In America, taking a day off from work, let alone a few days, to recover from illness, is at best discouraged, at worst penalized. Sometimes the consequence is a pointed comment from a manager, encouraging an employee to “work through it.” Other times, as Amazon employees can attest, even a tiny drop in productivity means losing their jobs. Perhaps that’s why 47% of Americans went to work sick in the past year, according to a HuffPost/YouGov survey.

Employer expectations are being tested with spread of the coronavirus, at least when it comes to being physically present at a workplace. In some industries, companies are encouraging their employees to heed the Centers for Disease Control and Prevention guidelines: work from home, avoid large crowds, and see a doctor immediately if you’re sick.

But those recommendations are not an option for workers in the service industry and the gig economy, who can’t work from home, won’t get paid if they don’t work, and often don’t have adequate health insurance.

As The New York Times reported this weekend, “[this] 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.”

Most retail and service workers unable to work from home because their jobs depend on person-to-person contact. For example, home health aides can’t care for homebound seniors, waiters can’t serve food and drivers for ride share companies can’t ferry passengers via laptop — nor can warehouse workers assembling packages with the hand sanitizers Americans can’t seem to stop ordering, causing a nationwide shortage. And unlike most white-collar office workers, they don’t have paid sick leave.

This cohort is most likely to be among the 27.5 million people in America without health insurance, according to 2018 data from the American Community Survey Current Population Survey Annual Social and Economic Supplement.

Portia Green, a restaurant employee who spoke to the Times, doesn’t have paid sick leave or health insurance. If she doesn’t work, she doesn’t get paid, and that means losing at least $100 per day. If her child’s school closes, she can’t afford child care. The expectation in her industry is that sick workers will show up. “They’re going to push you to do it anyway,” she explained, adding, “You go to work, pop a vitamin C and if you can do it, you do it.”

Kris Garcia, an airport worker in Denver, told a similar story. “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,” he said. Garcia does get paid sick days after six months on the job, but he is out of luck if he needs to deal with health issues before then.

Infectious disease experts echo workers’ concerns. “Very quickly, it’s going to circulate a lot faster in the poorer communities than the wealthiest ones,” Dr. James Hadler, Connecticut’s former epidemiologist and now a consultant to the state, told the Times.

Only 10 states and 33 cities have passed some version of paid sick leave, according to the National Partnership for Women and Families, but they vary in amount and eligibility, which is a particular cause for concern as coronavirus cases mount.

“It’s very clear,” said Nicolas Ziebarth, associate professor of economics at Cornell University, who wrote multiple papers on the subject. “When people don’t have access to sick leave, they go to work sick and spread diseases.”

Read the full New York Times story here.