RSV, flu and COVID-19: How employers can help reduce the spread and improve worker productivity
Tripledemic! Hospitals over run! Everyone is sick! It’s difficult to listen to the news right now and not hear about the onslaught of RSV, flu, and COVID-19 that is making just about everyone feel sick, crowding hospitals.
Is this year worse than normal? It’s still too early to know, but we do know that RSV cases are surging earlier than normal and flu case rates are above expected for this time of year.1,2 Employers are seeing record number of workers staying home to care for themselves and family members impacting worker productivity.
Tracking infectious disease prevalence
Using our MarketScan® healthcare claims data and proprietary AI algorithms, we worked with IBM Research to maintain a monthly blog on the impacts of COVID-19.3 The impacts of the COVID-19 prevention efforts were felt far-and-wide in the healthcare system, from reduced cancer screenings, unpredictable costs and gaps in chronic disease management. Yet, some of the most stunning impacts were on the diagnosis patterns of infectious diseases.
Some experts feel this abnormal pattern of infectious disease is caused by an immunity debt that society incurred from the preventive measures practiced during the pandemic.4
The line graphs below show dramatic drops in the prevalence of many infectious diseases. RSV and flu rates declined almost 100% in December 2020 through February 2021, compared to December 2019 through Feb 2020.
Flu trends and vaccination strategies
After preventive measures for COVID-19 were put in place, the flu was basically eliminated.5 There was a small increase in the winter of 2021 to 2022, but the increase fell short of the seasonal surge in the winter of 2019 and 2020 (pre-pandemic).
Figure 1: Change in the prevalence rate of Influenza from March 2019 to Feb 2022
The 2022-2023 flu season is making many headlines, largely because the 2021-2022 flu activity was so low. Flu timing, severity, and prevalence can vary significantly each year. There is an old saying, “Once you have seen one flu season, you have seen one flu season.”6 However, the 2022-2023 flu season will be characterized by peaking earlier this year than any year since tracking has started.7
Figure 2: CDC Weekly U.S. Influenza Surveillance Report (not all seasons shown)
The flu vaccine has many benefits. Not only does it protect against getting the flu, but it is also one of the best ways to prevent getting seriously ill from the flu. This year’s shot has a nearly 50% efficacy against hospitalization from the major strain of the flu, according to the CDC.8 The benefits of getting vaccinated against the flu are many, and for employers and payers a few notable benefits include:
- Improve worker productivity and reduce absence9
- Lower rates of cardiac events10
- Reduced hospitalization for diabetes and chronic lung disease11
Flu vaccination rates for those 18 years and older has been growing since 2018.13 In the past 12 months, 50% of those 18 and older received a jab (or the mist for those needle-shy among us). More concerning is that CDC data shows stunning disparities in vaccination rates by racial and ethnic group. Flu vaccination rates for Black, non-Hispanic populations are almost 14% lower than white, non-Hispanic populations in 2020 (42.7% Black, non-Hispanics versus 56.4% in White, non-Hispanic populations). This disparity has been increasing since 2018.13
The MarketScan® data below shows flu vaccination rates by age group (September 2020-2021).
Figure 3: Commercial population flu vaccination rates using MarketScan® Treatment Pathways
Below are evidence-based strategies to improve flu vaccination rate within your population. Leveraging data and analytics can help decide if these strategies might be right for your organization.
Identify high-risk populations for personalized outreach
It’s important to target those at highest risk for complications (e.g., over 65 and pregnant women). Our risk profiling methodologies help to identify high-risk patients or those with no evidence of vaccination for outreach. Please note: this approach may be limited if there is limited flu shot data available.
Auditing provider performance or clinician reminders
Flu vaccine data is not always reliable because flu vaccinations do not always come through the claims data. Our imputed PCP methodology and managing provider methodology help identify the list of providers likely responsible for delivering flu shots. You can then partner with those providers to help increase vaccination rates.
Financial incentives for providers to meet vaccine targets
Use existing data and estimates from the literature to model flu shot targets. Start by designing the cost and benefit scenarios of offering provider incentives. For example, if X% of workers get flu shots, productivity will improve by Y%. Therefore, if providers meet their targets, we will pay them $Z.
Financial incentives for patients
Many organizations are applying financial incentives (e.g., premium reductions) to those that get vaccinated against the flu. Merative can help plan on how a financial incentive can fit into a larger total rewards program.
Reduce barriers to flu vaccination
Offer free onsite flu clinics or work with local partners to make getting a flu shot even easy.
Respiratory Syncytial Virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.14 Like the flu, RSV largely disappeared from the population in the first year of the pandemic. However, unlike the flu, there was a surge in RSV infections in the summer of 2021 – a time of year when RSV tends to be less prevalent. The current surge likely speaks to an even greater opening of daycares and schools than was seen during the summer of 2021. It should be noted that RSV is not necessarily more prevalent this year, but it is occurring earlier than expected.
Figure 4: Prevalence of Respiratory Syncytial Virus Infections from March 2019 to Feb 2020 and March 2021 to Feb 2022
Currently, there is no vaccine for RSV, but one is likely coming sooner than later. Pfizer, for example, recently announced a promising vaccine candidate for pregnant moms to protect newborn children.15
Other infectious disease trends
RSV, flu and COVID-19 are the three infectious diseases dominating the media, but the IBM Research analysis showed that many infectious diseases were essentially “cured” as a result of the COVID-19 pandemic prevention measures. Bacterial pneumonia, sinusitis, and strep, largely went away after the start of the pandemic and have not returned to pre-pandemic levels as of February 2022. Primary care docs and pediatricians are noticing patients with “overlapping viruses” and “people being sick for weeks, rather than days, with simple colds”.16 Young children are particularly vulnerable because, for many of them, this is their first year of exposure to these diseases.
Figure 5: Prevalence rates of select infectious disease episode groups from March 2019 to February 2020 and March 2021 to February 2022. (a) “Pneumonia, Bacterial”, (b) “Sinusitis”, (c) “Headache”, (d) Pharyngitis, Non-Streptococcal”, ( e ) “Other Ear, Nose, and Throat Infections”, (f) “Pharyngitis – Streptococ”al"
Infectious diseases, like the flu, are coming back with a vengeance this year. Employers need to prioritize employee wellbeing and help keep their staff healthy.
A business response
One thing the charts above demonstrate is that these preventive measures can successfully control the spread of infectious diseases. There were many public health measures implemented to reduce the spread of COVID-19, but staying home when sick was always at the top of the list. Three years later and a culture of staying home when sick has not necessarily carried over from the start of the pandemic to this current time. If you or a family member has recently tested negative for COVID and then went to work “a little sick”, you are not alone.
The reasons workers will go to work sick include: wanting to demonstrate a strong work ethic, a feeling or need to attend crucial events or meetings, a lack of sick time, the need for money for hourly workers, or fear of punishment for not showing up.17
Employers should promote encouraging workers to stay home when sick or when needing to care for a sick family member. Not only is there the benefit of reducing infectious disease spread, but also the benefit of improving worker’s mental health.
Staying home when sick greatly reduces the spread to coworkers. This is especially respectful and important for those coworkers that are still fearful of getting sick in public places. In addition, workers are just not as productive when they are sick. Similarly, families with young children will often send their child to daycare or school not feeling well so the parents can go to work. This makes other children sick, requiring other workers to stay home and care for those sick children.
Staying home when sick will not halt the spread of infectious diseases. However, encouraging workers to stay home and care for themselves and their family members will improve overall wellbeing, leading to improved productivity and employee morale.
Here are a few approaches to get started:
- Support employees and provide recommendations on when you should and shouldn’t come to work
- Design a wellbeing program that offers paid sick time for when a worker (or a family member that requires care) is sick
- For workers that don’t have to work on-site, encourage remote work when sick
- Offer accommodations to incentives for productivity that allow for sick time
For organizations that rely on hourly workers, a culture like this may be challenging, but COVID-19 proved that organizations could promote a culture of health while remaining competitive. Merative teams use data, analytics and industry knowledge to identify health and wellness programs that promote and enhance your organization’s culture of health, leading to a healthy and productive workforce.