For over 30 years, Joyce Barnes has worked as a home healthcare aide in Richmond, Virginia, without any paid sick days. She makes $8.25 an hour and often works through illnesses because she can’t afford to lose income from taking the time off.

“I can’t afford to miss pay so I have gone to work before several times sick as a dog, masked up so my patients wouldn’t catch what I have,” Barnes said. “Every day I pray and I ask God to give me strength that I won’t get sick so I can keep on making it and that’s the way we have to do it.”

Last July, Barnes contracted an illness from one of her patients that caused her a stay in a hospital for over a week. She relied on family members to help with bills to make up for the income she lost from missing work, and still has to make regular monthly payments toward the thousands of dollars of medical debt she accrued, despite having health insurance.

“I have a lot of medical debt I have to pay. They had to do a test on my stomach when I was sick. That one test cost me $3,000 and I’m still paying it because I can’t afford to pay everything back,” Barnes added.

As the coronavirus outbreak (Covid-19) has begun to spread through the US, millions of low-wage workers in service industries are left vulnerable due to lack of proper medical benefits and paid sick leave. There are growing concerns that these workers will be extra vulnerable to the disease themselves, or, due to lack of health insurance and poverty, help its spread by continuing to work while ill.

More than 32 million workers in the US have no paid sick days off, and low-wage workers are least likely to have paid sick time. These workers are also significantly less likely to have access to healthcare and medical benefits, making them potentially especially vulnerable to the coronavirus outbreak as it spreads.

According to the latest data available from the Bureau of Labor Statistics, 69% of low-wage workers, those in the 10th lowest percentile of median wage earners in the US civilian workforce, do not receive paid sick leave benefits.

“Their earnings are low so they can’t afford to take unpaid leave and when they are sick they have to keep working and expose other people in the process,” said Harry Holzer, a professor of public policy at Georgetown University.

“That’s the reason advocates for paid leave make the case – it’s not just for the worker, it’s for the public good. There’s a reason for the government to help provide it.”

Dr Erica Groshen, a senior extension faculty member at the Cornell University School of Industrial and Labor Relations, explained changes in technology have made it easier for more professional workers to work from home, making them less vulnerable to getting sick and able to cope with the potential quarantine conditions of a coronavirus epidemic. Already King county in Washington state – which includes Seattle – has recommended its residents work from work.

But low-wage workers are increasingly more vulnerable as they feel the pressure of the threat of having their work outsourced to contractors. They also often do work – fast food jobs, manual labor, care work – that cannot be done from home. That means the coronavirus could cost them their livelihoods, as well as their health.

“That’s what we’re seeing, a widening of inequality on that front,” said Groshen.

Many low-wage workers, such as airport workers, are on the frontlines of the coronavirus outbreak, yet are left unprotected from contracting the virus or receiving adequate medical treatment.

Leila Benitez, an airplane cabin cleaner at Miami international airport for eight years, has no health insurance or paid sick leave.

“When I finally do take a day off because I’m so sick, I have to pay hundreds of dollars in medical bills to get a doctor’s note,” said Benitez. She often travels to the Dominican Republic, where she is from, to receive medical care because treatment and prescriptions costs a fraction of prices in the US.

“When I’m cleaning the planes, there are bodily fluids, trash, dirty tissues. We don’t get enough time to wash our hands in between planes. The protective gloves are thin, and often don’t fit correctly.”

Several states and cities around the US have passed laws mandating employers provide workers with paid sick leave. A 2017 study published in the Journal of Public Economics found US cities that mandated sick leave for workers experienced up to 40% declines in seasonal flu rates. But many low-wage workers in these areas are still in positions where they have to work through an illness.

In Maryland, the state passed a paid sick leave law in 2018 under which employers must provide one hour of paid sick leave for every 30 hours worked, but adjunct professors often only accrue a few hours every semester and have restrictions on when and how they can use it.

“This past month, I had to teach while sick and it prolonged my illness. I was worried my students were going to contract it. I felt like I couldn’t take off because I can’t afford to lose the money,” said Val Pappas-Brown, an adjunct professor in the Baltimore area for two years.

Joan Bevelaqua, an adjunct professor at several different colleges in Maryland for 20 years, explained she has never taken sick time off for fear of losing income. She currently has health insurance through medicare, but is now missing work due to a fractured femur.

She is currently trying to schedule extra courses to teach over the summer to try to make up for the income she is losing this semester, while pushing state legislators to pass the Time to Care Act, which would set up a sick leave insurance program for workers in Maryland.

“Being an adjunct, we all went into this profession hoping to become full-time professors and more and more you remain an adjunct,” she added. “We are much cheaper, they don’t pay benefits, and we don’t have adequate sick leave so we come to school sick.”