Trends in Working While Sick in the Aftermath of the COVID-19 Pandemic

• In Event: Paid Sick Leave Policies and Precarious Work in the Context of the COVID-19 Pandemic

Abstract

Prior to the COVID-19 pandemic, working while sick (also called “sickness presenteeism”) was common, with an estimated prevalence of 2% of US workers in any given week. Working while sick poses risks beyond the individual by increasing the spread of infectious diseases, a fact made apparent during the COVID-19 pandemic. Early evidence suggested that working while sick may have declined during the pandemic, with possible explanations including expansions in paid sick leave, declines in illness, and normative changes in attitudes toward presenteeism. However, evidence for these trends does not extend beyond the peak of the COVID-19 pandemic. Further, much of the available evidence focuses on workers who were able to transition into remote work, where working while sick takes on a different meaning with more limited public health implications. 

We address these gaps in the literature by examining trends in working while sick using longitudinal repeated cross-sections of survey data collected from fall 2017 through spring 2024 from samples of service sector workers in retail, food, and related industries who had few, if any, opportunities to work remotely. We estimate multinomial logistic regression models with a 3-level outcome: whether a respondent worked while sick, stayed home while sick, or was not sick during the reference period. Adjusted models control for (a) demographics, (b) job characteristics, (c) paid sick leave benefits and residence in a state with a paid sick leave law, (d) residence in a state with a mask mandate, and (e) local influenza rates. 

Consistent with prior evidence, we find that working while sick dropped significantly in the first year of the COVID-19 pandemic. Incorporating more recent survey waves, however, reveals a “u-shaped” curve, where working while sick gradually increased from the nadir in fall 2020 until approximately spring 2023, when rates returned to near pre-pandemic levels. Further examining these changes in a series of nested models, we find little evidence that access to paid sick leave explained the reduction in working while sick.  Instead, this u-shaped curve appears to be due to both normative changes in attitudes toward presenteeism and lower rates of illness. More workers reported staying home from work when sick after the pandemic began, an increase that persists, albeit attenuated, in the post-pandemic years. At the same time, fewer workers reported being sick in the first pandemic years. Reports of being sick gradually return to baseline starting in 2021, mirroring contemporaneous increases in working while sick. 

This paper provides new evidence to understand trends in working while sick following the onset of the COVID-19 pandemic. While normative attitudes shifted away from working while sick, these changes only account for small reductions in working while sick. Instead, large but temporary reductions in illness during the height of the pandemic likely account for most of the reductions in working while sick. This suggests that pressures to work while sick that existed before the pandemic did not meaningfully dissipate, at least among service sector workers whose incomes are often tied to being physically present in the workplace.

Authors

• Julia M. Goodman, OHSU/Oregon Institute of Occupational Health Sciences
  Presenting Author

• Daniel Schneider, Harvard University
  Non-Presenting Co-Author

• Kristen Harknett, University of California, San Francisco
  Non-Presenting Co-Author