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A man wearing a protective mask rides his bicycle past a masked mural during the COVID-19 pandemic in Toronto, Thursday, Nov. 12, 2020.Nathan Denette/The Canadian Press

Last month, Niki Gurgen, a personal-care worker in a Toronto long-term care home, woke up with a cough and feeling a little warmer than usual. She considered staying home, but without paid sick days and unable to afford to forgo wages, she said that she has little choice but to go to work.

“You could be tired with a headache and a little cough, but you don’t know if it’s the virus,” said Ms. Gurgen, who, as a cancer survivor, is immunocompromised. “Of course you want to stay home, but you can’t – who will pay you to do it?”

Ms. Gurgen has not tested positive for COVID-19, but some of her co-workers have. Her case exemplifies the tug of war between precaution and a full paycheque faced by many long-term care, warehouse, manufacturing and retail employees as coronavirus cases soar across the country.

How many coronavirus cases are there in Canada, by province, and worldwide? The latest maps and charts

More than half of workers in Canada above the age of 18 don’t have access to paid sick leave, according to a recent report from Theresa Tam, Canada’s Chief Public Health Officer. The federal government introduced a sick-leave benefit in September, but public-health officials and labour advocates say the program falls short of providing workers with mandated, immediately accessible paid sick days. They are now calling on provinces to fill the gap.

The issue is more pressing than ever. Workplaces are playing a larger role in the spread of the infectious disease, as COVID-19′s second wave threatens to overwhelm hospitals in many provinces. In some cases, employers are not doing enough to limit risks, medical officials have warned.

Alberta’s chief medical officer of health Deena Hinshaw said last week that “too many cases” result from people going to work while sick, adding that 10 per cent of individuals in the province with active COVID-19 cases are not staying home.

In Peel Region, west of Toronto, the spread of the virus in warehouses and food processing plants has led to community spread among household and other close contacts, according to the region’s medical officer of health. These types of workplaces tend to not to offer paid sick leave, and people who cannot afford to lose wages are going to work with COVID-19 symptoms.

“It’s time for employers who choose not to pay employees when they are sick to put people over profit,” said Lawrence Loh, Peel’s medical officer of health, last week. “The cost of COVID-19 spreading across our community is far greater than the price of a few sick days.”

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Storefronts and pedestrians in Toronto on Nov. 19, 2020. More than half of workers in Canada above the age of 18 don’t have access to paid sick leave, according to a recent report from Theresa Tam.Fred Lum/The Globe and Mail

In March, the U.S. government introduced two weeks of emergency paid sick leave at 100 per cent of the person’s salary, up to US$511 a day, for COVID-related reasons. In the 38 states that did not mandate paid sick leave, the new regulation resulted in 15,000 fewer cases a day nationwide, or 400 fewer per state, according to an October report in the journal, Health Affairs.

The Trudeau government didn’t introduce the Canada Recovery Sickness Benefit (CRSB) until late September. The benefit provides $500 a week for up to two weeks for workers who need to take time off because of COVID-19.

But the federal program pays less than what a worker would receive at minimum wage in most provinces. For people living paycheque to paycheque, any drop in income or delay in receiving the government benefit would cause unbearable financial stress, according to Carolina Jimenez, a nurse and spokeswoman with the Decent Work and Health Network.

Workers are also not eligible for the benefit unless they lose more than half of their hours in a week, making it difficult to stay home for a day or two if they think they may have the virus and are waiting for test results.

“If you wake up in the morning with symptoms and there are any barriers in accessing a sick day, workers are not as likely to use the benefit,” Ms. Jimenez said. “People are worried that they won’t be eligible.”

So far, 295,000 applications and $147-million under the CRSB program have been approved for nearly 178,000 people, according to data from the federal government. At the same time, workplace outbreaks have continued to rise, drawing questions about the effectiveness of the initiative.

“Whatever the arrangements presently in place, they are either not adequate or not adequately understood,” Toronto Mayor John Tory said during a recent news conference.

Access to paid sick leave varies widely across Canada. Ottawa mandates that federally regulated industries – including banks, telecommunication providers, marine, rail and air transportation companies – provide at least five paid personal days each year.

But that’s not the case in many provinces. With the exception of Quebec, where employees receive two paid sick days after three months of continuous employment, and Prince Edward Island, where workers are eligible for one day after five years, other provinces do not mandate that employers pay any sick days. Ontario previously mandated two paid personal emergency leave days a year, but Premier Doug Ford’s Conservative government replaced the benefit with three unpaid days for personal illness in early 2019. Earlier in the pandemic, the province extended the policy to an unspecified number of days to allow workers to isolate without pay.

Some provinces have offered other measures. Alberta introduced emergency isolation pay in early spring, but ended the program after the government lifted the state of public-health emergency in June. (That state of emergency was reinstated this week.)

Alberta, British Columbia and the other provinces also mandate a few days of protected leave, and some have extended the policy to a few weeks to match isolation periods required during the pandemic. But that leave is unpaid, leaving people with little choice but to go to work sick, according to Canadian Union of Public Employees Alberta President Rory Gill.

“There are folks – in long-term care especially – who may be on their fourth or fifth round of isolation,” Mr. Gill said. “Our chief medical officer of health is telling people to isolate … but if you don’t have sick days or you’re working precariously then it’s tough luck.”

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