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If you have a fever, stay home from work. If your kids have a fever, they should stay home from school.
That's what the experts at the Centers for Disease Control and Prevention have been saying for months, in an effort to wrestle H1N1 influenza into submission. It's a pretty straightforward message.
But for some people, heeding it is anything but simple.
Consider one Maytown couple, whose names are being withheld to protect their livelihoods. He has worked at a manufacturing plant for more than a decade. She is a hair stylist. Neither gets paid sick days.
The only time she takes off is when their toddler isn't feeling well. Then, she has no choice: Their child care provider won't accept a child who has a fever or is vomiting.
Otherwise, this couple said they go to work, no matter how they're feeling.
"Nowadays, we're struggling to get by anyway," she said. "You can't miss a whole day's pay."
He said he would have to be unable to get out of bed before he'd call in sick. Having a fever hasn't kept him home in the past, he said. Working while ill is "horrible," he said, "but you need the paycheck."
Swine flu has brought on more than one kind of headache for workers, and in particular working parents, who have to worry not only about their own health and its implications for their jobs, but balancing the needs of their kids with their employer's demands.
With seasonal flu looming, more sick-day dilemmas lie ahead.
According to the U.S. Bureau of Labor Statistics, nearly 40 percent of American private-sector workers do not get paid sick leave. As The New York Times recently reported, "Low-wage workers are far less likely to receive paid sick leave than high-income workers, touching off fears that front-line workers at fast-food restaurants or child care centers might be spreading their illnesses."
Pennsylvania does not require employers to provide paid sick days. But Congress is considering the White House-supported Healthy Families Act, which would require companies with 15 or more employees to provide paid sick leave.
The legislation would enable employees to accrue up to seven days a year they could use for their, or a child's, illness.
Flu pandemicSwine flu has thrown the sick-leave issue into sharp relief.
The CDC has issued guidelines for businesses, stating that companies should expect employees with the flu to miss three to five days. The CDC urges flu sufferers to stay away from work or school until they have been fever-free for at least 24 hours.
Dr. Allison Agwu, an assistant professor specializing in infectious diseases at Johns Hopkins University School of Medicine, said, "The unfortunate reality of our society is that there are people whose jobs depend on them being there, and there's no flexibility."
Another reality: Health experts might lay down rules to manage and contain disease, but some employers "don't go by the same rules," Agwu said. "They want you to be there.
"When we're dealing with this kind of infection, there needs to be some kind of leeway for people," Agwu said.
It might be inconvenient for employers, but it is critical that people stay home when they have a fever, she said. If people go to work or school with a high temperature, they contribute to the "circle of disease," she said.
"To tell people to stay out of work until every symptom is gone is unrealistic," she said, but fever is a symptom that should be heeded. (Fever is associated with increased shedding of the flu virus, according to the CDC.)
Tag-team illnessOne Lancaster County woman, who asked that her name be withheld, had swine flu last month. Her two young daughters also contracted it, in tag-team fashion.
The woman, who works for a Lancaster nonprofit, ended up missing a full week of work.
She might have missed fewer days had her husband been able to take off a day or two. But "there's no way" he could, she said.
Her husband has worked for the same manufacturing company for more than a decade. He gets three weeks of paid time off, which can be used for vacation or illness.
But his company, like other manufacturers, sometimes has to close over the holidays if business is slow. And its workers don't get paid during the shutdown if they are out of PTO days. Moreover, taking sick days after exhausting one's PTO time leads to an assessment of points. Employees with more than a few points risk being fired.
So workers tend to hoard days off, sometimes working through illness, in case the plant shuts down in December.
For this mom, that means she is always the parent who takes off when the kids are sick. She said she hates feeling as if she is taking advantage of her employer.
She and other working parents often feel torn between wanting to care for their children and wanting to fulfill work responsibilities. "It's really hard," she said. "You don't want to be a bad mom, and you don't want to be a bad worker. ... How do you keep your job and your kids healthy at the same time?"
Chain's policyWal-Mart Stores Inc. recently came under fire for its sick-leave policy. The company charges employees a point, or demerit, for calling in sick. Employees with six or so points in a six-month period face being fired, according to media reports.
The National Labor Committee recently issued a report accusing Wal-Mart of contributing to the spread of swine flu by essentially forcing employees to work while sick.
After an ensuing public outcry, a Wal-Mart executive told The Washington Post that workers needing to stay home because of swine flu would not receive demerits.
Jean Martin, executive director of Community Services of Organized Labor in Lancaster, said many companies employ punitive point systems.
If an employee is late to work, he may lose half a point. If he stays home to care for a sick child, he may lose a whole point. "Every company is different in why you lose points, and how you can get points back," Martin said.
Martin said many workers live in fear of losing their jobs. If they work for a downsized company, they may worry that their absence will glare in a work force already overburdened.
In this economy, "Workers are under stress that is just unbelievable right now," Martin said.
School lessonsHempfield School District Superintendent Brenda Becker said school officials have taken steps to ensure that sick children — and ailing employees — are not in school.
She has encouraged her staff to report any student or staff member exhibiting flu-like symptoms to the school nurse. The sick are sent home, Becker said. And when they return to school, they are checked to ensure they are symptom-free, she said.
"As someone who was a working single parent of two children, I well understand the pressures on working parents," and what it's like "trying to find last-minute child care," Becker said in an e-mail.
Cheryl Gahring, director of child care services at the YWCA of Lancaster, said that she knows she puts parents in a tough spot "when I have to call them and say, 'You have to come pick up your child. He's burning up.' ... My heart goes out to them."
Like most child care providers, the YWCA program requires children be fever-free for 24 hours without medication before returning to the program.
"We feel really bad. ... Parents will come to us and say, 'I can't miss any more work. I'm going to get fired,' " Gahring said.
But then she said she thinks about the other children in her program and "the obligation I have to them, too."
Still, Gahring said she sympathizes with parents in this bind. With companies laying people off and cutting hours, "You want to be on your best behavior," she said. "You don't want to have to call in and say, 'My kid is sick.' "
Most people have backup plans — relatives or friends on standby — for when their kids get sick.
But some people are anxious about influenza — particularly H1N1 — and might not be willing to help. So, "All of a sudden those backup plans are not there, and I do think that's making it more of a struggle for working parents," said Laura Monzon, who works as a human resources manager for a Lancaster County company with about 100 employees.
Many employers now are going to pooled leave time, which can benefit employees by giving them control over how to use their time off. "But if you have two or three kids, and they each get sick for a few days, now all of your time is taken up," Monzon said.
Monzon said she knows people who had planned to take time off over the holidays, but no longer can because their leave time was spent caring for kids with swine flu.
Sick days not for kidsSome workers are not permitted to use sick days to care for sick children.
One West Hempfield Township woman, who works as a home health-care worker, said she gets ample sick leave for herself, but none to take care of her daughter. "It's kind of don't ask, don't tell," she said. "You just call in and say you're sick."
Lancaster General Health has a paid time bank for its 7,400 employees, and a short-term disability bank that employees can use if they need a week or more off because of illness. Employees can use the time to care for sick kids, and there is no demerit system, said Lancaster General spokesman John Lines.
He said employees are urged to contact their managers if they are going to be absent, "so the service levels are consistent."
Lancaster General has had about 125 employees who have been absent — for an average of about five days each — because of influenza-like illness over the past month, Lines said.
He added that Lancaster General Health has made it clear to employees that they are not to come to work sick. And co-workers are helping to enforce this by urging colleagues to go home if they don't look well, he said.
Mandated sick daysAl Duncan, CEO of the company that owns Miller's Smorgasbord, AmishView Inn & Suites and Plain & Fancy Farm Restaurant, said his company does not provide paid sick leave for any of its 240 employees, but does offer paid vacation time to its 101 full-time workers.
His company is considering adopting a paid time-off program, which would allow employees to use their leave time as they see fit.
Duncan said his employees are forbidden from working if they are sick. They can often make up the lost time.
"We're not unsympathetic to the work force. We're in the people business," Duncan said.
Duncan is wary of any legislation that would require employers to offer paid sick days. If businesses have to provide seven sick days, some employees will use those days whether they're sick or not, he said.
This will drive up costs, which will be passed on to customers, Duncan contended, noting, "In any business, especially small business, at the end of the day, you have to make the numbers work."
Thomas Baldrige, president of the Lancaster Chamber of Commerce & Industry, said his organization has not taken a position on the Healthy Families Act, but would oppose any government mandate on employee sick leave.
"The vast amount of employers are responsible and truly care about their work force, and will do the right thing in the best interest of their bottom line and that of their employees," Baldrige said.
Martin, of Community Services of Organized Labor, said she knows that businesses will complain if required by law to provide paid sick leave, but she maintains such legislation is necessary. "Most companies won't do it on their own," she said.
Suzanne Cassidy is a staff writer for the Sunday News. Her e-mail address is scassidy@lnpnews.com.
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