Working with long COVID: Guidance for people professionals

Long COVID is defined by NICE as ‘signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis’. 

The three most common debilitating symptoms reported are fatigue, breathing issues, and cognitive dysfunction (that is, memory loss, brain fog and concentration and speech difficulties).

Commonly reported symptoms include:

• Fatigue
• Breathlessness
• Brain fog and poor concentration
• Short-term memory loss
• Slurred speech
• Chest pain
• Muscle and joint pain
• Headaches
• Sore throat
• Vertigo
• Hair loss and changes
• Digestive difficulties
• Autoimmune conditions
• Insomnia
• Heart rate changes
• Blood pressure changes
• Loss of taste
• Loss of smell
• Menstrual changes/early menopause
• Poor skin
• Depression
• Anxiety

People with long COVID experience some unique challenges that make aspects of this new and complex condition distinct from other long-term health conditions:

• Symptoms can vary, are overlapping and affect multiple systems in the body and so no two experiences are the same.
• Symptoms can hinder individuals from performing certain work-related tasks or impact their ability to perform them.
• Symptoms can be unpredictable and fluctuate over time, characterised by periods of recovery and sudden relapse, sometimes with new or different symptoms.
• Mild symptoms can be followed by more severe symptoms that impact on ability to perform day-to-day tasks.
• Relapse is common and can be caused by physical activity, mental activity, stress, heat and alcohol, and for some there is no identifiable cause.
• Symptoms can last for many months, and recovery can be slow and very gradual over many months.
• Many individuals with long COVID experience the uncertainty that comes with a new condition; this can include no clear diagnostic criteria, treatment or management plans. 

Importantly, many people report that their symptoms improve with time. Whether an individual is recovering or learning to live with their symptoms, there is need for ongoing support.

There are many compelling reasons why we need to consider the impact of long COVID in the workplace. As a new chronic health condition, many people with long COVID face a period of great uncertainty as they wait for confirmation of a diagnosis and an effective management plan. This has significant implications for sickness absence, return to work and ongoing work. 

Many employees awaiting diagnosis are not offered adjustments to help them stay in work as most organisations’ policies tend to be diagnosis-led, rather than symptom-led. This is a particular challenge for people with long COVID as even healthcare professionals are still learning about the condition. 

This means that many employees with long COVID risk not receiving the support they need to return to, and stay at, work. It also means that many individuals often return to work too quickly over a period of weeks rather than months. Consequently, their return to work is less likely to be sustainable and there are longer-term risks to their health. 

Organisations need to adapt their health and wellbeing plans and policies to take these unique circumstances into account while continuing to adapt their support as we learn more about this new condition. 

See the CIPD guide on Managing a Return to Work after Long-term Absence for tips on reviewing your absence management policies to support people with fluctuating conditions.

Long COVID shares many characteristics with other long-term conditions. The CIPD guide Managing and Supporting Employees with Long-term Health Conditions outlines key principles for creating a supportive workplace. These can be useful in planning support for employees with long COVID. These principles are described in more detail in the sections below.

• Managers play a vital role in supporting the health, wellbeing and engagement of their team. Research shows that employees are more likely to return to work and stay in work when they are supported by their line manager.
• Organisations that have good people management practices are best placed to enable employees to thrive when managing a long-term health condition such as long COVID. Good practices include inclusive recruitment and assessment processes, training and support for line managers to protect and promote health and work, as well as access to information and support through multiple channels.
• When managers manage well and build trust-based relationships with their team, they help to create an environment that is open, respectful and kind, in which people feel ‘psychologically safe’. This means individuals feel able to speak up about a health or work issue like long COVID without fear of criticism and in the knowledge they will be listened to and receive support and understanding. 

• Many employees find telling others about any long-term health condition challenging. In the case of long COVID, this could be even more challenging because they may not be able to obtain a clear diagnosis or treatment pathway.
• Employees working in supportive environments are more likely to discuss a health condition, to ask for help when needed and to return to work following sickness absence. Build a culture of psychological safety, where good working conditions and open conversations are prioritised, and mental and physical health are given equal standing.
• It’s important to remember that it’s unlawful for an employer to ask any job applicant or employee about their health or disability and an individual doesn’t have to disclose a health condition. However, people often find that talking to others about their condition and its impact on their work can bring a number of benefits, including access to support and helpful work adjustments, improved working relationships and peer support, and feeling they can bring their real self to work. By communicating these benefits, organisations can help to foster an inclusive culture where someone is more likely to share their experience of long COVID.
• The CIPD People Managers’ Guide to Mental Health has useful tips and a conversation checklist to open a conversation about someone’s health and its impact on their work. 

Information on legal obligations for employers relating to health, wellbeing and absence is available in section 7 of the guide on Managing Long-term Health Conditions.

• Absence and return to work are often managed as a one-off event, but many employees with long COVID will need to take multiple absences as their condition fluctuates over time. The most common approaches to managing absence in organisations include return-to-work interviews, trigger mechanisms to review attendance, and disciplinary or capability procedures for unacceptable absence. These approaches are often an additional stressor for employees with long COVID. Taking a flexible and individualised approach can help prevent unhealthy presenteeism.
• An understanding of the condition and its likely impact on a person’s capacity to be in work and to perform in work by their line manager should be the foundation of a more individualised and sensitive approach to managing absence.
• The CIPD guide Managing a Return to Work after Long-term Absence sets out the guiding principles to follow when navigating the key steps to managing an effective return to work:
  1. maintaining communication while absent
  2. preparing for a return to work
  3. supporting the employee and manager during the immediate return
  4. supporting the employee and manager on an ongoing basis on return.

• Ensuring employees have access to appropriate work adjustments can help them to sustain work. The nature of an adjustment will differ depending on many factors, including the nature of the job, the organisation and the employee’s unique needs. It could be that someone needs a number of different adjustments. As the symptoms of long COVID are likely to fluctuate over time, different work adjustments may be needed at different times. It’s vital to have ongoing and supportive conversations to review work adjustments.
• Providing that agreement has been given, it may also be helpful to contact the employee’s doctor, GP or consultant for advice about their condition and the most appropriate work adjustments that need to be made to enable them to remain in work.
• CIPD research on working with long COVID identified a number of specific work adjustments used by employees with long COVID to help them stay in work, such as:
  • home or hybrid working
  • other flexible working arrangements
  • reduced or off-peak commuting time
  • adapting work tasks to make them less physically, mentally or cognitively demanding
  • a wellbeing room for downtime during the working day. 

• Wellness action plans are a simple but empowering tool to look after wellbeing while working, and to help employers know how best to support employees. The plan sets out how an individual feels and behaves when they are well, what they need to do to maintain their wellness, any signs or triggers known to impact health, and the preferred action or response if these signs are noticed by others. Mind has downloadable wellness action plans that can be readily adapted for any condition.
• Health passports or a written adjustment agreement approach can empower individuals to manage their health condition with the organisation’s support. Only 9% of organisations reported using them, but where they are in place, they are broadly seen as effective.
• Specialist support from occupational health or vocational rehabilitation professionals can help employees stay well in work. Early engagement with specialists can help employees supplement advice and treatment from their healthcare practitioner with guidance specifically related to their work. In doing so, employees are better able to find strategies to manage their work and health, and work productively. 

• Typically, an individual with long COVID will need to make a series of adjustments to treatment regimens or lifestyle to manage their symptoms and keep well. These self-management strategies can play a vital role in enhancing work and health outcomes. However, many employees with long COVID, particularly during the (often challenging) early stages of diagnosis, are not fully aware of what self-management strategies will benefit them or how to access them in the workplace.
• Treatment or medication may impact an employee’s mood, behaviours or wellbeing and have several side effects. Self-management support in the workplace can help employees to develop skills and techniques to manage the impact of their symptoms and treatment. Different symptoms require different strategies, and self-management means different things to different people. Individuals will also have different preferences, but examples may include attending therapy or treatment sessions, completing cognitive fitness exercises, or using technology to remind people of appointments.

Everyone has a role to play in supporting employees with long COVID at work. 

The IGLOO framework for thriving at work, developed by the University of Sheffield and Affinity Health at Work, outlines the different resources at individual, group, leader/line manager and organisational level that can help an employee when managing a long-term health condition such as long COVID.

IGLOO framework for sustainable return to work 

• Wherever possible, it’s important for employees with long COVID to prioritise self-care and take appropriate responsibility to manage their condition. This includes developing an understanding of their condition, being able to identify early warning signs of symptoms and knowing how best to manage their symptoms.
• Employees may need support to develop their ability to manage their condition effectively, for example in areas of self-management strategies, resilience and confidence in their ability to manage their work and health. 

• Friends, family and colleagues play a vital role in supporting people with any long-term health condition, including long COVID. They can help them to identify early signs of onset and step in to support them in doing tasks that could exacerbate their condition.
• Employees are best able to stay in and thrive at work when their colleagues support them through constructive feedback on tasks, helping when completing challenging tasks and treating them as the person they were before experiencing long COVID.
• It’s important to agree with the employee what information about their condition and symptoms they would like to be shared with others, how this will be communicated and how they would like the team to support them. This helps to avoid misunderstandings and uncertainty. 

• What leaders and managers say and how they behave can affect whether the employee feels able to take steps to manage their condition in work, to take early action to mitigate deterioration and, ultimately, to stay in work. This is because managers are often the first contact point, and responsible for day-to-day management of the employee. They are also key to providing access to work adjustments and the implementation of job modifications.

CIPD research on working with long COVID identified a number of recommendations for supporting employees with long COVID to return to and stay at work. These included:

• Individual actions
• Group actions by their colleagues
• Line manager actions
• actions taken by their Organisation
• help and support from Outside their organisation. 

We call this the IGLOO for working with long COVID. These actions are summarised in the checklist below. Use this checklist to see what you can do to help employees with long COVID. Read the statements in the ‘Do I…’ column. Answer ‘yes’, ‘no’ or ‘sometimes’, marking your answer in the column.

Versions of this checklist can be shared with the individual with long COVID, their colleagues and their line manager. These can help everyone to be clear on specific actions that they can take to support employees with long COVID. 

The prevalence of long COVID is a reminder that the effects of the pandemic are far from over and will continue for some time. If people with long COVID don’t receive appropriate understanding and support, the risk is that work could exacerbate their symptoms, and some people could even fall out of work. 

It’s important that HR professionals review their existing provision to ensure that adequate offerings are in place to support employees with long COVID. By embedding support for people with long-lasting symptoms of COVID-19 within their wider health and wellbeing framework, employers can help to ensure their support is sustainable and long term.

Working well with long COVID involves everyone taking a shared responsibility. It requires:

• Individuals with long COVID to prioritise self-care and self-management to sustain their health and work
• Groups and colleagues to provide valuable practical and emotional support
• Line managers to help employees access the work adjustments and flexibility that they need to work effectively
• Organisations to design and implement compassionate and flexible absence management policies that accommodate individual needs
• Outside services to be signposted so that employees with long COVID can access specialist support.

HR professionals can share the guides for line managers, colleagues and employees with long COVID to support this shared responsibility.

• Society of Occupational Medicine COVID-19 return to work guide for recovering workers
• NICE COVID-19 rapid guideline: managing the effects of COVID-19
• NIRH Living with COVID19: A dynamic review of the evidence around ongoing COVID19 symptoms
• NHS: Your COVID Recovery

You can also find more information in our related employee guide.

Professional and advisory organisations

Acas (Advisory, Conciliation and Arbitration Service): www.acas.org.uk/

BACP (British Association of Counselling and Psychotherapy): www.bacp.co.uk

BPS (British Psychological Society): www.bps.org.uk

CIPD (Chartered Institute of Personnel and Development): www.cipd.org

DRC (Disability Rights Commission): www.drc.org.uk/

IOSH (Institution of Occupational Safety and Health): www.iosh.co.uk/

HSE (Health and Safety Executive): www.hse.gov.uk/

SOM (Society of Occupational Medicine): www.som.org.uk

TUC (Trades Union Congress): www.tuc.org.uk

RCOT (Royal College of Occupational Therapists): www.rcot.co.uk

VRA (Vocational Rehabilitation Association): https://vrassociationuk.com

This guide has been developed by Affinity Health at Work, the University of Sheffield and the CIPD, and outlines practical recommendations developed from the CIPD working with long COVID research. It draws on evidence and research with returning workers, line managers, occupational health, employment advisers, and rehabilitation professionals as well as HR professionals and the Long Covid Support group.