Understanding the legal context for this new condition, as well as the stigma associated with it, is key.
Employers have been grappling with serious illnesses, deaths and economic upheavals due to the COVID-19 pandemic for over a year. As vaccination rates rise and the pandemic recedes, employers should pay more attention to those who have had COVID-19 and continue to have disability symptoms weeks and months later. This is known as “Long COVID” or more formally as Post-Acute SARS CoV2 (PASC). By treating this developing condition in the same way as other chronic illnesses employers can proactively deal with disabilities related to Long COVID.
Studies on long-term effects in patients with COVID-19 have shown very different results. A report from a review of electronic health records in Lancet Psychiatry showed that a third of those who survived COVID-19 had residual neurological symptoms, although this includes many with depression and anxiety, which are common even in those who have never had COVID Pandemic times. A report recently published in the Journal of the American Medical Association reported that 4% of recovered health care workers were tired, 2% were short of breath, and under 1% had difficulty concentrating eight months after infection. A study in Nature Medicine reported that 2.3% of those who recovered from COVID continued to have symptoms 12 weeks later. Those older and hospitalized and on mechanical ventilation seem most likely to have persistent symptoms, although even some young, healthy people have developed potentially disabling symptoms.
Jackie Reinberg, CCM, CDMS
The most common symptoms attributed to Long COVID are difficulty concentrating, fatigue, shortness of breath, chest pain, rapid heart rate, loss of smell and taste, anxiety and depression. This is similar to chronic symptoms seen in patients who have recovered from two related coronavirus infections, SARS (Severe Acute Respiratory Syndrome) and MERS (Middle Eastern Respiratory Syndrome).
There have been reports that vaccination against COVID could help some patients with long-term COVID recover from some symptoms, although the biological explanation for this is unclear. Anyone who has recovered from COVID or who has had long-term COVID symptoms is recommended to get vaccinated. However, employers should not assume that vaccination will relieve persistent symptoms.
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Employees who experience persistent symptoms after recovering from COVID may not be able to do their usual job. The federal government granted employees of employers with fewer than 500 employees extended family and sick leave under the Families First Coronavirus Response Act (FFCRA), even though the required coverage had expired in late 2020. Many states and some cities have also met new requirements for pandemic sick pay and vacation, but the majority have only a few weeks of wages.
Employees can use available sick time or paid time off if they continue to have symptoms after COVID, although many employees have little or no available benefit, especially if they have already missed work due to acute COVID infection. While applying for leave under the Family Medical Leave Act (FMLA) is an option, employees who choose this route have no income replacement and the potential for job loss after 12 weeks.
Many with Long COVID are covered by the American With Disabilities Act Amending Act (ADAAA), and employers must take reasonable steps to continue performing their essential functions. Some employees may be eligible for vacation accommodation under the ADAAA. Such leave is unpaid, although the benefits are maintained and their work is protected. The ADAAA requires employers to participate in an interactive process and review the circumstances of each employee individually. Employers can request information including medical reasons with an expected return date. Corporations are not required to provide perpetual vacation under the ADAAA, and such vacation vacations seldom last longer than 12 to 15 months.
Mike Xarras
General symptoms such as fatigue can justify accommodations designed to conserve an employee’s energy. Common solutions such as reduced working hours, alternating seated / light work tasks or the use of ergonomic devices can serve as useful techniques to support an employee’s return to work. Neurological symptoms can also affect an employee’s decision-making ability and cause memory deficits. Housing for these types of impairments and restrictions is available, but requires additional steps to monitor the employee’s performance for quality.
Some employees may not be able to return to work due to symptoms of Long COVID. Without abnormal lung or heart tests, they could have difficulty receiving short-term disability benefits (STDs). Disability insurers require objective medical evidence to support an approved leave of absence and it is difficult to provide certification for symptoms such as “brain fog” and “fatigue”, although these symptoms can be a profound disability. Disability insurers may require diagnostic tests such as neuropsychological assessment and functional assessment to determine eligibility and the substantial cost of such testing is the responsibility of the employee. Such tests may not be covered by employer-sponsored health insurance, and not all employers offer or offer STD coverage. A handful of jurisdictions, including California, Hawaii, Massachusetts, New Jersey, New York, Puerto Rico, Rhode Island, and Washington, offer short-term disability insurance. Connecticut will begin its program in 2022 and Oregon in 2023. These programs offer benefits for 12-52 weeks.
Jeff Levin-Scherz, MD, MBA
The same skill challenges exist for employees seeking long-term disability (LTD). Even those eligible for LTD coverage are likely to be eligible for a limited period of 24 months under the terms of the Mental Health or Subjective Symptoms Policy. Employees who are permanently unable to fulfill their professional duties can apply for Social Security Disability Insurance (SSDI), although the approval process is lengthy and few benefits are granted without objective medical tests to prove the disability. Many of those with post-infectious neurological complications will require significant assistance in navigating the disability system, and some will likely face significant financial difficulties.
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Additionally, people suffering from a new disease syndrome that is poorly understood often find clinicians, colleagues, and family members rejecting their symptoms. Symptoms that persist after people recover from other communicable diseases such as Epstein-Barr virus, Lyme disease, and SARS were initially dismissed by the medical community, but were later classified as part of recognized diseases. Patients whose complaints were not taken seriously often developed a cycle of worsening symptoms along with depression. Employers can offer those affected by Long COVID a tremendous sense of relief by showing empathy and acknowledging that their symptoms are “real”. Employers should treat patients with PASC with empathy and not assume that they are misrepresenting their symptoms or exaggerating them.
In addition, it is important that employers, under the direction of the HR department, are vigilant to avoid discrimination against those suffering from Long COVID. By using standard approaches to assessing and supporting people with long-term COVID symptoms, employers can eliminate the stigma attached to the condition. By providing shelter and following standard guidelines to avoid preferring some employees to others, you can ensure compliance.
We are only just beginning to understand the potential effects of Long COVID, and it is possible that some of the worst symptoms will improve or improve over time. HR departments can protect their employees and businesses by familiarizing themselves with Long COVID, treating employees who complain about these symptoms with empathy, and developing clear policies and procedures to address employees who complain about residual symptoms after recovering from COVID .
Jackie Reinberg, CCM, CDMS, is the director of the National Absence, Disability, and Life Practice at Willis Towers Watson. Mike Xarras is a consultant at Willis Towers Watson. Jeff Levin-Scherz, MD, MBA, is the general manager and head of public health for the Willis Towers Watson Health and Benefits Practice.
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