Work-related factors significantly affect the risk of persistent COVID
Work-related factors play a significant and independent role in the risk of developing persistent COVID, according to a new study based on the COVICAT cohort and led by the Barcelona Institute for Global Health (ISGlobal), a centre promoted by the ”la Caixa” Foundation, in collaboration with the University of Turin and the Germans Trias i Pujol Institute (IGTP). The results, published in the journal BMJ Occupational & Environmental Medicine, highlight that a substantial proportion of persistent COVID could be prevented through specific measures and policies in the workplace.
The health impact of persistent COVID is far from over. Beyond the infections that continue to cause illness and death worldwide, millions of people are living with long-lasting health consequences. Globally, around 6 out of every 100 cases develop persistent COVID, which equates to 400 million people affected and an annual economic impact of approximately one trillion dollars, or 1% of the global economy.
"Occupational factors have been associated with the incidence and severity of SARS-CoV-2 infection. However, the occupational determinants of persistent COVID are poorly understood," explains Kurt Straif, ISGlobal researcher and study coordinator. This knowledge gap motivated the scientific team to explore whether work environments and occupations influence the risk of persistent COVID, based on data from COVICAT, a population cohort established in Catalonia at the start of the pandemic.
The analysis included 2,054 employed adults from the COVICAT cohort who had had a confirmed SARS-CoV-2 infection, were between 18 and 70 years old at the start of the study, responded to the three follow-up surveys (2020–2023) and provided complete occupational information. Of these, 486 (23.7%) developed persistent COVID. Most presented neurological symptoms (64%), followed by musculoskeletal (38%) and respiratory (28%) symptoms.
Main risk factors: who is most vulnerable?
Individual factors associated with an increased risk of persistent COVID included being female, having a low level of education, obesity, multimorbidity, and having experienced more frequent or severe SARS-CoV-2 infections. In contrast, vaccination against COVID-19 prior to infection, having had the first infection during the Omicron wave, and older age were protective factors.
Occupation also emerged as a strong and independent determinant. People with jobs considered high risk for COVID-19 were 44% more likely to develop persistent COVID compared to those working in low-risk occupations. Working in person rather than teleworking increased the risk by 57%; infrequent or inconsistent use of FFP2/FFP3 masks increased it by up to 52%; and regular travel on public transport increased it by 58%. The group of occupations at highest risk included healthcare and social care professionals, teachers, retail, transport and security staff.
‘These results are consistent with emerging international evidence and suggest several mechanisms through which occupational exposures may influence the development of long COVID,’ says Sara de Matteis, a researcher at the University of Turin and first author of the study. Possible mechanisms include greater viral exposure in professions with high contact with patients and the public, and a weakened immune response due to high physical demands or work stress.
Implications for prevention and public policy
The results reinforce the need for workplace measures, such as the proper use of personal protective equipment, masks and strategies to reduce close contact, not only to prevent infection but also to mitigate long-term consequences.
‘Given that occupational factors are modifiable, our results indicate that much of the burden associated with persistent COVID could be avoided with specific measures,’ says Manolis Kogevinas, a researcher at ISGlobal and co-author of the study. The authors call for the strengthening of COVID-19 vaccination campaigns, the provision of FFP2/FFP3 masks and regular health checks for high-risk occupations. They also urge policymakers to expand the recognition and compensation of persistent COVID linked to employment.
This study is the result of a joint effort by ISGlobal, IGTP and the University of Turin. It is based on data from the COVICAT cohort, part of the GCAT project—a large Catalan population cohort coordinated by IGTP, which since 2020, in coordination with ISGlobal, has been conducting dedicated follow-up to assess the long-term effects of COVID-19.
Reference
De Matteis S, Consonni D, Espinosa A, de Cid R, Blay N, Castaño-Vinyals G, Karachaliou M, Alba Hidalgo MA, Papantoniou K, Garcia J, Kogevinas M, Straif K. Occupational determinants of Long-COVID in the population-based COVICAT cohort. 2025. BMJ OEM. doi:10.1136/oemed-2025-EPICOHabstracts.140
