LONG COVID – THE NEXT OH CHALLANGE

Although advising on this new disease is daunting, we have the existing knowledge and skills to be able to support employees and management. We already assess the functional impact of the symptoms outlined above and offer advice regarding their impact on workability and appropriate adjustments. This is because these symptoms are not unique to COVID 19. We can utilize the knowledge we have gained regarding conditions such as multiple sclerosis, fibromyalgia, chronic respiratory disease, cancer, stroke and traumatic head injury to inform our practise. Going back to basics and carrying out a good functional assessment, looking at the impact on activities of daily living, is a cornerstone of OH practise. The World Health Organisation (WHO) in their training package on COVID-19 rehabilitation, repeatedly advocates the use of well validated assessment tools to assess and monitor progress.¹ The concept of fatigue and how it impacts on daily life is hard to describe. Therefore, assessment tools such as the Chandler Fatigue Scale (CFQ11)^15,16 and the Fatigue Assessment Scale (FAS)¹⁷, can help us to assess the impact the fatigue is having on both physical and mental functioning, in a reliable and reproducible manner. The Medical Research Council (MRC) dyspnoea scale¹⁸ has long been used for grading the effect of breathlessness on daily activities, with a level 3 score being used as a criteria for further investigation and respiratory rehabilitation.¹⁹ Other specific assessment tools have been developed by various multidisciplinary COVID rehabilitation clinics and are included in the appendix of the NHS England guidance for post-covid syndrome assessment clinics.²⁰

It is estimated that approximately 15 – 20% of people who develop COVID-19 symptoms will require hospital treatment, while 5% are likely to need intensive care^13.  This cohort of patients is the group that multidisciplinary rehabilitation services are predominantly targeted at. However, as many individual’s with post COVID symptoms will not have been hospitalised or have had limited contact with primary care services, we may provide their first in depth interaction with a health care professional. This gives us chance to really add value by helping them to learn to mitigate the impact of their symptoms and aid rehabilitation, by highlighting available techniques, signposting them to patient education materials and referring them to rehabilitation services or primary care, as appropriate.

For example, highlighting the importance of avoiding over exertion resulting in prolonged periods of rest (Boom and Bust type scenario), as this is not thought to be helpful. Instead taking the 3 Ps approach, planning activity to be as efficient as possible e.g., using equipment to reduce the effort required to carry out a task, does it need to be done today, can it be delegated. Prioritising the most important or demanding tasks to when the individual feels the most refreshed. Pacing activity to available energy, i.e., carrying out short periods of activity but taking a rest, or alternating to less demanding tasks, before exhaustion hits. Many people are trying to speed their recovery up by pushing their activity. I have been using the analogy of a broken bone: it takes time for the body to heal, and effort and will are not necessarily going to speed recovery. Instead, adopting a graded approach to gradually increasing activity is likely to be of more benefit.^2,21

Experiencing breathlessness can understandably cause anxiety. However, as with back pain, there are suggestions that fear avoidance behaviour can prolong recovery.^2,21 Using breathing exercises and posture can reduce the effort required and make breathing easier. Deep breathing and pursed lip exercises can help with anxiety, paced breathing can help meet the demands of exertion, while controlled breathing techniques may reduce breathlessness. However, as with back pain, there are some potential red flags due to the increased risk of cardiac conditions and PE. If patients feel severe shortness of breath that does not improve with positions and breathing techniques, then further medical assistance should be sought. I am not advocating we as OH professionals teach these techniques, as for most of us this will be outside our area of expertise. However, having an awareness of them can be helpful. The WHO have created a free online E training package on post COVID rehabilitation and an associated patient guide which covers these techniques in more detail.² There is also the NHS ‘your COVID recovery’ website, which is a good resource to direct employees to.²¹

Managers and HR are looking to Occupational Health for guidance in order to help them manage their workforce. Indeed, some in the HR sphere have already identified the significant impact Long COVID is likely to have on a large cohort of the workforce, and that they need to start taking into consideration how they might need to review sickness absence policies on rehabilitation, phased return to work and redeployment, to accommodate this.²²