Do Employers Need a Workplace Contact Tracing Plan or App?

02 Nov, 2020 Terry Bogyo

                               

If you are an employer, you have a positive duty to protect workers from harm.  Industry-specific guidelines on how to do that in the COVID-19 environment are now published by occupational safety and health organizations (such as  CDC, SafeWorkAustralia, and WorkSafeBC). The physical barriers, personal protective equipment, physical distancing, cleaning guidance and safe-work protocols required to discharge this duty are essential preventative measures. 

Prevention is rarely perfect.  The safeguards, barriers and defenses put in place to protect workers from harm may be subject to inadvertent active or latent defects;  despite multiple layers of precautions, when gaps or defects in prevention align, workers in your workplace may well be exposed to harms including the COVID-19 virus. 

Every jurisdiction has specifically emphasized employer responsibilities during this pandemic.  For example, consider this guidance to employers in Ontario:

The employer is required to take every reasonable precaution in the circumstance to protect the health and safety of workers, and do a risk assessment to determine what parts of the jobsite and what other workers the affected worker would have had contact with.

Based on this risk assessment, the employer may be required to:

  • send co-workers who were exposed to the worker home for two weeks. Ask them to self isolate and self monitor and report any COVID-like illness to their employer
  • shut down the job site while the affected workplace area and equipment are disinfected

[See Government of Ontario, COVID-19 (coronavirus) and workplace health and safety]

No employer wants any worker to be exposed to or infected by this virus; nor does anyone want to see operations shut down or healthy employees quarantined.  Yet, close contact exposures may occur in your workplace; planning for them can mitigate the impact on your employees and operations. 

Just the facts

The science around COVID-19 is still developing but there are four very important facts to keep in mind: 

  1. COVID-19 is a respiratory illness contracted when virus particles are either directly inhaled from droplets expelled by an infectious person or indirectly transferred from contaminated surfaces to face, eyes, mouth or nose. 
  2. After unprotected close contact with an infectious person or contaminated surface, an exposed person’s symptoms may develop during an incubation period of 14 days, however, up to a quarter of those infected are asymptomatic. 
  3. An infected person is infectious to others during a communicability period; that period for those with mild symptoms begins two days before the onset of symptoms.  Infected persons are considered infectious until 10 days after onset of illness, as long as they are fever free and have improved. Those with more severe cases may be infectious until two consecutive negative laboratory test results, at least 24 hours apart, which could take weeks to establish.
  4. Just because a person is no longer infectious does not mean they are fully recovered.  Lingering symptoms including fatigue, cough, respiratory and neurological issues may persist. 

Exposure and Close Contact

Unless you are in the healthcare sector, you or your employees may not know when, where, or exactly how an exposure to COVID-19 has occurred.  It is very unlikely a customer will produce a sudden, uncovered cough or sneeze then announce, “I’m positive of COVID-19”.  (If that every happens, your response as an employer would have to be immediate).   More likely, an employee or public health contact tracer will report a close contact exposure, an illness suspected to be caused by the coronavirus, or a positive test result.  The actions you take next are critical to stopping the spread of the disease in your enterprise and the broader community.   

COVID-19 is a respiratory illness.  Your employee breathing in a quantity of droplets from an infectious person, for example, is certainly an exposure that may lead to the development of the disease.  The now ubiquitous plexiglass shields erected in workplaces prevent some of that, but surfaces, tools, and containers may become inadvertently sources allowing a worker to transfer virus particles to their hands then to their eyes, nose or mouth.  Just because a barrier is in place does not mean all potential contact in the workplace has been eliminated; nor do the precautions you take eliminate the possible introduction of the virus into the workplace by other routes. 

Workers may also be exposed to the virus outside the workplace and not realize they have been exposed. Crowded spaces like transit, house parties, and shopping venues have been identified as places where the virus easily spreads.  An employee may be exposed in any of these settings, become infectious, and expose others at work. 

You employees may be exposed at work or in the course of their employment.  It is not uncommon for a worker, customer, or other person in the workplace (such as a delivery person, courier, student, service technician, inspector) to begin to feel symptoms while at work.  Infectious persons (possibly asymptomatic or pre-symptomatic) in “close contact” with workers or customers may inadvertently and unknowingly expose others in the workplace. Definitions of “close contact” vary but if you work within two meters (6 feet) of another worker, customer, or other person in the workplace for fifteen minutes or more, you would likely meet the definition in most jurisdictions. 

Not all exposures or close contacts with a person who is infectious will result in illness. With the knowledge that some people are asymptomatic or pre-symptomatic but infectious, we now know that exposures to this virus may be more common and less obvious than in the above example.   In many cases, the first sign that one of your workers was exposed will be when they report being ill.  Where they were infected may not be obvious.  Their safety and health are paramount but beyond that, investigating the source of the exposure and protecting workers and others in the workplace must be your priority.

A Workplace Scenario

As an employer, you are likely to encounter a case of COVID-19 in your workplace at some point.  Whether or not an employee becomes infected in the course or employment, you are going to have to determine who came in close contact with a source of the infection (an infectious customer or co-worker, contaminated surfaces or discarded tissues used by an infectious person) , which employees should be quarantined, and when the diagnosed and quarantined employees can return to work.  Acting quickly is critical to stopping the spread of the virus and limiting the impact on operations.

Consider this scenario:

Anna and her two other team members worked in close proximity Monday to Thursday.  They did their best to keep physically distanced, but the nature of their work meant working side by side for periods of time.  On Friday morning, Anna woke with a dry cough, headache and fever.  She called her manager’s line and left a message regarding her symptoms; she then called her doctor who told her to self-isolate and immediately referred her to testing.  On the following Monday morning her test results were received:  positive for COVID-19.  After receiving the diagnosis and instructions from her physician, she called her manager with the news.

As Anna’s employer, you will be concerned for her.  You will also have concerns for your other staff and your production.  While it may not be clear if Anna contracted the disease at work, you have a duty of care for your other employees who were in close contact with her and others who may have been exposed through the immediate operational space.


 

When can my employee return to work?

In the above scenario, Anna will be told to isolate and will not be returning to work for at least 10 days from symptom onset. Isolation prevents sick persons from spreading the disease to others, including family members.  Isolation means not going out for food or entertainment and definitely not to the workplace.

If Anna is well enough and can work from home while isolated, that may be an option; she can’t end her isolation until she is no longer infectious.  The infectious period begins two days before the onset of symptoms and extends for at least 10 days even if symptoms subside.  Beyond the 10 days, isolation is required until the worker is fever free for three days and all other symptoms are resolving. 

Even though the isolation period may have ended, workers like Anna may need more time to recover from other symptoms to return to work. For some occupations, another test may be necessary to confirm a worker is no longer infectious.  Although no longer infectious, many who recover from COVID-19 experience fatigue and other symptoms that may delay a full, safe, and durable return to work.  Your “duty to accommodate” a worker extends to such cases. 

What about close contacts?

Remember, Anna was likely infectious for the two days prior to symptom onset.  It is likely her team members were in close contact with her during that time.  Cleaners, supervisors and others who visited Anna’s work area may have been exposed.  Perhaps she met with her manager or another team concerning the next project.  None of those employees may report being ill (or ill yet). 

The sooner well employees are informed of their exposure, the better the chances of arresting the spread of the disease.  As a precaution, workers with close contact should be told to self-quarantine for fourteen days from the date of exposure.  Quarantine is a means of restricting the contact and movement of a person who has been exposed; it prevents the spread of disease to others.  The following concisely describes what Anna’s close contacts will be expected to do 14 days from last contact with her: 

  • stay at home and monitor yourself for symptoms, even just one mild symptom
  • avoid contact with other people to help prevent transmission of the virus prior to developing symptoms or at the earliest stage of illness
  • do your part to prevent the spread of disease by practicing physical distancing in your home

[see How to quarantine (self-isolate) at home when you may have been exposed to COVID-19 and have no symptoms, https://www.canada.ca/en/public-health/services/publications/diseases-conditions/coronavirus-disease-covid-19-how-to-self-isolate-home-exposed-no-symptoms.html]

Exactly how your enterprise will handle COVID-19 absence for those who must isolate or quarantine is up to you.  It may require amended sick-leave policies, new procedures for initiating quarantine, and even supports to enable quarantine to be effective.  Your quick action can prevent cascading exposures to other workers, their family members, and the broader community.  If Anna’s test results are negative for the COVID-19 virus, then her continued self-isolation and quarantine of her close contacts would not be necessary.

If informing employees waits until there is a positive test result, the implications may be more profound. The well employees may have returned to work on Monday morning but once Anna (or a public health contact tracer) makes you aware of the positive COVID-19 test, all employees having had close contact with Anna must quarantine for fourteen days following the last close contact.  The potential length of the quarantine does not change but the delay in starting their self-isolation raises the potential for Anna’s close contacts to unknowingly become infectious and infect others at work, home or in their community.    

In the scenario above, Anna experienced the first symptoms on Friday morning and got her test results on Monday.  That may be close to the ideal case.  Had she come to work ill, the potential for a wider exposure would expand.  The fact she stayed home and got her test result so quickly means she had limited contacts and the virus had limited opportunities to spread.  Co-workers with close contact would count their quarantined period from their last close contact.  Team member that worked with Anna on Wednesday or Thursday would count their quarantine date from their last close contact with Anna.  Hopefully, quarantined employees will not get sick but if they do, they will not spread the disease further.  Quarantined workers can return to work once the quarantine period expires if they are otherwise healthy and symptom free.

Can I leave identifying close contacts up to public health contact tracers?

Public health contact tracers have special training and knowledge to do their jobs but you, as an employer, have a duty to protect your workers.  As an employer, you have important information for contact tracers. You know your workplace and are in the best position rapidly identify close contacts.  Your attendance records, work schedules, employee contact information, building entry logs, and meeting minutes can help you rapidly identify close contacts and prevent wider exposure.

It may be that you as an employer will be contacted by public health with information that an infectious customer, technician or other person was at your workplace, raising the possibility of close contact exposure.   Your records of who was working with or serving that customer will be important to the contact tracer but also to your ability to fulfill your duty of care for your employees.  Remember, the faster exposures are identified, the sooner the spread of the virus can be halted; the impacts on your workers’ health and your operation’s production are limited the sooner you act.

Isn’t there an app for that?

Many countries and some employers are mandating or recommending smartphone apps or other technologies to facilitate contact tracing.  Korea, Singapore, the UK, Iceland, Norway and others have implemented programs with varying degrees of success.  The apps generally use Bluetooth technology to register either location and/or proximity to others with the app or tracking “token”.  If a person is identified as infected with COVID-19, the app can quickly identify others who may have had close contact during the infectious period. [see Ryan Brown, Why coronavirus contact-tracing apps aren’t yet the ‘game changer’ authorities hoped they’d be, CNBC, July 3, 2020].

These apps are not without controversy.  They only work well if widely enabled on many devices, so public acceptance (or government mandate) are required.  In Singapore, for example, temporary foreign workers are required to carry a tracking token and that interacts with the nationally mandated smartphone app (voluntary for citizens).  [see Saira Asher, Coronavirus: Why Singapore turned to wearable contact-tracing tech, BBC News, Singapore, 5 July 2020].  Not all smartphones are capable of handling contact tracing apps and those with greatest vulnerability such as lower income citizens and older individuals may not have access to the latest technology.      

Corporate apps are also available.  These may be adopted and mandate by a firm for employees but there are both privacy and efficacy issues.  Not everyone is OK with 24 hour a day GPS tracking by an employee or a government.  Questions about how data will be collected and used are often raised. 

Privacy issues aside, efficacy issues include the false positives of proximity.  Even if the app only measures proximity to another smartphone for a given period (say, 15 minutes), that may not mean any exposure has taken place.  Just because the agent renewing your insurance or the Uber driver were taking you to your appointment were close enough to register contact in a tracing app, the presence of a plexiglass shield  or divider will not be registered;  if either you or the other person is identified as infectious, the close contact warning would be a false positive.  The converse is also true; a missed close contact is like a false negative.  If an infectious person does not have the app or token (or the device is out of power or app not enabled), no close contact can be recorded.  Tracing apps cannot record proximity to environmental exposures and may yield a false sense of security.   These technologies cannot detect the virus; they only detect proximity (or location, in some cases).  

Take action now

Before COVID-19 hits your workplace, put your plans in place. Besides doing what is necessary to comply with OSHA and public health orders or guidance, you need to have a plan for what to do when an employee or public health identifies a COVID-19 exposure or transmission. Your plan may include containment and decontamination teams, but you will need to address policy issues like when and how to isolate, deep clean and disinfect the area concerned.  Your personnel plan for containment, informing close contacts, supporting quarantine, isolation and return-to-work is even more important.  The speed and thoroughness of your actions to stop the chain of transmission is essential to the safety and health of your employees and others in your workplace.  With that in mind:  

  1. Prepare: develop policies and procedures so staff know what to do if they feel ill and particularly if they are diagnosed with COVID-19.  Privacy laws and policies will vary so keep those in mind as you prepare.  Confidentiality is important and safeguards should be built into your policies and procedures. Involve staff and union representatives in your plan development. Consultation, addressing concerns, developing policies, and then training staff will challenging in the COVID-19 era but critical to your planning and preparation.   
  2. Update and keep current: Where people work, seating floor plans, travel records and entry/exit logs need to be accurate and immediately available when required.  Meetings may not always have minutes, but every meeting should have a record of attendees, location and times. Update employee contact information for home, mobile phone numbers, and email.
  3. Operationalize your plan:  Assign specific resources to manage suspected or known COVID-19 exposures.  Delays in identifying close contacts can result in wider spread within your operations and beyond.  Having key resources familiar with operations and records, knowledgeable of your policies and equipped with the commensurate authority to act will be necessary.  Be sure to build redundancy into your plan. Your plan needs to operate even if the specific resources become ill or unavailable.
  4. Consult, train, build awareness: Your operations depend on people.   The very steps necessary to limit the spread of COVID-19 and facilitate contact tracing need to be understood and concerns addressed in advance of any need.  Activity logs, attendance at meetings, entry and exit logs are necessary but concerns over why they are needed, how long they will be kept, who has access and the purposes allowed for that access need to be clear and understood.  Build awareness of your plans and why the procedures are needed to protect workers and others in the workplace.
  5. Build resilience:  For the near to medium term, COVID-19 is part of our reality.  Anticipating the consequences of exposures and close contacts in your workplace can mitigate against the greatest impacts and accelerate your ability to keep workers safe and restore operations.  Having your plans and resources in place, assigning and cross-training personnel, and testing your plans are essential to restoring and maintaining the health and safety of your employees and the success of your operations.

COVID-19 will be in our workplaces for some time—likely measured in years rather than months. Whether this or some other infectious disease, workplaces must adapt in ways to protect workers and others in the workplace.  

By Terry Bogyo

Terry is an active researcher, speaker and commentator on workers compensation issues. Now retired, he was the Director of Corporate Planning and Development for WorkSafeBC. His responsibilities included environmental scanning, strategic planning and inter-jurisdictional comparisons.

Terry says of himself: I am a student of workers' compensation systems. Many years ago I discovered two things about this area. First, workers' comp and OH&S are of vital importance to people. Protecting, caring for and providing compensation to workers are important, noble and morally responsible endeavors. The second thing I learned was that no matter how much I knew about workers' comp/OH&S, there was always so much more to learn. This is an endlessly challenging area of study. My purpose, therefore, is not to lecture, but to reflect on the ideas and issues that are topical in this area... and to invite others to share in a learning experience. By adding your knowledge and insights, others with similar interests can participate in the discovery and study of this important domain.


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