At Work, Healthcare Starts with Testing

by RaeAnne Marsh

Healthcare is arguably the most popular of employee benefits. COVID-19 has made this an even higher priority — while at the same time adding to businesses’ challenges in providing it. And addressing the need to keep the workplace and the workforce healthy has put COVID-19 testing front and center in business operations even while information changes on a nearly daily basis.

Testing for COVID-19

Testing for COVID-19 remains a critical concern, even as our understanding of the virus increases. “There is no single ideal test for COVID-19,” says Jason Scalise, M.D., orthopedic surgeon and vice chairman at The CORE Institute, whose physicians and healthcare workers are on the front lines. “Diagnostic tests (e.g., the nasal swab) that detect the virus reveal only if the individual is currently harboring the virus. While antibody tests do not detect the presence of the virus itself, they can reveal if the individual has mounted an immune response to previous exposure.” It is that response which may impart a degree of protective immunity to the individual. Dr. Scalise emphasizes that it is still unclear to science what level of antibody response is truly protective — and that further research will be required. Regardless of the test results, however, social distancing and good hand hygiene should remain important for everyone.

Organizations looking to safely deploy their workforce may consider using a rapid antibody testing strategy to serially screen employees on an ongoing basis. As time goes on, knowledge of who may have acquired a layer of protection against COVID-19 will be very helpful, according to Dr. Scalise. Furthermore, this type of screening program can help filter who those with an antibody response who may be indicated for additional viral testing, and potentially isolate them from the workplace until diagnostic test results have returned.

Dr. Scalise points out this is a more practical yet still thorough approach for screening than frequent molecular tests whose results may not be available for 24 to 48 hours — and adds that this level of enhanced yet rapid screening can be an effective adjunct to other safety measures for businesses looking at instituting re-opening procedures.

COVID-19 Testing and Workplace Healthcare Programs

Businesses may rightfully be concerned also about liability and workers’ compensation. Programs like the COVID-19 Work Safety Program that Healthcare Solutions Centers offers may remove potential liability from human resources departments, which are often the ones directing employees regarding their medical issues. “This program directs all employees and family members (patients) who are feeling ill or have any symptoms of COVID-19 directly to HCS for a telehealth appointment,” explains Frances Ducar, founder and president of HCS. “HCS’s nurse practitioners are performing a telehealth appointment with these patients. Patients who have signs or symptoms of COVID-19 will be quarantined and directed to an HCS clinic for the nasopharyngeal swab to test for COVID-19. These patients will be placed under medical surveillance and treated by the nurse practitioner.”

HCS is working directly with Sonora Quest Laboratories for all the tests, and Ducar expresses appreciation at being able to administer the tests as needed. “We’re testing all the time,” she says. “We’re using a lot of swabs.”

Noting that the COVID-19 Work Safety Program follows CDC guidelines and was designed to assist HR so they would not need to handle medical issues, Ducar says, “Employees will only return to work when the nurse practitioner has cleared the employee to work and is safe.” She reports that the program was implemented on March 20th for all HCS’s clients and is working very well.

Following CDC-recommended protocols for testing, HCS administers the PCR NP swab to individuals who show symptoms of COVID-19 or who are known to have been exposed. Patients testing positive will be sent home for quarantine for 14 days, with medical surveillance by HCS. Once the patient is off quarantine and is asymptomatic, an HCS clinician may determine there is need for a follow-up IgM or IgG test before clearing them to return to work, such as if other members of their household had tested positive for the coronavirus.

The Rapid COVID-19 Antibody IgM and IgG tests are for those who are asymptomatic — and for those looking to return to work following a COVID-19 quarantine. With an IgM positive, the patient is immediately sent home from work and sent to an HCS clinic for a PCR test. With an IgG positive, the patient remains at (or returns to) work but is to leave work and call HCS if symptoms arrive. If both tests are positive, the patient is sent home immediately and sent for a PCR test; if both tests are negative, the patient remains at (or returns to) work.

HCS also uses the IgG Serology test, which detects antibodies in the blood that shows if the patients have had COVID-19. “All patients who have had a PCR-positive test will be sent for the IgG Serology test 60 days after their positive test to see if they have converted to IgG positive,” Ducar says.

HCS will keep data on all testing, and, as the provider, is responsible for all documentation with regards to returning employees back to work. Employees must have a return-to-work note sent to their email, or a photo of the note texted to them, and will be directed to give or send their note to their HR department. These RTW notes cannot be given in advance; employees must be placed on a telehealth appointment and cleared the same day the note is given.

AI and AR Post-COVID-19

Telehealth has made such inroads into medical care that is it considered mainstream. AdviNOW Medical, a local company founded in 2016, has developed new advances to this healthcare option that benefits patients and providers. Benefits are especially timely during this COVID-19 pandemic, but the company sees them advancing healthcare post-COVID.

AdviNOW’s artificial intelligence collects all the patient information and uses augmented reality to take measurements. This automation protects providers and patients from potential infection as the provider can complete a comprehensive examination without physical contact. The AI automates the patient experience by asking all of the questions that a doctor would need to diagnose and treat the patient. And the company’s augmented reality platform guides patients to take medical measurements with medical precision to give the provider the images and sounds required for the visit.

Significantly, the automation that enables the low touch/no-touch medical visit also helps doctors spend more quality time with patients, as the AI does all the documentation that would usually take two-thirds of the doctor’s time.

The system automates COVID-19 response by integrating telemedicine into the traditional clinic at a level that removes the location of care as a requirement for diagnosing and treating the patient. The system includes automated triage; virtual visits; and COVID-19-routed guidance to testing, AI-driven decision making, and prescriptions and directions to appropriate testing facilities if applicable. Seventy percent of the EMR documentation is completed upfront.

Looking beyond the now to also a post-COVID world, AdviNOW Medical uses both AI and AR in offering what is now the only end-to-end automated healthcare system in the world that enables medical visits to be done from anywhere with the similar efficacy and billing level as in-person visits.

COVID-19 Testing Protocol

Healthcare Solutions Centers’ COVID-19 protocol complies with CDC recommendations, taking them a step further by actually administering the PCR test at all “recommended” points:

  • If employee tested positive for COVID-19, they should remain under home isolation precautions for 14 days from specimen collection OR until 72 hours after all symptoms of infection resolve without medications.
  • If employee tested negative for COVID-19 and have compatible symptoms with COVID-19, they should stay home and away from others until 72 hours after all symptoms of infection resolve without medications.
  • If employee has a fever, cough or shortness of breath and has not been tested for COVID-19, try to get the employee PCR tested. They should stay home and away from others until 72 hours after all symptoms of infection resolve without medications.
  • If employee has other symptoms that do not meet COVID-19 criteria and have not been tested for COVID-19, try to get them PCR tested. They should stay home until 24 hours after all symptoms are gone without the use of medicine.
  • If employee has travelled and has any symptoms of COVID-19, try to get them PCR tested. If negative PCR test, have them self-quarantine until 72 hours after all symptoms of infection resolve without medications. If positive, self-quarantine for 14 day. [HCS will stay in touch with the patient to monitor and treat their symptoms until they resolve.]
  • If employee has traveled and has NO symptoms of COVID-19, employee “meets” with an HCS clinician for a telehealth appointment to be cleared to return to work. [This is often on a Sunday, Ducar explains; employees traveling over a weekend will inform HCS prior to travel and schedule the telehealth appointment in time for them to return to work on Monday.]
  • If employee has travelled from NY, NJ or CT and has NO symptoms of COVID19, offer them PCR testing or 14-day quarantine. Negative: okay to go back to work. Positive: 14-day quarantine.
  • If employee has been exposed to someone positive with COVID-19 without symptoms, try to get PCR tested. Use the IgM and IgG rapid COVID antibody test kits ONLY if employee is asymptomatic.

COVID-19 is a dynamic topic, with information and guidelines — notably, travel advisories — changing frequently as knowledge and critical situations change.

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