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Long COVID: Returning to work with brain fog and fatigue poses a challenge for employers


Struggling to find familiar words, their memories and thinking fuzzy, losing their train of thought mid-conversation, gasping for breath and battling constant, intense tiredness – for COVID-19 “long haulers” this is reality for weeks, even months, after contracting and seemingly recovering from the disease.


“Long COVID”, with symptoms of brain fog, fatigue and shortness of breath lasting for six months or more, is set to become the biggest health challenge facing business and the healthcare system beyond the immediate crisis of the COVID-19 pandemic.

Prof. Renata Schoeman, head of the Health Care Leadership MBA programme at the University of Stellenbosch Business School (USB) said the likely long-term impact of Long COVID on productivity and employee retention would call on employers to be flexible and adaptable to accommodate employees on the long road to recovery.


Since the global spread of COVID-19 from early 2020, there is an emerging body of evidence from many countries of a growing number of people who experience prolonged symptoms beyond the initial, acute stage of the disease.

“Individual studies indicate that between 10% and 30% of patients who recover from acute COVID-19 become ‘long haulers’, still experiencing symptoms six months later. In one study, of 3 762 patients who had confirmed or suspected COVID-19, most of whom had symptoms lasting longer than 90 days, 45% needed a reduced work schedule compared to before they became ill and 22% were not working due to their health conditions.1

“This illustrates the scale of the likely impact on employers, employees, and the healthcare system that will need to accommodate these patients,” Prof Schoeman said.


While organisations have so far focused on primary prevention of COVID-19 infection – measures such as masks, sanitising, physical distancing and working from home – Prof Schoeman said employers also need to turn their attention to employees returning to work after recovering from COVID-19 and to what is needed to accommodate those suffering from Long COVID.

Although definitions and diagnostic criteria have not yet been settled, Long COVID is generally seen as symptoms that last for more than 28 days after initial infection or diagnosis of COVID-19.2


Long COVID affects multiple bodily systems, with cognitive dysfunction (“brain fog”), fatigue and post-exertional malaise (a relapse or flare-up of symptoms after physical or mental effort) the most common symptoms and the most long-lasting, still experienced six months after infection.1

Brain fog is an umbrella term referring to symptoms such as memory loss, confusion, muddled thinking, poor concentration, and generally feeling mentally sluggish,3 and up to 25% of people infected with COVID-19 experience this and other neurological symptoms.


“Organisations are facing a potential increase in employees needing workplace accommodations for ill health or disability, on long-term sick leave or even medically incapacitated and no longer able to perform their current job.

“Employers need to be reviewing their occupational health services, employee assistance and wellness programmes, policies on sick leave and reasonable accommodation, post-illness return-to-work plans, and ensure they are not discriminating on grounds of mental health or disability,” Prof Schoeman said.

She said understanding of Long COVID was still evolving and a timeline for when maximum improvement of the condition can be expected still remained to be determined.


“The implications are far-reaching, and the likes of healthcare funders and income-protection insurers need to be reviewing their policies and guidelines on treatment and disability. The medical profession and policy-makers need to arrive at objective diagnostic and assessment criteria, and guidelines for best practice in evidence-based treatment and management of Long COVID.”

Prof. Schoeman said developing objective criteria for a diagnosis of Long COVID is important since many of its key aspects such as brain fog and fatigue are largely “invisible”, and employers would need to guard against abuse of sick leave, flexible work arrangements and workplace accommodations.


Similarly to acute COVID-19 disease, the symptoms of Long COVID are diverse and vary between individuals, and also change and fluctuate over time – making it important for employers to discuss their condition with individual employees and understand what support they need, and to allow for flexibility in workplace accommodations.

She said that where Long COVID persisted for more than a month, during which the person may need to take sick leave, by the second month the employer would need to be looking at reasonable accommodation and/or reduced responsibilities.

Beyond two months, she said it was likely that assessment and treatment by a multi-disciplinary team would be the correct approach, involving the general practitioner along with professionals in areas such as psychiatry, neuropsychology and occupational therapy.


For anyone experiencing symptoms of brain fog, Prof. Schoeman recommends tried-and-tested self-care and good mental hygiene – getting enough sleep, regular exercise (gradually phased-in if experiencing fatigue and post-exertion relapse), eating healthily and taking time out from digital devices.



1 Hannah E Davis, et al. Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact. MedRxiv. December 2020, updated April 2021:  https://www.medrxiv.org/content/10.1101/2020.12.24.20248802v3

2 Mendelson M, et al. Long-Covid: An evolving problem with an extensive impact. SA Medical Journal. January 2021. http://www.samj.org.za/index.php/samj/article/view/13141/9649

3 What to know about Covid-19 and brain fog. Healthline. https://www.healthline.com/health/covid-brain-fog