Due to persistent symptoms, a significant number of patients with long Covid are unable to return to work and may require long-term rehabilitation. There are a number of risk factors, including societal and medical attitudes, reduced capacity and changes in cognitive and mental function, that must be considered when planning the return to work of someone with long Covid.
What is Long Covid?
Long Covid is a term used to describe the effects of COVID-19 that continue for weeks, or even months beyond the initial illness. The World Health Organisation (WHO) defines long Covid as continuing for longer than 12 weeks and which cannot be explained by any other diagnosis.
Societal and Medical Attitudes towards long Covid
Since long Covid is a new concept in the early stages of research, many long Covid patients report dismissive attitudes by medical providers. This can make seeking care (whether psychological or physical) even more challenging. Likewise, friends and family who are unfamiliar with the emerging science on long Covid may express doubts or surprise at how severe and persistent the symptoms are. These societal attitudes and lack of understanding have resulted in many people avoiding care.
These attitudes must also be considered in the return to work environment, where employers and insurers may not be understanding of the difficulties faced by someone experiencing long Covid-19 trying to return to preinjury duties and hours.
Cognitive Function and Mental Health
Patients with long Covid-19 frequently rank cognitive function and mental health at the top of their concerns. When talking with patients who have long Covid-19, it’s important to start by asking about their most prominent concerns and what their goals are.
This may include asking the following overarching questions:
- “What are you hoping to get back to?”
- “If you weren’t sick, what would you do today?”
Answering these questions can help patients and health practitioners to identify specific goals and start developing a plan for what a meaningful life could look like. It is important for patients to know that their experiences are valid and real and that they can try to alleviate them by making changes to their mood, behaviour, and more.
So far, research indicates that COVID-related encephalopathy may lead to other neuropsychiatric outcomes, including psychosis. It’s important to bring in psychologists who can monitor and address any mental health symptoms that emerge.
For patients experiencing issues like brain fog or memory loss, their mental health will affect their cognition. Patients with severe cognitive issues, such as difficulty accessing important memories or lack of executive functioning would require referrals to a specialised psychologist or neuropsychologist.
For patients reporting less acute symptoms, health professionals may provide the following:
- Education on anxiety management strategies
- Coping strategies for irritability, frustration and sadness
- Behaviours patients can engage in to improve emotional states
- Positive, yet realistic thinking strategies
Health professionals can help people with long Covid-19 manage anxiety about what their symptoms may look like in the future by teaching them to focus on the present. Mindfulness therapy can be one avenue for patients to increase awareness and acceptance of their experiences and change their mental and emotional reactions to physical symptoms, and it can help control panic over symptoms like breathlessness. We cannot control what the future holds. All we can control is your behaviours and thought patterns in the present.
Reduction in Work Capacity
Clients with fatigue may need help mapping out plans for how many tasks they can complete that day, and what they can ask their families to take on. Many people with long Covid may not be able to accept having reduced or no capacity to work, leading to a decline in self-worth and independence. Other consequences may include feelings of hopelessness, thoughts of self-harm and suicide, and the fear that COVID-19 could affect the rest of their lives.
Fear of Returning to Workplace
Many people with long Covid-19 experience fear and anxiety returning to the workplace. This may include fear of infecting others, past infection of others and fear of becoming reinfected. This is particularly prominent if they have infected someone previously who has deconditioned or passed away. These are additional factors that must be considered when planning the return to work of someone with long Covid.
A number of symptoms of long Covid-19 are related to fatigue, shortness of breath, heart palpitations and pain which may not only affect someone’s capacities and abilities to complete pre-injury duties/hours but may also pose a risk to themselves or others in the workplace. Consideration of additional risk factors due to symptoms of long Covid-19 is crucial to facilitate a safe return to work.
EU-OSHA’s guide explains the challenges of returning workers and managing long Covid symptoms:
It outlines some modifications to workplace duties and hours that may facilitate a return to work and recovery at work plan.
- Alterations to timings and hours
- Alterations to workload
- Taking regular breaks
- Additional support and supervision
- Time off for healthcare appointments
- Phased return to work and option for working from home
- Equipment adjustments
It also outlines what employers can do to assist with facilitating return to work:
- Stay in touch while the worker is absent from work
- Prepare for the worker’s return
- Have a return-to-work conversation
- Provide support during the early days of the return to work
- Provide ongoing support and review regularly
Rehab Management has been working closely with our customers to research the ongoing impacts of long Covid, particularly from a return to work perspective. We will continue to share our research with our clients.