Long COVID

Coronavirus (COVID-19) can cause symptoms that last weeks or months after the infection has gone. This is sometimes called post-COVID syndrome or "Long COVID".  The symptoms of Long COVID can be many and are varied and the NHS guide, Your COVID Recovery provides helpful guidance on the most common types of symptoms that may be experienced. 

It is still early days in the knowledge and treatment of Long COVID with studies taking place worldwide. This guide is to provide advice and link to resources whether you have Long COVID yourself, are looking to return to work or are experiencing difficulties with your employer. We also have a range of resources to help you if you are treating patients who are experiencing symptoms of Long COVID.

Please also see the RCN position on COVID-19 and our COVID-19 FAQs.

We have collated some frequently asked questions which are below about returning to work following long term absence with Long COVID.

It is important to note that diagnosis of Long COVID is not dependent on having had a positive test for COVID-19.

If you are working in the NHS, the Agenda for Change handbook, 14.7 states that absence caused by injuries, diseases, or other health conditions that are wholly or mainly attributable to the employee’s NHS employment and which have been sustained or contracted in the discharge of the employee's duties of employment, should be disregarded for the purposes of calculating sickness absence allowances.

If you are working outside the NHS, employers have discretion to grant additional paid leave and members are advised to request that COVID-19 absences are discounted. Support is available from RCN representatives to negotiate an agreement with local management. 

If you are involved in a formal sickness process, or require further advice and support, please contact us. 

If you have evidence that you caught COVID-19 in the course of your work, you may be able to claim NHS Injury Allowance or Industrial Injuries Disablement Benefit (IIDB). There is no entitlement to benefit in respect of a disease if it is not listed in the IIDB Regulations, or if a person's job is not listed against the particular disease but, there may be entitlement to benefit under the industrial accident provisions if a disease has been caused as a result of an accident. Please see our information on IIIDB for more information on how to claim.

If you believe your employer was in some way negligent, for example, there were insufficient health and safety controls in place to prevent COVID-19 transmission, for example inadequate personal protective equipment (PPE), you may be able to make a legal claim for personal injury compensation. This is not easy and requires a high level of evidence. Speak to your RCN rep or contact us for more information. You can see our personal injury page for information about the service.

How to access additional sick pay

• Ask for a meeting with your line manager to review sickness absence arrangements. You can contact us prior to the meeting for advice and support.  
• Conduct research, review your employer’s policies on sick pay before the meeting. Your HR department and/or your manager can assist you locate the relevant policies.  
• At the meeting, establish when your contractual entitlement to sickness absence runs out.  
• Be clear about your current state of health, capabilities and your pro-active efforts to manage your condition. 
• If you reasonably believe the condition was contracted at work, say so and be specific about how and when.  
• Make the following formal requests, ensuring that they are captured in the meeting notes:  
  • that your absence to date is not being considered as part of any absence management process 
  • that future absence (if required) will be on a paid basis for example, the employer agrees to extend paid leave beyond your existing entitlement  
  • that the employer recognises Long COVID as a disability for the purposes of the Equality Act 2010 
• If the employer cannot make a decision in the meeting, ask for the decision to be sent to you in writing within a reasonable period, for example 14 days

What to do if the request(s) are denied 

There is no automatic right to additional paid leave in the case of extended absence related to Long COVID. If your employer refuses to grant additional paid leave: 

• Ask for the decision in writing with clear reasoning as to why the request(s) have been refused.  
• Consider raising a formal grievance in response but contact us prior to this as we may be able to advise and support you throughout the formal parts of the process.
• Any grievance will be heard by a different or more senior manager and if this process is unsuccessful, the RCN may be able to asses your case to establish the prospects of any legal claims. In some circumstances it may be that a refusal to grant additional paid leave could amount to unlawful discrimination. However, cases are assessed on their individual merits and legal support is contingent on there being reasonable prospects for success in your case.  

The RCN expectation is that all employers will look favourably on applications to use discretionary options to extend sickness absence. Long COVID has the potential to amount to a disability as defined by the Equality Act 2010 and as such, employers are likely to be under a legal duty to make reasonable adjustments to remove the disadvantage created by the condition. This includes but is not limited to consideration of extended paid leave arrangements in the event of COVID-19 related absence.

If you are involved in a formal sickness process, or require further advice and support, please contact us.

You can also access our Financial wellbeing resources and support.

If you have been receiving Statutory Sick Pay (SSP) during your time off work with COVID-19, you will need to claim Employment Support Allowance from DWP when your SSP runs out. SSP can be paid for a maximum of 28 weeks in any one period but will be reduced if you have any time off sick immediately prior to this period.

The reason for absence on a Fit Note is usually a matter agreed between the GP and the patient. It would be advisable to discuss this with your GP because if your condition can be linked to exposure to COVID-19 in the workplace, you may be entitled to additional financial support.

Check your contract and employer’s sickness policy. You should also keep a record of your sickness dates. Our sickness advice guide also has helpful information. 

Your fitness to work is a matter between you and your GP and is described in your Fit Note. However, legally this is only “advice” to an employer, and they may wish to take further medical advice, for example from an occupational health specialist. HM Government advice to employers states the following: 

“You can choose to give this other evidence precedence over the advice in the fit note. Your employee may disagree with you, and you may need to demonstrate to an employment tribunal why the alternative source of evidence was more acceptable to you than the fit note.”

In England please also see the NHS plan for improving long COVID services 2022, the NHS Employers guidance supporting recovery after long COVID and the NHS Joint Trade Unions’ Briefing August 2022- Long Covid Guidance for NHS Trade Union Reps.

This should be discussed in any absence management meeting and you may wish to take someone with you as support. Speak to you RCN rep or contact us for further advice. 

The RCN expects all health and social care employers to give maximum support to any staff who are absent due to COVID-19,  this should includes financial as well as employment support.  However, if, after taking medical advice, it appears unlikely that a staff member will be able to return to work in the future it is not automatically unfair for their employer to seek to terminate their contract. This can be complex area so you should seek support from your RCN rep or by contacting us.

As with any long-term illness/absence, your employer should discuss the best way for you to return to work in advance of your return. They may wish to seek advice form an Occupational health adviser or from your GP via advice on your Fit Note. It can be helpful for you to go into any discussions with suggestions which can be implemented to enable you return to work successfully. In the NHS, most employers will have an Absence Management Policy that outlines the process they will follow.

All NHS organisations should follow, as a minimum, the guidance outlined in Annex 26 of the NHS Terms and Conditions of Service handbook which describes the requirement for early intervention and consideration of rehabilitation and redeployment. This also includes a requirement for phased return on full pay for an agreed length of time before staff are expected to utilise their annual leave if their hours are still reduced.

In England please also see the NHS Long COVID plan 2021/22, the NHS Employers guidance supporting recovery after Long COVID and the NHS Joint Trade Unions Long COVID Briefing (October 2021). The Society of Occupational Medicine has published some helpful guidance on return to work following Long COVID.

The National Institute for Health and Care Excellence (NICE) in their guidance  COVID-19 rapid guideline: managing the long term effects of COVID-19, has defined Long COVID – or “Post-COVID-19 syndrome” – as “Signs and symptoms that develop during or after an infection consistent with COVID 19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body”.

Section 6 of the Equality Act 2010 outlines that a person has a 'disability' if they have:

(i) a physical or mental impairment and,

(ii) which has a 'substantial' and 'long-term' adverse effect on their ability to carry out normal day-to-day activities.

Due to the evolving nature of COVID-19, there is currently no definitive answer to whether Long COVID satisfies the above statutory definition. An employee suffering with Long COVID symptoms could likely demonstrate a physical or mental impairment that impacts their ability to carry out 'normal day-to-day activities'. For example, an employee suffering with breathlessness, extreme fatigue and cognitive impairment may struggle to complete day-to-day activities such as concentrating or walking as easily as they could before.

An Employment Tribunal ruling has now accepted that Long COVID can meet this definition on the facts of that particular case.  Each case will be decided on its own facts. 

ACAS has issued sickness and absence advice for employers and employees dealing with Long COVID. Most notably, when approaching the subject of whether it amounts to a disability, ACAS has stated that “it is a good idea for the employer to focus on reasonable adjustments they can make rather than trying to work out if an employee's condition is a disability.” The guidance therefore doesn't answer the question directly but takes a pre-emptive and cautious approach.

For further information on disability discrimination and reasonable adjustments please see our guide, Disability discrimination and the Equality Act 2010. You may also find our Health Ability Passport Guidance to be helpful on reasonable adjustments.

We acknowledge that this is a difficult situation due to the evolving nature of Covid-19 and you can contact us at any time for advice contact us.

There are a number of criteria that need to be satisfied to make a successful application for NHS ill health retirement.  Please see our Ill health retirement advice guide.

One of the criteria is that you must show you have a long term health condition that has a substantial impact on your current or future employment.   Due to the evolving nature of COVID-19, there is currently no definitive answer to whether Long COVID would satisfy the criteria, and you will require robust medical evidence to support your application. 

Pensions outside of the NHS

Different employers offer a range of different pension schemes. The rules in different schemes vary significantly however, if your employer offers a defined benefit pension it is likely that there are ill health retirement options available to you. To access such benefits, you need clear medical evidence that you are unable to continue working in some capacity on a permanent basis. There are often different levels/tiers on ill health retirement depending on the severity of your incapacity. 

If you have a defined contribution pension, many schemes offer the ability in the case of permanent incapacity an option to access your pension early if you have the medical evidence to support your application. In either case, the RCN recommends seeking independent financial advice from a regulated provider before making any pension related decision. You can access free advice through your RCN membership via Lighthouse Financial Services.  

Please contact us if you require additional support.

• Faculty of Occupational Medicine of the Royal College of Physicians:  Guidance for managers and employers on facilitating return to work of employees with Long Covid
• Royal College of Occupational Therapists: Good work for good health
• Derby NHS Trust: Returning to work with on-going COVID-19 symptoms: Guidance for employees and managers (video) 
• Society of Occupational Medicine: COVID-19 return to work guide: for managers 
• Society of Occupational Medicine: COVID-19 return to work guide: for recovering workers 
• Vocational Rehabilitation Association: Return to work after Covid – Support for Individuals
• Long Covid Support (registered charity in England and Wales)
• Business in the Community: What if your job was good for you?  Report on best practice and case studies on improving wellbeing at work
• NHS - Your COVID Recovery 
• NHS Joint trade union guidance 
  

The RCN provides additional support to members through our Member Support Services.

Our Peer Support Service provides a range of helpful resources and guidance for members suffering with ill health and disability. We have a closed Facebook group for members affected by COVID-19 where you can give and receive non-professional support. You will need your RCN membership number to join the group. Please also note that you are joining for support with Long COVID.

We also have a Counselling Service for members that can provide support with personal or work-related issues. 

If you are experiencing financial difficulties, we have a range of services including tools, resources and support through the RCN Welfare team. For more information go to our financial wellbeing information.

Our careers resources also have guidance on managing a career around your health in addition to general careers advice.

We have a range of clinical resources on COVID-19 which can be found in our Clinical Guidance for managing COVID-19.

We also have the below relating specifically to Long COVID:

• Long COVID and Post COVID Syndrome - Self Care Forum
• Faculty of Occupational Medicine of the Royal College of Physicians: Guidance for healthcare professionals on return to work for patients with Long Covid
• BMJ September 2020: Safely returning clinically vulnerable people to work
• Case Management Society
• Health Education England: Work and Health - e-Learning for Healthcare (e-lfh.org.uk) -  how to support practitioners confidence in support patients with long term health problems
• National Institute for Health Research: Hundreds tune in to hear about latest long COVID trials – webinar presentations March 2022
• NICE: COVID-19 rapid guideline: managing the long term effects of COVID -19
• NHS: Long term effects of coronavirus (long COVID)
• Long Covid Support (registered charity in England and Wales)
• Royal Society of Medicine July 2021 - Reading list 
• The Society of Occupational Medicine: Find an OH Provider company.