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In early March, when we published our HBR article “8 Questions Employers Should Ask About Coronavirus,” there were fewer than 100,000 cases and 4,000 deaths globally. Now, not quite three months later, infections exceed 5.5 million and employers face a whole new set of questions as they consider how to reopen the workplace after weeks or months of restrictions. As always, employers must remain nimble, and play close attention to local conditions and changing guidelines and practices. Here are eight questions they must now address.
When is the right time for employees to return?
According to a survey of 854 U.S. employers we completed in early April, 42% reported that the majority of their workforce could work remotely — compared to just 14% before the pandemic. Employers now want to know when and how to bring many of their remote employees back.
The World Health Organization recommends that nonessential workers return when there is a sustained decrease in community transmission, a decreased rate of positive tests, sufficient testing available to detect new outbreaks, and adequate local hospital capacity to accommodate a surge of new cases should that occur.
Companies should be prepared to adopt different timetables for different geographies depending on local circumstances. They will do well to prioritize opening workplaces where work cannot be sustainably performed remotely, where there is high demand for the workplaces’ output, and where redesigning the space to allow for physical (social) distancing requires few changes.
Who should return to the workplace?
Not everyone, and not all at once.
It’s best to have workers return gradually, which allows for lower density, making physical distancing less of a challenge. Maintaining a partially remote workforce also facilitates stress-testing physical or workflow changes to minimize disruption as more employees return to the workplace over subsequent weeks and months.
We suggest that workers at highest risk for complications of Covid-19 — those over 60 and those who are obese, have chronic lung or heart disease, diabetes or kidney disease — remain remote where possible until the amount of community transmission is very low. We also suggest that employees with children at home and who lack alternative child care, and employees for whom transport could pose a significant risk of exposure, should be encouraged to continue to work remotely if possible.
One option which can help avoid discrimination is for employers to simply allow employees to state they are uncomfortable returning to the workplace, without asking whether this is due to age, chronic disease, transportation concerns or child care.
How can we protect employees who come to work?
The most important protection in the workplace is to effectively exclude those at highest risk of transmitting the disease. Forty-five percent of employers in our survey reported using thermal scanning to identify employees with fevers and exclude them. In the U.S., the Equal Opportunity Employment Commission (EEOC) has determined that during the pandemic employers may require employee temperature checks or testing without violating the Americans with Disabilities Act. Since most people do not have a fever when they first get sick with Covid-19, it is essential to couple scanning with questioning of returning employees, e.g., asking them whether they have a known exposure, a sick family member at home, or other symptoms including cough, shortness of breath, chills, muscle pain, sore throat, or new loss of taste and smell. Many companies will restrict visitor access to the workplace to reduce the potential for exposure.
Some employers are using a mobile app or web form to ask these questions; others use signage in the workplace. Employers can exclude employees who answer affirmatively at their discretion, and we recommend opting for more rather than less exclusion in the early days of reopening. Bear in mind that that employees with paid sick leave are less likely than those without it to come to work when they are ill. While sick-leave policies may be expensive, the cost of inadvertently allowing infected employees into the workplace may well be higher.
The Centers for Disease Control and Prevention recommends cloth masks for those who will come within six feet of others, and we recommend that employers require and provide masks for returning workers. Masks can be uncomfortable and must be removed for eating or drinking, but they provide some protection against spread of respiratory disease. Employers should explain that the mask is not to protect the wearer, but rather to protect co-workers. Handshakes are not coming back any time soon, and even elbow bumps don’t allow for the recommended physical distancing.
The workplace — whether it’s cubicles, an open workspace or an assembly line — should be arranged so that employees can remain at least six feet apart. Standing in lines should be abolished where possible; if a line is required such as at a cafeteria cash register, mark out 6-foot intervals to avoid crowding. (In the cafeteria, salad bars and finger food could promote spread of the virus; individually wrapped foods are safer.) More employees will eat at their desks, and companies can use sign-up sheets to decrease congestion in shared kitchens. Companies should continue to encourage hand-washing.
Companies should set capacity limits on conference rooms to allow six-foot spacing; if a meeting is too large for the available room, some participants should call in even if they are in the building. Plexiglass dividers can help prevent coronavirus spread in manufacturing, lobby, and retail settings.
Ninety-seven percent of companies in our survey reported enhancing their cleaning and disinfection, as well as increasing access to hand and surface sanitizers. While there is new evidence that the risk of virus transmission from surfaces is low, employees or cleaning staff should use disinfectant wipes regularly on shared surfaces such as vending machines or drink dispensers or shared printers, and employees should not share office equipment such as keyboards or phone headsets. Water fountains and ice machines can spread virus and should be turned off. Companies should also disable jet driers in bathrooms, which may disperse virus particles, and supply paper towels instead.
Finally, if an employee in the workplace is found to have Covid-19, companies must inform those who might have been exposed to him or her at work during the two days prior to symptoms. Those coworkers will need to be excluded from the workplace and self-quarantine. Employers must also maintain the infected employee’s confidentiality by not sharing their name.
What role can testing play in making workplaces safer?
Testing can currently play only a small role in ensuring a safe return to the workplace. Right now, tests are expensive, in short supply and not accurate enough. Tests for current infection have low sensitivity rates (that is, they yield false negatives), so a negative test alone isn’t adequate to ensure that a worker is not contagious. However, testing can be useful in helping to identify asymptomatic coworkers at workplaces where there has been a known exposure. Point of care machines that yield “rapid” results can only process a handful of tests an hour, and nasal swabbing in the workplace could itself cause disease spread. Antibody tests, which require a blood sample, have a high rate of false negatives for current infection, and false positives for past infection. Further, after a person recovers from infection, it’s not clear that a positive antibody test indicates that they will be immune from future infection.
What should we do if we discover an infected employee in the workplace?
Many have few or no symptoms early in a Covid-19 infection, and it’s likely that many workplaces will have an exposure despite the employer’s best efforts. As discussed, an employee or visitor with suspected Covid-19 should immediately leave the workplace and be advised to seek testing or medical attention. Areas used by the ill person for prolonged periods in the last week should be cordoned off and disinfected after allowing 24 hours for respiratory droplets to settle. Increasing air exchanges or opening windows can also reduce risk.
Employers should identify any employee who spent more than 10 minutes within six feet of the infected person during the two days before symptoms began, and those employees should also leave the workplace, self-quarantine, and monitor for symptoms until 14 days after their last exposure. Employees who have had passing contact, such as in a hall or an elevator, need not self-quarantine. Some exposed critical infrastructure workers such as transportation and health workers can return to work after exposure using masks and physical distancing along with heightened disinfection of their workspaces.
When can employees return to business travel?
International business travel is unlikely to rebound until after this pandemic has receded. Many countries, if they allow international arrivals, require 14 days of quarantine, and business travelers might be quarantined again on return home. International business will continue to use teleconferences and videoconferences for many months to come, and travel will only resume substantially when there is a vaccine, effective treatment, or herd immunity.
Domestic travel will also remain limited in the coming months. Local areas that have new outbreaks will likely restrict movement, and a business traveler to such a region could be stranded there for weeks or months. Travel by personal car will come back first as this does not involve risk of exposure to others. Travel by train, bus, and airplane will take longer to return, and when it does business travelers are likely to encounter limited schedules that could increase travel time. When necessary, travelers can stay in hotels as most have ramped up their cleaning and disinfection; however, it’s still wise to use disinfectants on surfaces. Business leaders must clearly communicate and enforce company travel guidelines as they evolve.
How can we meet employees’ growing mental and emotional health needs?
Many have suffered profound losses during the pandemic and have not had sufficient opportunity to grieve. Almost all of us have experienced loneliness. There will be more cases of anxiety and depression, and some survivors and their families will have post-traumatic stress syndrome. Access to mental health services was often poor before the pandemic, and needs will be greater now. Employers must step up to this challenge.
Most employers in our survey (58%) report increasing access to tele-behavioral health such as audio or video therapy sessions, while 83% report increasing communication about Employee Assistance Programs. Some types of cognitive behavioral therapy can be effectively delivered via mobile app, and we anticipate increased used of digital solutions to address some mental health needs. Some employees benefit from mindfulness and mediation programs, and the value of online programs has increased.
Employers can also establish virtual social networks to address isolation, and train supervisors to identify employee mental health needs in the remote workforce and make appropriate referrals. Consideration of family and child care responsibilities and encouraging exercise and time away from work also helps support employees’ emotional health.
How should we communicate around return to the workplace?
False and unfounded rumors can spread as fast as a virus, and companies need to earn the trust of their employees through frequent and accurate communications. Companies should address employee concerns about the safety of returning by focusing communications on the actions being taken to protect them, including workplace cleaning, screening policies, and changes being made to allow social distancing. This information should be shared in regular pushed communications such as email, as well as through the company intranet and human resources sites.
Visual communication about appropriate behavior is also important. Companies should retire stock photos of employees who are clustered tightly together. They should also avoid images of people wearing medical-grade protective gear such as face-shields or N95 masks in non-clinical workplace surroundings as these remain in short supply and are not recommended.
Finally, because pandemics can incite xenophobia, bias and stigma, leaders should be alert to the potential for some groups or individuals to be stigmatized, and speak out against it. Hate crimes against Asians, for example, have increased with the current pandemic, much as African Americans were wrongly blamed for spread of the 1918 influenza pandemic. Our survey showed that 47% of companies are currently taking actions to reduce stigma during this pandemic, and 21% are planning to take such actions; still, almost a third of respondents have no such plans. Unconscious bias and anti-discrimination communication and training are key elements of diversity and inclusion strategies, and their importance is even greater now.
Covid-19 is a fast-moving virus and its impact on organizations and the world has been strong and swift. The practices outlined above will not only help protect employees, the community and company reputation, but also position companies for a smoother transition as they arrange return to the workplace.
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Jeff Levin-Scherz, MD, MBA, is a managing director and co-leader of the North American Health Management practice at Willis Towers Watson. Jeff trained as primary care physician, and has played leadership roles in provider organizations and a health plan. He is an Assistant Professor at the Harvard TH Chan School of Public Health.
Deana Allen RN, MBA, is a senior vice president of the North America Healthcare Industry practice and serves as the Intellectual Capital and Operations Excellence leader at Willis Towers Watson. In addition to work as a clinician she has served as a health system corporate director of risk and insurance and healthcare consultant.
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