He warned that this might spread disease, and that these financially squeezed workers might send their flu-stricken children to school, infecting others.
Well before President Obama declared H1N1 a national emergency, the federal Centers for Disease Control and Prevention was emphasizing that businesses should adopt “flexible leave policies” to allow workers with the flu to stay home. In one advisory, the C.D.C. encouraged employers “to develop nonpunitive leave policies.”
Despite such recommendations, some employees say they have no choice but to go to work sick.
When Latisha Carter caught H1N1 from her 6-year-old daughter in June, she suffered headaches, chills and diarrhea, but she reported to her $13-an-hour help desk job at a Milwaukee insurer nonetheless. The temp agency that placed her does not offer her paid sick days.
“If you’re sick, they encourage you to stay home, but I couldn’t afford to take off if I wasn’t going to get paid,” said Ms. Carter, 29, who said she stuck to her small work area to avoid spreading the flu.
Georges C. Benjamin, executive director of the American Public Health Association, a group of 30,000 public health professionals, said, “Providing workers with paid sick days is essential if we’re going to get serious about the public health recommendations for swine flu — stay home until 24 hours after your fever is broken. That usually takes about five days.”
For many businesses, H1N1 has created a dilemma. “This is a very difficult issue for companies,” said Nina G. Stillman, a lawyer with Morgan, Lewis & Bockius who advises companies on sick-leave policy. “Employers who do not offer sick days are not prepared to offer them now, and they recognize that this may result in not achieving what they say they would like, which is that people who are sick stay home.”
The C.D.C. says that swine flu is widespread in 48 of the 50 states and has already hit as many as 5.7 million Americans.
Many worker groups and women’s groups have seized on the H1N1 pandemic to argue that Congress should enact legislation guaranteeing paid sick days. San Francisco and Washington have enacted such legislation, but similar measures face obstacles in Congress.
“Sometimes you talk about legislation in the abstract, but this is making people begin to understand the problem,” said Rosa DeLauro, Democrat of Connecticut and lead sponsor in the House of a bill, with more than 100 co-sponsors, that would require employers with 15 or more workers to provide seven paid sick days a year.
Business groups oppose such legislation, calling it expensive and unnecessary. They say that employers already allow and even encourage sick employees to stay home.
“The vast majority of employers provide paid leave of some sort,” said Randel K. Johnson, senior vice president for labor at the United States Chamber of Commerce. “The problem is not nearly as great as some people say. Lots of employers work these things out on an ad hoc basis with their employees.”
According to the Bureau of Labor Statistics, 39 percent of private-sector workers do not receive paid sick leave.
Workers at many retailers and restaurants say their employers’ policies discourage them from calling in sick. At Wal-Mart , when employees miss one or more days because of illness or other reasons, they generally get a demerit point. Once employees obtain four points over a six-month period, they begin receiving warnings that can lead to dismissal.
In addition, when Wal-Mart employees call in sick, their first day off is not a paid sick day (although workers can use a vacation day or personal day), but the second and third days are paid. The policy is meant to keep workers who are not actually sick from taking a day off to, say, go fishing.
Paul Hotchkiss, a support manager at a Wal-Mart store in Hastings, Minn., said the point system pressured him to report to work two weeks ago even though he had swine flu.
“There are a lot of people who have swine flu right now who are going in because they worry about getting fired for having too many points,” Mr. Hotchkiss said.
His supervisor sent him home because he looked pale, he said, adding that he did not see a doctor because he could not afford the company’s health insurance.
Wal-Mart officials say the company insists that workers with H1N1 stay home and has policies making it easy to do so.
Mandy Pillar, a nurse at Linwood Elementary School in Wichita, Kan., said more than 20 percent of the students were out sick when H1N1 swept through two weeks ago.