What Employers Should Know About Workers Who Have Long COVID

Allen Smith, J.D. By Allen Smith, J.D. September 29, 2023

​Nearly 7 percent of U.S. adults—approximately 18 million people—have had long COVID, while 3.4 percent, or approximately 8.8 million, said they still had it as of 2022, the Centers for Disease Control and Prevention (CDC) said in findings published Sept. 26.

Long COVID was defined as self-reporting the presence of symptoms for at least three months after having COVID-19 among those who reported a positive test or a doctor's diagnosis of COVID-19.

The symptoms of long COVID vary widely in their nature and severity, said Susan Bickley, an attorney with Blank Rome in Houston. Symptoms include anxiety, "brain fog," chest pain, change in smell or taste, cough, depression, diarrhea, difficulty concentrating, dizziness, exhaustion, fatigue, fevers, headache, heart palpitations, insomnia, joint or muscle pain, post-traumatic stress disorder, rash, shortness of breath, stomachache, and tingling feet or hands.

Some individuals with long COVID "report that they cycle through a variety of changing symptoms that seem to wax and wane, making their condition particularly difficult for employers to accommodate because it poses a moving target," Bickley said. "The symptoms are not necessarily predictable or manageable, and they may not present the same day to day."

Long COVID's unpredictability can take its toll on employees. Awareness of mental health benefits can be critical for long COVID patients who are dealing with the emotional effects of the disease, said Dr. Jeff Levin-Scherz, population health leader with WTW in Belmont, Mass.

Women (8.5 percent) were more likely than men (5.2 percent) to have ever had long COVID, the CDC report found. Women (4.4 percent) also were more likely than men (2.3 percent) to have long COVID at the time they were surveyed.

Prevalence estimates of long COVID were higher among adults ages 35 to 49 compared with other age groups, and among adults living in more rural areas compared with those living in large central metropolitan areas. Prevalence estimates were lower among Asian Americans compared with other racial and ethnic groups, and among adults with family incomes of 400 percent or more of the federal poverty level compared with those with incomes from 200 percent through 399 percent of the federal poverty level.

An Expensive Illness

An August report from the nonprofit Workers Compensation Research Institute (WCRI) found that care for long COVID can be costly. Many workers who developed long COVID continued receiving medical care a year after their infections. At an average of 18 months of post-infection experience, workers with long COVID received more than 20 weeks of temporary disability benefits and received on average about $29,000 in medical care. This was more than 10 times higher than the average medical payment for COVID-19 claims that didn't develop into long COVID, the WCRI found.

Among claims where workers had intensive care unit stays during the acute stage of the infection, the average medical payment per claim was over $190,000, the WCRI report said. Among claims with hospitalizations during the acute stage of the infection, the average medical payment per claim was $66,000. The report also noted that the intensity of medical care provided early after the COVID-19 infection differed widely among patients. More than half of workers with medical care had only one day of visiting the medical system and had no hospitalization or intensive care unit treatment.

Besides costs, experts said that long COVID has other implications for employers.

"As employers and people leaders, we need to look holistically at our leave policies, evolving state laws around leaves, including paid sick leave, and our total benefits backage, including short-term disability, long-term disability and the affordability of our medical benefit plan," said Stephanie Argentine, chief people officer and head of legal affairs for Centivo, a Buffalo, N.Y.-based health plan for self-funded employers.

In addition, long COVID could be considered an Americans with Disabilities Act (ADA) disability, and the ADA prohibits employers from making employment decisions based on a fear that the employee's disability could result in higher insurance premiums or other expenses, said Robin Shea, an attorney with Constangy, Brooks, Smith & Prophete in Winston-Salem, N.C.

Accommodation Requirements

Common ADA accommodations for individuals who have long COVID include quiet workspaces or noise-canceling headphones to help with brain fog, reduced lighting to help with headaches, and more frequent breaks or a place to sit to address dizziness, joint or muscle pains, or shortness of breath, according to Abigail Orgeron, an attorney with Dykema in San Antonio.

Bickley noted that under the ADA, accommodations might also include:

  • Remote work.
  • Extended time to complete tasks.
  • Flexible scheduling, particularly for intermittent symptoms.
  • Part-time or modified work schedules.
  • Job restructuring.
  • Reassignment to a vacant position if the employee can no longer perform their job.
  • Leave.

As long COVID tends to cause symptoms that are continuing in nature—which include recurring flare-ups—the amount of leave needed might be long, Orgeron said.

"One consideration to anticipate, with the newness of long COVID, is that health care providers may have difficulty determining the duration of any needed leave," she said. "This may result in requests for indefinite periods of leave, which many courts have rejected as reasonable accommodations."

ADA leave might be required beyond what's mandated by the Family and Medical Leave Act's (FMLA's) unpaid 12 weeks in each 12-month period.

"Many employers still wrongly believe that employees are not entitled to any leave once they have exhausted available leave under the FMLA and could easily run afoul of the ADA," said Tory Summey, an attorney with Parker Poe in Charlotte, N.C. Leave for a definite period may be a required ADA accommodation, but Summey said the Equal Employment Opportunity Commission hasn't clearly defined the length of time off required by the ADA. Instead, employers must determine that on a case-by-case basis, determining at what point ADA leave might be an undue hardship.

If the appropriate accommodation isn't clear-cut, employers should brainstorm with employees about options, Shea said. 



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