Investigating the Role of Exposure Management and Presenteeism in Occupational Covid-19 Transmission Among Healthcare Personnel

The SARS-CoV-2 pandemic had a swift and severe impact on healthcare facilities worldwide. Healthcare-based infection prevention and control programs deployed transmission reduction strategies at an unprecedented scale and intensity. Among these strategies were efforts to identify and remove exposed and symptomatic healthcare personnel (HCP) from the workplace. This research had two aims. First, we evaluated an exposure management program instituted at University of North Carolina Medical Center (UNC-MC) from March 2020 through June 2021. This analysis found that compared with standard illness management that relies on HCP to self-report symptoms or positive tests and stay home, exposure management strategies (contact tracing and monitoring self-reported exposures) reduced the hours that a COVID-positive HCP worked while infectious, hours worked while symptomatic, and to a lesser extent, onward exposures and secondary cases. Likely due to the many other COVID-19 mitigation strategies in place at UNC-MC, secondary HCP cases were low overall. This translated to low efficiency in exposure management over the 15-month study period, with UNC-MC staff tracing and monitoring hundreds to thousands of HCP exposures per secondary HCP case prevented. The second aim examined presenteeism, defined as working in person with acute respiratory illness (ARI) symptoms, specifically fever plus cough and/or sore throat. We characterized the occurrence and motivations of presenteeism across two pandemic phases, pre-Omicron (2020-2021) and Omicron BA.1 (2022). Analysis of survey data found that 24 to 32% of healthcare personnel reported working with ARI. HCP reported many motivations for presenteeism, including concerns about employment impact and sick leave in the pre-Omicron era and, during the Omicron era, low COVID-19 risk perception and pressures from workplace culture. Presenteeism was associated with seeing sick colleagues at work, hearing criticism of HCP who stayed home, feeling professionally obligated to work, and unclear call-out procedures. Infection prevention and control during pandemics requires understanding not only the effectiveness of institutional interventions but also the behavioral and structural factors that shape HCP behavior. Improving response in future pandemics will require more agile and resource-efficient exposure management models, and a stronger evidence base for interventions that address the underlying motivators of presenteeism.