In early December, it was widely reported that the Centers for Disease Control and Prevention (CDC) had changed its guidance with regards to how long people should quarantine after being exposed to someone who has tested positive for – or is strongly suspected to have – COVID-19.
However, when you read the CDC's brief, the guidance hasn't changed at all. The agency still recommends a quarantine period of fourteen days and suggests options to reduce the period of quarantine to ten or seven days based on a combination of local circumstances, diagnostic testing, and symptom monitoring.
Nonetheless, because of the way in which the news was reported, many organizations and public health agencies have adopted ten-day quarantine policies in high-risk areas without the resources available to support diagnostic testing and symptom monitoring – potentially putting whole communities at risk of infection.
For businesses, the situation is exacerbated by many employees wanting to get back to work as soon as possible. While this might be good for productivity, the risk exists of more widespread infection among workforces, potentially disrupting business operations and leading to COVID-19 personal injury claims. So, how do businesses avoid bringing back exposed workers too soon?
The Reasons Behind the Revised Quarantine Guidance
The CDC's original fourteen-day guidance was based on an analysis of COVID-19 cases reported in early 2020. The analysis found that the median incubation period for the virus (the time between exposure and symptom onset) was five days, and that 97.5% of people who developed symptoms of COVID-19 did so within 11.5 days – although some did not develop symptoms until Day 16.
While the guidance is only guidance (local governments have the power to determine their own quarantine rules), fourteen-day quarantine policies were widely adopted. However, according to the CDC's December brief, this had the consequence of imposing “personal burdens that may affect physical and mental health as well as cause economic hardship that may reduce compliance”.
To address the issues and encourage compliance with quarantine guidance, the CDC now suggests two options to reduce the quarantine period from fourteen days to ten or seven days:
- Option 1: If the individual has been monitored for symptoms of COVID-19 – and no symptoms have been reported – quarantine can end after Day 10 provided symptom monitoring and mask wearing continues until Day 14 and the individual is counselled on mitigation strategies such as social distancing.
- Option 2: Quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring, provided symptom monitoring and mask wearing continues until Day 14 and the individual is counselled on mitigation strategies such as social distancing.
Although the options to reduce quarantine periods have been positively received as an acceptable balance, it is important to note diagnostic specimen tests have to be conducted forty-eight hours prior to the end of quarantine. In the case of Option 2, this means on Day 5 - which was the median incubation day in the CDC's original analysis, implying half of active cases could be missed.
What Could Possibly Go Wrong?
It didn't take long for the “balancing act” to go wrong. On November 30th, Santa Clara County announced a mandatory fourteen-day quarantine for people entering the region from more than 150 miles away. Three days later, following the CDC's brief, the county changed its quarantine policy to ten days – despite not having the resources to conduct sufficient diagnostic specimen tests.
On the day the original fourteen-day quarantine was announced, the county reported 760 new cases of COVID-19, 239 COVID-related hospitalizations, and 71 patients in intensive care units. Two weeks after the revised quarantine policy was announced, the county reported 1,668 new cases of COVID-19, 608 COVID-related hospitalizations, and 85 patients in intensive care units.
It is not automatically the case the 120% increase in infections and 155% increase in hospitalizations are attributable to a reduction in the quarantine period, it is likely to have been a contributory factor. Quite possibly there is also a misunderstanding about how long a person remains infectious after symptom onset (hint: it is typically longer than 14 days from the date of exposure).
The Risk of Reducing Quarantine Periods for Businesses
While the CDC's two options may be suitable for accelerating a return to work, they have their risks. Compared to a median Post Quarantine Transmission Risk (PQTR) of 0.1% when employees have quarantined for fourteen days, Option 1 has a median PQTR of 1.4% and Option 2 a PQTR of 10.7% due to the high number of asymptomatic people who contract the virus but never display symptoms.
Therefore, before changing employee quarantining policies to account for the CDC's revised guidance, businesses should conduct a risk assessment to determine the consequences of requiring employees to return to work four days earlier (14x enhanced risk of a workplace outbreak) or seven days earlier (107x enhanced risk) - notwithstanding different virus variants act in different ways.
The risk assessments should take into account factors such as local transmission rates, the measures put in place to mitigate workplace transmission of the virus, and the cost of employees being absent for four or seven days longer compared to the potential cost to the business if an employee who has been exposed to the virus returns to work while they are still infectious.
The Benefit of Reducing Quarantine Periods for Employees
The motive behind the CDC suggesting options to reduce quarantine periods in order to increase compliance with quarantine guidance is flawed. Research conducted in April 2020 found that the majority of people are complying with lockdown and quarantine orders despite “the personal costs of compliance” such as the impact on personal income, employment, and social relationships.
While it is true the research was conducted fairly early into the pandemic - and prior to the emergence of pandemic fatigue - it is also true that people are becoming more accustomed to self-quarantining, that contact tracing agencies are monitoring for compliance, and that options exist for “involuntary quarantining” when individuals are considered to be a threat to the community.
However, it has become apparent that during the pandemic the nation´s mental health has suffered. Prior to the pandemic, one-in-five adults reported having a mental health issue, while in July 2020 the CDC reported two-in-five adults report struggling with mental health or substance use. According to one survey, 63% of people have more difficulty concentrating than before the pandemic started.
The statistic relating to concentration is a major concern for businesses, who won't want employees returning to work with concentration issues. However, an article published in The Lancet suggests people who quarantine for ten days or fewer suffer lower levels of distress than those who quarantined for more than ten days. Therefore, it can be in the best interests of both businesses and employees to adopt ten-day quarantine policies - provided the return to work is managed safely.
Using Technology to Manage a Safe Return to Work
In addition to recommending the shortest necessary quarantine period, the Lancet article provides five further key messages about reducing the psychological impact of quarantine. Although the messages are targeted at public health officials, they are equally applicable to businesses wanting to safely bring back employees who have been exposed to the COVID-19 virus:
#1 Information is key; people who are quarantined need to understand the situation
Due to the volume of misinformation circulating about COVID-19, it is not only important employees receive accurate information, but also that it comes from a credible source. According to the 2020 Edelman Trust Barometer, employers (76%) are considered more trustworthy than the government (49%) or mainstream media (49%), and therefore COVID-related information communicated by an employer is more likely to be believed.
While it is not necessary to go to the extremes some businesses have (i.e., bringing doctors in on team calls to explain how the virus spreads), it is important that quarantine policies and return to work protocols are clearly explained to all employees so they have reasonable expectations about the length of quarantine, the conditions that have to be fulfilled to reduce the length of quarantine, and the measures they will be expected to comply with on their return.
#2 Effective and rapid communication is essential
Communicating consistent messages to all employees simultaneously can be difficult when some employees are on-premises and others are working from home or self-quarantining - or when some employees have access to the Internet and other don't. Consequently, the method used for communicating COVID-related information is also important in order for it to be effective.
In almost use cases, the most effective method of communication is SMS texting as everybody is familiar with how SMS texting works, no Internet connection is required to send or receive an SMS text, and SMS texting supports two-way communication. For businesses, the quickest way to send SMS texts to large groups of employees is via a mass SMS texting platform such as Rave Alert.
#3 Supplies need to be provided
While this key message is more relevant to public health agencies (in terms of general and medical supplies), it is important businesses provide hand washing facilities, hand sanitizer, and face masks to mitigate the risk of transmission in the workplace. Employees should be informed these supplies exist, and guidance should be provided on how often hands should be sanitized (CDC guidance can be found here) and how frequently masks should be changed (daily according to the WHO).
Two capabilities of the Rave Alert platform can help promote COVID safety in the workplace – message scheduling and database segmentation. Using these capabilities, businesses can send periodic reminders to employees to sanitize their hands and schedule the reminders for different groups of employees at different times in order to prevent large groups of employees visiting sanitation stations simultaneously in breach of social distancing best practices.
#4 and #5 Encouragement is better than enforcement
The fourth and fifth key messages share a common theme. #4 states “most adverse effects come from the imposition of a restriction of liberty; voluntary quarantine is associated with less distress and fewer long-term complications”; while #5 states “[public health officials] should emphasize the altruistic choice of self-isolating” - the common theme being encouragement is better than enforcement; but, for this to happen, the issue of presenteeism may need to be addressed.
In “normal times”, presenteeism – or employees coming to work when they are sick – is tolerated by many businesses because it shows a certain level of dedication and reduces the management headache of covering absences. During the COVID pandemic however, there should be no circumstances in which presenteeism is tolerated because a sick employee may well transmit their illness to other members of the workforce and cause more significant disruption in the long term.
Not only should businesses advise employees of a zero-tolerance presenteeism policy and encourage them to self-isolate for the general good when they have been exposed to someone who has tested positive for – or is strongly suspected to have – COVID-19, but they should also conduct proactive wellness checks on employees. Ideally, the wellness checks should be conducted before the start of the working day and away from the workplace, rather than “at the factory gate”.
With Rave Alert's geo-polling capabilities, remote wellness checks can consist of a simple SMS text message in a Q&A format which employees respond to by pressing a key on their mobile device.
Watch: Geo-poll in Action
An example of how this might work is:
A text message is sent an hour before a shift is due to start asking if the recipients have been exposed to someone who has tested positive for the virus or are experiencing any symptoms of the virus. Sample answers might include –
Press #1 for “As far as I know, I have not been exposed to COVID-19 and have no symptoms”
Press #2 for “Someone in my household has tested positive for COVID-19 but I have no symptoms”
Press #3 for “I don´t think I have been exposed to COVID-19, but I have a headache and fever”
Press #4 for “My partner is waiting for the results of a test after being exposed. I have no symptoms”
The platform records every response (and every non-response) and can be configured to send secondary messages according to how recipients have responded to the initial Q&A. Depending on the results of the business's risk assessment and any subsequent policy changes, the secondary messages may be:
Message to employees responding #1: Glad to hear it. Look forward to seeing you later.
Message to employees responding #2: Please start a period of self-isolation. We´ll be in touch.
Message to employees responding #3: Please organize a test. Do not come to work.
Message to employees responding #4: Do not come to work until the results of the test are known
Further Use Cases for Rave Alert's Geo-Polling Capability
The geo-polling capability of the Rave Alert platform not only helps with addressing the issue of presenteeism. Once employees have been advised to refrain from coming to work until the results of a test are known or until a period of self-quarantine is finished, businesses can keep in touch via the geo-polling capability in order to support quarantine compliance and symptom monitoring – possibly enabling employees to take advantage of the CDC´s options for an early return to work.
While affected employees are away from the workplace, businesses can also use the geo-polling capability to cover absences. This will involve sending a geo-poll to the group of employees most capable of covering a sick colleague's duties (once again making use of the database segmentation capability); and - to prevent responses continuing after the absences have been covered – the geo-poll can be configured to automatically close once sufficient positive responses have been received.