The data is stark — lockdown prevented COVID-19 among wealthy, white Torontonians, but failed to protect low-income and racialized households in the same way. Unfortunately, this comes as no surprise to us as doctors, since we’ve been caring for patients with COVID-19 since the pandemic arrived in our emergency departments.
It’s clear that sound public health advice to “stay home when sick” is simply not enough. Workplaces were a major source of COVID-19 spread during the lockdown, because essential workers are denied essential protections, from personal support workers staffing long-term-care homes, to meat processing workers, grocery store workers and migrant farmworkers sustaining our food system. COVID-19 thrives where racialized workers are denied paid sick days, and where asymptomatic migrant workers are told to keep working even after testing positive for COVID-19. Now, as the economy reopens in the midst of the pandemic and in the lead up to flu season, the denial of paid sick days remains a public health threat, from nail salons to schools.
Prime Minister Trudeau recently announced a “pan-Canadian sick leave” program, which will provide income support to workers without paid sick days for up to 10 days of leave related to COVID-19. This temporary measure will help some workers stay home while sick with or caring for someone with COVID-19, but it’s not the paid sick-day policy our patients need. We are concerned it will fail to protect low-income and racialized workers, the very people who need paid sick days most.
Restricting paid sick leave to a temporary measure for reasons “related to COVID-19” undermines its effectiveness. COVID-19 can present with atypical symptoms, and test results are neither immediate nor 100 per cent sensitive. In addition, COVID-19 is contagious early in the illness course. If those who develop COVID-19 symptoms continue to work while they’re awaiting test results or uncertain if the diagnosis will be considered “related to COVID-19,” the damage may already be done. This is not to mention how crucial paid sick days will be for the upcoming flu season and to prepare for future outbreaks. Paid sick days must be permanent and ensure workers can stay home at symptom onset, regardless of the ultimate diagnosis.
With 51 per cent of Torontonians affected by COVID-19 living below the low-income threshold, they simply cannot afford to lose any money off a paycheque. If there is no guarantee that sick-day pay will arrive in time to pay rent and buy groceries, workers may be forced to continue working while sick. Any administrative barrier to accessing paid sick days is a barrier to staying home when sick. In 2018, 82 per cent of Canadians said that they would go to work sick if their employer required a sick note. Paid sick days must be seamlessly accessible without an application process, waiting period or required sick note, and be paid by the employer on workers’ next paycheque.
The outbreak and deaths on Ontario farms have made it painfully clear that paid sick days will not protect against a pandemic if they are not available to all workers. But a patchwork of exclusions from employment standards deny many workers basic protections, including migrant farmworkers. Paid sick days must be available to all workers, regardless of employment or immigration status.
As emergency providers, we also know that crisis response must be linked to improving underlying conditions and closing long-standing gaps in protections for racialized, low-income workers. The benefits of paid sick days are clear: improved vaccination rates, reduced spread of infections in workplaces and schools, and reduced reliance on the emergency department. Medical professionals have been calling for seven paid sick days for several years to align public policy with medical evidence and public health recommendations. In light of the pandemic, it is now clear that an additional 14 days is necessary during outbreaks.
The health gaps due to COVID-19 are stark, but they are not inevitable. The Trudeau government has taken a first step in committing to a pan-Canadian paid sick-leave program. It’s time to work with the provinces to ensure universal, permanent, and seamlessly accessible paid sick days are available to workers across Canada. We need policy change now. If we wait until COVID-19 cases are rising again, it will be too late.
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