Long Covid in the Workplace: Strategies to Help Employees Manage Illness

Employers may be surprised to find that the implications of COVID-19 are still far from over as affected employees continue to face barriers in the workplace. In October 2022, estimates from the Canadian COVID-19 Antibody Health Survey indicated that 14.8% of adults with a confirmed or suspected COVID-19 infection experienced longer term COVID-19 symptoms¹. That’s about 1.4 million adults in Canada who can be described as “Long Haulers.”

More than 100 symptoms have been reported by those living with the Long Covid condition that appear associated with reduced quality of life, function, and ability to work². Much is still unknown about the condition. Staying at work or returning to work will be difficult for these employees as they deal with the mental, physical, and cognitive symptoms with limited support and intervention. Employers should consider the unique role of Occupational Therapists in their ability to help employees manage and recover from illness.

What is Long Covid?

WHO officially defines Long Covid, or Post-COVID-19 condition, as the following:

“[a condition that] occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.”³

There are several theories about why Long Covid exists: residual organ damage, continued and exaggerated immune response, remaining virus in the system, etc. Diagnostic tests often appear normal, despite the persistence of symptoms. While the causes and long-term impacts are still being studied, research shows that long-term symptoms are most common in people of working age, females, those living in deprived areas, healthcare and social workers, and those with pre-existing health conditions and disabilities.

Symptoms and Functional Implications

Long Covid is multidimensional, episodic, and unpredictable. It appears differently in every individual, though some of the most commonly reported symptoms include the following:

• fatigue
• sleep disturbances
• shortness of breath
• chest pain and palpitations
• general pain and discomfort
• cognitive problems, such as memory loss and difficulty thinking or concentrating (sometimes called “brain fog”)
• mental health symptoms, such as anxiety and depression

Some patients also report that over-exertion can exacerbate symptoms. As a result of post-exertional symptom exacerbation (PESE) or post-exertional malaise (PEM), individuals may have an abnormal response or “crash” after a minimal amount of activity⁴. There is often a delay of response, which makes it difficult to anticipate what activities require “too much” energy expenditure. Triggers can be physical, cognitive, or social-emotional.

Symptoms can strongly impact an individual’s ability to participate in meaningful occupations and activities. The Canadian COVID-19 Antibody Health Survey indicated that of the adults with Long Covid experiencing symptoms:

• 3% experienced symptoms for 1 year or longer
• 3% report that their symptoms often or always limited their daily activities
• 1% of those who were employed or attending school, missed work or school due to symptoms (an average of 20 missed days per person)

As Long Covid does not have a cure, finding strategies to manage symptoms is critical to ensuring Long Haulers can return to meaningful activity in their lives.

Occupational Therapy Intervention

Occupational Therapists are experts in managing complex experiences and are trained to support employees living with a variety of mental, physical, and cognitive health issues. With their speciality of helping employees re-engage in meaningful activity in the home, at work, and in the community, Occupational Therapists are primed to help employees living with Long Covid.

Depending on a specific person’s support needs, Occupational Therapists can help patients develop the following strategies:

• Symptom self-management: client-centred and goal-oriented, this strategy is about providing individuals with education, validation, peer support, and resources to manage their condition.
• Energy conservation: one of the most impactful starting places, this strategy can help individuals plan, prioritize, pace, and position themselves to maximize and track energy use.
• Ergonomic assessments and adjustments: considering the work set up and employee habits can help with fatigue and pain management.
• Mental health assessments and treatments: OTs can provide CBT strategies to help employees reframe negative thoughts about their condition, resiliency strategies, and other mental health resources.
• Physical and cognitive rehabilitation: OTs can help individuals learn compensatory strategies for symptoms and build cognitive and physical activities back into a regular routine.
• Return to work programs: OTs can help build activity tolerance set expectations with employees and workplace stakeholders about returning to work after a lengthy time off with illness and develop schedules that allow employees to gradually resume regular activities.
• Accommodation strategies: considering changes to the work, worker, and workplace can help employees continue to participate in meaningful work; some examples of strategies include flexible schedules, altering tasks, remote work or changes to the work environment, and assistive devices, among many others.

What Can an Employer Do?

Managers are the first point of contact for a worker. They are best placed to help employees feel valued and to greenlight accommodations and job modifications. Employers should consider the following ways managers can provide support to employees:

1. When returning someone to work after they have been off with COVID-related illnesses, communicate regularly and openly about limitations that might impact job performance and safety at work. Limitations may include:
   
   • Difficulty focusing or concentrating and cognitive challenges
   • Difficulty managing worry and anxiety
   • Difficulty with high fitness level activities
   • Challenges with safety sensitive decisions
2. Develop a gradual return to work process to support gradual return to duties for those off work for extended periods of time.
3. Consider temporary work adjustments that compensate for cognitive challenges and fatigue (e.g., scheduling, energy management, microbreaks/pacing).
4. Request an accommodation assessment to assist the employee in having the tools to perform the work.

How Can Gowan Consulting Assist?

1. We provide accommodation assessments for employees to ensure that they can stay at work sustainably and successfully.
2. Our return to work facilitation program supports employees who may need the development of a customized return to work process.
3. Gowan Consulting can provide a Functional Cognitive Assessment to ensure that the employee has the cognitive skills and strategies to perform high cognitive demand and safety sensitive work.

Make a referral here or contact us at [email protected] to learn more.

References

[1] Government of Canada. (2023, March 15). COVID-19 for health professionals: Post-COVID-19 condition (long COVID) - Canada.ca. Retrieved March 29, 2023, from https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals/post-covid-19-condition.html

[2] Ontario COVID-19 Science Advisory Table. Understanding the post covid-19 condition (long covid) in adults and the expected burden for Ontario. (2022, September 15). Retrieved March 29, 2023, from https://covid19-sciencetable.ca/sciencebrief/understanding-the-post-covid-19-condition-long-covid-in-adults-and-the-expected-burden-for-ontario/

[3] World Health Organization. (n.d.). A clinical case definition of post covid-19 condition by a Delphi Consensus, 6 October 2021. World Health Organization. Retrieved March 29, 2023, from https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1

[4] Long Covid Physio. (n.d.). Post-exertional symptom exacerbation. Retrieved March 29, 2023, from https://longcovid.physio/post-exertional-symptom-exacerbation