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Vaccination, testing and prevention keys to returning employees to the workplace

Health and Benefits|Bienestar integral
COVID 19 Coronavirus

By Jeff Levin-Scherz, MD | April 6, 2021

Increase in vaccination and availability of new at-home COVID-19 tests pave the way for slowly and carefully returning employees to the workplace.

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About our “The COVID-19 Crisis” series

The COVID-19 Crisis” series is a weekly update by Dr. Jeff Levin-Scherz covering the latest developments related to the COVID-19 pandemic in the U.S. Explore the entire blog series.

When I go out on a cold day, I take a layered approach to staying warm. Sometimes the sun will come out and I can take off a layer. Sometimes the wind will make me grateful that I have one more layer. Employers should take a similar approach to protecting employees, customers and the community from COVID-19. As many employers contemplate returning remote workers to the workplace, employers need multiple different but complementary approaches to keep them safe.

Basic public health measures

Employers should continue to emphasize basic public health measures to prevent the spread of respiratory disease until the pandemic is over. This means:

  • Require masks, which have been well demonstrated to decrease the rate of infection after exposure by at least 75%. 
  • Promote physical distancing. Being closer indoors for longer increases the risk of spread. For many employers, effective distancing means decreasing density of employees as well as imposing capacity limits on indoor spaces.
  • Improve ventilation, which can also decrease spread when there is a workplace exposure. Some employers are doing this through tweaks to heating and cooling systems or with enhanced filtration.
  • Promote handwashing. We now understand that SARS-CoV-2, the virus that causes COVID-19, is rarely spread from surface contact, so we can decrease our emphasis on “deep cleaning.” The good news is this also means no one needs to wipe their groceries or produce with disinfectant either!

With masks and distancing and handwashing, we’ve decreased influenza this season by 99% — so it’s possible that some of these public health measures will serve us well post-pandemic, too.

Vaccination

Employers also need to promote vaccination of their employees. We now know that vaccination is highly effective at preventing both symptomatic COVID-19 and asymptomatic COVID-19. That’s especially helpful, since spread from employees who themselves don’t realize they are ill has been responsible for many workplace outbreaks. Employers can improve vaccination at their worksites through effective communication, reassuring employees they will not face unexpected bills, time-off policies and flexibility to allow for vaccination, including pay for hourly workers who miss work to get vaccinated. Here’s a link to an article we wrote in Harvard Business Review about using behavioral economics to help promote vaccine confidence.

Few employers are offering cash incentives for vaccination at this point, and fewer still are mandating vaccination. This could change in coming months as vaccinations become available to all employees and there are more months of demonstrated safety and effectiveness.

Employees in high-risk occupations (hospitals, nursing homes, some food processing plants) are most likely to face mandates, and some states might require vaccination for other types of workers. Vaccination requirements for travel or attendance at high-capacity events could make it easier for employers to mandate COVID-19 vaccination.

Testing

As we move toward vaccinating all willing adults, employers should focus on testing to diminish the risk of workplace spread. Up until now, testing has been implemented by a minority of employers, largely because tests have been expensive and many tests have required up to three days of processing, making them far less useful in preventing workplace spread.

The good news is that this is changing.

The Food and Drug Administration (FDA) announced emergency use authorization this week for two at-home COVID-19 antigen tests that will be sold directly to consumers without the need for a physician prescription. Both tests are approved for surveillance, as opposed to previous tests, which were restricted to those who displayed COVID-19 symptoms. These tests, Abbott’s Binax Now and Quidel’s Quickvue, are likely to be widely available and priced far lower than the $100 that most polymerase chain reaction (PCR) tests still cost. Prices are also expected to drop as manufacturers scale up production.

The FDA also announced authorization to use BD’s Veritor antigen test in schools and physician offices for surveillance testing; in the past, this was authorized only for those with symptoms, although it was likely used for screening as well.

Here is why this matters: Most areas of the country continue to have high rates of community transmission, making it necessary to severely limit how many employees can return to the workplace. Tests could help reduce risk even as more employees return to the workplace.

The antigen tests detect at least 90% of cases and are exceptionally good at finding the most infectious cases of COVID-19. An employer implementing a program of twice-a-week home testing could substantially decrease the risk of a workplace exposure. The new batch of tests could turbocharge employer efforts to diminish risk at the workplace because:

  1. Antigen tests can be done at home, so potentially contagious employees do not come to the workplace.
  2. Antigen tests give the results in real time. Instead of removing employees from the workplace after they have already exposed colleagues, they can stay home after testing positive. 
  3. Newly approved tests don’t require a physician’s prescription and don’t require a telemedicine visit to observe sample collection.
  4. Antigen tests are dramatically less expensive. Testing 200 employees twice a week with a $100 PCR test would cost $1.6 million — and logistics would further increase this cost. The cost of doing this with $20 antigen tests would be just $320,000, and logistics are straightforward. 
  5. There are four antigen test in the works with expected prices $20 or less.
    Antigen tests with current and expected prices

    *Quidel, Ellume and Gauss said they haven't settled on initial prices for individual tests but share these estimates. Source: Kaiser Health News

A few other notes from recent COVID-19 news

  • The CDC issued much-awaited new guidance on travel for those who are fully vaccinated:
    • Fully vaccinated people can travel within the United States and do not need COVID-19 testing or post-travel self-quarantine as long as they continue to take COVID-19 precautions while traveling — wearing a mask, avoiding crowds, socially distancing and washing hands frequently.
  • Johnson & Johnson will discard ingredients for 15 million doses of vaccine, which were mishandled by a contract manufacturer in Maryland. J&J says that it will still reach its target of 100 million doses distributed to the U.S. by the end of May. This is a setback, but it also shows that the quality control system is working even as companies work overtime to meet the need for vaccines.
  • COVID-19 infections continue to tick up in the U.S., and low rates of testing in some communities makes epidemiologists worry that we might be underreporting a new surge. Employers should monitor infection rates in communities where they are considering returning remote employees to the workplace.
  • New infections continue to trend up. The seven-day moving average on April 4, 2021 was 63,065.
    Daily trends in new U.S. COVID-19 cases

    The seven-day moving average on April 4, 2021 was 63,065. Source: Centers for Disease Control and Prevention

  • Vaccine confidence continues to increase. Kaiser Family Foundation reported this week that many of those who were “hesitant” are now ready to get the vaccine. The largest increase in willingness to be vaccinated is among Black people. There’s been little movement in those who are firmly opposed, though.
  • 32% of Americans have received one dose of vaccine. Those taking a “wait and see” approach has decreased significantly since December.
    Vaccine hesitancy declines

    One-third report having received at least one vaccine dose. Those wanting to “wait and see” continues to shrink. Source: KFF COVID-19 Vaccine Monitor.

  • Pfizer and BioNTech announced excellent efficacy results for their vaccine in 12- to 15-year-olds, making it likely that we can vaccinate high school students this summer before the school year begins in the fall. The FDA is likely to grant emergency use authorization for adolescents in the near future.

Returning employees to the workplace is neither simple nor easy, but a measured, multi-layered approach makes it possible to keep them safe.

Author

Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led Willis Towers Watson’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.


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