The life of a hotel front-desk clerk in a red state can tell you a lot about America's COVID-19 failures. He doesn't want to be identified, because he is worried about being fired, but I can tell you this: He doesn't have paid sick days or health insurance. About a month ago, he got COVID and took four days off, using three of his seven vacation days and going a day without pay. Last week, one of his kids tested positive for COVID, and he thinks he has it again. But when he tried to get tested, the earliest appointment was in a few days. So with a headache, a sore throat, and a runny nose, he went into work anyway. "If I need to pay rent and buy food, I gotta go to work," he told me. "I was feeling pretty bad earlier, but it's like, well, I could just take some DayQuil."
He wears a mask. He tries to be careful. He is worried about infecting other workers and guests. But sometimes it feels pointless, because some hotel guests have walked in maskless, announced that they have COVID, and later summoned the hotel staff to their room for fresh towels.
When the CDC shortened isolation guidelines for people with COVID to five days, from 10, some people felt that the agency was prematurely pushing sick people back to work. But realistically, many Americans were never able to take a full 10, or even five, days off to recover from the coronavirus. Like the hotel worker, many people who think they might have COVID can't immediately find tests. The federal government offers no services for or payments to people in isolation, and has no one checking in with the sick. Most local and state governments don't do anything for people in isolation either. Most important, millions of Americans still don't have paid sick leave, so taking any time off work--five days, 10, or two--can be financially ruinous. The CDC issuing isolation guidelines of any length to workers without paid leave is the equivalent of the government telling people to make sure that they quarantine inside a lime-green Lamborghini. "The lack of guarantee to paid leave is the key missing public-health element in our response to the crisis," says Hannah Matthews, the deputy executive director for policy at the Center for Law and Social Policy.
About a fifth of all U.S. workers don't get paid sick leave, and the lowest-paid workers--those who serve food, clean hotels, or stock groceries--are least likely to have it. Fourteen states and Washington, D.C., plus about two dozen cities and counties, have paid-sick-day laws, but approximately 75 million private-sector workers live in jurisdictions not covered by those measures, according to the paid-leave-advocacy group A Better Balance. Some states expanded paid leave during the pandemic, but many of those programs have since expired. Some employers also began offering paid leave, but it's not clear how long they'll continue to do so. Already, Walmart, taking a cue from the CDC, has cut paid leave for workers who get COVID down to one week from two.
The emergency paid-sick-leave law passed by Congress in 2020 prevented about 400 COVID cases per state per day. That provision has since expired, as has a second one granting tax credits to employers that offered paid leave voluntarily. Even when the 2020 measure was in effect, it didn't cover every worker; only half of all workers knew about it; and about 15 million Americans a month still lacked sufficient sick leave, a study found. Since then, there's been nothing. "We're allergic to imposing new regulations on workplaces in this country," says Vicki Shabo, a senior fellow for paid-leave policy at the think tank New America.
A good way to make sure a problem is never solved is to avoid measuring it. This is perhaps why no American agency appears to measure whether COVID-positive Americans can afford to self-isolate, or whether they are actually doing so. We're running on a nationwide honor system, and skyrocketing case numbers suggest that we aren't behaving particularly honorably.
Other countries provide money or paid sick leave to people in COVID isolation, but even in those places adherence to quarantine rules is not great. In the United Kingdom, where low-income people received ?500 (about $680) each time they were required to isolate, about 80 percent of people admitted to leaving home at least once in the week after developing COVID symptoms. In Norway, where sick pay is statutory, 65 percent of people who were supposed to isolate didn't. In Japan, where COVID-positive people received a sickness allowance, just 17 percent of people who had fever or cold symptoms in the spring of 2020 practiced strict self-isolation.
It's therefore unlikely that sick Americans, many of whom get no money while they isolate, are isolating more consistently. Daniel Schneider, a Harvard sociologist, surveyed hourly workers in the fall and found that just 45 percent of those who had contracted COVID had paid sick leave. These workers practically live in poverty: A fifth of them told Schneider that they had gone hungry in the past month because they couldn't afford enough food. Of those who reported feeling ill at some point during the pandemic, 65 percent worked while they had symptoms, many because they were afraid they'd get in trouble for calling out sick.
Another major reason Schneider's survey respondents gave for going into work was "I didn't want to let down my co-workers." In many jobs, coming in sick is a virtue, or at least the norm. Lots of things in public health get upheld through norms, rather than fines or punishment, and this norm has been slow to change with COVID, says Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials.
A Better Balance, which runs a helpline for workers struggling with paid-leave issues, gets calls "more or less daily" from people saying, "I've tested positive; is there any compensation I can get?" says Marcella Kocolatos, the helpline's director. "I often have to tell them no, unfortunately there isn't." She recalled one fast-food worker who was ordered to finish her shift even though she tested positive in the middle of the workday.
Employees who don't have a union--which is the large majority of workers--have little recourse after being asked to work while sick. Last year alone, the Occupational Safety and Health Administration, the branch of government that polices employers, received dozens of complaints from employees saying that their boss was allowing sick workers to return to work, or that workers were being disciplined for not returning to work while still in isolation. A liquor store in Pennsylvania was allegedly "telling employees to come into work before the criteria to discontinue home isolation are met"; "employee forced to return to work before isolation period over and then another 2 employees got sick," someone at a cellphone store in Virginia said; "employees are being encouraged to work when sick due to limited staffing," according to a pizzeria worker in Minnesota. Some of these are "closed" complaints, which during the Trump administration usually just meant that OSHA had called the employer and told them to stop, says Deborah Berkowitz, a former OSHA senior policy adviser and a fellow at Georgetown University. (OSHA did not reply to requests for comment.)
The law behind the agency is weak and OSHA is underfunded, Berkowitz told me. Under Republican administrations, like the one that governed the United States for all of 2020, the agency's enforcement work grinds to a halt. When Berkowitz was at OSHA, she worked on a regulation that was meant to protect workers from silica dust. It took six years to issue it. "Workplace exposures are a significant driver of this pandemic," Berkowitz said. "And workplace exposures put workers at a heightened risk of COVID."
The government could fix the paid-leave issue--it showed in 2020 that it is capable of doing so. Instead, it issues "guidelines" and watches people spread COVID because they can't afford not to.