Long Covid: An Employer's Guide to Supporting Staff

In May 2021, the Office for National Statistics ?found that 1.1 million people were experiencing ongoing Covid symptoms, otherwise known as Long Covid (LC). The details indicated that most found LC symptoms limited their day-to-day activities weeks or even months after the infection had gone. However, the chances of having long-term symptoms did not seem to be linked to how ill you were when you first got COVID-19.

Why is this important?

The term “limitations in day-to-day activity” becomes increasingly relevant when considering whether an employee has a disability and if the Equality Act requirements are applicable. But let's just pause there and go back to the key figures first.

COVID-19 Facts and Figures

• The Trades Union Congress survey resulted in 3300 respondents who had self-reported as having LC. This included a high percentage of key workers, who continued to work during the height of the pandemic.
• The University College London survey indicated that 1 in 6 middle-aged people experienced LC symptoms.?
• The Journal of American Medical Association reported that approximately 30% experienced persistent symptoms 9 months after the illness. However, the study was limited by small sample sizes, a single study location and potential bias from self-reported symptoms.

What's happening now?

COVID-19 cases in the UK are rising and there is no evidence to suggest that the vaccine prevents LC. So, it's logical to conclude that LC will be around for a long time. However, the good news is that the majority of people with LC will make a full recovery within three months.

Still, many others are reporting ongoing and limiting symptoms for over 12 months. That is the not so good news.

Now, let us go back to the Equality Act - This legislation is there to protect employees against discrimination and/or harassment on the basis of their protected characteristics (e.g gender or disability).

The Equality Act stipulates that if an employee has substantial limitations to their day-to-day activities that are likely to last 12 months or more, they are considered disabled.

So, from a legal perspective, employers need to be aware of LC and the support required if they have an employee suffering from ongoing symptoms.

What Are the Symptoms of Long Covid?

LC symptoms are difficult and frustrating for all of those affected, including the actual sufferer, their friends, family, employer and healthcare provider(s).

The evidence about LC is growing, but slowly; research is still occurring. So our understanding is limited. But we do know LC symptoms include:

• Fatigue – common
• Breathlessness – common
• Brain fog; difficulties concentrating, memory, processing – common
• Joint & muscle pains – common
• Chest pain or tightness
• Cough
• Difficulty sleeping (insomnia)
• Heart palpitations
• Dizziness
• 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
• Rashes
• Mental health is affected; anxiety/depression

To clarify, LC symptoms are not caused by poor mental health but having LC impacts your ability to complete activities and that in turn can increase feelings of low mood and anxiety. Furthermore, worries about finances, job security, difficulty gaining treatment and access to healthcare, loss of life enjoyment is how mental health can deteriorate.

LC can also trigger other health conditions, such as inflammation of the heart muscle, inflammation of the heart sac, blood clotting problems, strokes and brain changes. Therefore, it is important that employees and employers are aware of ‘Red Flag’?symptoms and the employee must not do anything physically exerting until being medically assessed.

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 your employee is off sick with LC symptoms, you should try to keep in regular touch with them. It can be a very lonely period and loneliness can negatively impact mental health, exasperating LC symptoms further.

Moreover, the return to work will be easier for the employee and employer if contact has been maintained and supported throughout.

If your employee is stating they feel ready to return to work, you should invite them to have an occupational health assessment with a fully qualified and registered healthcare professional. The occupational health professional will help determine if the person is ready to return to work and offer them and the employer guidance on how to enable a safe and successful return.

Is your employee ready to return to work?

A successful return to work means that your employee is able to sustain both their work and non-work life. Energy levels could be a significant barrier to this. Therefore, it's important to consider these factors when assessing an employee's ability to return to work:

• Able to manage a good home routine, 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

Plan - Ask your?employee to compile a list of their work tasks (physical, cognitive and emotional) and indicate which are high, medium and low energy demands or difficult to do. For instance, handling heavy items for 10 minutes could be considered low whilst 15-20 minutes could be high.

It's also worth considering:

• What tasks does the employee most and least enjoy?
• Plan for the workstation to be assessed. The use of equipment such as a 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.

Prioritise

The employer and employee should both determine what work is considered a priority- high, medium & low. This will be an ongoing process as the employees' abilities fluctuate.

Pace

This is about using energy carefully to avoid “boom & bust” sequences - Boom & bust sequences are when an individual uses all their energy too quickly, resulting in burnout and extreme fatigue - In these instances, it is important to learn the technique of pacing?and effective rest .

Effective rest is the process of having regular breaks within the day, to disconnect from anything overly stimulating - social media, reading, bright lighting, noise, talking, watching - and sit and/or lie in a quiet, low light level environment.

Phase 2 -?Adjustments

Adjustments to work content, location and time periods often prove helpful to the individual working as well the employer because adjustments enable the employee to attend work consistently and complete tasks well.

LC symptoms can also fluctuate over time meaning adjustments may need to be altered. Therefore, it is a really good idea to organise regular reviews with your staff. The reviews should determine how the employee is doing at work and whether they're coping at that present time.

Feedback is important but it must be given in a way that the employee feels able to make the changes and assess the effectiveness from the employer and employee perspective of the adjustments.

Common adjustments made to support staff with Long Covid

Use the examples listed as ideas to start considering what you may be able to offer your staff:

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 chooses 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 and /or traveling in non-rush hour
• Work from home, sometimes
• Reduce noise levels at work
• Able to work with noise-cancelling headset or earbuds 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 laptop riser, upright mouse, soft-touch keyboard, all of which can reduce the 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 include consideration of how the person is feeling (wellbeing), the 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

Want to keep learning? Find out more about the author -?Anna Harrington , Founder, Managing Director and Clinical Lead of?WHIB .