By Steven Greenhouse

New York Times News Service 

Public health experts worried about the spread of the H1N1 flu are raising concerns that workers who deal with the public, like waiters and child care employees, are jeopardizing others by reporting to work sick because they do not get paid for days they miss for illness.

Tens of millions of people, or about 40 percent of all private-sector workers, do not receive paid sick days, and as a result many of them cannot afford to stay home when they are ill. Even some companies that provide paid sick days have policies that make it difficult to call in sick, like giving demerits each time someone misses a day.

Public health experts say policies like these encourage many people with H1N1, commonly called swine flu, to report to work despite official warnings from the government and most companies that they should stay home.

"For people who are really caught on a weekly income, if they can't make a go of it, they might say, 'I'm desperate. I'm going to do what I have to do, and I'm going into work even though I'm sick,"' said Robert Blendon, a professor of health policy at Harvard.

He warned that this might spread disease, and that these financially squeezed workers might send their flu-stricken children to school, infecting others.

Well before President Obama declared H1N1 a national emergency, the federal Centers for Disease Control and Prevention was emphasizing that businesses should adopt "flexible leave policies" to allow workers with the flu to stay home. In one advisory, the CDC encouraged employers "to develop nonpunitive leave policies."

Despite such recommendations, some employees say they have no choice but to go to work sick.

When Latisha Carter caught H1N1 from her 6-year-old daughter in June, she suffered headaches, chills and diarrhea, but she reported to her $13-an-hour help desk job at a Milwaukee insurer nonetheless. The temp agency that placed her does not offer her paid sick days.

"If you're sick, they encourage you to stay home, but I couldn't afford to take off if I wasn't going to get paid," said Carter, 29, who said she confined herself to her small work area to avoid spreading the flu.

The CDC. says that swine flu is widespread in 48 of the 50 states and has already hit as many as 5.7 million Americans.

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