Last reviewed 21 June 2021
Long Covid is associated with significant health issues for individuals — and therefore will have significant implications for employers. The latest figures from the Office for National Statistics show that one million people have self-reported Long Covid. Laura King provides an update on the disease and what is known so far.
What is Long Covid?
“Long Covid” is a term often used to describe a range of symptoms that continue after an acute infection from Covid-19 has passed. Officially, the Covid-19 illness is split up into three clinical stages (NICE guideline, NG188) as follows.
Acute Covid-19: signs and symptoms of Covid-19 for up to 4 weeks.
Ongoing symptomatic Covid-19: signs and symptoms of Covid-19 that occur 4 to 12 weeks after a case of Covid-19.
Post-Covid-19 syndrome: signs and symptoms that develop during or after an infection consistent with Covid-19, which continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.
Long Covid includes both ongoing symptomatic Covid-19 and post-Covid-19 syndrome. Crucially, the definition for post-covid-19 syndrome means that someone suffering from suspected Long Covid does not need to have had a positive Covid-19 test to be diagnosed.
Signs of Long Covid can be highly varied — some researchers have listed up to 205 symptoms ― but some of the most common ailments include severe tiredness (fatigue), shortness of breath, chest pain, muscle aches, difficulty sleeping and “brain fog”. According to data collected by the ZOE COVID study app there are two groups of sufferers: those with an ongoing respiratory illness, and those who have symptoms affecting a number of organs including the brain, gut and heart. The disease can also have a significant element of relapse (either randomly, or where the relapse is triggered by certain events or activities).
The severity of disease can also vary. For example, the latest ONS data found that 45% of people said that their symptoms were slightly affecting day-to-day activities, while nearly 20% reported that their ability to undertake their day-to-day activities had been considerably limited.
How many people get Long Covid
A recent technical report from the Welsh Government suggests that 10% of those who managed the illness at home show symptoms of Long Covid, rising to more than 70% of people who have been hospitalised. A lack of awareness, as well as gaps in the diagnosis of Covid-19 in the early stages of the pandemic, have meant that many people experiencing long-term symptoms may not have associated their symptoms with Covid-19. The picture is further complicated by issues such as declining mental health, which has become more common in the population and can share symptoms with Long Covid, such as disturbed sleep or low energy levels.
As a result, estimates of prevalence vary, but in its report published in January 2021, Independent SAGE wrote that the current best estimate was that 5–10% of people who caught Covid-19 would go on to develop Long Covid.
How long does Long Covid last?
As a relatively new illness, there are no clear indications of how long it takes for symptoms of Long Covid to resolve. However, there are clear signs that, for some, symptoms can last a year or more.
The latest ONS data (which captures instances of Long Covid one year after the first wave of infections) showed a marked increase in the number of people self-reporting symptoms that have lasted more than 12 months. In its latest study, 376,000 said that they had been experiencing symptoms for more than a year after a suspected infection ― up from 70,000 in the release dated 1 April 2021. Of the total one million self-reported cases, this figure represents more than one-third of sufferers.
Who is affected by Long Covid?
As with Covid-19, the data indicates that Long Covid affects some more than others.
According to the ONS:
women are more likely to suffer Long Covid than men (58% compared to 42%)
those aged between 35–69 years of age made up the majority of the cases (29% of cases were 35–49-year-olds and 36% were 50–69 year-olds)
the top five sectors affected were health care, social care, retail, teaching and education, and civil service and local government
those living with an existing health condition were more likely to be affected
those living in the most deprived areas were more likely to be affected.
Initial findings from the ZOE app indicate that increasing age, Body Mass Index (BMI) and female sex are all risk factors, as is severity of the initial infection (ie individuals with Long Covid are more likely to have experienced hospitalisation, and those experiencing more than five symptoms during their initial infection are also more likely to develop Long Covid).
The PHOSP-COVID study (an observational study of those who have been discharged from hospital after suffering Covid-19) found that although the profile of patients admitted to hospital is largely male and from an ethnic minority background, those suffering Long Covid are disproportionately white, middle age females with other conditions such as diabetes or heart disease. Recent findings from the research programme indicated that 70% of people discharged from hospital had not fully recovered after five months, with an average of nine persistent symptoms. Of those working prior to infection, more than 17% were no longer working and nearly 20% had experienced a change in their work due to their health conditions.
Employers and Long Covid
There have been calls from MPs to define Long Covid as an “occupational disease” and to compensate frontline workers who are affected by it.
In the meantime, employers are likely to have to manage instances of Long Covid within the workforce ― some instances of which may be classed as a disability under the Equality Act 2010 where they last over a year.
Acas has produced guidance to assist employers in managing those within the workforce with Long Covid, and the Government has also published advice for workers as part of its Your Covid Recovery support service. As well as planning services to accommodate absences and potential long-term sickness (eg by having multi-skilled teams), it is important for employers to note the following.
Employee rights and entitlements with regards to sickness have not changed.
An employee does not need a positive Covid-19 test to be diagnosed with Long Covid.
Symptoms of Long Covid vary considerably between individuals and can be characterised by relapses which may, or may not, have a trigger.
Employers should agree how to keep in touch with their employee while they are off sick and identify any support that is needed.
On return to work, employers should work with their employees to identify if any adjustments are needed. Employees best understand their condition, and so should be encouraged to identify adjustments that would suit their needs. Some examples might include a phased return, or a review of workloads. It is important to note that, in some cases, a standard phased return over a few weeks might not be enough due to the nature of the disease.
Where possible, occupational health experts should be involved to help develop any return-to-work plans.
The most recent statistics from the ONS show that Long Covid is affecting around 1.6% of the population, and an increasing number of individuals are now reporting symptoms that have lasted for more than 12 months. Employers will need to be aware of the potential impact of Long Covid on services, and be mindful of the varied and potentially persistent nature of Long Covid when managing cases of employee sickness.