Struggling With Long-Haul COVID

In March 2020, Caroline Boyd Tricarico contracted what she thought was a mild case of COVID-19. Now, more than a year later, she’s been forced onto short-term disability and early retirement as debilitating symptoms linger.

Boyd Tricarico, a former executive at several top financial firms as well as CEO of the Animal Rescue League of NH, went from being a leader to having days she couldn’t even get out of bed. Her symptoms have included short-term memory loss, “brain fog,” auditory and visual hallucinations, and insomnia. She developed atrial fibrillation (irregular, rapid heartbeat), which was not present prior to COVID-19. And her COVID symptoms have exacerbated her fibromyalgia. On a good day, she can maybe make breakfast, cross stitch or go for a short walk, she says.

Her firm offered to let her work part-time, but she didn’t even have the energy for that and eventually, her symptoms forced her to resign as COO at MassMutual. “It’s a job you can’t just wing it,” Boyd Tricarico says. She says she is struggling to come to terms with her new reality. “I have always been achievement oriented. I always had high-powered jobs,” Boyd Tricarico says. “It’s such a part of my identity.”

And then there is the stress of fighting with her insurance company for both short-term and long-term disability, which took months and several rejections to sort through as she was among the first wave of people to experience this. “Nobody understood long-haul COVID,” she says. “It was exhausting fighting with the insurance companies.”

Symptoms
While optimism abounds for those seeking a return to normalcy, much is still unknown about long-haul COVID. And employers must be ready for how that may affect their workforce.

According to a National Institutes of Health study of 3,700 self-described COVID “Long Haulers” in 56 countries, nearly half could not work full-time for six months after getting sick. While more than half say they never sought hospital care, more than 2,400 reported symptoms such as fatigue, shortness of breath, trouble sleeping, “brain fog” or cognitive dysfunction, or memory loss persisting six months or longer.

The Centers for Disease Control and Prevention have also identified joint and chest pain, depression, muscle pain, headache, intermittent fever and heart palpitations as long-term symptoms. Less common, but more serious, long-term complications include inflammation of the heart, lung function abnormalities, acute kidney injury, rash, hair loss, smell and taste problems, anxiety and changes in mood.

“There is still a lot we have to learn about the disease,” says Dr. Jose Mercado, associate hospital epidemiologist for Dartmouth-Hitchcock Medical Center.

“We are focusing on how to prevent further complications. I’m not sure we are at a point where we have treatment for these folks,” Mercado says, especially to get them back to functioning normally at work.

Mercado says that since there is no set standard for identifying long-haul COVID, the number of cases is likely underreported.

Mercado also points out that 30% of patients who experience a mild form of COVID may experience acute post symptoms.

“The younger-age population think they are less vulnerable. We have messaged out so far if you are young, you are less likely to have severe disease and more likely to have mild or asymptomatic disease that may make them feel less vulnerable, but there is still a good chance they will experience long-term symptoms,” Mercado says.

What Employers Need to Know
How should employers respond? Adam Hamel, vice chair of employment law at McLane Middleton in Manchester, says while the U.S Equal Employment Opportunity Commission was asked last year whether chronic COVID-19 symptoms could be considered a disability, it has yet to issue any guidance.

Therefore, Hamel says employers should handle such cases using their existing paid leave and short and long-term disability policies as well as the Family Medical Leave Act.

Hamel says those who contracted COVID early in the pandemic may not have been tested, which can make proving long-haul symptoms were caused by COVID difficult. If an employee requests time off or accommodations related to long-haul COVID, the employer should request certification from a doctor that such actions are necessary. However, employers cannot request employees’ medical records.

Once an employee files for short-term or long-term disability, it is no longer the purview of the employer. It is then an issue between employee and insurer. However, Hamel says long-haul COVID is relatively new, and it could be difficult for an employee to receive disability.

Hamel says there is a potential for the Americans with Disabilities Act to come into play if an employee requests some form of reasonable accommodation to deal with long-haul COVID. The employer needs to have a conversation, whether it’s about a leave of absence, a flexible work schedule, working part-time or working from home. Hamel says employees must be able to do their job with or without accommodation. “One of the biggest things is to make sure to treat everyone consistently,” he says.

Whether it is the effects of long-haul COVID, working remotely, furloughs or the economy, employers will be dealing with the effects of the pandemic well past vaccines being administered, says Jim Reidy, a partner at Sheehan Phinney in Manchester and chair of the firm’s Labor and Employment group.

“Employers are encouraged to have flexible leave policies,” Reidy says. “That will be the reality throughout 2021 as well.”

If an employee requests to work from home as an accommodation, it is up to the employer to determine whether the request is a preference or a necessity. “There’s lots we don’t know about the long-term effects of COVID,” Reidy says. Employers need to treat each employee’s request as unique and ensure that it does not create an undue burden on the employer, he says. “Work with the employee to the extent possible.”