Health and Economic Consequences of Universal Paid Sick Leave Policies During the COVID-19 Pandemic

ImportanceUniversal paid sick-leave (PSL) policies have been implemented in jurisdictions to mitigate the spread of SARS-CoV-2. However empirical data regarding health and economic consequences of PSL policies is scarce. ObjectiveTo estimate effects of a universal PSL policy in Ontario, Canadas most populous province. DesignAn agent-based model (ABM) to simulate SARS-CoV-2 transmission informed by data from Statistics Canada, health administrative sources, and from the literature. SettingOntario from January 1st to May 1st, 2021. ParticipantsA synthetic population (1 million) with occupation and household characteristics representative of Ontario residents (14.5 million). ExposureA base case of existing employer-based PSL alone versus the addition of a 3-or 10-day universal PSL policy to facilitate testing and self-isolation among workers infected with SARS-CoV-2 themselves or because of infected household members. Main Outcome(s) and Measure(s)Number of SARS-CoV-2 infections and COVID-19 hospitalizations, worker productivity, lost wages, and presenteeism (going to a workplace while infected). ResultsIf a 3- and 10-day universal PSL were implemented over the 4-month study period, then compared with the base-case, the PSL policies were estimated to reduce cumulative SARS-CoV-2 cases by 85,531 (95% credible interval, CrI -2,484; 195,318) and 215,302 (81,500; 413,742), COVID-19 hospital admissions by 1,307 (-201; 3,205) and 3,352 (1,223; 6,528), numbers of workers forgoing wages by 558 (-327;1,608) and 7,406 (6,764; 8,072), and numbers of workers engaged in presenteeism by 24,499 (216; 54,170) and 279,863 (262,696; 295,449). Hours of productivity loss were estimated to be 10,854,379 (10,212,304; 11,465,635) in the base case, 17,446,525 (15,934,321; 18,854,683) in the 3-day scenario, and 26,127,165 (20,047,239; 29,875,161) in the 10-day scenario. Lost wages were $5,256,316 ($4,077,280; $6,804,983) and $12,610,962 ($11,463,128; $13,724,664) lower in the 3 day and 10 day scenarios respectively, relative to the base case. Conclusions and RelevanceExpanded access to PSL is estimated to reduce total numbers of COVID-19 cases, reduce presenteeism of workers with SARS-CoV-2 at workplaces, and mitigate wage loss experienced by workers. Competing interestsThe authors have no competing interests relevant to this article to disclose. FundingSupported by COVID-19 Rapid Research Funding (C-291-2431272-SANDER). This research was further supported, in part, by a Canada Research Chair in Economics of Infectious Diseases held by Beate Sander (CRC-950-232429). The study sponsor had no role in the design, collection, analysis, interpretation of the data, manuscript preparation or the decision to submit for publication. Author ContributionsConceptualization: PP, JDR, BS, DN Data Curation: PP, JDR, BS, DN Formal Analysis: PP, JDR, DN Methodology: PP, JDR, BS, DN Supervision: PP, DN, BS Validation: PP, JDR, BS, DN First Draft: PP, JDR, BS, DN Review and Edit PP, JDR, BS, DN Key pointsO_ST_ABSQuestionC_ST_ABSWhat could be the health and economic consequence of more generous paid sick leave policies in the context of the COVID-19 pandemic? FindingsMore generous policies are estimated to reduce SARS-CoV-2 infections (and thus COVID-19 hospitalizations), lost wages and presence of individuals with infection at workplaces. MeaningMore generous paid sick leave can be a valuable addition to other COVID-19 public health interventions.