Stay Home When Sick…Unless You Are A Health Care Provider

The CDC urges most people who come down with flu symptoms to “stay home and avoid contact with others except to get medical care.” You could extend that advice to just about all communicable diseases such as COVID-19, norovirus, RSV, colds, walking pneumonia, whooping cough and HMPV (Human Metapneumovirus). They’re all out there this winter and tens of millions of people are sick, including many health care professionals. Why employers, including hospitals and clinics, don’t demand that doctors, nurses and other workers stay home when sick puzzles us. Read on for some shocking stories.

Public Health Messages to Stay Home When Sick Are Often Ignored:

You have probably heard the most common public health recommendations repeated ad nauseam:

• Get a flu shot
• Wash your hands
• Get a good night’s sleep
• Eat nutritious food
• Blah, blah, blah!

What is often left out of the messaging or is ignored by management is the message to stay home when sick! It’s bad enough that people may be contagious before they exhibit symptoms. That is certainly true for COVID. But once you are sniffling and sneezing, why are you spreading your germs to everyone in and out of sight?

When the Boss Refuses to Let You Stay Home When Sick:

During the COVID-19 pandemic, it became clearer than ever that paid sick leave is only a fantasy for the most essential workers. People who serve you coffee and toast at the diner work by the hour. If they don’t show up, they don’t get paid.

Here is a recent story from a reader about the problem of getting sick at work:

“I just got over what I think was norovirus. I came down with it at work; I work in a factory and have up to eight machines to keep running.

“I told my boss I was ill, spending more time in the ladies’ room than on the job. When I asked if she could call people on the next shift to see if anyone could come in early, she refused and wouldn’t let me go home.

“Then I went to medical. Despite running to the restroom to vomit as my blood pressure was being taken, the nurse refused to excuse me from work. I was expected to get through the day on Imodium and Pepto Bismol.

“This was a week ago. I spent that day with my boss yelling that machines weren’t running and wanting to know where I was. So, I told her. ‘Bathroom.’ ‘Vomiting.’ ‘Diarrhea.’ ‘Dry heaves.’

“I don’t know how many people I breathed on. I hope I washed my hands adequately. But last week, four more people called in sick, three of them, like me, hit with this bug at work and not allowed to go home. I wonder how many I spread this to, courtesy of an ignorant management.

“When she recently got COVID, she was ordered by her boss to report to work. She looked awful, was coughing constantly and wore a mask. But three more people in our department came down with COVID over the next 10 days. One of them has chronic asthma and was hospitalized. We all suspect the boss infected him and could’ve killed him.”

Penny Wise and Pound Foolish!

If that story doesn’t send shivers up and down your body, nothing will. Talk about short sighted. In an attempt to keep the business running at “full speed,” the factory described above probably lost money because so many people got sick.

Norovirus is incredibly contagious. According to the CDC, people shed billions of tiny viral particles when they have diarrhea or projectile vomiting. People can catch this “intestinal apocalypse” with as few as 18 viral particles. Because they can be airborne, just walking into a bathroom and breathing the air could lead to infection. Read more about norovirus at this link.

The European Policy: Stay Home When Sick

The Social Protection Committee (SPC) of the European Union offers this insight on “sick pay and sickness benefits:”

“Sick leave concerns the right to be absent from work during sickness and return to one’s job when recovered. Sick pay is the continued, time limited, payment of (part of) the worker’s salary by the employer during a period of sickness…All European Union (EU) Member States provide sick leave and sickness benefits.”

There is variability in sick pay. It can range from 25% to 100% of the gross pay. EuroDev reports:

“On average, employees in Europe receive 65% of their salary during sick leave.”

In the United states, many workers depend upon the good will of their employers when it comes to staying home when sick. As for paid sick leave, that too is highly variable. Although some states do have laws requiring paid sick leave, the vast majority don’t.

With fewer workers getting sick, paid sick leave might actually increase productivity and save money over the long term. We haven’t heard much clamor for such a policy, though. Perhaps that is because the low-wage workers who would benefit most directly don’t seem to have much influence with most politicians.

Can You Stay Home When Sick If You Have the Flu?

People who come down with flu symptoms like coughs, fever and muscle aches should stay home from work. Ideally, they would stay at home and away from other people who might catch the infection for at least 24 hours after the fever has disappeared. (That means the temperature has returned to normal without aspirin, acetaminophen or other treatment.)

Unfortunately, that’s easier said than done for millions of Americans. We are experiencing one of the worst flu epidemics in recent years. Every day there are new reports of people who have died of influenza.

Everyone is urged to wash their hands and get a flu shot to protect themselves from infection. Certainly, these measures are sensible, although they are not as effective as we could wish. But one of most important measures to keep flu from spreading is to keep sick people at home. A study suggests that just breathing in the presence of someone with influenza exposes you to the virus (Yan et al, PNAS, Jan. 2018).

Staying home is not an option for more than 40 million American workers, though. That’s because their employers don’t offer paid sick leave. If they get sick and have to stay home, they don’t get paid. For lots of people that could mean they can’t pay the rent or buy groceries, much less pay for prescription antiviral medicine such as Tamiflu or Xofluza. Consequently, they drag themselves into work even when they feel bad and are highly contagious.

What About Health Workers? Can They Stay Home When Sick?

You might think that doctors, nurses and other health care workers would be told to stay home when sick. Judging from our mail, though, that is not the case.

Here are just a few comments from health care workers:

“I am a nurse and have worked in the hospital setting for 21 years. Hospital managers treat us like we are children, requiring an ‘excuse’ when out sick. I refuse to go to my doctor just to be told I have a cold! These last two years I have started to stay home when sick. My health is important and the illness is a lot shorter when I get adequate rest.”

Another person wrote:

“Many hospitals tell staff to stay home when ill. However, managers write employees up, penalizing them on their yearly reviews if they miss more than three days of work in a row. Even with a note from your MD stating that you were ill, it is still considered an unexcused absence and requires a write up.”

This comes from a nurse practitioner (NP):

“I have been a NP for over 35 years at major medical centers. As a provider, being out of work due to illness, unless you were hospitalized, was plainly not accepted. I have worked with terrible colds, gastroenteritis and the worst was influenza…all because of pressure from management or direct orders from a supervising provider to work no matter what.

“I have been told to treat symptoms with medication and come to work. I would always wear a mask and keep my distance but the culture to work no matter how sick a provider is or how awful they feel is crazy and contradicts everything we teach. It is time to change this antiquated notion.”

Do as I Say, Not as I Do:

Doctors often advise their patients to stay home when they are ill, so they don’t spread their germs to healthy people. If only health professionals took their own advice!

A study conducted at the Children’s Hospital of Philadelphia (JAMA Pediatrics, Sept. 2015) found a surprisingly high proportion of health care providers report for work even when they are sick. Although these doctors, nurse practitioners and physician assistants recognized that showing up for a shift with a fever or cough could put their patients at risk, they worried even more about letting down their colleagues. More than half said they had come to work even though they were coming down with a respiratory tract infection such as a cold or the flu. Others came to work although they had an infection that caused diarrhea.

The researchers noted that the culture of health care systems encourages many providers to work even when they are sick. Changing this culture will be difficult, but it is essential for public health. Nobody should be expected to report for duty with a communicable condition, especially not health care workers. Health care systems may need to change their staffing policies to make sure vulnerable patients are not exposed to germs from sick health care providers.

Final Words:

Isn’t it time we got smart? Providing paid sick leave is cost effective in the long run because it keeps more people from becoming ill. It might also help a sick worker recover more quickly.

Health care providers should start following their own advice to “stay home when sick!” Patients should not be exposed to influenza, norovirus, colds or COVID from a doctor or nurse.

What do you think? We value your opinion. Please share your thoughts in the comment section below. If you have a friend or family member who might appreciate this article, please share it. And if you know a health care worker, please send it to them as well. Thank you for supporting our work.