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This content was originally published on Inc. 

For companies in the U.S., returning to work just became more complicated.  Many companies that started bringing people back to the workplace are now thinking of hitting the pause button, as COVID-19 cases spike in states across the country.  Other businesses are not there yet, but are wondering what to look for, in the coming weeks.

With varying messages across cities, counties, and state lines, it can be difficult for a company to assess next steps when it comes to reopening.  It is important to remember that there are places in the world, whether in Europe, Asia, or New Zealand, that have managed to reopen large portions of their economy without seeing sharp increases.  In other words, it is possible to do this safely.  But there are definitely some issues for employers to think through in advance.

If you, as an employer, are in the process of returning employees to worksites, consider the following:

Situational awareness: 

  • First and foremost, stay abreast of what is happening on the ground at the local level, where your workplaces are located.  Monitor health department websites, social media posts from area healthcare systems and clinics, as well as the local news. 
  • Look beyond COVID case counts in the community. Testing remains inconsistent in various parts of the country, so it may be difficult to discern whether case counts are accurate.  If counts are going up or down, are they doing so in the context of stable, increased or decreased testing? That information may not be readily available. So for more clarity, pay attention to indicators like COVID-related hospitalizations to understand the severity of illness in the community and the degree to which the healthcare system is overwhelmed.  Also consider monitoring reports of outpatient influenza-like-illness (ILI) in the area (typically found on health department websites).  This is the number of people showing up to their primary care doctor, urgent care or emergency room complaining of flu-like illnesses. Because flu-like symptoms are similar to COVID symptoms (and because flu viruses don’t circulate much in the summer), the number of ILI visits in an area will give you an idea of how much COVID may be circulating there.  If ILI visits start to rise steeply in a given community, chances are a spike in COVID cases and hospitalizations is right around the corner.
  • Monitor illness in your own workforce.  Are more people reporting they have COVID-related symptoms?  Are higher percentages of people absent from work?  Correlating this type of information with what you have gleaned from reports in the community can give you a sense of whether more COVID is coming your way.  And what if you believe it is?  Make sure to pre-identify concrete steps you might take, from ensuring greater physical distancing in the workplace to temporary re-closure, depending on levels of viral circulation.

Capitalize on the outdoors, as the weather allows

  • There is one factor that nearly every COVID-19 outbreak has had in common: indoor transmission.  In nearly all cases, there was either improper ventilation or a fair amount of talking, singing, or face-to-face contact. One recent study, which examined reported COVID outbreaks globally, found only a single outbreak that occurred in an outdoor environment.
  • The outdoors is generally safer than indoors, so think about how you might capitalize on that. Are there certain business functions that you can conduct outdoors when weather permits? Could you hold that important meeting in an outside space? Can customer waiting areas be outdoors? Consider whether it might make sense to invest in shade structures or heat lamps or other equipment that may extend your use of the outdoors as the pandemic wears on, because it is unlikely to end anytime soon.

Invest in better ventilation

  • Many companies initially invested in cleaning and disinfecting products, based on concerns that the virus spreads through high touch surfaces.  While enhanced cleaning remains important, there is increasing evidence that virus particles in the air may play a greater role than initially suspected in indoor transmission.  Increasing the amount of fresh air circulating inside a room can dilute the amount of virus within the space, and reduce the likelihood of COVID transmission.  
  • Consider simple measures like keeping windows open, or look into HVAC upgrades to help improve the ventilation within your worksite.  This is especially important to do before the onset of winter, when outdoor business activities will likely be limited.

Mandate masks 

  • Since the pandemic began, there have been mixed messages related to masks, with some major health organizations initially declaring them unnecessary.  But as studies revealed that many infected people lack symptoms, the CDC and other organizations began recommending widespread mask use. 
  • Now some population-level studies are showing the implications of mask use on a large scale. For instance, one recent study, examining infection trends around the globe, found that places where face masks were mandated had greater reduction in infection rates than places where no mandate occurred.   The authors showed a decrease in infection rates in NYC compared to the rest of the US within days after the city issued a face mask order.  They demonstrated similar findings in Italy.
  • While employers can’t mandate masks for whole cities, they can mandate their use within their own businesses, both among customers and employees. Examples from other countries suggest that mandatory mask use may enable a safer and more productive reopening of the economy.

Go slow

  • One major mistake that certain parts of the U.S. have made is rushing their reopening.  Rather than take a slow, stepwise approach, they’ve hurtled towards a pre-pandemic means of conducting business – and that has led to the recent tidal wave of cases.  If your community is seeing heavy viral transmission right now, your best bet may be to pause your reopening plans.  (The more virus there is circulating in your community, the greater the chance that it can enter your workplace). Waiting till there is better control will reduce the likelihood of false (and potentially costly) stops and starts.
  • If your community is not seeing heavy viral transmission, consider bringing back the minimum number of employees necessary for business operations and then wait.  Consider waiting at least 2 incubation periods of the virus (about 28 days) to see if illness rates among employees and indicators in the community remain stable.  If they do, then consider bringing back a larger percentage of the workforce.  If they don’t, consider what additional measures you should put in place, related to distancing, masks, ventilation, cleaning, etc – and wait another 2 incubation periods to see if those measures work.  Be sure to keep high risk employees at home, or offer them modified duties, to mitigate risk.

Invest in virtual clinical resources:  

  • As COVID cases rise in a community, healthcare resources are likely to get overwhelmed, and your employees may not have a place to get the in-person care they need.  Prepare in advance for that possibility.  For employees with COVID-19 concerns, consider making virtual guidance available through telephone support lines, clinician chat services, or other digital methods. In many cases, this will help offload those with mild concerns from an overstretched healthcare system, and help those who are really ill get the healthcare they need.
  • For those employees who are having difficulty getting into their doctor for routine visits or regular medication refills, consider what telehealth options or mail-order/delivery pharmacy solutions you might offer. 
  • And think about tele-psych or virtual behavioral health support options that you might offer your employees through this intense and difficult period.

Thinking through these considerations can help your company successfully navigate these turbulent times, and operate successfully. Remember, reopening the economy won’t work if people don’t feel safe.  That goes for both workers and customers.  By prioritizing health and safety, you are prioritizing your business – and hopefully preventing another lockdown. At Grand Rounds, we have virtual Chief Medical Officers ready to help you think through these types of issues as our nation returns to work. Contact us to learn more.

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