Manager’s guidance on how to support individuals returning to work who are recovering from COVID-19 (‘Long COVID’).
In response to the coronavirus pandemic and the subsequent UK wide lockdown, the UCL community has supported staff and students through a comprehensive guide, initially daily. In order to support staff returning to work, Workplace Health launched a new tool in addition to the comprehensive risk assessment tool on RiskNet. The COVID-19 individual health assessment tool for managers has been developed to help managers identify individual risk factors and consider what actions might support their staff.
The purpose of this document is to help managers support individuals returning to work after ill health due to COVID-19. Individuals may experience residual symptoms for some time after the initial infection has passed as they return to work.
According to the World Health Organisation (2020) COVID-19 is a mild disease for most people and some people may have no symptoms at all. Approximately 1 in every 5 require hospital treatment worldwide. Most individuals make a good recovery from COVID-19. Some are troubled by persistent symptoms, and this is more commonly seen in those who have had a severe illness and those who have required hospital treatment with intensive care. The collective term for persistent symptoms is “Long Covid”. The longer-term consequences of this illness are not yet fully understood and new information is emerging as the pandemic continues.
The most commonly described residual symptoms affect the lungs, heart, cognitive function and energy, and are described further below:
Mental health problems: Depression and anxiety disorders may develop as a new condition, or pre-existing mental health conditions may become more severe or relapse. (NHS England 2020). A consequence of severe illness and intensive care treatment may include symptoms suggestive of post-traumatic stress disorder (PTSD).
Post-Intensive Care syndrome (PICS) in those who have been ventilated or admitted to intensive care, which includes significant physical weakness from muscle loss, as well as impaired cognitive function such as problems with memory and concentration.
Cognitive difficulties: Mild cognitive difficulties are very common on discharge from hospital after acute respiratory distress syndrome and may persist to one year in about a quarter of patients. Attention, memory and executive function are often affected and even though mild, can impact on complex tasks such as managing finances, driving a car and returning to work. (NHS England, 2020).
Breathing difficulties or persistent shortness of breath, possibly associated with lung fibrosis, can occur in those who have had a severe pneumonia with COVID-19.
Physical weakness may also occur in those not admitted to critical care as a result of deconditioning. This can cause challenges with undertaking physical work, working normal contracted hours or completing a demanding commute.
Fatigue is commonly seen after viral illnesses but some individuals who have had COVID-19 seem to be experiencing extreme fatigue beyond the usual levels (NHS England, 2020).
Cardiovascular complications of severe COVID-19 can present as heart failure, with shortness of breath, fatigue and limited exercise tolerance, or arrhythmia (irregular heartbeat).
Chest pain: Individuals may report chest pain, which requires evaluation to exclude serious causes such as injury to the heart or lungs.
Insomnia: Sleep disturbance is common in those who have had a serious illness with COVID-19, lasting up to 12 months after hospital discharge with prevalence ranging between 10-60% at six months (NHS England, 2020).
Loss of sense of smell (anosmia): this can persist for three months or more in those who have tested positive for COVID-19.
Speech and language issues: Communication difficulties including dysphonia, disruption to language processing and cognitive-communication difficulties (NHS England, 2020).
Principles of a good return to work plan
Individuals with severe symptoms are likely to be unable to return to work until their recovery allows and it is recommended that contact is maintained with them during their absence. The NHS is planning for an increased workload in supporting those who require specialist assessments, treatment and rehabilitation support, and it is acknowledged that this may bring resourcing challenges.
Those who are able to return to work and are reporting symptoms that limit their capacity would benefit from support. It is suggested that the options listed below are considered in discussion with the employee, as they may assist with a return.
A phased return helps with easing an employee into the workplace when fatigue, cognitive function problems and deconditioning remain an issue. It may be helpful to extend the phased return from the standard four weeks and to acknowledge and accept that recovery may be slow
Flexible work arrangements could include:
- A combination of home and office-based work
- Adjusting work hours so as to avoid travelling at peak times
Time off for rehabilitation and medical appointments
Introducing fatigue management strategies such as regular rest breaks, temporarily reducing workload, help with prioritisation of tasks and encouraging gradual increases in activity.
Adapting work tasks, for example by considering the challenges in undertaking physical work for someone experiencing lung symptoms/shortness of breath and removing or adjusting manual tasks.
Implementing suitable control measures following a general COVID-19 individual health assessment in order to comply fully with the Health and Safety at Work Act, (1974). Further guidance can be found on the Keeping safe on campus webpages.
When to refer to Workplace Health
Some employees may be signed off work long-term, others who could work may have concerns about returning to work, and yet others may have tried to return and struggled. In these groups and for any employees where there is a concern about fitness for work and where more advice would be helpful, referral to Workplace Health would be appropriate. Details of the process can be found at management referral process.
Additional support for Employees
Employees may have had a bereavement, be concerned about their families and finances, or be experiencing mental health symptoms such as stress and anxiety. Additional resources are available as follows:
Mental health resources:
Employee Assistance Programme: Staff Support Service - Confidential, 24/7 mental health support in seconds: by phone, WhatsApp or Live Chat. Speak to information experts on legal, financial, housing and family related issues. Support available for both personal and work-related matters.
Wellbeing guidance can be accessed from Care First Zest by logging on as follows: Organisation Code: UCL1
Self-help resources from Staff Wellbeing, Mind and SilverCloud (online cognitive behavioural therapy) can be accessed through the following hyperlinks:
- Staff Wellbeing UCL
- How to improve and maintain your mental wellbeing
- How to manage stress
NHS resources include:
Cruse Bereavement Care helps people understand their grief and cope with their loss. They have a helpline (0808 808 1677, Monday to Friday, 9:30am to 5pm) and a network of local branches where you can find support.
Find and self-refer to your local IAPT service for NICE-recommended psychological therapy for anxiety, depression and PTSD for adults.
NHS Choices guidance on sleep, tiredness and insomnia.
How to manage post-viral fatigue after COVID-19
The Royal College of Occupational Therapists have also developed practical advice for people who have been treated in hospital, for those managing post-COVID fatigue at home, as well as for those in need of conserving energy during and after COVID.
We hope you have found this guidance useful. Should you wish to seek further advice particularly with concerns about how to manage chronic residual symptoms or if there are concerns about the worsening of symptoms, please consider a management referral to Workplace Health (UCL’s occupational health and wellbeing team) through the management referral process.
Further guidance and support is available from the WHO.
- Greenhalgh, T Management of post-acute COVID-19 in primary care (2000), BMJ (Accessed on 21/09/2020)
- Health and Safety at Work Act, (1974) (online) Accessed on 03/07/2020
- Reasonable adjustments: ACAS (online) Accessed on 03/07/2020
- Health and Safety Executive: Risk assessment A brief guide to controlling risks in the workplace: (online) Accessed on 03/07/2020
- COVID-19 individual health assessment tool for managers
- NHS online Accessed on 08/07/2020
- Supporting staff health and safety
- Coronavirus guidance for clinicians and NHS managers:
- NHS Secondary care
- NHS England (2020) After-care needs of inpatients recovering from COVID-19: (online) Accessed on 8 July 2020 and 21 September 2020
- World Health Organisation: Getting your workplace ready for COVID 19