Editor’s note: Find the latest long COVID news and guidance in Medscape’s Long COVID Resource Center.
As a leading disability insurance attorney in the US, Frank Darras has seen firsthand the impact long COVID has had on employees and the challenges they face navigating not only the disease itself, but also the workplace.
Through referrals that come in from across the country, Darras says he has a real-time view of the pandemic and the enormous obstacles employees with long COVID face trying to explain and prove their condition.
“It’s terrifying to be suffering from a disease and a problem that there’s no cure for yet,” says Darras, a founding partner of law firm DarrasLaw in Ontario, California. “And having your job and your family’s financial future hanging in the balance…is horrific for the employee.”
Already, experts are predicting that the economic fallout and ripple effect of long COVID could be in the trillions of dollars.
“It’s a very significant fraction of the total workforce…in a tight labor market environment as we’re in, it’s a really important factor,” says Matt Craven, MD, a partner with consulting firm McKinsey & Co, and author of an upcoming report that estimates that acute and long COVID will cost the US economy a billion productive days in 2022.
Meanwhile, there is still much about long COVID that remains unclear. The CDC describes it as a “wide range of new, returning, or ongoing health problems” that happen at least 4 weeks after infection. In one recent large study involving 100,000 people in Scotland, one in 20 COVID patients said they had not recovered “at all” more than half a year after the start of their infection, while about 40% reported being “only partially recovered.”
“Long COVID is a term that we use a lot, but it’s really not well-defined, because different people have been impacted by COVID in very different ways,” says Cheryl Bates-Harris, the senior disability advocacy specialist with the National Disability Rights Network.
Engaging and Accommodating Employees
Employees with long COVID generally fall into two categories: those with debilitating, long-term symptoms that prevent them from working altogether and those with milder to moderate symptoms that allow them to remain productive with the right workplace accommodations.
Employees may not realize they can ask for accommodations, experts say, while inexperienced employers may not know how to help, or what to do with an employee who suddenly may only be able to function at 50% capacity.
“In a situation where many industries are labor-constrained right now, the importance of maintaining the long-term employer-employee relationship is greater than ever before,” says Craven, who leads McKinsey’s public health response to COVID-19. “What flexibility are they able to offer so that they’re not permanently losing a worker who could be a great asset for them over the longer term?”
For employees with mild to moderate long COVID symptoms, employers should provide a safe and supportive environment to openly discuss how they can help, advocates say. It is also important to be educated about long COVID.
Under the Americans with Disabilities Act, employers are expected to make “reasonable accommodations” for people with a disability, but advocates encourage employers to set a positive example by having these conversations and listening to their employee’s needs regardless of their status under the Disabilities Act.
“You would hate to throw away years of work experience and years of training that’s gone into that person, simply because there’s a part of their job they can’t do or they’re now experiencing health impairments,” Bates-Harris says.
If an employee cannot walk long distances because they become out of breath easily or tire quickly, employers can offer telework as an option where feasible, allowing an employee to work from home, experts suggest. They can make sure the employee is equipped at home with the devices and tools they need to do their job well.
If an employee’s job does not allow them to work from home, an employer can reduce their physical exertion, make sure they are given enough or extra rest breaks, or give them more time to use inhalers and nebulizers for shortness of breath, for example. They can also provide individual mobility devices, like electric scooters, so that an employee can move around without exhausting themselves, says Bates-Harris.
Those who have brain fog may prefer a quieter workspace. There are also apps that can help, including ones that can help workers keep track of tasks and stay organized. Employers can also provide a shorter workday or set a more flexible work schedule, while maintaining employees’ full-time status.
“I don’t care if my people come in at 4 in the morning and work till 10 a.m.,” Darras says. “Whatever kind of flexible schedule works for them, I want to make sure that I’m flexible in making my premises accessible.”
A collaborative workplace environment and using shared tools and documents can help lessen interruptions if an employee is sick or absent. Zoom meetings that are recorded can also help employees catch up and stay connected. An employee may request different responsibilities and tasks more suited to their health condition.
As an employer himself, Darras has tried to make these accommodations, saying it’s a chance for employers to figure out how to keep staff happy.
A Legal Right to Go on Leave
Ultimately, long COVID requires employers to be more flexible, experts say. If a worker is exhausted from an intense week, they may need to take time off to recover or attend medical appointments. Bates noted that one of the biggest complaints her organization gets are calls regarding time off and attendance.
While every case is different, in the US, the Americans with Disabilities Act and the Family Medical Leave Act grant many workers a number of protected rights, including unpaid sick leave. Those working for a company with 50 or more employees or for a government or public entity for at least 1,250 hours over the course of 12 months may qualify for up to 12 weeks of unpaid leave per year for family and medical reasons.
The Leave Act protects an employee from being fired for going on extended leave and requires employers to continue their group health benefits during that period of absence.
If people have long COVID symptoms so severe that they can’t work at all, they may qualify for Social Security Disability Insurance benefits, advocates say. But they caution that the process to qualify may not be quick or easy, and is compounded by the fact that many with long COVID can’t work due to extreme fatigue and brain fog, making the physical process of applying even more daunting.
Re-evaluating Workplace Policies
As many pandemic-related costs shift away from the government back to individuals and the private sector, employers will need to decide what kind of workplace benefits and health coverage they offer, says Pooja Kumar, MD, a senior partner with McKinsey who leads the firm’s work on US public health.
“What do their benefits structures look like? How matched are they to the known impact from long COVID?” she says, adding that it is not just about benefits and accommodations. “How do you actually continue to motivate a workforce when people are functioning at 80% because of physiological reasons?”
Darras says employers should also have a COVID-19 safety plan and make sure the company’s short- and long-term disability insurance benefits do not have limits on self-reported conditions — symptoms such as pain and chronic fatigue that are difficult to verify using medical tests but that are common among long COVID patients. It is something he has done at his own firm, and he suggests employers ask for guidance from a regional office for the Occupational Safety and Health Administration if necessary.
Part-time employees should not be forgotten either, advocates say. Employers can consider what they can do to help part-time staff meet the requirements to make them eligible for disability insurance.
While many of these accommodations may cost money, advocates stress the long-term benefits.
“The institutional knowledge and experience that current employees have far outweighs anything they’re going to get by hiring a new person off the street and training,” Bates-Harris says. “Employers who have experience hiring people with disabilities learned long ago that the cost of accommodating an employee far outweighs the cost of hiring new employees.”
With less than 3 years of information on COVID-19, Craven also stresses the importance of being agile. “Create policies now but revisit them over time based on new information, how people are using them, how they’re working for employees, how they’re working for employers,” he says.
“Version one doesn’t have to be perfect.”
Resources for Employers
Employers can also reach out to the Job Accommodation Network, which is funded by the US Department of Labor. It is a leading source of free, expert, and confidential advice for issues including workplace accommodations and disability employment.
It’s a resource many employers are unaware of, Bates-Harris says, and is “designed to keep people on the job and to allow employers to retain long-term employees.”
Employers can also consult the Equal Employment Opportunity Commission, a federal agency that deals with employment discrimination, or the Department of Labor website to learn more about their legal obligations.
“Frankly, as an employer, I’m responsible for [my employees], so I’ve looked at it and said, “It’s just an investment in my people,'” says Darras, who has a large percentage of staff who have been with the firm for more than 20 years.
“I want people to retire with me…. I want them to be healthy and thrive.”
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