Long COVID: Understanding Vulnerabilities for Workers and Legal Protections

The Hidden Toll of the Frontline

While the acute phase of the COVID-19 pandemic has subsided, millions of workers continue to grapple with its lasting consequences. Recent research published in BMJ Occupational & Environmental Medicine reveals a troubling reality: essential workers face a significantly higher risk of developing long COVID than their peers who worked remotely or in lower-risk occupations.

A study by the Barcelona Institute for Global Health, analyzing over 2,000 workers from the COVICAT cohort, found that nearly 24% of workers who contracted COVID-19 developed long COVID. However, this burden was far from equally distributed. Workers in high-risk occupations had a 44% higher likelihood of developing long COVID than those in low-risk jobs.

Who Are the Most Vulnerable?

The research identified specific occupational groups bearing the heaviest burden of long COVID:

• Healthcare and social care professionals – continuous patient contact and high viral exposure

• Teachers and education workers – required in-person instruction during the pandemic

• Retail workers – daily interaction with the public in enclosed spaces

• Transport workers – reliance on public transportation and close quarters

• Security staff – essential services requiring physical presence

Essential workers who worked on-site rather than teleworking had a 57% increased risk of long COVID. Additionally, workers who commuted regularly by public transportation faced a 58% elevated risk, while those who used personal protective equipment inconsistently saw their risk increase by up to 52%.

Understanding Long COVID's Impact

Long COVID encompasses a constellation of debilitating symptoms that persist for months or years after initial infection. The BMJ study found that most workers with long COVID experienced:

• Neurological symptoms (64%) – including brain fog, memory problems, and difficulty concentrating

• Musculoskeletal symptoms (38%) – chronic pain and weakness

• Respiratory symptoms (28%) – shortness of breath and reduced lung function

These symptoms don't just affect quality of life – they directly impact workers' ability to return to their jobs. Many require workplace accommodations, gradual work reintegration, or face permanent disability.

New Jersey's Legal Protections: The Amato Decision

Recognizing the unique vulnerabilities of essential workers, New Jersey enacted groundbreaking legislation creating a rebuttable presumption of workers' compensation coverage for COVID-19 cases. The recent case of Amato v. Township of Ocean School District has clarified and strengthened these protections.

What Is the COVID-19 Presumption?

Under N.J.S.A. 34:15-31.11 and 34:15-31.12, enacted in September 2020, New Jersey established that if an essential employee contracts COVID-19 during a public health emergency, it is presumed to be work-related and fully compensable under workers' compensation law. This presumption applies to claims with dates of service from March 9, 2020, through June 4, 2021, and from January 11, 2022, through March 7, 2022.

The law shifts the burden of proof from the employee to the employer. Rather than workers having to prove they contracted COVID-19 at work, employers must now prove by a preponderance of evidence that the worker was not exposed to the disease at the workplace.

The Amato Case: Defining Essential Workers

The Amato case centered on a dependency claim filed by the husband of a teacher who died from COVID-19 after returning to in-person instruction. The central legal question was whether teachers qualified as "essential employees" under the statute.

In December 2024, the New Jersey Supreme Court addressed this issue, with important clarifications from the Appellate Division decision:

• Teachers are essential employees under the statute, supported by guidance from the Department of Homeland Security's Cybersecurity and Infrastructure Security Agency and the New Jersey Office of Emergency Management

• Judges can determine essential employee status as a matter of law before trial proceedings begin

• The presumption remains rebuttable – even after finding an employee is essential, employers can present evidence to rebut the presumption that COVID-19 was contracted at work

The Court also addressed a unique judicial recusal issue, ruling that a judge who previously sponsored the COVID-19 essential employee presumption legislation was not automatically disqualified from presiding over cases involving that law.

Who Qualifies as an Essential Employee?

The statute defines essential employees broadly to include:

• Healthcare workers and first responders

• Teachers and education personnel

• Food service and agricultural workers

• Transportation and delivery workers

• Retail and customer service workers

• Critical infrastructure workers

• Any essential employee as defined by NJ Executive Order 103 of 2020

The Path Forward: Prevention and Protection

The convergence of occupational health research and legal protections highlights critical lessons for protecting essential workers:

Workplace Interventions

Research demonstrates that targeted workplace measures can prevent a substantial portion of long COVID cases. Employers should prioritize:

• Adequate personal protective equipment – particularly high-quality masks (FFP2/FFP3) for high-risk settings

• Strategies to reduce close contact – including improved ventilation, physical distancing, and hybrid work models where feasible

• Support for alternative transportation – reducing reliance on crowded public transit

• Remote work options – when possible, allowing workers greater control over their environment

Legal Protections and Workers' Rights

Essential workers in New Jersey who contracted COVID-19 during the public health emergency periods should be aware of their rights:

• The rebuttable presumption applies – workers don't need to prove they contracted COVID-19 at work; employers must prove they didn't

• Coverage includes all workers' compensation benefits – medical expenses, lost wages, and death benefits

• Premium protection exists – COVID-19 claims don't affect employers' experience modifier rates

• Workers' compensation provides the exclusive remedy – protecting both employees and employers from protracted civil litigation

Conclusion: A Call for Continued Vigilance

Essential workers carried our communities through the darkest days of the pandemic, often at tremendous personal cost. With approximately 400 million people worldwide living with long COVID and an annual economic impact approaching $1 trillion, the occupational health crisis is far from over.

The research makes clear that occupational factors play a significant and independent role in the risk of long COVID. These are modifiable risk factors – workplace interventions can meaningfully reduce the burden of this debilitating condition.

Legal protections such as New Jersey's COVID-19 presumption statute recognize the unique vulnerabilities that essential workers face. The Amato decision affirms that these safeguards apply broadly to protect those who had no choice but to report to work during the pandemic.

As we move forward, we must not forget the lessons learned. Essential workers deserve not only our gratitude but concrete protections: safe working conditions, adequate protective equipment, and fair compensation when workplace exposures lead to lasting harm. The convergence of public health research and legal recognition provides a framework for honoring that obligation.

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References:

De Matteis, S., et al. (2025). Occupational factors of Long-COVID in a population-based cohort in Catalonia: the COVICAT study. BMJ Occupational & Environmental Medicine.

Amato v. Township of Ocean School District, No. A-2542-23 (N.J. App. Div. Nov. 25, 2024).

N.J.S.A. 34:15-31.11 and 34:15-31.12 (New Jersey Workers' Compensation Act COVID-19 Presumption).

Recommended Citation: Gelman, Jon L., Essential Workers Face Long COVID, Workers' Compensation, 12/24/2025.