Healthcare worker attitudes to lateral flow device testing and sick leave for influenza-like illness in the UK: A hypothetical scenario-based study.

Background: Widespread use of lateral flow device (LFD) testing of healthcare workers (HCW) during the COVID-19 pandemic allowed for rapid diagnosis, informing sickness absence.

Aims: In winter 2023-24, we investigated HCW attitudes towards sickness absence based on LFD availability and results.

Methods: Within the SIREN (SARS-CoV-2 Immunity and Reinfection Evaluation) HCW cohort, participants were randomised into one of four hypothetical scenarios: waking-up with fever, cough, runny nose and: a) LFD unavailable b) LFD negative c) LFD positive for COVID-19 or d) LFD positive for influenza. For each scenario, participants were then asked if they would attend work, their rationale, when they would return to work, and their attitudes toward LFD use. Proportions were calculated to compare scenarios.

Findings: 5,357 participants were included, with similar demographics across scenarios. >80% would stay at home if COVID-19 or influenza LFD positive, 54% if testing was unavailable and 39% if LFD negative. The main reason for not taking leave was concern about increasing their colleagues' workload. For each scenario, most participants reported they would return to work only when feeling well enough. However, in the COVID-19 positive scenario, a higher proportion of participants reported they would wait 5 days before returning to work. 84% reported they would use an LFD before work if they had influenza-like illness symptoms, regardless of hospital policy.

Conclusion: We demonstrate LFD results are useful in helping HCWs make decisions on whether to attend work if symptomatic. LFDs remain an important consideration in managing HCW infections and may reduce transmission of respiratory infections during winter.