Last reviewed 30 November 2020

Months after being infected with Covid-19, people are still suffering with symptoms commonly known as “long Covid”. Laura King considers how workplaces should respond.

At the beginning of the Covid-19 pandemic, the virus was commonly perceived to cause a relatively short-term illness for many. For the majority, this continues to be the case; at the time of writing, the NHS advises that “most people with coronavirus (Covid-19) feel better in 3 weeks”. However, a growing number of people are reporting symptoms that are lasting for months.

Many of these personal stories can be found in growing online repositories such as the Long Covid Support and Long Covid SOS websites. Social media is also awash with individuals’ accounts, often tagged using hashtags such as #longcovid or #longhaulers. However, the phenomenon is not just limited to sufferers telling their accounts. A study published in the BMJ found that a third of doctors have also reported treating people with long-term Covid-19 symptoms, and the Government has recently issued general guidance and a video on the condition.

This twist in the ever-evolving journey of the pandemic will bring about new challenges. Businesses and organisations have already adapted to make workplaces and working practices Covid-19 secure, and will have found ways to accommodate the absences of those formally diagnosed or needing to self-isolate. Now it is likely that they must also consider how to respond to those struggling to return to work after becoming ill.

What is long Covid?

As with the development of vaccines and other therapeutics for the treatment of Covid-19, our understanding of long Covid has developed at a rapid pace.

Already, health professionals from the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Care Excellence (NICE) and the Royal College of General Practitioners (RCGP) have published a working case definition of the disease as part of a package of work to develop guidelines for the treatment and management of long Covid, officially called post-Covid-19 syndrome. The case definition, which will be continuously reviewed, currently describes post-Covid-19 syndrome as “signs and symptoms that develop during or following an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”.

It goes on to say: “It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.”

Importantly, the definition does not assume that a patient has previously tested positive for Covid-19; this requirement can be based on a clinical diagnosis with or without a test, and can be made retrospectively where individuals self-managed a suspected Covid-19 infection.

How prevalent is long Covid and what are the symptoms?

Analysis of data from the Covid Symptom Study app by King’s College London found that while the majority of people who had tested positive for Covid-19 reported feeling better in 11 days or less, 13% had symptoms lasting at least 4 weeks. One in 50 people (2.3%) were still suffering 3 months after they were formally diagnosed.

Incidents of long Covid are also not confined to those who were hospitalised, and although older people are more likely to be affected, occurrences of long Covid are also much more evenly spread throughout the age groups. The app research showed that 10% of 18 to 49-year-olds are affected with long Covid after becoming unwell with Covid-19; this rose to 22% in the over-70s.

The symptoms are varied, but there are a few that seem to be consistent across cases. Commenting in the New Scientist, Professor Tim Spector, who has been analysing the Covid Symptom Study app data said that fatigue and headaches were “virtually universal”. However, a raft of other ailments are also reported, including shortness of breath, a chronic cough, muscle pains, change in taste and smell, cognitive difficulties, diarrhoea, liver and kidney problems, skin rashes and hair loss. Many have also reported that the symptoms come back after they have seemingly disappeared.

Long Covid and the Equality Act

There is still much that needs to be understood about long Covid: how long it lasts, whether it is one syndrome or a combination, who is most at risk, what the best treatment options are. However, while these questions are being answered, workplaces will still have to manage the consequences of a proportion of staff who are ill for potentially long periods of time.

Currently, where chronic illnesses can be defined as a physical or mental impairment that have a “substantial” and “long-term” negative effect on a person’s ability to perform normal daily activities, they are covered by the Equality Act 2010. Currently, suffering an acute Covid-19 infection does not meet this definition; however, long Covid might.

Certainly, the first criterion of having a “substantial” effect is met for many sufferers. However, the second qualifier is still impossible to know; long term is defined as a period of more than 12 months, and our understanding of the condition has not been with us that long.

Many do not think businesses should wait and see. UNISON, for example, have said that long Covid might ultimately qualify under the Equality Act 2010 and recommend that employers undertake risk assessments for affected individuals and make reasonable adjustments. The Teachers Union, NASUWT, goes further, stating: “if an individual is not experiencing an improvement after a period of time, it would be reasonable to assume the condition is long term and therefore should be counted as a disability.”

Options for employers

While the symptoms of long Covid should not be belittled, it must be remembered that long-term and chronic conditions are not a new phenomenon and that many examples of best practice already exist.

A study from Loughborough University looking at mental and physical wellbeing among employees reporting different chronic illnesses showed that workplace support was critical in helping people manage their symptoms. Specifically, it demonstrated that where employers worked with their staff to help them overcome any limitations, individuals were much better at managing their illness, as well as their work.

Accordingly, where employees are suffering with suspected long Covid, employers should work with occupation health teams and the individual to develop personalised assessments which include adequate provisions for returning to work. This might involve a phased return, as well as a degree of flexibility to allow staff to manage the variations in their condition.

Maintaining an open-minded and compassionate approach will be key to any strategy. For example, although work is ongoing within the medical profession, and the Government is setting up initiatives such as long Covid clinics, the illness is still poorly understood. This might mean that it is difficult for staff to get a diagnosis, it is likely there will be geographical differences in access to support and, at first, doctors may find it hard to provide advice.

As with many other aspects of the pandemic, this “newness” also means that the attitude of managers and workplaces will be crucial. Managers who are able to listen to problems and provide an inclusive and non-judgmental response will develop inclusive, stronger and more resilient teams ― undoubtedly a much-needed asset in these most challenging of times.

Conclusion

Long covid is thought to affect around 10% of people — including those with mild cases of Covid-19.

Although there are no formal guidelines for how businesses should respond, long Covid has similarities with many chronic conditions and may eventually be covered by the Equality Act 2010. As such, businesses are encouraged to work with occupational health teams and affected individuals to manage their return to work.

Best practice for working with chronic conditions within the workplace can be found in the Chronic Health Conditions topic.