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Am Fam Physician. 2021;103(12):710

Author disclosure: No relevant financial affiliations.

To the Editor: Post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID, can have lasting effects on patients. A World Health Organization report found that up to 10% of people with COVID-19 are still symptomatic at 12 weeks.1 Symptoms include excessive fatigue, cough, chest pain, shortness of breath,2 and cognitive complaints of concentration and memory,1 which, in the authors' experience, patients may refer to collectively as “cognitive fog.”3 A disability can negatively affect a person's ability to work and perform basic activities of daily living.

The prevalence of persistent PASC symptoms may lead people to leave their jobs temporarily. The American College of Occupational and Environmental Medicine advises that prolonged absence from the workplace is detrimental to a person's mental, physical, and social well-being.4 A 2006 British government report commissioned by the Department for Work and Pensions introduced the concept of worklessness and noted the strong association between worklessness and ensuing poor health.5

The best way to help patients with mild to moderate symptoms of PASC stay functionally engaged is appropriate workplace accommodations and an adjustment to a job or work environment that makes it possible for a person with a health-related disability to make a timely and safe return to work and to perform their job duties effectively. Accommodations are guided by physician-directed restrictions and limitations, broadly defined as:

  • Restrictions generally address risk and indicate tasks that a person is capable of doing at work but should not do for medical reasons;

  • Limitations generally address capacity and speak to what a person is not currently capable of doing at work for medical reasons.

Primary care and occupational medicine physicians can advise human resources or management leaders on structured, individual return-to-work strategies for patients with PASC.6 Examples of typical accommodations related to fatigue, which is a common limiting symptom of PASC, include reduced time at work, reduced work volume, starting work later to compensate for sleep disruption, increased liberty to self-pace the workload, avoiding tight deadlines, or being excused from more complex work that has higher cognitive demands.

The long-term prognosis of post-acute sequelae of SARS-CoV-2 infection is unknown; therefore, accommodations should be periodically reassessed and adjusted based on the patient's clinical progress. Appropriate physician accommodation guidance for patients with post-acute sequelae of SARS-CoV-2 infection can preserve their remaining functionality and protect against the secondary effects on the health of worklessness.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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