5 Mar 2023
Occupational health, HR, OSH professionals and managers require a greater understanding of how to support employees suffering with Long Covid, to enable them to recover at their own pace, and enhance the probability of a full return to work in the long term.
According to the World Health Organisation (WHO), ‘post covid’ or ‘Long Covid’ is when people who have had Covid-19 still have symptoms after three months, which last for at least two months, and which cannot be explained by an alternative diagnosis.
Dr. Margaret O’Regan, an occupational health physician and GP based in Cork, explains that she has seen many patients suffering with Long Covid. “Fatigue is common, verging on exhaustion, insomnia, shortness of breath, and an exercise intolerance”, she says. “I’ve had two marathon runner patients who can only walk 20 minutes tops, after three months”.
Another common issue for individuals is ‘brain fog’, which can be mild or severe, similar to concussion. Anxiety and depression can also be present, due to the impact on the person’s lifestyle and quality of life, she says. What this means is that employees who are affected by Long Covid will require extra support in the workplace, as the condition can have unusual patterns, with relapses, and phases with new, sometimes unusual, symptoms. What can appear initially to be a mild case can be followed by severe symptoms, significantly affecting a person’s day to day activities and their ability to work.
Complexity and severity of symptoms
Discussing treatment options, Dr. O’Regan explains that it is important that any other conditions are ruled out before a diagnosis of Long Covid can be made. “Each person should be managed on a case-by-case basis and there should be regular reviews to check how they are doing. Some people will do very well after a month, others will require more time, depending on if their symptoms are mild, moderate or severe”, she says.
She suggests that employers should engage an occupational health physician if the employee is out of work, as they will need to be medically assessed by someone with experience in this area. “The occupational health physician can work in tandem with an occupational health nurse, and they should also liaise with HR in the company”, she explains. “Employers are not medical, and this condition is very variable in terms of its duration and its symptoms”, she notes.
For some employees, there may be a need to look at work accommodation, including reduced hours, and for others it may be necessary for them to remain out of work until their symptoms resolve. She cites the example of a nurse suffering with Long Covid with respiratory symptoms, and a teacher suffering with ongoing fatigue. “It really depends on the complexity and severity of the symptoms, there is no one size solution that fits all, but what we do know is that returning the employee to work can be successful but may require alterations to ‘work pace’ or duties initially. It is likely that the majority of people with Long Covid will return to normal hours and duties after a rehabilitation period”.
Don’t push people
Expanding on the importance of the paced approach to recovery, Dr. John (also known as Jack) Lambert, professor of infectious diseases at UCD, outlined what he sees as a common challenge for many sufferers. “Many patients I see have had no interventions, and they are told to go back to work, and to push themselves more”. They are advised to do graded exercise, for example, on day one walking around the block, on day two a slightly longer walk and by day five they are ready to collapse, he outlines.
“It’s really important not to push people, and pacing is essential to their recovery”, he says. ‘Pacing’ means that the person only does what their body tells them they are able to do that day. In essence, it is about paying attention to how their body is feeling, or else they will end up crashing, which means a more protracted and delayed recovery period. leading to more time out of work.
Asking Dr. Lambert about how long recovery from Long Covid can take, he makes the point that each person has “a different trajectory”. The treatment needs to be individualised, and research published in The Lancet Respiratory Medicine journal shows that one year after having Covid-19, only 29% of hospital patients have recovered. He cites some examples of different workers, whose recovery has been impacted by the approach adopted by their employer. This includes an ambulance driver who was requested to increase work hours, but has to spend a day in bed to recover between shifts, and a nurse who is managing to work four days, but is being asked to return to a five-day week.
Lot of misunderstanding
Examining what employers can do to support their employees with Long Covid better, Dr. Lambert is keen to emphasise the importance of staying informed and up to date on the latest guidance. “There is a lot of misunderstanding out there, even amongst GPs and consultants”, he says. In some cases, individuals are being sent for the incorrect tests, including patients with brain fog being sent for pulmonary tests, he adds.
The most important message is to support those suffering not to crash and to adopt a paced approach to recovery. The role of occupational health is central to this, to ensure that if a person needs job alterations, modifications, reduced hours, or time off work, that this is given. This should be done in consultation with the worker, and any other parties who can have an input, including occupational health and safety, HR and the person’s manager.
Another person who agrees with Dr. Lambert’s advice for employers to stay informed on this condition is Sarah O’Connell, co-founder of Long Covid Advocacy Ireland (LCAI). “No employer can support their employees unless they understand it themselves”, she says. She talks of some of the horror stories Long Covid patients in Ireland have experienced. This includes employees who have been asked to work when they are suffering with an acute Covid-19 infection, whilst research now shows that adequate rest during acute infection may help prevent Long Covid.
She also says the risk of re-infection is an issue, and there is still a risk of developing Long Covid even if someone didn’t develop it following a previous infection. She adds that Covid continues to pose a threat in the workplace and that employers should “continue to focus on providing clean air, for example consider using HEPA (High Efficiency Particulate Absorbing) filters, and provide a hybrid model of work where it is possible”, she cautions.
Referring to the role of occupational health in supporting employees, she recognises the need for more up-to-date information on the correct advice to give employees, to ensure they don’t feel pressurised to return to work before they are able to. “We see that Long Covid patients are more likely to deteriorate (leading to a longer recovery time) if they attempt to try to 'push through' their symptoms, for example if they return to work too soon”, she says.
She is also aware of some employees feeling bullied by the employer to return to work, even when they had the “right medical documentation” supporting them to remain out of work. “In certain cases employees have had to make the difficult decision to leave or go on leave of absence, including a nurse who was suffering from brain fog, and felt unable to safely administer medication”, she says.
Occupational health role
Delving further into the role of occupational health when it comes to the recovery process, Margaret Morrissey, an occupational health nurse/advisor with a large pharmaceutical company in west Cork, talks about some of the support systems their company has in place for workers who have Long Covid, which she and her team are helping to rehabilitate to return to work over a staged basis. “We complete a full assessment on employees with this condition, and collaboratively develop a rehabilitation programme taking into consideration their physical and cognitive limitations”, she says.
This approach is individualised, and can often involve a conversation around job modifications or job changes that may be required to facilitate the person coming back to work. I put it to Margaret that it can be challenging to reaccommodate people in another job if their symptoms require this. She agrees it is not always easy, but it can mostly be achieved with some creative thinking and flexibility. “It’s important that the employee is involved in the discussion around what is workable for them, and whatever they are doing has to be meaningful, and tailored to their needs”, she says.
Margaret also praises the generous illness payment programme which her company has in place for those who have to remain out of work for longer periods, and the Long Covid programme offered by their health insurer. This programme provides Long Covid sufferers with an assessment by an occupational health physician, cognitive behavioural therapy, nutritional and physiotherapy sessions, and ongoing reviews and support with the physician and occupational health nurse.
Talking about how she keeps her knowledge on Long Covid up to date, Margaret tells me about one group she is grateful to be connected to, which is the network of occupational health nurses whatsapp messaging group. There are up to 60 members, where suggestions, advice and research on Long Covid is shared. There is also a peer support group within the INMO ( Irish Nurses and Midwifes Organisation) where they meet and discuss current issues, and provide workshops to their members. She is also very grateful for Ibec’s EHS group weekly meetings hosted by Michael Gillen, where Covid-19 updates were discussed and best practices shared.
Irish data With this need to stay up to date on what is still a relatively new condition, (it is only two and half years old), it is important to know how many people are affected in Ireland. Whilst there are limited Irish specific statistics, research commissioned by Denis Naughton, TD and member of the inter-parliamentary working group on science and technology, suggests that there could be up to 230,559 suffering, with over 36,000 people impacted a lot in their daily activities. These figures are taken from a self-declared incidence of Long Covid in Ireland survey carried out by the polling company Ireland Thinks in November 2022, which indicates that 6% of adults in Ireland have symptoms in excess of 12 weeks.
These figures are in line with data produced by the UK, where research shows Long Covid has impacted the dayto-day activities of 1.1 million people, with 322,000 (19%) reporting that their ability to undertake day-to-day activities has been “limited a lot”. Of particular interest to employers, is that the highest prevalence occurred between the ages of 35-49 years, with women slightly more likely to have symptoms than men.
With this in mind, it seems that for such a relatively new condition, there is still a lot of research, understanding and knowledge-sharing required to help those suffering with Long Covid, and to enable employers, OSH, HR and managers to adequately support employees.
The European Agency for Safety and Health at Work (EU-OSHA) has succinctly summarised its recommended approach in its Long Covid guide for managers: “Although recovery from Covid-19 can be slow, many people improve with time, and treatments are expected to improve as more becomes known. Returning to work is part of the recovery process, even if it must be flexible or involve reduced hours and ‘pacing’ over many months.”
Further information :
Long Covid Ireland : Home | Long COVID Ireland
Long Covid Advocacy Ireland:
EU-OSHA Covid 19 infection and long covid – guide for managers:
Contacts featured in this article include:
Dr John (Jack) Lambert, professor of infectious diseases at UCD.
Dr. Margaret O’Regan, LFOM, MICGP, occupational health physician and GP, Co. Cork.
Margaret Morrissey, occupational health nurse/advisor, mobile: 087-7574690
Sarah O’Connell, cofounder of Long Covid Advocacy Ireland (LCAI); email@example.com