HJAR Jul/Aug 2020

24 JUL / AUG 2020  I  HEALTHCARE JOURNAL OF ARKANSAS PHARMACISTS All employees, including floaters, are noti- fied if they have been exposed to a co-work- er who tested positive, CVS said. Regarding whether employees are notified if they are as- signed to a store that has had previous cases of COVID-19, CVS said, “Employees who were not exposed and work subsequent shifts are in a work environment that has been deep cleaned or has had hourly or more regular cleanings.” Both a CDC report and a New England Journal of Medicine study flagged staff mem- bers who work inmultiple facilities as a factor in the hundreds of cases of COVID-19 associ- ated with the Life Care Center of Kirkland, a nursing home in King County, Washington, and to the spread of the virus to other nurs- ing homes in the area. “It’s a common prac- tice within the nursing industry and within health care to work in multiple places,” said Timothy Killian, a spokesperson for Life Care Centers of America, which manages more than 200 long-term care facilities nation- wide, acknowledging that “it was possible” that such mobile workers “contributed to the spread of COVID-19.” An employee at a Walgreens in Houston who tested positive worked at other store lo- cations while infectious, in close contact with fellow employees, according to an informal complaint submitted in March to the Occu- pational Safety and Health Administration. “The employer is aware of this information and has not communicated that to other em- ployees, nor allowed them to self-quarantine for 14 days as per current CDC guidelines,” a summary of the complaint stated. Walgreens said that it used contact tracing to investigate the complaint, which involved a pharmacist who worked at two stores. It then informed OSHA that the complaint was inaccurate, it said. “All employees who were deemed in close contact with the teammem- ber were asked to self-quarantine at home and put on paid leave,”Walgreens said. “None of the employees that worked with this team member tested positive for COVID-19.” Af- ter receiving the company’s response, OSHA closed the complaint. Recognizing the propensity to increase contagion, some long-term care facilities and nursing homes, including Life Care Centers, have discontinued the practice of having staff float from one facility to another. “When we got notified about the first case, we stopped that right away and put in place a policy that if a nurse had a job elsewhere we wouldmake them choose one location,” Killian said. In April, the Centers for Medicare and Medicaid Services advised long-term care facilities that “staff as much as possible should not work across units or floors.” Floaters are often younger graduates of pharmacy schools, though many late-career pharmacists also take up the role, prizing its freedom from the demands of a single store’s bureaucracy. Neither CVS nor Walgreens provides information on the percentage of its workforce — some half a million workers combined — that floats. Many large companies have come to rely on a temporary pool of workers, whether they are in-house or drawn from an agency, said Susan Houseman, the director of research at the Upjohn Institute for Employment Re- search, a think tank in Kalamazoo, Michigan. “This kind of on-demand workforce, where workers just appear as regular employees but have unpredictable schedules, is very prevalent in retail, restaurants and across the hospitality industry,” she said. Such pre- carious work schedules can make it difficult for temps, substitutes, floaters and part-time employees to benefit from the same safety precautions as their stationary counterparts, she added. Whitney Abbott floated for about nine years as a pharmacist, traveling anywhere within a two-hour radius, until she settled at a Walgreens in Columbia, South Carolina. She’s witnessed firsthand the pressures on current floaters to pick up part-time work. “If you see a shift pop up, even if it’s in a hot spot, you can’t really afford to turn it down,” she said. Now the ex-floater is worried that floaters taking shifts at her location may be carry- ing the virus. After a co-worker contracted the virus from an unknown source, Abbott, who is in her third trimester of pregnancy, was recently quarantined for possible ex- posure. Multiple floaters have been filling in for her. “They could have come from a town that was a hot spot and potentially brought it into our store,” she said, “and the next day they could be back in a small town where everyone knows everybody.” Such a travel dynamic is “exactly how a virus like this keeps spreading,” according to Colin Furness, an infection control epi- demiologist and assistant professor at the University of Toronto. “The disease follows people,”he said. “So if there’s a higher risk in a populated area, and you travel to a rural area, you are bringing the disease from a higher- risk area to a lower-risk area.” Conditions at CVS and Walgreens may heighten the dangers for floaters and for those who come into contact with them. De- pending on a store’s layout, recommended social distancing measures can be difficult if not impossible to enforce behind the coun- ter. “Our locations are too small to socially distance while we work, so we’re potentially exposing all sorts of people,” said Fram, the Walgreens tech in Manhattan, who spends hours in the same small space as colleagues. Despite the cleanings stipulated by both Walgreens and CVS, employees said that it is difficult to clean stores frequently and that supplies remain scarce. When someone test- ed positive at one of the CVS stores where the Dallas floater worked, the people in charge