Health Care Personnel Absenteeism and Decision-Making Authority Across COVID-19 Pandemic Phases

Health care personnel (HCP) absenteeism during the COVID-19 pandemic threatened health system capacity during critical surge periods. Evolution of absenteeism patterns across pandemic phases and factors influencing decision-making remain poorly characterized. We hypothesized absenteeism shifted from employer-directed early in the pandemic to HCP self-determination later.

We analyzed HCP enrolled in Preventing Emerging Infections through Vaccine Effectiveness Testing (PREVENT), test-negative case-control studies, from November 2020 to April 2024 across 25 adiverse US health care facilities. We included 10,573 HCP tested for SARS-CoV-2 (4,920 positive, 5,653 negative) who completed standardized surveys about absenteeism, decision-making authority, and reasons for stopping work. Mixed-effects logistic and multinomial regression assessed associations between pandemic phase (Alpha, Delta, Omicron, post-Omicron), sociodemographic characteristics, and absenteeism outcomes, adjusting for age, race/ethnicity, sex, job role, education, income, comorbidities, vaccination status, and prior infection.

Among COVID-19 positive HCP, 91.0% reported absenteeism; Delta period showed highest absenteeism (aOR 1.70 95%CI 1.12-2.59 vs Omicron). Physicians (aOR 4.11 95%CI 2.70-6.27) and nurses (aOR 4.54, 95%CI 3.28-6.30) had highest odds versus non-clinical roles. Graduate degree holders had lower absenteeism (aOR 0.38 95%CI 0.26-0.56 vs high school/some college), as did those earning ≥$200,000 (aOR 0.37 95%CI 0.14-0.97 vs <$25,000). Employer-directed decisions were more common during Alpha (aOR 1.70 95%CI 1.21-2.38 vs Omicron). Recently vaccinated HCP had lower odds of employer-directed (aOR 0.77 95%CI 0.63-0.94) or joint decisions (aOR 0.75, 95%CI 0.60-0.95) versus HCP-only decisions. Among absentee HCP, 95.2% cited symptoms/positive tests whereas Alpha and Delta showed higher odds of other reasons (aOR 3.34 95%CI 2.30-4.84, 1.71 95%CI 1.15-2.52 vs Omicron).

HCP absenteeism and decision-making authority shifted across pandemic phases, from employer-directed to employee-initiated over time. Significant disparities were found across roles, education, and income. Findings support adaptive, risk-stratified return-to-work policies for future pandemics balancing infection control with workforce sustainability and equity.