Could that person you’re talking to be making you sick?

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People don’t like admitting they are ill, especially if it interferes with their social life.

That conclusion emerges from a series of studies conducted at the University of Michigan measuring people’s responses to having an infectious illness. Overall, 75% of the 4,110 participants—including 61% of health care workers--said they had either hidden such an illness or might do so in the future.

In the first study, the researchers asked 399 health care workers and 505 students to report the number of days they felt symptoms of an infectious illness beginning in March 2020, at the start of the COVID-19 pandemic. They measured how often the participants hid their symptoms, came to classes or work without revealing they were feeling ill, or lied on symptom screeners the university mandated for anyone using its facilities.

The results showed more than 70% of participants covering up their symptoms, most of whom did so because illness would conflict with their social plans. A small percentage did so because of institutional policies, such as lack of paid time off. Only five participants said they hid a COVID-19 infection.

In the second study, the authors randomly assigned 946 participants one of nine conditions and asked them to imagine being either moderately or severely ill while in a social setting. Each condition was designated either low, medium, or high for its risk of contagion. Participants said they were most likely to hide their sickness when symptom severity was low, and least likely to do so when symptoms were both severe and highly contagious.

In a third study, the researchers asked 900 participants—including some who were actively sick—to rate the transmissibility of their illness (whether real or imagined) and likelihood of hiding it during a hypothetical encounter with another person. The results showed that those who were actually ill were more likely to hide their illness, regardless of its transmissibility, than were the participants with an imagined illness.

In an accompanying news release Wilson Merrell, a doctoral candidate and the study’s lead author, said the results “suggest that sick and healthy people evaluate the consequences of concealment in different ways, with sick people being relatively insensitive to how spreadable and severe their illness may be for others.”

Merrell added that the findings carry public health implications. “People tend to react negatively to, find less attractive, and steer clear of people who are sick with infectious illness,” he said. “It therefore makes sense that we may take steps to cover up our sickness in social situations. This suggests that solutions to the problem of disease concealment may need to rely on more than just individual good will.”

The study, “When and Why People Conceal Infectious Disease,” was published by the Association for Psychological Science.