Testing in the workplace could be the next step in fighting the coronavirus pandemic, but testing shortages and a lack of uniform standards are complicating the path forward.

Experts are largely unified in their call to make regular testing available in vulnerable places such as prisons or nursing homes, and Senate Republicans are considering ways to support testing in schools. But a clear picture has not yet emerged on testing in workplaces, which spurred a number of outbreaks around the country. 

A June poll of 40 large employers conducted by the Pacific Business Group on Health, or PBGH, found that just 6 percent plan to implement on-site testing. Thirty-three percent of respondents said they would not require testing for employees to return to work, while 56 percent had not decided. Cost and privacy issues topped their list of concerns. 

“I don’t think that they’re relying on testing as their major strategy until it becomes more user friendly,” said Lauren Vela, PBGH senior director of member value, adding that tests typically cost between $100 and $150 each.

Maeve O’Meara, CEO of employer consultancy Castlight Health, said testing will likely be industry-specific, with more vulnerable employers like airlines taking the lead. Early discussions on antibody tests, which assess whether someone was exposed to the virus, petered out as their reliability came into question.

“Even with a high sensitivity and specificity, because of a low incidence, inherently we’re going to have a lot of false positives and false negatives,” she said.

The questions of who receives tests and who pays for them are crucial as political leaders seek to balance economic concerns with public health in the absence of a vaccine. Lawmakers want to provide more money for testing, but another coronavirus aid package is facing partisan hurdles on issues such as granting employers liability protections for outbreaks among their workers.

[Health officials: US not scaling back COVID-19 testing capacity]

A new spike in the pandemic is also threatening the progress made on testing capacity, as cases surge in states such as Arizona, Florida and Texas. Quest Diagnostics, one of the nation’s largest lab companies, recently said the increase in demand has slowed turnaround times for nonpriority patients to between four and six days. The American Clinical Laboratory Association is also warning of delays as demand mounts.

HHS on Tuesday announced surge testing sites in Florida, Louisiana and Texas. But Assistant Secretary for Health Brett Giroir told reporters July 1 that the surge is also partially attributable to a nationwide push for testing in prisons and nursing homes, which should wane after baseline case counts are established. 

“What we’re seeing is an unusual bump in their normal baseline operations, which are very high, that are a result of this surge that we’ve asked the governors to do,” he said.

Testing with little guidance

The Centers for Disease Control and Prevention recently estimated that nationwide antibody test results indicate cases could be as much as 10 times higher than recorded. The high rate of transmission from people without symptoms is prompting some states and employers to implement ongoing “surveillance” testing with little federal guidance. 

The CDC has released guidance for testing in dense workplaces like meatpacking and manufacturing plants, but the guidelines focus on tracing infections stemming from exposure to a known COVID-19 patient. 

The CDC and the Centers for Medicare and Medicaid Services have laid out guidance for ongoing testing in nursing homes, however, recommending that workers be tested weekly.

Giroir expects surveillance testing in workplaces and schools to eventually be conducted in pools of five to 10 samples in order to cut down on cost. Pooled testing should be available when students return to school in the fall, he said.

States are implementing their own patchwork strategies, from requiring ongoing testing in places like nursing homes and grocery stores to offering free tests for the public. While state leaders say flexibility to adapt testing approaches is essential, the federal government’s role is also critical — as evidenced by a recent backlash that prompted the administration to delay handing over the last of several federally run testing sites in Texas to state leaders.

Congress required free cost sharing for COVID-19 tests under a law enacted in March. But last month, CMS released guidance that allows insurers to decline to cover tests for back-to-work programs, triggering ire among Democrats.

“That guidance is totally contrary to law,” New Jersey Rep. Frank Pallone Jr. said. “The law says that it has to be free.”

Some Republicans are eyeing tax incentives as a way of encouraging employers. Sen. Ted Cruz has a bill calling for employer tax breaks, while a fellow Texan, Rep. Kevin Brady, said GOP Ways and Means Committee members will introduce employer incentives in a broader bill.

Democrats might not be on board. Ways and Means Health Subcommittee Chairman Lloyd Doggett of Texas said tax credits can be “inefficient.”

“We need to be helping employers,” he told CQ Roll Call. “I just would not favor doing it through the taxpayer.”

Workplace experiences

Employers also face pressure from labor unions like the United Food and Commercial Workers International Union, which says more than 29,000 workers were exposed to the virus and 238 died. 

Tyson Foods is one company that spearheaded a big testing effort after seeing outbreaks cripple facilities. The company said around 40,000 employees so far, or roughly one-third of its workforce, were tested for COVID-19, either through Tyson or elsewhere. Tyson is also rolling out ongoing surveillance testing in partnership with Matrix Medical Network, based on the prevalence of the virus in communities with plants.

After facing early criticism for its response to the pandemic, Tyson began testing workers, finding extremely high rates of asymptomatic and pre-symptomatic transmission.

At one Arkansas poultry plant, the company found 199 positive COVID-19 workers — only one of whom had shown symptoms. 

Dennis Medbourn, an employee at a Tyson Foods pork facility in Logansport, Indiana, said management was not transparent enough with workers about test results. Medbourn contracted the virus during an outbreak that affected nearly 900 employees and shut down the plant for two weeks in April. Workers have a right to know if they’re working next to an infected person, he told reporters on a UFCW call.

A Tyson spokesman said the company contacts employees to communicate COVID-19 exposure.

“If a positive case is identified, any team member who was determined to be in close contact is notified and a health assessment completed,” he said. 

The testing issue is challenging for low-profit nursing homes, many of which are under state mandate to test their staff regularly. In New York, staff are tested once per week under phase two reopening guidelines, down from twice a week under phase one. The cost has been “astronomical,” said Len Russ, administrator of Bayberry Care Center in New Rochelle, New York.

The test backlog means employees are sometimes tested two or three times before they receive even the first set of results. 

While Medicare and Medicaid largely cover the costs of testing residents, they don’t cover the costs of testing staff. Joel Smith, health services administrator at BayView in Seattle, said testing costs about $30,000 a month. 

“It’s quite a price to pay, but when it comes to life and death, you have to make that hard decision,” he said. 

Nursing homes may be the most likely industry to receive congressional attention. Deaths among nursing facility patients are estimated to make up as much as 40 percent of the total. 

“If the administration doesn’t do any better job than that, then we need to perhaps take additional steps to compel that to be done,” Doggett said of testing, “beginning with the most sensitive areas, of which nursing homes will be at the top of the list.”

Lindsey McPherson contributed to this report.