As the coronavirus spreads across the United States, major U.S. companies and business groups have put out hand sanitizer and discussed precautions they are taking to keep sick workers away from customers. The Centers for Disease Control and Prevention has advised employers to “ensure that your sick leave policies are flexible and consistent with public health guidance.”

Although most Americans say businesses should offer sick pay, at least a dozen states, including Florida and much of the Southeast, have passed legislation since 2011 to block efforts to require medical leave. Even in liberal-leaning states that have passed sick pay requirements, some companies sidestep the requirement by counting their workers not as employees, but as contractors.

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In Orlando, for example, voters overwhelmingly approved a measure that would have guaranteed that Flynn and thousands of other service workers in the tourist capital would get sick pay. But in 2013, according to Florida news reports, business lobbyists for Walt Disney World, Darden Restaurants and the Florida Chamber of Commerce pushed state officials to overrule the Orlando mandate.

Stopping Orlando’s sick pay requirement, former governor Rick Scott (R) said at the time, was “essential to ensuring a business-friendly environment.”

Organizers of the measure said they were stunned.

“I never thought they would put up such a big fight over something so small,” said Stephanie Porta, one of the leaders of the ballot initiative. “They were so dug in on ‘You can’t tell businesses what to do.’ But if workers had more protections right now, the coronavirus outbreak would look much different.”

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Even with confirmed U.S. cases of the novel coronavirus rising to more than 600 on Monday, much of the opposition to the Orlando sick pay mandate remains committed to blocking such measures.

Scott is now a U.S. senator, and in a statement Monday, his office said that “businesses should have the ability to make the best decisions for their employees.”

A representative of the Florida Chamber of Commerce, Edie Ousley, said the organization is “confident employers will do the right thing … without government getting in the middle of something that should be left to the private sector.”

Representatives of Walt Disney World did not respond to a request for comment.

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At Darden Restaurants, the company that owns Olive Garden and LongHorn Steakhouse, managers announced Monday that they would be offering employees as much 40 hours of paid sick leave annually. The benefit had been under consideration, officials said, but Darden moved quickly because of the coronavirus threat.

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“As we continue to make investments in our employees, we strengthen our greatest competitive edge — because when our team members win, our guests win,” Gene Lee, Darden’s president and chief executive, said in announcing the new benefit.

Working while sick

White House advisers on Monday were planning to present President Trump with measures aimed at halting the economic disruptions caused by the coronavirus. Among the potential remedies was paid sick leave.

Across the country, efforts to contain the coronavirus are complicated by the legions of low-wage workers who lack paid sick leave but often feel compelled to show up even when they are showing symptoms. Experts have a name for this phenomenon: “contagious presenteeism.”

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For years, these workers say, they’ve just muddled through.

In Detroit, Katie Muncy knew when she got bronchitis last year that there was no way she could afford to call in sick to her job loading catered meals onto airplanes. Instead, she took Robitussin and showed up to her job for two and half months with a respiratory infection.

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“I went in every day,” said Muncy, 39, who has two teenage children. “I was constantly wiping everything down, washing my hands, sanitizing things because I didn’t want anyone else to get sick.”

She eventually caught the flu and took a couple of days off without pay. But it was tough: Bills went unpaid, her family did without milk and fresh produce for a month, and she started relying on the local food bank for meat.

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“Honestly, I try not to go to work ill but I really don’t feel like I have a choice,” she said. “If I want to put meals on the table, I have to suck it up and go.”

In Allentown, Pa., nursing home worker Christine Talley, 63, came down with a week-long cold in December but decided she had to work anyway, calling out Bingo for the facility’s 65 residents and wheeling them to art class. She had used up all of her vacation time and doesn’t get dedicated sick time, so Talley tried to ignore the sneezing, coughing and runny nose. She washed her hands obsessively and wore a mask.

“Getting sick just throws a monkey wrench in your plans,” said Talley, who worked as a nurse for 25 years.

In Miami, Frank, who asked to be identified only by his middle name because he feared retribution at work, said he spends each shift helping hundreds of international travelers make their way through customs checks at Miami International Airport. Last month he tried to work while he had the flu and pneumonia and ultimately ended up in the hospital for a week. He was behind on rent for his studio apartment that month.

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“When I don’t make enough money, I struggle to pay my bills,” he said.

As the coronavirus spreads, he said he increasingly worries about his health. He doesn’t usually have time to wash his hands more than twice a day, he said, and has begun wearing a mask during to work, even though his managers have asked him not to, saying it scares travelers.

“They don’t train us. They don’t tell us what we should be doing to protect ourselves or passengers,” he said. “I worry about it all the time. We still have big flights: 400 people coming from France, 300 people from Spain, planes from Italy and the U.K. We just have to hope that none of us gets the coronavirus so we don’t get other people sick.”

‘Super spreaders’ lack sick leave

For years, the difficulties of working without sick pay have received only a smattering of attention, but with the coronavirus outbreak, the question of sick pay has risen to national prominence.

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About 24 percent of U.S. workers, or more than 30 million people, lack access to paid sick leave, according to the Bureau of Labor Statistics. Moreover, many of them are low-wage workers whose jobs involve working closely with the public — restaurant and retail workers, health-care aides — and this could conceivably make them virus “super spreaders.”

“If employers are providing hand sanitizer and cleaning their offices, but they still have workers come in because they can’t take a day away from work when they’re sick, that’s simply not sufficient,” said Sarah Fleisch Fink, vice president for policy and strategy at the National Partnership for Women and Families, an advocacy group that has campaigned for sick pay requirements.

The same geographic polarization apparent in presidential elections also arises in debates over sick pay: Some states, most in the Northeast and on the West Coast, are requiring sick pay. Many other states, particularly in the South, are heading in the opposite direction. They are passing legislation explicitly forbidding such mandates.

Since 2011, 13 states and the District of Columbia have required employers to offer sick pay, according to the National Conference of State Legislatures. Those states are: Arizona, California, Connecticut, Maryland, Massachusetts, Maine, Michigan, Nevada, New Jersey, Oregon, Rhode Island, Vermont and Washington.

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Over the same period, more than dozen other states have passed legislation forbidding any such mandates, regardless of whether the people of a city or county want the requirement. Those states include: Arkansas, Florida, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Wisconsin.

In Wisconsin, for example, Milwaukee voters approved a measure requiring sick pay for workers, but state leaders led by Gov. Scott Walker (R) passed legislation overruling the local measure.

“This law gives employers the flexibility they need to put people back to work and that makes Wisconsin a more attractive place to do business,” Walker said at the time. A spokesman for Walker declined to comment on Monday.

For Milwaukee workers like Tracy Jones, 52, who at the time was a factory machine operator and didn’t have paid sick leave, the reversal was “inhumane.”

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One day, she recalled, she stayed on the line despite what turned out to be a blood clot in her leg.

“I didn’t want to lose the day’s pay, and I didn’t want to lose my spot,” she said.

When the mandate was undone by state officials, “I was so livid,” she said. “The people had spoken.”

Companies find loopholes

Even when states mandate sick pay, however, many workers can remain without it. Companies that hire people as “contractors” rather than “employees” say they are not obliged to offer sick pay.

Jordan Anderson, 44, an Instacart shopper in Portland, Ore., where the state requires employers to offer sick pay, is one example. Although Anderson works 40 to 50 hours a week picking up groceries and other items for Instacart customers, she is not entitled to paid sick leave.

Anderson said she cannot remember the last time she took a day off: not when she had the flu, or a pulled muscle in her back, or the several times a month she has debilitating migraines. More than once, she has vomited in the parking lot in the middle of a shift, then walked back into the supermarket to resume picking out groceries and delivering them to customers’ homes.

“If I don’t work, I don’t get paid,” said Anderson. “So far, it’s been like, good luck out there and try not to get sick while you’re at it.”

Anderson figures she has to make at least $60 a day to cover monthly expenses and pay rent on her one-bedroom apartment, which she moved into last summer after a year of sleeping on friends’ couches and in her car.

“I shouldn’t be puking next to my car and going inside, washing my hands and doing somebody’s grocery shopping,” she said. “But I am because I don’t have a choice.”

With the rise of coronavirus cases, customers sometimes ask her to wear rubber gloves while she shops or to leave groceries in the garage. She says Instacart sent workers a note a couple of weeks ago urging them to wash their hands and stay home if they are sick. The company is also recommending that shoppers who have recently traveled abroad to countries such as China and Italy, or who live with someone who has, stop working for 14 days.

A spokeswoman for the San Francisco-based company said it is working with local and national authorities to monitor the coronavirus outbreak.

“I don’t think anybody working this job full time — and there are a lot of us — would definitely stay home because of a cough,” Anderson said.

Businesses rethink stance

Last week, Sen. Patty Murray (D-Wash.) and Rep. Rosa L. DeLauro (D-Conn.) introduced legislation to immediately provide paid sick days to workers. The legislation requires employers to allow workers to accrue seven days of paid sick leave each year and to provide an additional 14 days available immediately in the event of a public health emergency.

On Sunday, House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) said any coronavirus economic stimulus plan from the administration should include, among other things, sick leave.

“We are demanding that the administration prioritize the health and safety of American workers and their families over corporate interests,” they said in a statement.

Research by economist Nicolas R. Ziebarth at Cornell University and his colleagues has also buttressed arguments in favor of paid sick leave.

Using two independent data sets on flu outbreaks — one from Google and the other from the CDC — the researchers found that, in both cases, places that imposed sick pay requirements reduced flu cases by about 10 percent or more.

The researchers also found that workers who had sick pay coverage through the mandates took two or fewer days of sick leave annually and that the economic costs of the regulation were fairly small — about 21 cents per hour worked.

Based on the research, Ziebarth said, mandated sick pay “would definitely slow down the spread of the disease, which is crucial in these times.”

For now, as the coronavirus toll mounts, some business groups say they are at least willing to talk.

“We’re talking with our members and elected officials about how to help employees and restaurants address this unprecedented crisis,” Sean Kennedy, executive vice president of public affairs at the National Restaurant Association said in a statement.

The American Health Care Association said its nursing homes “face low reimbursement rates and slim operating margins, sometimes making it challenging to offer paid sick leave as well as overtime to other employees, or hire an agency who have to cover for those sick employees.”

The National Retail Federation, an industry lobbying group, told its members last week that “sick leave policies need to be flexible” and that “it may be necessary to develop an emergency sick leave policy.”

For Flynn, the Orlando sushi chef, the idea that companies will agree to such mandates seems unlikely. The restaurants he’s known, he said, have long paid lip service to public health while demanding that employees show up for work even if they’re not feeling well.