Long COVID; what you need to know:

Long COVID is an emerging phenomenon that is not yet fully understood. There is no internationally agreed definition, and so estimates of how common it is, or what the main symptoms are, vary. New evidence is continually emerging however, and this enables experts to further explore and analyse health information that is hoped to expand our knowledge base and offer a better understanding of this virus.

As a consequence of COVID-19, as of 2 January 2022 an estimated 1.3 million people living in private households in the UK 2.1% of the population were experiencing self-reported long COVID symptoms, this meaning symptoms that have persisted for more than four weeks after the first suspected COVID-19 infection that were not explained by something else. The likelihood of long COVID developing is not thought to be linked to the severity of the initial illness, including whether an individual was hospitalised, and this means that for some individuals, the aftereffects of a COVID infection can be worse than their original experience.

There is no definitive test to diagnose long COVID and people do not need to have a positive test for COVID-19 at any point in order to receive this diagnosis; diagnosis is formed from reported symptoms and from a thorough medical assessment.

Who is affected?

Anyone can be affected – young, old, male, female, employed, unemployed, fit and healthy as well as those with underlying health conditions who may be more vulnerable. People can be affected directly, or indirectly, and the impact from either can be profound.

How are people affected?

From a health perspective – both physically and psychologically – and both acute and chronic – a reduction in stamina and fatigue, a decline in cognitive function, and an increase in fear, anxiety and depression are common reported health factors.

Financial, Motivational and Vocational impact – due to job losses, and loss of or reduction in income i.e. furlough, deskilling & access to training, and the knock on impact this has.

Environmental impact unable to pay rent / bills / buy food etc., unsafe environment by being at home more – poverty / domestic abuse / safeguarding issues

• Social impact – isolation not seeing colleagues, not being able to socialise – due to restrictions as well as affordability, although this is likely to change for some following the lifting of restrictions, resentment and anger towards others, including amongst colleagues [who are not compliant re PPE, have a “blaze” attitude, who don’t believe, who are “in their space”, who are not respecting the individuals wishes etc.
• Financial, Motivational and Vocational impact – due to job losses, and loss of or reduction in income i.e. furlough, deskilling & access to training, and the knock on impact this has.
  
• Environmental impact unable to pay rent / bills / buy food etc., unsafe environment by being at home more – poverty / domestic abuse / safeguarding issues.
  
• Social impact – isolation not seeing colleagues, not being able to socialise – due to restrictions as well as affordability, although this is likely to change for some following the lifting of restrictions, resentment and anger towards others, including amongst colleagues [who are not compliant re PPE, have a “blaze” attitude, who don’t believe, who are “in their space”, who are not respecting the individuals wishes etc.

What is the wider impact of LC upon families?

It is emerging that Long COVID does have a profound impact on people it comes into contact with: It may bring about:
New or additional caring responsibilities – i.e., family members caring for family members affected by Long COVID

• Anxieties in caring for loved ones
• Mourning for loved ones lost
• Strains on relationships / relationships breakdowns – A lack of understanding – stigma – “Comparable Commonalities”
• Safeguarding issues
• Increase in domestic abuse
• Accessibility issues to health and specialist services

What are the symptoms?

• Symptoms can vary from person to person, but commonly reported symptoms are:
• Extreme tiredness, even after rest
• Shortness of breath
• Chest pain and / or chest tightness
• Problems with memory and concentration often referred to as “brain fog
• Cognitive decline and inability to focus
• Changes to taste and smell
• Joint and muscle pain

Patient surveys also suggest a range of other symptoms may also be present, including physical impairment, “heavy” legs, dizziness and loss of balance, gut problems, insomnia and visual changes.
Symptoms can also fluctuate and can “come and go”, and so sufferers may feel better one day, and worse the next. This can make it difficult for sufferers to plan, and to manage their condition, both in their home and working lives, and it is important that employers are aware of these factors.

Long COVID symptoms are reported to have adversely affected the day-to-day activities of nearly three quarters of reported sufferers, with 244,000 reporting that their ability to undertake their day-to-day activities had been “limited a lot”.

In addition to many other variable, but perhaps less common symptoms, fatigue and cognitive decline continues to be the most common symptoms reported as part of an individual’s experience of long COVID; this is followed by shortness of breath, loss of smell, and loss of taste.

According to the UK Coronavirus (COVID-19) Infection Survey data, as a proportion of the UK population, the prevalence of self-reported long COVID was greatest in people aged between 35 to 69 years, which can be identified as society’s working age population group. In 2021, Occupational Health Nurse Advisor and Queens Nurse Tracie Mckelvie is quoted as saying “due to the impact of Long COVID, there is a real risk of our workforce, our future skilled labour, and our economy crumbling if this isn’t managed effectively; it’s not just the older workforce that we need to consider, but the younger generation too – the right response is critical in positively influencing the prospects of ensuring a healthy and functional workforce, both within the current and future working populations“.

Females, people living in more deprived areas, those working in health care, social care, or teaching and education, and those with another activity-limiting health condition or disability are other groups where self-reported long-COVID has been more notably prevalent.

What treatment and resources are out there for long COVID sufferers?

While there is now a clinical case definition for long COVID, meaning that long COVID is recognised as a real condition by healthcare professionals across the UK, currently, there are no proven drug treatments. The focus is on managing symptoms, and gradually increasing activity, where possible.

The National Institute for Health and Care Excellence (NICE) have developed a clinical guideline for health professionals, and this covers identifying, assessing and managing the long-term effects of COVID-19.

Long COVID assessment clinics have been set up across England which intends to bring together a multidisciplinary skill set of doctors, nurses, physiotherapists, and occupational therapists to offer both physical and psychological assessments and refer patients to the right treatment and rehabilitation services. There are about 90 long Covid assessment centres that have been set up across England, and in Wales, all 7 local health boards have developed multidisciplinary recovery services that GPs and health professionals are able to refer their patients into, after screening for more serious symptoms. All services also have a comprehensive assessment tool to ensure patients are treated holistically and individually.

What can employers do to support staff with Long COVID?

• There needs to be an understanding amongst employers on the impact of Long COVID, and what this may mean from an employment perspective
• A compassionate and understanding approach is essential.
• Employment issues may need to be carefully considered; for example, in looking at variables to substantive roles, and the upskilling and re-training of existing & new employees, this may be what is required from a business perspective in order to support & preserve the function of business, as well as our working populations.
• Consider “horizon planning” in order to establish what the future may look like for your business; if you or your staff are affected by Long COVID, this is a necessity that needs to be considered.