During flu season last year, Alfredo Galdamez recalls several co-workers showing up for work at his Chicago restaurant while sick. The eatery had an open kitchen, and at times the dishwasher could see cooks coughing or sneezing near the food they prepared.

Galdamez admits that he, too, washed dishes while ill, knowing that he could easily pass his sickness on to co-workers as well as diners. As is customary in the restaurant business, he received no paid sick leave, meaning if he didn't clock in, he didn't get paid. Regardless, his superiors urged him to work even if he felt under the weather, he said.

"I went into work with a fever, the flu, a cold," Galdamez, 44, said. "They told me I had to continue to work. They said, 'We have people here who want to eat.'"

The U.S. is now in the midst of a massive flu outbreak. The Centers for Disease Control has pegged flu activity as "high" in roughly half the country, while deaths from pneumonia and flu have climbed "slightly above the epidemic threshold." Experts have said this year's strain is one of the more severe in recent memory.

Now is the time that some bosses urge their sick employees to stay at home and rest up, lest a flu hero show up at work and infect half the office. Humaneness aside, there's evidence it's wise management. According to the outplacement firm Challenger, Gray and Christmas, in addition to costing roughly $10 billion a year in hospitalizations and outpatient visits, the average flu season costs businesses a bundle indirectly through lost productivity and absenteeism, a price tag likely in the billions.

But what about workers like Galdamez whose employers offer no paid sick leave whatsoever? They can choose between working while sick or possibly coming up short on their bills at the end of the month.

"Of course I think we deserve paid sick days," Galdamez said. "We're all working together for the overall benefit of that company. [Sick leave] is not a benefit that should just be given to management."

Proposals to mandate paid sick days have popped up in a handful of states and cities throughout the country in recent years. In 2011, Connecticut became the first state to pass such a law, requiring the state's large businesses to give workers 40 hours of sick leave over the course of a year. A similar bill failed in Denver, Colo., the same year amidheavy lobbying from business groups.

Advocates of paid sick leave argue that this year's particularly nasty flu provides a good argument for more such mandates, on the grounds of both economic fairness and public health. Workers who don't enjoy such benefits, like Galdamez, tend to be minorities or women working in low-wage industries. (Galdamez, a Guatemala native, received $8.75 per hour at his restaurant job; he spoke in Spanish through an interpreter.) Their lack of sick leave ultimately endangers colleagues and customers, particularly in the food industry, the logic goes.

"People are recognizing that it's highly problematic, especially when you have epidemics like this," said Sarah Jane Glynn, a policy analyst at the left-leaning Center for American Progress (CAP) who's studied the issue. "People are dying. And they're recognizing it's ridiculous to tell somebody, 'Oh, you have the flu, it's highly contagious, but you should come in anyway.' It's really heartbreaking."

According to CAP, roughly 36 percent of American workers have no kind of paid leave, be it vacation or sick days.

Restaurant Opportunities Center United, a workers advocacy group of which Galdamez is a member, surveyed 4,300 restaurant workers and found that 90 percent of them do not get paid time off when sick, and two-thirds of them cook or handle food while ill. The group has made sick leave one of its highest priorities, releasing an annual diner's guide to ethical eating that details which restaurant chains offer workers sick leave and which don't.

The U.S. is an outlier among Western nations in that there's no federal law mandating sick leave or vacation. A bill that would do so, the Healthy Families Act, has languished in Congress during previous sessions.

Given the hurdles in Washington, advocates of paid sick leave have taken their efforts to the state and local levels, with initiatives like the one in Connecticut. Such measures, however, face fierce opposition from business lobbies, which typically argue that the mandates put a squeeze on small businesses. Backers of such legislation try to address this concern by carving out smaller operations from the mandate.

As HuffPost previously reported, in the case of Denver, the National Restaurant Association poured $100,000 into an effort to defeat the local ballot measure, likely concerned the legislation would pick up steam in other municipalities or states around the country. (Fast-food chains KFC and Pizza Hut, where workers typically don't get paid sick time, also chipped money into the opposition campaign.) Denver Mayor Michael Hancock, too, opposed the legislation, even filming an advertisement in which he argued it would cost the city "thousands of jobs."

Bruce Elliott, manager of compensation and benefits at the Society for Human Resource Management, an HR lobbying group, said it's a little early to know how much momentum such initiatives have. For the businesses that can afford it, offering workers paid sick leave -- and urging them to use it when needed, particularly during a flu season -- is smart management that ultimately protects the bottom line, he said. Legal mandates are a good idea, too, he added, noting that he's "encouraged by what I've seen" in initiatives popping up in recent years.

"Sick-time policy is born out of commonsense thinking," Elliott said. "At the end of the day, you don't want to get your workers or your customers sick."

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  • 10. Pennsylvania

    <strong>Personal health care spending per capita 2009:</strong> $7,730 <strong>Personal health care spending per capita 2004:</strong> $6,148 <strong>Average percent annual growth 2004 to 2009:</strong> 4.7 percent

  • 9. North Dakota

    <strong>Personal health care spending per capita 2009:</strong> $7,749 <strong>Personal health care spending per capita 2004:</strong> $5,956 <strong>Average percent annual growth 2004 to 2009:</strong> 5.4 percent

  • 8. New Hampshire

    <strong>Personal health care spending per capita 2009:</strong> $7,839 <strong>Personal health care spending per capita 2004:</strong> $5,722 <strong>Average percent annual growth 2004 to 2009:</strong> 6.5 percent

  • 7. Rhode Island

    <strong>Personal health care spending per capita 2009:</strong> $8,309 <strong>Personal health care spending per capita 2004:</strong> $6,487 <strong>Average percent annual growth 2004 to 2009:</strong> 5.1 percent

  • 6. New York

    <strong>Personal health care spending per capita 2009:</strong> $8,341 <strong>Personal health care spending per capita 2004:</strong> $6,709 <strong>Average percent annual growth 2004 to 2009:</strong> 4.5 percent

  • 5. Delaware

    <strong>Personal health care spending per capita 2009:</strong> $8,480 <strong>Personal health care spending per capita 2004:</strong> $6,611 <strong>Average percent annual growth 2004 to 2009:</strong> 5.1 percent

  • 4. Maine

    <strong>Personal health care spending per capita 2009:</strong> $8,521 <strong>Personal health care spending per capita 2004:</strong> $6,590 <strong>Average percent annual growth 2004 to 2009:</strong> 5.3 percent

  • 3. Connecticut

    <strong>Personal health care spending per capita 2009:</strong> $8,654 <strong>Personal health care spending per capita 2004:</strong> $6,824 <strong>Average percent annual growth 2004 to 2009:</strong> 4.9 percent

  • 2. Alaska

    <strong>Personal health care spending per capita 2009:</strong> $9,128 <strong>Personal health care spending per capita 2004:</strong> $6,528 <strong>Average percent annual growth 2004 to 2009:</strong> 6.9 percent

  • 1. Massachusetts

    <strong>Personal health care spending per capita 2009:</strong> $9,278 <strong>Personal health care spending per capita 2004:</strong> $6,988 <strong>Average percent annual growth 2004 to 2009:</strong> 5.8 percent