What we now know about long COVID – and what to do about it 

From the early days of the pandemic, there have been reports of people who had COVID-19 experiencing lingering symptoms long after their infections resolved, and there are now people whose symptoms have lasted for years. This condition now has a medical name, Post-Acute Sequelae of SARS CoV-2 (PASC), although it’s most commonly known as long COVID. This label covers a wide range of conditions and for that reason has been difficult to study.

Risk factors for developing long COVID include age and underlying medical conditions such as asthma, obesity and diabetes. However, non-elderly people without medical issues also experience long COVID. How common it is remains a hard question to answer.  Estimates of the general risk of developing long COVID -- defined as symptoms lasting longer than 12 weeks – after being infected range from 20%-45%. Vaccination has been reported to decrease the risk, but it is not clear by how much -- estimates range from 15%-50%.

Three post-COVID scenarios

As we’ve learned more about COVID, we now recognize three different scenarios in which the infection leads to continuing symptoms. One occurs when people have been very ill and required intensive hospital-based care. It can take a long time to recover not only from the illness, but from the impact of being on a respirator or other support equipment. Convalescence can take months. Fortunately, as more people have been vaccinated, fewer people now require such invasive treatment.

A second scenario is when the infection itself produces long-term health consequences. Although COVID-19 is usually thought of as a respiratory disease, there is clear evidence that it can also increase the risk of blood clots.  Ongoing pulmonary problems are often due to blood clots in the lungs. Blood clots can affect many other parts of the body, including the heart, brain, kidney and blood vessels. The seriousness of the problem and the length of time that it affects a person varies considerably.

In the third scenario are the cases that are most commonly called “long COVID” or “long-haul syndrome.” Here, symptoms typically occur about six weeks or so after a mild infection not requiring hospitalization. They can include fatigue, nerve pain, headache, balance issues and what sufferers describe as brain fog. There is also data that shows an increased risk of anxiety and depression, although that seems to resolve in a few months. More worrisome is the noted increase in seizures. Studies into the mechanisms behind these issues are ongoing, but researchers have noted similarities to other post-viral illnesses and to how the brain and body respond to chemotherapy.

Impact on children

Fortunately, COVID-19 has had less of an impact on children in general, and as a result long COVID is also less common among children. As with adults, vaccination lowers the odds of children developing long COVID. A recent study from University of Colorado showed that underlying health issues and having a more severe initial illness both increase the risk in children. Myocarditis is the most common long-term complication found in this study.

Implications for employers

Given what we now know – and still don’t know – about PASC, what actions should employers consider to safeguard the health and well-being of their workers?

• Encourage employees and their families to stay up to date on their COVID vaccinations.  Educate them about the benefits of the new vaccine booster that has just been released and where they can get it – or arrange to have it administered on-site.  
• Be sure that your disability carrier has the programs in place to assess people with long COVID and to monitor their status
• Discuss potential accommodations for those with fatigue or other symptoms that may interfere with work and make sure that you have access to services that can provide functional assessments. A number of medical systems have established centers for long COVID care that can help.
• Be sure your employees and their families know how to connect with behavioral health resources through EAP or other services.

While there is still much to learn about long COVID, what we do know is that the condition is real and that anyone who has had COVID can be affected by it. People who are suffering with long COVID need help both medically and with work accommodations. At this time, most doctors still do not know how to evaluate the condition. Fortunately, the CDC is funding a major research effort that should lead to more effective care and treatment. Look for more clinical information coming over the next months.