Occupational health professionals need to be working proactively with employers to make sure they recognise the importance of long Covid in managing rehabilitation back into work, a discussion paper has emphasised.
The document, ‘Impact of long COVID on workplaces and workplaces and the role of OSH’ has been put together by the European Agency for Safety and Health at Work (EU-OSHA).
The agency outlines what we know so far about the potentially debilitating long-term post-viral condition and some of the key considerations for OH and employers.
It emphasises, for example, the importance of spelling out procedures and approaches. “For workers returning to work with Long Covid [sic], it is important that the manager regularly enquires about the employees’ health, to be aware of the limitations imposed by safety-critical symptoms and to ensure that the workers are not putting themselves, co-workers or customers at risk,” the document makes clear.
“It is therefore important that employers recognise the importance of Long Covid for the affected individual and the organisation and how it should be managed optimally to rehabilitate a worker to their job, or provide alternative work. This suggests a need for a dedicated policy within organisations or at least an explicit recognition of Long Covid within existing sickness absence policies,” it adds.
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Long Covid, EU-OSHA highlights, can have “a significantly negative” impact on workers and workplaces.
“Difficulty in breathing, fatigue, headaches and problems with memory and concentration are all symptoms which can last for weeks or even months. Employers face challenges when key workers have difficulty to fully return to their jobs due to Long Covid symptoms, and possible changes to work arrangements could be needed,” the discussion paper says.
Fatigue, breathing issues and cognitive dysfunction remain the top three most debilitating symptoms listed by long Covid patients.
Musculoskeletal, cardiovascular, gastrointestinal, pulmonary and neuropsychiatric symptoms were prevalent in about 85% of participants.
“Breathlessness may be due to scarring of the lungs, which may cause a permanent reduction in lung function or disordered breathing that may be treatable. In either situation, there are clearly limitations for workers’ capacity for physical work, especially if there are muscular symptoms as well,” it says.
“Some individuals may also have inflammation of the heart muscle (myocarditis), or even have had a heart attack, which could also affect their ability to undertake physical work. Some of these individuals can suddenly experience a rise in their heart rate from the normal level of around 70 beats per minute up to levels of 100-140 beats per minute.
The development of Long Covid can be a traumatic experience for previously active and vigorous workers and as a result, often after long hospitalisation, cause anxiety and depression in the individual” – EU-OSHA
“A further complication of Long Covid can be postural orthostatic tachycardia syndrome (POTS), which combines the difficulty in standing because of a sudden fall in blood pressure with a fast heart rate and a feeling of profound fatigue. These symptoms may be episodic and, in these workers, further occupational medical assessment and advice is required.”
Another common symptom (occurring in around 10% of workers) is ‘brain fog’, a neurocognitive effect of Covid-19 infection, when a worker has difficulty with concentration and memory, albeit usually a temporary effect.
Trauma
“Where there has been no permanent damage to organs, these effects of Long Covid can be expected to decrease and a worker’s health will usually return to normal. The development of Long Covid can be a traumatic experience for previously active and vigorous workers and as a result, often after long hospitalisation, cause anxiety and depression in the individual,” the document outlines.
“This requires treatment – either talking therapy such as cognitive behavioural therapy (in person by a therapist) or therapy available online, and sometimes, in addition, medication.
“The implications for worker’s occupational safety and health (OSH) of these conditions may be considerable and the fundamental principle of the employer being aware of the symptoms of a worker returning to work and their limitations is important for all workers with Long Covid.
“This knowledge will then inform the steps to be undertaken by the employer to ensure the safety of a worker, and the safety of others as well, which could be the case for drivers, process operators, heavy machinery operators and so on. This will have to be done through adjustment of duties and modification of tasks,” the EU-OSHA also recommends.
OH assessments
The important role of OH assessments in managing long Covid is emphasised, as also highlighted recently by the CIPD.
“If a worker with Long Covid has complex health issues that are preventing their return to work, an occupational health assessment will be necessary to identify their work ability and their limitations,” the discussion paper states.
“This may involve communication with the worker’s personal physician – providing there is consent given to do so. Employing organisations normally have sickness absence policies that have various triggers and thresholds for the level of absence from work, or incapacity that can be accommodated.
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“For workers with Long Covid, these triggers may however not be appropriate as recovery may be very slow because of fatigue or other symptoms, and modification of these policies may need to be considered and timescales extended.
“Most workers recovering from Long Covid will require a slow, phased return to work, beginning with a small amount of work every day and every week, and gradually extending working hours over a period of one to two months or longer,” it argues.
