LONDON — Every workday, Al-Hakim arrives at one of London’s largest public hospitals for a shift as a cleaner, earning little more than minimum wage even though his latest job includes disinfecting rooms reserved for suspected coronavirus patients.
He isn’t certain what he fears most: being exposed to the coronavirus himself, or having to be quarantined for 14 days, as he is one of thousands of private contractors, many of whom receive little sick pay. But he knows what he would do if he did contract the virus — report to work anyway, because he cannot afford to lose even a day’s pay.
“That’s going to be maybe suicide,” said Al-Hakim, who like several other health workers asked not to be identified by their full names, for fear of losing their jobs. “Let’s say I’m sick for one month now — how am I going to pay my rent? The bills are there — how am I going to cope?”
For the moment, Britain has managed to avoid a major outbreak of the coronavirus, with 51 confirmed cases. But as they move to emergency footing this week, government officials are preparing for the possibility that as much as one-fifth of the country’s work force could eventually require some form of sick leave.
The National Health Service, already under great strain, is critical to fighting the epidemic, even as health workers are potentially at risk. So far, at least two health care workers in Britain have tested positive for coronavirus. Health Secretary Matt Hancock said that any health care worker at risk should self-isolate and should be entitled to take the time as paid sick leave.
But officials have said little about the risks posed to low-paid contract workers like Al-Hakim, who constitute a growing number of the health service’s work force. The N.H.S. is one of the largest employers in the world, with a staff of more than 1.3 million. Even so, the service has a staffing shortage of roughly 100,000 positions, one of the reasons it has turned to private contractors.
The result is a two-tiered employment structure in which contract workers can find themselves paid less and receiving fewer benefits. Al-Hakim does not qualify for any pay during his first three days of sick leave, and receives only 94.25 pounds ($120.50) a week afterward. By comparison, regular NHS employees receive their full salary from their first sick day, for at least one month and up to six depending on the length of their employment.
“When the N.H.S. is under pressure, it’s under pressure for everyone,” said Dr. John Ashton, a leading public health specialist in the country. “It’s all very well putting doctors or surgeons on a pedestal, but all workers should be valued, and that absolutely means everyone should get full sick pay.”
The possibility that contract workers might come to work and not report being potentially exposed to the coronavirus could be devastating, he added. “They’re going to be spreading the virus around, and that is very dangerous for us all,” he said.
On Monday, one of Britain’s biggest unions, G.M.B., called on hospitals to ensure that all outsourced workers suspected of having the coronavirus are given sick pay. Some politicians have backed that call, urging companies not to put profit margins ahead of public health.
As yet, Al-Hakim’s hospital is not treating any known coronavirus patients, even though it has established a special unit for potential future arrivals. Days after the country’s first case was confirmed, he said, he was instructed to pull on a protective suit, goggles and a face mask and nudged inside the coronavirus isolation unit, alone and without any specialist training, to deep clean for the next 30 minutes.
“How do we know if it’s a coronavirus patient who has just come out of the room?” he said. “We see that patient and we go back home to our kids, to our families, and we could be infected. It’s like they want to wipe my family off — that’s how it feels.”
In Britain, unemployment is at a 45-year low, but wage growth has flagged and more people work in the gig economy than ever before, doubling to an estimated 4.7 million people since 2016. The self-employed work force has also grown to a record high of nearly five million. Large parts of the public sector, including health and social care, have been outsourced to private companies competing to offer the best value for the money.
In N.H.S. hospitals, this can mean that people doing identical jobs find themselves receiving starkly different pay and benefits simply because one person’s job is outsourced while another’s is not.
Danny Mortimer, the chief executive of N.H.S. Employers, a group that represents work force leaders in the health service, acknowledge that contract workers “face a dilemma” because their reduced sick pay. But he also underscored that “anyone working in an N.H.S. setting, should exercise the appropriate caution to avoid putting our patients and teams at risk.”
At the same time, the N.H.S. is bracing for a sharp increase in coronavirus cases. On Tuesday, N.H.S. England distributed a letter that ordered a nationwide review of the number of intensive care beds and for new contingency plans to cope with any surge in patients. The letter raised the possibility that patients stricken with the virus might have to be housed in general wards, if the number of cases grows.
This could potentially mean greater exposure for health care workers to coronavirus patients. Even now, several workers expressed deep concern. Michael, who also asked that his last name not be used for fear of losing his job over speaking out, is an ambulance driver in Essex, in southeastern England, who transports non-emergency patients to local hospitals. Essex has one confirmed coronavirus case.
“The simple fact is I can’t afford to be off sick. I’m living on such a tight budget,” he said. “Staff will mask any illness if they aren’t going to be paid sick pay. They simply can’t afford to lose two weeks’ wages,” adding that if he knew he had coronavirus, he would not report to work.
At a different large London hospital, another cleaner, Ms. Fernandes, worries about her own safety. Her hospital has yet to report a confirmed coronavirus case, but she is part of the preparations.
When news broke of the coronavirus outbreak, Ms. Fernandes said, the hospital gave her and other cleaners face masks, which they tested by spraying the mask and asking her whether she could taste the spray. When she told them that she could taste it, she said, she was instructed to use the mask until new ones could be delivered.
“To tell you the truth, I’m scared to go into work every day,” she said, asking not to be identified by her full name.
“I think it’s not fair that doctors get sick pay and we don’t, because I put myself in so much risk and for what?” she said. “For almost nothing.”