In June 2014, Rex Archer, the director of health in Kansas City, Missouri, quarantined five families during a measles outbreak because several of the families’ members had contracted measles. The residents were told to stay in their home and avoid returning to work for several days.
Quarantine is a necessary, though difficult, measure that public-health officials sometimes take for people who are unvaccinated or at high risk of contracting a very contagious illness. In the case of measles, quarantine can last three weeks. Breaking quarantine can be a crime—one Wisconsin man was recently charged with a misdemeanor for going to the gym when he was supposed to be confined to his home.
For the Kansas City families, it quickly became clear that the quarantine would take its toll. As Archer and his colleague Abby Edsall wrote in the November issue of the journal Health Security, the families received food donations, but these were a mishmash of ingredients that didn’t form complete meals: peanut butter but no bread; a five-pound bag of dried cranberries; boxes of cereal without enough milk.
The health department persuaded the restaurants where the families worked to not fire them, but the families nevertheless faced steep consequences from avoiding work, according to Archer and Edsall. One family missed so many paychecks that they were evicted. Several people had their phones shut off after unpaid bills racked up. Ultimately, the health department had a collection among its own employees to raise money to donate to the quarantined families.
Much of this could have been avoided if the United States had a mandatory-paid-sick-leave policy, Archer and Edsall argue. The Family and Medical Leave Act of 1993 protects the jobs of some workers for up to 12 weeks for medical reasons, but it does not guarantee pay, and it doesn’t cover more than 40 percent of all American workers. Ten states and 33 cities have their own sick-leave policies, but still, 28 percent of American workers lack access to any kind of sick leave. The United States and South Korea are the only countries in the Organization for Economic Cooperation and Development that do not mandate paid sick leave.
The problem in the United States is especially pronounced among low-income workers, many of whom work in service jobs. In one survey, 63 percent of restaurant workers admitted that they cooked and served food while sick. Food-service workers are the source of most norovirus outbreaks. “We’re eating at restaurants where folks can have diarrhea and we don’t even know it,” Archer told me by phone. (In a statement, a National Restaurant Association spokesperson told me that the organization “supports companies having the flexibility they need to set HR policies and procedures that work for their individual businesses.”)
The question is one of growing importance as more and more measles outbreaks occur, and as contagious diseases such as Ebola make their way to the United States by air. About 1,500 excess deaths occurred during the 2010 swine-flu outbreak because people did not stay home from work.
“For residents caught in the crosshairs of an outbreak in a state or locality without paid sick-leave legislation,” Archer and Edsall write, “the cost of compliance can be loss of income, loss of job, loss of home, or the inability to care for and feed family members.”