Amparo Ramirez of Los Angeles can’t afford to get sick.

Ramirez, a 38-year-old single mother, prepares airplane meals at Los Angeles International Airport. To protect herself and others from the coronavirus, or COVID-19—which has started to appear in Los Angeles County and whose spread is linked to international travel—she knows she should follow public health guidelines such as avoiding sick people, staying home if she develops respiratory symptoms, and calling a health provider if she suspects she might have the virus.

But, like many low-income workers, Ramirez would find it difficult to do any of those things.

As public health officials call on Californians to help stop the spread of the virus, many low-wage workers are being forced to make potentially life-threatening choices: whether to heed the precautions and lose income they rely on, or to show up for work anyway in order to put food on their tables and pay their rent. These choices could be critical because low-wage earners often have jobs involving interactions with the public, such as serving food, caring for the elderly or cleaning hotel rooms. If they become ill and are unable to access health care and time off, they may jeopardize not only their own health, but that of the broader community as well.

Across the state, about 7 percent of Californians—almost 3 million people—don’t have health insurance, often because they can’t afford it, because their employers don’t offer it, or because their immigration status prevents them from qualifying for federally funded health programs. Many low-wage workers also get only the state’s legal minimum of three paid sick days, not enough to cover a serious infection or extended quarantine. If they work as independent contractors, they’re not entitled to sick pay at all.

“When the CDC says stay home from work, for a lot of folks what that means is they’re having to make a decision whether or not they put food on the table or whether or not they get another month further behind on rent,” said Jeremy Arnold, program director at Clergy and Laity United for Economic Justice (CLUE), a Los Angeles-based group of faith and community leaders aligned with labor unions. “Without protections for workers … it just kind of rings hollow as they tell workers to stay home, don’t get sick and don’t get other people sick.” 

Ramirez has no health insurance, and therefore no doctor. Her company’s insurance plan costs around $400 a month, too big of a stretch for Ramirez’ minimum-wage earnings. If she gets sick and needs antibiotics, she drives across the border to Tijuana to buy them without a prescription.

This year, Ramirez has already taken her four paid sick days due to a finger injury, so she can’t take any more without losing pay—an impossible choice with an almost $2,000 monthly rent and teenage daughter to care for. Yet her job regularly involves interacting with airline crews from countries with coronavirus outbreaks. And many of her coworkers also can’t afford to take sick time or see a doctor, she said.

“I’m very, very worried,” she said. “I’m not prepared for this. Me as a single mother, I swear, (if I got sick) I don’t know what I’d do.”

In the San Fernando Valley, medical workers are preparing for a possible coronavirus outbreak and trying to answer a flood of questions from community members about how to adhere to prevention guidelines.

David Luna, chief medical officer at Valley Community Healthcare, which serves around 25,000 low-income and underserved people in the valley, said many patients want to protect themselves, but their choices are limited. Like Ramirez, many don’t have health benefits and paid time off work. They also frequently live in crowded housing where they share items such as eating utensils and towels, and it’s not possible to stay distant from people who are sick, Luna said.

“Patients are communicating to us, how do we do this? We’re willing to, but can you help us?” he said. “That’s what we’re struggling with in terms of guidance. It’s just very challenging right now.”

Language also poses a barrier, Luna added. A large number of patients are immigrants and some don’t speak or read English well. That makes communicating advice about coronavirus prevention difficult, he said.

Gov. Gavin Newsom and state health officials have taken some steps to mitigate the potential economic impact of the coronavirus on Californians. On March 5, the state announced that people covered by Medi-Cal or private insurance won’t have to pay out-of-pocket for COVID-19 screening or testing. Additionally, some workers can now file disability claims to receive a portion of their pay if they have to take time of work because they or a family member gets sick with COVID-19. Businesses experiencing a slowdown because of the coronavirus can also apply to the state for financial help to retain workers.

Luna said he hoped employers would take advantage of the help.

“I think the community and employers need to pay attention to what guidance is being given and try to anticipate these types of situations before they become a crisis,” he said.