To assess the frequency of and motivations for acute respiratory illness (ARI) presenteeism in healthcare personnel (HCP) during two waves of COVID-19.

Survey.

Large academic medical center, both ambulatory and acute care settings.

All HCPs (n = 11,429) at the University of North Carolina Medical Center were eligible for two voluntary, electronic surveys: pre-Omicron (n = 591, recall period March 2020 - December 2021) and Omicron BA.1 (n = 385, recall period January - April 2022).

We compared self-reported ARI presenteeism (working despite feeling feverish plus cough and/or sore throat) and motivators across time and demographics. We also estimated effects of workplace perceptions and culture on ARI presenteeism with log-binomial regression, adjusting for age, gender, HCP role, and patient interaction.

In the pre-Omicron and Omicron BA.1 eras, 24% and 34% of respondents respectively reported at least one instance of ARI presenteeism. In both eras, clinical frontline HCP were more likely to report ARI presenteeism than other roles, as were HCP primarily providing direct patient care vs not. Pre-Omicron motivators included disciplinary action and sick leave concerns, whereas workplace culture predominated during Omicron. Feeling professional obligation to attend work and observing colleague presenteeism increased ARI presenteeism in both eras. During Omicron, COVID-19 burnout, fatigue, and unclear call-out procedures increased ARI presenteeism.

ARI presenteeism was common and had diverse motivations, including workplace culture, disciplinary action, and sick leave. Efforts to reduce presenteeism should address these factors and prioritize frontline clinical personnel with direct patient interaction.