RETURNING TO WORK AND LONG COVID

28 May 2021

Covid legacy will be a long journey back to work for many

Just over a year ago Covid-19 took on the global force of a pandemic. Just about every country in the world would have to bow to the devastating impact this would have on our health, our economies and our quality of life. Despite the desperate death toll there was hope as millions recovered from this cruel disease and we began to find ways to limit the spread of infection and establish a new normal. But, for many, this return to ‘normal’ has not been the journey they were hoping for, with as many as 10 % of Covid-19 patients left living with Long Covid.

What is Long Covid?

Long Covid is a diverse syndrome in patients who are still experiencing symptoms of the disease more than 28 days after testing positive for Covid-19. The symptoms affect multiple body systems with commonly reported symptoms including fatigue, shortness of breath, muscle pains, chest pain, cognitive impairment, headache, and psychological disorders. It is difficult to predict who will develop Long Covid but what is clear is that it is more likely to be seen in people with pre-existing health conditions, who are over 50, obese, female and have had more than five Covid-19 symptoms.

Work and Long Covid

This is a debilitating condition and a patient’s health will fluctuate as symptoms progress or resolve.  Healthcare requires a multidisciplinary team approach focused on rehabilitation and symptom management. The NHS has established nearly 70  Long Covid clinics and several occupational safety and health organisations, including IOSH, have developed guidelines to assist managers with the return to work (RTW) process.  A significant aspect of this journey back to work is assessing a worker’s ability to assume their normal work, with attention given to those with unresolved cardiac, respiratory or neurological symptoms. Long Covid symptoms affecting the ability to cope at work include shortness of breath, fatigue, brain fog and chest pain. Whether it is physical restrictions (shortness of breath) or cognitive impairment (brain fog), you are managing workers who may be unable to cope with work for entirely different reasons, necessitating an individualised approach to care.

So, it is important to include the line manager and the worker in in decision making. Ask the worker for suggestions on working life adjustments (such as working from home, flexible working hours etc) to facilitate RTW. Address the mental health issues through good communication and provide realistic reassurances and advice where necessary. A worker may experience highs and lows and functionality will need to be monitored regularly to accommodate these transitions.

What does the future hold?

The impact of Covid 19 has been massive and its legacy will continue to be felt through Long Covid. It is not clear how long it will take workers to fully recover from Long Covid but there’s a real prospect we’ll have to manage the safety and health of workers with Long Covid for years to come. Successful integration into the workplace will very much call for a collaborative approach, with the wellbeing of the worker, the patient at the centre.

Further information

• IOSH Website, ‘Coronavirus Information’, https://iosh.com/coronavirus/

Dr Karen Michell

Research Programme Lead Occupational Health

IOSH

Supporting NHS staff with Post COVID-19 Syndrome (Long Covid)

The gift many had been waiting for (alongside the vaccine!) has arrived; the NICE COVID-19 rapid guideline: managing the long-term effects of COVID-19 (hyperlink to document https://www.nice.org.uk/guidance/ng188).It provides clear definitions for Acute COVID-19 (signs and symptoms up to 4 weeks), Ongoing symptomatic COVID-19 (4-12 weeks) and Post COVID-19 syndrome (more than 12 weeks). This clarity will help healthcare professionals collect data and offer a stepped care approach to return to work interventions as for many people, their symptoms will resolve within 12 weeks. So, what does this mean for NHS staff now who are struggling to return to work after COVID-19?

Acute COVID-19

The NICE guidelines state that crucial in the earlier stages is assessment, offering advice and written information about possible fluctuating symptoms and self-management. How the symptoms affect the person’s life and activities such as work should start at the assessment stage. Introductory advice is offered inYour Covid Recovery(hyper link to site https://www.yourcovidrecovery.nhs.uk/your-road-to-recovery/returning-to-work/)

Ongoing symptomatic and Post COVID-19 syndrome

If people develop longer term symptoms, the guidelines indicate that they may require a greater level of multidisciplinary assessment, support and rehabilitation to return to work. This would include using shared decision making to set realistic goals, treating fatigue and respiratory symptoms, and supporting people in discussions with the employer about what a phased return to work would look like. The use of graded activity, problem solving and worksite assessments will be key. It is hoped that this group of people will also be able to benefit from new sections in Your Covid Recovery that will provide more in-depth return to work advice.

Your Covid Recovery Group

So, can this be put into practice with potentially larger groups of employees with Long Covid in the NHS? Occupational therapists working in NHS Occupational Health have been doing just this offering both group and individual interventions.

Sara McGinness from Liverpool University Hospitals Foundation Trust has set up the “Your Covid Recovery” group which starts with a screening telephone appointment and is offered to NHS staff experiencing symptoms that significantly impact on their daily function and ability to work. The group runs for one hour a week for six weeks and uses the Work and Social Adjustment Scale (WSAS) and Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS) as outcome measures. The main topics cover – what Long Covid is, fatigue and respiratory management, returning to physical activity, cognitive dysfunction, acceptance and mental wellbeing.

Early results show improvements on both measures, particularly the WEMWBS. The group have also started their own WhatsApp group for ongoing peer support and are offered monthly group catch ups for 6 months. This focuses on ongoing symptom management and building on goals. They are also offered individual reviews with the occupational therapist for more tailored advice and intervention. The group is proving to be a life line for many, who would otherwise fall out of the work place. Interpreting and implementing the NICE guidance in this way may be critical in helping our workforce get back on its feet after the worst pandemic our country has seen.

Genevieve Smyth

Professional Adviser

Royal College of Occupational Therapists

2020 had been an extremely challenging year for everyone. Specifically, for Physiotherapists in Work and Health, it has required in a significant change to the way we work as well as a range of new challenges our patients and their employers are facing. For the ACPOHE it has been no different.  We have all had to change the way we operate almost overnight and have done so exceptionally well.

ACPOHE has been exceptionally busy throughout the year and have undertaken a myriad of activities. These range from: launching a new webinar platformto better network and deliver new content to our members and other Occupational Health (OH) Professionals; developing home working guidanceto support our patients and their employers during these challenging times; through to moving more of our education courses onlineto ensure more people have access to our training.

There are two additional areas of work that deserve a special mention:

1. Long COVID Return to work (RTW) guidelines

In response to COVID, a working group was put together to develop a set of RTW guidelines specifically looking at rehabilitation and return to work guidelines for those patients suffering from Long COVID.  This comprehensive guide was launched as a live webinarin October will be a valuable resource for those physiotherapists and other OH professionals working this patient group.   https://acpohe.csp.org.uk/documents/acpohe-recovering-covid-19-rtw-guidance

2. Online Open Access Journal

I am thrilled to announce that,  after much hard work, in 2021 we are due to launch a new journal titled the Journal of Physiotherapy in Work and Health (JPWH).  This is an open-access Internet-only journal, accessible to new researchers, early-career academics, and clinicians to share contemporary research and ideas regarding occupational health and ergonomics.

The JPWH is now open for submissionsand invites you to submit contemporary research, reviews, discussion papers, opinion pieces and editorials in relation to occupational health physiotherapy practice.  https://publications.coventry.ac.uk/index.php/JPWH/index

ACPOHE hopes that these tools and resources continue to support shared learning across all OH Professionals and facilitates closer multi-disciplinary working. As an active member on the Council for Work and Health, ACPOHE will continue to share these and any other new developments with council members.

Miles Atkinson

Chair ACPOHE

As the ‘Decade of Action’ (2020-30) for the United Nations Sustainable Development Goals (SDGs) grows in urgency, what should it mean for occupational safety and health (OSH) and ensuring that allwork is good work? How do we best address the needs of a virus-affected world and the challenges and opportunities of the 4^thIndustrial Revolution, the digital and green economies, demographic and technological changes, and the future of work? How do we ensure that we revitalise our support systems and ‘build back better and healthier’?

Many of the SDGs relate to work and to OSH, as highlighted in the IOSH sustainability policy, particularly SDG Goal 3 ‘Ensure healthy lives and promote wellbeing for all at all ages’ and SDG Goal 8 ‘Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all’, which includes ending modern slaveryand human trafficking.

Importantly, as we’ve all witnessed, the Coronavirus pandemic has reinforced the intrinsic links between environmental, public, occupational and general health, as well as shining a light on health inequalities and the need to better protect health and social care workers and others on the frontline, and to ‘build back better and healthier’. This includes ensuring effective test, trace and isolate systems, and access to personal protective equipment, vaccines, therapeutics and ongoing mental health support. Central to delivering improvement is SDG Goal 17 ‘Strengthen the means of implementation and revitalise the global partnership for sustainable development’. This UN call for international capacity-building and multi-stakeholder partnerships to ‘mobilise and share knowledge’ is a clear request for stronger multidisciplinary working and for all health and health-related professionals to contribute.

This is where I believe the collective health community, professional bodies and networks have pivotal roles, both now and in the future. We need to see OSH / OH professionals increasingly harnessed to help public policymakersand organisations tackle the complex work-related health challenges, such as from climate change, air pollution and extreme weather; increased sedentarianism; extended working lives; the needs of workers with health conditions and disabilities; tackling communicable and non-communicable diseases at work; and the exponential growth in new workplace technology, automation and artificial intelligence.

We need to work together to ensure greater focus on human-centred public- and corporate-policy and on managing psychosocial risk at work, with mental healthfinally gaining parity with physical health, and stigma ended. And we need to collaborate to support diverse and inclusive workforces, protect vulnerable groups and embed OSH risk-intelligence as a key life- and employment-skill, essential to long-term social value and achieving SDG Goal 4 ‘Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all’.

Thankfully, in the decade ahead, I think we can expect to see better-informed public opinion continue to drive higher societal expectationsand requirements on organisations and leaders seeking new ‘social licenses’ to operate and govern. And also see improved performance evaluation and transparency increasingly sought by stakeholders wanting assurance, not only that no-one is being harmed by public policy or corporate activity, but that people’s health and wellbeing is actively enhanced in line with our more socially conscious world.

This demand for transparency and comprehensive corporate reportingwill help drive meaningful and comparable OSH performance reportingat global, national and corporate levels and recognition that good OSH must be a fundamental right worldwide. Professionals have key parts to play, fostering positive and learning cultures; designing-in OSHand evaluating interventions; developing meaningful indicators and utilising data; and making recommendations to improve OSH performance across regions, organisations and supply chains.

So, what key changes are needed to tackle the millions of work-related deaths each year, improve OSH and wellbeing and deliver on the SDGs? I believe they must include:

• Recognising OSH as essential to public and socioeconomic good, so that it is designed into all public-policy,global trade, international development and corporate strategies
• Building global OSH capacityand improving access worldwide, including for micros, SMEs, the self-employed, migrant and informal workers and all those on the frontline
• Harmonising and standardising meaningful OSH performance reportingto drive global, national and corporate decision-making and investment for prevention, emergency planning and improved OSH and wellbeing

To close, can I just urge that, as professionals, influencers and networks, we continue working together and reaching out to ensure that this decade is one in which the true value of OSH / OH is harnessed to support good work for all, healthier populations and sustainable futures.

If you’d like to know more and support IOSH’s advocacy work on ‘building back better and healthier’, please contact the IOSH Policy team at publicaffairs@iosh.com.

Richard Jones

IOSH

13 November 2020

Leadership in occupational health over the first wave

As the pandemic hit, time seemed to alter, and intensity increased. The pace of “leadership responsiveness” required multiplied. Suddenly, we needed to be “just in time” rather than the days or weeks that medical societies usually take.

The office team “disappeared” in March to work (very effectively) at home. A new, wider, team emerged beyond the Society of Occupational Medicine, of professionals from different disciplines and organisations.  Subgroups focused on PPE and mental health at work were formed. New communication channels opened with daily briefs, weekly webinars, and front-line networks.

Expert leadership was important. Occupational Medicine experts quickly called out the Government’s position on PPE standards and supply. But we knew little about Covid, for example in terms of transmission mechanisms. We quickly hosted a webinar with an Italian occupational medicine expert, ahead of the UK in terms of Covid impact, as to what they were experiencing in hospitals.

It was inspiring to see leadership elsewhere. As Covid-19 deaths tragically increased, a former Windsor Leadership Trust Alumni, and a former President of the SOM, David McLoughlin kept me in touch as to the military’s amazing work setting up the Nightingale Hospitals. Many occupational health professionals working in the private sector volunteered to work in the NHS. NHS England put in place procurement to support NHS occupational health teams.

In April, we decided to move to proactive challenge and focus on the occupational health risk of health care professionals. Dr Will Ponsonby, the SOM President, publicly rejected the Government’s rhetoric of professionals on a front line “war”. Instead we campaigned with the BMA and others “that no health care worker should die of Covid transmission” if proper controls are in place. Amnesty International subsequently produced a report highlighting this issue[i].

In the middle of this, a refreshing culture emerged ofleadership that was still about rationality, objective truth and weighing up the evidence but also about warmth, collaboration and energy (although energy was hard to maintain when it was all online).

With the end of the initial lock down in sight, we focused on the risk of return to work. A collaborative, leadership style continued with new partnerships emerging. We achieved in weeks what would previously have taken months with organizations such as Mind, CIPD, BITC and Acas to offer advice and toolkits. And, even with the frenetic pace of activity, we found out a bit more about each other and our solaces (in my case re watching a lengthy BBC Programme about a shepherd taking Herdwick sheep off a hill).

Despite our new confidence of working with trusted partners, with the launch of effective new advice and “toolkits”, we struggled to influence.  Government was in an emergency “command / control mode”. Responses from the “Centre” on key issues were delayed or not forthcoming. It felt a bit Vicky Pollard … “yeah but no but yeah”.

Some things we did not get right. I regret not reacting to data that emerged showing that some occupational health groups such as minicab drivers and security guards were more at risk of dying from Covid. We must highlight the inequality that Covid is creating and avoid a “white collar” prejudice at the expense of those working in low income public facing roles or factories such as in meat packing who have a higher Covid risk.

In July we launched a new report on the mental health of nurse and midwives, but like many by the end of July, I needed a break. Zoom calls blurred into one and it was hard differentiating online with real life. I needed to practice what I preach in our “mental health in the workplace toolkit” and take a break.

In September, we started again with the confidence that we have a social purpose to make a difference to workplaces.  We were profiled in New Scientist magazine. However, pressures quickly started again though in terms of questions on testing and how any vaccine would be delivered.

Questions remain. In terms of risk, one risk of Covid transmission can be reduced in place of another in terms of the health risks of unemployment. We are hosting, with partners, a summit on this on 10^thNovember (at https://www.som.org.uk/civicrm/event/info%3Fid%3D313%26reset%3D1)

It is important to celebrate success (with an awards process for innovators who have come up with tools such as the “Covid Age” next month). We need to support current and future leaders through mentoring and peer support. We should be offering leadership training to those occupational health individuals who have the potential to become our leaders of the future. We are actively looking for funding for this.

We now need to pace ourselves for the winter…

[i]https://www.amnesty.org.uk/press-releases/uk-among-highest-covid-19-health-worker-deaths-world

Nick Pahl

Long-term Furloughs During COVID-19 Hold Risks for Employee Health and Wellbeing

By Carol Black and Christian van Stolk

Governments around the world have offered furlough schemes to try to delay employers from making any restructuring decisions during the COVID-19 crisis. The public purse covers a specific percentage (80 per cent in the UK) of a salary up to a certain level (typically the average annual wage in an economy). Employers then have the option to top up this wage.

An estimated 25 per cent of UK workers are now part of the government furloughing scheme, which has been extended until October. Employers will be asked to contribute pension payments and national insurance from August and a larger salary share from September.

The aims of such programmes are laudable. They may, however, come with unintended consequences. Two reviews for the UK government, Working for a Healthier Tomorrow and Psychological Wellbeing and Work, suggest the importance of ensuring that employees in furlough schemes stay connected to work and the need to look after the mental health of the workforce.

Currently, employees are not allowed to work at all while they are part of the furlough scheme. We know that an employee who is away from employment for a period of about six weeks becomes deconditioned — in effect, less likely to return to employment. At that point, an individual is more likely to enter the benefit system.

Furloughed individuals also may lose touch with the workplace altogether. They may be less likely to access the occupational health provision or health and wellbeing programmes offered in many workplaces. People could become cut off from some of their normal support networks. Without these networks, relationships at work could break down, and as a result, a fundamental part of an individual’s social fabric.

Moreover, mental health tends to deteriorate when people lose their sense of social purpose. This sentiment may become more prevalent among people who are on furlough schemes where they may feel that they are kept out of work artificially or face delayed unemployment. Mental health is already a concern in the present crisis, in which general uncertainty is coupled with the disruption of routines at both home and work.

This matters. Evidence tells us that those with common mental health conditions such as anxiety and depression are much more likely to be out of work or find it difficult to maintain a job. They are the most common conditions among those claiming out of work benefits, with 50 per cent of claimants typically reporting it as a primary or secondary health condition.

Even if workers maintain their employment, there may be significant challenges to their health and wellbeing arising from the crisis. Most employees have seen rapidly and profound changes to their working patterns including new forms of remote working, flexible working, social distancing at work and increased shift working. Many have had to combine work and caring responsibilities more than before.

The mental health of many workers likely will worsen over the coming months. Before the COVID-19 outbreak, one in six working-age people in England had a mental health problem. The prevalence is higher for younger workers, who are especially at risk of losing their employment in this crisis.

There is a need to look at how to support all workers with their mental health. This need is greater for the self-employed and smaller businesses, which employ most of the UK workforce but may not have the resources to support their employees at this time. Supporting the mental health of employees requires employers and governments to provide access to occupational health and NHS support at a time when social distancing is perhaps limiting service provision. It is important to find space on the policy agenda for this.

It is heartening to see that the UK government is allowing part-time employment in its furloughing scheme from July, be it with employers paying fully for the hours worked. However, it may be advisable for governments to incentivise employers to stay connected to their workforce by allowing part-time working sooner and even subsidising it. They could also allow keeping in touch days while people are in the furlough scheme.

A broader priority for government and employers in this crisis should be to invest in the health and wellbeing of all workers, especially in mental health. This could help avoid workers losing employment, remaining in the benefit system longer and lowering the long-term productivity among those at work. One of the main legacies of the crisis should be an appreciation of the importance of good employee health and wellbeing.

Prof Dame Carol Black is a physician who has over the past 14 years advised government departments and arm’s-length bodies on work, health and wellbeing. RAND Europe executive vice president Dr. Christian van Stolk has conducted extensive research on health and wellbeing in the workplace.