Occupational health must develop "trustful" relationships to support long COVID return

A return-to-work plan for an employee with long COVID should involve the worker, employer, line manager and occupational health professionals to ensure they receive the appropriate support.

This is according to an evidence review published by the Health and Safety Executive (HSE), which also found that the return to work for people with long COVID is complex and will differ for each individual.

The report, which summarises the findings of seven studies into the impact of persistent coronavirus symptoms on return to work, found the symptoms that had the greatest impact were fatigue, cognitive dysfunction, and changes in taste and smell.

Return-to-work interventions adopted by organisations and employees included working reduced hours, flexitime or working from home, moving to a role with lower physical or mental strain, and phased return.

Relapses could occur for those who returned to work, triggered by mental strains and stress, and some people with long COVID were unable to return to work at all.

"Long COVID patients experience persistent symptoms after the acute infection that prevent them from resuming their normal lives and work," said Professor Lode Godderis, a specialist in occupational medicine at the university KU Leuven in Belgium and director of the country's Service for Prevention and Protection at Work (IDEWE), who led the HSE study.

"It is important, in addition to searching for the causes, to help people to resume their daily activities and work. A multidisciplinary approach is therefore necessary, including support in getting back to work, because we know that after three months of incapacity it becomes increasingly difficult to return to work."

The report recommends that occupational health professionals should develop a "close and trustful" relationship with all stakeholders to help the employee return to work.

It also suggests that:

  • The worker with long COVID is encouraged to help redesign their work to enable them to return.
  • The employer should contact the employee as soon as possible after they contract COVID-19 - within the first two weeks of their absence is recommended.
  • All stakeholders, including health professionals, should be involved in reintegrating the employee in work.
  • Health professionals should provide return-to-work advice as soon as possible.
  • Employees should return to adapted work as part of their rehabilitation.

The study adds that a "progressive, adaptive, and appropriate" return to work should the primary goal for all parties, who should bear in mind that an individual does not need to be 100% fit to return to work.

A return-to-work plan could include a phased return, flexible work, time off for rehabilitation and medical appointments, fatigue management strategies and adapted work tasks, the HSE recommends.

According to a separate post-hospitalisation study led by the National Institute for Health Research at the Leicester Biomedical Research Centre, fewer than one in three patients who have ongoing COVID symptoms after being hospitalised feel fully recovered a year later.

Between five months and one year after discharge, the proportion of participants reporting feeling recovered remained very similar - at just under 30% at 12 months - as did those experiencing symptoms including breathlessness, fatigue and pain.

The Society of Occupational Medicine (SOM) has published a return-to-work toolkit to assist managers and occupational health teams in reintroducing an employee with long COVID to the workplace.

Organisational design consultant Lesley Macniven, who contracted COVID-19 in March 2020 and is a campaigner for patient group Long Covid Support, said: "Patient groups like ours have built up significant expertise on managing long Covid.

"It is evident one size can't fit all, and we must allow workers flexibility and support to listen effectively to their own bodies. Workers need to convalesce, then recuperate through a very gradual, phased return to work (over many months if absence has already been prolonged) to allow a sustainable return."