Avalere Health Insights Who We Help Expertise About Us Submit Connect July 22, 2020 Insights & Analysis COVID-19 Intel Center 8 Return-to-Work Considerations for Employers Amid COVID-19 Twitter LinkedIn Email SMS Summary As businesses across the country begin to reopen, navigating the COVID-19 pandemic will continually require employers to be resilient, flexible, innovative, and forward looking when it comes to returning employees safely to work sites. Among the myriad of concerns and considerations, organizational leadership will need tools that assist decision making and ensure compliance with Centers for Disease Control and Prevention (CDC) guidance. Each company’s return-to-work (RTW) plan will be unique based on a subset of characteristics, including location, size, local requirements/conditions, resources, external interaction, and function. Organizations will have to mitigate risk based on what we know up to this point (e.g., about infectiousness, immunity, vaccine development, and treatments), what we are learning real time (e.g., about trends in newly identified cases, availability of intensive care unit beds, emergency department and outpatient visits for COVID-like illness), and what we predict the future will look like (e.g., based on disease pathology, national/state forecasts, expert knowledge, and availability of key resources). To develop a RTW strategy that is safe and effective and protects both workers and customers, employers must recognize the value in data-driven solutions during this unprecedented and rapidly changing time. Visibility into the level of risk present in local communities—coupled with deeper knowledge on other indicators within the population that contribute to high risk—will become the bedrock for informed decision-making about workforce transitions. Avalere organizes 8 of the highest-level considerations below (see Figure 1). Figure 1. Return-to-Work Considerations While this list is not meant to be exhaustive, each of these considerations requires a set of guiding questions, metrics, and solutions that is customizable to any organization. Through its customer base, access to and experience analyzing real-world data, and lens on national health policy expertise, Avalere is prepared to help employers develop evaluative frameworks, strategic insights, and epidemiological assessments leveraging the Inovalon Population Health Insights: COVID-19 Dashboard. Further, Avalere is equipped to support employers in preparing for what they will need to return to work and what types of costs they may expect to incur through these changes. 1. Coordinate with Officials on Local Conditions Local conditions will influence decision making from municipalities regarding various stages of reopening businesses. This is likely to be contingent on the infection rate, hospitalization rate, and death rate due to COVID-19 at the community-wide or state-wide levels. Employers may consider following the CDC guidance on mitigation strategies and gating criteria outlined by the White House, in accordance with the level of community transmission or impact of COVID-19. While state regulations on reopening businesses will vary, some of the key factors for assessing local conditions include: Identification of new COVID-19 cases. All new COVID-19 cases in the jurisdiction can be rapidly identified through active surveillance, including proactive monitoring for asymptomatic cases through surveillance monitoring. Availability of data on contact tracing. Follow-up (isolation, self-monitoring, and rapid testing of selected contacts) can be initiated for nearly all identified contacts of newly identified cases. Test availability with a certain percentage of positive tests. The World Health Organization recommends a test-positivity rate below 5% for 14 days before reopening. Low rates of positivity in testing data can be viewed as a sign that states have sufficient testing capacity for the size of the outbreak and are testing enough of the population to make information decisions about reopening. Local lag time in obtaining testing results. Local conditions such as infection rates and testing capacity may lead to delays before testing results become available. Understanding such realities can inform the appropriate timeline to consider bringing employees back and other necessary measures to take based on testing results. Following guidelines such as the CDC’s SARS-CoV-2 Testing Strategy: Considerations for Non-Healthcare Workplaces can enable employers to form decisions about office worker capacity based on their existing testing policies and procedures. Meanwhile, they should communicate such plans and updates clearly to their employees. 2. Conduct an Assessment of Your Workforce There is no one-size-fits-all solution to returning employees to their work sites. Research shows that differences in vulnerability across sectors creates disproportionate levels of risk for lower-income workers, minority business owners, and business owners with less educational attainment. Further, employers that have substantial customer-facing obligations will need to risk stratify as they determine what reopening their businesses looks like. Each employer will need to evaluate a multitude of factors, including: Employee demographics. The CDC has issued guidance concerning those who are at higher risk from COVID-19, including “older adults and people of any age who have serious underlying medical conditions.” Aside from age and underlying health conditions, employers must consider other risk factors, such as mode of transportation to the worksite, size of organization, or employees living in the same household with an individual who is high risk. Risk tolerance to employer. Employers should consider conducting a risk assessment to their worksites as outlined in the Occupational Safety and Health Administration (OSHA) Guidance, which provides recommendations descriptions of mandatory safety and health standards. Employee preferences and availability. Employers may want to assess their workforce to determine which employees to prioritize returning to the workplace. Some employees may be eager to return, while others may be more reticent. Additionally, employees may have temporarily relocated their residences or may need to care for children whose schools are closed. Surveying your workforce is 1 best practice to soliciting employee feedback. Telework capacity. While telework is largely dependent on job site and function, as of this April, 62% of employed Americans were working at home.1 Employers must consider current telework policies, productivity levels, and technological resources available to their employees in any type of telework strategy. As organizations reconstruct how they work and define what can be done remotely, leaders can decide which roles must be carried out in person and to what degree. 3. Evaluate Current Infrastructural & Office Layout There will have to be a subset of architectural and engineering changes for offices to enhance infection control and safety in office spaces. Adjustments may include: Improving air exchange and air filtration in closed settings and reducing personnel density through staged work schedules can reduce transmission risk among employees, customers, and visitors. Physical adjustments to open-floor work stations, implementing protective shield barriers between desks, and spacing in common areas such as conference rooms and kitchens are among the many physical infrastructural changes employers will need to consider. Elevator policies should limit access to minimize risk. Trade-offs need to be considered for employees to arrive at their desks safely. For example, cutting down the number of people in an elevator at a time could. in turn, lead to more people waiting and huddling in a lobby. 4. Review and Adhere to Compliance & Legal Standards Employers will have to abide by a multitude of compliance and legal standards in order to protect their businesses, workers, and customers as they transition into a new way of working. As such, organizational leaders should engage with local, state, and federal policymakers to ensure compliance with employee protection laws in light of COVID-19. Topics that employers may consider legal counsel for include: Employee leave. Employers will need to be compliant with all policies adapted as a result of COVID-19, such as job-protected leave under the federal Emergency Paid Sick Leave Act, the Emergency Family and Medical Leave Expansion Act, state law, local sick leave laws ,or company policy. Some states such as Massachusetts are expanding access to emergency childcare as businesses reopen. If an employee is ineligible for emergency childcare and is caring for someone who is sick, the federal Families First Coronavirus Response Act requires some employers to provide paid leave to workers who have to care for someone subject to quarantine or a child whose school or day care is closed. Discrimination. Employers should carefully review the Age Discrimination in Employment Act (ADEA)2 and other similar state civil rights laws. For example, under the ADEA, advanced age by itself would not be a lawful reason to exclude an individual from the workplace or subject an individual to differentiated work standards. As statistics show, the risk of severe symptoms with COVID-19 rises with age, especially for individuals over 60. Employers must understand what authority they do or do not have to make accommodations to keep their employees safe without taking discriminatory action. Data privacy. Employers will have to assume the burden of all matters related to data privacy, while balancing public health and safety. Between policies around contract-tracing technologies, disclosing if an employee has COVID-19, and determining what personal health information can be shared, employers will need to determine what liability they face for sharing (or not sharing) certain information. 5. Develop Protocols for Safety, Protection, and Cleaning To ensure that employees understand and are compliant with public health and safety requirements, employers will need to develop protocols that are maintained and updated appropriately on various health and safety policies. Some of the many protocols on which employers will need to focus are: Testing. Employers will need to develop testing protocols that balance function with applicability. This will include a subset of decisions to make about types of testing (e.g., molecular or antigen testing), frequency of testing, consent for testing, site of testing, cost sharing, and information sharing. To limit risk in returning to the workplace, employers must consider a testing strategy and balance this with function and applicability. Under guidelines issued by the Equal Employment Opportunity Commission (EEOC), mandatory testing of employees for COVID-19 to identify and prevent direct threats to workplace safety is allowable under federal antidiscrimination laws, as long as the “testing is reliable and accurate, and the confidentiality of employees’ medical information is maintained.”3 Employers and the testing companies with which they work are required to report COVID-19 results to local public health authorities under the Clinical Laboratory Act regulations,4 the Privacy Rule requirements of the Health Insurance Portability and Accountability Act,5 and various state medical-privacy laws. Vaccines. While vaccines are under development, at present no federal laws require vaccination, and vaccination policies differ across state levels. Employers will need to consider these implications in future strategic decision making about vaccine protocols. Cleaning and use of personal protective equipment (PPE). The CDC has published guidance to assist employers with deep-cleaning protocols and outlining what needs to be disinfected versus what can be cleaned with soap and water. OSHA recommends that businesses consult the Environmental Protection Agency list of disinfectants approved to protect against COVID-19. Employers should ensure routine cleaning and disinfecting plans are in place when reopening an office. Finally, employers are obligated to provide their workers with PPE and must enforce protocols based on risk assessments for workers and customers. Included in this list of PPE are face coverings, such as surgical masks and respirators. Employers should determine the mask type appropriate for each employee based on their potential exposure and health risk and provide the necessary education and enforcement to ensure their effectiveness. Additional screening procedures. Employers will need to consider additional screening tools, such as body temperature checks, following the CDC and the EEOC. Response to confirmed or suspected COVID-19 infection and exposure. If an employee has a confirmed case of COVID-19 or has been exposed to someone with a confirmed case, employers will need to develop protocols for clearance from medical professionals, for self-quarantining, and for notifying company personnel and public health authorities. 6. Communicate, Educate, and Train Your Employees A strong communications plan, in conjunction with tools and resources for staff who are re-entering a work site, is critical for ensuring that employees feel equipped to navigate the new normal. Communication in all its forms will need to be considered: Who communicates? What should be communicated? When are communications shared with employees and with what frequency? What are the mechanisms for collecting questions and delivering answers? A communications plan must be tailored not only to staff but also to customers, stakeholders, and partners alike. Crisis communication should also be tantamount to any regularly maintained communication updates in the era of COVID-19. Some of the key resources that employers may consider include the following: Proper hygiene messaging. The CDC recommends that employers place posters relating to these concepts in the entrance to the workplace and in other workplace areas they are likely to be seen (such as bathrooms and kitchens). Affirmation forms. Upon reviewing state guidelines on returning to work, businesses must sign affirmation forms and may consider sharing this in a public forum with employees. A “Welcome Back” or “Work from Home” kit. This may consist of PPE, hand sanitizer, printed instructions on office policies, etc. Alternatively, if you expect a portion of your workforce to continue working remotely in some capacity, you may consider work-from-home kits, including adjustable-height desks and improved broadband internet. Recognizing that ever-changing guidance comes from various federal, state, and local authorities, in addition to the CDC, employers should be prepared to have their workplace policies become adaptable documents that will consistently be amenable to updating in the near future. Employers creating COVID-19-specific protocols related to health and safety, such as screening/testing and re-organization of the physical workspace to accommodate social distancing, should ensure they communicate these protocols as far in advance as possible to the restart of on-site operations. However, employers should also be mindful of other practical and logistical issues they want to communicate to employees prior to their transition, such as commuting, returning to work after being furloughed, and the modification of schedules. Employers will also have to consider communication in the context of updated compliance training. Managers who have supervisory obligations in particular will need an additional level of training once these policies are implemented. For example, what do you communicate to an individual who does not want to return to work or wear a mask in the office? Organizational leaders will need to think strategically and critically about communications to their workforce as they prepare for the new normal. 7. Address the Stigma and Mental Health Burden of COVID-19 The intensifying spread of COVID-19 continues to shed light on adverse mental health consequences, both on individual and population levels. Simultaneously, a growing stigma associated with fear of personal infection or infection of friends and family members is common among people exposed to any infectious disease outbreak.6 Employers must be prepared to provide their employees with the appropriate mental health resources. Some key considerations include: Leveraging state-wide mental health guides, such as Thrive in Your Workplace, to address workplace mental health inequities. Creating a checklist on the employer role for mental health during COVID-19 to ensure your organization can offer employee assistance programs or alternatives through your health insurance plans. Partnering with organizations that offer mental health educational resources to offer free training to your employees in support of the pandemic impact. 8. Be Flexible Based on Virus Epidemiology, Testing, and Therapy/Vaccine Development Employers have already undergone a major transformation in the last 4 months since the onset of the coronavirus in the United States. While guidance may suggest that some businesses are cleared to reopen in certain areas, employers must maintain a high level of flexibility and adaptability, since this could be rescinded at any time. Employers are required by law to comply with state and local directives, and OSHA recommends that employers establish flexible telework policies if possible. While many essential businesses have reopened, other larger corporations with flexible work-site accommodations are staying put. Given the unprecedented nature of the disease, employers are encouraged to keep the following recommendations in mind: Adapt as you go in the spirit of employee engagement. Be flexible and sensitive to workforce and customer needs, and recognize that many adjustments will need to change overtime. With new guidance released at such a frequent cadence, employers need to be prepared to communicate and act. Take the extra steps to protect your employees. The foundations of employer and institutional prevention are relatively inexpensive PPE; basic administrative controls such as segmenting the workforce, reducing density, and mandating self-deferral from work for those who feel ill; and environmental controls such as physical barriers and the careful management of air exchange and filtration. Ensure your employees and leadership feel protected and safe. Continue to be mindful of your unique setting. Each organization will have a different set of needs, and only by using data-driven solutions will employers know what will work well based on the risk factors. Ensuring that you have a plan to manage your work sites and optimize space allocation, prioritize employee health, communicate effectively, and maximize contact tracing will allow you to make informed decisions about workforce transitions. Contributor Leana Wen, MD, an Avalere Senior Advisor/Contractor, is an emergency physician and visiting professor of health policy and management at the George Washington University’s Milken School of Public Health, where she is also a distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. Dr. Wen is an expert in public health preparedness and previously served as Baltimore’s health commissioner. Check out our COVID-19 Intel Center. To receive Avalere updates, connect with us. Notes Megan Brenan, “US Workers Discovering Affinity for Remote Work,” Gallup, April 3, 2020. Age Discrimination in Employment Act, 29 U.S.C., §§ 621–634 (2018). Americans with Disabilities Act, 42 U.S.C., §§ 12101–12213 (2018). Clinical Laboratory Act, 45 C.F.R., § 493.1291(l) (2019). Health Insurance Portability and Accountability Act, 45 C.F.R., § 164.524(c)(3)(ii) (2019). Brooks S.K., Webster R.K., Smith L.E. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912–920. Emily Belowich Consultant I Elizabeth Carpenter Head of Advisory Services Kristi Mitchell Practice Director Related Content Considerations for a Shift from Pandemic to Endemic COVID-19... Webinar: Post-Pandemic Planning for Life Sciences Companies COVID-19 Pandemic’s Considerable Impact on Skilled Nursing Facilities Services From beginning to end, our team synergy produces measurable results. Let's work together. 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