Businesses as well as other organisations are encountering challenges at the moment when it comes to adapting to Covid-19.

For example, businesses need to re-open but staff, customers and visitors need to be protected. You probably already have a good supply of PPE, plus information about how to control infection and clean areas.  You are OK for now, but this is only today, what about next week, next month? How will you know when your risks increase and you need to take different steps? Will you be able to notice a new source of infection in good time? This is where regular and methodical testing can help.

It is important to understand that testing can only help if it is effective, and that means being part of a concerted effort with a systematic plan.

Right now, it is a confusing topic and good advice is hard to find. Until the government offers specific guidelines, you need to use your common sense and do the best you can.

So, what practical steps can you take to manage testing in your organisation?

First of all, the best advice is still to ask staff to monitor symptoms and be aware of what additional risks each staff member may be exposed to.  For example, are they living in a communal environment like a house-share, are they part of a large family with most members working and using public transport, do they use public transport themselves to come to work? All of these will increase their risk. This doesn’t mean they shouldn’t come to work – it is simply something to be aware of and bear in mind when working out your testing plan.

There are a number of issues to consider when setting up a testing programme and you need to be very careful about some of the hidden implications. It is not simply a medical or clinical question; the personal privacy aspects are just as important.

When designing a testing programme ensure it is:

• Planned and documented
• Systematic (even if you are doing random checks, you need to make it clear who is tested, when and how)
• Actionable: you need to know what specific action you will take if certain results are found
• Follows Public Health England (PHE) guidelines and if possible is carried out under clinical supervision. The latter may not be possible, although many occupational health physicians can provide this as a service.

The testing programme must also avoid these pitfalls:

• Improvising/introducing the latest test available without considering the implications
• Testing must not lead to discrimination or the perception of discrimination
• Once the data is no longer needed it needs to be destroyed and the process documented
• Using tests that are not approved by the Medicines and Healthcare products Regulatory Agency (MHRA)
• Interpreting results to one’s own purposes
• Using a system where security of data cannot be guaranteed (e.g. Excel)

In addition, there are number of questions you need to ask when creating a testing programme:

• What type of information will you be collecting and what action will you follow if you found it? For example: Will it lead to more testing of a specific group? How will PPE use need to change? Will shift patterns or workflow etc. need to change?
• What other information will you need to record in order to give context to the testing? For example, this could be linked to risk factors like ethnicity or sharing a household with a person who is at higher risk.

Example questions, with possible answers, might be:

Why are you in isolation or being tested?

1. I have symptoms (go to symptoms checker)
2. I have tested positive but have no symptoms
3. Someone else in my household has symptoms
4. Some in my household tested positive but has no symptoms

If you have symptoms, did they start:

1. Less than 7 days ago
2. Between 7 and 14 days ago

• What type of test needs to be carried out in relation to any symptoms? Will tests need to be repeated and, if so, at what intervals?

• How will you manage repeated testing? How long is the information valid?

The timing of these questions and answers as well as the related test result is really important; each test is only effective for a very precise period. Test at the wrong time, and the results will lose their meaning. However, the combination of the test result in relation to timing of the symptoms is really meaningful. This is why it is important to capture these together.

All of these questions need to be asked and answered. Unfortunately, it is unlikely that your current system for recording HR data is ready for the challenge, so a new system of Covid-19 testing is needed.

By using a dedicated testing platform to manage the process, it will be much easier to track the results, know what actions to take, and ensure that everyone who needs to be tested is tested.

There are also some common myths that need to be busted.

• Don’t wait for test results to decide whether you should self-isolate; you should self-isolate as soon as you have symptoms.

• Previous infections do not always produce anti-bodies. For example, the entire Hungarian national swimming team testing positive for the virus. Later they offered their plasma to help others in recovery. However, to everybody’s surprise, none of them produced any antibodies. (source https://index.hu/sport/uszas/2020/07/08/koronavirus-fertozott_uszok_antitest_verplazma_testnevelesi_egyetem/)

• According to the WHO, the so called ‘Immunity Passports’ should not be encouraged; we simply do not know how long immunity lasts and it can create a false sense of security; (Source https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19)

There is some evidence that people with a BAME background may be at higher risk. This may mean that they need to be treated differently (for example, testing more regularly, or shorter intervals between tests), however it is essential that you avoid any form of discrimination.

So, how can you best manage this? My advice is to be open and transparent about why and how you want to manage the testing, and, if necessary, get some advice/training about sensitive communication with employees at risk.

You will also need to talk to your team about a) the reporting procedure if a member of staff is found to have Covid-19; b) how testing will change or increase if a customer or supplier reports they have Covid-19, and c) what actions will be taken if a test is positive.  These elements need to be considered and decided in advance of the testing programme commencing.

Finally, make sure that your testing programme does not conflict with UK employment law. This is a grey area at the moment since as an employer you have a duty of care, but how would you carry out that duty without good information? Again, specific advice, both on the legal and clinical aspects of a testing programme as well as clear and transparent action plans are the best way forward.