“I don’t know how HR is going to manage this. I honestly don’t know how they will cope,” says Dr Clare Rayner, a former consultant occupational physician. She’s referring to so-called ‘long Covid’ – the condition affecting roughly one in 10 people who have contracted Covid-19 but continue to experience symptoms that vary wildly in both nature and severity for weeks or months afterwards. Described by the NHS as “the long-term effects of coronavirus” the condition is, by Rayner’s definition, “a collection of bizarre symptoms”. And she should know – she’s had it for nine months.
The symptoms can range from a loss of taste or smell, dizziness or anxiety, to respiratory difficulties, blood clots and even organ damage. “The key point is that it isn’t one condition,” Rayner says. “Individuals have got quite severe ongoing problems that can include physical damage to the organs, in particular the heart, alongside a collection of other things that kick in later, around the three-month point.”
Rachel Suff, senior policy adviser at the CIPD, adds that we are currently in the infancy of understanding what long Covid is from a medical perspective. “It’s unknown what long Covid actually is in terms of a medical classification, so even the medical profession is still getting to grips with what it is,” she says, although the All-Party Parliamentary Group (APPG) on Coronavirus is calling for it to be officially recognised as an occupational disease.
And it appears to be becoming more widespread. In January, MP Layla Moran told the APPG that there are currently 300,000 people living with long Covid in the UK. What’s more, membership of online support groups – a number of which have sprung up over the last year – is growing at an alarming rate. Lesley Macniven, spokesperson for the group Long Covid Support and Campaign and a patient herself, says the group has grown from several hundred members in June 2020 to 33,000 today, and continues to climb. Rayner’s chief concern, she says, is that every organisation will have a percentage of people on long-term sick leave because of long Covid.
The alarming prevalence and relatively unknown nature of the condition all point to a difficult situation for HR, both in terms of a potential uptick in people on long-term sickness absence, and facilitating a return to work while managing their symptoms. But while Suff agrees long Covid is a worrisome prospect for the people profession, she is confident that, with the right education and approach, HR will prevail. “They need to be aware of it and understand how broad a spectrum it can be but, at the same time, managing sickness absence is HR’s bread and butter,” says Suff. “They have experience with managing all sorts of long-term health conditions so they should know how to do it well, supportively and properly.”
But with the effects varying wildly from person to person and so little known about the illness, how can HR begin to support long Covid patients in returning to work while managing their condition effectively? Suff insists that the golden principle for how employers and HR approach the return to work and ongoing support is to assess each case individually. “We need to get across that long Covid is not just post-virus fatigue,” she says. “The employer and the manager need to have a really sensitive conversation with someone who has been diagnosed with long Covid to understand how the illness affects them personally, and the impact on them in terms of work. It must be on a case-by-case basis.”
But however individualised the support, Rayner highlights that recovery is not necessarily a straight trajectory, and many patients have fluctuating symptoms that can result in sudden relapses. There are instances of early rehabilitation, early recovery and early returns to work, but most are often “too ill”, says Rayner, who has seen evidence of this in online support groups. “People go back to work, but then a small amount of physical effort provokes a relapse and they are off again,” she explains. “We don’t understand why this is happening, but it’s incredibly demoralising for them and their organisations.”
After taking time out from her work as a freelance writer and consultant to rest and recover, Macniven also experienced a relapse when she started to take on more after mistakenly thinking she was better. “I was living a half life so I thought I was better than I was, but when I started to increase work I had a relapse and was out of it for two weeks – I couldn’t string a sentence together,” she explains. “This is a challenge HR will have to deal with, as people have periods when they get better but then relapse. It makes it incredibly difficult to do a traditional phased return.”
So is it time for HR to reassess its policies around sickness absence and phased returns? In some cases, at the very least more flexibility will be required, because a standard four to six-week return may not be enough to successfully reintegrate someone with long Covid without relapse. Rayner suggests this may need to begin with as little as two hours a week. And Rob Crowley, HR director at RateSetter, certainly believes it is HR’s duty to reevaluate its stance on sickness in the wake of the pandemic: “It’s the people profession’s responsibility to start looking at the policies in place around sickness to make sure they are fit for purpose,” he says. “There has to be an understanding of the condition and some judgement around it,” he continues, adding that the profession must be “pragmatic” towards long Covid and “review their approach because it is going to hit quite a lot of businesses, if it hasn’t already”.
Suff highlights that a reform of sickness policies may be necessary because there’s a chance they wouldn’t be useful in managing long Covid-related absence. “It’s for individual organisations to review and ascertain whether they are fit for purpose,” she says. “People might need to take multiple periods off sick through no fault of their own. If you had a trigger system for that they could face formal action, and what we need is a supportive approach based on rehabilitation.”
One of the main difficulties for HR, says Crowley, is the fact that we know so little about long Covid, and how it will affect people in the longer term. “If medical professionals are not there yet in terms of giving a prognosis of what needs to be done to get people back to work, it does make it tricky,” he says. Sophie Metcalf, head of HR at Expect Distribution, also points out that there are “a lot of unknowns” for businesses. “We need to start making preparations for if long Covid goes on for more than 12 months and what that will look like. Are we going to suddenly have an uptick of people classed as having a disability, for example?” she asks.
If the condition were to be classed as a disability in future, that would have further implications for people professionals. A disability, as defined by the Equality Act, is a physical or mental impairment that has a substantial and long-term adverse effect on the individual’s ability to carry out their normal day-to-day activities. According to Musab Hemsi, partner at LexLeyton: “If someone had long Covid, it is in theory possible they could meet the definition of a disability under the Equality Act.” But, he adds: “I suspect under more cases than none that they will not meet that definition – not because it is not a severe condition, it clearly is, but perhaps because of the long-term element of the legal text.” He explains that a “long-term illness” requires the condition to last for 12 months, but so far there haven’t been any cases lasting for that length of time. “So even though it is a severe physical impairment and has a substantial impact on that person’s ability to carry out their day-to-day activities, it doesn’t meet the long-term part of the legal obligation in the vast majority of cases,” he says.
While it may not currently meet the requirements for disability, Rayner hastens to add that it is only a matter of time. “In many cases these individuals are likely to be classed as having a disability,” she says. “If it is already causing this level of debility and impacting day-to-day activities six months down the line, it is likely to carry on for a year or so. These individuals will be classed as having a disability and it will be hard to argue that they don’t.”
While there isn’t (yet) a legal obligation to make reasonable adjustments for employees with long Covid under the Equality Act, Hemsi points out that there are still legal considerations for employers to successfully manage a person’s absence. “The best place to start is authentic dialogue and welfare check-ins. Far too many employers are at risk of being guilty of not checking in on staff who are sick,” he explains. “That is the starting point of the lawful process of managing someone’s absence. The employer’s obligation is to keep themselves appraised as to how an employee’s illness is progressing, and whether it is improving or getting worse. The business should be offering support to the employee during those calls.”
However, the exact nature of the support they should offer is not clear cut and could come in peaks and troughs, so Hemsi advises getting occupational health (OH) involved as soon as possible. “Changing working hours and patterns, for example, to give someone time to rest and recover throughout the day may not be done for everyone, and what works for someone at the beginning of the illness may not work for them throughout the illness,” he says. “HR may have to go back to OH and ask for people to be regularly reassessed. The duty to make reasonable adjustments in law doesn’t currently exist, so this is more of a moral obligation.”
Suff agrees that the level of support will be “hard to chart” because of the huge spectrum of symptoms and uncertainty surrounding the illness. “I think it’s likely that if someone’s symptoms are serious then you can make the assumption they won’t be back to full fitness for a long time,” she says. “That’s why you need to keep reviewing and stay flexible because it’s likely to be several months.” She adds that there should also be a case management approach between HR, OH and the individual: “It’s crucial that you involve the individual and base those discussions on OH and medical advice around fitness to work relating to that person.”
HR can be doing a number of things to prepare for long Covid among the workforce, but the most important is preparing your workforce for a significant loss of skills, says Metcalf: “We need to bolster our business to accommodate long Covid – that means making sure we have multiskilled employees. It’s good practice in any business to not rely on one person to do a particular role, because if that person is off sick you are left with a vacuum. The lesson we have learned over the last six months is that businesses need to be more agile.”
Rayner also shares concerns about the impact of long Covid on business continuity if a large percentage of the population is affected. “Occupational health will be giving so much advice [to stay off work] that organisations are going to have to strip business functions down to the essentials to keep things going,” she says. “There is going to come a point where HR will have to look at who they actually have in work, and it’s going to require major strategic decisions.”
So with all these considerations, should HR be worried about long Covid? “No, but it should be prepared,” says Crowley. “It’s something new but, if HR prepares for it and teams understand the condition, the worry will go away.”
Living and working with long Covid
“It feels like I’m just a tick-box exercise – it’s soul destroying”
Rebecca*, frontline NHS worker
Rebecca contracted Covid-19 back in April, which first presented itself as a headache. But nine months and three hospital admissions later, she is one of those unlucky enough to be left with long Covid, and experiences a range of symptoms including a sore throat, high temperature, headaches, loss of appetite, fatigue and muscle aches. She has so far struggled to get her HR department to understand her condition.
“The main argument is that you cannot put someone with long Covid into a box because the process isn’t linear, and no two days are the same,” she says. Her occupational health department advised that her phased return could only be a maximum of four weeks, but Rebecca has argued that this is not flexible enough to avoid a relapse. She also had to fight for full pay after HR threatened to move her to half pay. “I asked how they could possibly do that when I am off with a Covid-related illness, and since then they have agreed to secure my pay for an unknown amount of time.”
She feels that her HR department sees her as just a number and her sickness absence as a “tick-box exercise”, and describes the overall situation as “soul destroying”.
* Rebecca wished to remain anonymous and her name has been changed
“It isn’t going away and there’s nothing I can do to alleviate it”
Steve Carpenter, HR consultant (pictured)
The day after the first lockdown was implemented in March 2020, self-employed HR consultant Steve Carpenter had to make a phone call that no one wants to have to make. “I spoke to the Covid hotline and had a nurse come to my house,” he explains. “I didn’t have a test at that point because they weren’t available, but she confirmed I had every symptom of the virus.” Carpenter only had “slight” breathing difficulties and so refused to be admitted to hospital to save ventilators for people who needed them, but he describes his experience with Covid as “terrible”. Despite shaking off the virus in May, he now has long Covid, which he recognises is something he now has to “put up with”.
“I get nausea and fatigue every morning, but I’ve realised it isn’t going away and there’s nothing I can do to alleviate it,” he says. “No matter what time I wake up, I have about an hour of fatigue when I get out of bed in the morning.” Carpenter has had to learn to control his symptoms to continue his work effectively: “I have to get up earlier to get the nausea and fatigue out of the way before I can start speaking to clients. It’s not that I can’t do anything, it’s just that I don’t feel well.”
He also highlights that support for long Covid patients is currently nil, so he has no timeline for recovery. “Even now I’ve asked [my GP] if there is anything I can do to make myself feel better and they’ve said they have no solution. If you have a muscle injury they give you exercises to make you feel better, but there’s nothing like that for long Covid.”