What started out as a valiant effort to provide Americans with paid sick leave during an unprecedented health care crisis has ended with a paltry measure that will barely cover anyone who is still working in the COVID-19 economy.

On Thursday, the Department of Labor published guidelines on the new paid sick leave and family leave provisions enacted last month as part of Congress’s second coronavirus relief act.

The measures in the law were already a watered-down version of what Democrats and advocates wanted: real paid time off for all workers who get sick, are quarantined, or have to care long-term for a family member who is sick or a child home due to a school closure.

Instead, the law made 10 days of paid sick time and 10 weeks more of longer-term leave available to those working at companies with fewer than 500 employees. Millions were left out.

Now the Department of Labor has further hollowed out those provisions. It’s totally exempting the estimated 9 million people who work in the health care industry ― from a doctor to a pharmacy clerk to a janitor in a hospital. These are workers who are most likely to be in contact with infected patients, at high risk of getting sick. And under the new law, they can’t get a guaranteed sick day.

“Thanks to Republican opposition, the steps we’ve taken on paid leave are inadequate in light of the crisis, and now, the Trump Administration is twisting the law to allow employers to shirk their responsibility and is significantly narrowing which workers are eligible for paid leave. This simply can’t stand,” said Sen. Patty Murray (D-Wash.) in a statement slamming the “gratuitous loopholes.”

Andrew Harnik/ASSOCIATED PRESS President Donald Trump with Labor Secretary Eugene Scalia in the Oval Office at Scalia's swearing-in last September.

The new regulations give wide leeway to very small businesses, who can pretty much automatically bow out of providing longer-term leave to parents with kids at home from school.

Bottom line: Millions of more people ― including the workers who are most likely to come into contact with the coronavirus ― will be unable to do what the law intended to encourage: stay home if they’re sick and not be penalized for it.

“We know these occupations are essential, and we know that means that [health care workers] may have to keep working,” said Vasu Reddy, a senior policy analyst at the National Partnership for Women and Families. “But if they’re sick, they should be able to get the care that they need without having to worry about losing their paycheck or job.”

The law already exempted other workers whose roles are essential during the pandemic. Under pressure from big business, the White House and Republicans, the leave provisions had been gutted to only include companies with fewer than 500 employees ― meaning workers at large grocery chains, who like health care sectors are expected to show up and put themselves at risk, are exempt.

“Congress had an opportunity to enact a law that was stronger,” said Vicki Shabo, a senior fellow and paid leave expert at the liberal New America think tank. “Instead Congress made choices that are forcing people to continue to go to work potentially sick and infect others.”

On Twitter, Shabo simply said that the department took a “hacksaw” to the law.

Since Trump signed that law on March 18, large employers have proved again and again that they’re not up to the task of keeping workers healthy and protected.

Workers at Walmart, for example, told HuffPost that the company’s coronavirus sick leave is vastly inadequate. Amazon warehouse workers say that the company is incentivizing them to come to work even as more of them contract COVID-19. And they don’t feel protected on the job.

Under the department’s new guidelines essentially anyone who works for a business that is even remotely attached to the health care industry will not get paid sick leave or paid family leave.

The Labor Department’s guideline on health care providers gives an exemption not only for doctors but also “anyone employed at any doctor’s office, hospital, health care center, [or] clinic.” And the list goes on: Anyone working at a medical school, health department or agency, retirement home, nursing home, any home health care provider or laboratory that does testing. Even people who work at pharmacies are on the list.

An additional 4.4 million workers at companies with fewer than 50 employees are also out of luck when it comes to getting the 10 weeks of paid time off to care for children who are home because of school closures.

These companies can get out of that requirement if they decide it would be too burdensome to their business. All they need to do is write down that they’re taking the exemption ― and keep that written explanation on file somewhere.

There’s no enforcement.

“There’s no accountability to make sure these claims are actually legitimate,” Reddy said, adding that this is bad for the small companies that want to do the right thing. Those good actors will have to compete with other small businesses that are just exempting everyone.

The new regulations are just one more slap in the face for those who had been pushing for sick leave to handle this crisis. The United States, unlike most developed countries, does not have any kind of sick leave guarantee for workers.

While high-income workers mostly do get paid time off when they’re sick, low-income and hourly workers mostly don’t. So while doctors might have a reserve of paid time off, hourly workers in the health care system are far less likely to have such benefits.

About half the workers at the country’s biggest chains ― think McDonald’s, Krogers, Taco Bell ― say they can’t take a sick day.