Many of Trece Andrews coworkers contracted COVID-19 at the Detroit-area nursing home, Regency St. Clair Shores, where she works. Two residents in the home have died from the disease, she said.

But Andrews, 49, keeps coming to work. She and her colleagues dont have much choice: The home doesnt offer paid sick leave.

Some people come in knowing they dont feel good. You have administrative staff threatening to fire people if they dont report to work, she said. Its been very challenging. Very scary.

It seems obvious that during a pandemic, at whatever stage, workers who feel sick should stay home especially those working in high-risk situations, like in nursing homes or hospitals. The Centers for Disease Control and Prevention has consistently told Americans that not going to work when you feel sick is essential to slowing the spread of the disease.

And yet. Millions of essential workers are going without paid sick leave in this pandemic. In fact, the paid sick leave law that Congress passed in March to deal with coronavirus leaves out 4 in 10 workers: a total of 69.4 million Americans, according to a report from the Kaiser Family Foundation released last week. That includes an astonishing 17.7 million health care workers, like Andrews, who are either excluded or exempted from the law.

Ciena Healthcare, the parent company of Regency St. Clair Shores, did not respond to requests to comment on its paid leave policy.