WASHINGTON, DC—Workers who are sick with H1N1 should stay at home so others are not infected. However, many jobs in the private sector do not offer paid sick leave to make time at home possible, according to a panel that testified before Congress last month. “A lot of workers—particularly low wage workers in service-based industries who have a tremendous amount of customer contact—are among the least likely workers to have paid leave to be able to take time off from work. That is exactly the opposite of what you would want from a public health perspective,” Department of Labor Deputy Secretary Seth Harris told the Senate Health, Education, Labor, and Pensions Subcommittee on Children and Families last month.

The CDC estimates that an individual coming to work with H1N1 will infect 10% of his or her coworkers. CDC guidance for employers to mitigate the spread of H1N1 dictates that sick workers with influenza-like illnesses should stay home. Without paid sick leave, workers do not always stay home. Harris noted that when a sick employee does not stay home, an employer “could end up with dozens of sick workers, who are unproductive, making their coworkers unproductive, and potentially spreading a contagious disease to their families and friends.”

Rear Adm Anne Schuchat, MD, Assistant Surgeon General and Director of the National Center for Immunization and Respiratory Diseases at CDC, told the committee that CDC is encouraging businesses to be flexible with leave policies. When appropriate, telecommuting is also an option that would reduce the spread of illness in the workplace.

Reducing the Spread of H1N1

CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever, without the use of fever-reducing medications. Epidemiologic data collected during Spring 2009 revealed that most people with the 2009 H1N1 influenza virus who were not hospitalized had a fever that lasted 2 to 4 days. This would require an isolation period of 3 to 5 days in most cases. “Our guidance to schools, child care centers, and businesses all stress the importance of staying home when you are sick or keeping your child home if they are sick,” Dr Schuchat told the subcommittee.

Subcommittee Chairman Sen Christopher Dodd, D-CT, said that he is introducing emergency legislation that will guarantee paid sick days that workers can use to care for themselves and loved ones if they are affected by H1N1 or seasonal flu. “Experts estimate that if workers simply followed the CDC guidelines and stayed home, the number of people infected by pandemic flu could be cut by up to one third,” he said. Senator Mike Enzi, R-WY, said that in the absence of widespread access to the vaccine, employers are already taking steps to protect their workers. He expressed concern that a bill mandating paid sick days would hurt small businesses that are already struggling financially in the economy.

During the hearing, subcommittee members also discussed the delay in producing enough vaccine to satisfy demand. Doctor Schuchat said that one of the lessons that the government has learned from this circumstance is the importance of communication. “I think theAmerican public has been great about this, but I think if they understood in any one locality or state how the vaccines are being distributed, there would be an easier time,” she said.

Doctor Schuchat also noted that healthcare workers need to get vaccinated. “It is a sad feature of this pandemic that some healthcare workers have not been vaccinated, or have discouraged their patients from being vaccinated,” she said. Over the course of this flu season and future ones, she said that she expects that there will be a “greater uptake” of seasonal and H1N1 vaccine among health care workers because people “are beginning to realize that the flu can be serious.”

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