Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries*

We assessed the impact of social determinants of potential exposure to H1N1--which are unequally distributed by race/ethnicity in the United States--on incidence of influenza-like illness (ILI) during the 2009 H1N1 pandemic. In January 2010 we surveyed a nationally representative sample (n = 2079) of US adults from the Knowledge Networks online research panel, with Hispanic and African American oversamples. The completion rate was 56%. Path analysis examining ILI incidence, race, and social determinants of potential exposure to H1N1 demonstrated that higher ILI incidence was related to workplace policies, such as lack of access to sick leave, and structural factors, such as number of children in the household. Hispanic ethnicity was related to a greater risk of ILI attributable to these social determinants, even after we controlled for income and education. The absence of certain workplace policies, such as paid sick leave, confers a population-attributable risk of 5 million additional cases of ILI in the general population and 1.2 million cases among Hispanics. Federal mandates for sick leave could have significant health impacts by reducing morbidity from ILI, especially in Hispanics.

We examined the impact of access to paid sick days (PSDs) and stay-at-home behavior on the influenza attack rate in workplaces. We used an agent-based model of Allegheny County, Pennsylvania, with PSD data from the US Bureau of Labor Statistics, standard influenza epidemic parameters, and the probability of staying home when ill. We compared the influenza attack rate among employees resulting from workplace transmission, focusing on the effects of presenteeism (going to work when ill). In a simulated influenza epidemic (R0 = 1.4), the attack rate among employees owing to workplace transmission was 11.54%. A large proportion (72.00%) of this attack rate resulted from exposure to employees engaging in presenteeism. Universal PSDs reduced workplace infections by 5.86%. Providing 1 or 2 "flu days"-allowing employees with influenza to stay home-reduced workplace infections by 25.33% and 39.22%, respectively. PSDs reduce influenza transmission owing to presenteeism and, hence, the burden of influenza illness in workplaces.