Across the country, employers large and small have been thrust into uncharted territory as they confront the COVID-19 pandemic. For months, essential businesses — such as grocery stores, pharmacies, banks, and delivery companies — have found themselves squarely at the frontlines of the pandemic. As pressure to reopen the economy intensifies, many more employers will quickly find themselves in a similar predicament.
To date, most of the guidance for employers has focused on workplace safety — social distancing, limiting non-essential travel, temperature checks, and deep cleaning. Of these interventions, the most is known about the benefits of social distancing. While critical, all of these interventions focus on prevention. The projected course of the pandemic and evidence of the role of asymptomatic carriers in transmission suggests that despite our best efforts at prevention, infections will strike in the workplace. What should employers do then?
To succeed during this period of transition — and over the next 12-18 months of this pandemic — employers must take a comprehensive approach to COVID-19 that goes well beyond the current focus on workplace safety. As America reopens, we present a comprehensive strategy for employers to manage the health of their employee population that has four key pillars: prevention, early detection and expedited testing, clinical support and recovery, and contact tracing and isolation. For this comprehensive strategy to succeed, both data collection and multimodal communication are essential.
Despite our best efforts at workplace safety, it is inevitable that cases of COVID-19 will continue to emerge. How employees are managed across the virus’s life cycle — from symptom detection to diagnosis to management and recovery — will have a material impact on the next wave of the pandemic. If well implemented, a comprehensive approach can significantly benefit employees, employers, and society writ large. It will help employees navigate an ever more complex, rapidly changing, and over-stretched health system and ensure they effectively and efficiently access the resources they need to get better. It will also help ensure that employees who are affected by COVID-19 don’t return to work too soon, risking their health and the health of coworkers and customers, or too late, wasting scarce human capital.
Fortunately, we believe that for several reasons employers of a certain size can be well-equipped to the task. First, as the principal administrators of health and benefits for their employees and families, employers already have much of the core infrastructure in place to manage the needs of their employee population. Second, employees spend a significant share of their time at work. This means, for example, that many of an employee’s close contacts are in the workplace and are often individuals on whom employers have information. Third, employers often have more resources than underfunded community health organizations or public health departments. Lastly, and perhaps most importantly, employers have a vested interest in keeping their employees healthy and productive and their workplaces safe.
The Four Pillars
We have identified four pillars of a comprehensive strategy to manage employee health during this pandemic: prevention, early detection and testing, clinical support and recovery, and contact tracing and isolation.
Prevention. The CDC has released reasonable guidelines for how to prevent workplace exposure, including establishing policies for physical distancing and sanitation. Public health professionals have also written extensively about how employers can ensure their employees stay safe while at work. As guidance and best practices exist for prevention, we focus here on the other pillars.
Early detection and expedited testing. As soon as an employee has concerns about exposure to the virus or is beginning to show symptoms, they need immediate access to a healthcare professional. Every day an employee is possibly infected yet continues to work risks transmission to coworkers and customers. We believe the best way to achieve early detection is through on-site testing, or if not practical, a nurse triage line staffed with a trained nursing professional versed in the public health issues. The nurse will be able to triage the employee to determine the appropriate level of medical care, and given the current state of access to testing, which is ever-changing, ideally help navigate the employee to the most expedited source of care, as well as type of test (diagnostic vs serology, etc) — be it their usual primary care doctor or urgent care center with on-site testing, or a telemedicine service that is able to order drive-through testing (and when available, at-home testing).
Clinical support and recovery. All employees awaiting testing or who are COVID-19 positive need clinical support throughout the course of their illness. Data show that patients have the worst complications a week into their disease course, and not on presentation. In addition, self-quarantining can be difficult and lead to food or economic insecurity or emotional and behavioral health concerns. The traditional healthcare system often does an inadequate job of follow-up at baseline and, with their capacity even more overstretched with the pandemic, even less so now. Here, again, employers can utilize a nurse line that regularly checks in on ill employees to monitor their symptoms, provide telephonic support, and — when necessary — connect them with telemedicine or acute care services. Employers can also assist employees who are ready to return to work. Currently, most patients are being advised to self-quarantine for at least 7 days since symptoms first appeared and at least 3 days since recovery. But there is evidence that some patients remain COVID-19 positive and contagious well beyond this. Generalized fatigue and weakness, which can negatively impact employees’ capacity to work, can persist after the infection has cleared. As part of a comprehensive strategy, employers can provide on-site or virtual medical services to support the return-to-work decision. Ideally, employees would be medically and biologically cleared to work, meaning they have been evaluated by a healthcare professional and deemed free of infectious symptoms, physically able to perform the duties of their job, and tested negative for COVID-19 to confirm they are no longer infectious.
Contact tracing and isolation. Contact tracing refers to the identification and diagnosis of people who may have come into contact with an infected person in order to prevent further transmission. Contact tracing is typically done by public health professionals to contain outbreaks, but for the reasons stated earlier, employers are well-positioned to conduct contact tracing in the context of COVID-19. For any employee diagnosed with COVID-19, employers will need to obtain a list of close contacts at work and oversee the contact notification and testing process, with appropriate privacy measures in place to ensure patient confidentiality is protected. Employers should ideally coordinate workplace contact tracing efforts with local and state public health authorities to minimize duplication and facilitate public health reporting. Then as an extension of contact tracing, if an employee is found to be positive, there should also be a mechanism to allow for flexible, voluntary isolation. Close contacts who have a history of testing positive for COVID-19 via PCR test or IgG antibody test may not need to isolate. Although more data are needed, this may become one of the most valuable use cases for employers to provide widespread IgG antibody testing.
Data Collection and Multi-Channel Communication
For this comprehensive strategy to succeed, employers need access to accurate and timely data to help make business decisions about staffing, resources, and business continuity, and policy decisions about temporary office shutdowns, space closures, and work-from-home policies. Data strategy pairs with the clinical strategy articulated above. Centralizing access to a nurse triage line, for example, facilitates data collection and employee tracking. Using this data, employers could create a comprehensive, daily dashboard across the life cycle of COVID-19 (suspected cases, active cases, and return to work cases) and across the population, including cumulative incidence and test positive rates, appropriately aggregated to protect employee privacy. This type of information would be far more accurate than self-reported data, and timely than claims-based data, which typically has a 2- to 8-week lag.
Success also requires that employers have high rates of engagement with employee communications. New policies won’t have the intended impact if they don’t drive timely changes in employee behavior. We recommend that employers create multiple channels for pandemic-related communications, such as dedicated email addresses or team work-space channels for COVID-19-related questions, and rigorously track open, click-through, and view rates to continuously iterate and improve their communications.
We recommend employers put together a “SWAT” team with senior corporate involvement that includes representatives from human resources and information technology departments and is tasked with formulating and implementing a comprehensive strategy. This team should begin by evaluating their partner ecosystem and assessing gaps, and gauging existing employee data sources and blind spots. Employers should pay special attention to different populations that have different risks, needs, and benefits, including people with chronic conditions who have higher risks of complications, essential workers who have higher risks of exposure, and contract and part-time workers who often fall outside of the scope of employer benefits but may be the greatest exposure to COVID-19 for both coworkers and customers.
Such an approach should not be limited to large employers; small and medium businesses can benefit through pooled arrangements to share in such services; costs can be amortized and employee privacy can be protected.
It’s near time for America to get back to work. With a comprehensive strategy for managing their employee population’s health, employers can stay ahead and ensure that we stay open for good.
Shantanu Nundy, MD, MBA, is a primary care physician and chief medical officer at Accolade, a population health company that provides personalized health and benefits solutions for employers. He also serves as a professorial lecturer at the George Washington University Milken Institute of Public Health. Kavita Patel, MD, MSHS, is an internal medicine physician in Washington, D.C., who served as a policy director in the Obama administration and as an aide to Sen. Edward Kennedy (D-Mass.).
Disclaimer: The views or opinions in this post are personal to the authors and may not represent the views or opinions of their employers or other professional associations.
Last Updated May 27, 2020