October 2020
Vincent Nelson, M.D., Vice President, Medical Affairs, Blue Cross Blue Shield Association

If you’re planning on bringing your employees back to the workplace, your organization has safety top of mind—and testing and screening for COVID-19 may be part of your plan. But it’s a complicated topic, with a multitude of factors to consider. So, where do you begin?

Providing perspective and resources to employers during this health crisis has been a priority for Blue Cross and Blue Shield (BCBS) companies. Here, we will explore a few key areas to consider when creating your company’s policies: different testing and screening options, choosing the right testing model and employee communications. Keep in mind that this information is intended to be a high-level guideline. Things can change quickly, and we encourage all organizations to work with your state, territorial and local health officials to determine how to implement the best strategy for your circumstances.

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Consideration #1: Understanding the different testing and screenings options

SARS-COV-2 Tests
There are two basic types of testing: diagnostic (molecular and antigen tests) and antibody tests. The following chart from the U.S. Food & Drug Administration (FDA) helps explain the differences.¹

Source: U.S. FDA https://www.fda.gov/consumers/consumer-updates/coronavirus-testing-basics

* Please note that the time it takes to get test results varies and may be longer in some areas than what’s indicated in the FDA chart. We also recommend you continue to check for updates as this is a rapidly developing field.

Legally, the U.S. Equal Employment Opportunity Commission (EECO) points out that employers are permitted to require employees to undergo diagnostic viral tests in compliance with the Americans with Disabilities Act (ADA), while employers are prohibited from requiring employees to take an antibody test before returning to work. Click here for more EEOC guidelines.

It’s also important to point out that some consider antibody tests to be less valuable since they don’t assess whether someone is currently sick. Furthermore, it’s not yet clear if the presence of antibodies means an individual is immune.

Body temperature screenings and health checks
Even though performing screenings or health checks may not be completely effective as asymptomatic individuals or those with mild non-specific symptoms may pass through screening, some employers are implementing these strategies to reduce risk.

On-site temperature checks:
First, employers should consider who is administering the screening. Third-party vendors offering temperature check programs, like immediate care clinics, have been implemented across multiple industries. If companies administer it internally, the Occupational Safety and Health Administration (OSHA) notes that employees administering tests must be trained in the process and follow all personal protective equipment (PPE) guidelines.

Based on a survey conducted this May by the Business Group on Health, 68 percent of large employers have internal staff administering on-site temperature checks and 32 percent are using an external vendor. While solutions vary, some include access to a live nurse through an app. The individual takes their temperature using their own thermometer and shows the result to the nurse, who is online.²

Questionnaires:
If you plan on using questionnaires or self-certifications, the Centers for Disease Control and Prevention (CDC) provides guidance on what types of questions you can ask pertaining to an employee’s potential risk of illness and/or exposure.

Types of questions include:

• Confirmed illness
• Designated symptoms
• Exposure to others with symptoms
• Travel to heavily infected areas
• Certification individual is not in a high-risk population

There are also a growing number of mobile apps that allow employees to easily check and report symptoms prior to leaving home. And while there are asymptomatic cases, studies have confirmed that screening for a range of symptoms can be more effective than temperature screening alone at identifying employees who may be infected with the coronavirus.

According to the Business Group on Health survey, 28 percent of large employers reported having a home check procedure in place, adding that only those below the acceptable temperature threshold are permitted to report to the workplace. And 51 percent require employees complete a symptom checker before reporting to the workplace.²

Contact tracing:
When an employee is diagnosed with COVID-19, organizations should be prepared to act quickly and notify others who may have been in contact with an employee who tests positive. Setting up processes like recording attendance in all meetings and having a list of standard questions to identify an exposed employee’s movements can help. Legal and HR experts also say that you should be careful to maintain confidentiality and avoid alarming the entire organization when conducting contact tracing.

Regardless of the protocols you put in place, it’s important for employers to make employee health screenings as private as possible, establish a clear testing policy, socialize how information will be stored and used, and seek out state and local guidance as it relates to disclosure of medical information.

If you haven’t already, it’s also a good idea to reach out to your health plan partner and ask about the resources they have available to you. For example, many Blue Cross and Blue Shield companies have created dashboards to show trends in claims related to COVID-19 to help employers locate hot spots, which could inform testing and screening policies.

Consideration #2: Choosing a testing model that is right for you

The CDC suggests that a testing strategy could be appropriate in areas where there is moderate to substantial community transmission, and there are several testing scenarios you can consider for your company.³

Here are the 5 different testing scenarios, according to the CDC:

Testing employees who show symptoms.
If an employee is found to have a fever during a daily temperature check at work, that employee should immediately be isolated from others, sent home or to a healthcare facility, and be tested for the coronavirus. Any employee who might have been infected by that person should also be sent home to quarantine pending the test results.

Testing asymptomatic employees with known or suspected exposure.
If an employee has been exposed to a confirmed COVID-19 case at work or at home, he or she should be quarantined immediately and tested for the virus. Testing should be done several days after exposure because the virus might not be detected immediately, the agency advised. The employee should remain quarantined at least until test results are received.

Testing asymptomatic employees without known or suspected exposure for early identification in special settings.
This might be appropriate in areas where there is high transmission and workers are in close contact, and approaches may include initial testing of all workers before entering a workplace, periodic testing of workers at regular intervals, and/or targeted testing of new workers or those returning from a prolonged absence.

Testing to determine the resolution of the infection.
In most cases, evidence supports a symptom-based strategy to determine when to discontinue home isolation or precautions. For all others, a test-based strategy is no longer recommended except to discontinue isolation or precautions earlier than would occur under the symptom-based strategy. For those who are severely immunocompromised, a test-based strategy could be considered in consultation with infectious diseases experts.

Testing for public health surveillance.
This kind of surveillance program is more often a public health function or used to understand disease trends in the workplace better. Employers should undertake it only if the results have a reasonable likelihood of benefiting workers.

Again, things are rapidly changing in this area. Be sure to stay up-to-date on the latest testing information from the CDC and your local health officials. For full descriptions of all the testing scenarios, visit the CDC site.

Consideration #3: Establishing clear employee communications

According to a Harris Poll conducted in mid-July, 80 percent of Americans are concerned about a new wave of COVID-19 in their area.⁴ Now more than ever, it’s critical that you clearly communicate your organization’s testing, screening and safety protocols to not only educate your employees but also provide some peace of mind.

After sessions with a number of BCBS companies, employers and partners, here are several key takeaways and ideas your team can tap into as you prepare to bring your workforce back to the workplace.

Your organization’s communication strategy should:

• Utilize frequent and multiple touchpoints to engage and inform
• Provide up-to-date information from the CDC, FDA and local authorities
• Be fully transparent on any and all new workplace safety protocols (i.e. testing and screening, mask requirements, social distancing rules, sanitizing efforts)
• Educate employees on symptoms, test results scenarios, contact tracing and local testing facilities
• Give employees undergoing testing clear information regarding type of test, purpose of test, who will pay for the test and actions associated with the results of test
• Reinforce health plan costs and benefits related to COVID-19
• Be ready with “next steps” in response to employee exposure
• Emphasize how employee privacy and confidentiality is protected to counteract the stigma that may be associated with being diagnosed with COVID-19

It may come across as a bit cliché, but knowledge is power, especially now when we’re all adapting to and living through the coronavirus pandemic. Open and active communication is crucial as your organization navigates its way back to the workplace and aims to protect the health and well-being of employees.

Finally, below are a few additional resources so your organization can stay informed and up-to-date with expert guidance:

CDC: CDC Coronavirus Symptoms & Testing
EEOC: EEOC What You Should Know About COVID-19, ADA and Other EEO Laws
OSHA: OHSA Guidance on Preparing Workplace for COVID-19
SHRM: SHRM A Guide to Employee Temperature Checks

¹ U.S. Food & Drug Administration (FDA), “Coronavirus Testing Basics”
² The Business Group on Health Survey, May 2020
³ Centers for Disease Control and Prevention (CDC), “SARS-CoV-2 Testing Strategy: Considerations for Non-Healthcare Workplaces”
⁴ Harris Poll, COVID-19 Consumer Research, Wave 19, July 10-12, 2020