Employers are wrestling with workplace safety in the age of COVID-19. Dogged by issues of cost, access, logistics, and employee privacy, testing isn鈥檛 part of most back-to-work plans. Image via Reuters.

From nursing homes in New York and a landfill in Utah to Disney World and the Las Vegas Strip, employers are wrestling with workplace safety in the age of COVID-19 and making fraught calculations about how to safeguard both their businesses and their employees.

Mass testing, a critical tool to stem the virus鈥檚 spread, would appear an obvious solution.

But dogged by issues of cost鈥攄iagnostic tests start at around $100 each鈥攁ccess, logistics and employee privacy, tests aren鈥檛 part of most back-to-work plans. As health-care companies that work with employers in this capacity are fond of saying, there鈥檚 no silver bullet.

Another major deterrent is that COVID-19 tests only measure that point in time, notes Lauren Vela, senior director for the Pacific Business Group on Health, which represents large employers like Microsoft Corp. and Walmart Inc. If a worker is infected shortly after being tested, it wouldn鈥檛 show up but everyone would be falsely reassured by the negative result.

Testing is 鈥渘ot really available, feasible or easy, and it鈥檚 not a solution you can do for every employee, every day,鈥 Ms. Vela said.

So instead employers are favoring lower-cost, easier-to-implement interventions like temperature checks and symptom screening while also stocking up on masks, hand sanitizer, and cleaning wipes. While those measures help, asymptomatic individuals could still transmit the virus.

Image via Reuters.

Healthcare startup Buoy Health has been working with employers on COVID workplace issues. Only a few are taking an on-site testing approach.

鈥淭he cost of the test at scale is pretty prohibitive,鈥 Andrew Le, a physician and Buoy鈥檚 chief executive officer, said.

But at Walt Disney Co. theme parks, actors working the live shows are demanding screenings before they return.

Performers sing, dance, and hand things to each other, noted Kate Shindle, president of the Actors鈥 Equity Association, the union that represents cast members at Broadway shows and Disney鈥檚 Florida resorts.

鈥淭here鈥檚 a lot of people who can do their work when they鈥檙e wearing a mask and gloves. Our people can鈥檛 do that,鈥 Ms. Shindle said in an interview. 鈥淚t鈥檚 just very important to our membership, who otherwise is overwhelmingly eager to get back to work.鈥

In a June 24 letter to its unions in California, Disney said it doesn鈥檛 think testing is a good idea, citing a high rate of false negatives and concerns that it creates 鈥渁 false sense of security,鈥 among other factors. Instead, it鈥檚 focusing on physical distancing, wearing effective face coverings, hand washing and sanitization.

鈥楴OT IN CONTROL鈥
Intermountain Regional Landfill in Utah, located about an hour鈥檚 drive from Salt Lake City, has made a different calculation. Cases in the state have surged in recent weeks and an employee recently had to stay home for three days because of a potential exposure through a family member who ended up testing negative.

That was 鈥渘ot only cumbersome and a loss of productivity, but really frustrating to know we鈥檙e not in control of it,鈥 said Chief Financial Officer Adam Campbell.

Intermountain processes over four million pounds of waste a day and operations are easily disrupted even if only a few workers got sick. In the worst-case scenario, should infection hit all 15 employees and force a total work suspension, the business would face estimated losses of about $20,000 a day.

So Intermountain decided to test its workforce. It鈥檚 working with Atlas ID, a software company that had focused on employment verification systems before the pandemic, to work out how often to test and in which scenarios. It鈥檒l cost about $2,000 a round.

鈥淲e could be testing for years at a high level and never even touch just missing one day鈥檚 worth of having to divert our waste,鈥 Rob Richards, the landfill鈥檚 president and general manager, said.

INSURANCE HELP?
At nursing homes and assisted living facilities, which an analysis by the Foundation for Research on Equal Opportunity found account for 45% of virus deaths in the US, testing employees is mandatory for many. But the bill quickly adds up.

Len Russ owns Bayberry Care Center in New Rochelle, New York. His roughly 100 employees were tested twice a week for five weeks, at a cost of $20,000 a week. The screening did identify at least six sick employees, but Mr. Russ is still waiting to see how to cover the $100,000 tab. The lab that processed the tests will try billing employees鈥 insurance, though Russ said he doesn鈥檛 expect them to cover repeat testing.

Keene Valley Neighborhood House, an assisted living facility in upstate New York, has had success billing insurance, according to executive director Richard Rothstein. Yet employers are ultimately likely to bear these costs themselves through higher premiums.

The Centers for Disease Control and Prevention said on Friday that employers may use testing as part of a comprehensive approach to reducing the virus鈥檚 spread at work. But employers, many of whom are already facing massive losses from shutdowns, often find the cost doesn鈥檛 make sense. Antigen testing, which screens for active infections and provides rapid and cheap results, has promise but is only beginning to come to market.

Although antibody tests, which screen for past infections and are easier for labs to scale up, seemed like a solution, it isn鈥檛 clear what sort of immunity antibodies grant. And after the CDC said antibody tests shouldn鈥檛 be used in deciding to send people back to work, the Equal Employment Opportunity Commission issued a statement telling employers they can鈥檛 require the tests. Diagnostic tests for current infections are permitted.

Antigen testing, which screens for active infections and provides rapid and cheap results, has promise but is only beginning to come to market. Image via Reuters.

South of Los Angeles, EB Design builds decorative interiors for hotels and high-end restaurants, a group that was 鈥渂asically decimated鈥 during shutdowns, owner Eric Beneker said. He decided to test his 20 employees biweekly to ensure their safety, but couldn鈥檛 find information or resources on how to do it.

The company ended up booking appointments through facilities set up by local governments. It鈥檚 been time-consuming, though, as there were few open slots and long turnaround times. And they had to mislead the sites to get in because individuals have to be symptomatic to get tested.

鈥淚s it the honest thing to do?鈥 Mr. Beneker said. 鈥淧robably not, but we don鈥檛 have any other choice, and we鈥檙e not given any other choice.鈥

In May, two employees tested positive and EB Design closed down. The company paid a private lab to re-test everyone. It cost about $3,000 total, around 10% of the company鈥檚 payroll. It turned out neither had COVID-19. Could the company field that kind of bill regularly? 鈥淗ell no,鈥 Mr. Beneker said.

鈥淭he problem is we鈥檙e so far down the road here with reopening of the economy,鈥 he said. 鈥淲hile we鈥檙e trying, and we鈥檙e doing our best, we鈥檙e not getting the tools鈥 needed to help.

Logistical challenges abound鈥攔esults often take days or over a week to come in, supplies continue to be limited鈥攂ut privacy issues often weigh as heavily.

Suffolk Construction partners with Buoy Health on its workplace safety plan. A testing facility is available as needed, but the builder isn鈥檛 implementing mass screenings, executive vice-president Alex Hall said, citing privacy concerns and the limited usefulness of the results.

鈥淲e get it. There鈥檚 an element of Big Brother around this situation anyway,鈥 Mr. Hall said. 鈥淲e want to be mindful of how people are feeling.鈥

The battle is also playing out in Vegas, where cases have surged since casinos began reopening last month.

Managers, unions, and other business leaders created a program with a hospital to test workers at the convention center. But it isn鈥檛 mandatory, according to Bethany Khan, a spokesperson for the Culinary Workers Union Local 226, which represents casino employees.

While Caesars Entertainment Corp. has made testing mandatory after a worker died from the virus in June, others haven鈥檛. Ms. Khan said the union is pushing for regular testing and on Monday, it sued Harrah鈥檚 hotel, operated by Caesars, and MGM Resorts International鈥檚 Bellagio for not adequately protecting workers.

MGM said it鈥檚 working with health-care professionals to develop safety protocols, including mandatory testing for anyone with symptoms or exposure, as well as free ones for anyone who wants a test. 鈥淣othing is more important to us than the safety of everyone inside of our properties,鈥欌 the company said.

At a press conference last week, a bellman at The Signature at MGM Grand hotel spoke about falling ill in June.

鈥淚t was three months that we did social distancing, that we did lockdown in Las Vegas,鈥 Sixto Zermeno said. 鈥淚 go back to work, three days later I鈥檓 sick on the fourth day.鈥 鈥 Bloomberg