adults have some degree of immune compromise and are at higher risk of hospitalization and death from COVID-19. This includes people with certain diseases that affect the immune system, including HIV and cancer, those undergoing chemotherapy and those on medications that impair immune function.

Ending Interventions?

In this setting of shifting risks, employers are rethinking their COVID-19 protocols. Businesses can stop interventions they feel are ineffective or no longer needed, such as requiring pre-visit questionnaires or temperature checks to enter the workplace. These are burdensome and don’t effectively prevent workplace exposures. Companies can remove plastic shields or partitions, which can disrupt airflow and may paradoxically increase the risk of viral transmission. Employers can also stop doing formal contact tracing except where required by state or local law, given that most cases of COVID-19 are transmitted outside of the workplace.

Many companies instituted COVID-19 vaccine mandates during 2021, which helped increase the rate of community vaccination and likely saved many lives. However, mandates may no longer be needed. Few employers continue to mandate boosters or up-to-date vaccination, and the initial vaccination series in 2021 likely provides little protection in 2023. Further, the vast majority of those who are not vaccinated have had COVID-19 and therefore possess at least some degree of immunity. Therefore, many companies can discontinue vaccine mandates, although such mandates may still be required in healthcare facilities. Companies should continue to strongly encourage vaccination with the bivalent booster, which has been shown to decrease the risk of hospitalization by over a third compared to the primary vaccination alone.

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Early in the pandemic, some employers imposed benefit surcharges on employees who did not share proof of their primary series of vaccination. The rationale was that employees who were unvaccinated were at higher risk of infection and illness and therefore would incur more medical expenses. Employers may consider ending these surcharges, given that there is broad-based immunity in the entire population, and the primary series of vaccinations alone provides little protection given current variants and the passage of time. Employers can also reevaluate policies that have lower out-of-pocket costs for care of COVID-19 or for virtual care. These helped encourage virtual care and COVID diagnosis and treatment earlier in the pandemic and may no longer be necessary.

See also: The pandemic’s surprising impact on employee engagement and enablement

Adapting to the New Normal

Many employers have started to move forward with large meetings or conferences, with employees traveling, sometimes internationally, to attend. Once at their destination, employees must follow the regulations in place at the location of the meeting. The Centers for Disease Control and Prevention strongly encourages masking when in planes or trains to decrease the risk of transmission. Employees can be encouraged to test before traveling and after returning home. Meeting organizers should have a plan to support infected individuals who are effectively stranded at the meeting location. Employers can make telephonic or video options available where possible so that employees don’t feel pressured to attend in person if they or their family members are ill or immunocompromised.

Many employees have moved back to working in person, either voluntarily or at the behest of their employers. Employees infected with the coronavirus should follow CDC guidance, which currently recommends isolation for five days. At the start of the pandemic, some employers created a separate “bank” of paid time off days for COVID-19. This is no longer necessary, but it is still wise to offer employees adequate sick leave or PTO so that workers stay home while they are ill with COVID-19, influenza or any infectious diseases currently circulating.

At this point, the pandemic requires enhanced precautions that will not only help guard against COVID-19 but also against other respiratory viruses, especially as influenza and respiratory syncytial virus (RSV) rates have been higher than usual. Enhanced precautions may include many elements. First, readily available hand sanitizer can help limit the spread of viruses that impact the workforce. Second, employers should be sure the workplace is “mask friendly,” and can encourage the use of N95, KN94 or KF94 masks, which provide much better protection than cloth or surgical masks. Third, employers should increase their efforts to improve air quality in the workplace. Often, small changes in air handling systems can dramatically decrease the risk of viral spread. Carbon dioxide monitors may be a useful adjunct to help employers understand where to target improved air quality.

Employers continue to play an important role in protecting the health and safety of their employees, families and communities while still meeting their business needs and objectives. The coronavirus has likely become part of the permanent infectious disease landscape, and employers must continue to refine their response as we emerge from the public health emergency.

Related: Learn more about “Benefits for the Transforming Workplace” and related topics at HRE’s Health & Benefits Leadership Conference, taking place May 3-5 in Las Vegas. Register here.