Studies explore working in a pandemic, working sick

Lisa Schnirring

Sep 30, 2010 (CIDRAP News) A new study suggests that about half of essential workers, such as police and emergency medical personnel, might be unwilling to work during a serious pandemic. Meanwhile, another study indicates that it's common for employees in private industry to work while sick with flu-like symptoms.

Both studies were published on Sep 25 in an early online edition of the Journal of Occupational and Environmental Medicine.

In the first study, the goals of researchers from Columbia University's Mailman School of Public Health were to assess the ability and willingness to work specifically during a pandemic and to gauge the opinions of not just healthcare workers, but alsofor the first timeworkers from other essential sectors such as police, emergency services personnel, public health workers, and corrections officers.

Researchers in the second study conducted a monthly survey of workers from three US companies to explore if flexible sick leave policies influenced employee decisions to work while sick with a flu-like illness.

The US Centers for Disease Control and Prevention (CDC) has addressed both topicsrisky work settings and flexible sick leave policies as a possible social distancing measurein its pandemic guidance materials for employers.

Working in a severe pandemic setting
The Columbia University researchers recruited workers from Nassau County, in the New York City metropolitan area. The anonymous surveys asked employees about their ability and willingness to work during a serious pandemic. It was conducted from November 2008 to June 2009, a time that overlapped the first few months of the H1N1 pandemic. The survey also asked workers about their flu vaccination history, respiratory protection knowledge and use, workplace climate and trust, and employer pandemic planning.

They found that though 80% of workers would be available to report for duty in a severe pandemic, only 65% were willing. Less than 50% of the essential workers were both willing and able to report for duty. The proportion who said they were willing ranged from 56% in correctional workers to 74% in public health employees.

Investigators found that ability to work during a severe pandemic was closely linked to personal obligations, such as caring for children or sick family members.

Dr Robyn Gershon, professor of clinical sociomedical sciences at Columbia's Mailman School of Public Health, said in a Sep 28 press release that employer policies and programs can help workers meet their home obligations. "Even something as simple as making sure workers can communicate with their families while they are on duty can have a big impact on ability and willingness," she said.

Among other findings, authors learned that participants had little confidence in respiratory protection, but would wear it at work in a pandemic setting. Only 9% reported they were aware of their employers' pandemic plans, and only 15% said they had received training.

In what they called a surprising finding, the group found that 12% of study participants would consider retiring or leaving their jobs rather than reporting for duty in a severe pandemic. They said that outcome is a concern, due to a rapidly aging US workforce, many of whom are public service workers. "The development of strategies to retain these most experienced workers during public health emergencies remains an area for future exploration," they wrote.

The authors recommended other simple strategies that employers can use to boost employee support during a pandemic, including a plan to vaccinate essential workers and their families as soon as a vaccine is available, getting guidance in advance about respiratory protection needs, and making sure employees know about the workplace pandemic plan.

The study group included many workers who were involved in the response to the Sep 11, 2001, World Trade Center terror attack, and the authors wrote that they, like other workers in the area, are "highly motivated and altruistic." They cautioned that other workers in other areas might not be as responsive, and they recommended that further studies include essential employees in other geographic areas along with other types of essential workers, such as those in telecommunications, transportation, and commerce.

Which policies keep sick employees home?
In the flexible sick leave study, researchers recruited employees from three large US firmsa retail chain, a durable goods manufacturer, and a transportation companyand used a Web-based survey tool that asked them each month between November 2007 and April 2008 about flulike illnesses and workplace attendance. They also collected demographic information and details about employer-provided flexible sick leave policies, such as ability to work from home, adjustable working hours, or time off without pay.

Among 793 employees who said they were sick with a flulike illness, average duration of a severe infection was 3 days. About 72% said they worked while they had severe flu symptoms, on average for about 1.3 days.

The only flexible sick leave policy that was associated with working while sick was the ability to work from home. Those who were able to telecommute were 29.7% less likely to come to work sick with severe flu symptoms.

Researchers pointed out that the study is one of the first evaluations of the CDC's recommendation to institute flexible workplace policies in advance of flu season.

They recognized that though social distancing makes sense, employers who are setting their personnel policies must weigh possible unintended consequences of telecommuting, such as shirking work responsibilities, against the drawbacks of working while sick.

However, they wrote that the ability to work from home minimizes the economic impact of the employee being away from the workplace.

The group concluded that the findings support CDC social distancing recommendations for flu seasons. "When feasible, employers that implement teleworking policies may be able to effectively reduce the likelihood of employee-to-employee transmission of respiratory illnesses, such as seasonal of pandemic influenza," they wrote.