Key Insights: COVID-19 Surge in India

In a recurring weekly discussion series, the Business Group has been convening a small group of employers to discuss the urgent situation developing in India.

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May 24, 2021

In a recurring weekly discussion series, the Business Group has been convening a small group of employers to discuss the urgent situation developing in India. Conversation topics have covered vaccine distribution and access, oxygen supplies, financial and non-financial assistance, virtual health, bereavement and mental health support, emergency benefits and business continuity.

Vaccine Distribution and Access

Currently, COVID-19 vaccine access in India remains limited. Employers are working with regional and global partners to attempt to obtain access to vaccines for their employees and their families.

Vaccine Distribution

In response to the current challenges with vaccine supply and distribution in India, employers are taking the challenge into their own hands.

  • May 24 update: One employer is planning a hybrid approach with regards to vaccination- they hope to set up on-site distribution events in larger locations, and partner with local health providers in smaller areas. The hope is to fully contract out with hospitals but host vaccination events on-site, as employees may feel safer traveling to their workplace, rather than a hospital that may be overrun with COVID-19 cases.
  • May 24 update: Other employers are partnering, or planning to partner with Medtronic Foundation as part of a program to gain purchasing power to procure vaccine doses. While this is not yet permitted in India, companies hope to ramp up supply in the meantime.
  • One company hopes to go live with on-site vaccination in late May. Another employer noted that it has heard anecdotally that some larger companies have had success with getting doses by prepaying for vaccines but has not been notified of any hospitals accepting prepayment. Also, a few companies with the largest footprints in the region (those with over 45,000 employees) were able to secure vaccines before the crisis.
  • Companies with a large footprint in India are hoping to set up distribution events at their corporate park once the supply issues are resolved. These companies are aiming for late May or early June for the larger vaccine drives.
  • Some companies are partnering with local private clinics to provide vaccines to their employees.
  • One company is working to procure two million doses of a COVID-19 vaccine that has yet to be approved by the Indian government and shipping them to India in the hope that it will be approved at some point.
  • Other companies are working with local aggregator services to assist in setting up large vaccination events or helping employees in smaller-footprint locations access a vaccine near their homes.

Reimbursement

As of right now, the COVID-19 vaccine is not covered by private insurance plans in India, but many employers are working to get a reimbursement in place for their employees and dependents.

  • While not actively attempting to get vaccine supplies themselves, multiple employers on the line are reimbursing, or planning to reimburse the cost of the vaccine for their employees and dependents.
    • Some are limiting this reimbursement to $50 due to escalating costs.
  • One company is looking for guidance from the government on whether it can reimburse dependents, as this is not clear presently.

Oxygen and Medication Supplies

Throughout this most recent surge, global news reports have emphasized the shortage of oxygen as a key contributor to the ever-growing hospitalization and death rates in India. Employers are hoping to assist their employees in getting access to oxygen concentrators and emergency COVID-19 medications, whether they are at home or in a hospital.

Oxygen and medication distribution

Employers are partnering with local teams and providers to assist with combatting the urgent oxygen shortage in India.

  • Several companies have made progress in their goal of obtaining oxygen concentrators and supplying them to employees and providers in India. Employers note the importance of not reserving as many oxygen concentrators as they can find in an effort to prevent a fight over scarce resources and to balance doing the right thing with not manipulating the market. Predominantly this work is being driven by procurement teams.
    • One company attempted to work with third- and fourth-party providers to source oxygen concentrators, but the company experienced issues with quality and transparency once vetted and due diligence checks were conducted on the suppliers. Another concern that was raised was lack of control over what ultimately was included in the supplies. This company plans to gather hospital-grade concentrators (not those that can be used at home) and supply them directly to hospitals and hopes to eventually donate any unused supplies to the hospitals in the future.
    • May 24 update: Other employers, while not sending medical supply and PPE kits directly to employees, are reimbursing costs for any medical, PPE, and cleaning products that the employees can procure on their own. One company, for example, is reimbursing expenses for up to 10,000 rupees.
  • One company is partnering with Connect & Heal to conduct telemedicine visits with employees to determine if there is a need for oxygen to be sent, as well as managing follow-up and monitoring visits. If an employee is deemed eligible to receive oxygen, the local facilities team will distribute it to their home.
  • Employers are concerned about the high level of stress on the ground in India and want to make sure they are addressing the present needs appropriately and rationally.
  • Some employees have asked their employers to procure COVID-19 therapies such as remdesivir, but employers note that these medications, as well as supplemental oxygen/ventilators, are only needed for the gravest cases and are authorized for hospital use only.

Virtual Health Services

With hospitals around India nearing and surpassing capacity, employers look to their virtual health/telehealth providers as a necessary source for medical care for their employees as well as dependents.

Local and global vendors

Employers are utilizing any local, regional and global vendors to provide telehealth visits to their employees and families.

  • One company noted that its telehealth vendor in India is a local vendor that, as a result of the crisis, is maxed out. Therefore, the company is in the process of setting up an additional vendor to help address the gaps.
  • Several companies are also using their local vendors or partnering with new vendors to put together home health kits for their employees and dependents. The kits include PPE, thermometers and pulse oximeters.
  • One employer on the line sent out a communication to all employees reminding them that the employee assistance program (EAP) vendor can be used in crisis situations. The communication added that employees can work with internal employee resource groups (ERGs) to provide support to employees who may be impacted because they live in India or have family there.

Bereavement and Mental Health Support

With COVID-19 deaths in India increasing by thousands per day, employers are focused on providing as much support as possible to employees and families who have faced tragedy.

Bereavement leave and financial benefits

Employers have been ramping up bereavement leave and financial support for employees and their families.

  • May 24 update: One employer is experiencing a challenge when trying to ramp up life insurance and fill gaps wherein some entities within the company have larger life insurance allowances than others. They are looking into possibly instituting a self-insured arrangement to address these gaps. Additionally, employers can consider using a captive arrangement to save costs and cut through resistance at local level.
  • One company noted that due to the surge, employees and families are experiencing delays when attempting to process death claims. As a result, this employer is implementing gap measures (two months of pay) while they wait for these benefits to kick in.
  • Several companies have added additional time to their bereavement leave already in place while continuing to monitor the situation and ensure that the continuity of business is accounted for.

Mental health support

The psychological trauma of constant cremations in India has impacted employees’ mental health. as well as their ability to function day-to-day at work.

  • May 24 update: several companies have set up virtual sessions with resilience specialists for employees based in India. Employees have been responding positively to these well-being sessions. Employers are also using these sessions as an educational tool: concerned about the spread of COVID-19 misinformation, employers want to share facts and educational resources to address anxieties.
  • One company highlighted the concerns of their India-native employees working in other locations around the globe, and the mental toll that the crisis has taken on their ability to function. Some of these expat employees have asked to be relocated back to their home region in the hope of being closer to family as they continue to live through this crisis and anticipate future crises.

Emergency Benefits

Employers are providing support to employees based in India who may be experiencing financial hardship due to the current surge in addition to addressing urgent medical needs.

Fundraising

In response to employee requests, many employers are launching fundraisers to benefit their employees based in India.

  • Several companies have put together employee relief funds with company matches to address overall financial needs as well as to compensate for gaps created by medical plan caps. Many of these fundraisers allow employees around the world to donate to COVID-19- specific funds that would benefit their colleagues in India.
  • One company is doing a drive focused on raising funds for expenses that are specific to COVID-19, including reimbursement for pulse oximeters and PPE, as well as offsetting the cost of vaccines through the private health care system.

Emergency benefits

Several employers have implemented additional medical hospitalization coverage for employees and dependents, as along with salary advances to help pay for unforeseen medical costs.

  • May 24 update: One company has considered implementing payday advance loans to assist with employees who have hit medical spending caps, but as of now this policy has not been approved by company leadership. In the meantime, this company is looking into their medical plan to find the root causes of why employees are surpassing coverage, and plans to move up the effective date on the next year’s plan coverage, in hopes of addressing gaps.
  • Leave

    Another way that employers are supporting employees is by boosting offerings in their leave program.

    • May 24 update: One company has moved up their annual India PTO week to take place at the end of May, allowing employees to de-stress and spend time with their families, without worrying about getting shift coverage.
    • Some companies have added supplemental leave in addition to their existing COVID-19 leave so that employees can take time off to treat their own COVID-19 symptoms or care for family members who may be sick.
    • One company has received requests from employees hoping to donate unused leave to colleagues in India, but the company has not yet moved forward with this, as this company does not typically have leave donation programs in place.

    Non-financial support

    Several companies are also looking to provide mental and emotional support to employees as well as their families.

    • One company has set up local affinity groups to address on-the-ground communications and issues such as getting access to hospital beds. Several other employers are utilizing WhatsApp groups to stay in constant communication with employees, families and resources on the ground in India. Employers also noted how each city in the region is very different, and local champions help create a non-monolithic approach tailored to each area.
    • One company is hosting virtual mindfulness sessions to address stress, along with virtual activities to support children at home.
    • There is a significant demand for fun activities that would take employees’ minds off the crisis at hand. These employers are partnering with various ERG groups to create programming to assist employees and families in all aspects of their lives.

    Business Continuity and Preparing for the ’Next India’

    The current crisis in India is multipronged: Employers must support their employees by providing resources and flexibility but must also ensure continuity of the business. Additionally, as variants spread and cases rise in other areas, questions loom about what country might be next for a major surge.

    Business continuity

    Employers must grapple with the philosophical question of “what is the role of the employer?” and support their employees’ needs while also keeping the business running.

    • The pandemic has exposed the reality of how differently health care delivery systems have been built from country to country, and the equity issues that have resulted from these differences. Employers play a role in providing health care to their employees and families, as well as influencing the structure of health care systems around the world.
    • With climate change a looming issue for the globe, employers are aware that COVID-19 will not be the last crisis that they will have to contend with. They will have to revisit crisis planning and how to determine what interventions are necessary from a business operational standpoint.

    The next India

    Employers are concerned about rising cases in a number of countries and regions, including Malaysia, the Philippines, Poland, Italy, Mexico, Bangladesh and Brazil.

    • There are three major drivers for this possibility: poor health infrastructure, poor vaccine rollout and lack of social distancing protocols.
    • Employees in these regions have already reached out to global HR teams to inquire about receiving the kind of support that employees in India are receiving right now. However, it is not clear if these countries are at risk for experiencing the same issues that India has faced due to the strong private health care system in some countries such as Brazil.

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