Elsa Erazo’s voice is faint when we speak on the phone. She’s in bed. She struggles to find words, in both English and her first language, Spanish. Our conversation is repeatedly interrupted by deep, rattling coughs.

On January 14, Erazo was at her job as a wheelchair attendant at George Bush Intercontinental Airport in Houston, Tex., pushing elderly and disabled passengers and their luggage through the airport, when she started feeling sick. She got tested for Covid-19 the next day and the test came back positive. She thinks she must have gotten the virus one day at security, where she has to remove her mask when showing her ID, when a passenger who was coughing got too close to her.

Erazo hasn’t returned to work since the 14th, which means she hasn’t earned a cent since then. Her employer, the subcontractor Huntleigh, has never offered her paid sick leave. So every day spent at home now is a day of forgone wages.

“It’s very, very hard,” she said, her voice foggy. “The bills, they continue, they don’t stop.”

Nearly two weeks after she first got sick, she still had significant pain in her back, a nagging cough, and fatigue. She’s not allowed to return to work until she gets a negative test result, which she was waiting for when we spoke. Despite the persistent symptoms, she vowed to go back to work as soon as she had a negative result. She has to pay for health insurance, car insurance, and utilities, cover her rent, and send money to her mother in Honduras. She had to call her phone company and ask them to postpone cutting off her service until she could get paid again. Even once she starts working again, the temporary loss of income will continue to affect her. “The next month [will be] a little hard,” she said.

One of the first things Congress did in response to the emergence of the Covid pandemic was to guarantee paid sick and family leave for the very first time in United States history. Lawmakers passed the Families First Coronavirus Response Act in March 2020 on a bipartisan basis, and President Trump signed it into law. It guaranteed two weeks of sick pay for people who got Covid as well as 12 weeks of paid family leave to care for children whose school or day care center had closed.

There were a number of holes in the policy: It excluded businesses with more than 500 employees and offered an exemption to smaller ones, and then–Secretary of Labor Eugene Scalia expanded a carve-out for health care workers such that few qualified, although his actions were later undone by a judge. But even with the act’s flaws, a study found that FFCRA paid leave reduced Covid cases by 15,000 a day in the first wave of the pandemic.

It was “a proof point that actually the federal government can do this,” noted Josephine Kalipeni, executive director of Family Values @ Work. “The idea that we can’t do this and that we can’t afford to do this is one of the myths that was absolutely obliterated.”

Now, the country is in the throes of the deadliest Covid wave yet. While the surge in cases caused by the Omicron variant is starting to plateau or fall in some parts of the country, the number of cases is still far higher in many places than at any other phase of the pandemic. And yet Congress let FFCRA paid leave expire at the end of 2020, leaving only a tax break for employers who decide to offer it voluntarily. Now, about a quarter of private sector workers no longer get paid sick leave from work. Only 13 states, 19 cities, and Washington, D.C., guarantee paid sick leave. Outside of those places, many workers are faced with the choice between going to work sick or losing pay. Some workers might be afraid to take a test for fear of getting a positive result and being forced to go without income. An even greater share of workers, three-quarters, doesn’t get paid family leave, and only nine states and D.C. mandate it. So most parents have few options when their children get sick or have to stay home from child care or school because of exposure. Between December 29 and January 10, about 8.8 million people didn’t work because they had Covid or had to care for someone who did.

“If you have to make a decision between whether or not to quarantine or to face eviction, that’s an impossible choice to make,” Kalipeni said. Lack of paid sick leave “really feels just so negligent of our federal government.”

Crystal Orozco’s son tested positive for Covid on a recent Friday. By Sunday she started to feel unwell herself, so she told her manager at a Jack in the Box in Folsom, Calif., that she wasn’t going to come in to work on Monday. Her manager pressured her to return, and by Wednesday said she’d have to bring in a doctor’s note to be allowed to stay home, but Orozco doesn’t have insurance or a doctor. She took a home Covid test and it was positive, so she texted her manager a picture of the test. “All she said was, ‘OK,’” Orozco said.

Orozco thinks it’s likely she got Covid at work. The Thursday before she got sick, a coworker was feeling unwell and taking medicine to get through his shift. Before that, another coworker who felt sick asked the manager for permission to go home but wasn’t given it; even after she tested positive and she showed the result to her manager, she was told, “Don’t worry, everyone has it, you can still work. Just wear a mask and don’t tell anyone,” according to a complaint employees later filed with CalOSHA.

California requires employers to give their workers one hour of sick leave for every 30 they work, but, since the year has just started, Orozco hasn’t put in many hours and thinks she doesn’t have much leave accrued. California instituted an emergency provision during the pandemic entitling employees to 80 hours of supplemental paid sick leave for Covid, but that expired in September. Orozco missed over a week of work while sick. She returned as soon as she could to keep earning money. If she had the paid leave to cover it, though, she’d stay home at least a week more. “I know I didn’t fully recover right. I came back too soon,” she said. She still struggles with shortness of breath and fatigue. “I can’t stop working, because I have to worry about where I’m going to get my check,” she said. Even back at work, she’s going to have to ask for help from family or friends to pay her rent this month.

“We are actively investigating the concerns raised and reiterating current state and federal protocols with our franchisees to maintain and uphold the utmost health and well-being of our personnel and customers,” a Jack in the Box spokesperson said in response to a request for comment. “While Jack in the Box franchisees set their own paid sick leave policies and Covid-19 protocols for their respective employees, as a brand, it is our priority to promote safety and clarity for all restaurant workers and guests alike.”

Other workers who haven’t gotten Covid yet, like Jacinth Finch, live in terror that they’ll come down with the virus and suffer the economic consequences. Finch works as a home health aide for two elderly women in Opa-locka, Fla., seven days a week almost 24 hours a day. She could get paid sick leave if she worked in a nursing home, but she enjoys the one-on-one time with clients in her job. “I love what I do. I love it, absolutely love it,” she said.

But she’s never gotten sick leave from the agencies that employ her. “When you work, you get paid,” she said. “If you’re sick and you have to stay home, you’re on your own.” She has knee pain from the physical toll the job takes on her—she’s 62—and a doctor has told her she needs to have knee replacement surgery, but that the recovery would take about three to six months. There’s no way she could afford to miss that much pay. “I just have to bear the pain and go to work,” she said.

Finch has done everything she can to protect herself from Covid: She’s fully vaccinated and boosted; she wears a mask at work; she even takes supplements to ward off sickness. But her clients see other caregivers who may not be as careful, and one of her client’s sons isn’t vaccinated and won’t wear a mask. “I’m just praying that nothing goes wrong,” she said. “In all honesty, I can’t afford to get sick. I cannot get sick. And God knows that.” She can barely contemplate getting Covid. “It’s scary to think about it,” she said. “I work from paycheck to paycheck. So that would definitely hit me hard.”

It wasn’t just the federal government that recognized the need for paid leave at the start of the pandemic; many large companies offered their own policies too. But in December the Centers for Disease Control shortened the recommended isolation period after someone gets Covid from 10 days to five, which has prompted a number of employers to pare these policies back, including Amazon, CVS, Walgreens, and Walmart.

At Walmart, the paid sick leave offered to workers who test positive or have to isolate was cut in half, from 10 days to five. At the store where Peter Naughton works in Baton Rouge, La., he estimates that more than half of his coworkers are out sick with Covid. But because they now only get five paid days off, he knows coworkers who have returned before they felt recovered and, he fears, before they’ve stopped being contagious. “They had to come back to work. Because their five days were up, they weren’t going to get paid,” he said. He’s even heard of Walmart coaches—its title for assistant manager—calling people just two days into their Covid sick leave to urge them to come back to work and threatening to fire employees who don’t return.

“It scares me to death,” he said. Naughton is fully vaccinated and boosted, but he lives with his mother and father, who are both in their late ’70s. “I don’t want to get them sick with that, because if they did, I don’t think they’d make it,” he said. And yet he feels that it’s not a question of whether he’ll get Covid, but when. When the virus hits him, he said, “five [days] would definitely not be enough.” “It’s not even enough for the flu. It’s definitely not enough for Covid.” But he’ll have little choice, as he can’t afford to give up pay.

“We have updated our COVID-19 Emergency Leave policy in response to the latest CDC guidance which recommends 5 days of isolation and associates who are mandated to quarantine or have tested positive for COVID-19 may receive up to one work week of paid leave,” a Walmart spokesperson said in response to a request for comment. “Our policy also states that associates who have contracted COVID-19 and are unable to return to work after the one work week of COVID-19 Emergency Leave may be eligible for additional pay replacement for up to 26 weeks.”

Cinthia Alaniz managed not to get Covid herself, but in some ways that made her problems worse. Alaniz works at an elementary school in Mesa, Ariz., as a family support specialist, and she accrues one sick day per month, plus vacation time based on the hours she works. When the pandemic started, her district gave employees access to a separate pool of paid time off if they test positive for Covid, which allows them to preserve their other benefits. But it doesn’t apply when family members get sick with or are impacted by Covid.

Just three days into the resumption of school after the winter break, Alaniz’s 13-year-old daughter tested positive for Covid. It meant that Alaniz’s two twin 4-year-old daughters, who are too young to be vaccinated, had to quarantine for 10 days, too. Even after the 13-year-old was able to return to school, her twins were still home.

Then, a week after her daughter got Covid, the 4-year-olds came down with the flu, and her two other children, ages 7 and 8, also got it, as did Alaniz herself.

Alaniz’s husband is currently working out of state; as the only caretaker for her children, she had to stay home from work for almost two weeks. Because she never got Covid herself, she couldn’t access any of the district’s extra leave, so she’s burned through nearly all of her paid time off—she has about six hours left. “If anyone else gets sick for any other reason, even if my kids get Covid, I have no other option but to stay home and not get paid,” she said. Even a child coming down with symptoms at school who needs to be taken to get tested and then home would quickly eat up her remaining time off. That would be a real hardship for her family, especially now that the extra Child Tax Credit payments that went out monthly last year have stopped. “It’s just really, really tight,” she said. “There’s hardly any room for error right now.”

“Having paid leave shouldn’t be a privilege, especially when we are the most evolved country in the world, in a pandemic,” she said. “It really shouldn’t be that difficult. We should be able to care for our families.”

Democrats in Congress are currently locked in a stalemate over President Biden’s sweeping Build Back Better agenda, which originally would have guaranteed 12 weeks of paid family leave, a provision that got stripped out before the entire negotiating process over the legislation came to a halt at the end of last year. But there is some nascent talk among lawmakers about the need to enact emergency measures to respond to this latest iteration of the pandemic, potentially tied to a larger package to fund the government or even as a stand-alone measure. Democrats are looking at “every option,” a congressional staffer said, for how they might guarantee paid leave right now. “Paid family leave has to be an essential part of the economic policy of this country and I’m doing everything I can to get it passed,” Senator Patty Murray said recently in a virtual town hall.

“As Congress considers whether more Covid relief is needed to protect public health,” said Vicki Shabo, a senior fellow at the Better Life Lab at the New America Foundation, “it would be beyond the pale of reason not to include emergency paid sick leave again and make it applicable to businesses of all sizes.”

For her part, Kalipeni isn’t interested in temporary measures anymore. “It’s time to pass something permanent,” she said. “Whether it’s a pandemic or a sick child with the flu, workers are going to need leave.”