COVID Long Hauler Syndrome:  Is this a new health condition or a variation of an old health condition reimagined?

COVID Long Hauler Syndrome: Is this a new health condition or a variation of an old health condition reimagined?

As of April 5, 2021, there have been over 1 million reported cases of COVID-19 in Canada and over 23,000 deaths and almost 56,000 active cases.  With over 927,000 recovered cases, a large number of Canadians who have had COVID-19 have recovered in the past year. 

There are a number of studies that are now showing symptoms in individuals that are persisting. Many physicians and specialists are beginning to report a cohort of individuals who have recovered but continue to show unusual symptoms, whether it was from minor non-hospitalized patients to severe post-hospitalization patients. There are some that are describing brain fog, hearing loss, shortness of breath, fatigue, tremors, heart damage, neurological symptoms, CNS damage, and lung damage—and the list keeps growing.   

The debate is about the cause. Is it a direct result of the virus and the impact on organs and the CNS or is it related to inactivity or even psychological trauma as a result of dealing with this virus?

Defining Long COVID

  • Post-acute COVID-19 is defined as persistent symptoms and/or delayed or long-term complications beyond four weeks from the onset of symptoms.

How Many Long COVID Cases Are Predicted?

Anthony Komaroff, MD Professor of Medicine at Harvard Medical School and editor in chief of the Harvard Health Letter, predicted that 20 MILLION cases of Long COVID will appear in the next year – and they will be similar to other post-viral syndromes, e.g., chronic fatigue syndrome. This prediction was based on the following:

  1. The predicted 200 million COVID-19 cases globally by the end of 2021.
  2. Previous data about myalgic encephalomyelitis suggesting a 10% rate of symptoms persisting at least a year following a variety of infectious agents (and as you’ll read below, up to 75% with work disability).
  • Approximately 70% of long-haul patients were women and 16% had preexisting autoimmune disorders.
  • Some reported they were 95% recovered after 2 months, while in 10% it took 9 months.

What Are the Symptoms of Post-acute COVID 19 (Long Hauler Syndrome)?

Here is a list of reported symptoms post-COVID identified in a 2021 study by Annals of Clinical and Translational Neurology (Medscape 2021):

  • Cognitive dysfunction, reported by 81%
  • Headache, 68%
  • Numbness or tingling, 60%
  • Disorder of taste, 59%
  • Disorder of smell, 55%
  • Muscle pain, 55%
  • Dizziness, 47%
  • Pain, 43%
  • Blurred vision, 30%
  • Tinnitus (ringing in the ears), 29%
  • Fatigue, 85%
  • Depression or anxiety, 47%
  • Shortness of breath, 46%
  • Chest pain, 37%
  • Insomnia, 33%
  • Variation of heart rate and blood pressure, 30%
  • Gastrointestinal complaints, 29%
  • Many patients (42%) reported depression or anxiety prior to COVID diagnosis, said Koralnik, suggesting a “neuropsychiatric vulnerability” to developing long-haul COVID-19.

The picture below shows the symptoms at various weeks length of recovery from COVID and the potential impacts. 

Nalbandian, A., Sehgal, K., Gupta, A. et al. Post-acute COVID-19 syndrome. Nat Med (2021).

Research from The Lancet also indicates that “COVID-19 is followed by significant rates of neurological and psychiatric diagnoses over the subsequent 6 months.” According to their studies, those who require hospitalization have a higher risk of adverse outcomes, but the risk is also increased for COVID-19 patients who were not hospitalized” (The Lancet). The following neurological and psychiatric diagnoses have been associated with patients post-COVID:

  • The risk of cerebrovascular events (strokes and hemorrhage)
  • Dementia
  • Anxiety and mood disorders
  • Psychotic disorders
  • Substance use disorders

Common psychiatric disorders showed a weaker link than neurological disorders, which may suggest that some psychological systems may reflect the implication of a COVID-19 diagnoses rather than a manifestation of the illness itself (The Lancet).

What Is the Cause of Long Hauler Syndrome?

The large group of people who self-identify with Long COVID includes at least three sub-groups:

  • A sub-group of people who are simply having slow recoveries because their tissues were severely damaged or deconditioned by serious COVID-19 illness (ICU, ventilator, long hospitalization, etc).  
  • Another subgroup that had less severe illness, but probably has some residual (temporary or permanent) biologic dysfunction in various organs or body systems that suffered damage or were altered — but we don’t currently have a way to “see” it.   In the absence of objective signs or lab tests, there is no way to distinguish this subgroup from the one below other than by the passage of time and their behavior — the way they respond to their predicament, to alternative causal hypotheses, and appropriate treatments. 
  • The largest subgroup may be those that have persistent somatic symptoms and dysfunctional behavioral responses as the result of the psychic trauma of this pandemic period – especially those whose situations are complicated by risk factors for the development of chronicity.

How Does Long Hauler Impact Return to Work?

Of concern is that there are RTW slips without restrictions by treating physicians that do not address these issues.  And from the employers, we have heard, “the person who left sick is not the same person who has returned.” This is now being termed as “Long Hauler Syndrome.”

A real concern is that employees are hesitant to say anything because they are drivers, engineers, or security force.  Can they safely drive, wear a respirator, or perform high cardiac demand jobs (firefighters) without a RTW evaluation? 

Supervisors may need to pay close attention to their employees and watch for any issues and may need to request a Fitness for Duty evaluation. It may be advisable that the employee would benefit from a Functional Cognitive Evaluation or an accommodation assessment by an Occupational Therapist or potentially a referral to other specialists (Jay Hammett MD, Oak Ridge, TN).

What Can an Employer Do?

As an employer, it is important to notice those signs or symptoms that may be impacting the employee’s return to work or ability to perform the work activities. It would be suggested that you consider the following steps as part of your Fitness to Work process.

  1. When returning someone to work after they have been off with COVID-related illnesses, discuss any behaviours or limitations that might impact the job performance and safety at work.
  2. Develop a gradual return to work process to support gradual return to duties for those off work for extended periods of time.
  3. Ensure that you have a fitness for work form that is completed by the health care provider to determine any restrictions or limitations in the return to work planning.
  4. When an individual returns to work, notice if someone is showing signs or symptoms that they are not able to perform the essential duties of the job.  These signs may include the following:
    • Difficulty focusing or concentrating and cognitive challenges
    • Difficulty managing worry and anxiety
    • Difficulty with high fitness level activities
    • Challenges with safety sensitive decisions
  5. Consider temporary work adjustments.
  6. Request an accommodation assessment to assist the employee in having the tools to perform the work.

How Can Gowan Consulting Assist?

  1. Gowan Consulting can provide an Accommodation assessment for your employees to ensure that their return to work is sustainable and successful.
  2. Gowan Consulting has a TIPS Program that is a 4-session return to work/stay at work program to support an employee in coming back into the workplace successfully. This program includes work focused Cognitive Behavioural Therapy to manage any worries or concerns about return to work and provision of support to implement job coaching for stay at work strategies.
  3. Gowan Consulting can assist with a return to work facilitation program to support employees who may need the development of a customized return to work process.
  4. 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 to learn more.

Tools and Training

  • FREE webinar series: Accommodation Conversations: In April we are hosting three sessions on accommodating employees during and after a pandemic. Sign up for one session or all three!
    • April 15, 2021: The Impact of COVID on Accommodations
    • April 22, 2021: Unique Accommodation Issues
    • April 29, 2021: Dealing With the Program Issues
  • Implementing the CSA Work Disability Standards: This interactive virtual program includes three hours of virtual training and online modules to help employers understand the components of the Work Disability Management System Standards published in 2020.
  • Our virtual office ergonomic assessments are now ON SALE for a limited time! Now until April 30th, get $100 off – that’s only $300 for a virtual ergonomic assessment! Make a referral here to take full advantage of the deal.
  • Manager Mental Health Training is now running all year long! Our next session takes place on May 18, 2021. Get a full list of dates and more information on the sessions here.
  • Manager’s Toolkit and Webinar – Our FREE Manager’s Toolkit now comes with a webinar to help provide strategies and resources for employees’ return to work post-quarantine.
  • TIPS for Return to the Workplace Program– Consider enrolling in our new 4-session work-focused CBT program to assist you or your employees in having the strategies to successfully return to work.
  • Complex Accommodation in the Workplace – Our online certificate program will help you understand how to develop your accommodation program and give you strategies to manage complex accommodations.


Workfitness roundtable 2021 discussions

Harvard Medical Review

Nalbandian, A., Sehgal, K., Gupta, A. et al. Post-acute COVID-19 syndrome. Nat Med (2021).

Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study Daniel Ayoubkhani, Kamlesh Khunti, Vahé Nafilyan, Thomas Maddox, Ben Humberstone, Ian Diamond, Amitava Banerjee; BMJ 2021;372:n693 | doi: 10.1136/bmj.n693

Neurologic Symptoms Frequent in Nonhospitalized COVID Long-Haulers – Medscape – Mar 23, 2021.

6-month neurological and psychiatric outcomes in 236379 survivors of COVID-19: a retrospective cohort study using electronic health records, The Lancet, Maxime Taquet, John R Geddes, Masud Husain, Sierra Luciano, Paul J Harrison, Published online April 6, 2021,

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