Iraje Ahmed*, Ashia Bibi*, Dee Burrows*, Penny Firshman*, John Knight* 

*Commentary co-written by these five authors, listed alphabetically. This work was supported by Dr Brendan Dempsey and Dr Danielle Lamb. 

Introduction to the Authors 

We are five (IA, AB, DB, PF, JK) healthcare workers who contracted COVID-19 and developed Long COVID while working in the NHS.  

• I (IA) was working as a Radiotherapist at the beginning of the COVID-19 pandemic. I developed…  

• I (AB) was working as an Acute Occupational Therapist. I developed…  

• I (DB) was working as a Clinical Nurse Specialist, and I developed Long COVID after my first COVID-19 infection in 2021. My NHS contract was terminated in July 2023 due to ongoing ill health after two years, though I now manage a little volunteer work for a Long COVID charity and some very limited independent practice 

• I (PF) was working as a Critical Care Clinical Lead Occupational Therapist, and I developed Long COVID in 2020, following my first COVID-19 infection. Following 18 months off work and a 5-month phased return to my original role, I applied for a new position and transferred to a 4-day week non-clinical management role. I have had difficulty getting reasonable adjustments for this new role due to my disability and have since gone through a redundancy. 

• I (JK) was working within the Estates Department of an Acute Hospital. I first contracted COVID-19 in 2020 and developed Long COVID after a second infection in early 2021. I returned to my original position full-time, after a 3-month period off work and a 3-month phased return. 

Since first developing Long COVID, we have all worked hard to learn to manage our symptoms, and this process continues today. 

In this commentary, we reflect on the results of three research papers on healthcare workers’ (HCWs) experiences with Long COVID from the NHS CHECK team. The first is a review that looked at international research exploring Long COVID among HCWs,¹ while the second and third used data from the NHS CHECK cohort (over 23,000 HCWs in England)² to look at the prevalence, symptoms and risk factors associated with Long COVID ³ and sickness absence due to Long COVID.^REF We are members of the study’s Patient and Public Involvement and Engagement (PPIE) group and we supported the team to design the research and interpret their results.  

The NHS CHECK study is crucial research, not just in terms of adding to the current literature on risk factors, prevalence and symptoms of Long COVID for HCWs and associated sickness absence, but also to gain insight into the potential risks for staff in future pandemics. Please note that as “sufferers,” we prefer the term Long COVID, which was generated by people with ongoing symptoms, rather than other terms (such as Post COVID-19 Syndrome) which have been applied and enforced on the community by health care practitioners and researchers. In June 2024, the U.S. National Academies of Science, Engineering and Medicine chose to use the term Long COVID in their definition of the condition to better reflect the lived experiences of the community.⁴ We welcome this and encourage others to do so. 

Many of the most prevalent symptoms uncovered by the NHS CHECK team resonated with us, and we experienced many of those listed in Table 3.³ Between us, we found that breathlessness, fatigue, cognitive dysfunction, significant heart rate fluctuations, chest pain, joint pain, headaches and migraines, insomnia and hypersomnia, diarrhoea, vomiting, and issues with swallowing have been the most impactful on our everyday lives. This demonstrates the multitude of impactful symptoms that many with Long COVID experience, which makes this a difficult condition to manage. Long COVID has severely impacted our ability to socialise, manage childcare and other caring responsibilities, and feel safe when we leave the house. This condition has also severely impacted our ability to work, with breathlessness, fatigue, cognitive dysfunction, and heart rate fluctuations being the most impactful when we tried to return to work. Difficulty with concentration impacts all other symptoms and Long COVID has also worsened other conditions that we have, such as asthma. 

Between us, we had many of the risk factors for both Long COVID and Long COVID-related sickness absence that were identified in the papers. These are difficult to read as individuals with Long COVID, because they are not things that we can necessarily change to reduce our risk.  

The team found that having symptoms of mental health disorders (such as depression, anxiety, or PTSD) in the first year of the pandemic was a risk factor for developing Long COVID at follow-up. This is totally new information to us, and we are not sure how we feel about it. Perhaps a little ashamed and a little guilty. It is difficult to unpick this finding as many NHS staff had mental health concerns, particularly at the beginning of the pandemic when the risk factor data were collected. Many of us are also members of Long COVID groups and this finding doesn’t match with our experiences in these groups – so many people we have talked to develop mental health difficulties as a consequence of Long COVID and the majority of these people said that they had no problems before. We hope that people do not assume this finding is evidence that Long COVID is a psychological condition. Poorer mental health may be a risk factor, but that does not mean it is the cause! 

We also think there may be an inherent gender bias in the finding that female HCWs were more likely to report Long COVID symptoms compared to male HCWs, which we think is heightened given the high number of females working in healthcare. The study also found that sex was not a risk factor for reporting a formal diagnosis of Long COVID, meaning that males might just be worse at reporting symptoms than female colleagues. Additionally, gender didn’t have a significant effect on sickness absence, indicating that the condition equally impacts both. 

Focusing on sickness absence, we think it is important to note that many people with Long COVID are rushed back to work too quickly, rather than lose their pay or their job. We would like to see further research explore if there is a difference in the return-to-work experiences and outcomes of those who felt rushed back and may have had several failed returns compared to those who took a longer period of time off work and had a successful return on their first attempt. We think there is likely a difference, and that people who develop Long COVID would benefit from a longer time off work to focus on their recovery and learn to manage their symptoms rather than trying to push through their symptoms and cope with their pre-infection workloads. If this is the case, this could be an efficient strategy to support people with Long COVID to return and remain in work. Additionally, while the NHS CHECK team looked at the impact of Long COVID on sickness absence, we would like to see more work on the functional impact of the condition on people’s lives. An example could be a study considering the reasons why people leave their jobs following Long COVID; we imagine that much of this decision is due to a lack of flexibility from their employer, but there may be other reasons we need to consider!  

In terms of future work on Long COVID, we also think that further research is needed to look at all of the risk factors in more detail. For instance, is there a difference in risk of getting Long COVID or needing sickness absence between people with mild and those with severe asthma. The same can be said for those with mild versus severe mental health concerns and so on. This is particularly important to ensure that occupational health risk assessments during a pandemic are fit for purpose. We know many people with Long COVID (including ourselves) who are receiving limited if any reasonable adjustments to support them in work or are losing their registrations and having their contracts terminated due to ongoing ill health. We think that more targeted research is needed to assess and improve risk assessments in the NHS. 

Secondly, we have some concerns that employers may use the findings that symptoms of mental health disorders are a risk factor for Long COVID as a reason to block HCWs from successfully claiming their condition as an occupational disease. We believe it unlikely that the other risk factors, such as female sex, age, and premorbid respiratory conditions, would be used in the same way. Understanding the equality of mental and physical health as risk factors has come a long way in society, but not always in the workplace.  

Finally, the studies also highlight that the symptoms of Long COVID may be very common, and that more needs to be done to design interventions that can help people manage their condition and symptoms. We have used a variety of treatments to learn to manage and live with our symptoms, though a lot of this has been self-directed and there are still very limited interventions available to treat Long COVID. Things that we’ve found helpful include using occupational therapy and energy conservation (e.g. pacing and prioritising day to day tasks) to manage fatigue, cognitive impairment, and get back to some semblance of normal life, partaking in the English National Opera Breathe programme to manage breathing difficulties, completing counselling to deal with the trauma that Long COVID has caused, and accepting that we have been impacted by Long COVID and that we can’t put too much pressure on ourselves to undertake the same everyday tasks that we did pre-infection. These, however, are not a cure and five years on these symptoms are still so pronounced that we all cannot do everyday activities, go back to the clinical careers that we had, or manage a full-on non-clinical job, as we have to constantly try and adapt to the limitations we now have. We agree that more needs to be done to support staff impacted by this condition.