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flu season

Flu Season and Presenteeism: Why People Work Sick—and What Helps

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When flu symptoms start, staying home is the safer choice for coworkers and the people they serve. Yet workers may still go in because they feel able to do the job, worry about lost pay, or cannot arrange coverage. Here, presenteeism means attending or working while ill; it is different from absenteeism (being away from work) and from working remotely rather than on-site.

Should you go to work with flu symptoms?

CDC’s current general respiratory-virus guidance advises staying home and away from others when you have respiratory symptoms that are not better explained by another cause. CDC’s flu-prevention advice is direct: “If you begin to feel sick while at work, go home as soon as possible.” That wording appears on its Healthy Habits to Prevent Flu page, updated September 1, 2026.

Remote work is not the same as going to the workplace: working from home can avoid exposing colleagues on-site, but it still means working while ill rather than resting or taking paid sick leave. Whether remote work is practical depends on the job and how the worker feels.

An archived CDC business page advised staying home until at least 24 hours had passed since both overall symptoms began improving and fever ended without fever-reducing medicine. Because that advice is from an archived page, it should not replace current guidance or applicable workplace, occupational-health, or healthcare-setting instructions. See the archived CDC business guidance.

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How common is working while sick?

There is no universal current estimate for all workers. The clearest quantified example here is a CDC/NIOSH-reported survey of healthcare personnel during the 2014–2015 influenza season. In a national opt-in internet panel of 1,914 healthcare personnel, 414 reported influenza-like illness, defined as fever plus cough or sore throat. Of those 414, 183 (41.4%) said they worked while ill; the median reported duration was three days. The figure describes that subgroup and season, not today’s workforce generally. The panel was nonprobability-based and the responses self-reported.

The journal abstract reported higher occupation-specific rates among pharmacists (67.2%) and physicians (63.2%); hospital-based personnel had the highest setting rate (49.3%). Those figures are specific to the same study and should not be treated as representative rates for every workplace. The CDC/NIOSH summary and the original study record are available from NIOSH’s 2018 bulletin and the American Journal of Infection Control study record.

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Why do people work while ill?

In the healthcare-personnel survey, workers most often described a mix of personal judgment and workplace pressure. Common reasons included:

  • They believed they could still perform their job duties or did not feel ill enough to miss work.
  • They did not think they were contagious or could make others sick.
  • They felt a professional obligation to coworkers.
  • They had difficulty finding someone to cover their work.

Healthcare personnel in long-term care most frequently cited being unable to afford lost pay. That makes the practical point clear: reminders about transmission risk may not be enough if workers cannot afford to stay home or essential duties have no backup. In the bulletin, NIOSH medical officer Sophia Chiu, MD, MPH, wrote, “Working while ill, or presenteeism, increases the likelihood of influenza transmission to coworkers and patients.” Her statement concerns healthcare workers and the people they care for.

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What paid leave and workplace norms can change

A 2020 CDC study of workers aged 19–64 with medically attended acute respiratory illness or influenza during the 2017–2018 season found that access to paid leave was associated with fewer days worked during illness, both overall and at the usual workplace. Workers who said their employer discouraged coming in with influenza-like symptoms were less likely to attend their usual workplace. These are observational associations in a defined study population, not proof that any one policy causes a specific result.

Telework access in that study was associated with more days worked overall while ill, but not more days at the usual workplace. This distinction matters: telework may reduce on-site exposure while allowing work to continue, but it does not provide time away from work. The study is published in CDC’s Emerging Infectious Diseases journal.

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During the high-severity 2017–2018 U.S. flu season, health-related workplace absenteeism rose sharply in November and peaked in January, according to a CDC analysis. That is an absenteeism measure from a historical season—not a presenteeism estimate or a forecast for a future season. See the CDC MMWR analysis.

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What employers can do to reduce flu spread at work

CDC advises employers to provide paid time off and create flexible leave and telework policies so workers can stay home when sick or care for sick family members. The practical aim is to make the safer choice feasible, not merely to tell workers to make it.

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  • Make sick leave usable. Flexible, nonpunitive leave can help employees stay home rather than choosing between health and income.
  • Plan coverage. Cross-train coworkers and identify essential tasks that need backup so one person’s absence does not leave critical work uncovered.
  • Set a clear expectation. Explain that workers with flu-like symptoms should not come to the usual workplace, and that someone who becomes sick at work should leave as soon as possible.
  • Offer telework where it fits. Remote work can prevent an on-site visit, but should not be framed as equivalent to sick leave or recovery time.
  • Make prevention supplies accessible. Maintain tissues, soap, paper towels, alcohol-based hand rub, and disposable wipes; routinely clean frequently touched objects and surfaces.
  • Make vaccination accessible. CDC says annual flu vaccination is the single best way to reduce the risk of seasonal flu and potentially serious complications. Employers can help workers find out whether on-site vaccination is available.

For healthcare settings, the considerations are stricter because workers may expose patients as well as colleagues. CDC recommends nonpunitive, flexible sick-leave policies consistent with public-health guidance to allow and encourage healthcare personnel with suspected or confirmed influenza to stay home. Patient-care precautions and facility rules should be handled through occupational health and applicable healthcare-setting guidance; see CDC guidance for healthcare settings.

Workplace options at a glance

Option What it addresses Important distinction
Paid sick leave Time away from work without losing pay, when available under the employer’s policy. In the 2017–2018 worker study, access was associated with fewer days worked during illness; the finding is not proof of causation.
Flexible, nonpunitive leave Reduces practical and social barriers to following stay-home advice. CDC recommends this approach; healthcare facilities should align policies with applicable public-health and facility guidance.
Telework Can avoid attendance at the usual workplace when a job can be done remotely. It is still work while ill. In the cited study, access was associated with more days worked overall while ill, but not more usual-workplace days.
Coverage and cross-training Makes absence workable when duties otherwise fall to a single employee. CDC recommends cross-training coworkers to cover essential work.
Vaccination and hygiene supplies Support prevention at work through annual vaccination access and everyday hygiene measures. Supplies do not make it safe to attend work while contagious and do not treat flu.

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