To the best of our knowledge, there are no previous reports of similar studies, particularly none that examined sensitivities around absence reporting and the disclosure of symptoms by HCWs. Some of the key findings here have been highlighted in the 2009 NHS Health and Well-Being Review Interim Report [14] . These include under-resourced occupational health services and uncertainty over the role and function of these departments (including the balance between supporting staff and managers), the issue of HCWs coming to work when feeling unwell, and the perception that senior managers or the employing organisations fail to take a positive interest in HCWs' health. Another study has also provided evidence that HCWs attend work with symptoms suggestive of communicable disease [15] . Similar to findings here, a study by Blake et al. found a loss in income was associated with the general working population's ability to comply with recommendations during an influenza pandemic in the US, resulting in symptomatic staff in the workplace [16] . A recent survey, also in the US, found that 55% of workers without sick pay compared to 37% with, would attend work with an infectious disease [17] .