Background

Workplace spread of SARS-CoV-2, the virus responsible for COVID-19, causes a substantial burden of illness among essential workers and their families, and is a significant contributor to community transmission driving the third wave in Ontario. Workplace outbreaks result in economic loss, and disruption of essential services. Public health measures such as workplace screening and testing, isolation of people with SARS-CoV-2 infection, and quarantine of their contacts, can reduce SARS-CoV-2 transmission, and prevent workplace outbreaks.^1,2 Cumulatively, these measures contribute toward reduced cases of SARS-CoV-2 infection, COVID-19 hospitalizations, and COVID-19 deaths among both workers and their household and community contacts.

While many members of the Ontario workforce are able to work from home or have access to paid sick leave while ill or self-isolating, this is far from universal. In Ontario, 60% of workers do not have paid sick leave apart from the federal CRSB program.³ Essential workers cannot work from home, and they most commonly work in trades, transport, equipment, manufacturing, utilities, sales, services, agriculture sectors, and health care.^4–6An estimated 42% of Ontario’s workforce is employed in occupations that could be conducted remotely.⁷Moreover, essential workers are disproportionately represented in jobs that do not include sick leave benefits.⁸

In Canada most people without paid sick leave earn less than $50,000 in annual income, and more than 60% of seasonal, casual, or contract workers have no paid sick leave at all.^8,9 In Ontario, the highest proportion of SARS-CoV-2 infections are in neighbourhoods with the highest proportion of essential workers.^10,11 Financial support that enables Ontario workers to follow public health measures can limit SARS-CoV-2 transmission, reduce COVID-19 illness, and minimize economic loss.^8,9 The intersection between the absence of paid sick leave and lower or inconsistent levels of income creates a situation where essential workers face a tension between meeting basic needs (e.g., food and rent), and following public health measures (e.g., self-isolation, quarantine, testing, and vaccination).

Questions

What has been the impact of COVID-19 on essential workers and Ontario workplaces?

What paid sick leave policies have been implemented nationally and internationally to support essential workers in following public health measures during the COVID-19 pandemic?

What is the evidence for the effectiveness of paid sick leave in supporting essential workers in following public health measures, preventing SARS-CoV-2 infection among essential workers, and mitigating COVID-19 outbreaks in essential workplaces? 

What evidence can be extrapolated from the impact of paid sick leave in mitigating other infectious diseases such as influenza-like illness?

How can paid sick leave support COVID-19 vaccination among essential workers?

What is the economic impact of paid sick leave?

Which ethical principles and considerations should inform public policy on paid sick leave in Ontario?

Findings

Impact of COVID-19 on Essential Workers and in Ontario Workplaces

While information about workplace transmission in Ontario remains incomplete, data from regions with high concentrations of essential workplaces, such as manufacturing facilities and warehouses, highlight workplaces as a significant sites for SARS-CoV-2 transmission.^12,13 In Ontario’s Peel Region, 66% of community outbreaks from September to December 2020 occurred in workplaces.¹⁴ Occupational exposure was the most common likely source of infection that resulted in secondary household transmission in August 2020 in the Peel Region. Between August and December 2020, 1,993 out of 7,874 surveyed workers (25%) in Peel reported attending a workplace outside of their home for one or more days following symptom onset, 80 of whom continued to work after the date that their positive SARS-CoV-2 result was reported to public health.¹⁴

Many workplaces experiencing outbreaks use temporary workers who tend to have fewer worker income supports than permanent employees, and work in multiple settings.¹⁴

Overview of Paid Sick Leave Policies in Canada and Internationally 

The CRSB provides $450 after taxes per week for up to four weeks for workers who miss at least 50% of their work week because they are unwell or isolating from COVID-19.¹⁵ This allocation is $100 lower per week than a full time (37.25 hour) weekly salary at Ontario minimum wage ($14.25 hourly).¹⁶ Payments are not timely as it can take up to 4 weeks for workers to receive funds (see Table 1 above).¹⁷

There are additional concerns that the CRSB cannot financially support workers in following public health measures. Because the CRSB does not cover shorter absences, it excludes worker time off to get tested or vaccinated, or those workers who stay home due to symptoms or exposure, subsequently test negative for SARS-CoV-2 infection, and are then cleared for return to work within 50% of their work week.

Since CRSB is limited to a 1-week period, is not renewable, and can only be used four times per year, it may not be enough for workers in high SARS-CoV-2 exposure occupations. The CRSB application places the administrative burden of applying for the benefit on essential workers, and requires computer access, internet literacy and an understanding of English or French. Taken together, these limitations and barriers of the CRSB may hinder adequate protection of essential workers and effective mitigation of workplace outbreaks during the COVID-19 pandemic.

A number of provinces and territories introduced unpaid sick leave of varying durations in response to the COVID-19 pandemic.¹⁸ Only Yukon provides a paid sick leave benefit for workers who become sick, or who must quarantine or isolate, which guarantees 10 days of wages per employee. Employers can only access the program once per employee.¹⁹

During the COVID-19 pandemic, paid sick leave has been implemented in several jurisdictions internationally to support essential workers in following public health measures.²⁰ In response to the COVID-19 pandemic, 16 of 38 Organization for Economic Cooperation and Development (OECD) countries temporarily expanded or initiated paid sick leave policies.²⁰ For example, countries like France and Ireland waived waiting periods for sick pay and benefits. Australia and Spain introduced additional dedicated sick benefits for workers with COVID-19 who exhausted accrued employer‑provided sick-pay entitlements. The United States introduced the FFCRA, a temporary measure for employers to provide paid sick leave for reasons related to COVID-19.²¹

Evidence for the Effectiveness of Paid Sick Leave

Reduction in mobility is a proxy for measuring the time individuals stay at home, and is associated with reductions in SARS-CoV-2 transmission and COVID-19 cases.²² A study using GPS data from cellular devices found that the introduction of the FFCRA in the United States increased the average number of hours at home by 4.2%.²³

Figure 1 shows the estimated daily number of COVID-19 cases per state in states that introduced the FFCRA, relative to comparator states. After adjustment for a variety of factors, the introduction of FFCRA was associated with an approximately 50% decrease in confirmed COVID-19 cases per state per day.²⁴ This is equivalent to about 1 prevented case per day per 1,300 workers. 

Survey data from the United Kingdom found that non-adherence to public health guidelines for patients with COVID-19 was associated with factors including dependent children in the household, lower socioeconomic status, and being an essential worker.²⁵ Financial support, and wrap around services, are in particular associated with improved ability to self-isolate.^25,26

Figure 2 shows risk factors for influenza-like illness among a nationally representative sample of 2,042 adults from the United States during the H1N1 influenza pandemic in 2009.²⁷ Inability to work from home and absence of paid sick leave were associated with an approximately 50% increase in the risk of influenza-like illness. 

There are many studies demonstrating that paid sick leave policies at the state and municipal levels are associated with reduced transmission and outbreak prevention for respiratory infections. For example, influenza surveillance data in the United States shows that access to paid sick leave led to a decline of 290 influenza-like illnesses per 100,000 individuals per week .²⁸ An OECD report notes that that paid sick leave reduced influenza-like illness rates by 10% and total work absence by 18% in some American cities.²⁹

Paid Sick Leave and COVID-19 Vaccination

Evidence from the United States indicates that paid sick leave is associated with increased influenza vaccination rates among workers, since they are guaranteed to receive paid time off to get immunized.^30,31 A survey of 8,634 health care workers reported that they were much more likely to get vaccinated if direct financial support like paid sick leave were available.³²

As part of the Centers for Disease Control and Prevention (CDC) best practices for workplace COVID-19 vaccination, it is suggested that employers allow workers to take paid leave to get vaccinated and financially support transportation to off-site vaccination clinics. They further suggest that employers provide flexible leave policies for those who may have post-vaccination symptoms.³³ Recently, Saskatchewan and British Columbia mandated employers to provide paid time off for vaccination.^34,35

Economic Impact of Paid Sick Leave

Data from the COVID-19 pandemic and other epidemics demonstrate that paid sick leave is an important strategy for public health containment as well as for economic stability and recovery.^20,36,37 Paid sick leave can increase productivity, and reduces absenteeism by preventing outbreaks and the chance of workplace closures. Job losses and working hour reductions during the COVID-19 pandemic have been larger in American states without a paid sick leave system.³⁸

Small businesses that provide paid sick leave for their employees require compensation to ensure economic viability. Many OECD countries have lowered the costs for employers through government subsidization.²⁰ In the United States, California has recently extended eligibility criteria for paid sick leave to include being in quarantine, caring for a family member in quarantine, experiencing symptoms of COVID-19 and seeking a medical diagnosis, or missing work to receive the COVID-19 vaccine.³⁹

Ethical Principles Supporting Paid Sick Leave in Ontario

Paid sick leave as a critical public health measure is supported by public health ethics principles as summarized in Table 2.^40,41 It demonstrates efficiency by reducing worker absenteeism overall, and protects the public from harm by containing the spread of infectious diseases and optimizing economic stability and recovery. Moreover, it provides mutual support by reducing the burden on those disproportionately affected by their type of work and overall compensation; it is a fair, reasonable, and proportional response to the health and economic threats of the pandemic; and minimizes damage to collateral groups by isolating infectious and potentially infectious workers from others who are susceptible. Finally paid sick leave builds a common purpose in society when viewed as supporting critical public health measures, and building public trust in decision-makers.

Ethical Principle	Brief interpretation in the context of paid sick leave in Ontario
Protection of the public from harm	A foundational principle of public health ethics is the governmental obligation to protect the public from harm. In a pandemic, this includes effective public health measures to contain the spread of infectious diseases and to reduce the burden of illness in workplaces. It also includes protecting the public from economic harms related to worker absenteeism, enhancing business continuity, and enabling economic stability and recovery. The protective effects of paid sick leave will be important as the economy moves into recovery.
Reciprocity	Reciprocity requires that society supports those who face a disproportionate burden when protecting the public good. During the COVID-19 pandemic, individuals who must self-isolate, and their families, may experience significant social, economic, and emotional burdens.Provincially mandated sick leave that is immediately accessible and eliminates or greatly reduces the financial burdens of compliance with public health measures meets the duty of reciprocity for essential workers.Small businesses that provide sick pay for their employees should also be appropriately supported if the costs of doing so put their business in jeopardy.
Equity	Equity requires that measures be taken to redress health and other social inequities that are unfair and exacerbated by public health measures like quarantine and isolation.Many essential workers are from disadvantaged groups who have fewer resources with which to protect themselves and their families and are therefore unfairly and disproportionately burdened by the impacts of COVID-19. Policymakers are urged to consider the health risks not only to workers but also to those with whom they live. Supporting workers to quarantine and isolate by providing paid sick leave also reduces harm for co-workers by reducing their exposure to COVID-19 and by respecting their right to a healthy workplace.
Proportionality	Proportionality requires that measures taken to mitigate the pandemic should correspond to the actual level of risk, or critical needs of the community.As a public health measure, paid sick leave is a proportionate response to both health and economic threats posed by COVID-19 and will play an important role in maintaining safety, productivity, and business continuity as the relaxation of public health measures begins.
Systemic resilience	Government has a moral imperative to prevent population level health harms.  Anticipating public health threats and preparing for them is an ethical requirement for good public health governance. Paid sick leave will need to be considered with stepwise relaxation of public health measures, into the post-COVID-19 period. Preparing for future pandemics requires improving the adaptability of paid sick leave to the economic and health challenges posed by pandemics.
Solidarity	Paid sick leave reflects a sense of common purpose in society when viewed as an important public health measure. It also can help build public trust, which is essential for public health compliance.To foster solidarity, we must protect the income and jobs of society’s most economically and biologically vulnerable. Paid sick leave provides reassurance to workers that their wellbeing and dignity are being respected but it also represents what we would all want if we were in the same position. Stopping COVID-19 requires a collective effort. Providing paid sick leave is a critical example of a public health measure that builds a sense of common purpose between workers, between workers and employers, between businesses and the public and between the public and government. When public trust is increased through compensatory mechanisms, such as paid sick leave, it is beneficial for other aspects of outbreak response such as vaccine uptake.

Interpretation

Observational real-world evidence suggests that paid sick leave is associated with a reduction in SARS-CoV-2 transmission and COVID-19 illness among essential workers, and an improvement in productivity. This has been found both during the COVID-19 pandemic and in observational studies of paid sick leave for influenza-like illness, including increased influenza vaccination rates. No randomized trials are available to inform public health decisions about the implementation of this or any other public health measure used throughout the COVID-19 pandemic.

Most Ontario COVID-19 workplace outbreaks outside of long-term care homes have occurred in the manufacturing sector, as well as forestry, agriculture, fishing/hunting, transportation and warehousing.^43,44These services are essential to the functioning of society and to the Ontario economy. Workers in these sectors are paid relatively low wages and are often members of disadvantaged communities.⁸ Further, these workers may live with other people who work in essential services, putting more individuals and workplaces at risk.⁴⁵

Paid sick leave preserves the jobs of workers who cannot work from home and prevents harms related to loss of income while following public health measures. In Ontario it is estimated that this accounts for 3 million essential workers.⁴⁶ Paid sick leave also increases job security and improves population health overall.⁴⁷ The absence of paid sick leave is often characteristic of insecure work, which is correlated with poorer overall health and worse occupational health and safety outcomes, and which contributes to health inequities in Ontario and disproportionate burdens from COVID-19 being born by essential workers.^48,49

The existing federal CRSB cannot financially protect essential workers in following all public health measures, places the administrative burden of applying for the benefit on essential workers, and neither provides sufficient, nor timely payments. Table 1 above lists the characteristics of a model paid sick leave program as compared with the CRSB. Figure 3 presents a proposed process for an essential worker and their employer accessing the model paid sick leave program. Implementation of the model program should be done in a way that is easy to navigate and quick for employers.

Ontario’s essential workers require paid sick leave that offers more money, is easily accessible, is immediately paid, and supports them in following all public health measures. This includes providing essential workers with paid leave when they are sick, have been exposed, need to self-isolate, need time off to get tested or vaccinated, and when their workplace closes due to an outbreak, with guaranteed salary payment regardless of duration of absence (minimum 2 hours, maximum 2 workweeks).⁵⁰

Reducing SARS-CoV-2 transmission is a collective effort across all sectors of society. Enabling employers to provide paid sick leave to employees during the pandemic ensures workplace safety, and protection of the public. Moreover, it is a measure that fosters a sense of common purpose among workers, employers, the public and government, and builds public trust which is essential for COVID-19 vaccine uptake.⁵¹

Paid sick leave is an essential public health measure that, if applied in Ontario, will both help control the third wave of the COVID-19 pandemic and prevent the emergence of further workplace and community outbreaks prior to the vaccination of every willing Ontarian.

Methods Used for This Science Brief

The COVID-19 Evidence Synthesis Network performed a research evidence scan for this Science Brief, published in an Evidence Synthesis Briefing Note. The COVID-19 Evidence Synthesis Network is comprised of organizations in Ontario’s evidence synthesis and knowledge translation community who collectively provide high-quality, relevant, and timely synthesized research evidence about COVID-19. The Methods for the evidence scan can be found in the methods section of the Briefing Note. The evidence scan was last updated on February 17, 2021.¹⁹

1.         Government of Ontario. Ethical framework for COVID-19 vaccine distribution. Published January 11, 2021. https://www.ontario.ca/page/ethical-framework-covid-19-vaccine-distribution

2.         Iddins BO, Waugh MH, Buck B, et al. Benchmarking SARS CoV-2 infection in the workplace to support continuity of operations. J Occup Environ Med. Published online March 19, 2021. https://doi.org/10.1097/JOM.0000000000002188

3.         Decent Work and Health Network. Health experts, teachers, frontline workers sound the alarm for paid sick days. Decent Work and Health Network. Published August 19, 2020. https://www.decentworkandhealth.org/beforetoolate

4.         Government of Canada. Occupational classifications. Statistics Canada. Published November 21, 2011. https://www.statcan.gc.ca/eng/concepts/occupation

5.         Government of Canada. Percentage of workforce teleworking or working remotely, and percentage of workforce anticipated to continue primarily teleworking or working remotely after the pandemic, by business characteristics. Statistics Canada. Published November 13, 2020. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=3310027401

6.         Angus Reid Group. Canadian workforce of the future survey. PwC Canada. Published 2020. https://www.pwc.com/ca/en/today-s-issues/upskilling/canadian-pulse-survey.html

7.         Deng Z, Morisette R, Messacar D. Running the economy remotely: Potential for working from home during and after COVID-19. Statistics Canada. Published May 28, 2020.https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00026-eng.htm

8.         The University of British Columbia. Ability to work from home and paid sick leave benefits by precarious employment and socioeconomic status. Published June 3, 2020. http://pwhr.sites.olt.ubc.ca/files/2020/09/GSS-COVID-19-Research-Brief-2020.pdf

9.         Government of Canada. General social survey: canadians at work and home (GSS). Published July 12, 2016. https://www23.statcan.gc.ca/imdb/p2SV.pl?Function=getSurvey&SDDS=5221

10.       Chagla Z, Ma H, Sander B, Baral SD, Mishra S. Characterizing the disproportionate burden of SARS-CoV-2 variants of concern among essential workers in the Greater Toronto Area, Canada. medRxiv. Published online March 26, 2021:2021.03.22.21254127. https://doi.org/10.1101/2021.03.22.21254127

11.       Sundaram ME, Calzavara A, Mishra S, et al. The individual and social determinants of COVID-19 in Ontario, Canada: a population-wide study. medRxiv. Published online November 12, 2020:2020.11.09.20223792. https://doi.org/10.1101/2020.11.09.20223792

12.       Baker MG, Peckham TK, Seixas NS. Estimating the burden of United States workers exposed to infection or disease: A key factor in containing risk of COVID-19 infection. PLOS ONE. 2020;15(4). https://doi.org/10.1371/journal.pone.0232452

13.       Watson T, Kwong JC, Kornas K, Mishra S, Rosella LC. Neighbourhood Characteristics Associated with the Geographic Variation in Laboratory Confirmed COVID-19 in Ontario, Canada: A Multilevel Analysis.; 2021:23. https://www.medrxiv.org/content/10.1101/2021.04.06.21254988v2.full.pdf

14.       Health Services Region of Peel. Briefing note: paid sick days and supports for essential workers. Published January 22, 2021. https://peelregion.ca/advocacy/paid-sick-leave/briefing-note.pdf

15.       Government of Canada. Canada recovery sickness benefit (CRSB). Published March 25, 2021. https://www.canada.ca/en/revenue-agency/services/benefits/recovery-sickness-benefit.html

16.       Government of Ontario. Your guide to the Employment Standards Act: minimum wage. https://www.ontario.ca/document/your-guide-employment-standards-act-0/minimum-wage

17.       Government of Ontario. Keep getting your payments: Canada Recovery Sickness Benefit (CRSB). Published October 2, 2020. https://www.canada.ca/en/revenue-agency/services/benefits/recovery-sickness-benefit/crsb-getting-payments.html

18.       Canadian Labour Congress. Sick leave across Canada. Canadian Labour Congress. Published March 31, 2020. https://canadianlabour.ca/sick-leave-across-canada/

19.       Research, Analysis, and Evaluation Branch. Evidence Synthesis Briefing Note: Paid Sick Leave Benefits during the COVID-19 Pandemic. COVID-19 Evidence Synthesis Network; 2021. https://esnetwork.ca/wp-content/uploads/2021/02/Evidence-Synthesis-BN-Paid-Sick-Leave-During-COVID-19-Pandemic_23-FEB-21.pdf

20.       Stricot M, MacDonald D. Paid sick leave to protect income, health and jobs through the COVID-19 crisis. OECD. Published July 2, 2020. http://oecd.org/coronavirus/policy-responses/paid-sick-leave-to-protect-income-health-and-jobs-through-the-covid-19-crisis-a9e1a154/

21.       U.S Department of Labor. Families First Coronavirus Response Act: employee paid leave rights. Published December 31, 2020. https://www.dol.gov/agencies/whd/pandemic/ffcra-employee-paid-leave

22.       Zipursky JS, Redelmeier DA. Mobility and mortality during the COVID-19 pandemic. J Gen Intern Med. 2020;35(10):3100-3101. https://doi.org/10.1007/s11606-020-05943-7

23.       Andersen M, Maclean JC, Pesko M, Simon K. Effect of a Federal Paid Sick Leave Mandate on Working and Staying at Home during the COVID-19 Pandemic: Evidence from Cellular Device Data. National Bureau of Economic Research; 2020. https://doi.org/10.3386/w27138

24.       Pichler S, Wen K, Ziebarth NR. COVID-19 emergency sick leave has helped flatten the curve in the United States. Health Aff Proj Hope. 2020;39(12):2197-2204. https://doi.org/10.1377/hlthaff.2020.00863

25.       Smith LE, Potts HWW, Amlôt R, Fear NT, Michie S, Rubin GJ. Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys. BMJ. 2021;372:n608. https://doi.org/10.1136/bmj.n608

26.       Madad S, Nuzzo JB, Bourdeaux M. The missing piece In America’s COVID-19 isolation and quarantine strategy: wraparound services. Published December 10, 2020. https://www.healthaffairs.org/do/10.1377/hblog20201207.458415/full/

27.       Kumar S, Quinn SC, Kim KH, Daniel LH, Freimuth VS. The impact of workplace policies and other social factors on self-reported influenza-like illness incidence during the 2009 H1N1 pandemic. Am J Public Health. 2012;102(1):134-140. https://doi.org/10.2105/AJPH.2011.300307

28.       Pichler S, Wen K, Ziebarth NR. Positive health externalities of Mandating Paid Sick Leave. J Policy Anal Manage. Published online February 5, 2021:pam.22284. https://doi.org/10.1002/pam.22284

29.       Thewissen S, MacDonald D, Prinz C, Stricot M. The critical role of paid sick leave in the COVID-19 health and labour market crisis. VoxEU.org. Published July 8, 2020. https://voxeu.org/article/paid-sick-leave-during-covid-19-health-and-labour-market-crisis

30.       Zhai Y, Santibanez TA, Kahn KE, Black CL, de Perio MA. Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among U.S. workers. Vaccine. 2018;36(48):7316-7323. https://doi.org/10.1016/j.vaccine.2018.10.039

31.       Wilson FA, Wang Y, Stimpson JP. Universal paid leave increases influenza vaccinations among employees in the U.S. Vaccine. 2014;32(21):2441-2445. https://doi.org/10.1016/j.vaccine.2014.02.084

32.       Desveaux L, Savage RD, Tadrous M, et al. Beliefs associated with intentions of non-physician healthcare workers to receive the COVID-19 vaccine in Ontario, Canada. medRxiv. Published online February 26, 2021:2021.02.19.21251936. https://doi.org/10.1101/2021.02.19.21251936

33.       Centers for Disease Control and Prevention (CDC). Workplace vaccination program. Centers for Disease Control and Prevention. Published March 25, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/essentialworker/workplace-vaccination-program.html

34.       Government of Saskatchewan. Phase 2 of vaccine delivery plan launches, special vaccination leave introduced. Government of Saskatchewan. https://www.saskatchewan.ca/government/news-and-media/2021/march/18/phase-2-of-vaccine-delivery-plan-launches-special-vaccination-leave-introduced

35.       Government of British Columbia. Paid leave for workers to get COVID-19 vaccine. BC Gov News. Published April 19, 2021. https://news.gov.bc.ca/releases/2021LBR0018-000739

36.       Stearns J, White C. Can paid sick leave mandates reduce leave-taking? Labour Econ. 2018;51:227-246. https://doi.org/10.1016/j.labeco.2018.01.002

37.       Pichler S, Ziebarth NR. The pros and cons of sick pay schemes: testing for contagious presenteeism and noncontagious absenteeism behavior. J Public Econ. 2019;171:86-104. https://doi.org/10.1016/j.jpubeco.2019.03.005

38.       Chen S, Igan D, Pierri N, Presbitero A. The economic impact of Covid-19 in Europe and the US: outbreaks and individual behaviour matter a great deal, non-pharmaceutical interventions matter less. VoxEU.org. Published May 11, 2020. https://voxeu.org/article/economic-impact-covid-19-europe-and-us

39.       The National Law Review. Statewide COVID-19 paid sick leave returns to California. The National Law Review. Published March 27, 2021. https://www.natlawreview.com/article/statewide-covid-19-paid-sick-leave-returns-to-california

40.       Thompson AK, Faith K, Gibson JL, Upshur RE. Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics. 2006;7(1):12. https://doi.org/10.1186/1472-6939-7-12

41.       Upshur REG, Faith K, Gibson JL, et al. Stand on Guard for Thee: Ethical Considerations in Preparedness Planning for Pandemic Influenza.; 2005:29. https://jcb.utoronto.ca/wp-content/uploads/2021/03/stand_on_guard.pdf

42.       Ontario COVID-19 Bioethics Table. Ethics of paid sick leave for the COVID-19 pandemic. Joint Centre for Bioethics University of Toronto. Published April 23, 2021. https://jcb.utoronto.ca/ethics-of-paid-sick-leave-for-the-covid-19-pandemic/

43.       Smith B, Warren C. The Inequitable Burden of COVID-19 Exposure at Work: The Occupational Exposure to COVID-19 Risk Tool. Public Health Ontario; 2020. https://www.publichealthontario.ca/-/media/event-presentations/2021/covid-19-rounds-inequitable-risk-of-exposure-at-work.pdf?la=en

44.       Murti M, Achonu C, Smith BT, et al. COVID-19 Workplace Outbreaks by Industry Sector and their Associated Household Transmission, Ontario, Canada, January – June, 2020. medRxiv. Published online November 30, 2020:2020.11.25.20239038. https://doi.org/10.1101/2020.11.25.20239038

45.       Messacar D. Inequality in the Feasibility of Working from Home during and after COVID-19. Statistics Canada; 2020. https://www150.statcan.gc.ca/n1/en/pub/45-28-0001/2020001/article/00029-eng.pdf?st=MAYr4LGs

46.       Institute for Work and Health. Incidence of COVID-19 Transmission in Ontario Workplaces.; 2021. https://www.iwh.on.ca/sites/iwh/files/iwh/reports/iwh_issue_briefing_covid19_workplace_ontario_2021.pdf

47.       Hill HD. Paid sick leave and job stability. Work Occup. 2013;40(2). https://doi.org/10.1177/0730888413480893

48.       Rao A, Ma H, Moloney G, et al. A disproportionate epidemic: COVID-19 cases and deaths among essential workers in Toronto, Canada. medRxiv. Published online March 11, 2021:2021.02.15.21251572. https://doi.org/10.1101/2021.02.15.21251572

49.       Scott-Marshall H, Tompa E. The health consequences of precarious employment experiences. Work Read Mass. 2011;38(4):369-382. https://doi.org/10.3233/WOR-2011-1140

50.       Ontario COVID-19 Science Advisory Table. Fighting COVID-19 in Ontario: the way forward. Ont COVID-19 Sci Advis Table. 2021;2(23). https://doi.org/10.47326/ocsat.2021.02.23.1.0

51.       Yaqub O, Castle-Clarke S, Sevdalis N, Chataway J. Attitudes to vaccination: A critical review. Soc Sci Med. 2014;112:1-11. https://doi.org/10.1016/j.socscimed.2014.04.018

Updated on May 4, 2021. Version 1.0 is available under Additional Resources.

Author Contributions: AT, NMS, JG, PJ, BS conceived the Science Brief. AT, NMS, KB, AM, PJ, BS wrote the first draft of the Science Brief. AM and PJ performed the analyses. All authors revised the Science Brief critically for important intellectual content and approved the final version.

Citation: Thompson, Alison, Stall NM, Born KB, et al. Benefits of paid sick leave during the COVID-19 pandemic. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2021;2(25). https://doi.org/10.47326/ocsat.2021.02.25.1.0

Author Affiliations: The affiliations of the members of the Ontario COVID-19 Science Advisory Table can be found at https://covid19-sciencetable.ca/.

Declarations of Interest: The declarations of interest of the members of the Ontario COVID-19 Science Advisory Table, its Working Groups, or its partners can be found at https://covid19-sciencetable.ca/. The declarations of interest of external authors can be found under additional resources.

Copyright: 2021 Ontario COVID-19 Science Advisory Table. This is an open access document distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.

The views and findings expressed in this Science Brief are those of the authors and do not necessarily reflect the views of all of the members of the Ontario COVID-19 Science Advisory Table, its Working Groups, or its partners.