Covid-19 rates are unequivocally going up in the US as the rate of new cases per day is reaching almost 200,000 cases per day. By all observable metrics, this increase is not a function of simply positive cases in asymptomatic individuals. The number of both hospitalized individuals and ICU beds occupied due to the disease are at pandemic highs of 91,635 and 18,040 as of November 28. The number of patients on ventilators nationally is at a 5-month high at 6,152.
With airlines reporting the highest travel rates during the Thanksgiving holiday since the beginning of the pandemic, Covid-19 rates will invariably keep going up through the holiday season and the New Year. As Covid-19 rates are going higher, the likelihood of every business, school, or organization having constituents test positive for Covid-19 will increase.
Should they be doing anything differently during this critical time? Can they even prevent or limit potential cases?
Organizations have three pieces of ammunition to combat this deadly disease: monitoring, testing, and tracing. All three will be necessary and are complementary. A strong symptom monitor will prevent those will overt or subtle symptoms from going to workplace. A tracing program will alert certain individuals that they may be infected.
However, testing asymptomatic individuals and identifying those who are infected will prevent the most damage.
There are many benefits to a strong screening program for an organization. These programs may keep elite talent on the job such as professional athletes and top hedge fund teams. The testing may detect asymptomatic cases and avoid potential superspreader situations that can decimate a workplace or close a school. They may even save the life of vulnerable members of an organization. Secondarily, they may effectively increase productivity because employees will worry less about Covid-19 and feel safer in their environment. The programs may evoke more employee trust in management and hence fulfill employee retention.
Importantly, as the White House discovered the hard way, flawed testing programs can be more destructive perhaps than not having a testing program. To prevent a similar debacle, individuals and groups need to recognize the proper way to use a testing program and understand its limitations. They need to know that individuals only test positively at certain days after contracting the illness. On subsequent days after the test, a previously tested negative individual can become a superspreader. Finally, they need to know that a negative test does not preclude standard precautions of the Covid-19 era such as mask wearing and distancing.
The type of test, the frequency of the testing, and the proportion of individuals tested will determine the success of any program for Covid-19 screening. To be overly simplistic, the best test given most frequently to the most people will yield the best results. Therefore, organizations should understand that antigens tests are considerably worse than PCR-based tests. Testing a few individuals only once a month will yield more missed cases and potential outbreaks than testing the whole organization weekly. However, this more comprehensive approach may be not be possible with existing budgets.
Importantly, testing needs are not the same for all entities. Some organizations with large numbers of vulnerable population such as nursing homes may need to do exhaustive testing of its workforce and residents to prevent large numbers of fatalities within its system. In general, testing the most vulnerable populations is important but many organizations have already curtailed the interaction of these individuals with others. Consequently, the highest priority is now being given to current participants in the organization who are actively present and likely to be exposed to other members of the organization. Other entities may be able to test less frequently but still gain valuable information from the results that can prevent potentially destructive outbreaks.
A multiplicity of cost-savings maneuvers can be utilized to get the best bang for the testing buck. Pooled testing can be used in low prevalence areas to allow more individuals to be screened at a cheaper per person rate. Strategies around whom to test may also help an organization limit the damage of positive cases. Testing key irreplaceable individuals such as a vital decision-making manager or someone with unique technology or creative skills may limit the effect of Covid-19 cases. Testing someone frequently who interacts with a marquis client may be appropriate.
The timing and frequency of the testing is also important. The frequency should be determined by the prevalence of the disease in the local community and in the institution. If many cases are detected during a screening program, a more intensive program may be necessary. Testing after holidays, breaks, and travel may yield higher results of asymptomatic cases and provide valuable insight into the penetrance of a disease into the institution. Increasing randomness also allows better capture of all cases and the pervasiveness of the disease in the system. Individuals who interact with the most other people in the organization could be preferentially tested.
The risk of transmission is paramount to the need for testing. Workers in hot areas such as meatpacking plants with poor ventilation, diminished mask wearing and less capacity for distancing will have higher rates of transmission. Individuals working in louder areas will need to yell more and may aerosolize more.
Keeping track of the testing results and who has been tested is another issue. Organizations may want to stagger testing to different groups or locations during different times. Others may want to test half their workforce certain weeks and the other half in other weeks. These variable programs may be challenging to monitor. Fortunately, specialized software platforms have been created to keep track of such individual testing demands and these can be integrated into some existent symptom monitor platform that many organizations already use.
The era of screening for Covid-19 is here and necessary so that organizations can continue their missions. Earlier adoption and allocation of available of resources would be best served being deployed now so that there is still a viable entity to preserve when vaccines start mass rollout in the spring.