As we are now well into a second, or is it now the third, wave of Covid-19 it is becoming apparent that Covid is something we have not experienced before and it has unique implications for staff management. It is not just the possibility that staff may become acutely ill with the virus, but that for some they may go on to develop persistent debilitating symptoms that will affect their ability to go back to work. This article looks at the implications of long-covid for HR and service managers when looking to support health care professionals (HCPs) return to work.
It is becoming apparent that Covid is not just a mild infection that goes away after two weeks but can leave sufferers with persist health problems for weeks and months. Data collected by ONS for the Coronavirus (COVID-19) Infection Survey is beginning to show the incidence of long term illness following Covid infection. They estimate that around 1 in 5 people testing positive for Covid will show post infection symptoms for 5 weeks or longer, whilst around 1 in 10 people will still show post infection symptoms at 12 weeks or longer.
Like SARS, Covid is leaving some people with significant and persistent physical symptoms characteristic of chronic fatigue syndrome. Sufferers report symptoms like muscle and joint aches, brain fog, memory problems, post exertion fatigue, shortness of breath and these symptoms do not appear to be linked to the severity of the initial infection experienced by people.
People who have experienced mild symptoms, who may not have been to hospital may not have a diagnosis but develop debilitating post-viral symptoms. This long-tail end of Covid is likely to present new challenges for managers endeavouring to maintain patient services over the next phase of the pandemic and beyond.
Data from the Covid Symptoms Study App show that patients can have these debilitating symptoms for many months. Clinicians are now describing this pattern of post infection symptoms after ‘mild’ Covid as ‘long-Covid’ because these symptoms can persist for months (possibly years) after infection.
“We don’t know about corona, but I think it will lead to many, many cases of post-infective fatigue syndrome.”
Simon Wessely, former president of the Royal College of Psychiatrists
The longer-term health after mild (non-hospitalised) Covid infection is ‘frighteningly poor’ says Michael Rutgers, the Director of Longfonds, the Dutch Lung Foundation; a charity dedicated to reducing lung disease. Longfonds conducted a survey of 1600 people with Covid-like symptoms. The average age of those who participated was 53 years and over 85% reported having good health before Covid. After their illness only six percent said they felt well. More starkly half of the respondents reported that they were no longer able to exercise with more than 6 in 10 of those surveyed reporting they have difficulty walking and 95 percent reporting problems with simple daily activities. Ninety one percent of respondents reported that they had never visited or been admitted to hospital, and four in ten did not get diagnosed by a doctor. They are effectively invisible.
Without a label there is the worry that their condition is not taken seriously, or they will not be believed. Reports from sufferers also suggest that the symptoms they experience are fluctuating, relapsing and remitting. This makes planning to go back to work difficult as they don’t know when they are going to ‘get better’ and get back to normal.
There is evidence of long-term employment consequences for people who contracted SARS and developed post-SARS symptoms (sleep disturbance, physical, and psychological symptoms). A Toronto study found that those affected by post SARS symptoms were experiencing fatigue, muscle weakness and sleep problems up to three years later and were unable to return to their former occupation.
Currently there is no clinical definition of ‘long Covid’ and no way of recording this on the GP record via Read Coding. Why is this important? Many sufferers of ‘long Covid’ may struggle to convince their employers, line manager or colleagues that they are too ill to return to work. There is also uncertainty about what will be recorded as the reason for their sickness absence. Like SARS healthcare workers are at a higher risk of contracting Covid and although they may not have developed a severe form of the illness the residual physical symptoms are likely to have a noticeable impact on the workforce.
HR and OD professionals can support their organisations to be better able to manage this potential loss of productivity and key employees by
- recognising this complex picture and communicate this to the wider organisation.
- have practical advice for employees and their managers about returning to work and be aware that not all ‘long-Covid’ sufferers will have had a diagnosis.
- develop policies for flexible working arrangements to enable employees to have a phased return to work
- be proactive after return to work to check how the employee is coping
- recognise that employees may also be suffering psychological symptoms and introduce initiatives to support staff and raise awareness e.g. Mental Health First Aid.
- recognise that staff maybe suffering from brain fog, poor ability to concentrate and poor memory as a result of long-Covid and discuss ways to manage this.
- develop employee’s psychological resilience through skills training aimed at increasing psychological flexibility.
- Proactively monitor sickness, unexplained absences, accidents and mistakes as potential indicators that employees are continuing to be affected by ‘long-Covid’.
- Recognise that psychological symptoms amongst employees who perceive they are affected by Covid can create conflict and grievances.
There are resources that organisations can use to help support staff from British Association for CFS/ME (BACME) and the ME Association.
The key message: staff distress will happen after the epidemic and planning MUST happen now for access to interventions for all staff over the next couple of years. Interventions offered should be a range see below. This slide comes from a presentation to HPMA last November which explored the stress-control dynamic and window of control to support HR professionals’ understanding of how psychological flexibility supports resilience because it supports some of the known protective factors against psychological distress in HCPs.
Valerie Amies is a PCC associate. Valerie has published articles on the impact of Covid on healthcare workers and runs psychological skills training for resilience workshops for PCC. For more information please contact firstname.lastname@example.org