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Long COVID

Manager’s guidance on how to support individuals returning to work who are recovering from COVID-19 (‘Long COVID’).

Introduction

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.

Long COVID

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: 

NHS resources include:

Physical Health resources:

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.

References

Contact us

Forms

All Occupational Health forms used at UCL Workplace Health

Quick links

Workplace Health Confidentiality Statement 

Long Covid support 

Disabilities equality  

Eyecare application  

SEQOHS accreditation