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Why did some COVID-positive healthcare staff still go to work?


April 11, 2023

BOSTON , MA — Nearly 50 percent of COVID-positive healthcare workers continued working at least part of one day with symptoms, and about half of these returned to work at least an additional day, according to research at VA Boston Healthcare System published today in Infection Control & Hospital Epidemiology.

“Healthcare workers who were required to stay home with COVID symptoms continued to come to work anyway, despite the fact that COVID is very transmissible, even if paid leave was available,” said Dr. Katherine Linsenmeyer, lead author of the study, attending physician at VA Boston HCS, and assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine. “We wanted to know why.”

The observational cohort study included 255 healthcare workers at VA Boston HCS who tested positive for COVID-19 infection by polymerase chain reaction – or PCR – test, between Dec. 1, 2020, and Sept. 30, 2021. Presenteeism was defined as working at least part of a day while newly symptomatic with COVID-19. Those without presenteeism tested positive prior to the start of their shift and did not work with symptoms. Workers who reported COVID-19 symptoms during the study were sent an anonymous, confidential survey to explore rationales for presenteeism.

Healthcare workers with presenteeism did not differ significantly from those without with respect to age, sex, race, vaccination status, or whether they were providing direct patient care. Among all respondents, concerns over workload burden for coworkers and personal responsibility were endorsed more frequently than limits on paid leave or perceived expectations to work while sick.

“Providers faced a tough choice, and a perception that they knew how to take precautions to avoid getting others sick may have in turn led to a perception of decreased risk,” Linsenmeyer concluded. “We think new strategies are needed to help healthcare workers better reconcile their duty to do no harm with their duty to provide or support care. As we prepare to shed masks in medical centers, preventing presenteeism will only become more important.”

The study is available at

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