Long Covid the ONS estimates 1.1 million people in the UK are experiencing this illness.
Long Covid is not exclusive to certain groups of people, prior fitness and health is not a certain determinant nor is severity of acute Covid-19 illness, as indicated by hospital admission or not. Meaning that you can prior to having Covid-19, have been a middle-aged person, with no underlying ill health conditions, self-declaration of mild acute Covid-19 illness, good physical activity levels and experience the limiting effects of prolonged symptoms. This is one of the frustrating aspects of this illness; it is not predictable as to who will be affected.
People with Long Covid are not infectious.
Most will recover within a 12-week period.
For some the symptoms last and affect work and day to day living for much longer; 12+ months.
It is reassuring to appreciate that people with Long Covid are not infectious or contagious.
The symptoms are very wide-ranging encompassing multiple body systems. Some predictable systems such as the respiratory, cardiac and other less predictable; neurological, gastro-intestinal, skin. Narratives include descriptions of breathlessness, fatigue affecting mental and physical capacities, cough, unable to concentrate, reduced memory function, hoarse voice, loss of taste and smell. Additionally, symptoms wax and wane, sometimes are
intense and debilitating
and other times hang around in the background still draining but easier to carry on and do essential or desirable activities.
The diagnosing of Long Covid involves listening to the person, hearing of symptoms being experienced, learning of when they had acute Covid-19.
positive Covid-19 test is not necessary
to be diagnosed with Long Covid.
Some symptoms may suggest complicating diagnoses affecting the heart, blood clotting system, lungs such as
chest pain,
palpitations,
not improving,
breathlessness,
confusion.
A GP assessment is strongly advised especially prior to doing anything physically exerting and no matter if it is 4 weeks or 3 months+ after the acute Covid-19 illness phase.
It is an anxiety provoking mental health impacting illness.
To be absolutely clear Long Covid is not caused by mental ill health.
Limiting essential and desirable aspects of living brings worry, loss of uplifting enjoyable occasions, loss of a sense of fulfilment, satisfaction of achievement, grief from the erosion of the way life was experienced, fear for the future, the unknown, uncertainties and unpredictable characteristics can be a heavy toll in addition to the physical symptoms.
People with Long Covid have proved to be resourceful, determined and action orientated with estimate of 21 Facebook groups created, between a few hundred to 22,000 members. It was the people with prolonged symptoms who provoked medical and health care interest, a NICE guideline, research, provision of multidisciplinary rehabilitation and treatment where appropriate. The NHS and Society of Occupational Medicine have Long Covid task force with representatives from people experiencing it, researchers and medical specialists.
Treatment suggests cure, however this that may not be fully, rapidly or easily achieved. Some of the symptoms could be amenable to treatment. But, particularly with fatigue, people have to find ways to manage. Self-management and supported self-management are recommended in the NHS guideline NG188 and enabled through the use of the NHS platform – Your Covid Recovery. Supplementary to this platform WHIB Ltd have created an eLearning resource – Long Covid advice & guidance on how to manage symptoms and return to work.
What about work?
Work can be a very important part of recovery; the sense of purpose, routine, social aspects, financial. For most it is an essential and rewarding aspect of living. It has been a very tough time for employers and now many will have employees who are struggling to attend work and perform at the level required.
It is an employer and employee decision about returning to work. Knowing when to start a return to work, the employee can find it difficult to predict. Having a health professional talk with the employee about work demands and an appropriate time to consider return can be invaluable. Some considerations prior to return to work are –
· Employee able to do most day-to-day tasks without requiring very frequent periods of rest
· Employee able to be emotionally balanced and appropriate to the context
· Employee’ sleep is partially restorative
Referring to occupational health at this stage is useful to determine fitness to work, advice on workplace modifications or adjustments for employer and employee to consider. If the role requires physical exertion medical clearance is strongly advised.
The Society of Occupational Medicine (SOM) have this useful guide for employees’ returning to work following Covid-19.
CASE STUDY Administrator – full time, doing telephony and computer-based work, based in the open plan office, 45-minute drive one way. Work impacting Long Covid Symptoms – breathlessness on talking, fatigue, lowered concentration and memory functions.
Example Modifications – reduced hours and demands that gradually increase when able. Flexi work location; both home and office. When in the office able to park close to the entrance. Additional flexi breaks to take when fatigue is beginning to limit concentration. Supply a voice amplifier to avoid exertion of voice. When in the office is able to use noise cancelling headset. Regular wellbeing reviews with the line manager with lots of positive feedback. If the employer is not able to sustain reduced work capacity and modifications, the employee will require more time away from work, to make health improvements, which is likely to be taken as sickness absence. It is advisable that the employer agrees with the employee about how, when to have contact whilst they remain off sick from work.
A return-to-work meeting with HR and/or the line manager is essential to make the arrangements of how to return to work, plan the phases, agree reviews and expectations. Line managers are crucially important in the success of an employee return to work. Empathetic and listening approach will assist the employee to feel supported and confident about returning. Here is a guide for line managers, from the Society of Occupational Medicine (SOM).
A collaborative approach with the line manager and employee necessary, reflecting the fluctuating characteristics of Long Covid symptoms not being amenable to rigid work demands and the person needs to feel confident in being able to complete the work expectations. It is a demanding time for both employer and employee. The line manager and employee may want to think about work modifications in these three domains-
· Flexi work content; complexity, emotionally demanding, volume and exertion (physical, mental, repetition and occasional) required
· Flexi location; able to work at locations that make it easier to concentrate and manage symptoms
· Flexi time; able to regulate own start, finish times, break times
The progression back to full contracted hours and demands in the case of Long Covid will be very difficult to forecast. This will challenge employers who require consistency and predictability. A standard and steady increase of hours and demands is not going to be likely. There will need to be occasions when keeping the expectations unchanged for a while is appropriate. Listening to the employee, how they are feeling, coping with the work, recovering from work and managing life out of work will guide how to enable to person to remain in work and avoid a relapse of symptoms.
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