Author: Dr Mark Ali MBBS BSc FRCS CTh, Medical Director
PHE: Guidance on Return to Work
Getting employees safely back to work
The UK economy is set to enter the worst recession for 300 years with output plunging nearly 30% in the first half of 2020. In the early days of the coronavirus crisis, employers focused on establishing remote working and restructuring. As events move on and the government starts to ease current restrictions, the focus shifts towards the return to work strategies.
Getting employees safely back to work is a Herculean task that requires tremendous planning. There will need to be modifications of the work environment, changes in employee behaviour and alterations in company structure and infrastructure. The approach will need to vary depending on the type of organisation but the same guiding principles apply. Organisations must safeguard the health and well-being of employees and clients or customers. Many people will be concerned and anxious about returning to work. Customers and clients will be concerned about visiting. Confidence will be key to getting things moving. People will want to know that the company is doing everything it can to make the environment as safe as possible, supporting physical and mental well-being.
The government has already started to release guidelines for “COVID-safe workplaces” and any return to work strategy must follow these. In addition, we believe that it is crucial for organisations to develop clinical strategies and protocols to safeguard employees, customers and clients on return to activity. Each organisation must have robust systems in place to monitor and respond to infection when it occurs. It is likely there will be a second (or even third) wave of infections and companies must be prepared to manage this.
Who should go back to work?
Employers will be reviewing their working structures, evaluating who can continue to work remotely. However, many employees will need to return to workplaces. It is important that they do so safely and with confidence: employees must feel protected and know that everything possible is being done to safeguard their health.
This requires a bespoke approach, evaluating individual employees and their level of risk to themselves and others. Corporate reasons for return must be evaluated alongside medical risk. From a medical perspective, we can assess risk based on medical history alongside our knowledge of COVID-19. We can also offer testing before return and ongoing as part of a programme to mitigate risk in the workplace and reassure employees, clients and customers.
Test, test, test
It is clear that COVID-19 is going to influence lives globally for a significant period of time to come. Early on, testing was identified as a key part of the response- “test, test, test” said the Director-General of the WHO. Indeed those countries with widespread rigorous testing have fared much better and it is clear that testing will be an ever-present vital part of managing risk and our response to outbreaks. It is here to stay.
We can offer testing to detect those who have already been exposed, have antibodies and may, therefore, be viewed as a lower risk to themselves and also transmission. These are a tool to be used alongside other assessments and in the context of their limitations. We would only recommend using approved tests (both our antigen and antibody tests are approved by Public Health England) with results interpreted and acted on in line with government guidance. It adds vital information as part of the risk minimising process. Alongside this, we can test employees for the presence of the virus prior to re-entering the workplace (currently performed by a PCR test on a swab sample). This testing would be part of an ongoing programme to detect and respond to cases and minimise transmission.
As society re-opens, it is extremely likely that new cases will rise, as has been witnessed in other parts of the world where restrictions have been relaxed. A second (or even multiple) wave is a very real threat. Companies must have a response plan: we suggest a rigorous testing protocol (for presence of the virus) to ensure that employers can test, track and trace cases as they arise.
Any programme must follow government guidelines. In offering private tests, we are able to add a further level of security as many employees are not currently eligible for testing. The testing programme should be robust with protocols that are bespoke to the specific organisation and different groups within the company depending on exposure risk. Some may wish to swab high-risk employees at a regular frequency, irrespective of symptoms, as it is well recognised that asymptomatic and pre-symptomatic spread are great drivers of the disease. Imperial College analysis suggests that testing healthcare workers once weekly would reduce transmission by a further 16-23% on top of self-isolation based on symptoms. The Premier League, for example, aims to reassure players by testing with swabs twice a week. Care homes in the USA now swab staff twice weekly. Alternatively, for employees without customer-facing roles and lower risk activities, employers may choose to swab only in response to symptoms. This is in line with current practice for key workers. Employers may also consider swabbing unwell household contacts to minimise work lost due to quarantining.
As with all medical tests, the swab results must be evaluated within the clinical context. With the current swab used everywhere (including by the NHS), there is around a 30% false-negative rate. It is for this reason that a negative result must be viewed in context. Furthermore, employees are recommended to have two negative swabs, 24hrs apart before they return to work.
Test development is fast-moving and we are continuously monitoring the market in order to provide the best test available at the time. Our duty as medical professionals is to ensure that these tests are used appropriately with a clear understanding of the implications and limitations.
If an employee displays symptoms or has a positive swab on routine testing, it is important that they self-isolate. We then need to test, track and trace to ensure that we safeguard the health of others and minimise further spread. There have been big technologically-driven changes to contact tracing that we can leverage. For example, there has been widespread uptake of contact tracing apps in the Far East and the UK government is trialling its own on the Isle of Wight. However, within a workplace, the approach should be different. There are multiple different apps that do not cross-talk and people are concerned about downloading them. They are not fit for purpose if uptake is low. We can offer an app to function within the workplace that gives hyperlocal tracking (more local than the government app). The benefit here is that we can identify employees who have had significant contact. If someone develops symptoms or swabs positive, it is then straightforward to trace a contact. The data is not shared nationally and tracing only occurs within the workplace.
What will the new normal be?
Workplaces will operate differently for some time to come. Some changes will be adopted indefinitely. Our role is to form part of the return to work strategy to ensure that companies make the workplace as COVID-safe as possible. This is vital for employee-employer health and relations and for customers who will want services. Changes to the work environment and behaviour are of the utmost importance. Testing will become widespread and vital for the response for months to come.