Doctors are urging employers to plan for the effects of Long COVID now as cases continue to grow. Without planning how to manage the condition in advance, employers risk being left with big staffing problems.

“The Medical profession knows about post viral syndromes, but the potential scale and complexity of Long COVID is presenting new challenges” says Dr. Greg Irons MBChB MFOM, an occupational health specialist practising in London.

“The UK Government’s Office for National Statistics published data last November showing that around one in five people who tested positive for COVID-19 had symptoms that lasted for 5 weeks or longer – and one in ten people had symptoms that lasted for 12 weeks or longer” he said.

One large study recently published in The Lancet following 1,733 adults in Wuhan who were recovering from COVID found 76% of patients reported at least one post-viral symptom. More than 50% showed chest problems on scans. Other studies have shown many patients had lingering lung problems three-months after infection.

Considering that approaching 4 million people in the UK have tested positive so far (and the true number of infections is likely to be higher), employers are potentially looking at a significant number of Long COVID cases within the UK workforce.

Difficult to Prove
It is likely to be challenging for employers and doctors to navigate the complexities of Long COVID. Unless a PCR swab test was taken (and gave a positive result) at the time of infection, or specific (highly accurate) antibody testing was done in the weeks soon after, it is difficult to prove if an employee has had COVID-19 or not.

Importantly, a negative result from an antibody test does not mean an employee has not had COVID-19. Over time, antibody levels may have depleted and become undetectable. Consequently, it can be impossible to definitively confirm if an employee has had COVID-19 in the past.

Because the diagnosis is subjective and the symptoms are varied, Long COVID is reminiscent of other chronic conditions, which can also be challenging for employers to manage. Fibromyalgia, Chronic Fatigue Syndrome (ME) and some types of chronic back pain are just some examples.

There is no definitive guide for exactly how long it may take to fully recover from Long COVID. Recovery times can be different for every patient, although symptoms usually resolve within 12 weeks for most people. This will present difficulties for employers.

As far as is understood, the chances of developing Long COVID are not thought to be linked to the severity of the initial infection. Some patients report long-term problems, although were not hospitalised during the initial infection. New or ongoing symptoms can occur and can also change dramatically at any time.

Psychological & Physical Repercussions
Many patients are reporting psychological or cognitive concerns following infection, sometimes long after they have recovered.

Mike Battista, Staff Scientist at Cambridge Brain Sciences, the online platform for assessing cognitive function says “With COVID-19, the severity of cognitive impairments can vary widely from person to person. Traditional methods of measuring those problems are usually a one-off binary decision: is someone severely impaired or not? Clinicians are much better served by a continuous measure of cognitive capacity to track subtle changes over time.”

However, assessing the physical elements of Long COVID can also be very difficult. Physiotherapy can certainly help, although rehabilitation is likely to require care and support from many different medical disciplines. That is not always a straightforward process.

Consequently, rehabilitation from Long COVID may involve a multi-disciplinary approach. That can take time and requires employee consent. Primary Care, Occupational Health, Respiratory Physiotherapy and other services are likely be involved. This may well require significant patience and co-ordination, especially if it is led by an employer.

“Just because an employee has a long-term medical condition, it does not mean an employer has no options” says Magnus Kauders, Managing Director of Occupational Health Assessment Ltd, a nationwide occupational health provider. “Rehabilitation can be time consuming and tricky, but it can be done” he said.

“As a last recourse, the capability channel will remain available for employers. However, that will usually require professional insight, at the very least support from occupational health and probably specialist legal support”, he continued.

Clinicians are already suggesting that the future support for Long COVID recovery will involve a much more nuanced approached than historical approaches to rehabilitation.

It will also involve cutting-edge tools providing doctors and employers with an objective evaluation of each patient’s progress at every stage of their rehabilitation.

Although these tools to support rehabilitation are there, it still may not be an easy path for employers. “It is likely to require physical, psychological, biological and social support, possibly for many years to come” says Dr. Irons.