More than 2 million employees in the United States missed work due to illness in mid-April this year. This is the highest number on record.

An empty home office desk, used to illustrate how work absences suggest higher-than-reported COVID-19 cases.Share on Pinterest
Were there actually more COVID-19 cases in April 2020 than officials initially reported?

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This increase does coincide with the surge in COVID-19 but suggests that the number of cases may be higher than officials initially reported.

The COVID-19 pandemic has had an undeniable impact on the way we work. More people than ever before have shifted to working from home, while for others, the pandemic has meant working in challenging conditions or job loss.

In fact, in many parts of the world, the pandemic has created an unemployment crisis. In the United States, for example, the unemployment rate for April reached 14.7%, compared with 4.4% in March. This is the highest since the Great Depression of the 1930s.

The pandemic has also brought into focus the need for paid sick leave. Almost a quarter of U.S. civilian workers do not have access to paid sick leave, putting people with COVID-19 symptoms in a near-impossible situation.

Although the Families First Coronavirus Response Act has helped with this, not every employee is eligible, and many will continue to experience adverse economic impacts from the pandemic.

New research in JAMA Internal Medicine sought to investigate the impact of COVID-19 on the U.S. workforce.

The study authors — who are physicians from Cambridge Health Alliance in Massachusetts, Harvard Medical School in Boston, MA, and the City University of New York’s Hunter College — analyzed employee absences in the first 4 months of 2020, when COVID-19 was beginning to spread through the country.

They found that in mid-April 2020, over 1.5% of the workforce (more than 2 million people) were off sick. This is almost triple the percentage for the same period in 2019.

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The study authors used information from the Current Population Survey, which is a monthly survey of people in employment in the U.S.

They looked at how many people reported being “out sick” — that is, being absent from work due to illness, injury, or other medical problems — from January to April 2019 and over the same period in 2020.

They found that in January and February, trends were much the same between the years, with 1.1 million jobholders being out sick in both 2019 and 2020.

However, for March and April, the rapid spread of COVID-19 meant that there were stark differences in absence rates between the years.

In March 2020, more than 1.3 million people were out sick, compared with around 98,000 in 2019. By mid-April, when COVID-19 hospitalizations and deaths were reaching a peak, more than 2 million people were out sick in the U.S. This accounts for over 1.5% of all jobholders.

The number of people out sick in April 2020 was more than twice as high as the number of people out sick in the same period in 2019. It was also the highest rate since at least January 1976.

The excess of people away from work due to illness in mid-April 2020 compared with 2019 was roughly five times greater than the number of diagnosed COVID-19 cases that week. This suggests that the real number of COVID-19 cases may be higher than the number that officials initially reported.

“[O]ur study indicates that the pandemic has sickened many more people than we had realized, especially vulnerable employees like immigrants.”

– Lead study author Dr. Adam Gaffney

The increase in sickness-related work absences was disproportionately high for some groups, and highest for immigrant workers.

The absence rate among immigrant workers, who had a lower absence rate than native-born workers the previous year, increased by almost five times in 2020 compared with 2019.

The study authors suggest that this may be because immigrant workers are more likely to be involved in essential work at high risk of exposure to SARS-CoV-2 and less likely to be in roles that allow them to work from home.

They also found a higher increase in absences among workers without a college education and those aged 55 and above, which is consistent with the higher COVID-19 risk for older adults.

In light of these findings, the study authors suggest that immigrant workers and other vulnerable workers need better protection.

“Many are uninsured and have no income if they miss work. The least we can do to protect them is to assure paid sick leave and universal healthcare, benefits that workers in every other wealthy nation already enjoy,” says study co-author Dr. Steffie Woolhandler, a primary care doctor and professor of public health.

It is important to note that this analysis does not include any information on the illnesses that caused the work absences.

Therefore, it is currently unknown how many employees were sick with other illnesses, chose to stay home due to concerns about contracting COVID-19, or cared for others in their household with the illness, for example.

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