One of the aspects of living with COVID-19 is that some people infected by the virus exhibit long-term symptoms that can last for weeks or months. According to a survey by the Census Bureau carried out in June and July, more than 16 million “working-age Americans” suffered from those symptoms. Collectively known as long or long-haul COVID, those symptoms are keeping as many as 4 million people (1.8% of the civilian labor force) out of work, stated an article by Brookings Institution, a nonprofit public policy organization based in Washington, D.C.
While the fallout of long-haul COVID could hurt the U.S. economy with employers already struggling to retain employees, that damage could be reduced if companies implement policies and make greater accommodations for employees suffering from the virus.
Impact on Labor Shortage
“We are currently going through a crisis where employers are looking to retain and attract all of their talents,” said Siupo Becker, MD, a senior director at WTW and a board-certified infectious disease physician. “Under the Americans with Disabilities Act (ADA), you can’t discriminate against those with long COVID, and human resources will have to make accommodations for those suffering and come in with a doctor’s note that says, ‘This person has long COVID and can’t work so many hours because they get easily fatigued.’”
This might affect the budgets of companies that might not be able to accommodate additional short-term disability leave to make up for the loss of workers, which might hurt the productivity of companies, explained Becker.
“I worry the most about the healthcare provider system who are the hardest hit by COVID because all their frontline workers were exposed and at some point, had COVID and again, it’s the question of the chicken or the egg. Would they have developed these symptoms anyway or not?”
Becker also explained that with COVID there is an increased risk of diabetes and heart disease. “There are studies that show that even if you were at low risk for diabetes before if you had COVID, this increases your risk of developing diabetes. This also impacts employers in terms of their chronic cost management and the potential long-term impacts there. We have seen an increase in cardiovascular spending even higher. A lot of it in 2021 was the return to care but we are thinking that also a proportion of it could be due to COVID and the associated heart disease from that.”
That doesn’t take into account the effects of lost earnings, which Brookings calculated to be from $168 billion to $230 annually. Brookings came up with those numbers: “Using the average U.S. wage of $1,106 per week, the estimated 3 million people out of work due to long COVID translates to $168 billion a year in lost earnings. This is nearly 1% of the total U.S. gross domestic product. If the true number of people out of work is closer to 4 million, that is a $230 billion cost.”
Understanding Long COVID
The National Research Action Plan on Long COVID defines long COVID as “signs, symptoms, and conditions that continue or develop after initial COVID-19 or SARS-CoV-2 infection.”
The plan further explains that long COVID “is a multifaceted disease that can affect nearly every organ system. In total, about 200 symptoms of long COVID spanning nearly every organ system have been reported.”
A recent Kaiser study narrowed down the 17 most “common acute and persistent” long COVID symptoms.
They include symptoms like other lower respiratory diseases, diabetes gastrointestinal disease, conditions associated with dizziness or vertigo, abdominal pain, nonspecific chest pain, mental health, anxiety disorders, genitourinary symptoms and ill-defined conditions, malaise and fatigue, and cardiac dysrhythmias.
There are also numerous definitions of long COVID, pointed out Siupo Becker, MD, who is a senior director at WTW and a board-certified infectious disease physician.
“There are studies that show that between 3% and 37% of those who had COVID have developed long COVID and a large proportion of them are part of the working population,” Becker said. “Part of the problem is, there is no consistent definition for long COVID and it’s a diagnosis of exclusion; there’s no one test we can do to say yes, you have long COVID. This leads to people getting confused. Are these symptoms someone might have had and would have developed and then you just happened to incidentally have had COVID? This makes it hard to figure out these things.”
To lessen the economic impact of long COVID, employers should provide the necessary support for long haulers.
“Employers need to make sure they have a good sick leave policy in order to support employees with long COVID,” WTW’s Becker said. “Making sure disability, long term and short term, are all in place, that they make the required work accommodation quickly, and support such employees as much as possible in getting the needed clinical care that they may require are all important steps.
“Some employer groups have second-opinion services and these second-opinion vendors are actually able to get patients in earlier into some of the long COVID rehabilitation centers than waiting and doing it through traditional means,” Becker added.
She said that long COVID rehabilitation centers are also available in every state. They employ multidisciplinary clinical teams that look at the patients as a whole to try and treat the patients “holistically.”
Part of the problem is that the federal government will likely stop covering the costs of vaccinations and associated care. Becker said these costs will likely shift to employers, and that employers may pay more than the federal government did.
“Employers need to make sure that even if it is more costly, they still continue to make sure to cover those vaccines as they would for the flu shots,” she said.
Becker also pointed out that new studies have shown that Paxlovid is known to decrease the risks of long COVID, referring to a recent blog by her WTW colleague, Jeff Levin-Scherz, MD, suggesting that employers can help cover the cost of this drug through their health insurance benefits.
In addition, there are essential steps to tackle long COVID among their employees to facilitate their return to the workplace.
“Some employees don’t know what is available to them in terms of clinical care,” Becker said. “So, employers can make sure these employees don’t face discrimination because whether or not these symptoms are related to long COVID, these are actual symptoms and problems people are having and have to get them treated. Employer support, in the long run, will help retain the employees and help them be more productive once they return to work.”
Organizations also need to focus on sensitizing managers and co-workers about long COVID because the ambiguity surrounding the condition, including where to go for help, makes it harder to deal with such cases, Becker said.
Employers should consider putting in place a COVID resource page, including information on ADA regulations, to help employees take more time off because of long COVID, Becker said. Employee assistance programs (EAPs) should also address long COVID-related challenges.
While there is COVID burnout, “workplaces still need to be more aware/sensitive to those who might be more susceptible to falling sick and continue taking all precautions necessary, including practicing social distancing and/or masking,” Becker said.
Stigma surrounding long COVID is especially prevalent among those suffering from neurocognitive issues, she said.
“If I am an employee, I wouldn’t want to tell my employer I have long COVID and how I now get really confused and tired,” Becker said. “And if you ask your manager for help, you are worried that will make them judge you at work or there will be some form of retaliation. Employers aren’t allowed to discriminate in such cases under the ADA, but the stigma makes it harder for employees to share that information or even to know if it is because of the virus, because long COVID can occur whether someone had a mild or severe case.”
The ADA and Long COVID
In some circumstances, long COVID can be a disability under the ADA, said Justine Farris-Niehaus, an associate at Barnes and Thornburg law firm.
“Under the ADA, a leave of absence can be a form of accommodation, but an employee would only be entitled to an accommodation if they have a disability,” she said. “The employee is going to have to show that the long COVID substantially limits a major life activity. There are circumstances when an employee can meet that definition.”
For example, she said, “If an employee has problems breathing, then the person may be able to show that he/she has a disability under the ADA. In such a case, the employee would have to show why their long COVID necessitates an accommodation, such as a leave of absence. If they are able to show those things, they may be entitled to an unpaid leave of absence (or other reasonable accommodations) under the ADA.”
But if an employee comes to an employer and says they need an accommodation that enables them to perform their job and they need that accommodation because of the long COVID, then employers will have to engage in the interactive process and talk to that employee to figure out what a reasonable accommodation might look like, Farris-Niehaus explained.
“In that circumstance, if the disability isn’t clear then the employer may ask the employee to submit some limited medical information from their doctor so that the employers can make the determination,” she said.
In some cases, accommodation isn’t just a leave of absence. It can also include changes to the employees’ job schedule, for instance, but they need to show why they need that because of their condition.
“I think the leave of absence is the most prevalent benefit, but also employers are dealing with this issue without knowing that the condition is long COVID since it manifests itself in different ways,” Farris-Niehaus said. “It’s important to realize that just titling the condition ‘long COVID’ doesn’t change the analysis. The employer still has to figure out whether the employee has a disability under the law.”
Employees can take legal recourse if an employer does not provide the relevant support and accommodation required in such instances.
“If an employer does not reasonably accommodate an employee who has a disability under the law or terminates someone because of the disability, whether that be long COVID or any other disability, then the employee has rights to pursue legal action under the ADA,” Farris-Niehaus explained. “Typically, by filing a charge of discrimination with the Equal Employment Opportunity Commission and then later bringing a court action, the employee could be entitled to damages. For example, if the employee was terminated because of a disability then the employee can take action to recover their back pay.”
Farris-Niehaus thinks employers are trying their best to navigate the situation. “For a long time, employers were very sensitive to this issue and had a lot of empathy for their employees who were dealing with issues related to COVID, and they still do,” she said. “But, as people start getting back to work, there are shortages in the workforce. Employers are trying to figure out how to get employees back so that they can staff their businesses.”
“Some employer groups have second-opinion services and these second-opinion vendors are actually able to get patients in earlier into some of the long COVID rehabilitation centers than waiting and doing it through traditional means.”
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