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More than six months after becoming ill, Paul Garner’s out-of-office email message asked for patience due to recovery from “post-viral symptoms associated with a Covid-19 infection”.

The professor of infectious diseases at the Liverpool School of Tropical Medicine traces the start of his infection to March 19. In the first two months, he was “floored” by the aggressive illness.

Night sweats and “cyclical attacks” of the illness became less severe after about three months. Severe fatigue persisted for three more. “I could talk for 15 or 20 minutes, but if I went on too long or spent too much time at the computer, my speech got muddled up, and I would not be able to find words. This really went on up to month six. I had to be careful about judgments as the fatigue gave brain fog . . . You have to be gentle with yourself. I am used to driving through. If I have problems, then I just increase the effort to overcome them. This strategy does not work if you are ill with Covid.”

Most people with Covid-19 recover within two weeks. Some, like Prof Garner, with so-called Long Covid (symptoms lasting longer than three weeks), continue to experience excessive fatigue, breathlessness, headache, insomnia, muscle fatigue and pains, chest pains, persistent cough, intermittent fevers and brain fog. 

Tim Spector, professor of genetic epidemiology at King’s College London, warned in a recent report that “long-haulers that could turn out to be a bigger public-health problem than excess deaths”. The study finds about 10 per cent had symptoms for a month, with between 1.5 and 2 per cent after three months. The median age of those with Long Covid is 45, and women are more likely to be affected.

Sufferers have found support in groups such as Body Politic, Long Covid Support Group and Long Covid SOS.

Because those most vulnerable to Long Covid are of working age, the condition also presents a challenge in workplaces. Dr David Strain, senior lecturer at the University of Exeter Medical School, is researching Long Covid and says “we don’t know enough about it” to predict that long-haulers “will be better within 12 months”. Employers’ best strategy, he says, is “making sure the workplace is Covid-secure”.

Healthcare workers face Long Covid strain

Living with Long Covid is a particular challenge among frontline healthcare workers. One, aged 31, recovered from the virus after three weeks and prepared to return to work. Several false starts later, he is still dealing with palpitations, chest pain and fatigue. “By the very nature of this long illness, it is impossible to tell if you are fully recovered and fit to return to work, as the symptoms come and go and life becomes a series of peaks and troughs, good days and bad. Staffing rotas will inevitably become difficult if large numbers of a workforce become unwell.”

Some workers report frustration in dealing with human resources executives or co-workers, whose only knowledge of Covid-19 is that people end up in hospital or recover relatively quickly. And this comes at a time when many employers are struggling to keep afloat and public services are stretched. Prolonged illness has a profound financial impact on those not covered by employer sickness schemes or state sick pay. There is a sharp divide between those who can do some work at home and those with physically demanding jobs.

One woman who works for a private care provider is unable to work, six months after becoming infected. “I have the fun version of Long Covid that involves continually developing symptoms,” she jokes bleakly. Currently receiving Statutory Sick Pay (£95.85 a week), it is unclear if she qualifies for additional payments to support social care workers self-isolating.

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“I am feeling more than a little abandoned,” she says. “Long Covid wasn’t a thing when a lot of the planning was being done . . . I fear we are being missed. I seem to be deemed to be an acceptable casualty of the pandemic. It feels like the equivalent of leaving the occasional injured soldier behind because they are just too much bother.”

One UK-based GP with Long Covid says that workplace sympathy can wane. “Initially, the World Health Organization said you would be better in 10 days.” For the past six months she has had fever, headaches, brain fog and slurred speech. “It’s unpredictable. Some days it can hit you like a brick. Other days I can feel normal if I pace myself.”

Her GP practice, like many in the UK, is run as a partnership. The partnership agreement states if she were unable to fulfil her duties over six months, she could be expelled from the practice. That has now happened. “It became evident that due to my ongoing, relapsing and remitting symptoms, particularly daily fever, I would not be able to return to work before the six-month period was up. My illness is too unpredictable.”

Managers advised to ‘tread carefully’

Some long-haulers complain of medical gaslighting by doctors who do not understand a new illness with diverse symptoms. For this reason, Clare Rayner, an occupational health physician who has suffered from Long Covid, advises managers and colleagues to tread carefully and be understanding. In the UK, existing workplace policies should cover Long Covid, but “managers who deal with employees off sick should receive training and updates on how to manage sickness absence in accordance with employment law”. 

Clare Rayner © Handout

Silicon Valley-based Joy Wu is currently looking for work while still experiencing symptoms after she was infected with Covid-19 in March. “I know I cannot work full time because I have significant fatigue; I also have both insomnia and hypersomnia. I do not even have a rough figure of how much I can work in a week since everyday is different,” she says. Ms Wu is transparent with potential employers: “Whether it's the reason or the economy, I haven't heard back from a single person.”

She is living off savings and will soon lose her previous employer’s health insurance. “I know others have been rejected for disability because long-hauler symptoms are not considered a disability; I have not tried that path yet.”

Joy Wu © Handout

Prof Garner’s experience at work has been positive. “People want to work, but they may be ill and they need space to recover . . . and agree to work plans that make sense, or provide support where they need this.”

Stopping work completely may have an impact on mental health, he says. “I needed the social contact through Zoom calls and meetings to keep me going. People need to stay socially engaged.” Yet he set limits on his meetings, taking regular breaks and reducing his workload.

Dr Strain also advises employees to carry on with some form of work if possible. “When they do recover they are in a position to continue — [because] if you have to stay out of work for six months, [you have] got a lot of catch-up.”

For senior managers experiencing cognitive problems, Prof Garner recommends creating or updating a risk management strategy. In his own case, he jointly manages a grant with a colleague and set up a process so that any big decision involving finance or staff would require her agreement.

His advice to employers? “Understand this virus messes with your head and mood. It’s important to be considerate.”

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