Down with the flu in the US: can you afford to stay home?

Good post, revere. Even workers with sick leave may have trouble staying home with ILI. Many
employer absentee policies, especially in healthcare, discourage workers from staying home. A recent survey I did of healthcare workers in California showed only about half of hospitals had modified sick leave policies for the H1N1 flu.

Yep, it's one thing to have the leave, and another to be able to use it without being hassled for it. And for many jobs, they've got some number of employees who *have* to be there for the business to operate. If you're down to just three people being well enough to come to work, and one of them wants to call in sick, they're going to get a lot of pushback, even if they're not risking their job staying home.

Many jobs are capable of being done from home, with no risk of spreading the flu. But relatively few employers are willing to accept that, and many have rather inflexible policies about it--in order to work from home you must have X forms and Y arrangements and it must be only Monday and Thursday of each week and so on.

Actually, there's another wrinkle to this. Consider two countries, Absenteeland and Bravoland. In Absenteeland, people can and do stay home when they get moderately sick. In Bravoland, people come to work unless they're sick enough to be in the hospital.

Increased virulence of the flu virus in Absenteeland makes the virus less fit--people who start running a fever and coughing and feeling awful stay home and don't spread the virus very well. So the virus gets a kind of selection pressure toward mildness of symptoms.

Increased virulence in Bravoland has a smaller fitness cost, since people who are seriously ill and miserable are still going to work and spreading their virus. So the virus gets less selection pressure toward mildness.

I wonder if there's any way to test this idea. Or maybe it's all wet for some other reason I'm not seeing (or just because influenza is weird and unpredictable).

At many big companies you get x days off for sick leave and vacation - therefore, by not taking sick days you have more vacation days. This also encourages folks to go to work sick.

I work at one of those companies Texas Reader refers to, where we have one category of paid time off (PTO) for both vacation and sick days. We're also going through waves of layoffs, and if you get laid off, you get paid for your unused PTO. People can do math, and they realize just how much a day off today will cost them if they then get laid off later.

We've invested a lot of money in IT infrastructure that allows most employees to work from home, but the culture is such that if you do work from home, your manager and colleagues suspect you're not really working and feel free to say so.

So over the past five years, I've had two employees take maybe a total of five days off to stay home sick. I've tried several times to get HR to change the sick leave policy (including recently, referring to the pandemic), all to no avail.

If I look at this from a slightly different view - the majority of workers do in fact have paid days off, and unless their employers force them to go home the choice is up to them. And quite often they make their decisions financially rather than based on health consequences. So as an employee my day's pay, or my future day of vacation is worth more to me than my coworker's potentially life threatening illness. Not to mention the timing issue of flu season starting at the end of the calendar year when most workers have used up all their sick pay and vacation pay already. (In my position I have access to that information at my company and over 90% of vacation and sick time are used up by October 1st each year)

The question is how to internalize to the worker the costs of infecting others when you come to work sick?

In Japan you usually just put on a facemask and go to work. There's a serious 'be seen at work' ethic here. Compounding that the employment rules were 'liberalised' a few years back: temp agencies were allowed to use contracts with no sick days, in addition to allowing them to welch on pension and health insurance payments. We had a Swine Flu blip a month ago and now it's back - it'll be interesting to see how things play out with those on the edges of society.

I'm going to an anime convention in a few weeks and I posted in the forum if they were going to be giving reminders to those going to be mindful of the flu (about 100 people came down with it at PAX).
I was appalled to see a few responses where people said they would go anyway if they were sick, and even more so at the ones who said that they would just take a lot of immune boosters and Airborne!

Makes me want to stock up on tissues, hand sanitizers, and h1n1 info booklets and spend all day passing them out. Maybe if I dress up as Nurse Joy...

Has anyone tried to present the lack of basic health care for the working poor as a national security issue?

A moderately skilled writer/screenwriter could gin up a nice piece of speculative fiction about a bio-terrorist attack. Releasing an agent with a long incubation period and a high mortality rate in Wal-Mart after Wal-Mart. Place seems like an epidemiologist's nightmare anyway. Little plot, little counter-plot, hey presto! A nice kick in the pants to get the discussion moving in the right direction.

Too optimistic I suppose, sleep deprivation and hunger do that to me.

@Tom (and everyone else):

That may be a problem, but I don't think it's the problem... certainly not the prevalent problem.

First of all, we've all seen the stats showing the atrociously high numbers of workers who have no paid sick leave at all (not the best source, but the first one I could find on a quick google search... there are many more out there: http://money.cnn.com/2009/09/28/smallbusiness/swine_flu_vs_sick_leave/i…).

However, these numbers are an over-estimate of the number of people who can take sick leave.

First, many employers require a doctor's note to take sick leave. This can be particularly cumbersome when a) the employee has no health insurance, b) the employee cannot get the time off to go to the doctor to get a note and/or c) the doctor's office is so over-taxed and backed up that no one can get a reasonable appointment to get a note. I've heard some public health officials recommend that employers at least temporarily suspend this requirement in light of the pandemic. Unfortunately, no employers were in the room when this presentation took place, so I don't know how far this message is going.

Another requirement sometimes seen in paid sick leave policies is the requirement that the sick leave be prearranged, or that there be a waiting period before the sick leave kicks into place. For example, my husband works at a large retailer in Oregon (we're not talking small mom & pop places that can't afford to give employees sick leave...) To take sick leave he has to have a doctor's note and doesn't get paid until the third scheduled workday. It's completely useless against illnesses with short (or unknown) time spans, like the flu.

People are not going to stay home sick until employers make it clear to employees that keeping the other employees (and the public!) healthy is more important than having them show up at work. This means paid sick time with few to no barriers.

Tom in Iowa, you remind me of a story I heard from a mentor. He worked at a large company where workers earned a certain number of sick days each year. When the company scrapped that policy in favor of essentially unlimited paid sick leave, people started taking fewer sick days overall.

My mentor's interpretation was that many people had been habitually "spending" all their sick days each year. Whether to take a sick day was a decision with an economic consequence: you either accept the benefit or forfeit it. When the sick-leave limit was lifted, in effect, it became a decision without an economic consequence, so people were freed up to make it a purely ethical decision. As a result, they were less likely to take a sick day when they weren't sick.

Tasha, you make a great point about the economics of sick days: the economic pressure to infect your coworkers are even greater for those who have no paid time off or paid time off only with impractical restrictions.

Corporate CEOs and government agency heads need to be aware that the time is more than ripe for the return of the original labor organizer who made his last very important appearance around 1346 in Crimea. If 25% of the labor force is lost, what will happen to the price of labor?

At one point I worked for a Jewish agency that worked on the principle that the Jewish (read: moral) thing to do was to encourage people to stay home and take care of their health when sick. However, few places where I've worked have had much recognition for the obvious fact that de facto forcing people to come to work ill and spread illness to others is counterproductive, extending the number sick and thus lowering total productivity.

2beans and Stacy Mason--I see indeed a great video (youtube?) production here, potentially effective among employers, in which Mr. Wallmarstrt, inflexible CEO, while touring his flagship property with young daughter Cashsie, stops to look at (some cheap plastic toy) at the very moment his favored supervising manager, (name), is again refusing leave to sneezing salesclerk Jason X, who turns and staggers (pursued by, over his shoulder, the ghostly image of the fellow from Seventh Seal), and, trying not to fall, Jason places a hand on Cashsie's shoulder as he coughs. After which . . . Well, go for it!

Can anybody tell me why the CDC weekly flu website see the need to change their graphs every(almost) week. I was getting used to the last outpatient ILI graph that overlayed the last 3 years for comparison instead of compressing all 3 into the longer?weekly axis.

I've been sick all week with a cough, lethargy and minor body aches (I think Ive been spared the heavy handed version) - I only work on the weekends though so didn't need to call in - my secretary last Sunday didn't listen to me when I half-heartedly told her not to come in over the phone, she could barely speak. She kept insisting she wasn't sick the entire day though. Anyway I usually start work on Fridays in the morning in my radiology department. Called out this morning.

Calling out for my 2 double weekend shifts would be really stressful on weekday staff though So I'm going in and am going to avoid patient contact as much as possible - probably not affectively in a hospital with a high census recently.

Feel like this just became my confession box - sorry people.
I never developed a fever (that I noticed) minor aches are gone and its been almost a week.

Wish my patients luck.

Just now returned from the ER where it was confirmed my six-year-old has influenza A, which, the doctor told us, means seven days off school. I don't know ANYONE who works outside the home that can take seven days in a row off on short notice. Luckily, I work from home.

Also, I'm not even going to watch that video because I've been sneezed and coughed on more times than I can count in the last 24 hours.

Wicked Lad @11: I think that it's true that an unrestricted sick leave policy, or one combined with a short term disability plan, makes much more sense for both employees and employers. At my previous work place, there was no limitation on individual sick days (although admittedly, employees with repeated cases of the Friday Flu were spoken to rather firmly), but after 5 consecutive days employees were paid by our insurer and had to provide doctor's support if their absence continued.

Some managers still took an approach of "okay, if you REALLY think you need to take the day off you can..." but it generally meant our people stayed home until they were well, and since it wasn't taking away from vacation time or anything like that, there was less incentive to take frequent sick days.

Establishments which sell/handle food should have to make their sick leave policy public - posted with the local health department - in order to be licensed.

I work at a university and they just announced that if you get sick with flu, or your kid's school is closed you can take next year's sick days (by contacting HR).

In my former career, almost all jobs had no sick days. Oh, you could take off sick, but you wouldn't get paid, and everyone else had to work extra to make up for any sick person. My last job had paid sick days, but if you used them, you were more likely to be the first fired (this is a "right to work" state). And since a doctor's note was required and no health insurance offered, I never took any.

Now I work from home, but still had to get up and work as much as I could while sick because I only get paid for a finished product. As it is, I will take a dire financial hit this month for having the flu.

HELP! I tutor kids at my house, and I have begged and pleaded REPEATEDLY w/ parents to keep kids who are not 100% healthy at home. In desperation, I have tried the sympathy card - I have asthma, other students have asthma, other students have family members w/ suppressed immune systems, etc. not to mention that it's a waste of their time & money, b/c the session isn't productive when a child isn't 100%. I have repeatedly emphasized that parents can call me at the very last minute to cancel and then reschedule the session at a later time -- at NO ADDITIONAL CHARGE.

However, today yet another mother assures me that child is over the flu and not contagious -- even though child is coughing. I was able to stop the coughing by giving the child hot apple cider, putting a vaporizer in the room w/ us, and having the child suck on hard candy. I have a small number of students, and their mothers are wonderful, kind people. Yet, the majority of them have looked at me in complete disbelief when I tell them that I cannot work w/ a child who is coughing / sneezing. Am I wrong in my belief that a cough or sneeze is spewing virus / bacteria / whatever into the air? Revere, it seems like your first paragraph says as much.

This may seem off-topic, but if I am having this much trouble getting parents to cancel and reschedule a 90 minute tutoring session where there is no financial penalty; how in the world do we get adults to stay home from work? I get the same reaction when I tell a parent that a coughing child can't stay that I believe that I would get if I told them that their child is a leprechaun -- complete disbelief followed by, "but she feels fine", etc. Thank you!

A single shot to the head will stop that cough Leah....

Kidding.

Yeah, the asthma, COPD are loading the peeds ER at Le Bonheur almost now to the point that they are going to have to start moving them soon.

Parents though are as dumb as a box of rocks on this stuff...they are the kids in this. One I know from a friend who called and said that her grandson had a 103.4 and the mommy didnt know what to do. That single shot is sounding good all of a sudden..against the parent.

But here is the thing... The assertion by Revere is that the all encompassing government should force paid sick days on companies... Paid sick days. Now lets see...That means someone has to take up the slack to do this so if you are hourly it means that one to say four people will have to do that. This means overtime...So for you to have a single sick day with 8 hours in it that they will have to pay time and a half (another lefty trick) to someone else to do the work. All things being equal of course. But now you have a pandemic and two or three or more are out and there are just so many people in an office that can do the work anyway.

Meanwhile the cost of doing the job has quintupled to the employer... now it costs too much and they can go and get someone else and fire your sick butt which would be the smartest thing an employer could do. If it was only having to pay for the overtime thats one thing... But paying for everyone to be sick, paying for the overtime, paying for everything because you got flu with no production is kind of stupid dont you think? Why do you think the employers are all pissed at Obama now?

Can they afford it in this economy? We have seen the destruction of our economy because no one else in the world except parts of Europe has to comply with all of the crap that the lefties have come up with across the years. Paid sick leave? We didnt have it in 1918, 1957 and we didnt have it during the polio years either. We still made it and we were an economic power house before during and afterwards.

Uh-Anyone want to call us that now?

The only reason Carter didnt get thrown out on a trumped up impeachment was that the manufacturing was still working albeit at only 74% of capacity but we still had it. Now we dont have any of it... Its all in China and India and where they dont have the right to stick it to the employer at every turn. Why? Because they can replace you with in a heartbeat and their minimum standards is based on what the work will pay, not what organized labor pushed themselves into in the market place here.

The idea is that people should stay home from work. Uh-huh. I cant get them to close the schools right now with a 30% absenteeism. Do kids get a make up day? Nope.

But its those poor heartless companies that stick it to the employees because they are such bastards. If the company isnt there for them to work for, then who pays for their sick days then? No one. People would simply sit at home and complain because there isnt any healthcare or jobs or anything like that and wait for the welfare check to arrive. At what level will you work? For most its when you are hungry and you will do most anything... Kind of like India. There is no minimum rupee level there even with all of the jobs opening up.

There is a massive cost to "paid sick days" and low margin jobs employers cant afford to pay for them. The money isnt there. Hell you have to pay unemployment through the kazoo if you lay someone off now as it is. Its like a mother in law that wont leave. This is a killer, especially with the real job engines which are the mom and pops and less than 20 employee companies that are so strained now because no one is lending money. Give this economy another four months of this crap and go into the traditional down time of January to March and we will be good to see less than 13% unemployment and 10% interest rates.

This is surely coming and Obama played the Carter spending book to the hilt. They will have to raise interest rates to make the money worth something. Its worth arguably 45cents per dollar in buying power against five years ago now. He shutdown the military, he also lost Afghanistan and gave rise to the Ayatollah. Couldnt do shit about it because by his own hand he destroyed the military.

Can you afford not to go in? No, you really cant because the deflation of this economy and the raises in the min wage mean that there is also a min standard and thats what these people never understand. With a weak economy they can get the rocket scientist while you are just a nitwit with a 4 pack college degree...if that. .

They can get a engineer to run a machine in the lean times. So its a employer buying market. Why should I pay a dumbass or one that is chronically sick to work when I can get my new minimum wage employee that has the degrees? Of course you wont hear this in any of the economics classes nowadays. It just makes too damned much sense. Paul Krugman is a total toad and he still doesnt get the backend of any of his own arguments. Its okay, they gave Obama the Nobel based on what? Even Michael Moore said great, now go and earn it.

One of my neighbors was running a company, it closed and moved to China in the last four months. Now he is mowing lawns with a Phd. in Technology. He has an interview next week with an engineering firm but its reasonable to assume he will wait less longer than most. But even that type is expendable in this kind of economy as you can see.

The nanny state is about to collapse and when it does it will be complete and thorough and you wont have to worry about getting pissed about Wall Street. It will have been boarded up and packed away...The dollar will cease to exist at the rate we are spending money. At some point in time they will have to jack the interest rates and the taxes with them and that will shatter this economy like the egg it is. They wont do it now because if they do it will shatter the little bit of uptick we have seen. They will wait.

Or, if they dont then you still dont have to worry as the big plan might just be to collapse the world currencies and then create a world one... with the UN in charge. Just like the little Apparatchika's did and have always done.

Other than the rate hikes and the spending which I can assure you will happen the bottom line is simple and then the backlash will occur... just as it did when these morons were telling us all was fine with Freddie and Fannie....

Surely you recognize the perps who call Republicans - Rethuglicans? Another name for racists because Republicans can add and subtract and come up with the always biting question, be it defense or the welfare system in this country which paid sick leave is another part of...

http://www.youtube.com/watch?v=uR8cbfYtIB4

What do you think that first stimulus two years ago was? They knew then that it was going to tank. It was the smoke filled room and everyone who was smart started bailing out...the dominos started to fall. Its going to happen again and soon.

Yeah, paid sick leave. I like it. Lets attack the employers even more than we already have... .Good plan !

I've been thinking that part of employers' pandemic plans should be to give employees with the flu (Dr's note) time off that isn't counted against their allowed sick days. [How can you not have sick days??? Don't they accrue by statue at 1.25 days a month or some such?]

Monado: [How can you not have sick days??? Don't they accrue by statue at 1.25 days a month or some such?]

Hahahahaha. Who do you think we are? Canadians? or French? or Germans? or Scandinavians? We reserve our god given Right to be stupid and no government is going to take that away from us (see #21).

@20 .. Leah, if they drop off a sick child, call the parents and have them come get the kid. If the coughing child shows up with a parent, send them home.

Just be a cold-hearted witch and tell the parent that their child is apparently ill and should not be infecting the other children.

Send them all one notice first, and post a sign on the door that tutoring sessions are not open to children with signs of an upper respiratory infection.

http://www.cdc.gov/H1N1flu/childcare/guidance.htm recommends separating the sick ones and sending them home ASAP.

Randolph -- I quit teaching public middle school, b/c I was close to believing that the only solution for helping my most at-risk kids was to implement the "final solution" on their parents. However, I now have a private practice where I am HIGHLY SELECTIVE about the parents I will work with, and these moms are educated, caring and quite sensible about everything else. And, I consider them friends, which is why their determination to bring their sick children to me is completely baffling.

Tsu -- I have spoken to each mom in person, I have communicated repeatedly in writing -- firmly, clearly. I have turned them away at the door. I have called them to pick up the kids. I'm pretty sure they think that I am an OCD germophobe, but hopefully not an evil witch.

We are talking about a half dozen educated and caring mothers who are sensible and considerate about everything else EXCEPT this issue. And, you'll note that the CDC guidance emphasizes FEVER, which many of these kids do NOT have either b/c it's not a symptom or b/c they've taken ibuprofen or whatever. These moms are convinced that a child can be coughing and NOT be contagious, but I do not see how this is possible.

I hate to be negative, but based on my limited experience with a tiny population that should be a "best case scenario" -- educated, good to GREAT health care access / insurance, can afford to stay home, etc. We are DOOMED if this H1N1 morphs into something more than this supposedly "mild" version that is killing otherwise healthy people. I sure wish someone could come up with some tangible costs for this determined ignorance: financial cost of absenteeism, financial cost of having one of these "more than mild" cases that require hospitalization for weeks on end, years of life lost due to preventable deaths, etc. Not only do we have a major health care COVERAGE problem, but we have a major health COMMON SENSE KNOWLEDGE problem.

It seems like most of what I read about public healthcare deals with the dilemma of the impoverished and ignorant masses, but isn't it even more disturbing when the moms on the opposite end of the spectrum aren't embracing a message as basic as "stay home if sick". Thankfully, my moms are not into this whole anti - vax non-sense, which is yet another layer of insanity. Maybe someone could do a survey of mothers honing in on HOW they decide to keep a child at home??? In the defense of moms, FEVER / VOMITING / DIARRHEA seem to have historically been the "holy trinity" of criteria used to determine if a child is "really sick" enough to stay home.

Revere said: "Hahahahaha. Who do you think we are? Canadians? or French? or Germans? or Scandinavians? We reserve our god given Right to be stupid and no government is going to take that away from us (see #21)."

- Benefits and costs with everything. But the generous sick-leave systems in Scandinavian countries costs huge amount of money [sicke-leave is surspringly high compared to other countries, or perhaps not, depending on the relatively generous benefits]. Money going into paying workers on sicke-leave could have been spent on education, health care, infrastructure, lower taxes etc. These are difficult trade-offs, and I am not convinced that Canada, France or the Scandinavian countries have gotten it correct either.

Even though we are all at potential risk of dying from swine flu, in this context it may be worth remembering that during this year as well, most likely, you are more likely to die or being seriously injured from a car accident going to work than from dying from swine-flu (catched at work or any other place).

Sorry to beat the dead horse, but just to further make my point, THIS was the #1 top story in my daily "Top News" e-mail from the Washington Post...
"Top News
Families say flu scare comes with a dose of craziness
Glenn Dance does not have swine flu. But when he took the family cat to the veterinarian last week, he was greeted in the parking lot by workers in surgical masks. They knew that his wife and daughter had the flu and told Dance that he was not allowed inside.
(By Donna St. George, The Washington Post)"

NOTE THE HEADLINE...
"Families say flu scare comes with a dose of craziness"

So, it's now officially "CRAZY" when people are serious about not wanting to catch the flu.

Read More about this "craziness" here...
http://www.washingtonpost.com/wp-dyn/content/article/2009/10/24/AR20091…â=AR

Mike: Actually, depending on the year, your chances (on average) of dying of flu are about the same as being killed in an auto accident (average estimated excess mortality from flu is about 40,000 per year; some years it is less some years, double that). I've lived in Scandinavia and in my view, they've got the balance much better than the US. I'll let the Canadians, Germans and French defend themselves.

kruger -- sick time will not necessarily result in overtime for other employees. for instance, part timers almost never get sick leave, but when they do call in, it's picked up by the other part timers, at least at most large retail operations.

If chances of dying of flu even in an average year equal those of dying in an auto accident, then probably it makes sense for people to travel to any region, state, or perhaps country where vaccine may be more available for their group, yes? And--sorry to beat this ancient horse--maybe this especially holds for seniors? Most seniors I hear from (few being rightwingers, n.b.) are indeed seeing agism in the vaccine guidelines--and in social attitudes which treat the 95 children's deaths, of the 1,000 confirmed U.S. deaths so far reported from this flu, as a huge number--which indeed it is--and the approximately 70 (7 percent of the 1000) seniors' deaths as "a small proportion". Or which, indeed, lead to no follow-up (that I've seen, anyway) on the NY Daily News (hope I've that paper right) report a couple weeks ago on excess complications/flu in underprivileged minorities (much of which could well come, in fact, from lack of sick leave on their jobs).

I think Kruger has demonstrated that we have a nation filled with people who reject the germ theory of disease. Our education system has failed us again.

Llewelly, re no.31--yes, it is, and also filled with persons who reject any responsibility inconvenient for themselves. As in "If I stayed home, you nervous nellies would just get it from someone else" or "Keep Johnny home? Half the kids here are probably coming down with it already." And I just got home from taking a birthday present to a little girl whose parents forgot to mention, until I'd been there awhile, that they were all "finally pretty much over that flu."

We're all going to die. It's a broken system.

My workplace had, in our workplace agreement, 52 weeks per year of fully paid sick leave (with proof requirements after a few days, of course). Tremendously enlightened, I thought when I got here, and our sick-leave usage was dead-on average for our industry - it was just a great source of peace of mind.

We negotiated it down to 3 weeks in return for a one-off 2% pay rise.

I work with morons.

I am a Fed employee with the Canadian Government, I was SENT home one day about 2 weeks ago, I had a head cold, only symptom was a runny nose. let me emphasize, I was SENT home! I was to have a Dr's note to COME BACK INTO WORK!

I had to take one of my sick days, I had lots, but that's not the point. I have to wonder when my manager was able to get his medical degree and acquire the ability to diagnose pandemic swine flu!

Sending me home didn't seem to help, My manager has been off all week with the Flu!

Tense, that is sad you lost a sick day and lost your opportunity to possibly infect your coworkers with your illness, fortunately for you and them only a cold but which could have been 2009h1n1 flu or, for that matter, early whooping cough (among other possibilities). Then some of them, who may or may not have had, as you, "lots" of sick leave left, could have got sick too, probably infected their children or perhaps their elderly parents, etc., or lost their jobs. And after all, as you point out, your manager got the flu anyhow, so you might as well have spread your virus around. You are aware, I hope, that this is precisely the view that helps to spread infectious illness?