Long-covid update for employers
So far there have been over 246 million reported cases of Covid worldwide, with over 5 million deaths. In the UK, there have been over 9 million cases reported and 575,000 admitted to hospital.
Although mortality rates have fallen from over 30% of hospitalised patients to less than 20%, the spectre of long-covid still remains an issue for patients and employers.
It has long been recognised that surviving a critical illness can leave patients with poor health, reduced functional status and psychological impairment for many years.
So far the largest study on the long-term impact of COVID-19 on patients was conducted retrospectively (looking backwards at patient records) in Wuhan. It showed ongoing symptoms at 6 months post-infection with a strong association with the severity of illness: those who were most acutely unwell in hospital suffered more over the following months.
We reported in our long-covid guidance for employers (January 2021) that more than 80% of the patients tracked in the Wuhan study had persistent symptoms 6 months after infection. This was true even though many of the patients had not required supplemental oxygen treatment, which is a good indication that they had fairly mild infection.
A new UK study
Now a team of researchers has completed the largest study, across multiple UK centres, reporting on the impact of COVID-19 on the medium-term health of survivors.
The study (published in The Lancet Respiratory Medicine last month) tracked 1,077 patients across the UK. The patients underwent detailed physiological and biochemical testing between 2 and 7 months after discharge from hospital.
Of the patients tracked 36% were female, 31% were of non-white ethnicity, 27% had been on a ventilator and 50% had at least two other health conditions. The average age of the patients was 58 years old.
Breathlessness, fatigue, mental health, cognitive impairment and physical performances were all closely analysed in the study.
The results of the study
The new long-covid study was well structured, detailed and comprehensive. It found that:
- Only 239 patients felt fully recovered (29% of 830 participants)
- 158 patients had a new disability
- 124 experienced a health-related change in occupation
The main risk factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities and more severe acute illness.
The severity of physical and mental health impairments was closely related, whereas cognitive health impairments were independent. That suggests anyone who has long-covid, irrespective of the severity of infection, may be susceptible to cognitive impairment for months after the infection.
What it means for employers
The findings of the study confirm a large burden of symptoms persisting at 5 months after discharge, many of which may adversely affect attendance at work.
However, of note is the finding that a substantial proportion of survivors reported a new disability and disruption to employment. This has implications for workforce management, planning and recruitment.
As mental and physical health impairments were only weakly associated with the severity of acute illness, it may be incredibly difficult to predict who may need support and when.
Our report suggests that a proactive approach and broad ranging holistic clinical care are needed, owing to the large burden of health impairments. The scope of support indicated may be difficult to access via the NHS.
What can employers do to aid recovery?
The first step considered to support employees with long-covid is likely to be self-management. This includes helping to set goals to aid recovery, providing information about who to contact if things get worse, referral to support groups and sources of support.
It is not yet known whether over-the-counter vitamins are helpful, harmful or make no difference. However, encouraging all employees to maintain health diets and lifestyles is always sensible.
If symptoms persist, specialist medical advice may help. Phased returns to work or temporary adjustments to a role could be considered. If you haven’t already, it is at this point that you should consider making a referral to occupational health.
Depending upon the severity of symptoms, some employees may be referred into multi-disciplinary rehabilitation support. Many private and NHS support services are now up and running, however, some regional differences in available support do exist.
What else can employers do to support an employee?
Long-covid is incredibly challenging for both HR specialists and doctors. Because Covid infection cannot be ruled out, it is likely that every employee who presents with relevant symptoms will need to be given the benefit of the doubt.
Because a long-covid diagnosis is subjective and the symptoms are so varied, it is in many ways similar to some other chronic conditions, which can also be challenging to manage (like Fibromyalgia and Chronic Fatigue Syndrome/ME).
Primary care, occupational health, physiotherapy, EAP’s and other services are likely be involved, possibly in different phases. This may well require some significant patience and co-ordination, especially if it is led by an employer.
Just because an employee has a long-term medical condition, it does not mean an employer has no options. As a last recourse, the capability channel will remain available. However, that will usually require professional insight and support from occupational health and/or specialist legal support.
What does the future hold?
It’s incredibly difficult to predict the future, although as the number of people infected continues to grow, so will the number of people presenting with long-covid.
It is too soon to say what kind of impact vaccination has on long-covid, although studies are looking closely at the topic. Nobody knows how long the condition may continue for, although many patients do recover well after about three months.
It is likely that the burden of supporting employees with long-covid is likely to increase steadily before it falls back in the coming years, as case numbers fall. That extra work is likely to fall on HR shoulders too.
About Occupational Health Assessment Ltd
Occupational Health Assessment Ltd provides rapid access to expert occupational health support for businesses across the United Kingdom.