Sickness and Society: The Future of Infectious Disease in the Workplace


Increased global risk for infectious disease epidemics, coupled with state-level legislative trends expanding presumptions for communicable disease, mean that the burden of related costs may fall more heavily on employers and the workers’ compensation system. Employers can take note of strategies for a safer, healthier workforce.
The COVID-19 pandemic forced us to examine the impact and mitigation of infectious disease risk in the workplace as never before. It changed the way in which many of us work at least temporarily; for others, more permanently as some organizations make the decision to adopt long-term strategies for their workforce based on lessons learned from the pandemic. And in some cases, as exampled by the unprecedented federal mandate beholding businesses to rigorous vaccination and testing requirements for their employees, it is forcing employers to take on an increasingly larger role in solutioning what has traditionally been a public health issue.
In a 2021 PwC survey of corporate executives:1
expected to raise spending on virtual collaboration tools and manager training
planned to invest more to support hybrid working models, e.g., hoteling apps

Epidemics As a Growing Threat

Applying learnings from COVID beyond the pandemic and looking to the future to protect the health of employees, as well as the downstream productivity and cost considerations for employers, is a smart strategy, given the science and statistics of infectious disease in today’s environment.

The World Health Organization (WHO) states that “epidemics of infectious disease are occurring more often, and spreading faster and further than ever, in many different regions of the world.”2 The global organization attributes this to a combination of environmental, biological and lifestyle factors that include increased cross-border travel, urbanization, population displacement due to humanitarian emergencies, conflicts and natural disasters, and unhealthy agricultural and food production practices, just to name a few.

What do these global trends mean for U.S. employers? As we continue to battle the fallout from COVID-19, it will be prudent to look at how we can “future-proof” the workplace, too.

“Epidemics of infectious disease are occurring more often, and spreading faster and further than ever, in many different regions of the world.”
– World Health Organization

The Future of Contagious Disease Presumptions

While traumatic injuries such as sprains, strains and tears top the U.S. Bureau of Labor Statistics’ list of occupational injury types,3 illness directly related to exposure at work comprises approximately five percent of total occupational injury and illness incidence. It has been estimated in a separate analysis that on-the-job illness totals nearly $60 billion a year for both medical and indirect (productivity) costs.4

Prior to the COVID-19 pandemic, the definitions for occupational illness were typically quite narrow and predominantly applied to specific industries in which the risk of exposure at work significantly outweighs the risk of exposure in one’s daily life. For example, viruses transmitted in healthcare settings, such as human immunodeficiency virus (HIV) transmitted via needlestick injury, or infections arising from interactions with livestock in the farming or poultry industries.

But the legislative trends arising from COVID-19 have expanded how states are beginning to look at communicable diseases in the workplace – and where the responsibility for related medical costs resides. While the language and approach vary from state-to-state, 2021 saw a wave of proposals that would put permanent legislation into place allowing injured workers who contract a communicable disease in the workplace to file a workers’ compensation claim.

It’s a controversial trend. While some of the proposals are specific to high-risk occupations, such as healthcare workers, others take broader strokes. And even among these frontline jobs, a recent study demonstrated that infection prevention measures are working; the study found that nurses, who typically have a high rate of patient contact, were not at greater risk of contracting COVID due to their occupation versus their exposure to the general population.5

However, amid the uncertainty of the future, this point is certain: between the increasing global threat of infectious disease epidemics and the expansion of communicable disease presumptions, employers can’t afford not to implement strategies that will protect their workforce – and their organizations.

The Cost of Infection-Related Morbidity on Employers

Presumptions aside, communicable diseases – even those that are not deemed occupational – cost employers significantly in terms of employee lost time and productivity. Take the common flu virus. Pre-pandemic, the 2018-2019 productivity loss estimate due to influenza was $17.6B, based on a 4-day work loss assumption per sick employee.6

To compound this, as a society, we’re getting back to the usual business of being sick. For a period, the lifestyle adjustments made during the initial pandemic peak – quarantine, work-from-home accommodations, mask-wearing – appeared to also have reduced rates of infection for other respiratory illnesses. Emergency department visits for the flu and the common cold were lower in 2020 compared with 2019.7

But as pandemic restrictions were rolled back, daycares and schools reopened, and employees returned to their worksites, these common illnesses have bounced back. In fact, according to experts at the Cleveland Clinic, doctors “are seeing more colds and respiratory illnesses this year than in the past.”8

Strategies for a Safer Workplace 

“…COVID-19 prevention programs include measures such as telework and flexible schedules, engineering controls (especially ventilation), administrative policies (e.g., vaccination policies), PPE, face coverings, physical distancing, and enhanced cleaning programs with a focus on high-touch surfaces.”  
- Occupational Safety and Health Administration

Taking all the aforementioned factors into consideration, there are many strategies employers can employ to help reduce the risk of infectious disease exposure among their employees and create a more resilient workplace.

Define and implement worksite safety protocols.

This can be as simple as implementing protocols for disinfecting surfaces or rules for interacting in common spaces. It can also mean reconfiguring office layouts to help reduce close or frequent interpersonal contact, or implementing more rigorous policies specific to masking, temperature checks, screening or vaccination – such as encouraging or even requiring employees to be tested for COVID after traveling.

Map out an absence management plan.

If an employee is unwell, there should be clear guidance for expectations on remaining out of the office and the steps needed to gain clearance to return to work.

Educate staff.

Written policies for workplace safety should be highly visible and easily accessible to employees. This includes posting in the physical workspace, as well as via any digital collaboration tools so that all employees – whether in-office, remote or hybrid – can access.

Build a culture of trust through support and communication. 

A key attribute of organizations that “got it right” during the pandemic? Support and communication from leadership – and this specifically means communicating with urgency, empathy and transparency, according to the Harvard Business Review.9 Regular town halls, employee bulletins, or other means of communication help employees understand current policies and expectations, as well as their individual role in mitigating risk. Regular communication can also help reduce anxiety among employees in times of crisis. Leaders should listen to employees that have concerns with return to work and accommodate when possible.

“Employees in high-trust organizations are more productive, have more energy at work, collaborate better with their colleagues, and stay with their employers longer than people working at low-trust companies.” 

– Harvard Business Review10

Evaluate nontraditional workplace solutions. 

COVID forced many organizations to reimagine how we work and collaborate while not in the same room – in some cases while maintaining or even exceeding productivity. While remote or hybrid workforces are more applicable or effective for some job types versus others, if viable, these solutions can dramatically help reduce infectious disease exposure among employees.

Don’t skip the basics.

Staff education should include not only organization-specific policies, but encourage healthy practices such as proper hand-washing techniques, avoiding touching the face and eyes, and coughing into an elbow versus the hand. Simple, tried-and-true strategies go a long way in helping to reduce disease transmission.

Monitor public health guidance. 

The medical community continues to learn more about COVID and resultant recommendations continue to evolve; subsequently, workplace policies may also have to, as evidenced by the recent federal vaccine and testing mandates on businesses employing 100+ employees. Encourage employees to also keep up with the latest health guidance by sharing reputable websites they can access, as well.

Evaluate sick leave policies.

As we shift from a culture that has traditionally prioritized work over personal health, it may be time to take a fresh look at your organization’s sick leave policies to ensure they encourage employees to stay home when ill, rather than come to work sick and “push through.”


1. PwC. US Remote Work Survey. January 2021.

2. World Health Organization (WHO). Managing Epidemics: Key Facts About Major Deadly Diseases. 2018.

3. Bureau of Labor Statistics, U.S. Department of Labor. Employer-Reported Workplace Injuries and Illnesses – 2019. November 2020.

4. Leigh JP. Economic burden of occupational injury and illness in the United States. Milbank Q. 2011 Dec;89(4):728-72. doi: 10.1111/j.1468-0009.2011.00648.x.

5. Jacob JT, Baker JM, Fridkin SK, et al. Risk factors associated with SARS-CoV-2 seropositivity among US health care personnel. JAMA Netw Open. 2021;4(3):e211283. doi:10.1001/jamanetworkopen.2021.1283

6. 2019-2020 Flu Season Could Cost Employers $13B. Challenger, Gray & Christmas, Inc.

7. Rodgers L, Sheppard M, Smith A, et al. Changes in seasonal respiratory illnesses in the United States during the coronavirus disease 2019 (COVID-19) pandemic. Clin Infect Dis. 2021;73:S110–S117.

8. Why Does Everyone Seem to Have a Cold Right Now? Cleveland Clinic. July 2021.

9. Holtom B, Edmondson AC, Niu D. 5 Tips for Communicating with Employees During a Crisis. Harvard Business Review. July 2020.

10. Zak PJ. The Neuroscience of Trusts. Harvard Business Review. January-February 2017.


Since 2010, the semi-annual RxInformer clinical journal has been a trusted source of timely information and guidance for workers’ comp payers on how best to manage the care of injured worker claimants and plan for the challenges that lay ahead. The publication is an important part of Healthesystems’ proactive approach to advocating for quality care of injured workers while managing the costs associated with treatment.