A global health survey that fielded responses from people in almost 50 countries suggests the vast majority of workers would continue to go into work while experiencing symptoms of sickness, with many indicating they'd still turn up even with flu-like symptoms.
Before we go any further, it's worth pointing out the survey was conducted between late 2018 and early 2019 – nearly a year before the current COVID-19 pandemic gripping the world showed up, inevitably affecting how most of us think and feel about transmissible infections.
Nonetheless, the findings make particularly sobering reading in the era of this coronavirus affliction, revealing the extent to which most people would otherwise ordinarily keep showing up for work, even when they're ill and really should be staying at home.
This phenomenon is known as 'presenteeism', and the researchers behind the new study say their findings are only more relevant now that we have coronavirus in the equation too.
"It was bad enough before COVID-19 when it was just influenza and other respiratory viruses," says infectious diseases physician Peter Collignon from the Australian National University (ANU).
"But, now we have coronavirus it is more important than ever not go to work when you are unwell."
With a view to investigating the factors that drive presenteeism – especially in the context of medical care, where health care workers (HCWs) with an illness may end up unwittingly exposing patients to their infections – Collignon and his team conducted an online questionnaire.
The cross-sectional, anonymous survey was distributed through institutional groups working in healthcare settings, which helps explain why almost half (46.7 percent) of the 533 respondents were HCWs (physicians and nurses), with the remainder of participants (53.2 percent) being non-HCWs.
Regardless of where they worked though, the respondents' tendency for presenteeism was about the same across the board, with 312 of the respondents (58.5 percent) indicating they would continue to turn up to work with influenza-like illnesses (ILIs) – including things like a sore throat, muscle aches, headaches, cold chills, and fever.
When sickness symptoms were present but were more minor and thus more manageable, people's tendency to head into work while unwell was even greater.
"Almost all HCWs (89.2 to 99.2 percent) and non-HCWs (80 to 96.5 percent) affirmed that they would go to work with non-febrile 'minor' ILI respiratory symptoms, including sore throat, sinus cold, fatigue, sneezing, runny nose, cough and reduced appetite," the authors write in their paper.
While there are some differences in the results between the HCWs and the non-HCWs who took part in the survey, the biggest takeaway from the study is that the majority of people in both camps indicate they'd still go to work when they're sick – a worrisome finding, especially since the result still holds even when the symptoms become more serious (and potentially dangerous).
"Our results suggest that most HCWs and non-HCWs would continue working despite 'minor' ILI, based on their individual judgement rather than objective criteria presenting an unnecessary risk to patient safety and public health," the researchers explain.
"Despite international guidelines, we note with concern that HCWs and non-HCWs would continue working despite 'major' ILI symptoms, such as fever, cold chills, muscle aches and headache."
As for why people continue to do this, the researchers cite a sense of obligation to their colleagues or organisation, or logistic and cultural factors. Other times, people may not feel 'sick enough' to justify taking time off, or they may run out of sick leave, or not have paid sick leave in the first place.
"The decision to work through illness is a complex phenomenon and is shaped not only by personal factors or lack of knowledge regarding the importance of the risk of transmission but, more importantly, it is inherent in the organisational culture and policies with financial penalties, which may place possible constraints on absenteeism, thus resulting in presenteeism," the team explains.
The researchers freely acknowledge numerous limitations in their study. Mostly, these involve how the survey was distributed, meaning the results are not random, and may reflect certain biases – for example, towards people with internet access, and people who work in health.
Despite these factors, they suggest there's enough in the data here to offer some meaningful (and concerning) findings about how most people, more often than not, indicate they would still go to work through a sickness.
No matter how good people's intentions are, that's something that has to change, the researchers say, especially with something as transmissible and dangerous as coronavirus in our midst.
"Doctors and nurses might feel they need to go out of their way to help others, but it is best for everyone if they do not present to work if unwell," Collignon says.
"It was bad before COVID-19 and now we are in a pandemic, going to work sick is just unacceptable."
The findings are reported in PLOS One.