“I have no recollection of any year of my life where I have not had a cold for this long,” says John Swartzberg, a clinical professor emeritus of infectious diseases and vaccinology at the University of California Berkley’s School of Public Health. He estimates it’s been more than a year and a half since he last had the once-common illness.
Even as Covid-19 has upended our societies over the last 18 months, some common illnesses, such as flu and the common cold, have actually plummeted in many nations, in part because of pandemic-induced safety precautions.
But as people in nations with high vaccination rates tentatively emerge from lockdowns, many are wondering if a return to work will mean a return to these common sicknesses. When we return to spending our days working side-by-side with colleagues, there are measures – many of which we learned from the pandemic – that both we and our employers can take to help us avoid a significant uptick in colds and the flu.
Why flu is coming our way
Globally, the 2020-2021 flu season had some of the lowest numbers in recorded history. The UK reported just one flu case in total through December 2020 and January 2021, and no flu outbreaks at all for the entire season. In the US, the CDC recorded just 1,899 positive flu cases between 27 September 2020 and 22 May 2021, for a total flu season positivity rate of 0.2%. This is a huge drop from the comparable number for the last fully pre-Covid-19 flu season, in 2018-2019, which had 176,732 positive tests and a 15% positivity rate.
Experts highlight a historic take-up of flu vaccines; in the US, the CDC distributed 193.7 million doses by 26 February 2021, nearly 20 million more than the previous flu season. But they also say that measures aimed at preventing the spread of Covid-19, such as remote work, masking and social distancing, were extremely effective at stopping the spread of colds and flus.
There's going to start to be an increasing wave of flu that's probably going to be higher than normal – Eili Klein
The downside of these low flu numbers, however, is that many of us will be coming into this season with lower baseline immunity. “In general, even people who don't get the flu get exposed to the flu, typically, and it'll give them a boost in their immunity,” explains Eili Klein, an associate professor of emergency medicine at the Johns Hopkins University School of Medicine. “So, when it comes around again the next year, the antibodies haven't waned.”
There are also concerns over the effectiveness of next season’s flu vaccine. Scientists typically use data from the previous year to build the vaccine for the next one, but with so few infections, they may not have all the data they need. “There's going to start to be an increasing wave of flu that's probably going to be higher than normal. Possibly significantly higher,” warns Klein.
Some experts are hoping that we can avoid this by learning from the last 18 months – and leave behind many of the bad habits that make work one of the easiest places to get sick.
“Infections such as colds and flus spread via respiratory routes. So, if you’re in an overcrowded, poorly-ventilated space, that office becomes a high-risk environment,” says Dr Yelena Globina, medical director of Mount Sinai's Selikoff Centers for Occupational Health Staten Island Clinic, who studies how and why we get sick at work.
Distancing measures and letting some people work from home can help reduce workplace sickness transmission, experts say (Credit: Getty)
This chimes with findings from a 2011 Danish study, which showed that whether or not you get sick at work is “significantly related to having a greater number of occupants in the office”. The study also showed that occupants in open-plan offices, where workers sit elbow-to-elbow in open rooms with nothing separating them, took 62% more sick days than workers in individual offices. A 2013 study in Sweden echoed those findings, saying open-plan offices had a “significant excess risk for sickness absence”, compared to traditional closed offices.
One major reason we infect each other at work is that we show up even when we’re fully aware that we’re sick; a 2019 survey of US professionals by recruiting firm Robert Half found that up to 90% of respondents admit going to the office when ill. There are lots of reasons for this, like no sick pay protection in some nations, a culture of presenteeism or a precarious economic situation.
“Workers are incentivised to come into work not feeling well,” explains Globina. “If you have poor sick leave policy – for example you lose your insurance if you don’t reach a certain number of hours per month – that is a barrier to taking off a day when you’re not feeling well.”
Even employees lucky enough to have sick leave feel pressure not to use it. A 2015 study by UK health insurer AXA PPP found that only 42% of senior managers thought having a cold or flu was a good enough reason to miss work.
‘Keep pillars of safety’
The good news is that lots of the precautions we got used to during the pandemic can help keep us healthy in the workplace going forwards.
Opinions remain divided over the most visible public health symbol of the pandemic, the mask. The CDC doesn't currently recommend masks for the prevention of cold and flu infections, even for those at high risk of complications. Some doctors agree.
“Unless we move to a society where everyone wears masks all the time, it's probably not going to make a huge difference in terms of the impact on broad-scale public health transmission,” says Klein, pointing out that much flu transmission occurs before people know they’re sick.
Still, others see value in recommending mask-wearing. Swartzberg believes in what he calls “the Swiss cheese defense”, or the idea that lots of small health protections that aren’t highly effective on their own can work much better together.
He thinks masking can be a great addition, along with yearly flu vaccinations and hand washing, and would like to see a culture where a sore throat means it’s time to put a mask on. “You don’t have to wear a mask all the time, but use it judiciously, to protect yourself in certain circumstances and to protect others in certain circumstances.”
I can imagine big businesses preemptively saying, ‘For the next months, could you work from home a bit if you can?’ – Benjamin Cowling
How we arrange our days will also have an impact on workplace sickness levels. Globina recommends that workplaces try to introduce rotating schedules, where only part of a company’s workforce is in the office on any given day. This ensures “that the office space is not overcrowded, allowing for distancing”, she says. The more distance between you, and the less people there in the first place, the lower the chance that you’ll catch a cold or flu.
Given the success of remote work during the pandemic, some doctors suggest companies pre-emptively close their offices to help fight particularly bad waves of flu and be generous with home-working provision. Keeping sick workers out of the office doesn’t just help public health, it also helps the bottom line.
“Flu also has an impact on the workforce,” says Benjamin Cowling, head of the Division of Epidemiology and Biostatistics at the University of Hong Kong’s School of Public Health. “If there's a flu outbreak in an office, then suddenly that could be 20 to 50% of a team out of action for a few days… I can imagine big businesses preemptively saying, ‘For the next months, could you work from home a bit if you can?’.”
It’s hard to imagine such a request being made before the pandemic, but experts are hopeful that the pandemic has raised everyone’s awareness of best practice and could lead to long-lasting change.
“I think one of the important outcomes of the pandemic was the attention to understanding the risks inherent to many workplaces,” says Globina. “I think the important piece of it is making sure that occupational health maintains its priority in the workplace.”
“If you keep the pillars of safety that you’ve implemented in the last year and a half in place, with some modifications, we have a chance of really seeing lower influenza numbers and preventing outbreaks in the workplace. But the question is, are we going to learn from history?”