In a nutshell:

• The emergent novel coronavirus has created a certain level of panic, but has also led to a policy focus on public health preparedness.
• Limited availability of paid sick time leads people to go to work when they should stay home, increasing the likelihood of spreading diseases, as well as contributing to other adverse health outcomes.
•  Michigan’s recently enacted paid sick time policy may be inadequate to fully protect the public’s health, particularly during a pandemic.

The U.S. is one of the only economically advanced nations that does not guarantee workers paid leave for personal illness – a fact that has long been the case. While many employees are granted some amount of paid sick time without any legal mandate, around 1 in 4 Americans still don’t get any. Availability of paid sick time varies greatly by wage level and occupation type: high-income, full-time workers are far more likely to receive paid sick time than low-income and/or part-time workers.

Absent serious federal efforts to address this policy void, many cities and states have begun enacting their own paid sick leave policies. Yet, the limited availability and utilization of paid sick time—even in places where it is mandated—continues to create public health risks.

It is important to note that the Coronavirus Disease 2019 (COVID-19) pandemic isn’t really a justification for widespread panic among the general public. This novel coronavirus (SARS-CoV-2), while certainly a legitimate and serious cause for concern, is by no means a modern day black death. The origin of the disease likewise provides no justification for the spread of racist tropes and anti-Asian prejudice that have been concurrently observed.

At the same time, it is crucial for health experts and policy makers to make adequate preparations for COVID-19 and offer clear, fact-based guidance to the public regarding steps that must be taken to slow the spread of pathogens and mitigate the damage that will be caused by this pandemic.

While the novel coronavirus has our state and nation concentrating on public health matters, we might take the opportunity to look at one factor that causes diseases to spread more widely and quickly—the coughing service worker who can’t take a day off without losing a day’s pay.

(Author’s note: Could we also please agree to keep washing our hands whether or not there’s an infectious disease outbreak? After all, the right to criticize pandemics is also an obligation to maintain a basic level of personal hygiene.)

Paid Sick Time in Michigan

Michigan has been a paid sick time policy battle ground. Public Act 105 of 2015 prohibited local governments from creating paid sick time ordinances, among other prohibitions on regulating employment. In 2018, petitioners gathered enough signatures to submit to the legislature an initiated “Earned Sick Time Act” statute. The question would have appeared on the November 2018 ballot had the legislature not adopted the act in advance of the election. Shortly after enactment, the law was amended to scale back the sick time requirements it had initially created.

Michigan’s Paid Medical Leave Act, now law for nearly a year (effective March 29, 2019), provides a limited amount of paid sick time for eligible workers.

In addition to Michigan, 10 states and Washington D.C. now have laws requiring some level of paid sick leave, as do large cities such as Seattle, Dallas, and New York City.

Criticisms of paid sick time laws have generally been based on economic arguments that treat paid sick time as an individual-level employee reward or benefit, and something that should be between employers and the workforce, with little or no role for government. And yet, a study of Connecticut’s first-in-the-nation paid sick leave law found that the law had little to no impact on business costs and administrative burden. Others have further suggested that paid sick leave policies can reduce healthcare spending and increase worker productivity, offsetting any costs associated with providing paid sick time.

Any economic evaluation of paid sick time policies should be balanced against the effects of paid sick time as a public health mechanism – particularly since ignoring public health inevitably leads to greater costs in the long run. Besides, do you really want a service worker coughing while preparing your lunch because they weren’t permitted or couldn’t afford to stay home?

Paid Sick Time and Public Health

The U.S. Centers for Disease Control and Prevention (CDC) has provided very straightforward advice for preventing the spread of COVID-19:

“Stay home when you are sick.”

This advice should be, of course, applied to other infectious diseases as well, whether we’re talking about seasonal influenza or some as of yet unidentified future pandemic. Not surprisingly, research has shown that access to paid sick leave makes it more likely that sick workers will heed such advice.

People with paid sick leave are also less likely to make mistakes or suffer injuries on the job from working at reduced functional capacity due to sickness. Lack of sick leave is also a potential barrier to valuable preventative health care services, such as cancer screenings; workers with 10 or more paid sick days appear to utilize preventative care more frequently.

Paid sick time is, therefore, a broad means of both preventing premature deaths and reducing health inequities, as well as preventing the spread of communicable diseases. The public health value of paid sick time policies has long been recognized by the American Public Health Association, as well as many other groups in the health sphere (such as the American Medical Association).

Here’s an alarming data point to consider: Low-income workers—such as those working in food service or providing care to children and the elderly—are less likely to have paid sick time and are more likely to go to work sick, despite working in settings with a greater risk of spreading disease. For instance, 1 in 5 food service workers have reported working while experiencing diarrhea and/or vomiting – given the natural reticence of many to make such an admission, the true prevalence is likely higher. More than 1 in 3 private sector employees attended work while sick during the 2009 H1N1 pandemic in defiance of public health recommendations; this pandemic contributed to an estimated 12,469 deaths in the U.S.

Since evidence suggests that paid sick time policies reduce the spread of infectious diseases without creating any significant impact on wages or employment, it might be more reasonable to think of paid sick time as a society-level health policy, rather than an individual employee benefit. By extension, it may be time to reevaluate the adequacy of Michigan’s Paid Medical Leave Act of 2018 through a public health lens.

It’s certainly necessary to consider the potential costs that further expansion of paid sick time would impose upon businesses, and, by extension, consumers. At the same time, it’s also worth considering the benefits of coronavirus-free supermarkets, restaurants, nursing homes, and day-care centers.