An Evidence-based (Non-hygiene Theater) Return to Work Plan

This Return to Work (RTW) plan assumes that COVID-19 risk can be managed given certain parameters, that many core operations benefit from in-person working, and that some activities and individuals benefit more than others from being in an office. The goal of this plan to reduce COVID-19 risk as much as is feasible, and then prioritize business operations where the benefits of in-person working outweigh the COVID-19 risk. Firms can gain competitive advantage by returning to work safely and effectively, while other organizations operate sub-optimally either in the office or entirely at home.

I’m sharing this plan not because I necessarily think firms ought to return to work, but rather because I’ve seen many firms’ RTW plans focus on hygiene theater (constant surface cleaning and hand sanitizing) that will certainly fail. This plan assumes that masks, distancing, and hand washing will all be used scrupulously, but that those measures are insufficient for groups working indoors for 4-8 hours per day. If your organization is doing RTW planning and is focused on sanitizing and social distancing, I hope you find the below helpful in steering the conversation in a safer and more realistic direction. That being said, even with the below measures, there will always be some risk to working in person. My goal is to create a system where the benefits of working together outweigh (but notably do not eliminate) the health risks.

Evidence-based Risk Reduction

The risk reduction side of the Return to Work plan is based on using probability to reduce risk of transmission to acceptable levels. The plan assumes that indoor, aerosol and droplet transmission are the primary modes of contagion with fomites being a distant third (summary of evidence). The Risk Reduction plan has three core components:

  1. If the infection rate is too high, risk reduction cannot work due to the combinatorial explosion created by multiplying the risk of each additional infected person (and their contacts). Thus the first element of the plan is to use Public Health Triggers, such that offices can only open when the regional caseload and positivity rate are below a certain threshold. 
  2. When caseloads are at low levels, then we can institute a closed Test and Trace system that tests all employees on a regular basis to identify and isolate infected outliers. We can identify all of their work contacts and get them tested immediately to contain outbreaks. 
  3. Once we have minimized the number of infected individuals entering the workplace, we will focus on Aerosol Mitigation and modify the environment to increase air ventilation and filtration to reduce any viral concentration. 

Using Public Health Triggers, Test and Trace, and Aerosol Mitigation, in addition to physical distancing, masks and surface cleaning, we will be able to Return to Work safely. 

Public Health Triggers

Use public health data to define risks and triggers to open and close offices as needed.           

  • Use microCovid calculator to estimate the risk.
    • Input State and County for epidemiological data.
    • Define Person Risks
      • Number of people in office
      • Risk profile (adjusting for frequent testing)
    • Define Activity Risks
      • Type of Interaction = One time
      • Ventilation = Indoor (although our ventilation will be much better than average)
      • Distance (will we enforce 6+ feet?)
      • Duration (full or half days)
      • Masks (none, cloth or surgical)
      • Volume of conversation = normal
    • Decide what the acceptable number of microCovids (1 in 1,000,000 chance of infection)
  • Run the calculator every Sunday night to decide if office is open or closed.
    • In less dynamic environments, run every 2 weeks.
Test and Trace

Create a closed test and trace system that tests each employee using a rapid test once per week, carefully monitor who enters the office to trace any contacts.

Test model

      • Rapid Antigen tests are currently available, locate providers close to office.
        • Example locations: SF, Austin
        • Large employers with health care providers on-site, may be able to acquire an antigen testing machine.
      • Once available shift to the new rapid, Abbott paper strip test, BinaxNOW for cost savings (approx $5).

Frequency

      • Use weekly negative tests prior to entry.
        • Daily testing would be ideal, but…
        • With antigen test, cost ($120) will be limiting constraint.
        • With paper test, the initial launch being through HCPs (this is stupid and will change eventually), time/convenience will be the limit.
        • Rotate the day each employee is to be tested to catch outbreaks earlier. 
          • Ie Melissa’s test day is Monday, Andrew’s is Tuesday, etc.
      • As soon as possible, shift to daily paper strip testing.
      • Consider pooled, daily PCR testing when SalivaDirect is available.
        • Especially good for regions with extremely low number of infections due to accuracy over antigen tests.

Tracing

    • Record office attendance AND weekly test results in a public spreadsheet.
    • As soon as any positive test, have all contacts get a PCR, not rapid antigen, test. 
      • PCR tests can identify pre-symptomatic individuals.
      • To make this fast/easy, create an office stockpile of at home PCR tests from these providers to use with infected employees and contacts. 
        • These providers turn around tests within 48 hours regardless of the public health situation in your area.
    • Isolate infected individuals for duration of infection and allow back in office following another negative PCR Test.
    • Isolate negative contacts for additional 7 days and an additional negative PCR test. 
Aerosol Mitigation

We need to shift our focus from surfaces to airborne transmission (long FAQ on aerosol transmission) by prioritizing increasing ventilation (indoor-outdoor air exchange) and filtration (physically removing particles from the air).

 

Ventilation

Filtration

    • Remove particles from the air by installing MERV-13+ rated filters in building HVAC systems.
    • Add portable HEPA filters for additional filtration 

Using Public Health Triggers, Test and Trace, and Aerosol Mitigation, we can dramatically reduce the risk of COVID-19 infection and transmission within our workplaces and begin to get our teams back into the workplace without the need to wait for a vaccine.

Critical Business Operations and Individual Optimization  

The other side of the Return to Work Plan is to focus on prioritizing those operations which drive our key metrics AND benefit most from being in-person, and those individuals who benefit most from being in in-person settings. By weighting individuals by time devoted to key operations and how they individually benefit from being in the office, we can create a schedule that drives business and human performance. 

Critical Business Operations

Some activities have significantly more impact on our key drivers than others, and a subset of those activities are greatly enhanced by being performed in-person. That subset of activities should be prioritized for scheduling in the office.

Key Metrics

    • Define metrics we care most about right now, activities that drive them and whether or not they are significantly more effective in-person. Template below:
    • Revenue
      • Activity X that drives revenue (list out all activities)
        • Significantly more effective in-person: Yes/No
    • Profitability
      • Activity Y that drives profitability
        • Significantly more effective in-person: Yes/No
    • Cash Flow
      • Activity Z that drives Cash Flow
        • Significantly more effective in-person: Yes/No
    • Create cadence of prioritized activities across multiple metrics and identify the people needed for those activities. 
Individual Optimization

Some individuals benefit dramatically more than others by being in an in-person environment and that should factor into when they are scheduled to come into the office. We should create an RTW Index that scores employees by their individual characteristics in addition to any critical business activities they’re involved in.

Early Career Employees 

      • High priority should be given to employees with less than 2 years of experience in the organization due to difficulties in acquiring skills, informal networks and culture in an entirely virtual environment.

Leaders 

      • Leaders can affect more individuals informally within a workplace and thus should be given some priority. 

Individuals with strong preference for working in an office 

      • Examine engagement survey data or conduct specific polling to identify individual variation in mental state and productivity should inform some prioritization of individuals who go into the office first.
      • High priority should be given to those with previously high levels of performance and engagement
      • Some priority should be given to those who state a preference

Example of how the index might be weighted: 

    • Early career (+5), previous high performance/engagement (+5) = +10 
    • Leader (+2), preference for working in person (+2) = +4 

Individuals can opt-out of working in-person for any reason and at any time. 

By prioritizing our key business operations and the individuals on our team that benefit from working in-person, we can dramatically improve business performance in ways that organizations that are less prepared and strategic cannot–putting us at a decisive advantage until normal working conditions return. 

An Evidence-based, Business-driven Return to Work Plan

This Return to Work Plan is context-dependent, flexible and focused on improving business performance during pandemic conditions. By focusing on the best evidence available, we can use Public Health Triggers, Test and Trace, and Aerosol Mitigation to dramatically curtail COVID-19 infection risk within the workplace. Once a safe environment has been created, we can shift our most Critical Business Operations to an in-person setting and use Individual Optimization to allow our employees who benefit most from the office setting to return. In choosing to follow the evidence, we can accelerate our business performance in ways that our competition cannot or will not, giving us a strategic advantage and our people the opportunity to succeed. 

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