The mandatory employee Covid testing "mess" is complicated and costly

When an HR leader at a regional bank took this reporter’s phone call around 8pm last week, he didn’t complain. Besides, who would listen?

“It’s okay. I don’t ever stop working anymore,” he told HR Brew. “Figuring out this mess takes 150% of my day.”

The mess he was referring to is employer-sponsored Covid-19 testing—the overlooked component of President Biden’s September OSHA mandate, which calls for all companies with 100 or more employees to require employees be vaccinated or submit to weekly Covid tests.

On the surface, it sounds easy. Employees will take a test! It’s only got one question! And workers who get it wrong get to go home!

The reality, of course, is much more complicated, as employment lawyer with Ogletree Deakins Jim Paul explained.

“If we’re testing employees for the next year, or perhaps longer (we don’t know when this mandate will expire), there’s logistical nightmares at every step of the process: from supplying tests that are the right sensitivity to getting results to HR to communicating those results appropriately,” Paul told HR Brew. “Like, if you test positive, how do we responsibly contract trace? Do we tell your immediate team, the people you share a bathroom with down the hall, even more people? All these things need to be worked out. It’s way, way more difficult than what it sounds at first blush, and if we’re doing it every week for every employee that’s unvaccinated, that will take a lot of time, effort, and cost.”

The bank employee, who asked that his name be withheld because he was not authorized to speak publicly about the testing initiative, told us that all of these questions and more landed on his plate, then spilled over into his lap.

“We never hired anyone to handle Covid or vaccinations or testing. It’s just all been absorbed by the same team who would otherwise be doing other work. It’s really a full-time job,” he explained.

A shot in the dark. For HR teams across the country, developing testing policies feels more chaotic than coherent. Dr. Neal Mills, the chief medical officer at Aon, told HR Brew it was akin to “trying to write the rules of a game while you’re already playing.”

“I feel really bad for HR people these days,” said Lynne Rosen, the CEO of PhysicianOne Urgent Care. “You simply can’t ask a single HR person to handle the mandate. It’s not just one more task on their plate, it’s a massive undertaking.”

She noted that inconsistent federal guidance adds to the scale of the problem. “It’s too much information to actively monitor. The CDC guidelines change all the time, and that’s just federally.”

This is the experience of the HR bank manager. He says that trying to make a policy that covers California, New York, and Florida is as difficult as assembling Ikea furniture within the estimated build time. It almost can’t be done.

“We have offices in Florida and California, and they’re on opposite ends of the spectrum as far as what the rules are: There are certain things that are required in California that Florida says you’re absolutely not allowed to do. That makes it difficult, so we start with the CDC guidance and then we need to kind of localize it. But the rules are always changing. And you know, every time we publish a policy and then we go back to the CDC website, a week later, it’s different.”

Who buys this round? Another wrinkle in the equation: sourcing and paying for tests.  According to all experts interviewed, Covid tests have thus far been either performed as part of routine monitoring in which the employee population is surveilled for outbreaks, or “diagnostic testing,” in which symptomatic individuals or those with a known exposure receive a test to confirm a possible diagnosis. Diagnostic tests tend to be the more sensitive PCR tests, while tests used for broad monitoring can be performed with antigen tests or using an efficient method called “pooled testing.”

So far, there isn’t clear guidance from the government addressing whether employers have to provide top shelf (PCR) or bottom shelf (antigen) tests, and if they have to pay.

Insurance companies have, to date, mainly paid for diagnostic testing, leaving employers to foot the bill for weekly or biweekly company-wide tests.

“‘If employers require routine testing, it’s likely they pay, but that’s not true in every case,” Maryrose Robert of testing company GenetWorx explained. “There are employers that put the onus on the individual to pay. Those individuals are likely still relying on insurance. We don’t know how much longer insurance companies will pay for" mandated testing.

What’s the right answer? It isn’t as simple as bubbling in C and hoping for the best. According to Rosen, companies’ risk tolerance plays a major role in their decision. Less risk-averse companies will select the costly, but high-quality PCR tests. Companies just looking to “check the box” will offer the cheaper and less reliable antigen test.

“It really depends on how safe you want your workers to feel,” Rosen said. “They’re sharing space with other people in a building, and vaccinated people can possibly become carriers of the virus and bring it home to immunocompromised loved ones or little kids. Children are still not being vaccinated. So the most judicious companies aren’t worried just about their employees, they’re worried about their families and what breakout cases could do.”

The price adds up.

“Pricing varies greatly: PCR tests are the gold-standard and most expensive. Antigen tests are less sensitive but they are significantly cheaper. The range [per test] would be $20 to $115 per person depending upon the type of test, volume, and service provided,” Robert explained.

Not to sound like your parents telling you that if you just stopped buying Matcha lattes you’d be able to afford a house, but small costs do add up. We did the math: If only 15 employees remain unvaccinated and a company offers an inexpensive testing option, employers are still probably running thousands of dollars in expense.

Dr. Mills says that for the most well-meaning employers, making a testing strategy that is sufficiently frequent and sensitive enough to protect unvaccinated workers as well as vaccinated staff concerned about their families could become “very, very expensive” and even “a luxury businesses can’t afford.”

“Make it as inconvenient as possible.” Despite rumors to the contrary, HR usually doesn’t design policies to make employees miserable. But, when it comes to testing, some HR teams candidly acknowledged they want the process to be as difficult as possible.

“We aren’t paying for Covid tests for our unvaccinated workforce. We don’t want to make it easy for them,” the bank representative told HR Brew. “They are responsible for finding and taking PCR tests twice weekly. Our CEO wants everyone to be vaccinated, he wants our workplace to be as safe for everyone as possible. So yeah, he doesn’t want to make it easy for people who are not vaccinated.”

To that end, Robert said employers are often opting to make testing either a personal expense or something that has to be done on site, not in the comfort of an employee’s home. Robert says tests could be provided by mail, but some employers would rather the experience be onerous than cheap and efficient.

Robert told HR Brew, “We’ve seen clients say, ‘We want this to be as inconvenient as possible.’”

Bottom Line. On Tuesday, October 12, OSHA announced that it had submitted the initial vaccine mandate text to the Office of Management and Budget (OMB) for review. There is no definitive timeline for how long OMB review will take, but it may conclude in as little as a few weeks. As companies anticipate OSHA’s final rules around testing, the rules for how to source, administer, and pay for tests change at Squid Game-level pace. The stakes feel equally high. All experts agree: HR staff cannot be in the fight alone.

“These are uncharted territories,” Dr. Mills explained. “So getting trusted, reliable information is really important right now. HR is under a lot of pressure to bring people back to work or do events, because everybody's craving some kind of better workplace collaboration, but it’s extremely difficult to do that safely.”

“[Companies] shouldn’t be making those decisions without some clinical guidance. It’s too difficult,” Rosen agreed. “We advise all our clients to have a chief medical officer involved. If you’re trying to make those decisions as an HR person, and with no medical knowledge or experience, and just trying to read the results, or the sensitivity of various tests, I think that that would be a real issue.”—SV

Do you work in HR or have information about your HR department we should know? Contact Susanna Vogel via the encrypted messaging apps Signal and Telegram (@SusannaVogel) or simply email [email protected].