 Solution

The first departure from the no-symptoms state has an exponential distribution with rate $\lambda$. Spending the entire interval there means no departure at all, soThis is the holding time survival probability. The transition probability $p_{11}(t)$ only says that the patient is symptom-free at the endpoint, allowing an onset and recovery in between, and is therefore not the answer. The formula also covers $\lambda =0$, when state 1 is absorbing.