Sam Thinks He May Have COVID-19. Now What?

For companies returning people to work in larger and larger numbers, the answer to “Now What?” is: Contact Tracing.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman. Originally posted at: https://www.worksteps.com/news-and-insights/5-29-20-covid-19-brief-sam-just-called-in-sick-now-what

I’ve written more than once about the things companies should be doing to protect their employees, contractors and customers from COVID-19. Last week, I even used the analogy of a 4-part cocktail to help communicate the combined value of screening, distancing, mask-wearing and hygiene measures.

Notably, I’ve consistently set the expectation that the goal of mitigation strategies is to contain the spread of COVID-19 and prevent disease outbreaks among your workforce. I’ve not indicated that the goal is zero cases. Because asymptomatic and pre-symptomatic people can spread the virus, zero cases is just not feasible.

So, back to the title of this article: “Sam just called in sick. He thinks it may be COVID-19. Now What?”

For companies returning people to work in larger and larger numbers, the answer to “Now What?” is: Contact Tracing.

Contact Tracing – Why Employers Need to Act

While the term “Contact Tracing” is new to the ears of the average person, it is a well-developed and proven practice that has been used for decades to successfully fight the spread of infectious diseases. Contract tracing breaks the disease transmission chain by preventing newly infected people from infecting others. From AIDS to SARS to Ebola, contact tracing has helped save lives and prevent pandemics around the world.

Contact tracing is a well-developed practice that is typically in the domain of public health professionals; however, the SARS-CoV-2 virus presents some special challenges that require employers to take action. Consider these facts and implications:

Facts about COVID-19:

The virus is highly contagious.
People can spread the virus without knowing because people tend to be contagious before they feel sick, and some people never experience symptoms, even though they can still shed the virus.
The virus spreads through unremarkable activity. It is now believed that the primary means of transmission is simply close contact in a confined space. So having lunch, commuting, being in a meeting or just working with an infected person are enough to transmit the virus. And of course, people living in the same household as infected employees are at risk of getting sick.
Contact tracing often involves addressing language barriers, cultural differences, difficulties in recalling recent close contacts and trust issues.
COVID-19 has hit the world fast and hard.

Implications of the above facts:

Lots of people become infected.
For each infected person, there are lots of contacts that need follow-up.
Speed is of the essence in order to identify contacts who have been infected so they don’t continue to spread the disease.
Contact tracing needs to be thorough. Anyone with whom an infected person has had close contact (within 6 feet for 15 minutes or more) needs to be reached, interviewed and counseled.
Contact tracing is difficult and time-consuming work.
Our public health infrastructure is not prepared to handle the COVID-19 challenge.

Conclusions

In most areas of our country (and particularly in more densely populated areas) our public health departments are simply not equipped to handle the volume of contact tracing activity that is needed with the speed and thoroughness required. Note: We recommend companies reach out to their local public health agency to gauge their capacity and responsiveness, keeping in mind that those things may change if there is an outbreak in your area.
Therefore, to prevent workplace outbreaks and avoid further business disruptions as they return employees to work, employers need to develop internal resources or engage trusted partners who are capable of providing timely and robust contact tracing support.

Contact Tracing – How To

Building contact tracing capabilities internally is not out of the question, but it isn’t easy. Certainly, this article is no place to go into the details. There are a couple of resources worth reviewing to get a sense of the task at hand. Both are written from a public health perspective, so it’s more than any company would need to do. First, a link to the CDC’s Resource Page, and then a link to this Contact Tracing Playbook, which provides a good overview and some detailed guidance.

One More Thing – The L-Word

There is one additional item I am reluctant to bring up in this article because it begs more detail than I can provide in the space I have. It has to do with Workers’ Compensation Liability. Looking out at the marketplace, we are seeing a sharp rise in suits being filed by employees claiming that they became sick with COVID-19 at work/because of work. In addition to the cocktail of measures to help prevent the spread of COVID-19 in the workplace, employers should put in place a robust contact tracing program to make sure one case doesn’t become three or four or ten+ cases.

As always, let us know how your organization is dealing with this topic. And please contact us if you’d like to learn more about our contact tracing services.

Be well and stay safe.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS