In U.S., more than 1 in 4 healthcare workers lack paid sick leave - study

(Reuters Health) - Many U.S. healthcare workers on the front lines in the COVID-19 pandemic lack basic health insurance and more than 1 in 4 have no paid sick leave, increasing the risk that they will show up for work even if they are infected with the coronavirus, an analysis in the Annals of Internal Medicine has concluded.

And 1 in 4 healthcare workers are over age 64 or have a preexisting condition that puts them at a higher risk of dying from the virus, officially known as SARS-CoV-2, if they become infected.

“Our data indicate that millions of health workers likely to be exposed to SARS-CoV-2 have medical conditions that increase their risk for poor COVID-19 outcomes,” said Drs. David Himmelstein and Steffie Woolhandler of the City University of New York at Hunter College.

“Many lack health insurance and paid sick leave, and more than 600,000 live in poverty, potentially compromising their ability to maintain social distancing outside their workplace. Poverty, particularly when coupled with lack of sick pay, might push minimally symptomatic workers to attend work,” they said.

The problem is particularly acute among people who work in nursing homes and home care, where pay and benefits can be notoriously stingy.

Using data from two national surveys, Drs. Himmelstein and Woolhandler estimated that 6.2% of healthcare workers with direct patient contact lack health insurance, 28.6% don’t get paid sick time and 5.7% live in poverty.

Working in a hospital is no guarantee of health insurance coverage: 3.1% don’t have it.

Among nursing home staff, 11.5% don’t have health insurance, and that’s true for 14.9% of home health workers - well above the national average of 9.1%

The percentages “were bigger than we expected, so we were slightly surprised by this,” Dr. Himmelstein told Reuters Health in a telephone interview.

“There are a lot of heroic people doing a lot of heroic things,” he said. “It’s nice that the politicians salute them as heroes. It would be nice if they would do something to help them out.”

“At least offer them hazard pay and emergency coverage during this pandemic. That’s the least,” said Dr. Himmelstein, a distinguished professor of public health at Hunter.

Broken down by job, 12.0% of licensed practical nurses and 5.1% of registered nurses had no insurance.

Among the estimated 3.2 million healthcare workers with chronic health problems such as asthma, lung disease, diabetes or a heart condition, 28.2% have no paid sick leave. Nearly 1 in 10 reported that they can’t afford their prescriptions.

“Millions of health personnel are assuming substantial risks to serve their communities. Depriving them of adequate income, sick leave, and insurance dishonors that service and threatens the well-being of both health workers and the public,” the researchers said.

Although Congress mandated expanded sick leave benefits, it exempted large employers, leaving 74% of hospital personnel and more than a third of home care and nursing home workers outside that zone of protection.

While only 2.5% of hospital workers have family incomes below the poverty line, the rates are 11.7% for nursing home workers and 14.6% for home care workers, according to the analysis.

At least 200 doctors and nurses have died from COVID-19.

SOURCE: Annals of Internal Medicine, online April 28, 2020.