COVID-19 Delta Variant: Implications for employers and the return to work WHITE PAPER - CVS Health
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WHITE PAPER COVID-19 Delta Variant: Implications for employers and the return to work
The SARS-CoV-2 mutation that now plagues the world is the B.1.617.2 variant,
known as the Delta variant. The Delta variant has spread through many countries
and is now the dominant variety of COVID-19 virus in the United States.
As of July 20, the Delta variant represented 83 percent of new infections and
will likely be almost 100 percent in a week or two.* This prevalence is likely to
have implications for employers’ return-to-work plans this fall.
Epidemiology and clinical impact
The Delta variant is a model of viral mutation — different small changes in the molecular
structure1 that occur as a result of random variation and create selection pressure for more
“successful” models. It is 60 percent more transmissible than the previously dominant
Alpha variant, which in turn was at least 60 percent more transmissible than the original
SARS-CoV-2 strain.
The “load” of virus, or the number of copies a person harbors early in infection, is likely at least
1,000 times greater than the amount harbored by those originally infected with SARS-CoV-2.2
In very real terms, whereas the original SARS-CoV-2 strain carrier would infect 2.5 people, the
Delta carrier likely infects up to 6 people.3
Not only more transmissible, Delta is also considered more virulent, in that it causes worse
disease. A study in Scotland suggested that people infected with Delta were 85 percent more
likely to be hospitalized than people infected with Alpha.4 The mortality differences are not yet
known, but public officials are very worried.
The Delta variant is now the
dominant variety of COVID-19
virus in the United States.
CVS Health: Perspectives on the COVID-19 Delta Variant | 2
COVID-19 rates
of transmission
SARS-CoV-2 3
COVID-19
Delta variant
83 %
of new
1 2.5 infections
person people
Delta variant
60%
more
transmissible
1,000x
viral load
1 up to 6
person people
CVS Health: Perspectives on the COVID-19 Delta Variant | 3The role of vaccinations
The key solution to this phase of the pandemic is vaccination, preferably with
messenger RNA (mRNA) vaccines.
Many of those who are vaccinated will be able to completely resist the virus and, if vaccinated
people do become infected, they are unlikely to get sick or be hospitalized.5 Moreover,
vaccinated individuals will have much lower viral loads and represent less risk to others.
Those who remain unvaccinated face substantial risk of
severe illness and will contribute significantly to ongoing
spread of the virus.
There is also evidence that Delta may be more likely to evade some vaccine protection. While
original reports6 suggested that protection from the Johnson & Johnson (J&J) vaccine was
similar for Alpha and Delta, results emerged on July 20 that seem to suggest the J&J vaccine
is less protective against Delta.7 The mRNA vaccines from Pfizer and Moderna appear to guard
against hospitalization and severe infection, but more viral-positive, previously vaccinated
people with mild disease are being reported — and they likely can infect others.
COVID-19 cases across
the United States have
significantly increased
since early June and
continue to trend upward,
especially in areas with
lower vaccination rates.
CVS Health: Perspectives on the COVID-19 Delta Variant | 4Viral density of the Delta variant
Perhaps the easiest way to look at this is to think about viral density.
Vaccination in any metropolitan area decreases viral density. Towns and cities with high
vaccination rates have much lower rates of virus present. But metropolitan areas that have low
rates of vaccination have much higher rates of virus present, and even vaccinated people are at
risk for infection.
Unvaccinated people are at risk for serious illness and death. Further, unvaccinated people who
have early infections with the Delta variant give off a dense fog of virus, compared to the wisps
of virus observed in March of 2020 with the original SARS-CoV-2 strain.
As a result, in a city with a low vaccination rate, a carrier of the
Delta variant who goes indoors to an office or a restaurant puts
everyone there at risk.
Unvaccinated people By contrast, people
who have early infected with the
infections with the original SARS-CoV-2
Delta variant give off strain gave off wisps
a dense fog of virus. of virus.
CVS Health: Perspectives on the COVID-19 Delta Variant | 5Testing trends
Our recent epidemiological analyses demonstrate this case. Figure 1 illustrates that rates of
positive tests are rising dramatically. Despite the hopes shared by many in early summer that
the pandemic would fade away, it is back — and unfortunately there is a chance that an even
more infectious mutant could replace the Delta variant.
Figure 1
Total US incremental testing and case trends
2.4M 22
2.2M 20
2M 18
1.8M
16
7-day Percent Positivity
1.6M
14
Tests Reported
1.4M
12
1.2M
10
1M
8
800K
6
600K
400K 4
200K 2
0 0
Jan 22, ‘20 Apr 22, ‘20 Jul 22, ‘20 Oct 21, ‘20 Jan 20, ‘21 Apr 21, ‘21 Jul 23, ‘21
Reported US Tests % Positivity
Source: View from CDC updated as of Jul 23, 2021
7 %
Testing positivity
has explosively
increased to almost
CVS Health: Perspectives on the COVID-19 Delta Variant | 6COVID-19 is back, COVID-19 Hospitalization Trends
Current State vs. June 6, 2021
especially in
areas with low Avg. Daily
COVID-19
vaccination rates Beds Used
Last 7 Days
% Change
vs. 7 Days Vaccination
State per 1 M Pop. Ending 7/24 Rate
Figure 2 compares rates of known
Nevada 323 +327% 53%
infection in various states for June
6 with rates today. In Missouri
Florida 273 +163% 57%
and Arkansas, for example, rates
of infection have risen eight-fold, Missouri 272 +150% 48%
with overall low rates of protected
individuals. With this rise in infections Arkansas 267 +259% 45%
is a concomitant increase in
Louisiana 183 +188% 41%
hospitalization rates, as shown in
Figure 3. Mississippi 154 +147% 39%
Based on what we know, the Alabama 143 +94% 42%
worst-case scenario is not being
Texas 141 +97% 51%
played out today, but could be a
few weeks from now if the Delta Oklahoma 139 +138% 47%
variant spreads unobstructed in an
unvaccinated population. Kansas 127 +190% 53%
Georgia 118 +51% 45%
Ultimately, this kind of biological
phenomenon can eventually help Arizona 117 +60% 52%
overwhelm vaccine opposition.
Wyoming 116 +51% 41%
As Figure 4 shows, rates of new
Alaska 104 +255% 51%
vaccinations in Arkansas this week
are more than double those in Kentucky 95 +33% 51%
Massachusetts. In addition, those
who survive infection will have some
immunity which, like vaccination,
protects the rest of the population.
States with the 15 highest
The overall pace of hospitalization rates
vaccinations is still slow all have vaccination rates
below 57%**
despite cases significantly
surging nationwide.
CVS Health: Perspectives on the COVID-19 Delta Variant | 7Implications for businesses
For businesses across the country, the Delta variant will force us to redraw the
map of how to return to the workplace. In the optimistic days of early June,
going back to work and life as normal in the fall seemed guaranteed; we now
see that it is not.
Vaccination requirements
For those who want to return to “normal” work, a reasonable option for employers to consider
from a clinical perspective is to allow only vaccinated individuals to enter the workplace.
Those who have not been vaccinated may increasingly be asked to work remotely, or, perhaps
in highly vaccinated areas, be allowed to return to the worksite only with full-time N-95 mask
coverage. As the Delta variant progresses, employers may wish to consider recommending
N-95 masks even for vaccinated colleagues. Otherwise, there is the risk that the unvaccinated
could infect even some of those who are vaccinated, who in turn can infect others, especially
children who are not yet qualified for vaccination.
Periodic testing
More frequent testing will also be necessary. Low-cost, very accurate tests are available today
that can detect the Delta variant and ongoing viral mutations. In some cases, employers may
decide that everyone coming into the workplace should be tested periodically.
Mask mandates
As we approach inclement weather that drives people inside, we will likely see another upswing
in infections. Masks indoors for all could very well be the default approach by year-end, as
we try to get to a more completely immune population, which would eventually decrease the
overall viral density and the opportunity for the virus to mutate toward more infectious variants.
It is not a pretty picture,
but prudent employers
should start to consider
their next steps with these
considerations in mind.
CVS Health: Perspectives on the COVID-19 Delta Variant | 8Looking ahead
The Delta variant will spread widely
in the coming weeks and months.
Ideas that were once thought to
be off the table, such as vaccine
mandates for employees, may
increasingly appear reasonable and
necessary. Wider use of masks likely
will return, as will testing.
At the beginning of this pandemic, wise
epidemiologists were unanimous that this
would be a three- to four-year struggle,
and they are appearing especially
prescient. Hopefully, this reality will
wear down vaccination hesitance and
antipathy to public health, which would
help us overcome this pattern of recurring
upswings in viral prevalence. Businesses
can help take the lead.
Troy A. Brennan, MD
Executive Vice President and
Chief Medical Officer, CVS Health
Sree Chaguturu, MD
Senior Vice President, CVS Health and
Chief Medical Officer, CVS Caremark
Kyu Rhee
Senior Vice President and
Chief Medical Officer, Aetna
CVS Health: Perspectives on the COVID-19 Delta Variant | 9APPENDIX Back
Figure 2
COVID-19 Case Trends
Current State vs. June 6, 2021
State Avg. Daily Cases per 1M Pop. Avg. Daily Cases per 1M Pop.,
Avg7Daily
(vs. Days Cases per 1M
Ending Pop
6/6) 7 Days Ending 6/6
State (Vs 7 Days Ending 6/6) Avg Daily Cases per 1M Pop, 7 Days Ending 6/6
Arkansas 605 (+1080%) 51
Louisiana 519 (+636%) 71
Florida 487 (+507%) 80
Missouri 394 (+649%) 53
Mississippi 306 (+715%) 38
Alabama 305 (+380%) 64
Nevada 276 (+262%) 76
Alaska 269 (+428%) 51
Oklahoma 237 (+748%) 28
Kansas 187 (+423%) 36
Wyoming 180 (+50%) 119
Texas 178 (+272%) 48
Arizona 175 (+166%) 66
Utah 169 (+135%) 72
California 164 (+616%) 23
Georgia 158 (+364%) 34
Kentucky 151 (+122%) 68
Tennessee 149 (+394%) 30
Hawaii 142 (+280%) 37
South Carolina 140 (+385%) 29
North Carolina 123 (+158%) 48
Washington 116 (+47%) 79
Idaho 115 (+84%) 63
Puerto Rico 100 (+357%) 22
Oregon 97 (+44%) 67
Indiana 91 (+50%) 61
Illinois 90 (+123%) 40
New Mexico 88 (+99%) 44
Montana 79 (+31%) 60
New Jersey 77 (+170%) 28
Notes:
1. Historical values may have slightly changed since first reported due to retroactive reporting changes by states.
2. Top 30 states by cases / population are shown in the chart.
3. Data as of July 25, 2021.
CVS Health: Perspectives on the COVID-19 Delta Variant | 10APPENDIX Back
Figure 3
COVID-19 Hospitalization Trends
Current State vs. June 6, 2021
State Avg. Daily COVID-19 Beds Used Last Avg. Daily COVID-19 Beds Used Last
7 Days per 1M Pop. per 1M Pop., 7 Days Ending 6/6
(vs. 7 Days
Avg Daily Ending
COVID 6/6)Last 7 Days / 1M Pop
Beds Used Avg Daily COVID Beds Used Last per 1M Pop,
State (Vs 7 Days Ending 6/6) 7 Days Ending 6/6
Nevada 323 (+327%) 76
Florida 273 (+163%) 104
Missouri 272 (+150%) 109
Arkansas 267 (+259%) 74
Louisiana 183 (+188%) 63
Mississippi 154 (+147%) 62
Alabama 143 (+94%) 74
Texas 141 (+97%) 72
Oklahoma 139 (+138%) 59
Kansas 127 (+190%) 44
Georgia 118 (+51%) 78
Arizona 117 (+60%) 73
Wyoming 116 (+51%) 77
Alaska 104 (+255%) 29
Kentucky 95 (+33%) 71
Utah 94 (+119%) 43
Tennessee 87 (+22%) 72
Indiana 81 (-16%) 96
District of Columbia 76 (-54%) 164
Idaho 72 (+12%) 64
Washington 71 (-20%) 88
Colorado 70 (-19%) 86
California 69 (+105%) 34
North Carolina 69 (+21%) 57
Rhode Island 67 (-21%) 85
Montana 67 (+12%) 60
Iowa 66 (-1%) 67
Ohio 65 (-29%) 91
South Carolina 65 (+61%) 40
West Virginia 59 (-46%) 110
Notes:
1. Hospitalization data is updated weekly; data as of July 24, 2021.
2. Top 30 states by COVID-19 hospitalizations / population are shown in the chart.
CVS Health: Perspectives on the COVID-19 Delta Variant | 11APPENDIX Back
Figure 4
Incremental Cases vs. State Vaccination Rates
Average Daily New COVID-19 Cases by State Vaccination Active States Last Week
Per 1M Population, 7 Days Ending 7/25/2021
(% Change vs. Prior 7 Days) ME
ME
46
(↑68%) 0.49%
AK
269 VT NH AK
29 26 0.42% VT NH
(↑94%) 0.39% 0.49%
(↑35%) (↑23%)
WA MT ND MN WI MI NY MA RI
116 79 41 47 55 42 69 60 64 WA MT ND MN WI MI NY MA RI
(↑24%) (↑40%) (↑45%) (↑52%) (↑84%) (↑74%) (↑51%) (↑102%) (↑97%) 0.64% 0.39% 0.52% 0.51% 0.54% 0.54% 0.81% 0.58% 0.69%
ID WY SD IA IL IN OH PA NJ CT
115 180 32 63 90 91 61 42 77 55 ID WY SD IA IL IN OH PA NJ CT
(↑40%) (↑31%) (↑75%) (↑114%) (↑79%) (↑38%) (↑76%) (↑85%) (↑67%) (↑93%) 0.43% 0.58% 0.73% 0.54% 0.78% 0.62% 0.47% 0.80% 0.89% 0.82%
OR NV CO NE MO KY WV MD DE
97 276 74 72 394 151 61 41 60 OR NV CO NE MO KY WV MD DE
(↑62%) (↑18%) (ϫ15%) (↑42%) (↑24%) (↑68%) (↑64%) (↑73%) (↑31%) 0.52% 1.10% 0.62% 0.83% 1.18% 0.80% 0.16% 0.77% 0.71%
CA AZ UT KS AR TN VA NC
164 175 169 187 605 149 64 123 DC CA AZ UT KS AR TN VA NC
65 0.91% 0.69% 0.66% 0.77% 1.75% 0.76% 0.74% 0.79% DC
(↑82%) (↑31%) (↑4%) (↑29%) (↑79%) (↑81%) (↑108%) (↑66%) 0.64%
(↑63%)
NM OK LA MS AL SC
88 237 519 306 305 140 NM OK LA MS AL SC
(↑39%) (↑67%) (↑101%) (↑132%) (↑87%) (↑74%) 0.73% 0.85% 1.48% 1.06% 0.95% 0.75%
TX GA
178 158 TX GA
(↑50%) (↑78%) 1.15% 0.58%
HI FL PR
142 487 100 HI FL PR
(↑82%) (↑61%) (↑111%) 0.40% 1.34% 0.89%
Daily Cases per 1M Population % 12+ Receiving First Dose Last Week
0 250 0.25% 1.00%
Last Refresh Date:
07/25/2021
CVS Health: Perspectives on the COVID-19 Delta variant | 12*COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University **COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries dataset, U.S. Department of Health and Human Services 1. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019- ncov%2Fcases-updates%2Fvariant-surveillance%2Fvariant-info.html. 2. https://www.medrxiv.org/content/10.1101/2021.07.07.21260122v1. 3. https://www.forbes.com/sites/williamhaseltine/2021/07/13/the-delta-dilemma-loosening-covid-19-controls-at-a-time-of-increased- danger/?sh=45471e222750. 4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01358-1/fulltext. 5. https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html. 6. https://www.gov.uk/government/news/vaccines-highly-effective-against-b-1-617-2-variant-after-2-doses. 7. https://www.nytimes.com/2021/07/20/health/coronavirus-johnson-vaccine-delta.html. This page contains trademarks or registered trademarks of CVS Pharmacy, Inc. and/or one of its affiliates. ©2021 CVS Health. All rights reserved. 106-55365A 072721
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