When the CDC shortened isolation guidelines for people with COVID to five days, from 10, some people felt that the agency was prematurely pushing sick people back to work. But realistically, many Americans were never able to take a full 10, or even five, days off to recover from the coronavirus. Like the hotel worker, many people who think they might have COVID can’t immediately find tests. The federal government offers no services for or payments to people in isolation, and has no one checking in with the sick. Most local and state governments don’t do anything for people in isolation either. Most important, millions of Americans still don’t have paid sick leave, so taking any time off work—five days, 10, or two—can be financially ruinous. The CDC issuing isolation guidelines of any length to workers without paid leave is the equivalent of the government telling people to make sure that they quarantine inside a lime-green Lamborghini. “The lack of guarantee to paid leave is the key missing public-health element in our response to the crisis,” says Hannah Matthews, the deputy executive director for policy at the Center for Law and Social Policy.

About a fifth of all U.S. workers don’t get paid sick leave, and the lowest-paid workers—those who serve food, clean hotels, or stock groceries—are least likely to have it. Fourteen states and Washington, D.C., plus about two dozen cities and counties, have paid-sick-day laws, but approximately 75 million private-sector workers live in jurisdictions not covered by those measures, according to the paid-leave-advocacy group A Better Balance. Some states expanded paid leave during the pandemic, but many of those programs have since expired. Some employers also began offering paid leave, but it’s not clear how long they’ll continue to do so. Already, Walmart, taking a cue from the CDC, has cut paid leave for workers who get COVID down to one week from two.