In a recent article published within the Infection Control & Hospital Epidemiology Journal, researchers conducted an observational cohort study amongst all healthcare employees (HCWs) of the Veterans Affairs Boston Healthcare System (VABHS) in america of America (USA) between December 1, 2020, and September 30, 2021.

They pursued evidence of sickness presenteeism, i.e., working while sick, in HCWs with reverse transcription-polymerase chain response (RT-PCR)-confirmed coronavirus disease 2019 (COVID-19).

Study: Sickness presenteeism in healthcare employees throughout the coronavirus disease 2019 (COVID-19) pandemic: An observational cohort study. Image Credit: DavidHerraezCalzada/Shutterstock.com

Background

Despite increased risks of nosocomial infection as a consequence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) than influenza, HCWs with COVID-19 demonstrated presenteeism.

Quite a few studies reported nosocomial COVID-19 outbreaks as a consequence of symptomatic healthcare professionals. Yet, there may be an absence of studies investigating the incidence of sickness presenteeism in SARS-CoV-2-infected HCWs and the rationale behind doing so.

Concerning the study

In the current study, researchers ensured that every one VABHS employees participated, including those not involved in direct patient care.

Throughout the study statement window, they asked them to self-review their COVID-19 symptoms day by day and leave work if experiencing symptoms. The team arranged for weekly or biweekly surveillance testing for all HCWs, especially those working in long-term care units.

In addition they gathered COVID-19 test results of employees working outside of VA Boston. For all HCWs who contracted COVID-19 as a consequence of community exposure or during contact tracing, the researchers arranged free, onsite testing and mandated it for those having COVID-19 symptoms.

On the time of the COVID-19 diagnosis, the team asked all HCWs to fill out a structured health interview, which helped them assess the time of symptoms onset, if present, and their variety of working days on campus while symptomatic.

Some HCWs worked on campus for some days while newly symptomatic as a consequence of COVID-19. The team also distributed an anonymous survey amongst all HCWs between October 21 and November 21, 2021, to explore each individual’s rationales for sickness presenteeism.

Study findings

Of nearly 4,000 HCWs at VABHS, 327 tested COVID-19 positive throughout the study period, of which 255 were assessed by the researchers with the assistance of a structured interview.

The prevalence of sickness presenteeism amongst these HCWs with symptomatic COVID-19 was 49.8% (127/255). That they had similar age, gender, vaccination status, or race as those without presenteeism.

Of all symptomatic HCWs, 26% (66/255) worked for no less than a while during a day when diagnosed but returned to work for added days with symptoms.

Regarding the sort of symptoms, some HCWs had specific (cough or shortness of breath), whereas others had nonspecific (headache or fatigue) symptoms (168 vs. 87). Strikingly, the rates of presenteeism didn’t vary markedly for HCWs with either sort of symptoms.

About 168 of 255 symptomatic HCWs had a minimum of 1 COVID-19–specific symptom, yet, 47% (79/168) worked while symptomatic. Of 87 HCWs with nonspecific symptoms, 54% worked while symptomatic.

Intriguingly, mandatory surveillance 3 times more likely identified HCWs with sickness presenteeism. It reflects that many aspects promote sickness presenteeism in healthcare settings; thus, targeted surveillance in such high-risk settings is crucial. It could help reduce the risks amongst HCWs who don’t undergo testing or misread their symptoms.

A complete of 52 HCWs, i.e., 20.4% of HCWs, accomplished the follow-up survey, wherein 79% self-reported working within the previous 12 months with a minimum of 1 COVID-19 symptom. Over 50% of respondents self-reported working with fatigue, headache, and nasal symptoms.

Nonetheless, they attributed these symptoms to not COVID-19 only. In 37%, 27%, 23%, and 15% of cases, they attributed these symptoms to allergies, colds, migraine, inadequate sleep, and mild COVID-19, respectively.

Strikingly, many HCWs demonstrated sickness presenteeism because they’d concerns over increased workload on colleagues and private responsibility, 66% and 45%, respectively.

Fewer, i.e., 19% and 10%, showed concerns about paid leaves and expectation to work while sick, respectively. There’s a necessity for novel strategies to assist HCWs with COVID-19 resume work while alleviating concerns about fulfilling their duties, most significantly, patient care without doing any harm.

Conclusions

In accordance with the authors, that is certainly one of the pioneering works estimating the prevalence of COVID-19-related sickness presenteeism.

Remarkably, this study demonstrated that presenteeism rates didn’t vary for HCWs working directly with patients, indicating that the perceived disease transmission risk from HCW to the patient didn’t alter decisions about sickness presenteeism.

One other insight provided by this study was that greater than 50% of HCWs with sickness presenteeism experienced nonspecific symptoms and never COVID-19-specific symptoms.

Perhaps they experienced these symptoms as a consequence of health issues, e.g., sleep inadequacy. Also, they perceived they were aware of taking precautionary measures to not infect others, including their patients.

Overall, the survey response rate was relatively low, but those that responded well represented your entire cohort concerning demography and symptoms; thus, the study estimate of 49.8% sickness presenteeism in HCWs with COVID-19 must be considered a maximum.