The Hidden Burden of Long Covid and What Companies Can Do

CURT NICKISCH: Welcome to the HBR IdeaCast from Harvard Business Review. I’m Curt Nickisch.

A few years ago, companies, managers and workers all had to adapt to a new reality thanks to COVID-19. The pandemic created a huge shift in how and where we work that has endured.

But there’s another lasting effect that many employers are just beginning to come to terms with, and that’s long COVID. In the U.S. alone, around 18 million people suffer from the illness with a wide range of symptoms. It’s not well understood and medical research is ongoing to find the cause and treatments for it.

But employers can’t wait for those. Even if they don’t realize it, many companies have a long COVID problem right now, making it challenging for them to recruit and retain employees and to support them in their work.

To help managers and HR departments with this, we’re joined by two guests, Ludmila Praslova, who teaches organizational psychology at Vanguard University, and Beth Pollack, a research scientist at MIT. Together with author and researcher Katie Bach, they wrote the HBR Big Idea article, Long COVID at Work: A Manager’s Guide.

Beth, Ludmila, thanks so much for being here.

BETH POLLACK: Thank you.

LUDMILA PRASLOVA: Thank you very much. I’m happy to be here.

CURT NICKISCH: So managers and HR departments have long put systems in place for chronic illnesses, but long COVID brings a particular set of challenges it sounds like, and we’re going to get to the practical advice shortly, but first we want to understand this better. Beth, what is long COVID and as someone who studies this, what’s the range of symptoms that you see?

BETH POLLACK: Long COVID is defined by the CDC and U.S. Department of Health and Human Services as signs, symptoms and conditions persisting for at least four weeks following infection with SARS-CoV-2. As of March 2024, there are about 17.8 million people in the U.S. who have long COVID.

CURT NICKISCH: Yeah, that’s almost the same number of people who have cancer. Is this pretty similar internationally as well?

BETH POLLACK: Yeah, and long COVID is a heterogeneous condition. It encompasses many different conditions.

So a survey study of long COVID in 2021 by the patient-led research collaborative found that long COVID encompasses over 203 symptoms and that the average patient had 55.9 symptoms impacting 9.1 organ systems. So this is a multi-system, multi-symptom set of conditions.

There was a 2022 study of 16,000 people who had COVID previously, and about 15% of them developed long COVID. And an important point here is that we have always had chronic illnesses following infection. Infection-associated chronic illnesses are not new, but SARS-CoV-2 is really important because so many people got it at once. And so what we’re seeing is a large portion of the country and really the world going on to develop chronic symptoms following this infection. And there is some evidence to suggest that multiple infections of SARS-CoV2 – so the more times you get COVID, the higher risk you have for developing long COVID. And we also know there are some risk factors for long COVID, so certain people are more likely to develop it than others.

CURT NICKISCH: These symptoms also come and go. They can really flare up and then subside and just be different day to day, which makes it really, really tricky.

BETH POLLACK: Sure. So the most common symptoms of long COVID include extreme fatigue, something called post-exertional or PEM, which is an exacerbation of symptoms following cognitive or physical exertion in.

CURT NICKISCH: Is this what people would just … I mean severe fatigue, but also just brain fog, like cognitive?

BETH POLLACK: Yeah, so cognitive dysfunction is a very common symptom, which includes brain fog and word finding issues and memory issues as well as autonomic dysfunction, so dysfunction of their autonomic nervous system, which can manifest as dizziness or blood flow issues. Headaches are common, gastrointestinal symptoms are common. Cardiovascular symptoms are common.

CURT NICKISCH: And is there anything you can do to make it better or is it basically waiting it out until the flare up goes away?

BETH POLLACK: So some people do recover from long COVID, but many people do not and they have lingering symptoms. Unfortunately, there are no official treatments, there are off-label treatments. But it’s really a piecemeal approach right now kind of treating the symptoms rather than trying to treat the underlying core disease mechanisms.

CURT NICKISCH: So basically we have – we’re talking years probably before exact causes are really well understood and that there are treatments for it –

BETH POLLACK: Established treatments through clinical trials. Yes. And clinical trials have begun, but it’s not going to be a one size fits all treatment.

CURT NICKISCH: So as part of this article, your team talked to patients of long COVID. What did they tell you?

BETH POLLACK: Yeah, so long COVID comes with a lot of loss. So for many people they lose their health and they lose their ability and their functionality to do so many things. But a big part of that loss in that grief also includes too often losing one’s career and losing one’s livelihood.

CURT NICKISCH: Yeah, there’s a portion of long COVID sufferers who’ve just had to quit their jobs altogether.

BETH POLLACK: Yeah. So what the research suggests is that about 65% of people with long COVID are able to continue working and that about 25% of people with long COVID have had to reduce their working hours. So we’re really looking at sometimes very severe manifestations of illness that cause significant reduction in quality of life that also impacts one’s ability to work. One of the common stories we heard was the challenge of navigating both a healthcare system where someone’s trying to get diagnosed, while simultaneously trying to navigate really being able to hold onto their job.

And the people who had support from management and navigating this and were able to access accommodations that really were adjusted to their symptoms ended up being able to navigate this better. We talked to many people who had to just leave their careers and their jobs, and it’s a significant part of the grief for them in developing chronic illness.

CURT NICKISCH: Ludmila, employers have always had to deal with employees who have chronic illnesses: post-concussion syndrome, autoimmune diseases. There are maybe similar circumstances that employers have had to work with before. Why is long COVID challenging employers in a new way suddenly if they do have a little bit of experience with dealing with chronic illnesses?

LUDMILA PRASLOVA: Employers have never dealt with disability in general and chronic illness very well. And in general, many employers do not think of disability as something that’s even relevant. People are either working or they are on disability. They don’t even think that so many disabled people actually work.

Only 5% of organizations, for example, even consider disability as a part of their diversity considerations. And then they are typically only thinking about very obvious, very visible physical disabilities. When it comes to something that’s non-apparent, most employers have really, really struggled to even consider.

And actually, employment of people with disabilities in general improved slightly during the COVID pandemic because finally employers started thinking about remote work as a reasonable accommodation, and many people were locked out of the workplace by that lack of flexibility.

CURT NICKISCH: You use the word accommodate. So remote work sounds like is one, being able to work from home is a key flexibility. What other kind of accommodations would you recommend an HR department sort of formalize?

LUDMILA PRASLOVA: And let’s make a distinction between accommodations and flexibility because very often people would get accommodations and then other people are going to bully them because they don’t see the illness, but they see flexibility and they’re envious.

So flexibility is something that really ideally should become a part of the mindset of employers. It’s one of the principles of inclusive organizations. I talk about in my book that intersectionally inclusive, flexibility, something that helps many kinds of people.

Flexibility also can come in many different forms. So work from home is a major one, something that people from multiple disability communities have been asking for years and years. There is also scheduling flexibility for people to be able to work different shifts, trade shifts, or if it’s not a shift type of work, just really work with your energy whenever it works for you without very rigid expectations of maybe being available at this particular time.

There could be a very narrow window when everyone is available so people could have meetings, but for the most part, it’s very helpful for people to work with their energy, with their schedules and have control over their time. Another way to adjust is just provide more options for leaves and rest times that are a little bit more prolonged.

CURT NICKISCH: Yeah, and some of this is even in facilities at the workplace, having quiet rooms –

LUDMILA PRASLOVA: Places for rest, quiet areas, areas where people can get away from the bustle, and just actually create physical environments, that’s another big portion, where people are actually comfortable and capable of concentrating.

CURT NICKISCH: You also mention providing seating for roles that are typically performed standing, improving air quality, better filtration windows that can open hydration, just making sure that people can get water.

Let’s talk about accommodating limited “uptime,” right, because you had an amazing story in the article of somebody who was assigned a presentation or a project that was due by the end of the week, excited to have that responsibility, got cracking on it, feeling great, and then had Wednesday, Thursday was bedbound because of a flare-up and just wasn’t able to deliver and just felt horrible about that. How as a manager – what could you do in that situation in similar situations to accommodate limited uptime as you put it in the article?

LUDMILA PRASLOVA: Obviously, when you have someone who is able to work from home, that is a lot easier. If you have someone for some reason they really need to be in the workplace, then providing places where people can lay down, providing chairs that are adjustable to the extent that they can allow someone to lay down and have their computer equipment positioned in the way that they can, for example, type lying down is a major accommodation.

But some things, again, can be very simple, such as seating for cashiers. That’s actually something that exists in many countries. It’s just assumed that cashiers are sitting. In the States, however, in most places, it’s assumed that cashiers are standing, which really has no impact on how they are able to do their jobs. So sometimes it’s actually looking at the job from the perspective of a manager and asking, what is the essence of the job? What do we want? We want the cashier to be able to ring someone’s bill and we want, let’s say, this knowledge worker to be able to produce the report.

How people accomplish that particular task should really be left to their own decision-making, because people know how they work best. People know when dizziness is going to kick in if they exert certain amount of effort. Again, sometimes it’s unpredictable, but generally the person will know better than the manager definitely. So give people a lot of option in how they achieve the goal and also try to plan ahead.

There is sometimes urgent work, but very often we even all know with our own life things are urgent because we haven’t done them or we haven’t planned in advance. I think we all find ourselves in that situation. So another thing that managers can think of is just to step back and plan ahead that people would just have a little bit more time flexibility to deliver those results simply because they know about something far in enough in advance to be able to work around their times of fluctuating energy and up and down times.

CURT NICKISCH: You also mentioned just kind of basic accommodations like letting people turn their camera off during video calls so that they’re able to lie down without feeling like they’re exposing their condition.

LUDMILA PRASLOVA: Absolutely. And there are many reasons why people want the camera off.

BETH POLLACK: One of the things we found is that there are patients who are just too sick to return to work, but there are patients who can return to work if they had accommodations that were based around their symptoms so that they could, if they’re too dizzy to sit up, lie down, if they have symptoms that fluctuate in certain times of the day or certain times of the month, which is very common in long COVID patients, they can organize their work schedule around this.

So it’s really giving, as Ludmila said, the flexibility to people to understand that they know how to navigate their illness, and if they are allowed to, they can work part-time or sometimes even full-time with these accommodations when previously maybe they weren’t even able to work at all without them.

I think one more important part of this is that many people with chronic illness lose the ability to work, however, that is not necessarily going to go on forever. Many people also regain functionality. These illnesses, they fluctuate. And so how do we help people return to work?

We often think about work hiatuses, we may think about parental leave or there are many different reasons, but chronic illness is one of them, but it’s not often discussed.

CURT NICKISCH: Speaking about starting and stopping jobs is really interesting because you have recommendations in your article for recruitment; some really practical tips, like not put into the job description that you have to be able to lift 20 pounds if you don’t actually need that. Sometimes people just kind of throw that in to be safe, but if it’s not really necessary, why are you trying to exclude that?

But I want to talk a little bit more about changing jobs or changing to a different role because some of the people that you spoke to, whether they really wanted to or not, they did end up agreeing to switch to a different job, or they left their company to go take a different type of job, not because it’s their passion or exactly the thing that they wanted to do, but it was going to give them the flexibility they needed for their illness. So can we just talk a little bit about that process and from the employer point-of-view?

LUDMILA PRASLOVA: From the employer point-of-view, sometimes organizations think about it, “Oh my gosh, those people are expensive and good riddance when they go.” Unfortunately, I’ve heard that from some people.

And that is such a problematic way of thinking, thinking that losing those people is going to be good turnover because supporting them and helping them to just maybe transition to a somewhat different role within the same organization and providing more flexibility is actually a lot less cost than completely re-advertising, retraining, bringing in new person and not knowing whether or not this hire is actually going to work out because many hires don’t. So from the employer perspective, turnover is actually very costly and it’s likely much cheaper to accommodate the person.

And then there is also a reputational concern. When people hear that the employee was treated in a way that was extremely supportive, like there’s also positive stories where people go above and beyond an accommodation, when that word gets out, imagine what’s going to happen with this organization’s talent pool as opposed to an organization that, let’s say, refused to allow someone to work from home three days a week. From the perspective of their organization, really supporting people is a good business choice.

CURT NICKISCH: How does a leader know when a job needs to be redesigned?

LUDMILA PRASLOVA: Sometimes you need to ask people who are doing the job because depending on someone’s position, managers may or may not even know those details, so actually checking in with people and asking if everything is still working. Jobs get redesigned all the time for a variety of reasons, changes in organizational needs, changes in technology.

CURT NICKISCH: Changes in employee wishes and interests and yeah.

LUDMILA PRASLOVA: Yes, job crafting. We’ve been talking about job crafting all the time, so this is really not that different. But in this particular case, the job needs to be redesigned to, let’s say, support someone’s abilities that changed because of the illness. Create an environment that is sufficiently safe for people to bring it up and disclose, because unfortunately, in many situations, people would rather push themselves at the cost of their health because they’re too afraid to disclose, because they’re afraid of discrimination. So show consistently that you are a disability-inclusive employer so that people would not be afraid to say something changed.

CURT NICKISCH: Well, it sounds like from this whole conversation that you basically have an issue that has caught organizations somewhat by surprise. They’re not as well-prepared for it as they should be, and they’re just still coming to terms with the scope and the consequences of it. But it sounds like from some best practices, companies that have done it well, from experiences like job crafting and managing medical leaves and things like that, that there are good practices to turn to in the meantime. To round out this conversation, what is the biggest misconception about long COVID that you want to take this opportunity to clear up? And I’d ask that for both of you.

BETH POLLACK: What I wish people knew about long COVID is how common it is, how diverse and heterogeneous it is, and that there’s a real need and opportunity now to learn about this illness, and also about similar infection, associated chronic illnesses, because I think only by really learning about the symptoms of this illness and the complexities of this illness, that’s how we’re going to best navigate accommodating it and supporting the people with these chronic illnesses.

LUDMILA PRASLOVA: From the perspective of organizations, managers, HR, what I would love people to know is long COVID and more generally, most disabilities that we talk about do not have to equate to inability or the lack of ability at all, because that is such a typical misconception. People think the word disability and they think the lack of any and all ability.

What we need to think about is that people might have very significant, very major struggles in some areas, but again, majority will have areas where they can perform. And just with some flexibility and open mind, which is something that exemplary pioneering companies have been doing, it is very possible to support those people and allow them to find satisfying careers that will also support organizational goals.

If we just focus on outcomes and we’ll let people work in variety of flexible ways that work for them, and organizations really don’t need to be as scared of disability as they unfortunately have been for a long time.

CURT NICKISCH: Well, Ludmila and Beth, this has been really, really valuable. Thanks so much for sharing your research and your advice and a growing set of best practices. I really appreciate you coming on the show to talk about this issue.

LUDMILA PRASLOVA: Thank you. So grateful for this opportunity.

BETH POLLACK: Thank you so much. It was great to talk with you.

CURT NICKISCH: That’s Beth Pollack, research scientist at MIT and Ludmila Praslova, a professor of organizational psychology at Vanguard University. Together with researcher Katie Bach, they wrote the HBR Big Idea article, Long COVID at Work: A Manager’s Guide.

And we have nearly 1000 episodes plus more podcasts to help you manage your team, your organization, and your career. Find them at HBR.org/podcasts or search HBR on Apple Podcast, Spotify, or wherever you listen.

Thanks to our team, senior producer Mary Dooe, associate producer Hannah Bates, audio product manager Ian Fox and senior production specialist Rob Eckhardt. Thank you for listening to the HBR IdeaCast. We’ll be back for our tech series on Thursday, and with a regular episode on Tuesday. I’m Curt Nickisch.