Stay home from work if you get sick. See a doctor. Use a separate bathroom from the people you live with. Prepare for schools to close, and to work from home. These are measures the Centers for Disease Control and Prevention has recommended to slow a coronavirus outbreak in the United States.
Yet these are much easier to do for certain people — in particular, high-earning professionals. Service industry workers, like those in restaurants, retail, child care and the gig economy, are much less likely to have paid sick days, the ability to work remotely or employer-provided health insurance.
The disparity could make the new coronavirus, which causes a respiratory illness known as Covid-19, harder to contain in the United States than in other rich countries that have universal benefits like health care and sick leave, experts say. A large segment of workers are not able to stay home, and many of them work in jobs that include high contact with other people. It could also mean that low-income workers are hit harder by the virus.
“Very quickly, it’s going to circulate a lot faster in the poorer communities than the wealthiest ones,” said Dr. James Hadler, Connecticut’s former state epidemiologist and now a consultant to the state. His work has found that influenza infections tend to strike low-income neighborhoods more aggressively than affluent ones, and that poor families are more likely to live in close quarters with others, and to share bathrooms.
Unequal access to precautionary measures cuts along the same lines that divide the United States in other ways: income, education and race.
“It’s definitely an equity issue,” said Alex Baptiste, policy counsel for workplace programs at the National Partnership for Women & Families, a nonprofit advocacy group. “You have not just an economic disparity but also a racial disparity between who has that access and can take care of themselves and their families.”
Portia Green, 33, is a restaurant worker in New York. She has no paid sick leave or health insurance. If schools closed, as a single mother she’d have no child care. A day off work means losing around $100 in pay, she said, and if she had to take more than a few days off, losing her job. The restaurants she has worked for are too understaffed to call in backup workers easily, she said, and the expectation is that you show up unless you’re “green.”
“They’re going to push you to do it anyway,” said Ms. Green, who is a member of Restaurant Opportunities Centers United in New York, an advocacy group. “You go to work, pop a vitamin C and if you can do it, you do it.”
The biggest disparity for workers is access to health care: In the United States, some 27.5 million people lack any form of health insurance. That makes them less likely to seek medical care when they become ill or to have access to preventive health benefits that can help them stave off illness. The uninsured are disproportionately low income.
Workers also have unequal access to remote working. The government recommended that people work from home in a coronavirus outbreak, but just 29 percent of American workers can do so, according to Labor Department data. They are most likely to be highly educated and high earners.
On an average day, 35 percent of the highest earners and 8 percent of the lowest earners spend some time working from home. Managers and professionals are most likely to do so, and service industry and construction workers least likely. Nearly half of workers with a graduate degree do some of their work from home, as do a third of those with a college degree. Just 12 percent of those who didn’t attend college work from home.
For many workers, being sick means choosing between staying home and getting paid. One-quarter of workers have no access to paid sick days, according to Labor Department data: two-thirds of the lowest earners but just 6 percent of the highest earners. Just a handful of states and local governments have passed sick leave laws.
Only 60 percent of workers in service occupations can take paid time off when they are ill — and they are also more likely than white-collar workers to come in contact with other people’s bodies or food.
“When you’re talking about paid leave and who should stay home, it’s the ones who need it most that don’t have access to it, the ones showing up at work sick touching your food, touching your bags, coming into everyday contact with your direct life,” said Kris Garcia, 43, an airport worker in Denver.
She will not receive paid sick days until she works at her job half a year, and even then, plans to save them for dealing with a chronic disease, hemophilia. “I think people should stay home,” said Ms. Garcia, who is helping an advocacy group on issues like paid leave called Family Values at Work. “But I know I’d need my infusions, whereas if I’m coughing and have a fever, I could push through five hours.”
Evidence shows that paid sick time reduces the spread of illness. A working paper on state laws that require employers to offer paid sick leave found that statewide influenza infections fell 11 percent in the first year after enactment compared with places that made no such change. An earlier paper, on city laws, showed a similar, but smaller, effect. (There are differences between influenza and the new coronavirus, but the two diseases are transmitted in similar ways.)
“It’s very clear: When people don’t have access to sick leave, they go to work sick and spread diseases,” said Nicolas Ziebarth, an associate professor of economics at Cornell University, who was a co-author on both papers.
Still, paid sick time works only if people take it. Even when workers have paid sick leave, American culture often rewards going to work at all costs. In an average month, one in 10 workers said they needed to take leave but did not, and the most common reason was for their own illnesses, according to Labor Department data.
The top reasons for not taking it when they needed it: having too much work, fearing negative repercussions or being unable to afford a day off.