In its overview of the novel coronavirus, the CDC has a few recommendations: Wash your hands thoroughly, avoid people who are sick, and importantly, stay at home if you are sick. Guidelines say symptoms could take up to 14 days to show up, so when possible, people who’ve traveled to areas where the new coronavirus has a stronger presence (China, Hong Kong, Singapore, Korea, Mongolia, Italy, Japan, Macau, and Iran as of publishing) are encouraged to self-isolate for those two weeks. It’s public health in action, ideally meant to protect as many people as possible from getting sick.

But anyone who has ever worked in a restaurant probably sees these recommendations as a fantasy. There’s no federal requirements for paid sick leave in the U.S., and restaurants and delivery services are notoriously hostile to shift workers calling in sick. In 2015, Whitney Filloon wrote for Eater that a vast majority of food workers will work while they’re ill, with 45 percent saying they “can’t afford to lose pay.” Recently, writer Lauren Hough tweeted about “how many service industry workers will continue going to work” throughout the pandemic because they won’t get paid otherwise; she received hundreds of responses detailing just what those in the food industry are expected to do. “Called in sick as a waitress with 105 fever. Was told if I didn’t come to work I was fired,” responded one person. “I worked food service for 9 years. The only times I was allowed to call out were when I was hospitalized,” said another.

I don’t think people realize how many service industry workers will continue going to work, cooking and serving your food, cleaning your houses, and selling you respirators, with flu-like symptoms because they don’t have paid sick days. — Lauren Hough (@laurenthehough) February 27, 2020

Writer Amanda Mull elaborated on the contradictory nature of advising people to stay home when they can’t afford to take a day with no pay, or risk being fired if they do. She writes that the work culture in the U.S. — the service industry, the gig economy, the general pressure to work all the time else you be labeled lazy — could exacerbate a new coronavirus outbreak, and that “tasking the workers who make up so much of the infrastructure of daily American life... with the lion’s share of prevention in an effort to save thousands of lives is bound to fail, maybe spectacularly.” Restaurants will keep cooking and drivers will keep delivering (possibly to people under the 14-day quarantine), because they literally can’t afford not to. And, at least so far, restaurants and delivery services show few signs of changing these conditions.

In a statement to Eater, Grubhub said “we are focused on prioritizing the health and safety of our drivers, diners, restaurant partners and employees during this challenging time. We will continue to monitor the situation closely, including assessing and analyzing the potential impact on our business.” However, the company did not respond to questions about a sick leave policy for drivers; according to reviews on Glassdoor, paid sick days aren’t offered to drivers on contract, and those who cancel scheduled shifts are penalized.

Uber Eats offered a similar statement, saying “we remain in close contact with local public health organizations and will continue to follow their recommendations,” and that it has published guidelines for drivers in case of an outbreak, advising them to keep their cars clean, wash their hands often, and to stay home if they have even a “mild illness.” However, Uber Eats also does not provide drivers with paid time off, so it’s not hard to imagine that drivers who need money would ignore advice to stay home.

The pressure for deliverers and food service workers to work through illness is especially concerning should the new coronavirus continue spreading if, as MarketWatch predicts, food delivery becomes in higher demand. Food delivery has reportedly been on the rise in China, though precautions like leaving food in a designated location instead of handing it off in person, and providing notice of employees’ temperature, are in place. But an investment note on Grubhub from D.A. Davidson, obtained by MarketWatch, implies this outbreak could be a good for business even if it’s bad for public health. The note says the threat of new coronavirus “increases the potential for consumers to stay home and order in, which could be beneficial to Grubhub’s sales in the March quarter and, even, the June quarter depending on the duration of the outbreak and the extent of the impact on consumer’s behavior.”

One way restaurant workers have been able to get better benefits, which allow them to actually follow guidelines like “stay home if you think you might have a virus,” is through labor organizing. G, a server in a hotel restaurant and an organizer with the Industrial Workers of the World, says he’s lucky that the hotel he works at is unionized and they receive paid sick leave, but that’s not been the case in every other restaurant he’s worked at. Other servers he speaks to outside of his workplace are afraid both of contracting coronavirus and of retaliation from employers if they take sick days. Unfortunately, this is nothing new. “The IWW had an international organizing campaign at Starbucks about 10 years ago, when baristas made demands for paid sick leave in 2009 when H1N1 was spreading,” he said, and also noted a Jimmy John’s campaign that circulated flyers about sick workers making sandwiches.

G notes that even when there are laws requiring paid sick leave, employers don’t always honor them. “I interviewed two organizers with the Little Big Union,” he said, “and even though [Oregon’s] legislature passed a law for paid sick leave, the employers weren’t honoring it. They don’t have to. There’s no one to hold them accountable.” Organization has been one way to actually get employers to provide benefits and adhere to them.

Some chains are making changes. Trader Joe’s, whose employees recently moved to unionize, is allowing employees to be reimbursed for sick time taken for “respiratory illness.” And Starbucks said in a memo that employees are encouraged to stay home if they feel ill. Crucially, Starbucks provides paid sick leave for workers. Other chains will ideally follow suit as the novel coronavirus situation develops, but this outbreak illuminates a deep flaw in the service industry that’s always been there; food service workers are pressured to work while they’re sick, whether it’s because they’re threatened by management or they can’t afford to lose wages. And while food industry workers have been more active in pushing for unionization and benefits recently, they can’t hope to keep up with the pace of a rapidly spreading virus.