Why Americans Can’t Call in Sick

In the past month, St. Francis Medical Center in Lynwood, California—a suburb of Los Angeles—saw a spike in staff members who were getting sick with COVID.

“By the last week of December and first week of January, everyone was getting sick,” says Ana Bergeron, a registered nurse who represents over 700 nurses at the hospital as president of St. Francis Registered Nurses Association, an affiliate of the union United Nurses Associations of California/Union of Health Care Professionals.

But many nurses have felt pressure to still report to work. During the Omicron variant’s surge, her hospital management, Prime Healthcare—which cut 20 percent of nurses during L.A.’s first surge in August 2020—sent out a memo that if workers tested positive but had no symptoms, they could come to work, she says. (As of publication, Prime Healthcare did not respond to requests to comment.) Some nurses simply did not have enough paid leave to afford to take off, including one nurse who’d only been at the hospital six months and was COVID positive.

“She’s conscientious enough that she doesn’t eat inside the cafeteria—she goes outside to eat, she is wearing an N95—but you can see that she’s tired. She’s still coughing. And she’s working,” says Bergeron. “Being asked to work when you’re sick feels like a slap in the face, because we have families, and we risk bringing it home.”

Versions of this scenario have played out at workplaces across the country over the last month as the highly transmissible Omicron variant spread across the United States. While a record number of workers are calling out sick, many more are showing up to restaurants, grocery stores, schools, daycare centers, government offices, and other workplaces, because they can’t afford to stay home. Even those who do have sick leave have felt pressure to return to work while still sick, or, if they work remotely, not to take time to rest.

In 2020, when the U.S. government passed a temporary sick leave mandate, and businesses and schools closed to prevent the spread of COVID, there was hope that the pandemic might change the United States’ attitude toward work. Many millions of people have reevaluated the place of work in their lives, while much of the U.S. economy had briefly put health ahead of work when they closed down to prevent the spread of the virus.

But as a 40-week, partially paid family leave policy languishes in the stalled Build Back Better bill, and people report pressure to show up to work with “mild” symptoms, it feels like America’s job culture has taken a particularly absurd and callous turn. Nothing, it seems, should come in the way of our jobs, and anything that keeps us from working is treated as our issue to sort out, and absorb the costs of, rather than one the larger community can collectively address through policy and culture shifts.

The U.S. is one of the only industrialized countries with no nationally guaranteed sick leave policy. The closest thing we have is the Family and Medical Leave Act, which only covers some workers, and does not cover short-term sick days. Powerful business interests like the U.S. Chamber of Commerce and National Federation of Independent Businesses have long opposed paid leave as “part of a broader opposition to government intervention into the economy,” according to Megan Sholar, a political science lecturer at Loyola University Chicago. This lack of policy effectively creates a culture where business needs are prioritized over health. The chamber and its allies argue paid leave would be a huge cost to businesses, even though in states and cities that have enacted paid sick leave—e.g., California, Connecticut, and New York City—employers have reported either no effect or a positive effect, including lower turnover and happier employees. Last year, when paid sick leave looked more likely to pass, even the chamber submitted comments on what such a program could look like.

But even in workplaces where companies offer paid sick leave, many workers agonize and strategize over how or whether to take it and feel they have to have a really good reason to do so. One daycare center employee, who recently took time off because she had a sore throat, fever, and chills, but had yet to be able to test, told NPR, “I’m almost more worried that I don’t have it, and people are going to be mad at me that I’ve been out these days.”

And for many white-collar workers now going remote, COVID is not a proper excuse to take off a couple of days from Slack or email. When she returned from the holiday break with COVID, LeaAnne DeRigne, a professor in the college of social work and criminal justice at Florida Atlantic University, says that there was never any question of whether she would teach her classes. “Not one person ever asked me if I was capable of teaching online. It was just assumed that I was fine, that I would sit in bed and lecture on Zoom,” she says. “For me to propose that I was going to cancel class, it would have had to have been, ‘I’m on the brink of being hospitalized.’”

DeRigne believes one reason workers have insecurity about calling out sick, even when they technically can, is because of the lack of federal policy. “Because there’s not a universality to it, it starts to then be a statement about your individual worth, your individual ability,” she says.  “[We think,] if my favorite barista can’t take a sick day, then why should I? If a teacher’s going to work sick or a nurse is having to report now after five days of isolation, why am I so special, why would I need more than that? It becomes an individual decision versus something we could fall back on as a right.”

This isn’t just about individual work ethic, but how we’re seen at our jobs in a society that values work so highly. Whether out of genuine devotion, fear, or both, “People don’t want to let the boss or the organization down. They may show up to work when sick because they put their organization’s interests above their own health,” says Elizabeth Eger, a professor of communication studies at Texas State University.

This is called “presenteeism,” and it is common across classes and occupations in the U.S., according to Eger’s research. Among 229 workers she surveyed—whose jobs included retail worker, call center employee, engineer, teacher, nurse, medical tech, massage therapist, union organizer, and professor—people felt pressure to work when sick, even with more serious illnesses like endometriosis, cancer, or mental health issues.

She recounts a woman who ran new employee training sessions at an organization and worked through laryngitis to the point she couldn’t speak, because no one else could do them. After, she had to take off a full week of work to recover.

The latest surge has turned our national aversion to sick leave into a particularly absurd Catch-22, where essential workers like nurses, teachers, grocery-store workers, go to work with COVID, infect their co-workers, further driving illness spread, and forcing parts of the economy to close because of staffing shortages.

Workers are pushing back against the demands of presenteeism. Bergeron and her union are currently joining with other essential workers in support of a bill in California that would provide two weeks of paid sick leave for those with COVID, after a previous version expired last September. (California’s current paid sick time is three days.) Others have gone on strike, or left professions altogether because of burnout.

At schools across the country, the younger generation has drawn attention to the absurdity of our country’s attitude toward staying home. In Chicago, the public schools system refused the Chicago Teachers’ Union demand to start the new year with virtual classes in light of the surge, because city public health officials didn’t think it was necessary, and Mayor Lori Lightfoot didn’t want to look like the district was capitulatinging to the union’s demands, according to the Chicago Sun-Times. After one week, Chicago Public Schools and the teacher’s union agreed to return to in-person classes. However, on January 14, a student-formed organization called Chi-RADS staged subsequent walkouts from class because they were concerned not enough was being done about COVID safety, with cases going underreported, and their inability to socially distance in overcrowded classrooms because of staffing shortages and lack of enforcement of mask rules. For these reasons, the students believed they should have had the option to go remote during the surge.

“It’s very important that our health at school be taken seriously, because we have older family members at home, and we have infants at home,” says a middle-schooler named Christian. Several students in Chi-RAD say that they had loved ones—a grandfather, a baby sister, an uncle—who got seriously ill from the virus; one had a loved one who died.

What got in the way of these health considerations was opposition—ironically from some prominent public health experts—to even temporarily closing schools during the surge. Along with the mental-health challenge and learning loss, these experts argued that parents need their kids to be in school to go to work. But that’s a reason to advocate for better leave policies—so parents can stay home when they need to—and safer school conditions, rather than making children, teachers, and other staff report to school during a pandemic surge.

Many businesses, unlike the powerful lobbies that claim to represent them, would prefer a government sick leave program. “It would allow them to provide the leave their employees need while not having to fund it directly out of their pockets since the cost would be shared with other taxpayers,” says Sholar.

Simply becoming aware of the concept of presenteeism can empower people to take sick leave or have conversations with employers, says Eger. “Participants would often share with me: ‘I knew I did this, but I didn’t know it had a name.’ Having language made a big difference for them to begin to reflect on what had been so systemic they might not have seen or recognized it.”

And perhaps most importantly, for those who have taken time off work to recover from illness or take care of loved ones, the world hasn’t ended. Around 8.8 million reported not working because they were sick, the highest number since the Census started collecting this data in April 2020. Stores that used to only ever close on Christmas, like Walmart, have actually shut down for a couple of days to sanitize against COVID. Others like Starbucks, Apple, and Macy’s have shortened their hours or limited service because of the labor shortages.

“One of the things during the Omicron surge is I see businesses just shutting down for the day or changing their hours. My local Starbucks’ hours are 7 a.m. to 1 p.m. That’s all they can staff. They used to be open until 9 at night. People are accepting it. We’re making adjustments,” says DeRigne.

The media has reported a lot on drastic labor shortages due to employees calling in sick. But what is rarely noted is that people recover more quickly and reduce the spread of disease when they stay home. In 2020, states that gained access to the government’s temporary paid leave program saw about 400 fewer cases of the virus per day. Jurisdictions with paid sick leave laws saw a 5.5 percent decline in flu cases, according to a 2016 study. One restaurant in Milwaukee decided that even though they “had enough staff to function,” closing temporarily because of the Omicron variant would allow staff who tested positive to quarantine and return healthy.

There are no easy decisions to make during a pandemic, and whether to close is one of the most difficult given the financial toll. But presenteeism exacts a cost far greater than staying home. American policy and culture need to support health, not see it as at odds with the economy. At a moment where we’re experiencing not only COVID, but mass burnout and job exodus, it is time to seriously rethink our society’s obsession with being open for business.