Why it matters
Workplace health interventions can raise complex ethical issues, for example relating to privacy, equity, and unintended consequences. This paper offers an ethical framework for asymptomatic COVID-19 testing programmes for staff.
The UK government and some advisory bodies issued guidance on mass asymptomatic testing for COVID-19 during waves of the pandemic, but few resources have focused specifically on the ethical issues in workplace settings.
We carried out a mixed-method study to address this gap, reporting on findings from a consultation in a case study organisation, and using the findings to inform the development of a framework to guide organisational decision-making about COVID-19 asymptomatic testing.
The study was carried out during a period before vaccinations were widely available and during a wave of infection. The findings and framework are likely to be of particular value in informing response to future scenarios where transmission rates are high and immunity is low, and are also of general relevance to informing decisions about workplace health interventions.
We reviewed the literature, available guidance, professional expertise and wider ethical thinking.
We carried out a consultation in a UK organisation that had introduced COVID-19 asymptomatic testing for all staff working on-site in its buildings. Staff were invited to take part in the consultation through either an online survey or a semi-structured interview. Participants took part in the consultation via our online research and development platform, Thiscovery.
61 staff members participated (50 survey respondents and 11 interview participants); approximately 10% of the organisation’s workforce.
We analysed the data from the survey results and interviews, comparing the views of the participants and identifying patterns. We then produced a final framework to guide decision-making around COVID-19 testing in workplaces, with themes based on the consultation findings and our wider analysis.
What we found
Our consultation revealed some of the tensions and dilemmas that need to be addressed in relation to COVID-19 asymptomatic testing programmes. Although we found that there was strong support for the asymptomatic testing programme in the case study organisation, with 90% of survey respondents stating that it is ‘helpful’ or ‘very helpful’, it is not uncomplicated.
Open-ended survey responses and interviews provided insight into participants’ concerns including how support for isolation would be organised, in particular for those in less financially secure positions. Other concerns included the potential for false negative results, the impact of needing to self-isolate on mental health, daily activities and the lives of other household members as well as whether the goals of the programme could drift (for example, an employer using the testing programme to also monitor presence at work).
Participants highlighted confidentiality and privacy as important, with support for minimising the number of people being informed of a person’s positive result. There was consensus among participants that high-quality, clear and honest communication was important to building trust in a workplace testing programme.
The findings of the consultation, together with the other inputs, informed our practical and actionable recommendations about the ethical considerations of COVID-19 asymptomatic testing in workplaces. This ethical framework includes hypothetical examples to illustrate the principles, which are likely to be useful and relevant for workplace health interventions generally.