Long Covid: An Employer's Guide to Supporting Staff
In May 2021 the Office for National Statistics1 found that 1.1 million people were experiencing on-going Covid symptoms; otherwise known as Long Covid (LC). The details indicated that most find symptoms limit them in day-to-day activities.
The term “limitations in day-to-day activity” becomes very relevant when considering if an employee may have a disability and if the Equality Act requirements are applicable.
But let us just pause that there and go back to thinking about the figures.
The TUC survey2 resulted in 3500 respondents who had, had Covid-19, 3300 of them self-reported as having LC. Most of these were key workers who remained going to work at the height of the pandemic.
University College London (UCL)3 surveys indicate 1 in 6 middle aged people experience LC symptoms.
Other surveys 4 report 30% of those who had Covid-19, nine months later are stating having on-going symptoms. Covid-19 cases, as this is being written, in the UK are rising. There is no evidence to indicate that the vaccine prevents LC. Therefore, the conclusion, I am coming to, is that if Covid-19 will be around for as long as we can perceive so will LC.
The majority of people with LC will make full recovery within three months. That is the good news. Others are reporting on-going and limiting symptoms for 12 months +. That is the not good news.
Let us go back now to the Equality Act. This legislation is there to protect employees (within this context) against discrimination and/or harassment due to a protected characteristics with disability being a characteristic. If an employee has substantial limitations of day-to-day activities that without treatment are or likely to last 12 months or more, they would be considered to be disabled under this Act. So purely from this legal perspective employers, need to be aware of LC and the support available if they have an employee with LC symptoms.
What Are the Symptoms of Long Covid?
LC symptoms are difficult, frustrating for all affected, the actual sufferer, their friends, family, employer, healthcare provider. The evidence about LC is growing, but slowly. Research is occurring. Understanding why there on ongoing, wide ranging and fluctuating symptoms is increasing. Typical symptoms described are :
- Fatigue – common
- Breathlessness – common
- Brain fog; difficulties concentrating, memory, processing – common
- Joint & muscle pains – common
- Chest pain or tightness
- Difficulty sleeping (insomnia)
- Heart palpitations
- Pins and needles
- Joint pain
- Tinnitus, earaches
- Feeling sick, diarrhoea, stomach aches, loss of appetite
- High temperature, cough, headaches, sore throat, changes to sense of smell or taste
Mental health is affected; anxiety/depression. For total clarity, LC symptoms are not cause by mental ill health. It is the LC impacts on activities that increase feelings of low mood and anxiety. The LC symptoms, worries about finances, job security, difficulty gaining treatment and access to healthcare, loss of life enjoyment is how mental health can deteriorate.
LC can trigger some pretty nasty and dangerous other ill health conditions such as inflammation of the heart muscle, inflammation of the heart sac, blood clotting problems, strokes, brain changes, as examples. Therefore, it is especially important that employees and employers are aware of ‘Red Flag’ symptoms and the employee must not do anything physically exerting until being medically checked out.
Red Flag Symptoms
- Chest pains
- Rapid heart rate
- Breathlessness that is not getting better
- New confusion
- Not getting any better
What Can Employers and Employees Do?
If you have an employee off sick from work with LC symptoms, keep in touch with them. It can be very lonely. Loneliness is awful for health. The return to work will be easier for them and the employer if contact has been maintained and supportive.
If an employee is stating they feel ready to return to work, I suggest you invite them to have an occupational health assessment with a fully qualified and registered professional. The occupational health professional will assist to determine if the person is ready to return to work and offer them and the employer guidance on how to enable that safely and successfully.
Successful return to work means that the employee is able to sustain both work and non-work lives. Energy levels could be a significant barrier to this. Indicators that an employee may be ready to return to work are:
- Able to manage a good routine at home of doing self & household care/tasks.
- Able to leave the house.
- Where the majority of days in the week are “good days”.
- They have learnt strategies for managing symptoms.
- Emotions are more stable and easily managed.
Phase 1 - Plan, Prioritise and Pace
Ask your employee to list out the work tasks (physical, cognitive and emotional) and indicate which are high, medium and low energy demands or difficulty to do. For instance, repetitive moving and handling of light items for 15 minutes could be low; 15-20 minutes medium and over 20 minutes high. Other examples include multi-tasking or switching between using different software systems is likely to be high demand.
- What tasks does the employee most and least enjoy?
- Plan for workstation to be assessed. Use of equipment such as soft touch keyboard and upright mouse requires less physical effort.
- Commute & work travel – how will this be done, how tiring is it?
- With the employee consent awareness raising with employee colleagues and work significant others of LC.
Both the employer and employee need to determine what work is the priority- high, medium & low. This will be an on-going process as the employee abilities fluctuate.
Ask the employee to determine non-work activities and use of energy. This should include time and energy for socialising and doing fun/uplifting pursuits.
This is about using energy carefully to avoid “boom & bust” sequences. It will also assist to manage pain. Boom bust sequences are when an individual uses most energy, pushing through and finds that they have a re-bound of overwhelming and extreme fatigue that results in little activity being possible. It is hard to learn the technique of pacing5 and effective rest. Effective rest is taking deliberate periods in the day to disconnect from anything stimulating; social media, reading, bright lighting, noise, talking, watching – to just sit or lie in a quiet, low light level place.
Phase 2 - Adjustments
Adjustments to work content, location, time periods are likely to be helpful to the individual plus to you as an employer if the adjustments enable the employee to consistently attend work and complete tasks well.
LC symptoms fluctuate; therefore, adjustments are also likely to need to be altered. It is a really good idea to organise for regular reviews. The reviews to include how is the employee doing at work, are they managing both work and home lives, give feedback that is uplifting; not just praise but corrective given in a way that the person feels able to make the changes and assess the effectiveness from the employer and employee perspective of the adjustments.
The following are examples. These examples will not suit all workplaces in all situations, all the time. Use the examples as ideas to start considering what you may be able to offer6.
Adjustments – Working Time
- Avoid night, early morning or late evening working
- Avoid shift working
- If standard breaks are longer than 20 minutes you may want to consider splitting into shorter more regular breaks
- Off flexi breaks – able to take them when the employee choses to
- In addition, being able to offer micro (2-5 minutes) breaks regularly can be useful
- Able to take breaks outside
Adjustments – Work Location
- Minimise the commute to work. This could be by working closer to home, lift shares, travel in non-rush hour
- Work from home, sometimes
- Reduce noise levels at work
- Able to work with noise cancelling headset or ear buds with background sounds
- Give control (if at all possible) over temperature and lighting levels
- Create a quiet, low light level space to be used for effective rest periods
- Complete a workstation assessment. Consider equipment such as lap top riser, upright mouse, soft touch keyboard, all of which can reduce energy being used
Adjustments – Work Demands
- Pull out the list of work demands that the employee made (see planning section). Have most of the day with low demand, with occasional medium and rarely high? As the employee progresses this ratio can be adjusted
- If high demands are not able to be limited, allow extra time and/or rest periods after completing
- Risk assessment7 moving and handling, both frequent moving of non-heavy items and infrequent moving of heavy items
- Reduce the frequency and speed of moving and handling of items.
- Reduce the weight of the loads
- Support such as being with another at meetings and sharing the meeting expectations
Adjustments – Other Ideas
- Give regular feedback; praise and corrective. Corrective feedback to be given leaning the employee confident in being able to make the changes
- Conduct regular reviews that are not linked to performance appraisal processes. The reviews to include consideration of how the person is feeling (wellbeing), effectiveness of current adjustments and adjustment changes.
- Working with another person, certainly initially on return to work can help build confidence
- Employee to use Pomodoro working for managing reduced or difficulties with concentration
- Use lists, reminders, alerts to help with memory deficits
- Office for National Statistics – Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 4 June 2021
- TUC – Workers’ experiences of long Covid
- University College London – Up to one in six people with Covid-19 report long Covid symptoms
- JAMA Network – Sequelae in adults at six months after Covid-19 infection