The possible impact of long COVID on the workforce

The COVID-19 pandemic has entered a phase where many people are returning to pre-pandemic activities and behaviors. The likelihood of hospitalization and death has diminished dramatically for most people – though the risks remain for the elderly and immunocompromised. However, risks of long COVID remain real and have serious implications for you and your employees.

Here are answers to some of the frequently asked questions you might have about long COVID:

What is long COVID?

• Long COVID is defined as new or returning symptoms four or more weeks after recovery from COVID-19. Symptoms can include
  • Fatigue
  • Cognitive impairment
  • Muscle or joint pain
  • Shortness of breath
  • Rapid heart rate
  • Sleep difficulties
  • Mood swings
• Long COVID appears similar to some other post-viral syndromes such as myalgic encephalomyelitis (more commonly known as chronic fatigue syndrome).
• Unfortunately, there is not one agreed upon definition of long COVID (WHO, British, Pediatric), which makes research on this topic challenging.

How many people infected with COVID-19 will go on to get long COVID?

• Studies suggest that 10% to 30% of those who have recovered from COVID-19 go on to have long COVID. At the same time, some studies likely overestimate long COVID by counting those with symptoms that are common in the overall population.

Is there a test for long COVID?

• No. There’s no specific test for long COVID. A clinician makes the diagnosis based on persistent duration of symptoms after a COVID-19 infection.

Who is at highest risk for long COVID?

• Those who are hospitalized, older and have more comorbidities are at higher risk for long COVID, and women are more likely to develop long COVID than men. Still many with long COVID do not fit into a higher risk group.

If I get long COVID, how long will I have it for?

• We don’t know. Many with long COVID have symptoms that last a year or more, but others recover in the months following their diagnosis.

Is there a medication to treat long COVID?

• Treatment largely addresses the symptoms of long COVID and helps people adapt to these symptoms. Drug trials for this condition are still in early stages.

Where can individuals get support and help for long COVID in the U.S.?

• Individuals with long COVID can seek an appointment at a multispecialty clinic specializing in the disease, although wait times maybe high.

Can anything prevent long COVID?

• Yes. Avoid catching COVID-19 and get vaccinated or boosted. The only way to develop long COVID is to get a COVID-19 infection, so preventing infections prevents long COVID. Also, population studies suggest that vaccination decreases the risk of long COVID. However, even some who are up-to-date on vaccinations can get COVID-19 infections and long COVID.

Is long COVID a disability?

• Yes, long COVID is considered a disability under the Americans with Disability Act (ADA) if it substantially limits one or more of your major life activities.

What is the impact of long COVID on the workforce?

• Some researchers calculated that a million Americans have left work and another 2 million Americans are working limited hours due to long COVID. On the other hand, Social Security Disability Insurance has not seen an upsurge in enrollment.
• Some, but not all, long-term disability carriers report increasing claims and are raising premiums. Over the longer run, 24-month caps on “subjective” symptoms mean that disability insurance reports could underestimate the frequency of long COVID. This is something that employers should watch carefully over the coming months.

What research is being conducted on long COVID in the U.S.?

• The National Institutes of Health (NIH) has a $1.15 billion research fund to address long COVID, although enrollment in the NIH trials is very low to-date.

Implications for employers:

• Offer accommodations to your employees who report having long COVID. Long COVID affects quality of life and can lead to lost productivity through absenteeism and presenteeism. By offering accommodations when able, you can support the productivity of your employees, especially those suffering from debilitating long-term symptoms.
• Keep an open mind to long COVID and prepare managers to respond to employees who report having this condition. Long COVID is effectively an invisible disability where symptoms are not always apparent to an outside observer. However, long COVID is a well-recognized medical condition so you should keep an open mind. Failing to address it could create legal risk under the ADA.
• Encourage vaccination. Preliminary research suggests that vaccination reduces the risk of long COVID and is proven to reduce disease severity, hospitalizations and risk of death.

BA.5 and other unpopular sequels

Omicron strains BA.4 and BA.5 now represent over half of all new U.S. infections. These variants have higher levels of “immune escape” than previous variants, meaning prior infection or vaccination is less protective against them. Also the two latest Omicron variants are about 20% more contagious than previous strains. These variants are one reason why U.S. case rates remain relatively unchanged over recent weeks.

New COVID-19 vaccines are on the horizon

One of the promises of mRNA vaccines is the ability to create new ones once the genetic changes in the virus are understood allowing for better protection against new variants. Yet while Pfizer and Moderna began research in early 2021 on vaccines for newer variants, there is still no vaccine targeted at new variants approved for widespread use.

The Food and Drug Administration (FDA) may change that. An FDA advisory committee evaluated data from Moderna and Pfizer last week for new vaccines aimed to provide immunity against Omicron BA.1. Both pharmaceutical companies sought FDA authorization for vaccines designed for BA.1, but the advisory committee asked them to develop vaccines designed to produce immunity to the ancestral strain as well as BA.4 and BA.5. So far, BA.4 and BA.5 vaccines have only been tested on animals.

It feels like we are always behind the coronavirus – debating vaccines for BA.1 when that strain departed the global scene months ago. We know that BA.1 is much closer genetically to BA.4 and BA.5 than the ancestral strain that was used in the initial vaccine – and antibody studies suggest that both of these new variant vaccines increase immunity against BA.4 and BA.5 (the current threat), not just BA.1. So a booster against BA.1 available in the mid-fall could prevent more disease than a booster against BA.5 that is available much later, by which time BA.5 will likely have already been supplanted by a new variant.

This might tell us, though, that we need a different approach to updating vaccines. We can anticipate ongoing evolution of the coronavirus, so we will likely need ongoing changes in vaccine composition. This means not requiring full clinical trials, which we do not require for annual flu shot revisions.

We also have given second boosters to less than a third of those who are eligible for them, suggesting that better targeted vaccinations are just one small part of our problem. Vaccinations administered via the nose could be easier to administer and prevent respiratory infection – and could therefore be more effective at stopping waves of infections. And broader vaccinations that are aimed at all coronaviruses could get us off the treadmill of always being behind the virus when it comes to vaccination composition.

Implications for employers:

• Encourage your employees to get boosters as recommended when available this fall, whether or not these include the Omicron BA.1 variant because each additional booster decreases the chances of severe illness, hospitalization and death.

Authors

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Jeff Levin-Scherz, MD, MBA

Managing Director and Population Health Leader

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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Patricia Toro, MD

Senior Director

Patricia is a physician and infectious disease specialist who consults with employers to improve the quality and cost-effectiveness of health care delivery. She has guest lectured at Harvard Medical School and currently develops pandemic responses and programs to address chronic conditions.

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