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Millions of American workers who don’t have paid sick leave could face an impossible choice if they suspect they are infected with coronavirus: their health or their livelihood.

Concerns are growing that workers who cannot afford to stay home will accelerate the spread of the virus, Vice President Mike Pence told reporters on Monday. The Centers for Disease Control and Prevention has recommended employers “ensure that your sick leave policies are flexible and consistent with public health guidance.”

Yet, even in this fast-moving crisis that has collapsed markets around the world, many still do without it. From home health care aides to restaurant employees, one in 4 U.S. workers – more than 32 million – have no paid sick days. According to the data from the Bureau of Labor Statistics, 7 in 10 low-wage workers do not receive paid sick leave. Some American workers don’t even have the option to take unpaid sick leave, forcing them to either clock in and risk the health of customers and co-workers or forfeit their paycheck and possibly their positions.

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Emergency paid sick leave has become an urgent public health issue with the rapid spread of the coronavirus, says Nicolas Ziebarth, associate professor of economics at Cornell University in the College of Human Ecology. The virus showed no signs of slowing Monday. Confirmed cases surpassed 600 across more than 30 states and the District of Columbia. The U.S. death toll rose to 26.

The studies Ziebarth has conducted show that mandated sick leave by individual states and cities significantly reduces transmission of the flu. Other studies show that adopting paid sick leave does not depress wages or job creation, he said.

“When people gain access to paid sick leave, the spread of the flu decreases,” he says. “It’s important in this situation that, when you have people who have symptoms and don’t feel well, that they do not go to work and spread diseases” to slow the infection rate and buy time for public health officials to develop a vaccine.

Darden Restaurants, which owns Olive Garden and LongHorn Steakhouse, said Monday that hourly employees would now be offered paid sick leave at a rate of one hour for every 30 hours worked.

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The move reflects how quickly paid sick leave – one of the options President Donald Trump is weighing to shield vulnerable workers and the American economy from the coronavirus – has risen to the top of the national political debate.

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In a White House briefing on Monday, Pence said he had been hearing from governors about the concern that hourly wage earners would feel they had to go to work even if they were ill.

“The president has tasked this economic team, and is working already with leaders in the Congress, to make sure that anyone is not – feels that they’re at risk of losing their job or losing a paycheck because they may contract the coronavirus,” said Pence, who leads the administration’s coronavirus task force. “When we tell people, ‘If you’re sick, stay home,’ the president has tasked the team with developing economic policies that will make it very, very clear that we’re going to stand by those hard-working Americans.”

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House Speaker Nancy Pelosi, Senate Minority Leader Chuck Schumer and other top congressional Democrats on Sunday urged Trump to take steps to protect workers, including paid sick leave for those being quarantined or caring for children kept home by school closures.

Sen. Patty Murray, D-Wash., and Rep. Rosa DeLauro, D-Conn., proposed legislation last week that would require all employers to give workers 14 days of paid sick leave during a public health emergency, including the current threat. 

“In the richest country in the history of the world, it is an outrage that we do not guarantee paid leave for everyone,” Sen. Bernie Sanders said via Twitter on Saturday. “We cannot let the greed of corporations risk the public health of our community.”

No federal laws require that employers offer paid sick leave. It’s required in 12 states and Washington, D.C., and in some 30 cities and local jurisdictions. Nevada’s paid sick leave law took effect at the start of this year. Maine’s takes effect in 2021, according to the National Conference of State Legislatures. 

Typically, these mandates require that employees earn a minimum number of paid sick hours or days each year. Paid sick leave is often opposed by business groups and many states have passed legislation to thwart any effort to require it. 

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The coronavirus, or COVID-19, has brought new urgency to the question of whether all workers should have paid sick leave.

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King County in Washington state, hardest hit by the coronavirus, has recommended residents work from home. Professional workers at major corporations from Amazon to Google have been given the green light to work remotely. That self-quarantining, aided by tools such as videoconferencing and group messaging, means they are at far lower risk of getting sick.

Some companies including Microsoft and Amazon have pledged to continue to pay hourly service workers – such as kitchen staff, janitors and shuttle drivers – even if their hours are reduced.

On Friday, Apple said it was encouraging its employees in Silicon Valley to work from home until the end of the month to halt the spread of the coronavirus. The company told USA TODAY on Monday that it is also providing additional paid sick time to retail workers with symptoms consistent with COVID-19. 

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Tens of thousands of gig workers who deliver hot meals and groceries or transport passengers are at a much higher risk of coming into contact with people infected with the virus but, classified by their employers as independent contractors, they don’t have the health benefits and job protections of their white-collar counterparts. 

Sen. Mark Warner, D-Va., sent letters to the CEOs of top gig economy companies including Uber, Lyft and Postmates, urging them to “publicly commit to prioritizing your workers’ economic security and the broader public health during this response.”

Uber says it will compensate drivers for up to 14 days if they’re diagnosed with COVID-19 or if they are quarantined by health authorities. Lyft will do the same for an unspecified amount of time.

Delivery services Instacart and Postmates are introducing “no-contact” deliveries and DoorDash says customers can put instructions in the mobile app for drivers to leave orders at the door.

Late Monday, Instacart instituted a new sick pay policy for all of its in-store shoppers nationwide, including part-time employees and independent contractors who are affected by COVID-19.

All Instacart part-time employees now have access to sick pay and any part-time employee who is diagnosed with coronavirus or placed in mandatory isolation or quarantine is eligible for up to 14 days of pay, the company said.

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