Substitute pharmacists warn their co-workers: We’ll probably bring the virus to you

The pharmacist, who requested anonymity because he was not authorized to talk to the media, eventually worked his way up to become a full-time manager at a store in Dallas. But recently he's returned to floating, this time at CVS, preferring its flexible hours. In the past three months, he's traveled between 10 stores.

As the pandemic rages on, though, he wonders if he's made a terrible mistake. When he shows up at a store, he said, he's not told whether any employees have shown symptoms or tested positive, so he doesn't know if he's at risk. On two occasions, the Dallas floater said, he only heard from colleagues after he started his shift that they had just been working alongside someone who was self-isolating with COVID-19 symptoms. Because his temporary co-workers had not shown symptoms, they were not advised to quarantine.

"There's no heads-up," he said. "It's terrifying to learn about it after you show up, if at all." Even more terrifying, he added, is the possibility that he and other floaters are catching the virus and unwittingly spreading it to other stores.

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Floaters are common in hospitals, nursing homes and pharmacies, and they play a critical role in making sure that these facilities have enough staff to properly care for patients. But in a pandemic, workers who pitch in at multiple sites could be at higher risk of both contracting and spreading the coronavirus, forming an overlooked link in the chain of transmission. They may catch the virus at one location, and once they're reassigned, carry it to their next stop.

"It's absolutely a concern to move people around where there's active transmission, some of whom might be susceptible," said Denis Nash, a professor of epidemiology at CUNY School of Public Health. "It puts the floater pharmacist at risk, and it potentially seeds transmission where it might not otherwise happen."

At pharmacies, some floaters are full-time employees. Others, including the Dallas floater, work part time for a specific chain; they don't qualify for general sick leave, although they do get two weeks' paid leave if they contract the coronavirus. Most are given schedules weeks in advance. But with pharmacies needing immediate replacements for people who have tested positive or fallen ill, floaters said that they are being given shorter notice than usual about where they'll be working next — and little information about whether anyone there has been exposed or infected.

Fifteen employees at CVS and Walgreens, the country's two largest retail pharmacy chains, told ProPublica that floaters are not given information about whether any employee has gotten sick with the coronavirus at a store when they show up to work there. One floater told ProPublica that he has worked in as many as 20 stores in the past month without being told about any infections before he showed up at a location. Several floaters said that managers at both companies refused to fill them in about potential exposure, citing privacy laws. Those privacy laws do not apply, experts told ProPublica. The Centers for Disease Control and Prevention guidelines advise employers to inform employees about possible exposure to the coronavirus in the workplace.

A floater in Ohio, who works at about a dozen Walgreens a month, said he warns his colleagues that he may endanger them. "I always tell people, 'Definitely stay away from me, don't get close to me, because as the floater, I'll probably be the one who is going to bring the virus to you,'" he said.

The use of floaters "is just going to turn pharmacies into hot spots," said John Fram, a senior pharmacy tech at a Walgreens in New York City. "Techs and pharmacists who worked with positive employees or work within a hospital are still moving around working at lots of other stores in the city." Fram said that a tech who took a shift at his store had previously worked at a Walgreens in Chelsea where ProPublica reported an outbreak of the virus among at least three employees in April.

Walgreens said that, to help reduce the risk of exposure, it is taking steps to limit the number of stores where floaters are working and "to fill open shifts with the same individuals as much as possible." When notified of a confirmed or presumed case of COVID-19, it said, its responses include "identifying and contacting individuals who may be at risk in order to self-quarantine or self-monitor their health, as well as cleaning and disinfecting impacted areas of the store or the entire location."

While there were pharmacists at the Chelsea location who worked at other stores, "none were ever presumed positive or in contact with someone who was presumed positive," Walgreens said.

CVS said it has introduced policies to ensure the safety of employees, whether they work at a single location or are part of the "subset of pharmacists who 'float' between different store locations." Those policies include requiring employees to wear masks; installing protective shields at counters and checkout stations; hourly cleanings for hard surfaces; and a wellness and temperature check before an employee begins a shift.

All employees, including floaters, are notified if they have been exposed to a co-worker who tested positive, CVS said. Regarding whether employees are notified if they are assigned 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 members who work in multiple facilities as a factor in the hundreds of cases of COVID-19 associated with the Life Care Center of Kirkland, a nursing home in King County, Washington, and to the spread of the virus to other nursing homes in the area. "It's a common practice 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 nationwide, 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 locations while infectious, in close contact with fellow employees, according to an informal complaint submitted in March to the Occupational Safety and Health Administration. "The employer is aware of this information and has not communicated that to other employees, 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 team member 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." After 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 would make 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 Research, 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 precarious 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 carrying 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 exposure. 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 epidemiologist 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. Depending on a store's layout, recommended social distancing measures can be difficult if not impossible to enforce behind the counter. "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 tested positive at one of the CVS stores where the Dallas floater worked, the people in charge of sanitizing it were the pharmacist and the lead technician, who cleaned the counters, keyboards and phones with Lysol wipes. It was a valiant effort, he said, but hardly the work of professionals.

CVS and Walgreens did not respond to questions about employee complaints that it's hard to maintain social distance and that cleaning is inconsistent.

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Whether they're floaters or not, CVS and Walgreens employees say that management rarely tells them when a co-worker shows symptoms or tests positive. But employees stationed at a single location are more likely than their roving counterparts to learn about such developments by word of mouth. While managers "have avoided giving us any notifications when someone gets sick," said Fram, who stays put at the Walgreens in upper Manhattan, "it's such a tiny district that we all know each other's business."

Floaters said that they are unaware of what's happened not only before they've come into a store, but also after they've departed. In one case, a floater stopped working at a store, and days later an employee there fell sick; the floater said he was not informed at the time and still doesn't know whether he was also exposed or even the source of the exposure.

"Because you're not on a conference call or on a mailing list with a core group of employees and managers, you don't receive the same regular communications that others would," the Dallas floater said. "You are relying on others to play telephone with you about what's going on."

When employees notify CVS or Walgreens that they are presumed to have COVID-19 or have tested positive, they are advised to quarantine for two weeks, for which they can receive paid leave. The CDC advises that workplaces then identify and contact any individual who "has been within 6 feet of the infected employee for a prolonged period of time." In practice, however, each workplace exercises significant discretion to define what prolonged means and just how risky the exposure was.

One floater in Ohio described receiving a last-minute change to her schedule and showing up to a store where co-workers told her that there had been a confirmed case. "Everything was done secretively and the safety of the employees [was] endangered," the floater wrote in an email to ProPublica in April. "If the company is sending people to work in a store that recently has a positive case, they should tell the people what to expect. They should, at least, tell them what happened there and advise them to wear masks or take precautions."

Employees in several CVS and Walgreens stores say that district managers have referred to the Health Insurance Portability and Accountability Act, or HIPAA, as a justification for not informing them about their potential exposure. "They tell us it's HIPAA, but they really just don't want us to be scared or to have to shut down the store," said one pharmacist, who worked in a store where neither he nor floaters were told by managers that multiple workers had fallen ill with the virus.

HIPAA, however, does not apply to this situation, said Joy Pritts, the former chief privacy officer at the U.S. Department of Health and Human Services. "In this case, it's being used as a shield," she said. HIPAA protects health information shared between patients and providers in health care settings, but it does not govern the notifications employers may provide to employees in a pandemic, she added.

While the Americans with Disabilities Act requires employers to keep medical information about individual employees confidential, employers are encouraged by the CDC and local health agencies to communicate anonymized information that may prevent the spread of an infectious disease. "When businesses don't want to share information, they often blame privacy laws," Pritts said. "But they are often making a business calculation as to whether to share the health information, not a legal one."

CVS and Walgreens did not directly respond to questions about whether managers were improperly citing HIPAA when employees sought information about possible exposure. A Walgreens spokesperson said that HIPAA and other privacy policies do not "prevent us from identifying and contacting employees who may be at risk from exposure to COVID-19."

During the first week of April, the Dallas floater was offered an open shift at a store. CVS didn't tell him that there had been two positive cases at that location, but he was lucky enough to know the manager there, who tipped him off, he said.

Once again he faced the same grim calculus as so many part-time workers in America: risk exposure or lose a paycheck. "If I don't take the shift, there are plenty of other people who would be willing to pick up those hours," he said. "They will pull people from all over Texas if they need to fill that shift, and they are banking on somebody not caring about the risk to do it."

Nevertheless, he declined.

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