Introduction
It has been evident in my practice that more and more individuals are being referred to Occupational Health (OH) over the past year (2021-2022) due to post or LC (Long covid) symptoms.
Long Covid (LC) is an umbrella term used to define post-covid symptoms lasting longer than 12 weeks. It refers to several new, recurring, and ongoing symptoms that present following initial covid infection. The main symptoms associated with LC are fatigue, breathlessness, cognitive dysfunction, and neuropsychiatric conditions such as memory and mood (Raveendran, 2021).
Although the prevalence of LC within the UK is not fully established, The Office for National Statistics (ONS) has estimated that 1in 10 people are affected by LC, within the UK alone. Due to the debilitating and fluctuating nature of LC, the evidence suggests that the effects will have negative implications on an individual’s daily functioning and their ability to remain at work and/or sustain a successful return to work. This poses challenges for both the individual and society (Rayner and Campbell, 2021).
The aim of undertaking this literature review was to understand the part OH practitioners (OHP’s) could play in the rehabilitation and recovery of individuals with suspected or confirmed LC. When searching, it was evident that, due to the recency of the condition, the literature surrounding LC and work is limited. The most widely available literature focuses on the definition of LC and its impact on individuals’ daily functioning, with only some research centred around its impact on work/employment. Additionally, very little research was found on the role that OH plays in the recovery/rehabilitation of individuals experiencing symptoms of LC. Therefore, the focus became the effects of LC in the workplace to make recommendations for practice based on the limited research available and in comparison, to other long-term debilitating / fluctuating conditions (Wong and Weitzer, 2021).
Long Covid and the workforce
Recent studies investigating the effects of LC concluded that the most prominent symptoms, 6 months post-infection, were fatigue, post-exertional malaise, and cognitive dysfunction with a substantial impact on daily life and work (Davis et al., 2021 C. Huang et al., 2021; L. Huang et al., 2021; Righi et al., 2022).
Two Scandinavian registry-based studies highlighted high-risk groups for long-term sickness absence (LTW) and emphasised how sick leave can be used as an indicator of well-being in the working population. They went on to provide insight into the burden of LC on the workforce by examining return to work trends and predictors of long-term sick leave (Jacobsen et al., 2022; Westerlind et al., 2021). The evidence available so far suggests that older age, severe Covid-19 illness (requiring hospitalisation), female gender and comorbidity were indicators of a reduced likelihood of returning to work within 6 months of infection. Jacobsen et al., (2022) hypothesised that due to the long-term health consequences of LC, those who remained absent for more than 6 months were more vulnerable to early retirement and/or unemployment.
Although there is evidence of individuals reporting a wide variety of symptoms including but not limited to; fatigue, myalgia, breathlessness, cardiac/gastrointestinal distress and cognitive deficits, the true burden of LC remains unclear (Datta, Talwar and Lee, 2020). The studies above highlighted that even if a small proportion of the millions of people infected with covid-19 go on to develop LC, the scale will have significant implications for public and global health. The main challenges that LC will present clinically are the need for long-term treatment and occupationally are thought to be long-term-term absences, presenteeism or early retirement (Michelen et al., 2020 Rayner and Campbell, 2021; Mathew, 2022). It is therefore imperative for OHPs to gain further understanding of disease presentation, prevalence, and proposed treatments for LC.
Recommendations for Practice
OH, specialists are well versed in conditions that adversely affect individuals’ daily functioning, ability to work or ‘work well’, and conditions that require multiple interventions for treatment/management purposes (Puchner et al., 2021).
Despite the recency of the condition, OHPs could play a key role in the support and management of employees experiencing LC for varying reasons: –
- OHPs use well-validated assessment tools, clinical guidelines, and a comprehensive approach during OH assessments, to provide clinically sound, beneficial advice to the employee and management.
- The comprehensive approach used in each assessment enables OHPs to examine employees’ biological, psychological, and social circumstances, matching this to their daily functioning and work.
All the above enables OHPs to aptly advise and signpost the employee experiencing LC symptoms to personalised rehabilitation interventions (Carter et al., 2015; Barnes and Sax, 2020; Godeau et al., 2021) which could include a personalised multi-disciplinary rehabilitation approach. Evidence available highlights that treatment and management of LC focused on improving physical capabilities. i.e., breathing and mobilisation rehabilitation interventions. In addition, psychological interventions such as CBT and complementary behavioural modification are likely to improve long-covid patients’ well-being and mental health (Yong, 2021). As previously cited, fatigue appears to be the most widely reported LC symptom and therefore OHPs may benefit from looking for guidance of fatigue-related conditions such as ME/Chronic Fatigue Syndrome (CFS). The gold standard treatment management advice for this is pacing, graded exercises and when warranted, CBT (NICE, 2021). OHPs are commonly able to refer and/or signpost patients to specialist services as highlighted above due to previous knowledge of other long-term condition management with symptoms that mirror long-covid (Rogers et al., 2014).
Advising and supporting a safe and sustainable return to work is a key aspect of OH services. The HSE (Health and Safety Executive) and CIPD (Chartered Institute of Personnel and Development) have published reports to inform appropriate guidance for employers and health professionals in supporting employees returning to work following absences due to long-covid. The main guidance provided is supporting the employees in the management and self-care of their condition. This includes ensuring employees have been adequately signposted to dietary, physical, and psychological resources whether online, in-house or via their GP. They also highlight that access to work adjustments and flexibility i.e., phased return to work, initial reduction to caseload and allowance to attend medical appointments, would allow for symptom management and the likelihood of a sustained return to work. LC is likely to have negative implications on the workforce. However as highlighted above, OHPs and services are well equipped in supporting and managing employees’ health needs at work. This can be achieved by utilising emerging scientific evidence and previous knowledge and expertise relating to relapsing and remitting long-term conditions with similar manifestations (Burdorf, Porru and Rugulies, 2020; Sinclair et al., 2020).
This research topic was of particular interest, as it is evident in the authors’ place of practice that more and more individuals are being referred to OH over the past year (2021-2022) due to post or long covid symptoms. Symptoms are as described and impact the ability to return to work as noted in this research. The advice to support individuals is consistent with business as usual for OHP’s when dealing with chronic multi-symptom conditions.
Phina is an experienced nurse who is currently studying for a specialist community public health nursing qualification, focusing on Occupational health. She is particularly passionate about community health and is a trustee of a charity centred on tackling mental ill-health within the African / Caribbean communities – Baba Yangu foundation. She works for PAM group which she says has been instrumental in her growth as an OH practitioner.
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