Connect the DOTS for Covid-19 workforce risk
Your business continuity plan did not foresee the true impact on the workforce of a pandemic. Now what? Leaders of businesses and other entities that continue to operate through the pandemic must take charge now with a tactical plan of attack to protect the workforce while also maintaining productivity. To manage Covid-19 workforce risks:
- Consult and use authoritative guidance from national, state and provincial, and local public health authorities
- Employ that guidance within our DOTS framework to develop and execute a tactical plan of attack
Which organizations can use the DOTS decision framework?
This framework is for non-healthcare organizations. Healthcare organizations, including nursing homes, urgent care centers, doctors’ offices, hospitals and others have detailed procedures to protect their employees that go well beyond this framework.
Build and execute a tactical plan of attack
When in a crisis and plans that work on paper no longer fit the situation and good information is in short supply, business leaders, risk managers, human resources managers, and business continuity managers can feel like they are grasping at straws. Since the crisis is already here, and we are beyond the planning stage, it is time to lead with a tactical plan of attack.
Building and executing a tactical plan of attack means that decisions will be made as events unfold, and many of those decisions will be made with incomplete information. Decisions that made sense last month, last week, or last year, will be the wrong decision today.
First, employers should refer to official guidance from national or local governments and health authorities. For example In the U.S., OSHA has published guidance for managing Covid-19 workforce risk, and in the UK, Public Health England has published guidance. Guidance from public health and safety authorities is the most authoritative available to employers. However, employers will face decisions that are not addressed directly by the guidance, and in some cases the guidance is very general.
The DOTS decision framework can help in executing the guidance provided by public health authorities and experts and provides a tool for good decision making in the management of workforce risk.
R and the DOTS — the Covid-19 decision framework
Many people have now heard public health experts mention R – the reproductivity rate of contagion. According to Adam Kucharski, author of the book The Rules of Contagion: Why Things Spread and Why They Stop, R is calculated by multiplying four factors – the DOTS:
R = Duration x Opportunity x Transmissibility x Susceptibility
If R for a contagious disease equals one, then on average one infected person passes the disease to one other person. For Covid-19, R in the general population with no steps taken for social distancing and hygiene is 2.8. Public health officials focus on driving down R below 1 so that they can gain control over an epidemic.
Taking their lead from public health officials, business decision makers can drive R down in the workforce to protect employees and maintain productivity. Use the DOTS, duration, opportunity, transmissibility, and susceptibility, to create a tactical plan of attack for managing Covid-19 workforce risks.
Duration (D) – A comprehensive study in China’s Shenzhen province of 391 confirmed cases and 1286 of their close contacts indicates that infected people either recover or die within about a month of symptom onset.[i] So, for planning purposes, 30 days is a good number for duration of time that someone who is confirmed to be infected will be out of the office. Keep in mind that 30 days is a median; younger employees, particularly those younger than 40, may be back to work in as little as 14 days. Older employees, particularly those nearing retirement age, may not be back to work for six weeks. It’s best to assume that if someone has symptoms and has tested positive, they are infectious.
Opportunity (O) – This is a measure of the number of people that an infected person is in contact with for each day they are infected. The sooner an infected person is identified and isolated, the lower the opportunity. Some people have more contacts than others, and in the Shenzhen study, 8.9% of primary cases led to 80% of the infections among contacts.
Transmissibility (T) – This is a measure of the probability that the virus will get from one person to another during a contact.
Susceptibility (S) – If the virus gets across during contact, this measures the probability that the person receiving the virus will become infected.
Applying DOTS as a decision framework
Each enterprise will be different and as you develop your own DOTS plan, it is important to refer to authoritative guidance from public health authorities. Here are some thoughts and examples on how to apply DOTS in your organization:
Duration – Assess the contagion risk for each employee
While this factor may seem out of your control, it’s not. Understanding duration can help you to protect your most vulnerable employees.
The longer the duration of illness of employees with Covid-19, the greater the negative impact on productivity. The aggregate duration for all people in your organization, or total person-hours of work that could be missed, can be reduced by understanding the variance of duration among employees.
Duration varies by age and medical condition. Younger employees are likely to have less severe symptoms and to miss less work than older employees. Employees with serious underlying conditions such as diabetes and heart disease will take longer on average to recover and have more serious symptoms than those without. By understanding the average duration of illness and the seriousness of symptoms for employees, you can construct a workforce risk register. The rest of the plan can be designed to protect all employee, but also provide additional protection for those who are most at risk.
Create a workforce risk register. Start with a list of employees and their ages. Then as a rough planning guideline, start with two weeks as the baseline for time missed by each infected employee, add one week for employees over 40, add another week for those over 50, and add two weeks for employees with underlying medical conditions.
Mitigate future legal liability. Privacy rules mean that you may not know of the medical conditions of some employees, but, in general, direct supervisors will know. However, being certain that you have identified all employees with underlying conditions will require asking them. This may put your business at risk of violating health privacy rules and could also provide a basis for future employee discrimination complaints. Since often laws and regulations have exceptions for the well-being of employees, you can consult legal counsel on ways to mitigate future liabilities.
If after consulting counsel, you decide in favor of ensuring extra protection of employees with underlying conditions, one way to mitigate future liability is to minimize the personal health information collected. After all, the DOTS framework is just a rough risk assessment anyway, and you do not need details. When collecting information directly from employees on underlying conditions, tell each employee you are doing so for their protection; let them know that sharing information is voluntary, and that you do not want details. You can simply give the employee a list of serious underlying conditions and ask if any of those apply. A simple yes or no will suffice. The employee does not need to share specifically which of the conditions are applicable.
Be careful not to record any details of underlying conditions in planning documents, since they would then fall under health privacy rules. A simple X under a column for underlying conditions will do. To maximize privacy protection, use pseudonymization by assigning a random number to each name, and use the random number as the identifier in the risk register and other planning documents. Keep the name and number key in a separate file folder and lock it.
Opportunity – Reduce the number of close contacts for employees
To reduce their numbers of contacts, many businesses are directing employees to work at home. In some cases, working at home all the time is not feasible. For those employees who must continue to work on-site or travel, other means of reducing opportunity must be applied.
Identify employees who normally have high numbers of close contacts. The people with the greatest oversight and management responsibility in the organization, the most senior executives, managers and supervisors, have high opportunity for contact with many people. Salespeople, cashiers, delivery and customer support workers and other customer-facing personnel will also have large opportunities for contact. The workstyles and interactions of all high opportunity people will have to change.
Reduce the number of contacts dramatically. Senior leaders, managers and supervisors, to the extent possible should work remotely from home. When not possible, they must avoid group and team in-person meetings. These meetings should be held over the phone or web-conferencing – even when in the office. When it is necessary to meet directly with their peers and team members, as few people in the room as possible is advised, and social distancing should be observed. Business dinners and luncheons with large groups and in crowded venues must be avoided.
Field sales and customer support personnel should do as much work as possible remotely and work-at-home when possible. If travel is a must, then those least at risk should do the travel. Workloads and clients may need to be shifted around.
Transmissibility – Social distancing is Key
The most obvious step to take for transmissibility is to prevent employees showing symptoms from coming to work. Ensure they contact their physician or, if there is one, call the official Covid-19 emergency number.
Establish and maintain social distancing. In the office, on the shop floor and in manufacturing plants, and in assembly areas, as much as possible, ensure social distancing. If possible, rearrange work and break areas. Restrict the number of people allowed in small spaces such as break areas, conference rooms or other meeting places. When employees unavoidably must work close to each other, consider wearing protective gear such as face masks and gloves.
Isolate employees who show symptoms. If they show signs at work, isolate them away from other workers – preferably in an otherwise unoccupied room. Provide them with a face mask to limit the spread to others. Cordon off their work area. Contact local health authorities and get advice on next steps.
Provide extra protection for employees in unavoidably high contact positions. For employees who must face customers daily such as delivery workers, in-store salespeople, and cashiers, social distancing should be practiced as much as feasible. For instance, one-meter to two-meter distance should be observed between people, and if it is unavoidably less, minimize the time that it is less. They may also wear face masks, which for employees with unavoidably high numbers of contacts, should they become infected, will help prevent them from passing it along.
Ensure employees understand and have materials for good hygiene and cleaning. Put up signs suggesting contactless payment and provide easy access to hand cleaning materials to both employees and customers. Provide surface cleaning materials and train employees to regularly clean surfaces that they, customers and others are likely to touch.
Train employees on social distancing, protecting themselves by avoiding touching their faces, how to properly wear the gloves and masks, and especially how to remove and dispose of them without getting contaminated.
Susceptibility – Shaping policy and practice
Studies in China and other countries have shown that older people and people with underlying medical conditions are more likely to become infected and develop severe symptoms requiring hospitalization that can lead to death. Certainly, there will be 80-year-olds that never get the disease, and there will be healthy 20-year-olds that succumb to it. However, with respect to Covid-19, the main factors in susceptibility are age and underlying conditions.
Older employees are more at risk of severe symptoms. What the age data enable us to do is to develop and refine estimates of relative risk that will affect the ability of the business to operate.
Employees with underlying medical conditions are also at higher risk of severe symptoms. In addition to age, employees with certain underlying medical conditions are at higher risk from Covid-19. According to the U.S. Centers for Disease Control,[iii] those conditions include:
- Chronic lung disease or moderate to severe asthma
- Heart disease with complications
- Immunocompromised, including cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
Prioritize the more at-risk employees. Having built a workforce risk table of employees, we know which employees, should they become infected, are more likely to have severe symptoms and therefore have prolonged absences. We can prioritize higher-at-risk employees for steps that are taken for social distancing and mitigation of opportunities of contact with infected people. For instance, if we implement a plan to have some employees work from home or in remote locations where office occupancy density is lower, we can give higher priority to the more at-risk employees. Or if we are going to minimize travel of sales or customer support personnel, we can prioritize reductions among employees who are more at risk of a serious case and a long absence.
Even when whole regions go into lock-down, many businesses and other entities must continue to operate. Managing Covid-19 risks to the workforce is essential for protection of employees and maintaining productivity. To manage Covid-19 workforce risks, consult and use authoritative guidance for national, state and provincial, and local public health authorities. Employ that guidance within the DOTS framework to develop and execute a tactical plan of attack.
Final Note – get more specific advice
Every company, every industry, and every geography is likely to have unique aspects to their challenges and opportunities. As a member of The Analyst Syndicate, I am committed to sharing my insights with you and your team. Like many of those reading this, my travel will be minimal for the next 2 to 3 months. I enjoy discussing important issues like workforce risks, and I have set aside time for complimentary initial assessment calls. Book a call with me on Calendly.
Additional resources from The Analyst Syndicate
I wish to thank my friends James Sundeen, MD, retired pathologist, and Gregory Gray, MD, Professor, Medicine, Global Health, and Environmental Health at Duke University for checking that I had the science right, or as right as possible in the current circumstances. Dr. Gray recently presented on the coronavirus threat and that can be viewed here: An Update: Emerging Respiratory Virus Threats.
I also wish to thank friends and colleagues at The Analyst Syndicate for their reviews and suggestions which immensely improved the final framework: Bruce Guptill, Tom Austin, Ken Weilerstein, Jim Hines, Bill Kirwin, and Jeff Vining.
[i] Bi, Qifang, Yongsheng Wu, Shujiang Mei, Chenfei Ye, Xuan Zou, Zhen Zhang, Xiaojian Liu, et al. “Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 Cases and 1,286 of Their Close Contacts.” Preprint. Infectious Diseases (except HIV/AIDS), March 4, 2020.
[ii] The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. “The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020.” China CDC Weekly, February 20, 2020.
[iii] CDC. “Coronavirus Disease 2019 (COVID-19).” Centers for Disease Control and Prevention, February 11, 2020. https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/people-at-higher-risk.html.