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Winter ‘Tripledemic’ Highlights the Need to Stay at Home When Sick—and the Need For Paid Sick Leave To Make it Possible

Individual on sick leave

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Individual on sick leave
Patient with cold symptoms

As the United States approaches nearly 100 million COVID-19 cases and the convergence of a widely reported “tripledemic” of COVID-19, the flu, and Respiratory syncytial virus (RSV), this holiday season and new year, policymakers should support paid sick leave policies to prevent the spread of infectious disease, say researchers at the Dornsife School of Public Health in a recently published paper in the journal Health Affairs.

The study’s authors compared sick leave and vaccination data from 37 major U.S. cities in 2021 and found that a lack of paid sick leave was linked to lower COVID-19 vaccination rates. Specifically, they found a statistically significant 17% higher rate of vaccination in cities that had mandated paid sick leave than in cities that did not require availability of paid sick leave. This link was strongest in the most socially vulnerable neighborhoods – as measured by the CDC’s Social vulnerability index — suggesting that sick leave policies particularly benefit lower-income communities and are a force for lowering health disparities among neighborhoods within a city. The research team controlled for other factors that might influence vaccination rates, such as how the city’s population voted in the 2020 presidential election, local health spending, and city sociodemographic attributes.

The authors found no relationship between vaccination rates and paid leave policies among those 65 years of age and older, suggesting that those who are less likely to be working are understandably less likely to benefit from paid leave policies.

“We know that lower-income workers are disproportionately more likely to be exposed to COVID-19 and are less likely to have sick leave available to them from their jobs, so it makes sense that sick leave policies are of particular benefit to the most vulnerable communities in cities across the United States,” said study lead author Alina Schnake-Mahl, ScD, an assistant professor in the Dornsife School of Public Health. “These workers deserve the respect and care that paid leave offers so that they can become vaccinated and also take care of themselves and their families when sick and create healthier workplaces for all.”

The United States lacks federally mandated universal paid sick leave, leaving more than 33 million workers without any paid time off for vaccination or sickness. The Family and Medical Leave Act (FMLA) requires some employers to provide up to 12 weeks of unpaid leave for certain situations. Some cities, such as Philadelphia, require employers with more than 25 employees to provide up to 40 hours of paid sick leave if they are unable to work due to personal or family sickness, but the state of Pennsylvania lacks a similar paid sick leave policy.

COVID-19 vaccination is associated with reduced risk of hospitalization for COVID-19 and decreased risk of long COVID. Approximately a fifth of those diagnosed with COVID-19 are suffering from long COVID, experiencing at least one long-term symptom of the disease at least four weeks after becoming infected, according to estimates from the Centers for Disease Control and Prevention. Long COVID can qualify as a disability under the Americans With Disabilities Act. A separate AJPM study found that deaths may drop by “more than 5% in large central metropolitan counties…if they were able to mandate a 40-hour annual paid sick-leave requirement.”

In October, The House Select Committee on the Coronavirus Crisis published a report on the U.S. workforce at 12 major U.S. companies. Among its findings, the analysis noted that paid sick leave improved worker retention and was associated with greater performance recognition, including higher rates of raises and promotion than among those who did not have access to paid leave.

“The benefits of universal paid sick leave for communities are clear,” said Schnake-Mahl. “Many cities and states have acted to provide sick leave to their residents absent a federal policy, but the best solution is for the United States to join nearly all the rest of the world’s top economic nations and take care of all workers by offering paid sick leave, to ensure every American can have access to paid leave when sick or getting important health care, such as vaccinations.”

For more information on the study, check out this policy brief from the Urban Health Collaborative.

Media interested in talking to Schnake-Mahl should contact Greg Richter, assistant director, News and Media Relations, at or 215.895.2614.

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