I have a confession. A few years ago I came to work when I was ill. Not desperately ill – but clammy-stay-in-bed-didn’t-want-to-ride-my-bike ill. Ill enough to stay away from work. But I was really busy and had loads to do. Working from home wasn’t really an option back then – you know, in the days when meetings were mainly face-to-face. Sure, you could dial in. But people often forgot you were there and couldn’t really hear you properly when you said something. So, I came to work. It was just before Christmas. And my gift to my office-sharer was a really nasty respiratory virus for Christmas.

I hope that COVID-19 has changed this culture of “presenteeism” (coming to work when ill) for good. Now we know from bitter experience that coming to work with symptoms of respiratory viruses results in their transmission to our patients and colleagues. And yet, presenteeism continues. A prospective study in the US following about 150 healthcare workers over two influenza seasons, and found that two thirds of these staff self-reported attending work for at least one day with symptoms of influenza.

A nice study in JAMA Paediatrics investigated the reasons behind this. This mixed methods analysis of a cross-sectional survey of around 500 staff working in a paediatric hospital found that whilst 95% of staff agreed that working whilst ill put their patients at risk, 83% of the staff had worked at least one day whilst ill in the past 12 months. Worryingly, about 10% of staff said they’d worked whilst ill on 5 separate occasions over the past 12 months. The key reasons for presenteeism were: not wanting to let colleagues down, staffing concerns, not wanting to let patients down, fear of ostracism by colleagues, and concerns about continuity of care. Some common themes in the free text responses were related to cultural norms about continuing to come to work unless “remarkably ill” (que this imaginatively titled article “You Have to Die Not to Come to Work”), and ambiguity about what “too sick to work” means.

If we are talking about the ‘hierarchy of controls’ to prevent COVID-19 in our healthcare workforce, then facemasks come at the bottom under ‘PPE’, “COVID-secure” offices come in the middle, but preventing presenteeism comes right at the top under ‘elimination’. And this is much broader than COVID-19 of course – other respiratory viruses and transmissible infectious diseases do exist. You don’t do anybody any favours by “soldiering on” and coming to work whilst sick. You’re a risk to your patients and colleagues, and the hole that you leave in the roster by transmitting whatever is making you ill to others is very likely to be bigger than the one that you fill by coming to work ill!

I have certainly learnt from the Christmas gift I gave to my colleague. I had a cold the other day and stayed firmly at home until my symptoms had resolved. Working from home is much easier now with virtual meetings etc but still a challenge for healthcare workers, especially those who spend most of their time with patients. I hope that the COVID-19 pandemic has kick-started a culture change to mean that coming to work when you are ill will be a thing of the past.