Post-Acute COVID 19 Syndrome, ‘Long COVID’

According to the World Health Organization (WHO), there have been 101,496,168 confirmed cases of COVID-19 with 1,103,936 deaths in the United States from January 3, 2020 to February 15, 2023 ( ^{World Health Organization [WHO], 2023} ). As of February 10, 2023, over 6 million doses of COVID-19 vaccines have been administered and globally, and an estimated 200 million people are living with on-going COVID 19 symptoms ( ^{WHO, 2023} ).

These numbers can be overwhelming and most people infected with SARS-CoV-2, the virus that causes COVID-19, recover within weeks. But for some, their symptoms can persist for weeks and months. This is called post-acute COVID-19 syndrome or “long COVID.” Symptoms of long COVID are wide ranging and include: fatigue, difficulty in thinking or concentrating (brain fog), headache, shortness of breath especially after any activity, dizziness on standing, palpitations, chest pain, cough, joint or muscle pain, depression or anxiety, fever, stomach pain, diarrhea, and loss of taste and smell. Vascular issues can also occur such as blood clots possibly leading to a pulmonary embolism. Extreme symptoms include severe damage to the heart, lungs, kidneys, skin, and brain (^{Centers for Disease Control and Prevention [CDC], 2022}). According to the Government Accountability Office, long COVID has affected 7.7 million to 23 million people in the United States (^{Government Accountability Office [GAO], 2022}).

Individuals most at risk for developing long-COVID are women, individuals re-infected with the virus, and those with previous conditions like lung disease, hypertension, obesity, and depression. It is important to keep in mind that there is no standard presentation or treatment of long COVID.

How do we support the workers that are in our care as occupational health nurses? (OHNs) In 2021, the Department of Health and Human Services (HHS) declared that long COVID be classified as a disability under Titles II and III of the American with Disabilities Act (ADA) (^{Health and Human Services [HHS], 2021}). Long COVID can affect activities of daily living, such as caring for oneself, eating, sleeping, and concentrating. Lung involvement can present with shortness-of-breath and fatigue. Neurological involvement leads to brain fog. All these symptoms can severely limit major life activities (Mayo Clinic, 2022).

Individuals whose long COVID qualifies as a disability are entitled to the same protections given under the ADA. Places of work should accommodate a person’s long COVID limitations and provide reasonable modifications to allow that person to continue working. Every effort should be made to assist workers to continue working. Unemployment can significantly affect health insurance coverage associated with long-COVID. To qualify for federal programs, social security disability insurance, and supplemental security income, applicants must be unable to work and have health conditions that last for at least 1 year or result in death.

The Administration for Community Living (ACL) which is a division of HHS has guidance available for people with long COVID. Resources are available at ACL.gov delineating the support offered in the community. The site also offers help in navigating the state’s system of services such as transportation, mobility equipment, and case management services (^{Administration for Community Living [ACL], 2021}).

Most workers with long COVID want to return to work. It is our responsibility as OHNs to make sure they are met with flexibility and support. The use of reasonable adjustments should be employed, such as offering reduced duties, shorter hours, or the opportunity to work from home where possible. In the case of health care workers, many became ill because they were trying to save other people’s lives, to neglect them now would be shameful. Long-COVID is often relapsing and remitting. Each case is different and offering flexibility is respectful of the worker’s skills. Cost wise it is often cheaper to keep a worker especially a highly skilled one rather than hiring new people who will have to be to be trained.