Faced with constantly shifting guidance from agencies and officials at every level, businesses are being asked to operate in a way that’s entirely unprecedented. Infection control for a business of almost any size used to be limited to basic hygiene, and now we all find ourselves becoming armchair experts in epidemiology.

Businesses need to be ready for almost any COVID-related eventuality and be able to pivot on a dime. Fortunately, there’s a group who has always had to operate this way: healthcare workers.

Business owners need to plan for their business the way healthcare workers plan for patients and infection control. This means treating everyone as both potentially infectious and potentially susceptible. It means developing protocols for all physical processes and training staff to implement them. It means using airflow to engineer airborne risk out of the physical space. It means adhering to physical distancing and navigating a confusing minefield of guidance, guidelines, recommendations, and regulations from the CDC, OSHA, and beyond.

The average business owner may be rightly overwhelmed, but this is the way healthcare workers think, plan, and operate under all circumstances, providing plenty for businesses to emulate as they develop their reopening plans.

Balancing adaptability with risk assessment 

First and foremost, businesses need a highly adaptable strategy that can flex up and down to match the course of the epidemic in their city or state. Currently, New York and California have seen an increase in the spread of the virus since initially reopening, and have begun to close again. Healthcare workers know that the road to our new normal is far from a straight shot, and stay ready to take steps in any direction at any time.

Businesses also need to recognise that risk cannot be eliminated, and determine what level of risk is tolerable in their context. Many large companies with nationwide footprints need multiple plans, each translating broad CDC and local health guidelines and predicting what epidemiologic shifts mean to their business. This takes sophistication, particularly when previously benign actions (such as the use of public transportation, elevators, and common bathrooms) now come with new risks.

Inside the office, new best practices are constantly emerging, from mask removal for telephone calls to a new trade in Perspex shields and sealed kiosks. COVID-19 may have even struck the death knell for the controversial yet ubiquitous open-office plan. There are no sacred cows in healthcare and the same must be said for the office environment.

Clinical settings take a “cohorting approach”, which has a lot of potential when it comes to office access, and is already being discussed for schools. In California, one recommendation is to consider a student cohort model, keeping and moving groups of students together as part of a comprehensive COVID-19 plan. If one person from a cohort is exposed or infected, the entire cohort can be isolated and tested, avoiding an entire school shutdown. Similar strategies can be applied to offices with staggered schedules, making contact tracing easier to do, and managing the impact when an employee is exposed or infected. Some businesses will require temperature checks, symptom reviews and even on-site testing and making that determination may require help.

Overall, businesses must maintain a “living” strategy with constant feedback and management that tracks the health of a workforce to prevent or detect infection, and control it when it inevitably happens. Staff must be engaged continuously, which for many businesses has become more difficult with the loss of easy touch points.

The reality is that many businesses are planning to return to the office without a full appreciation of the unique challenges they and their employees will face. Moving forward is not business as usual, and organizations will need to think of new and innovative solutions to problems that did not exist before this pandemic. Thinking, planning, and operating like healthcare workers is one place to start.

Farley Cleghorn, MD, is an epidemiologist and infectious disease expert with over 30 years' experience in international health development, research and program implementation. He holds an MD and MPH from Johns Hopkins University, and leads Palladium's Health practice. 

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