Monitoring Key Metrics, Parkland Recommends Action Plan to Guide Responsible Return to Work

Michael Wood, Manager, Education & Workforce

With layered interventions, widespread compliance, and a culture of accountability, businesses can make a largely safe transition back to the workplace assured Dr. Jennifer Rabaglia, Associate Chief Medical Officer, Chief Quality, and Safety Officer for Parkland Hospital.


Dr. Rabaglia spoke to members of the Dallas Regional Chamber as part of its “Responsible Return to Work” series. During the call, Dr. Rabaglia highlighted key metrics in the fight against COVID-19 and recommended a combination of strategies to prevent spread in the workplace.

Preventing spread requires that businesses understand how the virus is transmitted in the first place. Predominantly, the virus is passed from one person to another through droplets in the air produced by coughing, sneezing, talking, and exhaling. Transmission can also occur through direct physical contact with an infected individual or a contaminated surface. Risk of spread is highest when individuals stay less than six feet apart for more than 10 minutes, hence the widespread six-foot social distancing guidelines.

Maintaining that physical distance in the workplace is crucial for employee safety, as roughly 50% of patients diagnosed with the virus have no symptoms or fever at the time of their positive test. Experts believe patients may be infectious one to two days prior to exhibiting any signs of illness.

“That is what actually makes this virus so difficult to control,” said Dr. Rabaglia. “That’s also what makes the biggest challenge for re-opening businesses and re-opening our communities, when we don’t have any indication that somebody is infectious.”

As Dallas County’s COVID-19 case count continues to increase, some businesses and their employees may be hesitant to return to the workplace. Dr. Rabaglia asserts this measure may be confounded by an increase in testing, and suggests a better metric is prevalence – or how common the virus is in a community at a given time. Understanding the true prevalence in Dallas County would require testing of the entire population, an unrealistic solution. Instead, the percentage of positive tests can serve as a good proxy.

Dallas County’s percent positivity peaked in early April at 13.5%. Since then, it has steadied around 11%. The stability in the percentage of positive cases bodes well for the county, said Dr. Rabaglia. She expects the percentage to decline further as testing capacity ramps up.

Another useful metric – and one the state is monitoring closely – is hospitalization rates. Presently, Dallas County has an 18% rate of hospitalization for COVID-19 patients. Of those, 67% are less than 65 years old, 50% have no underlying health conditions, 32% are in the ICU, and 19% require mechanical ventilators.

While our understanding of the virus and its presence in our community has improved, there are still unknowns that complicate a return to normalcy. The emergence of multiple strains of the coronavirus, for instance, could limit the efficacy of an eventual vaccine and prevent lasting immunity among individuals who have recovered from the virus, allowing for re-infection. Questions also remain about the disease’s prevalence in children, who, despite their presumed safety from the virus, can still be carriers and transmitters of COVID-19.

These unknowns make for a difficult, but doable, return to work. In an effort to simplify and consolidate guidance from local, state, and federal agencies, Parkland has developed the “High 5,” a set of key actions businesses can adopt to protect their employees and customers.

The first action is hygiene, such as frequent hand washing, respiratory etiquette (coughing and sneezing into a tissue or the bend of the arm), and regular deep cleaning of the workplace and high-touch surfaces. The second is implementation of screening procedures to test employees for both symptoms and potential exposure to infected individuals.

Parkland strongly recommends distancing and using masks. For distancing, employers should strive to keep at least six feet of space between workers, although more may be needed in environments with high levels of physical exertion, as initial evidence shows that droplets may travel further with heavy breathing. Physical barriers should also be considered, especially if safe distances cannot be kept. Masking is perhaps the most effective method of preventing spread, said Dr. Rabaglia. Blocking 90% of droplets going out and 70% of droplets coming in, masks – if worn uniformly – can reduce droplet exposure by more than 90%.

To realize the value of these practices, a culture of compliance and accountability is important. Parkland suggests appointing a “czar” to ensure adherence to established guidelines, particularly in tightly occupied environments or large spaces where oversight may be difficult.

“When you employ all of these, it is best in class. It is the best possible safety precautions we can take,” Dr. Rabaglia said.

Still, Parkland urges flexibility. If possible, businesses should continue to leverage work-from-home options. If in-person operations are needed, employers should consider implementing rotational schedules to cycle employees into the workplace. Businesses should also develop response plans, including the possibility of temporary closures, in the event of an employee testing positive, a wider company outbreak, or a resurgence of cases in the region.