When can we reopen our office? An epidemiologist’s simple, evidence-based framework

Despite the high-profile instances of companies adopting indefinite work from home policies, in-person or blended offices are the future for almost every company. Over 70 percent of employees report being eager to return to the office. Yet workplace safety leaders tasked with chartering their organizations’ return to the physical office face a sea of uncertainty.

We’ve seen companies set office reopening targets ranging from as early as fall 2020 to as late as fall 2021, and many are moving to a permanent combination of remote and in-person workers. But what factors have gone into their decision-making and how are they preparing?

Decision makers must contend with an overload of information coupled with an environment of great uncertainty. Sources across government, academia, and the media share information that changes over time and frequently contradicts. And no singular source possesses the combination of expertise in public health, office design, and business processes that inform workplace safety decisions. Further, unlike retail businesses such as restaurants, barbershops, and hair salons, state and local governments have largely left the decision on when and how to reopen up to individual commercial businesses and their Physical Security, HR, Facility, and Executive teams.

I created Workplace 2030 as a not-for-profit initiative to gather expert voices across the scientific and workplace services and technology disciplines. Together, these experts can answer the questions employers are asking as they navigate the future of the office with the threat of COVID-19 and beyond. Not just for the next 12 months, but for the next 10 years.

How do employers know when they can safely reopen offices? Should they rely on publicly available statistics, milestones, or other guidelines from the federal or local government? And what capabilities do they need to have in place before employees return?

In consultation with epidemiologist Maureen Miller, PhD, we’ve developed a framework to inform employers’ decision-making as they work to evaluate and minimize the risks of returning to the office during the COVID-19 pandemic.

The COVID-19 pandemic will continue until the widespread availability of a safe and effective vaccine. Outbreaks flare up unpredictably. The pandemic requires frequent local monitoring. The framework developed here, along with the tools to understand the local situation, will help business leaders make transparent and data-driven decisions to safely bring employees back to the office.

In addition to this framework, the federal government and other nation-wide authorities have released guidelines that employers should be familiar with. The center for disease control (CDC) has detailed guidance for workplace safety, and OSHA has produced guidance for a wide range of industries as well.

“People want to get back to work. People want to get back to normal. They’re missing the office and the social connection and serendipitous interactions you get.”

- Dr. Maureen Miller

Evaluating the safety of office reopening

The first step in putting a timeline to office reopening is evaluating the level of COVID-19 risk in the communities where offices operate. An important concept in considering overall risk is the catchment area that includes the counties where office employees live. That includes all employees who will be working in the office setting, from the CEO to the cleaning staff. Organizations should know the level of COVID-19 infection in all counties where employees commute from to gauge the safety of office reopening.

“Because it has gone in waves, you need to evaluate the catchment area of all employees who are expected to commute to work. That’s where you need to evaluate. You have to be aware of where all your employees are coming from.”

- Dr. Maureen Miller

To help you think like an epidemiologist, we’ve broken this evaluation into three categories: metrics, milestones, and monitoring.

Risk Metrics

There’s no one-size standard for metrics that will indicate a safe reopening. Companies must combine different metrics around local case numbers, positivity rates from testing results, and healthcare capacity to get a more complete understanding of risk levels for employees.

The COVID Risk Levels Dashboard produced by researchers at Harvard is a good starting place. This dashboard provides a risk level of red, orange, yellow, or green for every county in the US based on a 7-day average of cases per 100,000 population. According to the scientists who created the Dashboard, Green is on track for containment (<1/100,000), Yellow indicates community spread (1–9/100,000), Orange indicates accelerated spread (10–24/100,000), and Red is the tipping point at which stay at home orders are necessary (25/100,000). Offices with catchment areas including counties with a red risk rating should not open, period. If all counties in an office’s catchment area are green, an organization can move forward with an office reopening. Yellow and orange risk levels must be understood in the context of other metrics before offices can open.

A 14-day decline in new cases is another bar to clear before opening offices. It cannot be a stamp of approval on its own, however. A county with a 14-day decline in cases but a red risk level would still have a caseload that is too high to safely reopen offices. Regions with a yellow or orange risk level but experiencing a 14-day decline in cases could be considered safe for opening offices, alongside careful evaluation of other metrics, particularly positivity rates.

Positivity rate, or the percentage of COVID-19 tests that come back positive, is another metric to consider. The Johns Hopkins Dashboard provides State level positivity rates on a 7-day moving average. In accordance with World Health Organization recommendations, employers should look for a positivity rate below five percent. This figure should be used to contextualize county level data, since a single state can contain all four risk levels. Additionally, this figure can be imperfect as a result of declining testing frequency, availability, and supply chain disruption.

Hospital capacity is another critical measure to evaluate employee safety. The US Department of Health & Human Services (HHS) tracks current usage of hospital beds for COVID patients. The Institute for Health Metrics and Evaluation (IHME) provides forward-looking estimates of hospital resource availability for additional context. Workplaces should only be opened when hospitals in the catchment area have available capacity to treat severe COVID-19 patients. Employers may be able to supplement state-level hospital data with local data from media reports.

Milestones

Non-numeric milestones can influence organizations’ evaluation on whether it’s safe to welcome employees back to the office. Business leaders may look to changing safety standards for other sectors of public life, in coordination with the metrics mentioned above, to contribute to their own decision-making.

In person school reopenings for children — either full time or hybrid remote learning — should also be monitored. Although the decision to reopen schools has been politicized in certain areas of the country, at least some percent of students and staff are being regularly tested. Cases identified in school settings will reflect the presence and potentially the level of COVID-19 spread in the community.

Indoor dining could be a signal that employees might feel comfortable returning to the office, as long as other indicators point to yellow risk-level or lower. Other openings for indoor activities can also be viewed as votes of confidence for returning back to offices, again provided that other metrics indicate low risk.

Of course, reopenings in other areas of life should always be viewed in the context of the color-coded risk level of outbreak in the community. If an area with a red or orange risk level reopens indoor dining, this does not mean that employees can safely work in the office.

“Because so many concepts around opening are politicized, you need to look at openings and understand the context of the communities. Indoor dining is a big one for me. When I feel comfortable dining inside, I know it’s going to be safe. Given that hierarchical understanding that you have capacity for people should they be hospitalized, your caseload is going down, and you’re in a yellow [or green] zone, you could take indoor dining as a signal that it could be safe to open your office.”

— Dr. Maureen Miller

Monitor

We are still in the first ‘wave’ of the pandemic in the US as new outbreaks occur in areas previously apparently unaffected. The accelerated spread of COVID-19 to the Orange risk level is frequently found when public health mandates and safety measures are relaxed. It’s critical that all of these metrics and milestones are closely monitored for increases in any of the metrics. For example, rising case numbers or positive test rates could indicate to employers that they should prepare to send employees home if the trend continues. Similarly, government decisions to relax large scale social distancing mandates, by allowing potential super spreader events, such as concerts, local or professional sporting events, and political rallies should cause employers to be extra vigilant. Once the government starts lifting the foot off the brake, the case load doesn’t appear to go up immediately.

Keep in mind that the bulk of positive infection test results are likely to come weeks after initial COVID-19 transmission to event participants. If reopening some type of indoor space (e.g., restaurants, movie theaters) leads to an increase in transmission, the impact may not be seen in hospitals for four to ten weeks, since the people most likely to initially attend are the least likely to be at high risk for severe disease. Stay on top of local news and closely track relevant metrics in order to be able to respond quickly to high-risk developments.

In addition to relaxing social distancing mandates as described above, universal mask use is an extremely effective prevention tool in the fight against COVID-19. Areas where this behavior is not encouraged will likely experience extra levels of risk and infection. IHME also provides independent estimates for public health social distancing mandates and universal mask use at the state level for all of its metrics: cases, hospital utilization, and deaths.

COVID-19 outbreaks flare up unpredictably. The pandemic requires frequent local monitoring. These are the tools you’ll need.

Office safety prerequisites

Once employers have evaluated the catchment areas of their employees, they must take actions to prepare for employees to safely return. We’ve broken these actions down into three categories: physical and technological infrastructure, employee behavior, and cultural investments.

Physical and technological infrastructure

COVID-19 requires a fundamental change in how employees interact with the physical space of an office. Companies should design away as many transmission vectors as possible. Many of these design efforts are simple and involve common sense. Visual prompts, such as footsteps for desired spacing, can provide subtle yet effective cues. In order to further mitigate risk in the office environment, employers need to address ventilation, PPE, physical barriers, and cleaning. Perhaps most importantly, share information with employees about the how and why of the efforts you’re taking to protect them.

The following are required protections to have in place:

• Social distancing of a minimum of six feet in passing should be maintained at all times. The capacity of your office to accommodate social distancing should dictate the number of employees you allow to return. It may be necessary to limit attendance to certain teams that can benefit the most from being in the office, and/or stagger days of the week. Limit time in conference rooms, and always keep conference room doors open. Single-directional movement through shared spaces can help maintain social distancing. Where possible, open windows to allow the circulation of fresh air.

“When you put feet [icons] on the ground, people automatically gravitate to those markers. It’s a really low-cost and effective method to help with distancing. The safest elevator etiquette I’ve seen is four people in the four corners, facing the wall, with feet markings on the ground.”

- Dr. Maureen Miller

• There should be no indoor cafeteria for eating together in large groups. Employees should eat at their desks or outside if weather permits. If two employees need to eat in the same room, they can alternate eating times, with one wearing a mask while the other eats.
• Screen employees with temperature checks and more importantly, early symptom and risk questionnaires prior to entry, every day. These data can identify high-risk employees before symptoms occur.
• Use technology to establish contact tracing for all employees who enter the office. If someone tests positive, other employees should be notified and alerted as to whether they had close contact.

“I would feel safer going into the office if I knew my company was monitoring these things. If someone in an adjacent section was positive, I would want to know that. That’s just responsible. You can prevent transmissions with that.”

- Dr. Maureen Miller

• Enhanced office air filtration should feature a filter certified to the MERV 13 standard or above with an external air source. HEPA filters located by desks can serve as an additional line of defense. Office doors and windows should remain open. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) has detailed guidance on air filtration. Air purification, as opposed to simple filtration, is recommended as well.

“Locally based HEPA filters will pull COVID-19 out of the air. If my windows were sealed and the HVAC was not effective, I would want a HEPA filter right by my side.”

- Dr. Maureen Miller

• Physical barriers should be implemented in areas where employees cannot maintain social distancing. Barriers extend at least from the waist, up, i.e. from desks to the ceiling.

“Physical barriers, especially clear plexiglass, help. As long as there is a serious barrier, people can stand closer than six feet. That will block droplets and aerosolized particles. There are engineering studies that show how droplets and virus particles disperse, and they drop down.”

- Dr. Maureen Miller

• When possible, employers should use touchless technology, from elevator buttons to hand sanitizer stations to lighting. All surfaces that require touch should be cleaned after every use, with nearby supplies to ensure this action. This includes door handles, elevator buttons, printers, coffee machines, water coolers, refrigerators, etc.

“The messaging around washing your hands all of the time has fallen off. If you’re really good about social distancing and you’re all wearing masks, the risks around hard plastic and hard metal surfaces play a bigger role. You need to ensure that you have high-touch surfaces cleaned regularly.”

- Dr. Maureen Miller

Rapid tests are not currently available at a volume to enable workplace testing. Organizations should monitor the approval of saliva tests, which would make testing much more economical and easy to implement. Yale has developed a saliva test that has been granted an emergency use authorization by the Food and Drug Administration (FDA), which may set the stage for wider availability. Frequent testing can help make up for a lack of sensitivity by reducing the risk of false negatives. A false negative result occurs when someone infected with COVID-19 tests negative.

“Even though cheap tests aren’t as sensitive, if you do it on Monday and again on Thursday, chances are really good you can pick up if someone is positive. Once you can do frequent rapid testing, that’s a game changer. Once that level of testing occurs, then you can get back to normal.”

- Dr. Maureen Miller

Employee behavior

Employees should be instructed to follow specific steps as a condition of returning to the office.

The following are required actions for employees:

• Wear a face mask correctly at all times in the office, except when eating and drinking in designated areas.
• Complete a risk questionnaire including high-risk behavior and early symptoms questions every day. In addition to flagging high-risk situations, the questionnaire encourages employees to be thoughtful about their own exposures.
• Wash hands with soap as frequently as possible, and with hand sanitizer if soap and water are unavailable.
• Maintain social distance — a minimum of six feet.

Cultural commitments

Reopening offices safely can’t be done without the cooperation of everyone in the office. All members of the organization must commit to strictly following safety guidelines to assure their own safety, as well as the safety of their peers.

Organizations reopening their offices should embrace the following principles:

• Lead by example. Executives and others in leadership positions should know and follow safety policies. Employees must understand that there are no exceptions.
• Prioritize transparency. Show how you are calculating risk and explain why policies are important. Back up your policies with data.

“All of the data that’s available should be used and promoted to employees. They want to know what’s going on and why you’re doing what you’re doing. You want to tell people that you’re going to be evidence-based for their protection.”

- Dr. Maureen Miller

• Enforce rules. Violating policies equates to endangering the safety of coworkers. Companies should implement consequences for employees who ignore protocols.
• Be responsive to the local pandemic. Have plans in place when data indicators suggest an outbreak is occurring in the catchment area.

The steps outlined here are more than just a checklist of safety precautions. Employers have no choice but to rethink every element of how employees interact with their office space.

Reopening offices to employees is a concrete step in recovering from the worst of the COVID-19 pandemic, but the workplace has been permanently transformed — perhaps, eventually, for the better. Just as a large earthquake forces us to address seismic risks that were always there, COVID-19 has forced us to address the pandemic risk that has always been present.

In some ways it provides an opportunity to think deeply about how the nature of work has changed the last 20 year, and of course the last 6 month, and design a workplace that will not only keep employees safer, but also foster the kind of collaboration and flexibility that the modern worker now requires. These changes to the office environment and culture will continue to protect employees from illness well into the future, from preventing colds and flu to mitigating and potentially containing any future pandemic.