Long COVID is a term used to describe the symptoms and effects of coronavirus that last longer than four weeks beyond the initial diagnosis.
The Office for National Statistics (ONS) reported that over a four week period ending 6 March 2021, an estimated 1.1 million people in the UK confirmed they were experiencing long COVID. The rates of self-reported long COVID were greatest in people aged 35 to 69, females, those living in the most deprived areas, those working in health or social care, and those with a pre-existing activity-limited health condition.
Symptoms may include: persistent fatigue, shortness of breath, brain fog (cognitive challenges), insomnia, dizziness, depression, anxiety and a range of other symptoms which can be found on the NHS website. (If you have any concerns about yourself/ a colleague's symptoms lasting four weeks or more after having COVID-19, please contact/ advise them to contact their GP).
There is still uncertainty around the prognosis of long COVID as each person can experience a range of different symptoms. In some cases, people have begun to feel better before experiencing a return of fatigue and needing further time off to recover. This is known as the ‘boom and bust’ pattern where the person's fatigue levels will fluctuate. Therefore, it is important to ensure that you are having regular conversations with your colleagues to ensure they understand what their needs are and to prevent the risk of relapse.
In this section, we have outlined how health and wellbeing leads can work with line managers to:
It should also be noted that there is an ongoing debate
whether employers should view long COVID within the context of workforce disability
in line with the Equality Act 2010, which states: 'A person has a disability if they have a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on their ability to carry out normal day to day activities. If the long COVID symptoms, described above, have a substantial adverse impact on the employee carrying out day-to-day activities and the impairment has lasted or is likely to last for 12 months, then it could fall within the definition of a disability under the Equality Act and the employee should not be treated less favourably as a result of that condition, and the duty to make reasonable adjustments
would be triggered.'
Recovering from long COVID can be a lengthy process and employees will need to be supported to recover at their own pace ensuring that they do not relapse. Line managers can support staff member with long COVID by:
- Having regular wellbeing conversations to see how staff members are feeling now that they have returned to work. Checking whether any staff member that is working reduced hours and has a less demanding caseload are still happy with this arrangement and whether they would like to make any reasonable adjustments.
- Asking whether the staff member is working flexibly to allow them time to adjust back into the workplace, working longer/ shorter days, taking longer breaks etc.
- Recommending that staff members join long COVID support groups and peer networks.
- Highlight wellbeing services and psychological support.
- Signpost staff to multidisciplinary post COVID rehabilitation clinics (where available) - staff can be referred via a GP or occupational health.
Line managers also need to be supported and guided on how they can manage and support their staff effectively while they are absent from work.
Line managers can review what support is already available to them in their organisation, which can be found in the section above (supporting staff at work with long COVID). Line managers may also want to ensure that they are:
- maintaining regular contact to support and connect with staff during their absence
- refer to local sickness absence procedures to ensure that appropriate principles are applied to support staff
- Signpost to local support/ in-house services such as:
musculoskeletal and rehabilitation services
financial wellbeing advice
guidance on working from home
chronic fatigue services
- refer colleagues to an occupational health adviser to ensure they are supported as early as possible.
When an NHS employee is on sick leave for a long time or is returning from sickness absence, they should be assessed by their occupational health team to ensure that they are ready and able to return to work. This is to ensure that the employer understands what their employee needs to return to work safely.
Occupational health may advise that the staff member:
- is unfit to return to work and should continue to stay on sick leave with regular check-ins
- returns to work on a phased return with reduced hours allowing sufficient time for recovery
- does a less physically demanding role such as admin/ taking phone calls/ reducing their caseload that will allow them to work at a desk or in some cases from home
- does a less cognitively demanding role by considering job rotation and adjustments such as moving to a less cognitively demanding work area and reducing caseloads.
Working closely with your organisation’s occupational health team on how to support staff with long-COVID can help you to understand:
- how to support staff during their sickness absence
- the symptoms of long COVID and how they can affect performance at work
- how to support staff returning on a phased return
- how to support staff remaining at work.
Employers should follow the latest government guidance to enable staff to work from home where possible. However, we understand that this may be difficult for the majority of NHS staff that cannot work from home due to their jobs being hospital-based.
Staff may be anxious about returning to the workplace after having time off sick with long COVID and may require additional support from their manager and organisation. This may include:
- holding a wellbeing conversation with staff about how they feel about returning to work, to listen and support them with any anxieties and explore options to support a return
- giving staff less physically and emotionally demanding jobs
- having a conversation about the staff member working shorter hours or take longer more regular breaks
- allowing staff to return to work on a standard or extended phased return
- ensuring that conversations about returning to work are under constant review and that staff feel comfortable about returning to work.
The Society of Occupational Medicine (SOM) has produced a return to work guide for managers on how they can provide ongoing support to staff to return to work following COVID-19 infection and long COVID.
The Faculty of Occupational Medicine (FOM) has produced guidance aimed at healthcare professionals to assist them in facilitating the return to work of staff members who were unable to work due to long COVID. This guidance includes a set of practical steps, a state of fitness for work, and supplementary policy and guidance documents.
Staff with long COVID may benefit from a gradual return to work that can be adapted to everyone’s circumstances.
Some may experience difficultly in being able to fulfil the physical, emotional and cognitive side of their role, therefore, the phased return may allow them to:
- work from home (when possible)
- work reduced hours
- work a more flexible working pattern, for example, three longer days instead of five shorter days
- take regular and longer breaks - research shows that short and frequent breaks are more effective
- reduce their caseload
- work less cognitively demanding jobs if the staff member is suffering from brain fog
- work at a desk if their current job is physically demanding, reduce physically demanding aspects of the job
- discuss opportunities to be redeployed.
For more information on a phased return, employers should follow the latest NHS Staff Council guidance Joint FAQs on COVID-19 sickness management – 3 September 2020 (question 3).
NHS Employers' Reasonable adjustments in the workplace web page features a number of organisations, including government bodies, that have developed a range of good practice videos and guidance to help employers support their staff.
The employer should regularly check in with the employee to ensure that this pattern of work is suited to them and explore if it is necessary to increase or decrease their workload
Please note that this guidance on COVID sick pay is currently under review.
The sick pay arrangements for those absent from work with COVID-19, including long term, are set out in the Department of Health and Social Care's workforce guidance and supporting FAQs.
The University Hospitals of Derby and Burton NHS Foundation Trust has created a helpful video presented by an occupational therapist (who is a part of the organisation’s therapy department) that outline how managers can support staff with ongoing COVID-19 related symptoms to return to work safely.
Chesterfield Royal Hospital NHS Foundation Trist has set up a peer support network for colleagues that have long COVID. The support group meets online to discuss the effects of long COVID and to check in on how they are feeling and share experiences. Managers and staff (who do not have long COVID) are invited to join these meetings to find out more information on how they can support their colleagues.
Herefordshire and Worcestershire Health and Care NHS Trust has been running fortnightly long COVID peer support groups for staff and managers. The group has been received well by staff with new members joining regularly. Staff can talk openly about how they are coping with long COVID and how their managers can support them. The trust's associate director of HR attended to answer questions on policies, sickness and pay, which staff found extremely valuable. A member of the long COVID group is scheduled to attend the trust’s workforce committee meeting (which a number of directors sit on) to share their story and experience of having long COVID to raise awareness and highlight the support needed.
Liverpool University Hospitals NHS Foundation Trust had 40 members of staff with long-COVID attend a six-week virtual programme with their occupational therapist. The trust now has a support group that meets monthly. The group is very proactive in researching ways on how to be the best they can be at work.
Belfast Health & Social Care Trust's occupational health department provide a long COVID assessment clinic that is occupational therapy led. This enables individuals to focus on functional ability that facilitates a holistic approach to individuals returning to work and importantly, remaining in work. The clinic provides self-directed rehab, multi-disciplinary team rehab, respiratory rehab and horticultural rehab. This innovative intervention has enabled staff to return and remain at work successfully.