Will Covid-19 change how we think about sickness absence?

The fact Covid-19 can cause anything from short-term illness through to longer term hospitalisation and even months of ‘long Covid’ may force us profoundly to rethink our attitudes to workplace sickness absence, argues Mike O’Donnell. Lessons from the past may also be helpful here.

Whichever way we look at it, the Covid-19 pandemic has reshaped many of our working practices, maybe forever.

Along with employers embracing home working and realising that it may benefit productivity and performance, employees are realising that it is, at best, a mixed blessing. Giving up the commute on crowded trains or buses, is a definite benefit.

However, trying to work in cramped, un-ergonomic home offices can be a struggle, particularly if there are two of you trying to work and the children are not at school. One form of work stressor has been replaced by another.

Altering perceptions of sickness and disease

It is not just working practices that are altering, but our perception of sickness and disease. When I qualified in medicine in the mid-1970s, it was not remotely unusual for people to take a week off sick with a cold.

I remember that when I was at school, I only had to mention a sore throat to my mother to be sent to bed for the day. Since then, levels of sickness absence have fallen. In 2002 the Chartered Institute of Personnel and Development reported that average sickness absence in their member organisations averaged around 10 days a year. Most recently, in 2019, it reported this had fallen to just under six days annually.

What has accounted for this change? Well, my view is that we became blasé about minor illnesses such as colds and mild flu because they rarely have long-term consequences and usually get better within a few days.

If we think back to the 1940s and 1950s, however, life was vastly different. There were no immunisations apart from for smallpox and diphtheria, but uptake for diphtheria was low in pre-NHS days.

The formation of the NHS coincided with the introduction of new vaccines and the means to provide mass vaccination programmes, so that by 1953 immunisation against diphtheria, TB and whooping cough had been introduced, followed by polio in 1956. After this, measles, rubella and mumps followed, with a major change in the pattern of infectious diseases.

Not surprisingly, it took a generation or more for people’s memories of these diseases to disappear. If you think that a mild cold and fever could at one stage have been an early sign of polio and that bed rest could help prevent paralysis while limiting the number of people you could infect, you can imagine people being very angry with you if you turned up to work with those symptoms.

I remember one older boy at school who had an ugly tracheotomy scar as his legacy from diphtheria.

Now we are back to the situation where you are told to self-isolate if you have a feverish cold.

Short-term absenteeism and presenteeism

Some people argue that younger employees have nothing to fear and we should be relaxed about the infection spreading among them, but as the disease spreads widely among them, the risk to older people increases too.

We are also starting to understand how long Covid-19 is affecting some people. In many cases, the syndrome appears to be caused by an overreacting immune system causing tiny blood clots throughout the body, with lung, heart or kidney damage, or even all three.

In other cases, it may be more like post-viral fatigue, which we all know can lead to chronic fatigue syndrome with its legacy of debility. No-one is going to want to expose their employees to that risk, and therefore employers will need to push less for people to come in to work when they feel unwell.

This means that a higher level of short-term absenteeism is likely to become the norm for the foreseeable future. We now know that such pandemics are likely to become more frequent for a variety of reasons and we shall all have to be more cautious in future.

It is no coincidence that in Asia, where SARS, an earlier coronavirus pandemic, broke out in 2002 people were already much more cautious and mask wearing was already commonplace.

In summary, I believe sickness absence is likely to increase for the following three reasons:

1. The virus itself makes people too unwell to work in the short term.
2. We are asking people who are infected and their close contacts to self-isolate.
3. Long Covid-19 is affecting an indeterminate, but not insignificant number of people who have apparently recovered from the acute episode. A proportion of these people may never return to work.

Finally, we all know that a car engine runs most efficiently and for longer if operated at cruising speed, with regular servicing, rather than at full throttle continuously.

Employers will need to take their feet off the accelerator and introduce some slack into the system if they are going to be able to accommodate the new reality.

That is not to say that occasionally running at full power will be harmful or that staff should be left to rust in the garage with only occasional short outings.

The focus, rather, should be on optimal rather than maximal performance. Who knows? it may be that other absences for stress-related illnesses could even fall with a different focus.

The introduction of vaccines is likely to mitigate many of these problems, but it would be a brave person indeed who said that things will return to the previous low norm for sickness absence any time soon.

Mike O’Donnell is chief medical officer at Cirencester Friendly Society

References
“A Review of Current Research into Absence Management”, Darcy Hill and Sue Hayday, Institute for Employment Studies, 2003, https://www.employment-studies.co.uk/system/files/resources/files/mp23.pdf

“Health and Well-being at Work”, CIPD and Simplyhealth, April 2019, https://www.cipd.co.uk/Images/health-and-well-being-at-work-2019.v1_tcm18-55881.pdf

“Childhood vaccination and the NHS”, People’s history of the NHS, https://peopleshistorynhs.org/encyclopaedia/childhood-vaccination-and-the-nhs/