With the delta variant surging, a growing number of employers are tiring of merely cajoling workers to get vaccinated against covid-19 and are following President Joe Biden鈥檚 protocol for federal workers: Either show proof of vaccination, or mask up and get regular testing if you want to work on-site.
鈥 the nation鈥檚 largest employer 鈥 unvaccinated employees to wear masks while working, get regular testing and take other precautions, like maintaining physical distance from co-workers and restricting work travel. Several states, including California, Hawaii, and Washington, also say unvaccinated state workers must get regular tests.
On Wednesday, California Gov. Gavin Newsom broadly extended such a to teachers and all school employees, the first state to do so.
Those programs, with their testing alternative, differ from outright mandates to get vaccinated, 鈥 including the of the Department of Health and Human Services, hospitals and the 鈥 are requiring.
Employers, fearing a backlash, frame the policy as a choice, with both sides of the equation seen as effective in reducing the spread of covid. Do public health experts think this approach will help?
All agreed the best solution is universal vaccination. Short of that, many said, the moves by employers will add a layer of protection 鈥 although how much remains to be seen.
Test results are 鈥渞eally only a snapshot in time,鈥 said Dr. Gigi Kwik Gronvall, an associate professor at Johns Hopkins鈥 Bloomberg School of Public Health. Even testing every day, as was the standard in the 鈥 without other measures like masking 鈥 didn鈥檛 prevent staffers from falling ill last fall.
And daily testing is cumbersome and costly.
Employers hope the hassles required to remain unvaccinated in the workplace will encourage the reluctant to just get a vaccine. 鈥淚t鈥檚 a forceful nudge,鈥 said Dr. Georges Benjamin, executive director of the American Public Health Association.
But there are challenges, too. Here鈥檚 what several experts had to say:
Universal Vaccination Remains the Gold Standard
Getting all eligible people vaccinated is 鈥渢he perfect way out of this whole situation,鈥 said Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officers. 鈥淏ut, given the realities of the current situation, I think it鈥檚 reasonable that employers and others who are setting up vaccine requirements offer some accommodations.鈥
But much depends, he and others said, on how well the rules are enforced.
鈥淚f [unvaccinated] people are wearing masks all day at work, even in the break room, that alone is pretty strong,鈥 he said. 鈥淲hen you add in the testing, it鈥檚 an alternative that is going to have some value.鈥
Some employers, he noted, are reluctant to set such edicts because they fear losing employees, particularly in areas already suffering shortages, such as nursing homes.
This Approach Relies Somewhat on the Honor System
Some states, health care organizations and New York City say they鈥檒l require proof of vaccination 鈥 a copy of an employee鈥檚 vaccination certificate or a version uploaded into an app on a person鈥檚 phone. But other employers say they will allow workers to self-attest that they鈥檝e had the vaccine.
鈥淭here will be some folks who fib, no doubt about that,鈥 said Dr. William Schaffner, professor of medicine in the division of infectious diseases at Vanderbilt University School of Medicine, in Nashville.
鈥淭hat will raise the issue of annoyance and concern by the vaccinated people,鈥 said Schaffner. 鈥淭hey will say, 鈥榃ait a minute. Charlie is here and he鈥檚 not wearing a mask and we know he鈥檚 not vaccinated.鈥 People know that sort of stuff about their co-workers.鈥
There are other consequences.
There is online traffic in buying forged vaccination cards, designed to look like the real thing from the Centers for Disease Control and Prevention 鈥 even though that is illegal and can lead to fines or even jail time, the Employers could also discipline workers who falsely state they鈥檝e been vaccinated.
As for test results, it鈥檚 less clear how the honor system will apply. Some workers 鈥 especially those in health care organizations 鈥 may well be able to get their tests done in-house. Other companies may allow workers to find (and pay for) outside testing. It isn鈥檛 known whether employers will allow the use of self-administered home tests. And what kind of test companies require matters, since the rapid antigen tests are not as reliable as the standard PCR versions. To complicate matters, rising demand for tests during the surge has led to for both kinds of in some parts of the country, and results for the more accurate PCR version may take days.
Frequency of Testing Will Vary and May Not Be Ideal
Many of the workplace edicts 鈥 including the one for federal workers 鈥 call for weekly or twice-a-week testing. Is that enough? It鈥檚 hard to give an exact answer.
Dr. Robert Wachter, professor and chair of the department of medicine at the University of California-San Francisco, prefers tests be performed twice a week, especially given the explosion of cases in many parts of the country.
鈥淚f you鈥檙e only testing once a week, there will be some cases that slip through,鈥 said Wachter. 鈥淵ou could get tested on a Monday, infected on Tuesday and could infect someone else that Friday or Saturday.鈥
Who鈥檚 Paying?
While some employers may pick up the cost, at least initially, not all will. And workers should not count on testing being fully covered by their health insurers, either. They may well have to pay out-of-pocket for employer-required tests.
鈥淕enerally, health insurance providers are covering covid tests that are taken for diagnosing or treating a patient 鈥 if they are displaying symptoms or have had contact with someone who has been diagnosed with covid,鈥 said Kristine Grow, a spokesperson for AHIP, the industry鈥檚 lobbying group.
But, she noted, said insurers don鈥檛 have to cover testing 鈥渃onducted to screen for general workplace health and safety, for public health surveillance, or for any other purpose not primarily intended for diagnosis or treatment.鈥
Bottom line: Employees could have to go through a lot of hoops to remain unvaccinated in the workplace. 鈥淭hat will get old very quickly for a lot of people,鈥 Schaffner said. 鈥淭hat will push a lot of people off the fence and onto the vaccination side.鈥