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Winter is almost here, and with it may come runny noses, coughing, and congestion. But how do you know if you just have a common cold, or if you have one or more of the three respiratory viruses that make up the “tripledemic” – RSV (respiratory syncytial virus), COVID-19, and influenza?
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With a triple pandemic of COVID, flu, and Respiratory syncytial virus (RSV) hitting the U.S. hard this winter and resulting in an explosion of cases, business executives need to take the lead on promoting the newly updated, Omicron-specific boosters. Doing so will help reduce the number of sick days taken by their workers, minimize COVID outbreaks and superspreader events in their companies, reduce employee fears about returning to the office, and position executives as trustworthy participants in stakeholder capitalism.
Research shows that the new boosters from Pfizer and Moderna, which are bivalent (they target both Omicron and the original COVID strain) are very safe, like current vaccines. They are also more effective than previous vaccines against the Omicron variants, which are prevalent in the U.S. and around the globe.
The boosters are widely available and price is not an issue: the federal government purchased plenty of doses to give away for free to anyone approved to get one. They’re authorized for Americans aged 12 or older. The Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky stated “there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it.”
Unfortunately, these recommendations are largely falling on deaf ears. Only 7.6 million Americans received the new booster in September, the first month it became widely available.
The reason for low uptake stems from vaccine hesitancy and a lack of awareness. According to a Kaiser Family Foundation survey, less than a third of the targeted population intend to get the new boosters.
This low number is not surprising, given an Ipsos poll showing that 65% believe there is a small or no risk in returning to their normal, pre-COVID life. That belief would not be a problem if we didn’t have hundreds of COVID-related deaths per day right now, and many additional deaths from flu and RSV as part of the triple pandemic. Moreover, the University of Washington’s Institute for Health Metrics and Evaluation projects a new wave of COVID in the winter that could more than quadruple the current infection rate, which aligns with projections of a major winter wave by the FDA.
The consequences for executives and their teams can be dire. We knew since early 2022 that, according to a CDC study, the original vaccine’s effectiveness against Omicron fades quickly. Those who received two doses of Moderna or Pfizer have 71% less likelihood of being hospitalized with COVID compared to non-vaccinated people within the first month of getting the shots. However, that effectiveness fades relatively quickly to 58% after four months and continues falling off after that. Someone who received the original two doses and then a booster gets a protection of 91% against hospitalization immediately. Effectiveness falls to 78% after four months.
By now, it’s been many months since most Americans received the original vaccine series and the booster shots. That makes us seriously vulnerable to COVID, especially the most experienced, senior staff at companies, whose age puts them in a high-risk category.
The immediate danger of staff members being out for several weeks in a hospital, or even dying, is just part of the problem. We can’t forget about the threat of long COVID, meaning long-term symptoms of COVID infection. These symptoms can range from fatigue and brain fog to sudden heart failure and strokes in otherwise healthy young and middle-aged people.
A CDC survey from June 2022 shows that 7.5% of Americans report having long COVID symptoms, defined as symptoms lasting three or more months after first contracting the virus. A study by the University of Southern California finds that 23% of those who get sick with COVID are likely to get long COVID symptoms.
Per a study published in The Lancet, 22% of those who had long COVID symptoms were unable to work, and another 45% needed reduced hours. The Brookings Institution evaluated these numbers to find that long COVID is keeping anywhere from 2 to 4 million Americans out of the labor force. No wonder we’re experiencing such labor shortages!
Nobody wants their staff–or themselves–to become part of these statistics. Yet what are executives doing about it? Not much. That’s despite serious recent outbreaks at major companies that mandated office returns, such as Google or CalPERS, the $441.9 billion California Public Employees’ Retirement System.
By failing to take action, business leaders are falling into the omission bias. This term refers to a dangerous judgment error–a cognitive bias that downplays the costs of inaction in our minds.
In fact, some companies are taking steps in the opposite direction in their desperation to drive staff to the office. For example, Goldman Sachs lifted vaccination requirements everywhere except in areas that have government vaccine mandates for being in the office.
What executives should be thinking about is the long-term consequences of failing to encourage new booster shots. Given the data, we can confidently state that the more employees get shots, the fewer sick days they will take. It will also lower the chance of staff having to permanently reduce their hours or even withdraw from the labor force.
Similarly, advocating for boosters will minimize COVID outbreaks in a company. Doing so avoids the bad PR from such outbreaks, as well as the decreased morale afflicting staff at a time when companies are trying to have their staff return to the office, as Google, CalPERS, and others have discovered.
On a related note, to reduce employee fears about returning to the office, encouraging everyone to get the new booster is an excellent strategy. Whether a company pursues a flexible, team-led model in returning to the office as I encourage my clients to do, or a more rigid, top-down approach, many employees have fears about COVID. An internal survey my company just completed for a Fortune 500 SaaS company showed that 64% of respondents felt somewhat concerned about COVID in the office. That aligns with broader surveys, such as one by Ipsos in September showing that 57% of those surveyed feel somewhat concerned about COVID.
Last, but far from least, comes the crucial role of executives to serve as trustworthy exemplars of what the Business Roundtable calls the new purpose of companies: stakeholder capitalism. A critical aspect of stakeholder capitalism involves “supporting the communities in which we work.”
There’s little doubt that reducing COVID among company employees supports broader community health and well-being. According to Edelman’s trust barometer, business leaders are trusted more than the government, nonprofits, and the media. Some 86% of respondents to the trust barometer expect CEOs to speak out on issues such as pandemic impact. This makes it only more urgent for executives who wish to be on the front line of stakeholder capitalism to speak out in favor of the new boosters.
Mandates are certainly not the right way to go about promoting new boosters, given that we are transitioning from the emergency of the pandemic into a more endemic stage of learning to live with the virus. A much better approach is creating appropriate norms and nudging employees to engage in win-win behaviors by using behavioral science-based approaches.
To create appropriate norms, executives need to both publicly advocate for the new boosters and get the shot themselves. The CEO at one of my client organizations wrote up a blog post for an internal company newsletter about the benefit of getting the bivalent booster, accompanied by a photo of himself getting the jab. She also strongly encouraged her C-suite and mid-level managers to get the booster and discuss doing so with their team members. The company also brought in a well-respected epidemiologist to talk about the benefits of getting a bivalent vaccine booster, who answered questions and addressed concerns among staff.
To nudge employees, this company offered paid time off for getting the shot, along with sick leave for any side effects. It also created a competition between different teams within the organization. Team members could submit anonymized proof of their shots, and the first three teams to have all their members get shots got treated to an all-expense-paid weekend getaway. The company offered the same prize through a lottery for five employees across the organization who got the booster within the first three months it became available.
Other companies I work with have adopted similar techniques to developing norms and nudging employees, customized to their own needs. These approaches help create a context that encourages employees to protect everyone’s health without forcing them to get the shot. Doing so benefits the bottom line by reducing sick days, addressing worker resistance to coming to the office, minimizing PR fiascos, and helping executives be at the forefront of stakeholder capitalism.
Gleb Tsipursky, Ph.D., is the CEO of the boutique future-of-work consultancy Disaster Avoidance Experts. He is the best-selling author of seven books, including Never Go With Your Gut: How Pioneering Leaders Make the Best Decisions and Avoid Business Disasters and Leading Hybrid and Remote Teams: A Manual on Benchmarking to Best Practices for Competitive Advantage. His expertise comes from over 20 years of consulting for Fortune 500 companies from Aflac to Xerox and over 15 years in academia as a behavioral scientist at UNC-Chapel Hill and Ohio State.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
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Oct. 25, 2022 — In early October, respiratory syncytial virus, or RSV, tore through Victoria Thiele’s Indiana home. Her three older children had manageable symptoms. But her 8-week-old newborn ended up developing a severe case.
Thiele, whose family lives in Fort Wayne, said the baby experienced chest retractions while breathing and was taken to the emergency room at a local hospital, where she was diagnosed with RSV and bacterial pneumonia.
An Unprecedented Surge in RSV
Thiel’s experience mirrors what’s happening across the country. On Oct. 21, the CDC director tweeted that respiratory viruses, including the flu and RSV, are surging. Data from the CDC shows the percentage of those testing positive for RSV has more than doubled over the past month – straining the capacity of children’s’ hospitals as they try to care for the sickest patients.
“Nobody has enough beds,” says Renee Higgerson, MD, pediatric intensivist and medical director at Pediatrix Critical Care of Texas and St. David’s Children’s Hospital. “We’re taking care of patients in every possible location we can in the hospital.”
Yvonne Giunta, MD, director of pediatric emergency medicine at Staten Island University Hospital, part of Northwell Health in New York, said the pediatric emergency department at her facility is seeing a high volume of RSV cases, along with other respiratory infections.
“It’s not uncommon for a surge in pediatric volume in the late fall and early winter,” Giunta says. “But this surge seems to have started earlier than in previous years.”
What’s Behind the Surge?
RSV usually has a predictable seasonal pattern, peaking in late December to mid February, according to the CDC. The virus hits young children hardest, causing about 58,000 hospitalizations of kids under the age of 5, and 100 to 300 deaths per year in that age group. But as the CDC noted, RSV was almost nonexistent in 2020, when pandemic prevention methods nearly knocked the virus out of circulation.
Christopher J. Harrison MD, professor of pediatrics at the University of Missouri-Kansas City, said children get RSV by the time they are 2, and these first exposures make children less susceptible to the virus.
But the COVID pandemic means that some children born over the past couple of years were never exposed to RSV.
“Since the hiatus where we lost regular viruses, we ended up really shaking up the whole epidemiology thing,” Harrison says.
The loosening of pandemic control measures coupled with a much more susceptible younger population is a “perfect storm” for this outbreak, he notes.
Hospitals Pitching In
Higgerson says she has been heartened by how hospitals in her area have come together, inviting patients to take free hospital beds on the rare occasions they become available.
“Everybody is working cooperatively,” she says.
But the biggest hurdles are nursing and staffing shortages.
“We’re opening some sections of the adult hospital, creating pediatric beds,” she says. “But what’s limiting us is the availability of nurses. We just need more nurses.”
Giunta says she is already strategizing ways to accommodate staffing needs.
“We are encouraging the swing shift, which typically would cover mainly the adult emergency department, to cross-cover the pediatric area in the later afternoon and evening hours,” she says.
Educating Parents
Michael Chang, MD, a pediatric infectious disease specialist at UT Health Houston and Children’s Memorial Hermann Hospital, whose facility is also operating at or near capacity due to a high volume of RSV, stresses the importance of parent education when it comes to managing this outbreak.
Many parents have resumed normal pre-pandemic activities and are burned out by pandemic protocols, Chang says.
“People are so tired of thinking about the pandemic that we have really returned to our prior behavior of shrugging off mild illnesses, runny noses, etc.,” he says.
Hospitals and pediatric offices should emphasize the ABCs of disease prevention when it comes to RSV, such as avoiding crowds, staying home when sick, and hand washing, Chang says. Teaching parents to recognize when symptoms can be managed at home, and when to take a child to the ER, could also help decrease the number of patients overwhelming emergency rooms.
What Parents Need to Know
In most children, RSV causes mild cold symptoms like sore throat, congestion, and coughing. But for children under the age of 2, children with weak immune systems, or those with asthma, RSV can be more serious.
In vulnerable children, RSV can cause bronchiolitis, an inflammation of the small airways, making it difficult to breathe. It can also cause pneumonia.
Most cases of RSV can be treated at home with extra fluids, cool-mist humidifiers, and nasal suctioning. But some children may need emergency medical care.
Theile’s baby was put on high-flow oxygen, but her oxygen levels remained below normal.
“At that point, they told me she would need to be put on a ventilator,” Theile says.
After 4 days of ventilation, antibiotics, and treatment with steroids, the infant was able to breathe on her own. Thiele says she’s grateful for the compassionate care her daughter received, but that the atmosphere at the hospital was chaotic and frightening.
“When we went into the ER, they had to take her stats in a hallway because all rooms were full of children with RSV,” Thiele says. “The PICU was filled with the sounds of children coughing and monitors going off due to their stats going down. It was truly heartbreaking.”
According to the Academy of American Pediatrics, signs your child may need immediate medical attention include:
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