Confused About On-Site Screening for COVID-19?

As restrictions are being lifted in communities across the country, employers are moving fast to get employees back to their worksites -- and facing the challenge of how to do it safely. With neither a vaccine nor a definitive treatment for COVID-19 yet available, safety comes down to stopping transmission. One thing we know for certain about this complex virus is that physical distancing works to decrease spread, which means that every RTW plan must solve for the problem of how to achieve distancing in a given worksite and reduce transmission risks. Measures include adjusting work schedules to limit the number of people at a worksite; re-configuring the space to create separate workstations; preventing congestion by closing conference rooms and cafeterias; requiring masks to decrease the risk of an asymptomatic case spreading the disease; providing easy access to hand and surface sanitation; and implementing cleaning schedules.

But what about trying to prevent those infected with the virus from entering the worksite in the first place? In a recent Mercer survey of more than 750 employers, 36% say they are considering conducting some form of onsite screening or assessment as part of their return strategy. Not surprisingly, the number of screening and assessment solutions on the market is growing every day. Many of these vendors are new to delivering services to employers, and should be closely evaluated. 

We’re hearing many questions from employers about what kind of screenings are the most productive, how best to administer them, what vendors to use, and how screening fits into their larger safety strategy. Let’s start with the last question first. No form of screening available today is foolproof, so it should only be used in addition to, not instead of, the distancing measures described above. That said, coupling screening with other measures can increase safety. Employers are concerned that employees feel that the workplace is safe for them, and screenings serve as a daily, visible reminder to employees (and, in some cases, customers) of the ongoing need for caution and of the organization’s commitment to protecting their health. 

Here's an overview of the types of screening and assessments that are being discussed today:

Symptom checkers The CDC has recently updated the list of symptoms seen with COVID-19. Different types of vendors, including telehealth organizations, onsite clinic vendors and others, have incorporated the CDC questions into an app that a person can check each morning. The app can then generate a report that attests to the fact that the person has done the check. This allows the employer to know that employees have checked, without having to collect personal health information themselves. A person with symptoms can be rapidly referred to a clinical facility for testing for the virus (PCR testing). These daily attestations can include questions about contact with anyone at home or in the community who has had symptoms or has been diagnosed with COVID-19; employees who have had contact can also be asked to stay home until they are evaluated for the disease.

Temperature checks Some screening protocols include temperature taking as well. Temperatures can be checked at home and can be part of the attestation process along with the symptom checker, or temperature can be checked onsite, most commonly with a thermal temperature checker taking readings from the forehead. If temperatures are taken onsite, the employer needs to be ready to respond to a person with a fever. Both symptom checkers and temperature checks can help identify people who should not be in the workplace -- but it’s important to remember that we have learned that 50% of people who are contagious with the virus do not have a fever, and 25% do not have symptoms. This means, again, that temperature checks can only be one piece of a comprehensive workplace safety plan.

Testing for the virus PCR testing is not currently available widely as a screening strategy except in healthcare settings. However, there is a strong emphasis right now on improving access to testing and on developing new techniques for sample collection that would make testing easier for everyone. At this time there are no standard protocols for general population screening – for example, should employees be tested every day, or twice a week? Another approach would be to test the entire workforce if one worker tests positive – but when? The most recent data suggests that the optimal day for testing may be as late as eight days after exposure. When protocols are introduced they will most likely vary by community and industry. Some industries will likely need more frequent testing than others, and the schedule should reflect how prevalent the disease is in the community. As testing becomes more available over the coming weeks, the key will be determining how to deploy it most effectively. As testing becomes more available over the coming weeks, the key will be determining how to deploy it most effectively.

Testing for antibodies  Serology testing is not useful in finding individuals who are contagious. Further, because there is no clear data on the immunity profile of this virus, a positive test does not in any way guarantee that an individual cannot get the virus (again) or pass it to others. Bottom line, antibody testing is not a helpful strategy for safe return to work at this point in time.

Contact tracing When someone in the workforce is diagnosed with COVID-19, the employer has responsibilities to notify those who have been in contact with the person that they have been exposed. They also have the responsibility to keep information about the diagnosed individual private. This is clearly a challenge.Contact tracing can be done by a person alone or supported digitally. With the former, a contract tracer interviews the infected person to find out who they have been with, and then contacts those identified to get them into quarantine. The other method relies on an app that keeps track of the movement of people and identifies those who meet the exposure criteria so they can be contacted. Employers considering contact tracing should be aware of concerns that some of the tracing apps, such as those developed by tech companies, are collecting too much information on individuals. Also, it is important to coordinate with any local public health efforts regarding community tracing.

Employers have been given a heavy responsibility as governmental distancing regulations are lifted: developing viable approaches for opening worksites that supports both the health of the employees and the health of the business. To the extent possible, draw on the experience of employers in essential businesses that have remained open throughout the pandemic, like Bimbo Bakeries and Brigham and Women’s Hospital System. But every worksite is unique, and ultimately the best course of action may be to open in stages, test your RTW strategy, and adjust as necessary – guided by our growing understanding of how this novel coronavirus operates.

While this is a new situation for everyone, Mercer clinical consultants have acquired a lot of experience quickly and can help companies structure an appropriate plan and select the best vendor partners for their unique situation.

Mary Kay O'Neill
by Mary Kay O'Neill

Partner, Clinical Services Consultant

Register for Mercer US Health News to receive weekly e-mail updates.