Workplace Support in the COVID-19 era – Back to Work Strategies

Just as we have a core value to treat individual patients in a personalised and bespoke manner, we have exactly the same ethosmanaging our corporate clients. 

Up until now our main work with small to medium sized businesses was looking after executives as part of our Concierge Clinic membership, providing both acute and chronic medical care with a strong emphasis on bespoke health screening and preventative medicine in order to optimise health. 

However, in view of the recent coronavirus outbreak we have been asked to work with businesses to advise on safely gettingback to work. Though each business is different with specific requirements and solutions we focus on four main areas. 

Reducing risk of exposure this can include strategies such as working remotely from home, having less people in the office with physical distancing measures and adequate office ventilation. It’s also important to look at the way individuals travel into work and the risk that that entails. In addition, there have been discussions around wearing of masks particularly in indoor working environments and daily temperature monitoring. 

Containment involves each individual reporting any symptoms, no matter how mild, so that their case can be assessed and they can be advised to self-isolate as required. This can also extend to reporting symptoms of anyone who is unwell in the household. With the use of healthcaretechnology, we now have clients who monitor vitals such as temperature, pulse rate and blood pressure at home daily prior to going to work. These readings get automatically sent via an app to the physician who can assess real time data. Setting up alerts on the app so that temperatures above 37.5 result in an urgent push notification to the physician means the case can be assessed urgently. 

Testing there are various ways of doing this and although there are limitations to all current testing methods, some organisations have requested antibody testing to assess whether employees / executives have previously been infected with COVID19. However, it’s important to note that even if this is the case, we are not yet sure whether this means they will not pick up the infection again. There are multitudes of antibody tests available with varying degrees of accuracy. The point of care test kits, although providing an instant result, is not specific or sensitive enough in the community for it to be reliedupon. The laboratory tests such as Abbott’s antibody test is significantly more accurate with more than 99% sensitivity and specificity. 

In addition to antibody testing there are also options for PCR testing (which tests for the actual virus) being trialled by organisations. This is usually recommended for workers who are symptomatic or if a member of their household is symptomatic. We still need to be cautious with negative tests as PCR swabs do have a false negative rate. Combining testing of SARS-CoV-2 with other respiratory viruses can give us further information. Notably, if another respiratory virus is showing as positive then we are less worried about a negative COVID-19 swab being a false negative (in saying that sometimes coexisting infections can also be present).

Some organisations prefer to test their employees on a regular basis even if they are not showing symptoms to pick up asymptomatic carriers and those in the incubation period. Whilst this is possible, there is not any evidenced based guidelines into how effective this strategy is and how frequently testing should occur. 

Personal Risk Stratificationcan be overlooked but is certainly a vital part of any back to work strategy. Patients that fall under the shielding category need to continue following the relevant Public Health England guidance. However, those with medical conditions and other risk factors falling into the moderate risk group also need to take extra precautions.

The challenge is the moderate risk group covers a very broad spectrum of risk and a one size fits all approach is simply not safe. Calculating an individual’srisk / probability of developing COVID-19 complications is important before deciding on further steps. There are various risk calculations tools available and these should be used to guide decisions but it’s also important to note many risk calculators are not validated and they will likely become more accurate and sophisticated as further evidence becomes available  -continuous review is important.

In summary, during what is likely to be an uncertain few months ahead of us, a bespoke and flexible plan is required for most businesses to get safely back to work. It’s important that any plan is regularly reviewed, particularly in light of any new developments as the pandemic progresses.