Working Sick: Americans With Long COVID Struggle to Make a Living

Late last month Congress passed a bill to end the COVID-19 national emergency, three years after it was declared, with the rationale that daily deaths and hospitalizations are way down from their peaks. But while fewer people are dying or in the ICU, the pandemic has left millions who recovered from the initial COVID infection suffering long-term effects, or long COVID, refuting the notion that a public health emergency is over.

Last year the CDC estimated that 7.5% of the adult U.S. population, or about 19 million people, had long COVID, and that 20% of adults 18-64 who recovered from their initial COVID infection have experienced at least one health condition that may be attributable to long COVID.

Long COVID was recognized as a disability by the Department of Health and Human Services in 2021. But specific help for sufferers, or “long haulers,” in the workplace — including flexible hours, sick leave and the ability to work from home — depends on the generosity of the employer. And nearly half of workers with long COVID say their employers either didn’t offer paid sick leave or weren’t making workplace accommodations for their illness, according to a report released last year. Without policies like paid time off for illness, American workers face a financial burden to the tune of more than $500 billion, according to a report by the Solve Long Covid Initiative. 

Given these numbers and the continued high transmission rate, the pool of long-COVID sufferers is more likely growing, not shrinking. Without paid sick leave those employees must out of necessity go to work sick, putting them at risk of yet another COVID infection.
 

At Work, Still Sick and Hanging On

Long COVID is a cluster of maladies that the Centers for Disease Control and Prevention says may linger for “weeks, months, or longer”; can affect the neurological, musculoskeletal, cardiovascular and respiratory systems; can cause kidney failure and blood clots; and very commonly leads to “post-exertional malaise.”

Amanda Finley is one of the luckier long haulers because she has a job with good benefits as a customer service rep with a large company in Kansas City. For most of the last three years since her first COVID infection, she had been out of work and endured nearly two years without stable housing.
 

“The burden of COVID is disproportionately affecting those least able to withstand missing their paycheck.”

~ Julia Raifman, assistant professor, Boston University School of Public Health

 
Before COVID took her out of the workforce in 2020, Finley was a part-time gig worker and archeologist without paid sick leave. She didn’t need it then, but now, with a host of ongoing health problems linked to at least three bouts of COVID, she needs more sick time than the company will provide. “At first it seemed like they would be flexible and work with me, but it’s becoming apparent that the additional accommodations people with long COVID need are not going to be easily won,” she said.

Finley is able to work from home, which is essential due to her long COVID-related neurological symptoms, including vertigo, which leaves her unable to drive. She has developed cardiac issues that sometimes require trips to urgent care or the ER during work hours. “My pulse baseline is about 100 and sometimes will shoot up to 200, and every now and then I get these chest pains,” she said. “It’s not something I can take lightly. I have to go in.” 

After less than four months on the job, Finley had exhausted her limited amount of paid sick time. She can take unpaid time off, but her employer will count it as an infraction and she can be written up for misconduct. “I feel like there’s a disincentive to seek medical care and [an incentive to] keep working.”
 

Widespread Transmission Means More Long COVID and More Economic Pain

The pandemic has exacerbated numerous disparities in the workforce. Jobs where workers are most at risk of COVID, such as leisure and hospitality, in which it’s hard to work remotely, are lower paid and much less likely to accommodate sick workers. 

“We see many workers in the U.S. living paycheck to paycheck, and the burden of COVID is disproportionately affecting those least able to withstand missing their paycheck,” said Julia Raifman, assistant professor of health law, policy and management, at the Boston University School of Public Health.
 

Hispanic and Black Americans are more than twice as likely to miss work due to COVID-19 symptoms than white or Asian Americans.

 
Raifman, who co-authors the Roosevelt Institute blog, analyzed numbers from the CDC and the Census Bureau and concluded that workers earning less than $50,000 per year were 12 times more likely to miss a week of work due to COVID-19 than people earning more than $200,000. Lower-income workers are much less likely to have paid sick leave, and a recent report by the Center for American Progress demonstrates that part-time workers are much less likely to have paid sick time than full-time workers. 

Hispanic and Black Americans are more than twice as likely to miss work due to COVID-19 symptoms than white or Asian Americans, a finding that tracks with CDC data showing that Black, Hispanic and Native American people are more likely to die of COVID.

As for long COVID, “Health inequities may put some people from racial or ethnic minority groups and some people with disabilities at greater risk for developing Post-COVID Conditions,” according to the CDC.

When employees don’t have paid sick leave they are forced to go to work, Raifman notes, potentially spreading illness and prolonging the pandemic. “I think [higher rates of COVID and long COVID] are due to additional exposure at work. We found that the disparities persisted even when adjusting for vaccination status.”

Even if those workplaces won’t offer paid sick leave, Raifman said, they could at least help stop the spread of COVID and protect working long haulers from getting sicker. “There could be large benefits to employers and employees to have plans in place to mitigate transmission through masking policies and increased testing at the beginning of surges. Being proactive about airborne virus transmission is smart.” 

A body of research shows that well-fitting masks worn consistently are associated with reduced virus transmission, although mask mandates have ended almost everywhere in the U.S.
 

Only 14 states plus the District of Columbia have mandatory paid sick leave laws.

 
In the fourth year of the pandemic, the American public is increasingly indifferent to the virus, and while the federal government touts low COVID transmission rates, it’s actually hard to pinpoint how widespread COVID is because most people test at home, if they test at all, and don’t report their findings. A possibly more reliable measure, wastewater testing, reveals a higher circulation of the coronavirus in the U.S. right now than at this time in 2021 and 2022, combined. A body of evidence also points to immune system damage from each COVID infection, which can leave people more susceptible to other infectious diseases. And a COVID infection only confers immunity for a short time.

Many lawmakers appear aloof with regard to the economic plight of workers suffering from long COVID and other chronic illnesses. Only 14 states plus the District of Columbia have mandatory paid sick leave laws. There are currently no federal requirements for paid sick leave in the U.S., although companies subject to the Family and Medical Leave Act must provide unpaid sick leave, which could apply to employees with COVID-19 or long COVID depending on the severity of their symptoms and treatment.

Aside from some state bills, including in California, that could make pandemic sick leave policy permanent, there is no relief on the horizon for COVID long haulers, and no action on the federal level. And as of April 1, states began removing millions of people from Medicaid’s rolls when the pandemic-era program keeping them enrolled expired, the latest piece of the COVID safety net to be taken away.

Finley knows she’s not alone at her company, and she hopes her persistent advocacy for the working sick will help co-workers with long COVID come out of the shadows and ask for accommodations. “Most of them are not seeking care,” she said. “They are suffering in silence.”

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