TUNE IN: Taking Action on AI Today and in the Future

RSVP to join our online audience

Center for American Progress

Lack of Paid Leave Risks Public Health During the Coronavirus Outbreak

Lack of Paid Leave Risks Public Health During the Coronavirus Outbreak

To prevent the spread of the coronavirus, workers need paid leave so that they are able to stay home to recover from an illness or provide care to a sick family member without risking their economic security.

A woman wipes down common areas inside an airport, March 2020. She says disinfecting things such as doors, handles, trash can lids, and anything else that people commonly touch was a routine part of her day even before the coronavirus concerns. (Getty/Brittany Murray)
A woman wipes down common areas inside an airport, March 2020. She says disinfecting things such as doors, handles, trash can lids, and anything else that people commonly touch was a routine part of her day even before the coronavirus concerns. (Getty/Brittany Murray)

A national paid leave policy is urgently needed to address the new coronavirus outbreak and to help protect the health and safety of the population in the future. The increasing spread of the coronavirus, which causes the disease COVID-19, is an urgent issue for the health and economic well-being of workers, families, and communities—with more infections and deaths reported in the United States every day.

The coronavirus’ high transmission rate and incubation period of up to 14 days may necessitate people self-quarantining at home for extended periods of time if they are sick with or exposed to the coronavirus in order to curb the spread of the infection; they may also be forced to stay home if their workplace or child’s school or child care provider closes because the outbreak worsens. This places workers in an impossible bind if they do not have access to paid leave. An estimated 32.5 million individuals—or 27 percent of private sector workers—in the United States lack access to a single paid sick day to recover from an illness such as COVID-19 or to care for a sick family member without losing their job or their paycheck. Low-income and service-sector workers—who are disproportionately women—and Latinx workers are the least likely to have access to paid sick leave.

Lack of paid sick leave is a public health risk

There are significant public health risks associated with a lack of paid sick leave, especially during pandemics such as COVID-19, which are becoming increasingly common. Millions of workers without access to paid sick days report to work when they are sick and may be contagious because they cannot afford to miss work and lose pay. A survey of workers found that those without paid sick leave were 1.5 times more likely to go to work when they have a contagious illness than workers with the benefit. A study of workers who need sick leave but did not or could not take it found that up to an estimated 3 million workers go to work sick every week, most of whom are low-wage workers, mothers with young children, or both. When workers go to work sick, contagious illnesses spread more quickly and widely. Researchers estimate that an additional 5 million people contracted the H1N1 virus during the 2009 pandemic because of a lack of workplace policies such as paid sick leave. The continued lack of a federal law that would provide millions of workers with access to paid sick leave means that the coronavirus outbreak will likely have a similar or even more severe infection rate.

Workers with a high probability of interacting with the public and spreading infection, such as restaurant employees and child care professionals, are especially likely to lack paid sick leave. Research has consistently shown that food service workers in particular are especially unlikely to have paid sick days. One study found that almost two-thirds of restaurant servers and cooks in the United States had gone to work while sick. The overwhelming majority—91.9 percent—of restaurant workers in Miami who reported working while sick did so because they could not afford to take a day off without pay or feared being fired or penalized as a result of calling in sick. This should not be surprising, given that the low median hourly wage for workers in food preparation and service-related occupations means missing work could potentially be devastating to a family budget.

The lack of paid sick leave has an enormous impact on the health of workers and their families, which, in turn, has significant implications for the health care system. Workers without paid sick days are found to be three times less likely to receive medical care and 1.6 times less likely to access medical care for their family members compared with working adults who have access to paid sick days. Research has consistently shown that access to paid sick days makes it more likely that a worker will stay home when they are ill. Workers with paid sick leave are also more likely to receive the flu vaccine and visit a health care professional when they are sick. When workers have paid sick leave, they are less likely to delay medical care when they or family members are sick, which may mean they recover faster and have a less severe illness. Access to paid sick leave also reduces preventable emergency department visits: If implemented nationally, the policy would result in cost savings of an estimated $1.1 billion annually.

Millions of U.S. workers lack access to paid sick leave

Despite the importance of paid sick leave in protecting workers’ health and economic security—and the health of the public, especially during a pandemic—there is no federal law to ensure that all workers have access to paid sick leave. The United States is an extreme outlier among developed countries in lacking any guarantee for workers to receive paid sick time for personal illness. While 11 states and 22 cities and counties have paid sick day laws, the lack of a federal standard means that disparities exist across geographic regions (see Figure 1), as well as across worker income, occupation, full- or part-time employment status, and race.

Figure 1 Workers in regions without paid sick day laws have lower access to the benefit

Private sector workers in states and localities without paid sick leave laws, such as those in the South and Midwest regions, have lower levels of access to the benefit. (see Figure 1) Rural workers are also less likely to have access to paid sick leave, which can be particularly challenging because closures of rural hospitals and other health institutions mean they must travel farther to access medical care. The patchwork of laws across the country leaves too many workers behind.

Figure 2 Workers access to paid sick leave is unequal

Without a federal, state, or local paid sick leave law, workers are left to the whims of their employer. This means workers in precarious and low-quality jobs—especially low-wage and service-related work—are also the least likely to receive employer-provided paid sick leave benefits. (see Figure 2) Independent contractors and freelancers are also unlikely to have employer-provided paid sick leave. More than two-thirds of low-wage private sector workers—those earning less than $10.49 per hour—do not have access to paid sick days, compared with only 10 percent of those earning $30.61 per hour or more. Women, especially women of color, are disproportionately represented in low-wage jobs, meaning they are less likely to have access to workplace benefits such as paid sick leave. Workers of color, and Latinx workers in particular, have been found to be less likely to have access to paid sick days. (see Figure 3) Most concerning is the lack of access for service sector workers, such as food servers and care workers, who are more likely to interact with the public: More than 2 out of 5 service-sector workers do not have access to a single paid sick day.

Figure 3 Access to paid sick leave is unequal across race and ethnicity

Lawmakers must act now to meet the needs of workers

The coronavirus outbreak highlights the urgent need for a comprehensive federal paid leave standard mandating, among other things, the provision of paid sick days to protect the health of workers, their families, and the public. Legislation is critical to lessening the spread of contagious illnesses, including COVID-19 now and others in the future, and it will ensure that workers can take time away from work to care for themselves or a family member without losing their job or a paycheck. During a public health emergency, the government should step in to provide businesses, especially small businesses, with targeted financial support to help them provide paid leave to their workers and weather the economic shocks of quarantines and business closures. It is also important for lawmakers to understand the importance of comprehensive paid leave options in addition to paid sick days, including paid family and medical leave, for workers who need a longer amount of time to recover or provide care for a serious illness. However, any paid leave legislation must include a robust enforcement mechanism to ensure employers are complying with the law.

As the coronavirus outbreak worsens, lawmakers will need to take steps to address the serious health and economic effects. They must ensure adequate funding for research, testing, and medical treatment for those affected by the virus, such as that included in the $8.3 billion emergency spending bill approved by the president in early March. Lawmakers must also prioritize other policies to support workers and improve public health. Such policy solutions may include shoring up the unemployment insurance system with increased funding and expanded eligibility, among other needed reforms, to provide direct financial support to workers who are laid off through no fault of their own. Lawmakers can also ensure that all workers, including independent contractors and domestic workers, are covered by labor protections and benefits—such as paid sick days—by adopting legislation such as the Domestic Workers Bill of Rights Act and the Protecting the Right to Organize (PRO) Act. Investments in public health infrastructure are also critically needed to help underfunded and underresourced hospitals and health care centers with expected influxes of COVID-19 patients.


As lawmakers consider how to respond to the urgent demands of the coronavirus and its risks to workers and public health, they must include a comprehensive paid leave law in addition to important health- and economic-related policies. This must include provisions for extended paid sick days and paid leave targeted toward longer-term medical needs and caregiving. Paid leave is a critical and commonsense policy to support the health and economic security of workers and their families. Action is needed now to lower the spread of the coronavirus and will be needed in the future.

The coronavirus has helped highlight how vital paid leave is to the health and well-being of the nation’s families and communities. Policymakers must act swiftly to address the current pandemic, while also ensuring the less sensational but no less critical health needs of working families in the future.

Diana Boesch is a policy analyst for Women’s Economic Security at the Center for American Progress. Sarah Jane Glynn is a senior fellow at the Center. Shilpa Phadke is the vice president of the Women’s Initiative at the Center.

To find the latest CAP resources on the coronavirus, visit our coronavirus resource page.

The positions of American Progress, and our policy experts, are independent, and the findings and conclusions presented are those of American Progress alone. A full list of supporters is available here. American Progress would like to acknowledge the many generous supporters who make our work possible.


Diana Boesch

Policy Analyst, Women’s Economic Security

Sarah Jane Glynn

Senior Fellow

Shilpa Phadke

Vice President, Women\'s Initiative