Credit: Jens Schlueter/Getty Images

Some 31% of Americans say the pandemic is over. But a roughly equal number believe they’re at least a year away from resuming their pre-pandemic life.

In this in-between, divided moment, what’s the right level of cautious to aim for? What precautions should workplaces still be taking? What’s the outlook for another virus surge this fall?

For guidance, we reached out to epidemiologist Dr. Jennifer Nuzzo, director of the Pandemic Center at Brown School of Public Health. Here are excerpts from the conversation, edited for space and clarity.

What are the trends or patterns right now in how workplaces are approaching Covid precautions?

What's probably driving it is employee preference. That's what should drive it, because I don't think any good comes out of banging fists and saying, ‘You must do this.’ If employees don't feel comfortable, then I'm not sure how productive coming back will be.

Different people have different levels of risk at this point. People who are fully vaccinated are well protected against the thing we care about most, which is severe illness, but there are still people who have medical conditions that may make them at increased risk, or people who live with people like that, or parents who have had young kids that were too young to be vaccinated. There's just different levels of comfort with the idea of coming back face-to-face with others.

The challenge is going to be that none of the medical tools we have are going to prevent people from becoming infected. If we want to bring down that risk of infection, we have to continue to rely on the things we've been using for the past two years, like masking, improved ventilation, trying to kind of limit the amount of congregation that we do. But that's hard in certain environments. And so there's no clear answer. It really comes down to, what the risks and trade offs are inherent in the workplace? Whether there are benefits to coming back versus allowing some flexibility for people to not.

Are there any decision-making frameworks that can help workplaces think through that risk-benefit analysis?

You have to start with an understanding of what the employee's comfort is, as well as what their physical presence actually means—whether it’s just due to, ‘We've always had it this way and therefore it needs to be done this way,’ or ‘We really can't do our jobs very well unless we do this.’ I think that has to be the starting point of the conversation.

From the epidemiological perspective, taking into account local transmission trends is really important. Obviously the more Covid there is in the community, the more likely someone's going to bring it to the office. Unfortunately it's increasingly hard to get at those trends, because a lot of the health departments are pulling back on the frequency of the information that they're sharing, which makes it harder to spot when the trends are changing. But it's important to consider the local trends because national numbers don't really tell you what's going on. You could have national declining numbers or national flat numbers, but your office could be in a hotspot.

You have to consider what the environment is. Places where the ventilation has been improved, or there are air-filtration units, or you can open the windows, that's clearly decreased risk from the stale-air windowless office environments that may also exist.

And then, what is the level of interaction? Even in hospitals, what they found is that although they may have had universal masking requirements, they may have had outbreaks when employees congregated in the break room and took off their mask to eat. So you have to consider where the exposures are, and then what you want to do about that. There might be some places where you're really trying to make sure nobody gets sick, or you might just say, ‘Listen, this virus is not leaving us. And we think it's really important for our business that we continue to operate.’

That's where those conversations with employees are really important to understand what level of control you're aiming for. You may want to say masks are optional but not require them, but know that that policy introduces some risk to the workplace. Whether that's going to be tolerable is both a business decision and a consultation with employees about their risk tolerances.

To go back to your point about local data—what is the optimal level of local? City? County?

For a business, you would want to look at where your business is operating. Where I live in Maryland, if I want to know what's going on, I go to the county website because it's more detailed than the state website. Maryland is not a huge state, but it does span very different populations. And so the state numbers don't really tell me what I need to know, but the county data do. I would probably also, if I were running a business, want to look where my employees generally live.

But people travel, they do other things, so that's not failsafe. You constantly have to use multiple data sources to get a sense of what’s going on around you and what the risks are. There’s no clear-cut formula to figuring it out. And again, if you had a lot of older employees who recently just went through chemo, that's a different story than if it's mostly 20-year-olds who had Covid last year. So that's where conversations with your employees, and trying to understand what they feel comfortable with, is really, really important.

I can't stress that enough, because so much of these decisions are driven by our personal risk tolerances. My comfort level going to large in-person meetings is not the same as some of my colleagues’. I accept some level of risk because I think it's important for my profession to do it, but also, everyone in my household is vaccinated. None of us have underlying health conditions. And I know that as a family, we could handle it if one of us got sick. We have sick-leave policies that allow us to stay home when we're sick, and space to isolate at home to reduce the chances of passing it on. But, you know, not all employees have those options. If somebody's caring for a medically fragile relative at home, they're gonna view the risk of the workplace much differently.

How should workplaces think about balancing the fact that infection rates may be constantly changing at the local level, and wanting to stay nimble, against providing some sense of stability and not changing policies on a dime?

We need the longer-term plan of how we're going to deal with this. Obviously you don't want to create a situation where you have to close because so many people are sick. But at the same time, this virus is not going away, and I think it is absolutely realistic that we're all going to get it, possibly multiple times in our lives. The idea that we're going to dodge this virus indefinitely is just not realistic. So some places are like, ‘Well, what else is there to be done?’

I do think that businesses should examine the extent to which they're enabling employees to stay home if they're not feeling well. That's really, really key. And making sure that employees aren’t choosing between earning a paycheck or losing their jobs and doing the right thing to protect others. Also allowing some flexibility, recognizing that we all have different life circumstances and that as long as employees are getting the job done, flexibility is not a bad thing.

As a society, we are going to shift in terms of our level of wishing to avoid this virus as more and more of us get it over time. Parents are happy that now they finally have a vaccine for their under fives. We have more therapies now, and we're learning about how they work and don't work. We have more testing options.

Are vaccine mandates for the office a best practice at this point in the pandemic?

It's been very commonplace that businesses have mandated vaccines of their employees. Will that prevent infections in the workplace? Probably not. May it decrease the chances that your employees are gonna be out for extended periods of time due to severe illness, and possibly raise your insurance premiums? Yes.

I'm not generally a fan of government-imposed vaccine mandates, but I think employers have different different considerations in terms of the potential benefits of vaccinations for their workforce. And also making it clear to their customers and others that they are trying to follow as many safety protocols as reasonably possible. So I could see benefits for employers requiring vaccination of their employees that are not just making sure nobody brings the virus to the office. There's also a potential lower risk of long Covid in people who have been vaccinated.

What is the current thinking around mask mandates at work?

A lot of businesses are aligning with the local governmental policies. Sometimes you'll see they're requiring masks of their employees to reduce the likelihood that someone will bring the virus to the office and then spread it to others, or possibly to make customers feel more comfortable being in their spaces. There's no hard and fast rule. I will tell you that continuing to wear masks is one of those tools that reduces our risk of infection.

What’s hard is that again, this virus isn't going away. And so the question is, for how long do we have to do it? Maybe some employers will choose to do it when the local case numbers are high, because, ‘We will operate better if people are not out sick. And if we don't have a superspreader event in our office we have a better chance of doing business.’ But I know some businesses, when they require masking, people tend to not want to be in the office as a result. It’s also a conversation to have with employees about what would make them feel comfortable.

If they do choose to mandate masks—and you can easily come up with reasons why that might be a good idea—it's worth explaining clearly what the goal of that mandate is. Are you trying to reduce the likelihood that people bring into the office and spread it, and then people will be out sick? Are you trying to make your customers feel safer? Are you trying to say, ‘At this time of increased illness, we're doing our part by reducing the likelihood that our business will contribute to additional cases in the community’?

Whatever it is, it needs to be clear, because some of the tension around masks has been a lack of understanding and clarity about what the goals are. And trying to decide, when are we not going to have to wear them? Some articulation of what the endpoints are is important. Ideally this is done, again, in conversation with employees, because people tend to be more supportive of processes and policies that they've had input to.

As you’ve pointed out, people have a wide range of comfort levels. What is best practice there for accommodating everyone?

I'm not sure I have an answer for you. I don't know that we've established what the best practices are. I will say I have not seen success in telling people they should feel differently. Businesses should hopefully know their employees. But I can't imagine it being productive to have everybody be there and be under duress.

When it came to the topic of school closures, I was very much hoping that the schools would reopen and reopen soon. But I also thought, with my kid’s teachers, the magic is the teachers come with their whole hearts and bubbly personalities. If they don't feel happy being there, are the kids going to get out of it what they should be getting out of it? I think the same thing is true for employees. With fairly high employee turnover and workforce stability issues, I'm not sure forcing employees to do things that they don't want to do is in anyone's best interest.

How should companies handle an employee being exposed to the virus, in terms of asking them to isolate and test before coming back to the office?

If they're vaccinated, I would follow CDC guidelines for vaccinated people. Rapid tests are also your friend. Ideally they would get two rapid test negative results within a 24-hour period before they come back. That's something I think employers could help with: making sure that employees are able to access those tests. I emphasize rapid tests, because PCR tests will continue to be positive for a long time. It also depends on the nature of the exposure. Was it a meaningful exposure, or just that they happen to work in the same office building?

With summer travel picking up, should workplaces be thinking about changing or updating their policies at all to account for workers who may have been at greater risk of exposure while away or on vacation?

The CDC publishes this list of countries where exposure risk is high, but we have a whole lot of Covid in the United States, so I'm not sure travel-based policies really make a lot of sense.

In an ideal world, we'd have so many rapid tests that after you think you had a high-risk exposure, you could test yourself every single day before you went to the office. But I think it's really symptom-based screening. And you can feel more comfortable about that with a vaccinated workforce, in part, because it does cut down on your risk of infection a little bit.

What about contact tracing within the office, or notifying employees about a potential exposure within the office?

It just goes to what the goals are of the workplace. A lot of congregate settings have just abandoned the practice of telling you that there was Covid in the workplace and to pay attention to any symptoms you may have, and to test yourself if you have symptoms. But a lot of places have also moved away from doing contact tracing. Some people wished we hadn't moved away from it. And I can imagine some workplaces deciding, ‘It's just too risky. We want to try to do everything we can to make people feel safe here and to limit transmission, so we're going to keep doing it.’ It goes back to what the goals are—if that's your goal, then we know what works. But the question is, Covid's not going away. So at what point are we going to stop doing that?

Does the same thinking apply to screenings or self-reporting for gatherings or big events?

I would love for large events if people could rapid test, if there's any way to facilitate that, because it just makes people feel more comfortable. The more people you get together, the likelier that one of those folks is going to have Covid. And now the tests are more available, so hopefully that should be possible, even if it's just highly encouraged. I do that when I go to large meetings, because I don't want to be the person that started the the outbreak at those places. I also do it when I go to see elderly relatives. I'm not worried so much about myself. I just don't want to be the person that brought Covid to the conference. So if there's any way to support that, I think that's useful.

But probably more important is making sure that the space is well-ventilated. Businesses should be asking about the ventilation of the physical spaces that they occupy, including event spaces. And if there's any way to open windows, do it.

At this point, how should businesses be thinking about the risk of hosting these events?

This is really a matter of philosophy. Yes, there's a lot of Covid. Will there be a time in which there's a lot less Covid? Possibly. So you might decide it’s not worth it to do it now. I also know some people are very happy to get back to seeing people and getting together. My husband just went to a large conference and he said it was so good. The quality of the conversation is something we have missed out on for a number of years. But other people might be like, ‘It’s just not worth it to me.’

Obviously if there was another situation like we had in December, where the case numbers are just like raging and there's worry that we're putting undue stress on the health system, that's a good time to reconsider, especially if you can't do the testing protocols. But otherwise I think it's reasonable to expect that there will be more and more large in-person gatherings, masks and tests can help reduce the risk of those gatherings.

Do you have concerns about another wave of the virus in the fall or winter? How would that affect schools and businesses?

My concerns are more like, will we have the tools we need then to combat a wave? I'm worried about the rapid test production pipeline possibly drying up. I'm worried about possibly not getting more up-to -date vaccines for the fall, and possibly not funding for vaccines and funding for tests. Am I worried that we're going to have large waves of deaths? Not as much, because we have seen a ratcheting down of deaths and severe illness, thanks in part to immunity. The vaccines and the therapies are absolutely helping.

For the love of God, I hope it doesn't affect schools. Our kids need to learn and they need to have normalcy. Given the risks to them, I think we have to work very hard to make sure that we preserve that. I'm also a little bit worried about flu returning. There are just many unknowns, but that's so far away, and I would be a bad epidemiologist if I gave you certainty about what's going to happen then. The overarching theme here is the importance of being flexible and being ready to pivot if the local conditions suggest the need to pivot. Flexibility not just at the institutional level, like, ‘Should we do this? Should we change course?’ But also at the employee level, recognizing that employees have different circumstances and allowing them to make decisions that are best for themselves and their families, and trying to support them in that decision-making process as much as possible.

It feels like part of what's changed recently is that people have moved away from the concept of contact bubbles. Is there a new framework for how we should think about public health in a workplace context?

We have to examine the physical space and whether we're providing tools to help people as much as possible. The physical space is a huge one. We have not made enough progress on improving ventilation in our buildings. And I think businesses should absolutely demand it of their buildings that they occupy. That to me the biggest thing: these out-of-sight protections, magic mechanisms that just operate in the background, keeping us safer, that we don't even have to think about. I also think sick-leave policies have to change. It shouldn't be that you're rewarded for pushing through it and showing up to work despite being ill.

And I also think masks are not going away. If I have cold symptoms and I'm going to be around people, even if I have tested myself and I know it's not Covid, we're probably not going to stay home for every single cold that we have. Employees may be encouraged to wear a mask, because nobody wants a cold either.

We’ve also downplayed the need to disinfect surfaces. It's true disinfecting surfaces is not necessarily important for limiting transmission of Covid, but it is important for other viruses that can rip through an office. Norovirus can shut down businesses. So cleaning is important, even if it doesn't need to be done hourly or whatever crazy level of disinfection we were doing in the false hopes of trying to control Covid.

We have to examine those practices, as well as policies that help us generally reduce the amount of infections that come to the workplace. Again, from the business standpoint, it's more about trying to limit employee absenteeism—not just that someone gets sick and can't come to work, but an employee brings home something and now their kid gets sick, and it's even a longer amount of time that they can't come to work.

Are there any other examples of things that are working in the background to keep us healthy, in the vein of ventilation and disinfection?

Those are probably the big ones. Also flu vaccines are something that we should be looking at a bit harder. We would have a better fall and winter if we could reduce the likelihood of people not only getting sick with Covid, but also getting sick with flu. wWhile many workplaces have asked employees about Covid vaccines, they've not done the same for flu vaccines, and I think they are really important. While you may not mandate it, you could strongly encourage it and perhaps incentivize it. Talking about the importance of those vaccines so that everybody can keep themselves and their coworkers healthy is important.

Are there any incentives there that have been proven to work around vaccines, flu or otherwise?

Reducing barriers to getting vaccinated tends to work. Maybe you get a half day off to go get your flu vaccine, or a couple hours off, just making it easier for people to get vaccinated. Some large employers may want to consider bringing in Walgreens or something to come offer vaccines to employees. Maybe they have occupational health divisions. I do wish I could tell you what the magic formula is. And I think that's one area where we need better research to know what the nudges are.

Should employers be concerned about the risk of monkeypox for their workers right now, or the risk of workplace transmission?

It is not nearly as transmissible as Covid. It requires close physical contact, generally speaking. So probably not. It's probably more between people who have relationships with each other. But it would be nice if employees that have a strange rash feel comfortable going to talk to a doctor and getting tested, and don't have ‘I need to go to work’ as the reason they don’t.

One thing that employers should consider is that people who are found to have monkeypox may be contagious for up to four weeks. So that's a really long period of time that they have to isolate. That probably exhausts most sick-leave policies, but you can imagine the real benefits of making sure that people who are still contagious with monkeypox don't come to work. So employers can help incentivize people to isolate for as long as they need to so that they're no longer contagious.

And incentivizing this case looks like paid sick leave for as long as is necessary?

Yes. And certainly not having people fear losing their jobs because they have to stay home for four weeks.