Covid restrictions in the UK have ended, and the number of new cases and deaths are falling – but the virus’ true impact on businesses and insurers is only just beginning. Dr Quinton Fivelman explains

There is mounting evidence that up to 30 per cent of people who contracted Covid-19 could develop some form of PASC (Post-acute sequelae of coronavirus), commonly known as Long Covid. This has a huge significance for businesses as they seek to manage staff illnesses, and for their insurers.

Many individuals who caught Covid have gone on to develop long-term symptoms that have impacted on their quality of life, and reduced their performance at work – in a development that could cost the NHS millions.

It is also very difficult to predict who may be worst affected, as there is currently no detectable correlation between the severity of the initial illness and the onset of PASC.

Managing significant numbers of people who are either off work ill, or who have returned to work but are unable to perform their full duties, looks set to be a challenge for businesses that will continue for some years.

There are an estimated 1.3 million people in the UK currently suffering from Long Covid symptoms, according to the government’s Office for National Statistics. While 1.3 million sounds like a large number of people, it is in fact only around two per cent of the population. Our concern, however, is that evidence is mounting that the true number of long-term sufferers will be much higher, particularly if we see another surge of infections.

A study conducted last year by the University of Washington found that in a random group of Covid patients (over 80 per cent of whom were outpatients and never hospitalised for the virus), around 30 per cent reported persistent PASC symptoms for as long as nine months after illness.

It is also likely that many people are either not reporting ongoing symptoms or are experiencing new health problems and not associating them with what seemed to have
been a mild Covid-19 illness some months previously.

Long-term symptoms in some PASC patients may be due to consequences from organ or tissue injury, or associated clotting or inflammatory processes during Covid-19.

A recent overview published in the journal Frontiers in Microbiology highlighted PASC symptoms as including fatigue; muscle weakness; insomnia; palpitations; congestion; taste disorders; chills; sore throat and headache.

Of even greater concern, a new study published in Nature in March shows that, even after a mild infection, the overall size of the brain had shrunk slightly in the majority of Covid-19 cases. Overall brain size in infected people had shrunk between 0.2 and two per cent. There were losses in grey matter in the olfactory areas, linked to smell, and regions linked to memory. Those who had recently recovered from Covid found it slightly harder to perform complex mental tasks – likely to be a cause of the continuing ‘brain fog’ that many people experience post-Covid, which can last for months after their other symptoms have apparently gone. This could well translate into some staff not returning to their previous performance levels for some time.

The Covid-19 virus spreads through the airways into the heart, brain and almost every organ system in the body, and can lead to significant problems from chronic fatigue and difficulty standing upright.

A study printed in the Annals of Neurology in December, found multisystem abnormalities in the cerebrovascular, respiratory, neuronal, and autoimmune systems in people suffering from PASC. Inflammation of small vessels is thought to play a role in this. A South African study found circulation problems associated with microscopic blood clots. These tiny clots may form during an infection but might persist in Long Covid patients and block the fine capillaries that carry oxygen to tissues throughout the body.

What should employers do to aid Long Covid sufferers? With anything up to 30 per cent of its workforce absent, or back at work but facing one or more of the symptoms outlined here, businesses will have to adapt.

The Chartered Institute of Personnel and Development says 26 per cent of companies report Long Covid as a main cause of extended absence. In a survey of 804 businesses, 46 per cent had employees that had experienced Long Covid. CIPD says that 45 per cent of employees suffering from Long Covid said that they were working reduced work schedules and 22 per cent were not working at all, due to their health condition.

Similarly, a Trade Union Congress survey of 3,557 workers with Long Covid, found 57 per cent had returned to work fully with 16 per cent returning to reduced hours. It is worthy of note, too, that the TUC is calling on the government to strengthen the Equality Act 2010 by specifying that Long Covid is a disability.

Despite these numbers, CIPD says only 19 per cent of employers provide guidance for their employees about managing health conditions while at work. Looking at these numbers, companies can’t simply turn a blind eye to the impact of Long Covid on their employees and on their bottom line. Adjustments will be needed to an employee’s work or work pattern, both from the point of view of helping staff successfully return to work, and under health and safety legislation to help employees manage the impact of Long Covid on their work life.

Long Covid is a particularly difficult illness to manage because on some days the affected individual might seem well, while on other days their symptoms can be worse, and they may need to be off work again.

Businesses and their managers are in a difficult position. Fear of a job loss or any sort of backlash could prevent staff from seeking the help they need. Managers will need to define an appropriate level of work, any downtime needed, and any adjustments staff need to make to their role while they recover. Communicating Long Covid sufferers’ problems to the wider team can help plug the gaps, but by law, managers need their employees’ permission to share any medical data.

According to the Advisory, Conciliation and Arbitration Service body, ACAS, if an individual is off sick with Long Covid, their employer should agree how and when to make contact during any absence, make sure their work is covered or shared out appropriately while they’re off, and talk about ways to support them as they return to work where and when possible.

As a patient returns to work, the following will need to be discussed:

1. Getting an occupational health assessment.

2. Making changes to the workplace or to how the employee works, such as different working hours.

3. A phased return to work.

4. What they want to tell others at work about their illness.

Increasing problems

While it is clear that Long Covid is a genuine, physical problem that can become a chronic illness, it cannot be denied that it is such an unspecific illness with so many potential symptoms that it is often difficult to medically diagnose and treat.

There has also been a rise in people taking sick leave because of Covid rather than directly due to it, such as general fatigue or depression rather than Long Covid specifically – not that people without Long Covid are not suffering, but this is generally a specifically psychological, rather than physiological, problem often due to anxiety or stress related to the pandemic as a whole.

This does not mean we shouldn’t address the elephant in the room. Since the pandemic, 40 per cent of workers are said to be considering changing jobs, so there is certainly an increased malaise amongst the working population.

A small minority may also simply use Long Covid as an excuse for absence. The problem here is that there is no specific test for Long Covid. Only certain specific symptoms, such as breathing difficulties, can be measured.

Another significant problem for businesses is deciding what to do when a member of staff never returns to full fitness and their role cannot be adapted to their new capacity levels. If an employee becomes unable to do their job due to an illness such as Long Covid, despite a period of adjustments or support, a capability issue may arise.

ACAS says businesses should make sure they have done everything they can before considering a capability procedure. If an employer dismisses an employee without first carrying out a full and fair disciplinary or capability procedure, there may be scope for the employee to make a claim of unfair dismissal.

Insurance considerations

Long Covid presents insurance problems both for staff and employers. Long Covid is a chronic condition, which, according to Aviva, means it’s not covered by private medical insurance, although that policy should cover them right up to the diagnosis of Long Covid – including eligible tests to determine the cause of their symptoms.

According to the Association of British Insurers, Covid has had a considerable impact on business insurance already, with carriers expected to pay around £2 billion in business interruption Covid claims from 2020 alone, out of an anticipated £2.5 billion in Covid-related claims across all insurance products, including travel and life.

However, in a Dear CEO letter issued to insurance firms, the Financial Conduct Authority wrote: “It remains the case that most SME business insurance policies are focused on property damage and only have basic cover for BI as a consequence of property damage, so are unlikely to pay out in relation to the Covid-19 pandemic and its effects.”

It is that final clause that is key here. The effects of Long Covid can be very damaging to a business. For example, what happens in the case of an owner of a small business who is unable to properly run their company because he or she is suffering from Long Covid? That is just one of the problems the condition has created.

A testing problem

The medical profession has reacted incredibly swiftly to the arrival of this new virus. At London Medical Laboratory we introduced a wide variety of new tests for Covid, to detect the presence of the coronavirus, and to meet the government’s ever-changing travel regulations. We also introduced an IgG antibody test, which provides 100 per cent sensitivity in detecting Covid-19 antibodies in people 14 days (or greater) after a confirmed illness. Determining Covid-19 antibody levels is the most effective measure we have of the level of immunity a person has built up to the disease. We also provide a wide range of blood tests which can help diagnose many of the symptoms attributed to Long Covid.

The fact remains though, that no comprehensive test for Long Covid currently exists, and such are the wide variety of symptoms reported, that a comprehensive Long Covid blood test seems unlikely to ever be developed. That places both businesses and insurers in a difficult position, and one that is likely to persist for some time to come.

This article was published in the March-April 2022 issue of CIR Magazine.

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