Expanding Paid Sick Leave as a Public Health Tool in the Covid-19 Pandemic

Abstract

LACK OF PAID SICK LEAVE FOR ESSENTIAL WORKERS Hospitalizations and deaths due to Covid-19 have disproportionately affected Latinx and Black populations in the US.1 This disparity is exemplified in the Bronx2 where 56.4% and 43.6% of the population are Latinx and Black/ African American (AA), respectively. Regional tracking of cases and a recent spatial analysis confirmed clusters in New York city having a greater concentration in communities with greater concentrations of service workers and occupations potentially classified as "essential services".3 Recent epidemiologic studies of other regions have demonstrated disproportionate impact of urban areas, poverty, unemployment, and rural areas.3–6 There are many socioeconomic inequalities that may impact these communities both exacerbating and perpetuating poorer health outcomes. These in turn make our patients more susceptible to suffer severe Covid-19 disease. For instance, compared to 29.9% of White workers, only 16.2% and 19.7% of Latinx and Black/AA workers, respectively, work in jobs that can be done remotely.7 In the US, the Latinx working population is the least likely demographic to have access to paid sick leave (PSL).8 More than half a million immigrants live in the Bronx, many of Latinx descent, and they disproportionately make up the essential workforce in New York City.1 This includes a large portion of the service industry, where the jobs require close contact with thousands of people daily. Being essential, stay at home orders do not apply to these workers, increasing their potential exposure to the virus. However, despite the increased risk, those who become sick are less likely to seek medical attention, due to associated losses in valuable wages or the possibility of being terminated, and more likely to contract and spread the Covid-19 virus. In order to counter the financial concern of obtaining medical care during the Covid-19 crisis, mandated PSL should be offered to all essential employees. EXPANDING PAID SICK LEAVE AS A PUBLIC HEALTH POLICY Research has shown that providing PSL has favorable public health outcomes including a reduction in all-cause mortality.9 Conversely, the risk of not providing adequate PSL to our labor force may have stark consequences on public health, especially during times of crises such as a global pandemic. It is estimated that an additional 1.2 million Latinx workers were infected by H1N1 due to a lack of protective workplace measures, such as PSL and having the ability to work from home.8 Alarmingly, SARS-CoV-2, the causative pathogen of Covid-19 disease, has a longer incubation period than influenza viruses presumably allowing it to spread more easily than H1N1 and related illnesses, suggesting this outbreak may last much longer.10 Furthermore, the risks of inadequate PSL not only impact workers, but their children and elderly family members as well. Children of parents without access to PSL are less likely to receive flu vaccinations and attend annual check-ups. This delay in routine medical care increases the number of future visits to the emergency department.11 In addition to public and preventative health implications, there are associated economic ramifications to be considered. One study showed that providing PSL to workers that previously did not have access to it could positively impact work productivity and decrease workplace costs of absenteeism due to influenza-like illnesses by billions of dollars.12 Interestingly, the same study showed that workers without PSL were more likely to report poor physical health status, making this working population even more vulnerable given that Covid-19 disease confers greater morbidity in those with pre-existing conditions.1 The worldwide spread of Covid-19 has caused devastating economic impacts on working class families around the world.13–17 Therefore, without proper workplace interventions, the potential for uncontainable spread, more death, and continued economic hardship seems to be a logical consequence. While most countries around the world provide PSL to some degree, many have policies that delay payment of sick days. A recent comparative analysis of workplace policies related to PSL found that only 55% of "high income" countries guaranteed PSL to workers on the first day of reported illness.18 The onset of the pandemic has caused governments to shift their PSL policies. For instance, the UK recently passed legislation that guarantees payment on day one of sick leave. This ensures workers can stay home as soon as symptoms present, preventing the delay of needed medical attention or treatment, and limiting the spread of infection.19 The policy also includes workers who have been advised to stay home and quarantine due to possible sick contact. However, as of now, this policy amendment is only temporary. The US, on the other hand, is one of only a few countries in the developed world without federal PSL policies.20 New York State has included in their 2021 fiscal budget legislation that will require employers with net income greater than $1 million to provide PSL, however this policy still excludes many workers. Not providing paid leave would disincentivize these individuals to seek needed medical care, as indicated by studies showing an association between usage of sick leave and subsequent lower wages.8 While these legislative actions are welcome steps, there are thousands of workers left in this PSL gap. Addressing this gap now will ensure that when a vaccine does become available for the SARS-CoV-2 virus, we can minimize the spread of the virus without essential workers having to fear wage or job loss. It is also important to note these recently enacted policies seem to be for the short-term amelioration of the current health crisis, discounting the possibility of future Covid-19 or other infectious disease outbreaks. It is therefore imperative to implement more inclusive, permanent legislation that provides PSL to the entire essential workforce. CONCLUSIONS To meet the public health needs of the disproportionately affected Latinx and Black/AA populations during this crisis now and in the coming months, it is important that employers, along with federal and state legislators take action to: expand PSL for workers deemed essential regardless of employer income or size and employee immigration status, expand PSL for workers deemed essential beyond the 40 hours under current legislation to include as much time necessary to provide proper health services, and provide SARS-CoV-2 testing upon granting PSL and before reentering the workforce.

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