We don’t really know how long the novel coronavirus (COVID-19) has been with us, but as we turn the page of our calendars into June, it is fair to say that SARS-CoV-2 (the virus that causes COVID-19) has perhaps been with us for as long as six months.

Even though the daily cases and deaths have not receded as much as we have hoped for in Ontario over the past several months, politicians and businesses are intent on reopening workplaces to restart the economic engine that we depend on. We are also yearning to get back to the social aspects of work and life that many of us took for granted just a few short months ago; yet, there is still a lot of uncertainty with how best to get back to some sense of normalcy with COVID-19 still prevalent in our communities.

To address these economic and personal uncertainties, when planning for reopening businesses and worksites, employers need to consider several interventions and actions to mitigate the risk of COVID-19 transmission and infection. They are working in collaboration with their Occupational Health and Health & Safety teams to assist with this effort. These considerations centre primarily on preventing the transmission of COVID-19 through respiratory droplets and surface contact/contamination, but should also address the mental health and recovery of employees; implementation and continuation of flexible human resource (HR) policies and procedures on absences and working remotely; and the ongoing need to protect employees while at work with preventative measures such as increased hand hygiene practices, physical distancing, and the use of face coverings when physical distancing isn’t possible.

Mental Health

Employers have had to pivot quickly to adapt to physical distancing requirements by accommodating remote work. Workers able to work from home did so, but many faced challenges with productivity, prolonged physical and emotional isolation from co-workers and friends; changes in team cohesion and engagement; and the disruption of their normal daily and weekly rhythm. Some have adapted well, while others still require more time to get used to the new normal.

For those working remotely, returning to the office poses concerns about readjusting and refreshing to yet another routine again after a long time away. The cognitive demand that comes with remembering and refocusing on workplace activities, routines, and different productivity expectations, can contribute to dysfunctional behaviour, interpersonal conflict, injuries, and expensive errors and quality problems when returning to the workplace.

For those workers whose job tasks did not allow for remote work, return to work (RTW) after a layoff or time away from the workplace may be a source of anxiety with unanswered questions: is it safe to go back to work? How is my employer ensuring my workplace is safe? Are my co-workers safe to be around?

Employers are similarly concerned: How can we protect our workers? How do we ensure workers are fit for duty for every shift? What happens to operations if we have a sick worker that may have unwittingly infected others at the workplace?

The employers who are well prepared to reopen their businesses have considered employee issues, such as educating their workforces on what COVID-19 is; raising awareness on what the symptoms are; advising employees how to conduct self-assessments; and having a plan on what to do if workers develop symptoms or come into contact with sick individuals. Recognizing the impact that mental health aspects of RTW will have on productivity and team cohesion, will mark the sophistication of the psychological health and safety culture of an organization, and should factor into the planning on reopening for business.

Testing Solutions

Another top priority among employers when considering how to enable a safe RTW is a focus on the role that COVID-19 testing can play in their overall RTW strategy and in the making of specific RTW decisions.

DriverCheck has been digging deep into the research and we’re in ongoing discussions internally with manufacturers of testing kits, labs, and customers to better understand the promises and limitations of testing, and to develop guidance regarding the use of testing in RTW policies and practices. We have also developed a screening app called DC Access, that enables real time employee self-assessments and advice on whether an employee is fit for duty or not, which is relayed back to business leaders to manage daily operations.

Our key points of advice to employers include the following:

We believe testing can play an essential role in a RTW strategy, but there are many considerations to take into account, such as procurement, logistics, data privacy, and communications.

No test on the market right now will give a clear-cut infected/not infected or immune/not immune result. The tests are just not there yet, but a comprehensive testing protocol is recommended.

Where possible, use two types of tests: a viral genetic (PCR) test to inform a clinical assessment for diagnosis; and when available and validated for widespread use, an antibody (blood) test which may have diagnostic value, but is primarily used to determine immunity.

Additional testing options using point-of-care-testing (POCT) kits that look for the same viral genetic material using PCR processes are weeks to months away from being widely available, and may offer a more portable and ease-of-use option for employers and their workers. Employers will need to remain alert to changes in testing technologies and the context of their policies, and agile to make changes that take advantage of opportunities to improve or streamline systems.

Comprehensive Approach to Managing COVID-19 in Workplaces

Perhaps most critically, we recommend testing be layered into a more comprehensive system of prevention measures. Because tests are imperfect, asymptomatic people who are sick with COVID-19 are likely to slip through, and those thought to be immune, may not be. Therefore, vigilance in daily testing with body temperature checks and questionnaires, distancing and barriers, disinfection, personal hygiene, and mask wearing should all be maintained.

Screening

Employers should implement a medical surveillance system that, at a minimum, includes educating employees on COVID-19 symptoms and advises them to stay at home if sick in order to eliminate all contact between healthy workers in the workplace and anyone with potentially infectious symptoms. For larger employers with jobs deemed essential or mission-critical, or where one ill worker could infect a larger group of workers, thus shutting down operations, a daily (or more frequently) administered medical questionnaire, with or without body temperature screening, should be used. This approach has an advantage of quickly identifying symptomatic workers to prevent them from attending work, and to sequester them away from others if they happen to develop symptoms while at work. Sick employees should be encouraged to undergo testing to confirm COVID-19. Diagnostic testing, using currently available lab-based PCR testing, has recently been made available to all Ontarians, whether they are symptomatic or not, and can identify asymptomatic spread in some circumstances.

Contact Tracing

Occupational Health teams, along with their counterparts in Health and Safety, may also be called on to conduct internal contact tracing if employees develop symptoms while at work, or have inadvertently passed on an infection to one or more co-workers. If there is a confirmed case in a workplace, the worker should identify their most common contacts in collaboration with Occupational Health or Health and Safety, HR, and local public health officials, while maintaining confidentiality. Contact tracing will help cordon off areas of contamination in the workplace, and identify exposed workers who will need to be quickly sequestered to prevent widespread exposure. Areas where the sick employee worked—including conference rooms, common areas such as lunch rooms or lounges, and the work floor or production areas—should undergo deep cleaning and decontamination to prevent spread. Recent studies have demonstrated that while surface contamination remains an exposure risk for COVID-19, it isn’t as concerning as initially thought; human-to-human transmission through respiratory droplets still poses the greatest risk for exposure. Still, potentially contaminated areas warrant a thorough cleaning to mitigate this risk.

Employees in contact with an infected co-worker should also undergo a risk assessment to understand the duration of contact with the sick employee, whether they were using any personal protective equipment (PPE); the type of protection used (e.g. cloth face mask vs. respirator); and to identify any other exposure risks. The most conservative approach employers can take would be to have exposed workers, who could be in an incubation stage, isolated and working from home for at least two weeks after the possible exposure, if feasible.

Flexible HR Policies and Practices

To support these actions, flexible HR policies for COVID-19-related absences will help keep sick workers away from work if employees aren’t incentivized with attendance bonuses, or unduly penalized with wage cuts or with unfairly depleting sick time banks. Employers should eliminate attendance bonuses and ensure affected workers have sufficient paid leave to observe an isolation period or are able to stay home as indicated. Occupational Health and HR personnel should continue to monitor sickness absences, but organizations should expand sick leave provisions to allow employees to stay at home if ill and to care for sick family members.

Protection and Prevention

Employers should continue to address additional protective measures in the workplace — that follow the hierarchy of controls for exposures to occupational hazards to reduce worker exposure risk — on an ongoing basis. While the most effective strategy to reduce occupational exposure risk is to eliminate a hazard, elimination of COVID-19 requires a treatment or vaccine, and these options are assumed to be a long way off.

Following that, the second most effective strategy to reduce occupational exposure risk is to engineer the hazard out, addressed by working remotely, physically distancing, and using physical barriers such as Plexiglas dividers between people. Administrative measures should continue to address worker scheduling (e.g. staggered shifts, breaks, etc.), work-from-home policies, virtual meetings, and the screening approaches described above. Personal hygiene measures focussing on worker actions or behaviours that may reduce hazard exposure include hand washing, respiratory etiquette, and wearing cloth masks for source control should continue indefinitely.

Lastly, the use of PPE where appropriate – this may include respirators, gloves, eye protection, gowns or coveralls – is the “last line of defense” when other controls are infeasible, inadequate, or exhausted, and should continue until there is a definitive remedy to the exposure risk that COVID-19 presents.

Despite all of the measures put in place, we can be sure of one thing: even with the best approaches to open up the economy and get people back to some semblance of normalcy, we will definitely see a second (and maybe a third) wave of cases and even deaths. This doesn’t mean that these approaches to reopening businesses or workplaces are wrong or have been miscalculated. It does mean that we have to be ready for this eventuality and prepared for this to happen. This is important in the big picture. Flattening the curve was not meant to avoid infection altogether, but rather to minimize the impact on our health care services, and we have to be ready for this and be mentally prepared to deal with it when it happens.

COVID-19, may remain with us for a very long time, but having protective measures in place to limit the extent of recurrent waves will minimize its health impacts, and will enable us to maintain a productive economy by keeping healthy workers out of harm’s way and duly engaged in work. With some luck, these measures will also allow us to regain the freedom of movement so suddenly taken from us, ease other restrictions, and re-establish a close-to-normal way of life that has been otherwise disrupted to such an extent in the first half of this year.

Jonathan W. Davids, MD, CCFP, FCFP, CCBOM, MRO, MME, Dip. Sport Med., CD

Dr. Davids is Board Certified in Occupational Medicine and Family Practice, with subspecialties in Sport and Exercise Medicine, and Diving & Hyperbaric Medicine. He is a certified Medical Review Officer (MRO) with the American Association of Medical Review Officers (AAMRO), a Designated Physician Marine Medical Examiner (MME) with Transport Canada, and the Corporate Medical Director with DriverCheck Inc.

Practicing Occupational Medicine for over 24 years, Dr. Davids has worked as Medical Officer with the Canadian Armed Forces, and as a Corporate Medical Advisor and Medical Director for organizations in the retail and manufacturing industries, nuclear energy sector, police services, healthcare, and education. He is an experienced leader in policy development for substance use in the workplace, determination of Fitness-For-Duty, Workplace Mental Health and Psychological Health & Safety, disability case management, workplace accommodation, and regulated medical surveillance programs.

Dr. Davids has extensive experience working with unionized workforces in Occupational Health & Safety. He has acted as an advisor to Human Resources, Labour Relations, and Legal counsellors, and has testified in Labour arbitrations and Human Rights tribunals on behalf of employers. He has managed and advised corporate clients on Public Health concerns that impact business continuity, employees, and customers, conducted and advised on Corporate Executive Medicals and Wellness initiatives, and has provided Travel Medicine consultations for business travel for corporate clients.

Employer Considerations in Reopening Workplaces During COVID-19