Samira Brooks has been a home health aide for nearly two decades. In high school, an elderly neighbor would call to her from her porch, asking Brooks to help with errands and tasks around the house; she’s been caring for people ever since. “I have a soft spot for people who can’t do for themselves and don’t have anyone else to do it,” Brooks said. “It definitely hasn’t been for the money.”

Brooks makes $9.25 an hour and works two jobs to make ends meet. In 18 years, she’s never gotten paid leave — for being sick, having kids or any other emergencies. That’s because home health aides like her typically aren’t salaried employees; instead, they’re contracted by each client individually.

In March, Brooks, who lives in Virginia, kept caring for her clients, even after the coronavirus pandemic began sending many nonessential workers home. One day at work in mid-April, Brooks started to get a headache. She felt deeply tired and fell asleep at 5 p.m. that night. A few days later, she could barely walk up the steps to her house and “felt like a train hit me,” she said.

By the next week, she’d tested positive for the coronavirus.

The last day Brooks worked before getting sick was April 15. By June, she said, she still hadn’t been able to return to work due to her illness and the fact that one of her clients contracted the virus. She didn’t get any paid leave throughout that time. Had Brooks worked for a different employer, she might’ve qualified to take two weeks of paid sick leave, guaranteed by Congress in the Families First Coronavirus Response Act. The legislation, passed in March, ensured workers at small- and medium-sized companies up to two weeks of fully paid leave if they got sick with the coronavirus. It also provided up to 12 weeks of paid family and medical leave at 67 percent of the person’s normal pay.

But the Labor Department carved out many workers — particularly health-care workers — from qualifying, leaving a huge swath of front-line employees like Brooks with little recourse if they got the virus. This disproportionately affected women, who make up more than 80 percent of the country’s nurses and nearly 90 percent of home-care workers. And it’s well-documented that people of color are dying at much higher rates than White Americans when they contract the virus.

In August, a federal judge ruled that it was illegal for the Labor Department to exclude virtually the entire health-care sector from the paid leave, finally extending those benefits to Brooks and other health-care workers like her. But millions of Americans in a variety of sectors could very soon find themselves in Brooks’s predicament.

The emergency paid leave guaranteed by Congress will expire at the end of the year, leaving as many as 87 million people across the country out of luck if they or their families get sick and they don’t otherwise receive paid leave from their employers. And if the current trend is any indication — in which women, who disproportionately shoulder unpaid care work, are far more likely to disrupt their careers to deal with the effects of the pandemic — it’s women who will keep suffering the most.

The stakes are now even higher, with the United States entering the worst of the crisis. Hundreds of thousands of people are testing positive for the coronavirus every day. In the absence of emergency legislation, about a quarter of the workforce doesn’t get paid sick leave from their employers, while only about 20 percent gets paid family leave. The emergency paid leave has been found to reduce the spread of the virus. But many workers will be left with nothing when it expires on Dec. 31.

Brooks’s situation may foreshadow what’s to come for many, especially low-wage workers whose employers are less likely to offer paid leave, as well as those at small businesses who often can’t afford to.

Beyond losing her income, Brooks’s husband also had to take two weeks of unpaid time off to stay home and quarantine after she exposed him. It took three weeks for her to start receiving the unemployment benefits Congress extended to independent contractors and those unable to work due to covid-19 at the start of the pandemic. She and her husband had to dip into their savings and ask for extensions on bills. “I have a mortgage … I have a daughter in college,” she said. Brooks also has a 17-year-old daughter at home, and she said “none of my bills stopped.” She cut down by bathing less frequently and buying fewer groceries.

The unemployment benefits helped once they started, Brooks said, but they weren’t enough to overcome weeks without pay. If she had been able to take paid leave when she first got sick, “I wouldn’t have missed any income,” she said. “It would have kept me right there where I was.”

Even some health-care workers whose employers offer paid sick leave were left high and dry by the Labor Department’s exemption during the crisis. When the pandemic started, Kerry’s occupational therapy clients at a Boston hospital stopped coming. So Kerry, who is being identified by her first name out of fear of retaliation by her employer, was tasked with escorting patients sick with the coronavirus from their cars in the garage to the hospital’s testing site.

She would help people who were “doubled over coughing, and I’m like, ‘I hope I’m okay,’ ” she said. There wasn’t adequate personal protective equipment (PPE), according to Kerry, and she had to reuse her mask and work without a gown. Then, one day, she developed a bad headache that was eventually accompanied by a 104-degree fever, intense body aches and a painful cough. She tested positive for the coronavirus on March 31. She had diarrhea and vomiting, but was too sick to make it to the bathroom, unable to take a few steps without losing her breath. She also lives alone. “I was laying in bed and so sick, and I didn’t know if I was going to die,” she said.

There was no way she could go to work. According to Kerry, she had banked up more than 300 hours of paid sick and vacation leave — she had never tapped into it in the decade she’d been working at the hospital. Yet her employer told her the hospital couldn’t pay her those benefits, because it was losing so much money during the crisis.

Instead, she was told to file for unemployment benefits or workers’ comp, so she did both, which landed her under investigation for unemployment insurance fraud after she was approved for both benefits. She had to put bills on hold, because she didn’t have enough money to cover them while she was out of work. She said the problem would’ve been solved if she had access to those two weeks of paid leave.

The inability to take paid leave has hurt even those who haven’t gotten sick with the virus. In mid-April, Trish Richmond, who lives in Las Vegas, came down with pneumonia, which kept her out of work from her job as a home health aide for months. She was so sick that her husband had to take a week of unpaid sick time from his job to care for their 3-year-old son.

She hadn’t been paid that entire time. Richmond tried to get a pay advance from the firms that she contracts for, but was denied because they didn’t know when she would be coming back to work.

She and her husband had to take money out of their two sons’ bank accounts, which hold money from a car accident years ago. It’s “so embarrassing,” she said. “I’m about to cry just thinking about it. … That’s like touching our kids’ piggy bank, but we had to.” The car insurance, utilities and rent were adding up, Richmond said, and “we had to use that not to be homeless and the power off.”

Congress is negotiating another relief package to contend with the pandemic, but the latest version doesn’t include any paid-leave provisions, and it’s unclear whether lawmakers will be able to pass anything at all. President-elect Joe Biden has promised that paid leave will be part of his covid-19 response once in office, but he won’t enter the White House until Jan. 20 and will need Congress to help him pass legislation. In the meantime, millions of Americans could soon experience what these three women went through if Congress doesn’t extend the emergency paid leave.

Kerry’s ordeal isn’t over. She went back to work in June, and she is now wearing a mask, face shield and gloves with every patient. But she’s still dealing with the fallout of going without paid leave. She appealed the fraud claim against her, only to have her appeal denied, and is waiting for the final outcome.

“I’m pretty exhausted from dealing with it,” she said. “I just can’t afford to lose my job at this point.”

Reporting for this article was supported by New America Foundation’s Better Life Lab.