Long Covid: a challenge for both the healthcare sector and employers

In Flanders, the workforce is around three million people. If we assume that one in three has been infected with Covid-19 and that 10% has developed Long Covid, we’re easily talking about over 100,000 employees with Long Covid. The impact on daily life varies from difficulties doing household chores and having to (temporarily) stop professional activities to financial and social consequences and reduced mental well-being.
 

To date, there is no clear, internationally accepted medical definition. In October 2021, the World Health Organization described the ‘Post COVID-19 condition’ as an illness that occurs in people with a history of probable or confirmed SARS-CoV-2 infection, usually within three months from the onset of COVID-19, with symptoms and effects that last for at least two months and cannot be explained by an alternative diagnosis.

The most common symptoms are:

• A sense of fatigue, abnormal exhaustion that is not consistent with the effort made;
• Concentration and memory problems (‘brain fog’);
• Shortness of breath, headaches, muscle pain, heart palpitations, persistent cough, loss of smell or taste, anxiety, sleeping disorders and depression.

The symptoms seem to be similar in part to those of other conditions, such as chronic fatigue syndrome, post-traumatic stress disorder, stress disorder, burnout and post-intensive care syndrome. Symptoms may persist from the initial illness or emerge later on and their severity may fluctuate over time.  

Long Covid spares no population or age group and occurs both after a severe Covid-19 infection and milder illness. Interestingly, the condition occurs most often in the working population. Why some people develop Long Covid and others do not has not yet been clarified. However, research shows that being female, the number of symptoms during the acute phase, a higher Body Mass Index and chronic conditions are all associated with a higher frequency of occurrence.

Some symptoms are the result of organ damage. Depending on the cause, the most effective treatment differs from one person to another. With organ damage, treatment primarily targets the affected organ system, such as the heart or lungs. In other cases, multidisciplinary rehabilitation, including physical therapy and neurocognitive rehabilitation, is recommended. Self-care and self-management are also addressed over time.
 

Long Covid is an ‘elimination diagnosis’. This means that other possible causes must first be excluded by the general practitioner, if necessary with the assistance of other professionals. If the situation is complex, a centre with expertise in Covid-19 should be contacted. The patient will then be offered a personalised multidisciplinary treatment plan.

Employers can help identify the extent and impact of the problem. It is important to take symptoms seriously and to be open to a gradual return to work. Employers can contact their occupational physician, who can provide the employee with relevant information. Depending on the knowledge of the work stations and employee's functional impairment, the employer can also be given custom advice.

Make sure to involve the occupational physician early on and absolutely (long) before the return to work. Good cooperation between the occupational physician, advising physician from the health insurer, medical officer and general practitioner can also make it easier to follow up on Long Covid patients and make their return to work a more successful one.

The bibliography can be obtained from the author.

Geert Laire, Prevention advisor – Company doctor