As employers navigate myriad challenges regarding how and when to return to work amid the global pandemic, Business Group on Health introduces this overview as the first resource in its series “Return to Work and COVID-19 – An Employer Guide”.
Stay-at-home orders, quarantines and shelter-in-place restrictions have changed the economy and the face of productivity. Dominating headlines worldwide is now the discussion of when businesses will reopen and employees can return to work. Several countries and states in the U.S. have already begun relieving restrictions and are gradually reopening certain businesses. Some companies deemed essential businesses have remained operational during the shutdowns, requiring them to navigate these challenges all along. As the remaining companies enter the strategic planning phase to prepare for when they will do the same, defining the scope and expectations of what is meant by “return to work” and learning from others that have already begun the transition will be paramount to avoiding dangerous pitfalls and positioning businesses for the best possible outcome.
COVID-19 is an emerging virus for humans, and testing is not consistently available in all geographies. We are still learning, among other things, how the virus is transmitted, its fatality rate and immunity post- exposure. Therefore, it remains to be seen how effective measures put in place to protect employees will be in the face of asymptomatic and pre-symptomatic carriers in the workplace.
Returning to the workplace is not without risk, and companies are creating cross-functional task force teams as they develop their plans and establish new processes. As companies implement measures to keep employees as safe as possible, here are 10 considerations to keep in mind:
Define Scope of Return to Work and Who Returns to the Worksite
The phrase “return to work” (RTW) can be misleading. For many employees and companies, work has continued uninterrupted, albeit differently, through teleworking. However, some roles and certain industries are less suited to teleworking, with those jobs and companies being most severely impacted – hospitality, retail and manufacturing, to name a few. Returning to the worksite will vary by location, as companies follow local guidelines at the state and country level, often based on prevalence of disease clusters. For production sites, a return to operations is also dependent on access that employer suppliers have to necessary raw materials that enable the supply chain to function.
Who Returns First in a Phased Approach?
In a phased approach, many companies identify essential employees, as well as those who have been unable to work from home or unable to work at full productivity. These are often the focus of most RTW discussions and implementations. Other employees, who can fulfill their job duties remotely, may continue to work from home; one large U.S. employer is considering whether to extend the ability of office workers to work from home for the foreseeable future, even as they look to bring manufacturing staff back on-site.
School and Child Care Closures Will Impact Ability to RTW
Available child care may need to be reserved for essential and frontline employees, and in certain locations – particularly in the U.S. – employers have reported that workers are having difficulty finding backup care. It’s unlikely this will change in the short-term until schools also open. Reopening schools is geographically driven, with decisions made at the country, state or district level. As several countries in Europe begin to phase back into schools reopening this spring, other countries will be looking to see whether additional controls, such as attending school in shifts, are needed to avoid a spike in COVID-19 cases.
Even as schools reopen, they may do so with limited hours, limited before/after care and few or no extracurricular activities, which will create continued challenges with child care. In one company headquartered in Europe, diversity and inclusion teams are noting that the female workforce may be more likely to need to stay home with school age children. As a result, additional support and awareness must be in place to ensure that they are not disadvantaged or perceived negatively because of the situation. Teleworking and leave policies that companies implement to support employees during the pandemic may require further modifications during the return- to- workplace transition.
Special Considerations for Caregivers or Vulnerable Populations
Employers should consider how they will create flexibility in their RTW plan for those individuals with underlying health conditions that put them especially at risk for adverse impacts if they are infected. People with diabetes, asthma, obesity, cancer, or other conditions that suppress their immune systems are particularly vulnerable. Furthermore, the risk of hospitalization and death increase significantly for people as they age. Employees caring for individuals with these conditions in their homes may be particularly concerned about RTW. Employers need to take the unique health risks of their employees and families into consideration as they continue with RTW phasing.
Visitors and Customers Need Attention as Well
In addition to employees, many companies are also restricting visitor access to those deemed essential. Some companies in China require cars and trucks to drive over an antiseptic mat to disinfect the wheels or potentially undergo a disinfectant spray upon arrival. For companies that regularly welcome customers on-site, like hospitality, movie theaters and sports venues, an additional significant challenge is the risk of exposure to customers.
Chart a Slow and Steady Path
In business, speed and velocity of implementation mean success. This is not, however, one of those times. A slow, staggered, gradual return, not a rapid influx, is what is necessary to prudently monitor the health and safety of employees as on-site operations are ramped up.
Set Expectations: This is Not a Return to Normal
Return to work does not mean return to pre-global pandemic habits. Whether it’s called the “new normal” or “transitional normal,” things will be different and require a new set of expectations. Emergency preparedness plans should not be put on the shelf. Rather, they need to be on the table, being updated during this next phase. Frequent, consistent, transparent communications to employees is as imperative during and after return to work as it was before the stay-at-home order. Employees should be clear about the measures the company is taking and the new processes and procedures in place.
Expect Change and Some Restrictions to Be Reinstated After Being Relaxed
Employers should prepare for the possibility of a “boomerang,” or spike in cases upon return to work that may require the implementation of restrictions again. Countries that were hit the hardest early and were considered to have the virus well-contained have had to return to some stricter social distancing measures, even after having employees return to work. For example, China, which has recently reported about 100 new infections per day, recently closed all the country’s movie theaters again, and Singapore has closed all schools and nonessential workplaces following a resurgence in cases. Be prepared to update your plan with lessons learned and best practices and be ready with improvements you would make if a mass work-from-home/stay-at-home restriction is required again.
Implement Physical Distancing in the Workplace
Companies are considering several options for keeping employees far enough apart to minimize virus transmission. In Singapore, some companies were shuttered when authorities deemed they had not implemented the proper physical distancing measures required for returned employees. For this reason, it is important for companies to take a methodical approach to planning how distancing can best be achieved.
Some tactics include:
- Only having a segment of employees be in the office;
- Having employees in the office in shifts on alternating days;
- Placing workstations at least 6 feet apart;
- Installing sneeze guards to protect cashiers and adjusting production lines to provide more space between workers;
- Touchless elevators; and
- Frequent hand sanitizer stations.
Regarding meetings, one company has prohibited any face- to- face meetings of more than five people. Smaller meetings could only be conducted in well-ventilated conference rooms, with mandatory handwashing prior to arrival. In China, some companies required the use of stairs instead of elevators to travel to meetings, or specified that elevators only stop at certain floors.
One company in China addressed the needs of nursing mothers by disinfecting lactation rooms twice a day, discouraging them from bringing personal items into the room and organizing online appointment scheduling to ensure that only one person at a time arrives to use the room.
Open Floor Plans
The trend in office space recently has been open design and shared workspaces. That workplace design makes virus containment more challenging, with many workers not comfortable sharing a space that has been occupied by another worker the day before. By keeping teleworking in place wherever possible, employers can temporarily allow shared workspaces to be repurposed so that those who are returning on-site can use a dedicated workstation each day.
Gyms, Cafeterias, and Other Gathering Locations
Consider closing down common areas such as cafeterias or gyms. Where common areas cannot be closed, employers can ensure that only a certain number of people are allowed in at a time and that they stay an appropriate distance apart. In some Chinese factory canteens, cardboard dividers have been placed at tables to separate diners from one another.
Providing Personal Protective Equipment (PPE)
While some employees may be required to use medical grade PPE to safely perform their job, for the vast majority of employees non-medical PPE is recommended to preserve medical grade PPE for those who need it. The amount of non-medical PPE required for employees returning to work cannot be underestimated. With many locations having legally mandated that individuals wear masks in public or enclosed areas, many employees may be required to wear one when returning to the worksite. In addition, if screenings such as temperature checks are to occur on-site, those administering those screenings need to have extensive PPE, such as faceguards or full body coverings. Employers report that sourcing PPE for employees conducting screenings has been a challenge. As the internal staff conducting screenings are often the priority, it may be difficult to obtain supplies for the entire workforce. One company said that it provides PPE for employees who do not have shields, who work on assembly lines or have jobs that require two people to work in close proximity. Some companies are providing cloth face coverings that employees need to launder and bring back each day. Some companies have also had their workers begin to produce masks in order to deal with the shortage.
Be Clear with Employees About Expectations for PPE on the Job
Guidance about mask usage has varied over time, and as it has evolved, so have government policies. The Singaporean government has made it mandatory for all persons (including essential employees at the workplace) to wear a mask when leaving their home, while still encouraging people to stay home as much as possible. In China, masks are also required when riding the company transportation shuttle; in fact, a well-controlled worksite that may not require employees to use PPE on the job may still require them to wear PPE to and from work (see more below on employee anxiety about RTW). The Centers for Disease Control and Prevention in the United States recently recommended that the American public wear cloth masks when around others but avoid using medical-grade masks in order to save them for health care workers. While non-medical grade masks have not been shown to be effective in preventing individuals from contracting the virus, given the evidence about asymptomatic transmission, masks may help prevent infection from someone who is an asymptomatic carrier of the virus. In this changing environment, employers will need to communicate regularly and effectively, as guidelines are continuing to change.
Testing to Identify the Infected and the Immune
Testing for the presence of virus, or diagnostic testing, can be conducted to confirm diagnosis if an individual is experiencing symptoms and seeking medical care, but it has also been a tool for population- wide screening in places like South Korea and can accelerate return to work. China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 days (the duration of the virus incubation period).
Who Pays for Testing and Who Gets it?
Access and availability to comprehensive testing varies significantly by geography. The cost of such broad and potentially frequent testing for the presence of virus in asymptomatic individuals also presents a challenge. In many countries outside the U.S., most testing is likely to be paid for by public health systems. In the U.S., the role of employers in paying for health care raises new questions regarding population wide testing for screening purposes, with such testing not driven by a national health response, but rather part of safe return to work policies. While some U.S. employers have attempted to conduct testing on-site in an effort to facilitate a return to work strategy, as of April 2020 they report shortages of test kits, indicating that a population wide testing regime may be well into the future. Regardless, benefit managers may want to consider how to implement or extend policies to access screening and counseling services related to COVID-19 at low to no cost.
Can We Identify Who is Immune to Lead the RTW?
Antibody testing is another possibility for one day establishing which employees have been previously infected and are now potentially immune to the virus. However, the scientific evidence is still outstanding, with uneven reliability rates, and concerns about the interpretation of such tests. Some tests have been deployed, but much is unknown, including knowledge regarding the level of antibodies needed for immunity or how long immunity would last against reinfection. Some countries, such as Germany, have contemplated “immunity passports” for those who have antibodies for the virus, but given the lack of necessary scientific knowledge of its effectiveness, most are cautious on implementation.
Conduct Temperature and Symptom Checks
Temperature checks have been a widely utilized tool to screen for symptomatic employees, particularly throughout Asia. In China, employers are required to check workers’ health and temperature daily, and anyone who shows symptoms is quarantined. In other countries, such procedures may require individual consent.
For employers who implement this approach, they have several different options for conducting temperature checks:
- Asking employees to take their temperatures before leaving home (with guidance to ensure accurate temperature capture and potentially also to provide employees with high quality thermometers);
- Having staff on hand to check temperature s when employees enter the office (or providing thermometers for self-checks); or
- Having employees walkthrough scanners if they’re available.
What Temperature Necessitates Staying at Home?
The World Health Organization (WHO) sets a benchmark of 37.3°C, or 99.1° F, as indicating an increased likelihood of having COVID-19. The cutoff temperature for requiring employees to stay home can be higher or lower than the benchmark, depending on each company’s risk tolerance and need to get employers back on-site. One company reports setting their fever “benchmark” at 100.4 F so they don’t turn away people who may have elevated temperatures for non-COVID reasons, while others have set it even lower than the WHO benchmark out of an abundance of caution and concern that employees who need to return to work for financial reasons may take over- the- counter medication to reduce their body temperature before being tested.
Another option for preventing infected employees from entering the workplace is screening for symptoms. For example, one employer has developed their own symptom app that asks three questions, after consultation with nearby health systems. The symptom tracker app will indicate red (for symptomatic) or green (for asymptomatic) and will be date- and time -stamped. Coordinators in the front lobby will make sure all employees are completing the app every morning. Another company is planning to have Environment, Health and Safety (EHS) team members ask workers about symptoms and take temperatures upon entering the building each morning. Brief questionnaires utilized for screening typically include questions regarding symptoms, recent known exposure and travel history. After measures such as these are taken, employees who are symptomatic and/or found to be positive for COVID-19 can be quarantined for at least 14 days in order to not infect their co-workers.
A Multipronged Approach is Necessary but Is No Guarantee of Effectiveness
While these measures may be effective in finding symptomatic employees, they do not address transmission by asymptomatic or pre-symptomatic individuals. Experts do not yet know for sure exactly what percentage of infected people do not show symptoms, but they believe it is a significant number. The virus can also be passed from person to person when someone is in the pre-symptomatic stage, or has been infected but isn’t yet showing symptoms—and fever isn’t always a symptom. Therefore, symptom screening and temperature checks should only be considered as one part of a broader strategy for keeping employees as safe as possible at work.
Create a Clean, Safe, Hygienic Workplace
Employers are setting up sanitizing and handwashing stations throughout their plants and offices. This is also an area where it can be empowering for employees to feel like they have some sort of control over their own health and can take part in keeping themselves safe. Some factories in China have placed mats soaked in disinfectant at workplace entrances. Additional deep cleaning and sanitizing of the worksite by office cleaning companies are also common. In addition, shuttle buses in China are sterilized prior to each shift. Communications and posters reminding employees to wash their hands, cover their mouth when they cough and stay home when they are sick are critical to reinforce.
Putting Contact Tracing in Place
When an employee tests positive for the virus, employers must have a robust plan in place for ensuring that they are reported to local health officials, do not return to the workplace and remain in self-quarantine for at least 14 days. Some employers are placing further restrictions, such as longer than 14-day quarantine s or 3 days symptom free; requiring a negative test or a doctor’s note clearing them as safe for return; or daily reports to manager of temperature and symptoms. Also, it is critical to have a plan to isolate sick employees if they become sick at work and a way to communicate the procedures. In addition, employers may be required to contact trace and identify other employees who came in contact with the individual and then notify those employees of their exposure to an employee who tested positive. Some employers have required those employees to self-quarantine for 14 days as well. Companies have adapted their leave policies to pay for the time they require their employees to remain in quarantine due to confirmed illness or workplace exposure.
What Happens if Those Living With An Employee Become Sick?
Employers may want to consider including a question about whether anyone an employee lives with has received a diagnosis for COVID-19. Close proximity to someone with the virus will dramatically increase the risk of that employee getting infected. Therefore, some employers are considering how to do additional monitoring or forcing quarantine for those employees as well.
Supporting Emotional Well-being and Mental Health
Some employees may ask how they can be reassured that they will be safe upon returning to work. Rates of stress and anxiety are expected to be on the rise for the foreseeable future, and for good reason. It’s understandable that some employees would be nervous about returning to the workplace, especially since they may have felt worried and isolated while at home. Therefore, it is critical that employers have a robust communication plan in place that clearly defines processes and procedures designed to address safety. For individuals who raise concerns, managers can have a conversation with the employee to better understand particular fears. For example, those who rely on public transportation to commute to work may have specific worries related to the safety of mass transit. Some countries with employee shuttles may be able to address this concern; however, many geographies do not have company shuttles. Alternative accommodations may be considered for those employees expressing personal safety concerns, though options and requirements may vary based on country laws, regulations, job roles and union/works council negotiations.
How will You Address Fearful Employees?
Several companies have indicated that they do not intend to put pressure on employees to return to the workplace before they feel comfortable doing so. As one company noted, being in a heightened state of fear can cause workplace issues such as errors and safety concerns, in addition to affecting someone’s personal well-being as well as their mental health concerns. For some employees, underlying social issues such as racial discrimination and domestic violence, which have been exacerbated during the pandemic, may cause further stress and anxiety. Reinforcing anti-discrimination policies can help make employees who perceive themselves as potential targets for discrimination feel protected. With regard to domestic violence, a relief from social isolation may feel positive to some employees. Now, more than ever, leveraging your company’s Employee Assistance Program is important, coupled with manager training to facilitate the transition for employees.
As companies consider their return-to-work strategy, they need to consider each individual country’s set of policies, guidelines and restriction requirements. Recently U.S. guidelines were published in addition to updated OSHA’s workplace safety guidelines. As one company noted, it is important to not only consider the issues the company and employees are facing today but also what well-being needs will emerge in the short-term (3 to 6 months from now), and longer-term. Companies need to position themselves to be prepared to support employees in an ongoing way. Being responsive and adaptive is key to navigating the broad and dynamic set of considerations impacting the time and scope of returning to work and reopening the economy.