Sick and tired at work

There's one in every office, factory or school: The colleague who slumps in the neighboring cubicle hacking and sniffling and wheezing, a mound of tissues rising like a viral mountain range.

Go home, already, you think to yourself. Instead, your colleague slogs through the day as the fog of flu or a cold rolls in, enveloping the workplace.

There's even a name now for the phenomenon: presenteeism. It's when people who should be absent from work or school -- because they're contagious or feeling so lousy they can't do their jobs -- aren't.

''Presenteeism may be a more significant issue than absenteeism, and that's a pretty bold statement, I realize," said Roslyn Stone, chief operating officer at Corporate Wellness, a provider of health services to upward of 1,000 employers. ''There are more people who come to work sick than call in sick on certain days, and that's pretty shocking."

And with the specter of a global flu epidemic hovering, that's more alarming than ever. Just two weeks ago, federal health authorities intensified their campaign to help workers and their bosses figure out when they should stay at home rather than coming into work, imperiling their own health, getting little work done, and spreading their germs.

But the realities of the modern workplace make this much more than a simple matter of personal responsibility. Millions of US employees don't get paid if they take a sick day. And millions more now have all their time off -- vacation days, personal days, sick days -- lumped into a single pot, meaning the more sick days they take, the fewer vacation days they'll get.

''People say, 'I'm not feeling great, but I've got to get in, other people are depending on me,' " said Walter Stewart, an epidemiologist who has extensively studied workplace health issues for Geisinger Health System, an operator of hospitals and medical practices in Pennsylvania.

''But by going in," he said, ''you may be doing harm to yourself and to others."

That exacts a cost from employers and employees alike. Stewart surveyed 29,000 workers, asking how their health affected their jobs. His findings: Health problems, from cancer diagnoses to backaches to the flu, result in $225 billion in lost work time annually in the United States. And most of that -- 71 percent -- can be traced to workers who showed up feeling punk, largely because of respiratory and gastrointestinal bugs.

Just ask Stone of Corporate Wellness.

One afternoon last week, the phone rang in her Mount Kisco, N.Y., office -- and rang again. Two companies, same problem.

At an Atlanta firm, a worker had come down with a stomach virus and stayed home from work for a day.

''But then the worker came back to work the next day," Stone said. ''Magically, three days later, five or six co-workers developed the identical symptoms."

At a suburban Los Angeles firm, three workers who shared a home also shared the flu virus. One called in sick, two came to work.

What do we do now, the companies wanted to know.

In the case of the Georgia company, Stone told the bosses to be vigilant for signs that other workers had the gastrointestinal illness and to tell workers with nausea, vomiting, or diarrhea not to return to work until they had been free of symptoms for 24 hours.

In the case of the California company, Corporate Wellness planned to swoop in and provide flu shots, recognizing that the respiratory illness had already established a beachhead.

Illnesses that can be spread person-to-person have always been a concern in the workplace, but those worries loom even larger now as avian influenza has sparked fears of a global epidemic among people.

But how sick is sick enough to warrant taking the day off?

Dr. Ronald F. Dixon, an internal medicine specialist at Massachusetts General Hospital, said that a fever surging above 101 degrees, an intensely sore throat, and a hearty cough are all reasons enough to call in sick.

''That's when you're going to be highly infectious, and that's when it may be best for your colleagues that you at least get evaluated by a doctor before going back to work," Dixon said.

Otherwise, there's a chance you could spread germs that cause strep throat or the flu -- and influenza and its complications are estimated to cause 36,000 deaths a year in the United States, mostly among the elderly and the sick.

It might even make sense for workers to stay home if they're still feeling fine but a family member has the flu, said Stephen S. Morse, a virus specialist at the Columbia University's Mailman School of Public Health.

''If someone in your family has it, there could be up to a 60 percent chance that you could get it, too," Morse said. ''And that could be an argument to wait it out for a few days, and it allows you the opportunity to give the loving care your family needs."

A garden variety backache or cold is a bit trickier.

''If somebody had a common cold, there's no reason they couldn't go to work, assuming they're not working in a bone marrow clinic" or somewhere else populated by especially vulnerable people, said Dr. Alfred DeMaria, top disease tracker in the Massachusetts Department of Public Health.

To assure that you don't spread your cold to a co-worker, DeMaria said, wash your hands frequently, sneeze into a tissue, and deposit used tissues in a garbage can.

Doctors, employers, and specialists who study the workplace all acknowledge that it can be challenging to establish a culture encouraging ill employees not to feel guilty about staying home.

And often, the decision to come into work while ailing has nothing to do with guilt and everything to do with economics.

Studies from the Institute for Women's Policy Research show that as many as 59 million US workers don't have paid sick leave and even more don't get paid if they take a day off to care for an ill family member.

Vicky Lovell, who led the study, said it's in the best interest of companies to offer sick leave so employees won't come to work ill. An official at the US Centers for Disease Control and Prevention made a similar pitch.

''We're recommending that employers look at their compensation and sick leave policies so they can offer liberal leave when a person needs to stay home when they're sick," said Lisa Koonin, associate director for business partnerships at the CDC's National Center for Health Marketing.

At WCVB-Channel 5, a respiratory bug ran roughshod through the newsroom last winter, according to Linda Walsh, a human resource administrator.

This year more than ever, this is the message at the station, which offers paid sick leave:

''If you're sick, we don't want to see you," Walsh said. ''We don't want you to infect other people."

Stephen Smith can be reached at stsmith@globe.com.