Being sick is bad enough, but employees in the U.S. feel so guilty about taking time off from work to recuperate that they often work through illness. 

Not all workers in the U.S. are entitled to paid time off from work. In 2022, almost one-quarter of private industry workers did not have paid sick time, according to the Bureau of Labor and Statistics. But even employees with allotted paid "sick days" are loath to use them when under the weather. 

Nearly 90% of U.S. workers say they worked through sickness over the past 12 months, according to a survey from Bamboo HR, a provider of human resources software. And despite the COVID-19 pandemic temporarily shining a spotlight on worker health, sick-leave policies in the U.S. remain subpar. 

"It's no longer just front-line workers who don't want to take time off, it is trickling over to full-time workers who have sick time as a benefit of being an employee," said Yolanda Owens, career expert for The Muse, a career information site.

The U.S. only guarantees workers unpaid sick leave, leaving them to choose between two essentials to well-being: Their health and a paycheck. 

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"Stress, anxiety, guilt"

Nearly 65% of workers say they experience "stress, anxiety, guilt or fear" when requesting sick time from their employer, the Bamboo HR survey found. Twenty-five percent, or one in four workers say they have been either pressured or explicitly asked to work while they've been sick.

"People are getting sick and they're deciding they're going to work through sickness," Anita Grantham, head of human resources at Bamboo HR, told CBS MoneyWatch.

She attributes part of workers' reluctance to take time off to the current economic climate, in which employers are conducting more layoffs and have regained some of the leverage they lost during the "Great Resignation" when large swaths of workers were choosing to leave their positions.

"In the salaried workforce people are feeling taxed, it's a tough environment with no economic relief in sight and there's no federalized support or care. That leads to a compounding effect which we're seeing in the data," Grantham said. "They're going to work because they need their jobs, they need their benefits."

Nearly 65% of workers say they experience "stress, anxiety, guilt or fear" when requesting sick time from their employer, the Bamboo HR survey found. Twenty-five percent, or one in four workers say they have been either pressured or explicitly asked to work while they've been sick.

Workers' anxiety over sick day requests isn't necessarily unwarranted or overblown, either. 

Almost 80% of managers say they have been skeptical of sick day requests, according to the survey.

Poor health, poor performance

In the end though, nobody — neither the worker nor the company — wins when an employee comes to work sick. They deliver poor results, can infect others, and their health worsens.

"If a company's workforce isn't physically and mentally well and there is mistrust between leaders and team members, performance will suffer," Grantham said. 

Change in attitude needed

A societal shift in attitude toward taking sick days is in order, according to experts.

"It is a matter of continuing to emphasize that taking a sick day is important," Rebecca Gorman, a compensation consultant for Salary.com told CBS MoneyWatch. "You can be a hard worker and productive contributor and still take a sick day. But for decades, centuries maybe, there has been this 'I'm going to work through it' attitude and we need to shift that paradigm."

It starts with leaders setting an example, experts say.

"It all starts there. When you have manager in the hospital answering emails and taking meetings, that sends a message that you better not take time off," Owens said. "If a manager says, 'I am not feeling well, I'll get back to you when I'm feeling better,' that is a much more positive response for people to follow."