Viewpoint: Returning to Work After COVID, Long-Haul Cases, Vaccine Mandates

Remember when we thought COVID would die down last summer, once vaccines became more widely available? Instead, we find ourselves still in the throes of the pandemic, managing the return to the workplace, vaccine mandates, long-haul COVID cases, and presumption determination. What does the scenario look like today? How do we respond to these new challenges?

Return to work. The initial enthusiasm for getting back to the office has waned. While first responders, health care personnel, and service workers may never have left their on-site jobs, millions of office workers quickly relocated to work at home when the pandemic began. Many of them found that they liked it – working from home was convenient, safer, and no one mourned the daily commute to the office. As the pandemic continues, some employers are walking back from earlier mandates to return to the office and continuing with at least hybrid work situations. Others have banned non-essential travel to protect their employees.

Employers must be vigilant in keeping up with federal and state legislation regarding COVID in the workplace and in business transactions. Sometimes state legislations may contradict federal mandates; in these situations, discussions with legal counsel and public policy experts are important to make decisions when guidelines are unclear. With many legislatures resuming in January, more changes may occur. With developments around COVID, it is not “one and done.” The situation is constantly changing and constant watchfulness is required. Above all, it’s essential to have clear policies in place so that management is not faced with a situation they don’t know how to handle.

In discussing return-to-work policies, it’s important to note that workplace expectations have changed during the pandemic. The phenomenon referred to as “The Big Quit,” in which a large number of employees are leaving their jobs to find more fulfilling career paths, is in part inspired by the anxieties and the time to reflect that occurred during isolation. The spike in anxiety, depression, and the use of substances like alcohol and medication during the pandemic has also prompted a much more widespread awareness of mental health issues and their impact on productivity and job satisfaction. There is an expectation, which will probably be long-term, that employers must make decisions and develop policies that are sensitive and fair to employee needs and expectations. Compassionate leadership is no longer just nice to have; most employees expect it.

What’s different about the Delta variant? This variant is known to be more contagious than the original virus. Therefore, additional precautions should be taken, especially with unvaccinated workers – social distancing, masks, cleanliness, more reliance on remote work.

One important factor about the Delta variant is that people who contract it can get very sick, very quickly. This threat applies primarily to the unvaccinated but can be a factor in breakthrough cases for those who are vaccinated. Therefore, employees and employers must be super-vigilant to monitor symptoms and exposure to reduce the potential risk. Nurse case managers should be assigned early on so that the appropriate interventions can be made. Tests can be conducted at home without requiring the individual to break quarantine. Using a combination of immediate testing, virtual nurse triage and remote virtual care, we are seeing good results in outcomes at 30 percent less cost.

Another aspect to this phase of the pandemic is that new cases are likely to arise among younger workers, ages 18 to 27. These young adults like to socialize, are less likely to be vaccinated, and may have the “young invincible” mentality that comes with being healthy and youthful. Contrary to the perception that they will have light symptoms, these younger workers can get very ill. This group may be a target for focused educational efforts.

Overall, those who contract COVID and are not vaccinated have a 7–8 times higher risk of requiring hospitalization. Again, early intervention is imperative to get the individual diagnosed, treated, supported, and hopefully, on the road to recovery.

We are seeing that several breakthrough cases are healthcare workers, with about 40 percent coming from the public-facing entities like social workers, first responders, and health care providers. This is not surprising, given that these individuals have considerably more contact with others, including those who may be unvaccinated. We all need to be continually vigilant about vaccinated employees, as well as unvaccinated. Employers should arrange for frequent rapid testing, immediate diagnosis and monitoring for positive cases, including oximeters at home to measure respiratory function, virtual care and nurse case management.

Our staff monitors reports of COVID cases daily, by client and region, to spot areas where outbreaks may be occurring and to secure early intervention. Companies should likewise monitor outbreaks of cases in their communities as well as a guide to possibly intensifying their precautions and their policies.

To Mandate or not? Health care organizations are among the most likely employers to mandate vaccines. Many others are following suit. Needless to say, there are numerous legal issues around such decisions. Some unions have protested, as well as employee groups. Employers should take appropriate steps as outlined by reliable sources such as Occupational Safety and Health Administration and the Centers for Disease Control. Stay on top of regulatory requirements and debates. In organizations and/or events where workers may be unvaccinated, employers should follow the OSHA guidelines for accommodating unvaccinated workers: facial coverings and social distancing.

Some employers offer incentives to their employees to become vaccinated – lotteries, raffles, cash prizes, and bonuses. However, this tactic needs to be carefully examined before implementing, as lawsuits have been filed stating this is unfair treatment of workers. Employers considering vaccination incentives should run these ideas by their legal departments to ensure they do not violate employee contracts. The same issues arose in the past about incentives for non-smokers with reduced health care policy payments—these decisions were ultimately upheld because science backed up the additional illnesses and costs that smokers experienced.

Is COVID the new asbestos? Will longtail claims persist for decades, requiring continued ongoing care and claims payments? Currently, approximately 3–5 percent of COVID cases fall into the category of long haul COVID, with symptoms persisting three to four months beyond the time the disease usually takes to run its course, which is typically 10–14 days. Consequently, files that have been closed may be re-opened. The most common symptoms include brain fog, joint pain, respiratory problems, and sometimes malfunctions of whole-body systems.

At this time, it is unknown how long these cases might take to resolve and if they can be fully resolved. In the long term, medical causality will be a determining factor in how these claims are funded. In workers’ compensation, states vary widely in their presumptive requirements. Investigations at the start of the claims must be compiled accurately and protected to aid future decision-making. We believe that insurance will be heavily engaged in managing COVID claims for at least 10 years.

In conclusion, companies must determine their policies proactively and thoughtfully, as COVID will likely be a long-term issue in the workplace and in the health of the nation for years to come. Policies will need to change and evolve based on changing conditions, scientific findings, and guidance from local, state, and federal bodies. The most important priority for companies is to have clear guidance in place that can be modified with changing conditions.