Return-to-work with long COVID: An Episodic Disability and Total Worker Health® analysis, 2023, Stelson et al.

[SNT Gatchaman]

Return-to-work with long COVID: An Episodic Disability and Total Worker Health® analysis
Stelson; Dash; McCorkell; Wilson; Assaf; Re'em; Wei

A growing number of working individuals have developed long COVID (LC) after COVID-19 infection. Economic analyses indicate that workers’ LC symptoms contribute to workforce shortages. However, factors that affect return-to-work from perspectives of people with LC remain largely underexplored.

This qualitative study of people with LC conducted by researchers living with LC aimed to identify participants’ return-to-work experiences using Total Worker Health® and Episodic Disability frameworks. 10% of participants who participated in a mixed-method global internet survey, had LC symptoms >3 months, and responded in English were randomly selected for thematic analysis using NVivo12. 15% of responses were independently double-coded to identify coding discrepancies.

Participants (N = 510) were predominately white and had at least a baccalaureate degree. Four primary work-related themes emerged: 1) strong desire and need to return to work motivated by sense of purpose and financial precarity; 2) diverse and episodic LC symptoms intersect with organization of work and home life; 3) pervasiveness of LC disbelief and stigma at work and in medical settings; and 4) support of medical providers is key to successful return-to-work. Participants described how fluctuation of symptoms, exacerbated by work-related tasks, made returning to work challenging. Participants’ ability to work was often predicated on job accommodations and support. Non-work factors were also essential, especially being able to receive an LC medical diagnosis (key to accessing leave and accommodations) and help at home to manage non-work activities. Many participants described barriers accessing these supports, illuminating stigma and disbelief in LC as a medical condition.

Qualitative findings indicate needs for workplace accommodations tailored to fluctuating symptoms, continuously re-evaluated by workers and supervisors together. Reductions in medical barriers to access work accommodations is also critical since many medical providers remain unaware of LC, and workers may lack a positive COVID test result.

Link | Paywall (Social Science & Medicine)

 

[SNT Gatchaman]

Due to uncertain recovery times for anybody that contracts COVID-19, workplaces may benefit from developing “universal” COVID recovery accommodation policies for anybody with suspected or confirmed COVID that can be adjusted over time. From analysis of participant responses and literature, employers, patients, and medical providers all seem to expect that RTW after contracting COVID would follow a linear process. [...] However, this linear expectation does not always match reality for individuals recovering from COVID or who develop LC. People living with LC experience a diversity of fluctuating physical, cognitive, and emotional symptoms, which can often be very difficult to anticipate. Who will develop LC following acute COVID infection is similarly difficult to predict.

Based on participant experiences in this and related studies, we also provide six recommendations to support LC-RTW (Fig. 3).

Second, we recommend that employers accept self-identified LC symptoms and related diagnoses as acceptable documentation to access accommodations since lags in many medical providers’ understanding of the illness (especially in areas that lack LC specialty clinics) will present an additional barrier to workplace supports for employees. By and large, workers in our study and other studies both wanted to and needed to return to work, and we believe that fabrication of LC symptoms by workers is unlikely. Employers need to respond to and respect the uncertainty of recovery processes, and such acceptance of worker-reported symptoms in lieu of medical documentation may reduce workforce attrition among people living with LC.

 

[Hutan]

To play devil's advocate, it's a big ask of employers, isn't it? Accept the word of the employee that they have this disease that limits their productivity. And then make all sorts of changes that actually won't work for a lot of jobs and workplaces or that at least impose substantial costs.

I haven't read the paper, but those recommendations seem very focussed on professional workers based in offices. I mean it's good to suggest these accommodations and some good employers will no doubt do them, but what about the self-employed brick-layer, or the factory supervisor, or the air traffic controller?

The impacts of many versions of Long covid and ME/CFS are so great that it seems unreasonable in many cases to ask employers to absorb the costs of accommodations. It is probably unreasonable in many situations to expect co-workers to increase their flexibility to pick up the shifts the LC person can't do at the last minute, or the endlessly extended deadlines. It's an untenable situation really.

 

[Midnattsol]

I haven't read the paper, but those recommendations seem very focussed on professional workers based in offices. I mean it's good to suggest these accommodations and some good employers will no doubt do them, but what about the self-employed brick-layer, or the factory supervisor, or the air traffic controller?

Or the bus driver, teacher, nurse, doctor..? These often show up high in sick leave statistics and are at more risk of being infected than me in an office.

 

[Trish]

There are so many occupations where these sorts of accommodations are simply not feasible. Manual labour, factory work, teachers, nurses and other clinicians, carers, and so many more. And even for office workers there are problems with sustaining concentration, meetings, basically anything that requires the worker to be able to sustain hours of physical and /or cognitive effort to someone else's timetable and deadlines.

Going part time can make some jobs more feasible especially if timetables and deadlines are flexible. I managed to keep going in a part time teaching job, but I was teaching over 16's and could if necessary just sit at the front and set them some work to get on with if I needed a break during a lesson and I could take preparation and marking home to work on at my own pace. In the end I got too sick to keep going, not helped by complete lack of understanding by my employer of accommodations I needed.

It's possible I could have recovered I'd I had been able to stop work and rest for a few months at the start. I'll never know. I think the push to get people back in to work can be counterproductive.

 

[Wonko]

But....at the beginning of the day....why would an employer hirw someone they thought couldn't be trusted.

And if they can be trusted then why assume they are lying about their health.

 

[Amw66]

But....at the beginning of the day....why would an employer hirw someone they thought couldn't be trusted.

And if they can be trusted then why assume they are lying about their health.

Reminds me of a Facebook post from around 3-4 years ago on a closed group where someone with ME/CFS had been assessed by DWP and advised that they were capable of working for 12 mins per hour. Where in earth do you find an employer offering that .... and how would any employer find your illness credible ?

 

[Sean]

but what about the... ...the air traffic controller?

There are some jobs for which a diagnosis of ME or LC should make that person ineligible for the job.

Hate saying that, but these conditions (and no doubt others) potentially compromise competence too much, particularly in situations where critical decisions have to made on the spot, without the luxury of time to reflect, and it places the public at significantly increased risk.

 

[Ash]

It is the responsibility of a human society to account for and accommodate human sickness.

To understand that people with chronic illnesses and impairments must be included and supported by the rest of society.

The trouble is capitalist societies are set up upon exploitation. They churn through the labouring classes leaving behind a trail of work related sickness and injury. Or punishing conditions of poverty inflicted upon workless workers and their families.

With the scale of this latest pandemic and the inadequacy of the government and corporate response, with the dominant world economies forcing through a concerted policy of non-response upon the rest of the world’s populations there is a massive death toll still unfolding and a mass disabling event still unfolding.

Corporations pressured governments to reduce
regulation designed to protect worker health and safety and conditions and sick pay before the pandemic during the pandemic and now still after a declaration from the richest governments that the pandemic be considered over. Vaccines for some nothing for everyone else.

So yeah corporations whose workers work in non-emergency or safety critical sectors do have to take responsibility for their workers, the ones that they helped make sick either directly through work place conditions or indirectly as lobbyists and beneficiaries of the current paradigm.

Corporations may have to change the way work works. We know that this is possible because it just happened.

Or corporations can shirk these responsibilities and just continue the churn at this accelerated pace.

Meanwhile ‘essential workers’, those who were instructed to get out there and face the deadly virus to keep society functioning and the economy rolling while the nonessential workers stayed home, are still falling victim to capitalisms support for this biohazard and others.

So many more dead or disabled people so many fewer healthcare workers.

I hope these accommodations advised for office work are implemented. But I am doubtful that this will be the case due to the conflict of ideology that will occur if they are. It’s a chip in the myth of individual responsibility. What if workers were to notice and start to question their own expendability?

On the other had it depends for how long non-disabled workers remain a free flowing resource versus just how much more job security can be cut for each sector and how inconvenient it is to keep on hiring and firing.

But looking at air traffic control the only remaining industry allowed to prioritise the mental acuity and physical function of their workers, then looking at the GPs, nurses, consultant specialists, who were not afforded such an opportunity, and evaluating this as a person disabled out of the workforce before I’d barely entered into it, and having topped up my cognitive impairment levels with a wee dose of long Covid, it is my judgment that we’re running out the good stuff. In the UK at least.

So good luck to the office workers. But as you all say up above, I can’t see these measures keeping the wheels on the track for too long.