Guest blog by Dr Yvette Martyn, Occupational Health Physician at Medigold Health
18 months on from the World Health Organization declaring a pandemic, the vaccination programme is in full swing. The emphasis has shifted from a need to protect workers from contracting COVID-19 to supporting employees with the potential aftereffects of the infection.
869,000 people in the UK are still experiencing symptoms 12 weeks after a COVID-19 infection with 376,000 reporting symptoms for longer than 12 months, according to the Office for National Statistics. Long COVID is defined as signs and symptoms that develop during or following an infection consistent with COVID-19 that last longer than four weeks and which are not explained by an alternative diagnosis, according to the National Institute for Health and Care Excellence (NICE). There is no need for a positive test for COVID-19 to meet the diagnostic criteria.
NICE published guidance on Long COVID in December 2020 in which the common symptoms are described. The symptoms are not confined to the respiratory tract but fall across most body systems from abdominal pain to tinnitus and depression to skin rashes.
I recently asked a group of Occupational Health Physicians what Long COVID symptoms they had encountered in workers they had assessed and while symptoms such as fatigue, shortness of breath, brain fog and muscle aches were most frequently reported, less recognised symptoms such as anxiety, reduced motivation and neurological symptoms were also described.
Recent research has tried to establish the course of this disease. The evidence suggests that individuals may be prone to experiencing relapses; these may be triggered by physical or mental activity, stress, menstruation, heat, or alcohol. But in some cases relapses can occur with no specific trigger. Some individuals have described feeling well after their initial infection, only to then experience a recurrence of symptoms, sometimes with new symptoms that they have not experienced before.
What is clear from the evidence base is that those with Long COVID often describe a significant functional impairment, they may have issues undertaking their activities of daily living, caring for dependants and feel unable to return to work. Those who feel able to return to their job may only feel able to do so at a reduced capacity.
Individuals with Long COVID may be experiencing ongoing symptoms, and in addition are faced with uncertainty about their future; given that it’s a new illness, the prognosis is not entirely clear. Recent research shows a high proportion of individuals continue to experience symptoms six months after an initial infection with COVID-19 indicating that recovery is likely to be slow.
Supporting an individual with Long COVID at work
With ongoing symptoms and an uncertain prognosis there is a dilemma for both employees and employers – when is the right time for a return to work and what level of workload is appropriate? Unfortunately, there is not a one size fits all approach. It is therefore recommended that workers with Long COVID are referred for an individualised assessment with occupational health, so that appropriate advice can be provided.
Occupational health professionals are experienced in assessing new conditions as well as diseases that are poorly understood. The emphasis is on assessing an employee’s functional ability alongside the demands posed by their workplace.
A phased return is likely to be beneficial, this means that hours or workload are gradually increased over time. While workplaces may have a restriction on how long they can accommodate in relation to a phased return, this may need to be reconsidered. If a phased return is timed inappropriately or planned incorrectly, then there is a risk that an employee could experience a relapse, so a longer phased return than the typical four to six weeks might be needed.
Other factors to consider are:
- What tasks does an employee undertake, does this need to be adapted?
- Is specific equipment needed for a worker to undertake their role?
- What hours will the employee work and how should breaks be allocated?
Employers should consider what support can be provided by the individual’s manager, since checking in regularly and adapting adjustments to changing circumstances is likely to be beneficial. Employees may also benefit from colleague support such as having an allocated buddy in the workplace.
While there is a lot of uncertainty around this condition, common symptoms seem to resolve in most people over time, albeit often slowly and over a period of several months. Returning to work can be an important aspect of an individual’s rehabilitation. If an employer can work with an employee in identifying and accommodating adjustments that allow a return to work, then this is likely to be beneficial to both the workplace and the individual.
You can watch Medigold Health's webinar 'The Long Road to Recovery - A Managers' Guide to Long COVID' here.
SOM Long COVID resources:
- SOM Podcast: Long COVID and work
- COVID-19 return to work guide: For recovering workers
- COVID-19 return to work guide: For managers
- Perspectives on Long COVID and work - Online summit recording