Many employers are looking to provide private Covid-19 testing for staff as part of their strategy for re-opening post lockdown.
A number of private medical companies currently selling both antigen and antibody tests online say that have already been contacted by a number of employers.
Typically these tests are selling for between £125 to £150 each for individuals, although it is expected that this cost will reduce significantly or bulk purchases.
The antigen PCR swab tests identify whether a person currently has Covid-19. Recently Public Health England also approved an antibody test, which indicates whether a person has had the disease in the past, from their level of antibodies.
However there remains some debate as to whether a positive antibody tests ensures immunity from this disease in future.
Private testing companies such as The Private Harley Street Clinic, Qured and CityDoc say they anticipate testing within the corporate market to be a major plank of their business going forward.
All three say they are already providing tests to private employers.
One of the major issues for employers though, and their employee benefit advisers, is knowing which tests to use.
As Dr Mark Ali of the Private Harley Street Clinic points out, there are already 179 different commercial tests out there. Pricing of these tests will vary, depending on which company is offering the test, how quickly they will deliver a result, the type of test, how often employees might be tested, whether these tests are done in the workplace, at a clinic or by post, and what type of test is used — for example is it a saliva swab or blood sample.
Ali says: “It is a huge but important task to sift through all these different offerings to find the most appropriate testing option.”
Howden Employee Benefits & Wellbeing head of benefits strategy Steve Herbert says: “As an employer the ability to roll out accurate testing across your business is an obvious game-changer. It can potentially enable a business to slowly return to some state of normality faster than is currently predicted.”
But he says while testing will be part of a ‘back to work’ strategy, he says it isn’t the only part of the jigsaw. For employee benefit consultants talking to clients there are concerns as to how such a testing regime would operate at present in the workplace.
Towergate Health & Protection distribution director Brett Hill says: “We are seeing interest from some employers for Covid-19 testing services, both for diagnostic tests to confirm if someone currently has the virus and should self-isolate, and for antibody tests to confirm if someone has had the virus and may now be immune.
“We believe some employers will be willing in principal to pay for such tests within reason, as they can form an important part of a return to work and absence management strategy.”
Mercer Marsh Benefits principal Neil Atkinson says: “In certain sectors such as banking and professional services we have been observing demand for tests for many weeks.”
He says the company’s policy has been to use tests only in line with the policy guidance set out by the NHS and Public Health England. Until very recently this has only recommended tests for front line staff only.
“There have been concerns that given Government delays in ‘ramping up’ the test rate, opening the door to private testing could negatively impact capacity for the processing of results for priority workers.”
But he says this stance has changed, as testing has become more widespread and with those working in other sectors, such as manufacturing and the construction sectors, now being encouraged back to work.
Hill agrees that the picture is changing. “Employers are being encouraged to re-open workplaces subject to safe working practice and social distancing requirements, and employees who cannot work from home are being asked to return to the workplace.
“This means those absence management challenges posed by self-isolation rules, that had begun to emerge before the lockdown, will now rear their head again.
“Any employee with possible symptoms of Covid-19, or who has a household member displaying possible symptoms, will be required to self-isolate for 14 days.
“If faced with the prospect of some employees repeatedly having to self-isolate, with all of the potential associated impact on their attendance and productivity levels, many employers may feel tempted to invest in the cost of rapid testing if this cannot be provided reliably by the public sector.”
One of the challenges for employers and their advisers is assessing the reliability and effectiveness of the different test options.
Atkinson says Mercer Marsh Benefits is engaging with a host of providers in the testing space, given the Prime Minister’s announcement on May 10th to start to easing some lockdown rules.
He says: “However, while we believe there is a place for Covid-19 testing in the workplace, this should be used to inform any return to work activities alongside a wide range of other measures, such as safe commuting, social distancing, increased cleaning and the use of protective equipment in the workplace.”
One of the key questions facing employers, and their advisers, is whether private testing companies can have the capacity for volume testing, and how quickly these test results can be turned around
Atkinson says: “Going forward processing lag between test and result, consistent accuracy of testing, and testing frequently will impact how effective a testing strategy will be to a more wholesale return to work.”
The private testing labs contacted by Corporate Adviser said the antibody and antigen tests offered met current government standards. The Private Harley Street Clinic, for example said it used the Abbott antibody tests, which has been approved by Public Health England.
For employers though it is important to note that tests may be marked as “approved” from more than one body.
For example a tests may be “CE marked”, “MHRA approved”, “FDA approved”.
Dr Ali explains: “A CE mark is a certification mark that is placed on medical devices to show they conform to the health, safety and environmental requirements in the directives.
“It applies to products sold within the European Economic Area but it is a worldwide recognisable standard. The CE mark shows that the device is fit for its intended stated purpose and meets legislation relating to safety.
“A CE mark does not mean that a product is approved by the MHRA (Medicines and Healthcare products Regulatory Agency). The test must meet the standards outlined by the MHRA in their target product profile.” FDA-approved relates to the US Food and Drugs Administration (FDA).
Most clinics are advertising tests results available within 2-3 days, or 3-5 days, depending on the company. Those quoting shorter timeframes note that this is the turnaround from when the swab or blood tests (for antibodies) is received at the laboratory.
Both Qured and CityDoc said they were not currently processing tests on behalf of the government for frontline staff, so this would not affect capacity for testing key workers.
Atkinson says that Mercer Marsh Benefits has already been approached by “a number of providers” offering Covid-19 testing.
But he adds: “In order for us to feel comfortable with any potential distribution partnership, we would seek to verify the vendor’s ability to guarantee test results’ accuracy and consistency, but also crucially maintain service levels should demand exceed a lab’s ability to process tests.
“Regardless of how attractive the testing proposition appears, MMB would need to be 100 per cent satisfied with clinical and operational due diligence.”
Another key consideration is cost. Although most providers are expected to reduce advertised costs for employers buying in bulk, many advisers say that a fee of £100 plus per test will prove uneconomic for many employers.
Herbert: “The cost needs to drop considerably for this to be a feasible option for many firms.”
As he points out, these tests are likely to run in conjunction with the government tracing app, currently being trialed, which may require people to have multiple tests if they are in contact with others on public transport and other places where social distancing is more difficult.
“People need to know a negative result promptly, so they can get back to work. Otherwise employers are looking at staff being forced to quarantine for two weeks, even if it transpires they subsequently don’t have the disease.”
It remains to be seen whether employee benefit providers are incorporating such tests within their existing products. But Hill says there are a number of challenges they face, not least the cost, given the potential volume of tests that could be required over time. This may make it hard to offer this service within existing premiums. He says this will be a particular issue if the pandemic occurs through successive waves.
Hill adds: “There is also the difficulty of keeping claims approval protocols aligned with a rapidly changing clinical governance landscape, as new tests and testing providers emerge.”
He adds: “Some providers may choose to partner with third party suppliers for the provision of tests on a pay as you go basis, as has happened in recent years with DNA tests, but only if they feel that the demand will be there over a sustained period. That in turn will depend on what progress is made in the development of an effective vaccine.”
Most advisers and employee benefit consultants were clear this testing regime needs to work hand-in-hand with occupational health, and other employee benefits. This will involve health and safety changes to ensure workplace remain as safe as possible, alongside comprehensive mental health support, as many employees will be anxious about returning to work.
Atkinson adds: “Realistically many clients will only be able to support, at least initially, a phased return for work for reasons of social distancing, though this will be crucial for the economy and in many organisations to cashflow.
“HR departments will find the return phase challenging. We would recommend clients reach out to their staff as soon as possible to gauge levels of anxiety, sentiment around returning to work, expectations of the new work environment and any underlying medical conditions that the employer should be made aware of. Open lines of communication are more critical than ever before. It may be that those who want to return promptly are different from those who need to.”
MAIN APPROVED ANTIBODY TESTS CURRENTLY AVAILABLE
|Type of test||chemiluminescent microparticle immunoassay (CMIA)||Enzyme-linked immunosorbent assay (ELISA)||Electro-chemiluminescence immunoassay (ECLIA)|
|At home or lab?||Lab||Lab||Lab|
|Antibodies detected||IgG||IgA and IgG||IgG|
|Sensitivity according to manufacturer||100%||IgA 100%, IgG 93.8%||100%|
|Specificity according to manufacturer||100%||IgA 92.4%, IgG 99.6%||99.81%|
|Independent evaluation examples||Journal of Clinical Microbiology: Sensitivity 100%, specificity 99%||https://www.medrxiv.org/content/10.1101/2020.04.09.20056325v1.full.pdf|
|Regulatory status||FDA EUA, CE mark, approved by Public Health England||FDA EUA, CE mark||FDA EUA, CE mark, Approved by Public Health England|
|Examples of current use||Widespread use in the USA and now the UK. Capacity set to hit 60 million by June. Approved by Public Health England planning to roll out nationally||Many independent research organisations, Beaumont health undertaking the USA’s largest serological survey, testing 38,000||Approved by Public Health England planning to roll out nationally|
Source: The Private Harley Street Clinic