Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among U.S. workers

Economic burden of COVID-19 for employers and employees in the United States

OBJECTIVE

Describe the economic burden of COVID-19 on employers and employees in the United States (US).

METHODS

A targeted literature review was conducted to evaluate the impact of COVID-19 on US-based employers and employees in terms of healthcare resource utilization (HCRU), medical costs, and costs associated with work-loss. Searches were conducted in MEDLINE, Embase, and EconLit using a combination of disease terms, populations, and outcomes to identify articles published from January 2021 to November 4, 2022. As data from the employer perspective were lacking, additional literature related to influenza were included to contextualize the impact of COVID-19, as it shifts into an endemic state, within the existing respiratory illness landscape.

RESULTS

A total of 41 articles were included in the literature review. Employer and employee perspectives were not well represented in the literature, and very few articles overlapped on any given outcome. HCRU, costs, and work impairment vary by community transmission levels, industry type, population demographics, telework ability, mitigation implementation measures, and company policies. Work-loss among COVID-19 cases were higher among the unvaccinated and in the week following diagnosis and for some, these continued for 6 months. HCRU is increased in those with COVID-19 and COVID-19-related HCRU can also continue for 6 months.

CONCLUSIONS

COVID-19 continues to be a considerable burden to employers. The majority of COVID-19 cases impact working age adults. HCRU is mainly driven by outpatient visits, while direct costs are driven by hospitalization. Productivity loss is higher for unvaccinated individuals. An increased focus to support mitigation measures may minimize hospitalizations and work-loss. A data-driven approach to implementation of workplace policies, targeted communications, and access to timely and appropriate therapies for prevention and treatment may reduce health-related work-loss and associated cost burden.

Paid Sick Leave Among U.S. Healthcare Personnel, April 2022

INTRODUCTION

Healthcare personnel are at risk for acquiring and transmitting respiratory infections in the workplace. Paid sick leave benefits allow workers to stay home and visit a healthcare provider when ill. The objectives of this study were to quantify the percentage of healthcare personnel reporting paid sick leave, identify differences across occupations and settings, and determine the factors associated with having paid sick leave.

METHODS

In a national nonprobability Internet panel survey of healthcare personnel in April 2022, respondents were asked, Does your employer offer paid sick leave? Responses were weighted to the U.S. healthcare personnel population by age, sex, race/ethnicity, work setting, and census region. The weighted percentage of healthcare personnel who reported paid sick leave was calculated by occupation, work setting, and type of employment. Using multivariable logistic regression, the factors associated with having paid sick leave were identified.

RESULTS

In April 2022, 73.2% of 2,555 responding healthcare personnel reported having paid sick leave, similar to 2020 and 2021 estimates. The percentage of healthcare personnel reporting paid sick leave varied by occupation, ranging from 63.9% (assistants/aides) to 81.2% (nonclinical personnel). Female healthcare personnel and those working as licensed independent practitioners, in the Midwest, and in the South were less likely to report paid sick leave.

CONCLUSIONS

Most healthcare personnel from all occupational groups and healthcare settings reported having paid sick leave. However, differences by sex, occupation, type of work arrangement, and Census region exist and highlight disparities. Increasing healthcare personnel's access to paid sick leave may decrease presenteeism and subsequent transmission of infectious diseases in healthcare settings.

Understanding the Experiences of Latinx LGBTQ Texans at the Beginning of the COVID-19 Pandemic

Marginalized communities have been disproportionately affected by COVID-19, including both racial/ethnic minority and sexual minority populations. To date, there has been little research examining the impact of the COVID-19 pandemic at the intersections of marginalized identities. Furthermore, available national data on COVID-19 outcomes may obscure our understanding of region-specific outcomes, particularly in the U.S. South. Using an intersectional approach, we explore differences in worries over COVID-19, preventative behaviors, and COVID-19 outcomes in the early months of the pandemic in a diverse sample of LGBTQ people (N = 1076) living in Texas. Our findings indicated that LGBTQ Latinx people in Texas reported more COVID-19 related worries and adverse outcomes than non-Latinx LGBTQ people. These findings are in line with previous research that found that the increased risk to Latinx and LGBTQ populations in public health crises is often overlooked and can be attributed to many factors such as socioeconomic status, occupational propensity, disparities in physical health, and barriers to healthcare access. Furthermore, our findings suggest the necessity of utilizing an intersectional approach when examining the disproportionate burden marginalized communities face in public health crises.

Is paid sick leave bad for business? A systematic review

Vigorous legislative activity both for and against paid sick leave has occurred over the last decade. Although a compelling body of evidence suggests that paid sick leave supports personal and public health goals, a notable barrier in opposition to paid sick leave is apprehension about the potential short-term and long-term harms to business. This review critically assesses the relationship between paid sick leave and favorable or unfavorable business conditions. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically review six research databases between 2000 and November 2022. Of 2664 studies identified, 123 were considered potentially relevant and 43 were included in the review. In addition to absence from work, paid sick leave was associated with favorable business conditions such as increased job satisfaction; improved retention; and reductions in occupational injury, contagion, presenteeism, and death; as well as some measures of firm performance and labor market conditions. Overall, our review discovered more evidence supporting the relationship between paid sick leave and favorable business conditions as compared with evidence that supported unfavorable business conditions. Although more research is needed, these findings can be used to inform firm-level and public policy decisions about paid sick leave.

Which Curve Are We Flattening? The Disproportionate Impact of COVID-19 Among Economically Marginalized Communities in Ontario, Canada, Was Unchanged From Wild-Type to Omicron

Person-level surveillance (N = 14 million) and neighborhood-level income data were used to explore magnitude of inequalities in COVID-19 hospitalizations and deaths over 5 waves in Ontario, Canada. Despite attempts at equity-informed policies alongside fluctuating levels of public health measures, the magnitude of inequalities in hospitalizations and deaths remained unchanged across waves.

Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without

Paid sick leave provides workers with paid time off to receive COVID-19 vaccines and to recover from potential vaccine adverse effects. We hypothesized that US cities with paid sick leave would have higher COVID-19 vaccination coverage and narrower coverage disparities than those without such policies. Using county-level vaccination data and paid sick leave data from thirty-seven large US cities in 2021, we estimated the association between city-level paid sick leave policies and vaccination coverage in the working-age population and repeated the analysis using coverage in the population ages sixty-five and older as a negative control. We also examined associations by neighborhood social vulnerability. Cities with a paid sick leave policy had 17 percent higher vaccination coverage than cities without such a policy. We found stronger associations between paid sick leave and vaccination in the most socially vulnerable neighborhoods compared with the least socially vulnerable ones, and no association in the population ages sixty-five and older. Paid sick leave policies are associated with higher COVID-19 vaccination coverage and narrower coverage disparities. Increasing access to these policies may help increase vaccination and reduce inequities in coverage.

Perceptions and Attitudes toward COVID-19 Vaccination among Pregnant and Postpartum Individuals

OBJECTIVE

This study aimed to characterize attitudes toward novel coronavirus disease 2019 (COVID-19) vaccination and to evaluate factors associated with vaccine uptake among pregnant individuals.

STUDY DESIGN

An anonymous survey was distributed to a convenience sample of pregnant individuals receiving prenatal care at two large urban academic hospitals in a single health care network in Massachusetts. Individual demographic variables were included in the survey along with questions assessing attitudes toward COVID-19 and vaccination in pregnancy. Data were analyzed using parametric or nonparametric tests when appropriate, and associated odds ratios (OR) were calculated via univariable logistic regression.

RESULTS

There were 684 surveys distributed, and 477 pregnant and postpartum individuals completed the survey, for a response rate of 69.7%. Overall, 233 (49.3%) had received or were scheduled to receive a COVID-19 vaccine. Age, White race, non-Hispanic or Latinx ethnicity, working from home, and typical receipt of the influenza vaccine were associated with COVID-19 vaccination. Further, 276 respondents (58.4%) reported that their provider recommended the COVID-19 vaccine in pregnancy; these participants were more likely to have received a vaccine (OR = 5.82, 95% confidence interval [CI]: 3.68-9.26, p < 0.005). Vaccinated individuals were less likely to be worried about the effects of the vaccine on themselves (OR = 0.18, 95% CI: 0.12-0.27, p < 0.005) or their developing babies (OR = 0.17, 95% CI: 0.11-0.26, p < 0.005). Unvaccinated individuals were less likely to report that it is easy to schedule a COVID-19 vaccine (OR = 0.56, 95% CI: 0.34-0.93, p = 0.02), to travel to receive a vaccine (OR = 0.19, 95% CI: 0.10-0.36, p < 0.005), and to miss work to receive a vaccine (OR = 0.30, 95% CI: 0.18-0.48, p < 0.005).

CONCLUSION

Strategies are needed to improve patient education regarding vaccine side effects and safety in pregnancy. Policy changes should focus on making it feasible for patients to schedule a vaccine and miss work without loss of pay to get vaccinated.

KEY POINTS

· There were racial and ethnic disparities in COVID-19 vaccination.. · Unvaccinated respondents were more likely to be concerned about vaccine effects for themselves or their growing babies.. · Unvaccinated respondents cited work and scheduling-related barriers to vaccination, indicating areas for advocacy..

The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study

OBJECTIVE

During the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare 'heroes' as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs.

METHODS

This study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs.

RESULTS

We found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19-related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges.

CONCLUSION

Significant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.

Analysis of the Effectiveness of Measures on the COVID-19 Vaccination Rate in Hong Kong

Background: The World Health Organization has set a target of at least 70% of the global population being vaccinated by the middle of 2022. There are only 17 countries that achieved a 70% vaccination rate (VR). This study aims to analyze the effectiveness of public policies to increase the COVID-19 VR. Methods: vaccination figures of all eligible population groups in Hong Kong from 22 February 2021 to 23 January 2022, were extracted for analysis. Weekly acceleration in the VR (AVR) was calculated as a measure of policy effectiveness. A total of 13 identified measures were classified into four policy categories: eligibility, accessibility, incentives, and restrictions. Age-weighted AVR (AWAVR) was compared by age group and policy presence vs. absence using Mann−Whitney U tests. Results: the AWAVR means across age groups ranged from −1.26% to +0.23% (p = 0.12) for eligibility; accessibility ranged from +0.18% to +1.51% (p < 0.0001); incentives ranged from +0.11% to +0.68% (p < 0.0001); and restrictions ranged from +0.02% to +1.25% (p < 0.0001). Conclusions: policies targeting accessibility, incentives, and restrictions are effective at increasing the VR. These results may serve as a policy reference.

Progress in National Policies Supporting the Sustainable Development Goals: Policies that Matter to Income and Its Impact on Health

From education to working conditions, from income to discrimination, social determinants of health (SDH) shape the majority of health outcomes. Governments are often best positioned to address the major SDH on a population-wide basis. In 2015, governments around the world committed to improving all core SDH when all countries agreed to a set of goals that would improve education, work, income, and equal opportunity, among other areas, in the Sustainable Development Goals (SDGs). Using data from the WORLD Policy Analysis Center, this article highlights how quantitative policy measures can be used to hold governments accountable for their commitments to the SDGs and thus to improve the SDH. Three areas are examined in detail to illustrate this approach to monitoring policy change: ensuring an adequate income, enhancing equal opportunities at work by prohibiting discrimination and sexual harassment, and enabling children and youth to complete their education.

Overview of legal measures for managing workplace COVID-19 infection risk in several Asia-Pacific countries

Background

Despite the lack of official COVID-19 statistics, various workplaces and occupations have been at the centre of COVID-19 outbreaks. We aimed to compare legal measures and governance established for managing COVID-19 infection risks at workplaces in nine Asia and Pacific countries and to recommend key administrative measures.

Methods

We collected information on legal measures and governance both general citizens and workers regarding infection risks such as COVID-19 from industrial hygiene professionals in nine countries (Indonesia, India, Japan, Malaysia, New Zealand, Republic of the Philippines, Republic of Korea, Taiwan, and Thailand) using a structured questionnaire.

Results

A governmental body overseeing public health and welfare was in charge of containing the spread and occurrence of infectious diseases under an infectious disease control and prevention act or another special act, although the name of the pertinent organizations and legislation vary among countries. Unlike in the case of other traditional hazards, there have been no specific articles or clauses describing the means of mitigating virus risk in the workplace that are legally required of employers, making it difficult to define the responsibilities of the employer. Each country maintains own legal systems regarding access to the duration, administration, and financing of paid sick leave. Many workers may not have access to paid sick leave even if it is legally guaranteed.

Conclusion

Specific legal measures to manage infectious disease risks, such as providing proper personal protective equipment, education, engineering control measures, and paid sick leave are recommended to be stipulated in occupational safety and health related acts.

Paid Sick Leave and Healthcare Utilization in Adults: A Systematic Review and Meta-analysis

CONTEXT

The U.S. is the only industrialized country in the world with no national policy mandating paid sick leave for workers. This study systematically reviews and quantifies the impact of paid sick leave on the use of healthcare services among employed adults.

EVIDENCE ACQUISITION

Articles published from January 2000 to February 2020 were located in MEDLINE/PubMed, SCOPUS, ScienceDirect, and Embase from March/April 2020. Key search terms included paid sick leave and health care utilization. Articles were assessed for methodologic quality, and qualitative and quantitative data were extracted. From the quantitative data, pooled OR, distribution, and heterogeneity statistics were calculated when possible.

EVIDENCE SYNTHESIS

A total of 12 manuscripts met the criteria for systematic review, and 8 of them had statistics required for meta-analysis. Individuals with paid sick leave had 1.57 (95% CI=1.50, 1.63; p<0.001) odds of having an influenza vaccination, 1.54 (95% CI=1.48, 1.60; p<0.001) odds of having a mammogram, 1.33 (95% CI=1.25, 1.41; p<0.001) odds of seeing a doctor, and 1.29 (95% CI=1.18, 1.39; p<0.001) odds of getting a Pap test compared with individuals without paid sick leave. However, the I² was relatively high with a significant p-value for most of the services, indicating potential heterogeneity.

CONCLUSIONS

Paid sick leave is likely to be an effective way to increase the use of primary and preventive healthcare services in the U.S. Further studies should be carried out to track outcomes over a longer period and to compare the effect of the number of paid sick days in relation to healthcare utilization.

Risk Factors for COVID-19 and Rheumatic Disease Flare in a US Cohort of Latino Patients

Objective

Latino patients are overrepresented among cases of coronavirus disease 2019 (COVID‐19) and are at an increased risk of severe disease. Prevalence of COVID‐19 in Latinos with rheumatic diseases is poorly reported. This study was undertaken to characterize COVID‐19 clinical features and outcomes in Latino patients with rheumatic diseases.

Methods

We conducted a retrospective study of Latino patients with rheumatic diseases from an existing observational cohort in the Washington, DC area. Patients seen between April 1, 2020 and October 15, 2020 were analyzed in this study. We reviewed demographic characteristics, body mass index (BMI), comorbidities, and use of immunomodulatory therapies. An exploratory classification and regression tree (CART) analysis along with logistic regression analyses were performed to identify risk factors for COVID‐19 and rheumatic disease flare.

Results

Of 178 Latino patients with rheumatic diseases, 32 (18%) were identified as having COVID‐19, and the incidence rate of infection was found to be 3‐fold higher than in the general Latino population. No patients required intensive care unit–level care. A CART analysis and multivariable logistic regression analysis identified a BMI of >30.35 as a risk factor for COVID‐19 (odds ratio [OR] 3.37 [95% confidence interval (95% CI) 1.5–7.7]; P = 0.004). COVID‐19 positivity was a risk factor for rheumatic disease flare (OR 4.57 [95% CI 1.2–17.4]; P = 0.02).

Conclusion

Our findings indicate that Latino patients with rheumatic diseases have a higher rate of COVID‐19 compared with the general Latino population. Obesity is a risk factor for COVID‐19, and COVID‐19 is a risk factor for rheumatic disease flare. Latino patients with risk factors should be closely followed up, especially post–COVID‐19 in anticipation of disease flare.

Socioeconomic Factors Associated With an Intention to Work While Sick From COVID-19

OBJECTIVE

We sought to understand barriers to staying home from work when sick from COVID-19 (COVID-19 presenteeism) to understand COVID-19 health disparities and transmission and guide workplace and social policy.

METHODS

We used logistic regression models to assess which socioeconomic factors were associated with intended COVID-19 presenteeism among an online study population working outside their home in March 2020 (N = 220).

RESULTS

Overall, 34.5% of participants reported intended COVID-19 presenteeism. Younger individuals and individuals making over $90,000 per year were less likely to report COVID-19 presenteeism. Individuals who were worried about having enough food had 3-fold higher odds of intended COVID-19 presenteeism.

CONCLUSION

Current policies around food access, paid sick leave, and other workplace protections need to be expanded and made more accessible to reduce health disparities as well as the transmission of COVID-19 and other infections.

Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017-2018

We assessed determinants of work attendance during the first 3 days after onset of acute respiratory illness (ARI) among workers 19-64 years of age who had medically attended ARI or influenza during the 2017-2018 influenza season. The total number of days worked included days worked at the usual workplace and days teleworked. Access to paid leave was associated with fewer days worked overall and at the usual workplace during illness. Participants who indicated that employees were discouraged from coming to work with influenza-like symptoms were less likely to attend their usual workplace. Compared with workers without a telework option, those with telework access worked more days during illness overall, but there was no difference in days worked at the usual workplace. Both paid leave benefits and business practices that actively encourage employees to stay home while sick are necessary to reduce the transmission of ARI and influenza in workplaces.

Barriers and facilitators to influenza-like illness absenteeism among healthcare workers in a tertiary-care healthcare system, 2017-2018 influenza season

OBJECTIVE

Influenza can be introduced and propagated in healthcare settings by healthcare workers (HCWs) working while ill with influenza. However, reasons driving this behavior are unclear. In this study, we examined barriers to and facilitators of absenteeism during the influenza season.

DESIGN

Cross-sectional mixed methods study.

SETTING

Ambulatory and inpatient settings in a large, tertiary-care healthcare system.

METHODS

An anonymous electronic survey was sent to HCWs between June 11 and July 13, 2018, asking participants to self-report influenza-like illness (ie, ILI symptoms of fever, chills, cough, or sore throat) during the 2017-2018 influenza season. We conducted a logistical regression analysis to identify factors associated with absenteeism.

RESULTS

Of 14,250 HCWs, 17% responded to the survey. Although 1,180 respondents (51%) reported symptoms of ILI, 575 (43%) did not stay home while ill. The most commonly perceived barriers to ILI absenteeism included being understaffed (odds ratio [OR], 1.78; P = .04), unable to find a replacement for work (OR, 2.26; P = .03), desiring not to use time off (OR, 2.25; P = .003), and paid by the hour or unable to afford being absent (OR, 2.05; P = .02). Common perceived facilitators of absenteeism included support from coworkers and management, clearer policy, better sick days availability, and lower perceived threat of disciplinary action.

CONCLUSIONS

Reporting to work with ILI symptoms is common among HCWs. Most barriers and facilitators are related to systems. Addressing system factors, such as policies regarding sick days and sick leave and ensuring adequate backup staffing, is likely to facilitate absenteeism among ill HCWs.

Shifting Coronavirus Disease 2019 Testing Policy and Research to Include the Full Translation Pipeline

The current severe acute respiratory syndrome coronavirus 2 testing policy and practice limits testing as a prevention tool. Radical shifts are required to increase the scale of rapid testing strategies and improve dissemination and implementation of venue-based and self-testing approaches. Attention to the full translation pipeline is required to reach high-risk segments of the population.

Behavioral strategies for reducing disease transmission in the workplace

The coronavirus pandemic highlighted that workplaces may serve as a hub of disease transmission if proper precautions are not enacted. The Centers for Disease Control recommends several strategies for decreasing the spread of illnesses in the workplace, including a) promoting proper hand hygiene, b) cleaning and sanitizing the work area, c) encouraging sick employees to stay home, d) personal protective equipment, and, e) social distancing. Research suggests that instructions are often not sufficient to change work behaviors, and behavioral interventions may be needed. Thus, the present paper reviews existing research that informs the implementation of behavioral strategies to reduce the spread of disease in the workplace, and makes recommendations for organizations to protect employees, clients, and customers. Intervention components such as training, prompts, the reduction of response effort, clear workplace policies, feedback, and consequences are discussed, and practical recommendations and suggestions for future research are provided.

Differences Between U.S. Workers With Asthma by Paid Sick Leave Status: An Analysis of the 2018 National Health Interview Survey

Having asthma is a chronic condition that requires both acute and preventive care as a vital component of asthma action plans. This study looks at how having access to paid sick leave days may be important to adherence to asthma action plans. Does having paid sick days facilitate preventive care, help people avoid acute asthma incidents, reduce the number of lost work days, reduce the cost of care, and lessen financial worry among asthma sufferers? This research builds on a growing body of literature that has established a relationship between paid sick leave days and preventive and acute health care use and outcomes and yet is the first of its kind to examine the relationship specifically between asthma and paid sick leave. This study used secondary data analysis to examine the relationship between six outcome variables categories and having paid sick leave in a nationally representative sample of N = 1,676 working U.S. adults in the National Health Interview Survey. Workers without paid sick leave benefits were significantly more likely to report they were worried about finances and struggle to afford their prescription medication compared to their counterparts who have paid sick leave benefits. Examined in light of past findings, workers with asthma who lack paid sick leave are in a precarious situation where they have increased worry likely due in part to reduced take-home pay due to unpaid sick days and increased medical expenses. There was no relationship between having paid sick leave and the receipt of preventive asthma care, measures of asthma control, receipt of patient education, and asthma medication use. Implications for policy and practice are put forth.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Social Distancing Measures

Influenza virus infections are believed to spread mostly by close contact in the community. Social distancing measures are essential components of the public health response to influenza pandemics. The objective of these mitigation measures is to reduce transmission, thereby delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system. We conducted systematic reviews of the evidence base for effectiveness of multiple mitigation measures: isolating ill persons, contact tracing, quarantining exposed persons, school closures, workplace measures/closures, and avoiding crowding. Evidence supporting the effectiveness of these measures was obtained largely from observational studies and simulation studies. Voluntary isolation at home might be a more feasible social distancing measure, and pandemic plans should consider how to facilitate this measure. More drastic social distancing measures might be reserved for severe pandemics.

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

Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.