Epidemiologists at Imperial College, London, have warned Long Covid might strike half a million people during this current wave of infections, and that over 2 million have already been affected by it to date. With symptoms ranging from breathlessness and fatigue to weakness and cognitive dysfunction, cardiac and respiratory issues, Long Covid can affect an individual for weeks or even months, and the long-term outlook still isn’t known. In the face of a new, potentially large cohort of chronically ill employees, how can occupational health teams help to manage the impact of Long Covid in the workplace?

Managers must be aware of its impacts
Being prepared for the potential impacts of Long Covid on the workplace starts from the top of the organisation. Understanding the illness and the different ways it can affect someone isn’t just down to the person with the illness, but also the organisation’s leaders, and any line managers. It’s important that they understand the impact of Long Covid and the ways that occupational health can support someone, and how vital that can be as an element of the employee’s management of the illness. 

Once an individual is referred to occupational health, they can be assessed for symptoms, and then their fitness for work. Can they do the job to the same extent? Are there any adjustments that need to be made in order to keep the person on board? It’s also important to note that reviews of fitness to work can be made at a later date, so the first decision reached does not have to be the final decision. We often see employees in our occupational health clinics who have been diagnosed by their GP as having Long Covid or who we determine as meeting the criteria for Long Covid. As a broad estimate, we could say that 10 percent of employees assessed come out with that diagnosis – which is a huge proportion, and significant enough for particular consideration by workplaces.

Planning support ahead of time
With infection rates still currently at a high level, how can occupational health professionals plan ahead to help navigate potential staffing problems? It’s a difficult one to call; typically, chronic illnesses cannot be diagnosed quickly so knowing what you will need to plan for won’t be obvious straight away. The minimum time threshold for diagnosis is twelve weeks, meaning individuals will have symptoms for at least three months at a similar intensity with no signs of receding. This is true for other chronic conditions, and for Long Covid it means that a period of illness with Covid, plus ongoing symptoms for twelve weeks or more, has to be waited out. You can see the National Institute for Health and Care Excellence (NICE) definition of the condition for more information. During this time of ‘wait and see’, it’s helpful to prepare for a possible outcome, with management, occupational health, and the employee collaborating together.

Preparing flexibility for the employee is vital. Chronic conditions are dynamic in nature; what someone can do one day, may change drastically the next. Over-exertion may make it worse. Reduced hours and home working, as long as they are made available, can also be utilised. 

There is also the need to recognise that Long Covid patients might need more than the average number of sick days. After a referral – as said above, this is the crucial element – an assessment can be made to see which of these adjustments will bring the most benefit.

A phased return, often used after injury or surgery, might not always be the best introduction back into the workplace. Fatigue and joint pain can persist for months, so this method, with its defined short-term phasing back into the workplace, is unlikely to be effective in rehabilitating the employee back into the workplace.

A longer term planned reduction in hours, enforced and frequent rest breaks, a focus on pacing themselves, even a change of role – all these will options have to be considered. Also consider emotional support for potential mental health issues. Depression and anxiety are higher in prevalence among the chronically ill, so planning effective Employee Assistance Programmes (EAPs) and counselling support will help staff to deal with them if they should arise. Over the last 6 months alone, we have seen an increase of 36% in referrals to the EAPs or counselling. We expect this to only continue to grow.

Recognition of the impact of Long Covid is the most important thing, in relation to, and as a part of, the group of other long-term illnesses that are more recognised, such as ME, fibromyalgia or chronic fatigue. 

If you don’t have an occupational health team, what do you do?
‘Long Covid’ is still a very loose term – after all, it has been less than two years since Covid became a term at all. 12 weeks after acute Covid, you could still have symptoms but it might not be as severe as Long Covid. There is no rhyme or reason as to who gets it long term, and it’s difficult to care for in the workplace without specialist provisions.

Without having access to occupational health support via their employer, employees will have no choice but to visit their GP and access support through that route. The GP, while providing exceptional primary care, is limited in their understanding of the workplace and how a period of chronic illness can affect the individual in their role.

Staff do not typically want to rely on overstretched GPs for conditions that can have such a strong link to their ability to work, and they don’t have to. Companies without the capacity for an occupational health team could struggle to cope if many employees feel the effects of Long Covid. It’s important to build that capability, whether in house or with a delivery partner. The partner should have an understanding of the different roles at the company they are working with, so they can refer people correctly. 

Being proactive, not reactive, is the key take-away here. Be aware, build your knowledge and capabilities as an organisation to stay flexible and be a strong network of support for employees.