As the raging omicron variant of COVID-19 infects workers across the nation, millions of those whose jobs don't provide paid sick days are having to choose between their health and their paycheck.
While many companies instituted more robust sick leave policies at the beginning of the pandemic, some of those have since been scaled back with the rollout of the vaccines, even though omicron has managed to evade the shots. Meanwhile, the current labor shortage is adding to the pressure of workers having to decide whether to show up to their job sick if they can't afford to stay home.
"It's a vicious cycle," said Daniel Schneider, professor of public policy at the Harvard Kennedy School of Government. "As staffing gets depleted because people are out sick, that means that those that are on the job have more to do and are even more reluctant to call in sick when they in turn get sick."
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Low-income hourly workers are especially vulnerable. Nearly 80% of all private sector workers get at least one paid sick day, according to a national compensation survey of employee benefits conducted in March by the U.S. Bureau of Labor Statistics. But only 33% of workers whose wages are at the bottom 10% get paid sick leave, compared with 95% in the top 10%.
A survey this past fall of roughly 6,600 hourly low-wage workers conducted by Harvard's Shift Project, which focuses on inequality, found that 65% of those workers who reported being sick in the last month said they went to work anyway. That's lower than the 85% who showed up to work sick before the pandemic, but much higher than it should be in the middle of a public health crisis. Schneider says it could get worse because of omicron and the labor shortage.
What's more, Schneider noted that the share of workers with paid sick leave before the pandemic barely budged during the pandemic — 50% versus 51% respectively. He further noted many of the working poor surveyed don't even have $400 in emergency funds, and families will now be even more financially strapped with the expiration of the child tax credit, which had put a few hundred dollars in families' pockets every month.
The Associated Press interviewed one worker who started a new job with the state of New Mexico last month and started experiencing COVID-like symptoms earlier in the week. The worker, who asked not to be named because it might jeopardize their employment, took a day off to get tested and two more days to wait for the results.
A supervisor called and told the worker they would qualify for paid sick days only if the COVID test turns out to be positive. If the test is negative, the worker will have to take the days without pay, since they haven't accrued enough time for sick leave.
"I thought I was doing the right thing by protecting my co-workers," said the worker, who is still awaiting the results and estimates it will cost $160 per day of work missed if they test negative. "Now I wish I just would've gone to work and not said anything."
A Trader Joe's worker in California, who also asked not to be named because they didn't want to risk their job, said the company lets workers accrue paid time off that they can use for vacations or sick days. But once that time is used up, employees often feel like they can't afford to take unpaid days.
"I think many people now come to work sick or with what they call 'allergies' because they feel they have no other choice," the worker said.
Trader Joe's offered hazard pay until last spring, and even paid time off if workers had COVID-related symptoms. But the worker said those benefits have ended. The company also no longer requires customers to wear masks in all of its stores.
Other companies are similarly curtailing sick time that they offered earlier in the pandemic. Kroger, the country's biggest traditional grocery chain, is ending some benefits for unvaccinated salaried workers in an attempt to compel more of them to get the jab as COVID-19 cases rise again. Unvaccinated workers enrolled in Kroger's health care plan will no longer be eligible to receive up to two weeks paid emergency leave if they become infected — a policy that was put into place last year when vaccines were unavailable.
Meanwhile, Walmart, the nation's largest retailer, is slashing pandemic-related paid leave in half — from two weeks to one — after the Centers for Disease Control and Prevention reduced isolation requirements for people who don't have symptoms after they test positive.
Workers have received some relief from a growing number of states. In the last decade, 14 states and the District of Columbia have passed laws or ballot measures requiring employers to provide paid sick leave, according to the National Conference of State Legislatures.
On the federal front, however, the movement has stalled. Congress passed a law in the spring of 2020 requiring most employers to provide paid sick leave for employees with COVID-related illnesses. But the requirement expired on Dec. 31 of that same year. Congress later extended tax credits for employers who voluntarily provide paid sick leave, but the extension lapsed at the end of September, according to the U.S. Department of Labor.
In November, the U.S. House passed a version of President Joe Biden's Build Back Better plan that would require employers to provide 20 days of paid leave for employees who are sick or caring for a family member. But the fate of that bill is uncertain in the Senate.
"We can't do a patchwork sort of thing. It has to be holistic. It has to be meaningful," said Josephine Kalipeni, executive director at Family Values @ Work, a national network of 27 state and local coalitions helping to advocate for such policies as paid sick days.
The U.S. is one of only 11 countries worldwide without any federal mandate for paid sick leave, according to a 2020 study by the World Policy Analysis Center at the University of California, Los Angeles.
On the flipside are small business owners like Dawn Crawley, CEO of House Cleaning Heroes, who can't afford to pay workers when they are out sick. But Crawley is trying to help in other ways. She recently drove one cleaner who didn't have a car to a nearby testing site. She later bought the cleaner some medicine, orange juice and oranges.
"If they are out, I try to give them money but at the same time my company has got to survive," Crawley said. "If the company goes under, no one has work."
Even when paid sick leave is available, workers aren't always made aware of it.
Ingrid Vilorio, who works at a Jack in the Box restaurant in Castro Valley, California, started feeling sick last March and soon tested positive for COVID. Vilorio alerted a supervisor, who didn't tell her she was eligible for paid sick leave — as well as supplemental COVID leave — under California law.
Vilorio said her doctor told her to take 15 days off, but she decided to take just 10 because she had bills to pay. Months later, a co-worker told Vilorio she was owed sick pay for the time she was off. Working through Fight for $15, a group that works to unionize fast food workers, Vilorio and her colleagues reported the restaurant to the county health department. Shortly after that, she was given back pay.
But Vilorio, who speaks Spanish, said through a translator that problems persist. Workers are still getting sick, she said, and are often afraid to speak up.
"Without our health, we can't work," she said. "We're told that we're front line workers, but we're not treated like it."
D'Innocenzio reported from New York and Durbin reported from Detroit.
Virus Q&A: Answers to common questions about COVID-19 vaccines, travel and more
Do at-home COVID-19 tests detect the omicron variant?
Yes, but U.S. health officials say early data suggests they may be less sensitive at picking it up.
Government recommendations for using at-home tests haven't changed. People should continue to use them when a quick result is important.
"The bottom line is the tests still detect COVID-19 whether it is delta or alpha or omicron," says Dr. Emily Volk, president of the College of American Pathologists.
Government scientists have been checking to make sure the rapid tests still work as each new variant comes along. And this week, the Food and Drug Administration said preliminary research indicates they detect omicron, but may have reduced sensitivity. The agency noted it's still studying how the tests perform with the variant, which was first detected in late November.
Dr. Anthony Fauci, the top U.S. infectious disease expert, said the FDA wanted to be "totally transparent" by noting the sensitivity might come down a bit, but that the tests remain important.
There are many good uses for at-home tests, Volk says. Combined with vaccination, they can make you more comfortable about gathering with family and friends.
If you've been exposed to a person who tested positive but you don't have symptoms, a rapid test five days later can give a good indication of whether you caught the virus. It can also help if you're not sure whether your runny nose or sore throat is COVID-19.
But consider the context when looking at results. If you feel sick after going out to a nightclub in an area with high infection rates, for example, you should look at a negative result from an at-home test with a little more skepticism, Volk says.
Following up with a PCR test is a good idea, she says. Those tests are more accurate and are done at testing sites and hospitals.
Can my pet get COVID-19?
Yes, pets and other animals can get the coronavirus that causes COVID-19, but health officials say the risk of them spreading it to people is low.
Dogs, cats, ferrets, rabbits, otters, hyenas and white-tailed deer are among the animals that have tested positive, in most cases after contracting it from infected people.
While you don't have to worry much about getting COVID-19 from your pets, they should worry about getting it from you. People with confirmed or suspected COVID-19 should avoid contact with pets, farm animals and wildlife, as well as with other people, according to the U.S. Centers for Disease Control and Prevention.
"If you wouldn't go near another person because you're sick or you might be exposed, don't go near another animal," says Dr. Scott Weese at Ontario Veterinary College.
Not all infected pets get sick and serious illness is extremely rare. Pets that show symptoms typically get mildly ill, the CDC says.
Some zoos in the U.S. and elsewhere have vaccinated big cats, primates and other animals that are thought to be at risk of getting the virus through contact with people.
This particular coronavirus most likely jumped from animals to humans in the first place, sparking a pandemic because the virus spreads so easily between people. But it does not easily spread from animals to people. Minks are the only known animals to have caught the virus from people and spread it back, according to Weese.
Three countries in northern Europe recorded cases of the virus spreading from people to mink on mink farms. The virus circulated among the animals before being passed back to farmworkers.
How easily animals can get and spread the virus might change with different variants, and the best way to prevent the virus from spreading among animals is to control it among people, Weese says.
Is travel safe during the pandemic?
It depends. It can be safe if you're fully vaccinated against COVID-19, but officials say people who haven't gotten the shots should delay travel.
Regardless of vaccination status, all travelers should keep taking precautions like avoiding indoor, unmasked crowds, says Dr. Keith Armitage, an infectious disease expert at Case Western Reserve University.
"The delta variant has really brought us back to an earlier time in the pandemic," he says.
The U.S. Centers for Disease Control and Prevention says not to travel if you're sick, or if you tested positive for COVID-19 and your isolation period isn't over yet — even if you're fully vaccinated. Unvaccinated people who decide to travel should get a COVID-19 test one to three days before travel and three to five days after returning.
All travelers must still wear masks on trains, planes and other indoor public transportation areas, the agency says.
Airlines say plane cabins are low risk since they have good air circulation and filtration. However, there is no requirement for vaccination or testing before domestic flights, and passengers can remove their face masks while eating or drinking.
Hotels aren't risky for the vaccinated as long as they wear masks around strangers, Armitage says. More fraught are family gatherings with unvaccinated individuals, particularly for those who are older or have health problems.
Health experts suggest looking at the case levels and masking rules in the place you are visiting before you travel.
Why can't some COVID-19 vaccinated people travel to the US?
Because they might not be vaccinated with shots recognized by the U.S. Food and Drug Administration or the World Health Organization.
When lifting overseas travel restrictions in November, the U.S. required adults coming to the country to be fully vaccinated with shots approved or authorized by the FDA or allowed by WHO.
Among the most widely used vaccines that don't meet that criteria are Russia's Sputnik V vaccine and China's CanSino vaccine. Sputnik V is authorized for use in more than 70 countries while CanSino is allowed in at least nine countries. WHO still is awaiting more data about both vaccines before making a decision.
Vaccines recognized by the FDA and WHO undergo rigorous testing and review to determine they're safe and effective. And among the vaccines used internationally, experts say some likely won't be recognized by the agencies.
"They will not all be evaluated in clinical trials with the necessary rigor," said Dr. William Moss, executive director of the Johns Hopkins International Vaccine Access Center.
An exception to the U.S. rule is people who received a full series of the Novavax vaccine in a late-stage study. The U.S. is accepting the participants who received the vaccine, not a placebo, because it was a rigorous study with oversight from an independent monitoring board.
The U.S. also allows entry to people who got two doses of any "mix-and-match" combination of vaccines on the FDA and WHO lists.
Are COVID-19 boosters the same as the original vaccines?
Yes, COVID-19 boosters use the same recipe as the original shots, despite the emergence of the more contagious delta variant. The vaccines weren't tweaked to better match delta because they're still working well.
The vaccines work by training your body to recognize and fight the spike protein that coats the coronavirus and helps it invade the body's cells. Delta's mutations fortunately weren't different enough to escape detection.
The increased protection you might get from a booster adjusted to better match the delta or other variants would be marginal, says Dr. Paul Goepfert, director of the Alabama Vaccine Research Clinic at the University of Alabama at Birmingham.
Manufacturing doses with a new formula would have also delayed the rollout of boosters.
Moderna and Pfizer are studying boosters tweaked for the delta and other variants to be ready if one's ever needed. Health authorities would have to decide if and when a vaccine formula swap would be worthwhile.
"What we don't know," Goepfert noted, "is if you have a delta vaccine compared to the regular vaccine, does it actually work better in preventing transmission or asymptomatic infection?"
The U.S. has authorized booster doses of the Pfizer, Moderna and Johnson & Johnson vaccines for certain people, and a few other countries also are using boosters of those shots or other COVID-19 vaccines.
Can at-home COVID-19 tests make gatherings safer?
Yes, combined with vaccination, home test kits for COVID-19 can add a layer of safety and reassurance by providing on-the-spot results during this second year of pandemic holidays.
"We will be using rapid tests to doublecheck everybody before we gather together," says Dr. Emily Volk, president of the College of American Pathologists, who is planning a holiday meal with six vaccinated family members. "We'll be doing it as they come in the door."
Home kits are not as accurate as the PCR tests done in hospitals and at testing sites, Volk says. But they have the advantage of giving results within minutes instead of days.
Testing kits are available at drugstores without a prescription, and a box with two tests typically costs about $25. Swabs, testing solution and instructions are included.
Adults and teens can test themselves. An adult can test a child as young as 2. How-to videos on product websites can be helpful.
Most tests require swabbing about a half inch inside both nostrils, so it may tickle but doesn't hurt. You will get a positive result if the test detects a viral protein in your sample.
Home tests will miss some infections and in rare cases mistakenly indicate an infection. One popular test misses around 15 out of 100 infections — these are called "false negatives" — and gives a false positive result in about 1 in 100 people who aren't infected.
Test shortages were widely reported during the last COVID-19 surge, but new options have recently hit the market and major manufacturers such as Abbott Laboratories have ramped up production.
The Centers for Disease Control and Prevention offers other tips on ways to enjoy the holidays safely. Vaccination remains the best way to protect against the coronavirus.
How will the world decide when the pandemic is over?
There's no clear-cut definition for when a pandemic starts and ends, and how much of a threat a global outbreak is posing can vary by country.
"It's somewhat a subjective judgment because it's not just about the number of cases. It's about severity and it's about impact," says Dr. Michael Ryan, the World Health Organization's emergencies chief.
In January 2020, WHO designated the virus a global health crisis "of international concern." A couple months later in March, the United Nations health agency described the outbreak as a "pandemic," reflecting the fact that the virus had spread to nearly every continent and numerous other health officials were saying it could be described as such.
The pandemic may be widely considered over when WHO decides the virus is no longer an emergency of international concern, a designation its expert committee has been reassessing every three months. But when the most acute phases of the crisis ease within countries could vary.
"There is not going to be one day when someone says, 'OK, the pandemic is over,'" says Dr. Chris Woods, an infectious disease expert at Duke University. Although there's no universally agreed-upon criteria, he said countries will likely look for sustained reduction in cases over time.
Scientists expect COVID-19 will eventually settle into becoming a more predictable virus like the flu, meaning it will cause seasonal outbreaks but not the huge surges we're seeing right now. But even then, Woods says some habits, such as wearing masks in public places, might continue.
"Even after the pandemic ends, COVID will still be with us," he says.
The AP is answering your questions about the coronavirus in this series. Submit them at: FactCheck@AP.org.