When I was a medical resident, saucy attending physicians, wanting to impress on us the importance of our work, said things like “If we’re not rounding with you, we better be rounding on you,” meaning that in order to justify missing hospital rounds we better be sick enough to need hospitalization ourselves. So it was no surprise that I once saw a residency classmate work through a night call shift with obvious symptoms of acute influenza.
In the COVID-19 era, working with patients through a febrile illness seems as dated as smoking indoors or driving without a seatbelt. But America remains one of the few developed countries that does not guarantee universal access to paid sick leave for all workers. Twenty-seven percent of all US employees and 17 percent of all US full-time employees cannot take paid sick leave. Congress tried to address this, albeit temporarily, with the Families First Coronavirus Response Act (FFCRA), which was passed on April 1, 2020 and expired on December 31, 2020.
As a reminder, FFCRA said that employers with up to 500 employees must cover, with exceptions:
Up to 80 hours paid sick leave at usual pay if the employee was quarantined and/or experiencing COVID-19 symptoms
Up to 80 hours paid sick leave at two-thirds usual pay if the employee was caring for someone else in quarantine
Up to 10 weeks of paid expanded family and medical leave at two-thirds usual pay if the employee was unable to work due to caring for a child whose school or child care provider was closed or unavailable for reasons related to COVID-19
About a quarter of US companies affected by the law used it in its lifespan; employers with 500 or more employees already overwhelmingly offer paid sick leave. FFCRA’s passage set up a “natural experiment” (we’ve talked about these before): in some states like Kansas without pre-existing laws around sick leave, workers gained the right to take paid sick leave. These were treated by researchers as the “treatment group.” Their change in COVID-19 rates were compared to changes in workers in twelve states and the District of Columbia who already had access to paid sick leave before FFCRA, the “control group.” Investigators were able to use baseline levels of infection in the few weeks before passage of the law as a baseline.
The results? States where employees gained new access to paid sick leave had a “statistically significant decrease of approximately 400 fewer confirmed new cases per state per day relative to the pre-FFCRA period and to states that had already enacted sick pay mandates before enactment of the FFCRA.” The authors estimate that this translated into about one prevented case per day per 1,300 newly covered workers.
Given COVID-19’s roughly 2% mortality rate, 400 cases fewer per day could equals as many as eight lives per state per day saved by a simple administrative decision. This is completely in line with previous research showing that paid sick leave induces employees with contagious infections like influenza to take sick leave, thus reducing influenza activity during non-COVID-19 times.
Besides the obvious humanistic angle, is this cost effective? After all, COVID-19 hospitalizations are expensive. I tried to muddle through some math to see how much each saved life cost, but I don’t trust my numbers. So instead I’ll ask you: if you’re an employer with fewer than 500 employees, how did FFCRA affect you and your bottom line?
As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.