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As public health agencies are accelerating efforts to scale COVID-19 contact tracing capabilities and stop the pandemic, many employers are doing the same. That effort is extremely complex.
Many employers are experimenting with a variety of workplace processes and technologies and learning on the go.
"Contact tracing needs to be done very quickly to minimize the risk of spreading the infection," said John Ho, chair of the OSHA Practice at the law firm Cozen O'Connor, headquartered in Philadelphia.
The difficulty of employer contact tracing
COVID-19 cases are increasing at an exponential rate, prompting more employers to identify affected employees.
"There aren't any relevant studies or analysis on how contact tracing in the workplace has panned out that I am aware of and I think it would be difficult to measure," Ho said.
"In addition, I am skeptical whether employers would want to share these results as they could be used in litigation," he said.
Many employers are leaning on the public health agencies for direction in who to test, when and how often, as well as for contact tracing services in some areas.
However, employers are also looking elsewhere for ways to deal with their own extended challenges from privacy issues to testing and contact tracing enforcement among employees, some of whom already resist simpler protective measures such as wearing a mask.
"Ultimately, the best method is one that can be done quickly and maintain privacy as much as possible and this answer will depend on the company," Ho said.
Manual tracing's benefits, inadequacies
Workplace contact tracing likely involves manual tracing. The benefits of manual efforts to trace COVID-19 include the ability to add the human touch to the equation and its rightness for certain organizations.
"Contact tracing for a small company with only a handful of employees probably lends itself to the manual method of asking the employee who he or she has been in contact with, while at a large company, the use of an app combined with direct questions to the employees may be more appropriate," Ho said.
The manual method generally consists of interviewing the employee who tested positive to discover who they came in contact with, and trying to validate that information by backtracking their interactions with others. Employers may review the employees work schedule over 14 days or more and augment that with various company records, such as timesheets, emails, meeting schedules and security video.
Premise Health, a large operator of on-site clinics for employers, posts its workplace contact tracing process. The steps include assigning a contact tracer to any employee who has or thinks they have COVID-19. The contact tracer then conducts an investigation that includes the following:
- interviewing the employee about symptoms and who they've been in contact with;
- communicating with their manager to identify other people who've possibly been exposed;
- calling other people who've potentially been exposed to conduct in-depth interviews;
- advising on COVID-19 containment processes such as quarantining;
- and providing information about additional resources.
By whatever process any given organization may use to manually conduct contact tracing, there remains one potentially fatal flaw in the plan: Sometimes the person who tested positive is unreliable. Perhaps that employee is too ill, evasive or unsure to completely recount everyone they came in contact with during a two-week period or longer. Or perhaps that person wants to protect their privacy or hide a misdeed.
"The employer is free to question the employee that tested positive about their whereabouts, both in and out of the office," said labor and employment lawyer Michael Elkins, partner and founder at MLE Law, located in Ft. Lauderdale, Fla. "If the employee refuses to answer, the employee could be subject to discipline."
Employers should restrict questions to contact tracing issues so as not to run afoul of other laws such as the Americans with Disabilities Act or the National Labor Relations Act, Elkins said.
Brian PhillipsDirector of Global Security Strategy, Traction Guest
"Other means of contact tracing would include questioning co-workers, reviewing security footage, checking computer use, comparing work schedules, and in some cases, reviewing social media," Elkins said.
Contact tracing technology's potential, downsides
Some companies opt to augment this labor-intensive process with data from wearables, apps and other technologies. None interviewed for this article relied solely on technology for contact tracing.
"At the employer level, contact tracing is challenging because there are few systems -- if any at all -- that will provide a full picture of any employee, visitor or other individual that had close contact with each other for an extended period of time," said Brian Phillips, director of global security strategy at Traction Guest, an enterprise visitor management software company, located in Burnaby, British Columbia.
Like similar organizations, its technologists and developers are scrambling trying to find a way to better use technology for contact tracing.
Privacy is key
From an employer's perspective, maintaining privacy is a key issue in both manual and technological methods of contact tracing.
"Generally speaking, [contact tracing] should be done maintaining confidentiality when possible and on a need-to-know basis, but the reality is in many instances, others will be able to identify the person testing positive," Ho said.
"An employer also wants to minimize sending the entire workforce into a panic while ensuring that appropriate coworkers are notified so they can monitor or quarantine as required," Ho said. "Another issue is the same as with the use of face coverings in that contact tracing has become politicized."
An employer needs to recognize this issue first in order to defuse it, he said.
Testing employees for COVID-19
The next question for employers after contact tracing has identified exposed individuals is often: "Now what?" Generally, the answer is testing followed by more testing.
But even that isn't a clear-cut path forward for employers. For one thing, there are different types and brands of tests to choose from as well as a variety of testing strategies.
"There's spot testing and serial testing and different testing strategies to consider depending on the workplace and the circumstance," said Ryan Ferris, co-founder, president and CEO of EMS service Garnet Transport, headquartered in South Burlington, Vermont.
The local health department is any employer's best resource on guidance in choosing an appropriate testing strategy, Ferris said.
Garnet was solely an ambulance and medical transport company, but was drafted to conduct on-site COVID-19 testing when a restaurateur, like a lot of other company leaders, found employee testing options slim.
"We started in June doing rapid antigen testing of employees [who worked] on site at the restaurant," Ferris said. "That soon grew from rising demand for testing access and we found ourselves testing on site at other restaurants, in co-working spaces and kid summer camps."
Garnet also does rapid influenza diagnostic tests with same-day results and ddPCR (Droplet Digital Polymerase Chain Reaction) testing, the gold standard in COVID-19 testing, with results returned in 36 to 48 hours.
As of now, after contact tracing, the best practice with employee testing is to broadly test those exposed with a quick antigen screen to isolate those who test positive and then retest to validate the positive read with a ddPCR test, which is more accurate, Ferris said.
"Generally, you'll need to do repeated testing to catch later disease developments," Ferris said. "That is usually done two to three times a week for two or more weeks as either spot checks or serial tests."
The local health department can offer guidance on how to best do testing in a given situation, he said.
Search for COVID-19 resolution can change business models
Long lines at testing sites are making it harder for companies to get employees promptly tested -- initially and as part of a follow-up retest strategy. Sometimes there is difficulty in getting insurance to pay for repeated testing, causing companies to seek workarounds.
This predicament is spurring interest in disruptor models known as concierge medicine, retainer medicine, membership medicine, cash-only practice and direct care, as well as variations on those themes. Garnet and other healthcare-related companies are banking on consumers and businesses preferring fast access to COVID-19 testing and physician advice over the current options.
Garnet's mobile testing service is a point-of-care lab operation that could test employees on site and return results in 20 to 30 minutes. The entire exercise is "a one-day engagement," Ferris said.
But the model was not as perfect as it seemed. While demand was high, logistical problems grew.
It's fairly labor-intensive to set up and often difficult to staff, Ferris said. Garnet looked for other ways to satisfy sustained high levels of demand for both businesses and consumers. While that model still makes financial sense for companies testing 200 or more employees at a time, Garnet has shifted to a hybrid model to meet demand for smaller group and individual testing. The company is now offering a mix of mobile, pop-up, fixed locations and airport-attached services.
"Since April, Garnet has worked with the Vermont Department of Health to staff pop-up testing sites and provide mobile specimen collection for at-risk and homebound patients for the University of Vermont Medical Center and the Vermont Department of Health," Ferris said in a statement to the press.
"Opening a location at the airport to serve travelers and the greater Burlington community is a natural addition to our work addressing the public health crisis due to the pandemic," Ferris said.
The airport location will also be open to non-travelers. Additional services are planned for business travelers, including fast access to flu and COVID-19 testing, on-demand physician visits for health or travel concerns, and telehealth services during their stay after traveling to a new destination.
The search for best practices in contact tracing and testing for employers is still in progress. However, several new models are rising to broaden current options, and many are likely to remain to address future disease outbreaks.