COVID-Free Workplace: Don't Let Perfect be the Enemy of Good

Employers, don't let perfect be the enemy of good when it comes to creating a COVID-free workplace.

• By Andrew Shulman
• Sep 24, 2020

When New York City became the pandemic’s epicenter, Mobile Health, a seven-facility occupational health provider, stepped up to provide mass N95 mask fit testing for FEMA, city hospitals, nursing homes, dentists, and other frontline workers. Once that emergency need subsided, focus immediately shifted to COVID-19 testing.  They moved from a time-tested, routine OSHA clearance procedure like respirator fit testing into a new arena where no one has operated before. Simply keeping up with testing options became a full-time job.

Months later, Mobile Health performs COVID-19 testing programs across the Northeast corridor. They have become a resource for employers struggling to understand differences in testing options. In crafting testing solutions for clients, the challenge is not only to stay abreast of testing advancements, but also to balance that information with product available in the marketplace.

COVID-19 Testing Conundrum

Every employer wants a rapid, on-the-spot, highly reliable COVID-19 test. In reality, however, those requirements don’t neatly align. This reflects the ‘iron triangle’ business maxim: You can choose two: cheap, fast or quality. Consequently, we help employers assess priorities in terms of test quality, cost, and speed of results, and suggest a solution. For example, a large school district may have vastly different testing priorities than a three-day television shoot.

For clients focused on quality, the PCR molecular swab test provides the highest sensitivity and specificity. However, lab based PCR tests can require 10 to 12 days for processing following receipt of samples. To solve this, we partner with smaller labs to reduce that turnaround, but the cost still ranges from $100 to $200 per test. Consequently, PCR testing may prove prohibitive for many employers.

On the other hand, employers focused on cost and/or speed should consider Point of Care antigen testing. Antigen testing has a lower sensitivity than PCR but delivers rapid results, often in under 15 minutes. We can test about 30 individuals per hour per antigen machine, at a much lower cost than PCR tests. A good compromise for that large school district would be to offer antigen testing, followed by a confirmation PCR test for anyone testing positive.

Finally, pooled PCR testing—mixing several samples into a ‘pooled’ sample, then testing that sample with a diagnostic test– is a viable solution for many clients, including that 3-day TV shoot. Pooled testing provides the same quality of PCR testing while lowering the cost. However, there is still a 24 to 72-hour wait for results.

Gambling on Test Investments

Adding complexity, one must ensure we can procure tests during this period of extremely high demand. Mobile Health had the foresight to invest in antigen testing equipment early on. Currently they are waiting for delivery of on-the-spot PCR tests. These testing investments have been a gamble. While Mobile Health strives to provide a wide array of testing options, how do they know a new and better test won’t arrive tomorrow, becoming the new gold standard? We live in an interesting and highly challenging environment.

Ultimately, you have to make calculated decisions, knowing you may suffer a loss later.

At the end of the day, the mantra guiding decisions is this: Don’t let perfect be the enemy of the good. That is, understand you can’t check all the boxes. An employer who opts for COVID-19 antigen testing might miss some positive cases, but this outcome is better than missing one hundred percent of cases in the absence of any testing.

To companies considering testing, weigh your options and institute a testing strategy that makes sense for your organization. Don’t waffle or wait.