Work and vocational rehabilitation for people living with long covid
Corrections
Long covid is a complex, highly variable, and sometimes relapsing-remitting condition that may have profound impacts on a patient’s wellbeing and ability to work.1 Many people living with long covid are attempting to return to work, or stay in work, while learning to manage an emerging long term condition.2 These challenges may be compounded by workplace burnout, fuelled by labour shortages, the psychological effects of the pandemic, widening inequalities, and global economic insecurity.
For some people, disabling symptoms lead to complete inability to work.3 In less extreme cases, “work instability,” which is a mismatch between patients’ functional abilities and the demands of their work, can threaten employment if not addressed.45 This may manifest as difficulties in executive functioning and communication which adversely affect those in roles where they are expected to deliver at optimum performance in high pressure working environments. Numerically, however, the greatest impact is on patients from underserved communities who face the multiple jeopardy of physically demanding, inflexible, and insecure jobs where they encounter hostile scrutiny and punitive disciplinary procedures from supervisors. This scrutiny, combined with fewer employment rights—such as little or no entitlement to sick pay, working cash-in-hand, or being self-employed—creates additional stress and anxiety, often exacerbating their symptoms.6 They are also more likely to have comorbidities that are worsened by prolonged covid symptoms, further affecting job security.
Workers may be fearful of disclosing a health condition, taking sick leave, or requesting temporary adjustments to their role.7 Employers facing staff shortages and financial uncertainties are less able to support workers with long term conditions. People who have been out of work for more than six months have a 50% chance of never returning to work; early intervention can help some people successfully reintegrate into the workplace.8 However, unlike other vocational rehabilitation programmes for different conditions, where much more information is known, long covid presents a unique challenge. The multitude of symptoms experienced by people living with long covid, and the often fluctuating nature of those symptoms, means there are gaps in our knowledge of the most effective strategies to support people back into work.
In this article we offer an overview of the impacts of long covid on people’s ability to work, and the types of patient scenarios clinicians may encounter. We outline how clinicians can respond to questions patients ask about work, suggest resources, and appraise what we know while considering patient experience.
