Accommodations for Long COVID 

July 20, 2023

An estimated 65 million individuals worldwide have Long COVID, which includes a constellation of conditions that occur or persist after infection with SARS-CoV-2. Symptoms can affect multiple organ systems, and while they are mild in the majority of people, they are debilitating in others. As it becomes clearer how Long COVID can affect people, it is necessary to discuss what accommodations may be needed and how to provide them in different settings.  

Long COVID symptoms, sometimes called post-acute sequelae of COVID-19, include cardiovascular, respiratory, neurological, immunological, and other conditions. Chest pain and palpitations, cough and dyspnea, new onset myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), other “brain fog” symptoms, dysautonomia, and autoimmune conditions are among the 200+ symptoms that have been described as related to Long COVID.1 

Recent work, based on the results from a study of nearly 10,000 participants in the Researching COVID to Enhance Recovery (RECOVER-Adult) study, has developed a framework for identifying Long COVID cases based on symptoms, an initial step toward defining Long COVID as a new condition (PASC).2 The RECOVER study, one of the largest initiatives ever funded by the National Institutes of Health, aims to shed light on the ways Long COVID affects children and adults, including pregnant people. 

Efforts to define Long COVID are even more critical than ever: as recently argued in The New England Journal of Medicine, “suspicion regarding the authenticity of long Covid” has led to “a barrier to appropriate accommodations for many people with disabilities.” The authors argue that physicians play an important part in fighting this phenomenon because they can thoughtfully fill out accommodation forms from employers, which can “combat unfounded suspicions” and “change the minds that matter, render the suffering of patients with long Covid socially legitimate and visible, and make theoretical legal protections a reality.”3 

According to the Civil Rights Division of the Department of Justice and Office for Civil Rights of the Department of Health and Human Services, Long COVID can be classified as a disability under sections of the Americans with Disabilities Act (ADA), the Patient Protection and Affordable Care Act (ACA), and the Rehabilitation Act, all of which are federal laws with provisions to protect people from discrimination based on disability.4  

Organizations committed to protecting individuals with Long COVID have published a wide array of suggested accommodations for individuals with Long COVID, depending on symptoms. These may include altering when or how a job duty is performed, redistributing responsibilities, allowing flexible schedules or work-from-home arrangements that conserve employees’ energy, and permitting the use of accrued paid leave or unpaid leave.5 The Family and Medical Leave Act (FMLA) entitles eligible employees to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave.6 

According to the U.S. Equal Employment Opportunity Commission (EEOC), which enforces the ADA and Rehabilitation Act, disability due to Long COVID can be defined broadly, thus favoring coverage to the maximum extent legally permitted. The ADA uses a case-by-case approach to determine if an applicant or employee with Long COVID qualifies as having a disability. Some examples include an individual diagnosed with COVID-19 who experiences “ongoing but intermittent multiple-day headaches, dizziness, brain fog, and difficulty remembering or concentrating, which the employee’s doctor attributes to the virus.”  Even if Long COVID symptoms occur intermittently, they can still be deemed to substantially limit a “major life activity,” such that they qualify as a disability. Cardiovascular effects related to COVID-19 such as heart palpitations, chest pain, and/or shortness of breath can also qualify a person with Long COVID as having a disability, while the EEOC clarifies that an individual who experiences “congestion, sore throat, fever, headaches, and/or gastrointestinal discomfort,” after COVID-19 infection, which resolve within several weeks and do not recur, “is not substantially limited in a major bodily function or other major life activity, and therefore does not have an actual disability under the ADA.”7 

Importantly, the end of the COVID-19 Public Health Emergency on May 11, 2023 did not change requirements of the federal equal employment opportunity laws relevant to the classification of Long COVID as a disability and thus a potential justification for accommodations.7 Individuals who believe that their rights have been violated by an entity covered by the ADA or HHS civil rights laws are able to file complaints online.8,9 

References 

  1. Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21(3):133-146. doi:10.1038/s41579-022-00846-2 
  1. Thaweethai T, Jolley SE, Karlson EW, et al. Development of a definition of postacute sequelae of SARS-CoV-2 infection. JAMA. 2023;329(22):1934-1946. doi:10.1001/jama.2023.8823 
  1. Dorfman D, Berger Z. Approving workplace accommodations for patients with long covid – advice for clinicians. N Engl J Med. 2023;388(23):2115-2117. doi:10.1056/NEJMp2302676 
  1. Office for Civil Rights (OCR). Guidance on “long COVID” as a disability under the ADA, section 504, and section 1557. HHS. Published July 26, 2021. Accessed July 2, 2023. https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html 
  1. Work accommodations & disability. Long Covid Families. Published January 25, 2022. Accessed July 2, 2023. https://longcovidfamilies.org/daily-living/work/  
  1. Family and Medical Leave Act. U.S. Department of Labor. Accessed July 2, 2023. https://www.dol.gov/agencies/whd/fmla  
  1. What you should know about COVID-19 and the ADA, the rehabilitation act, and other EEO laws. US EEOC. Accessed July 2, 2023. https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws 
  1. Office for Civil Rights (OCR). Civil rights and COVID-19. HHS. Published April 29, 2020. Accessed July 2, 2023. https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/index.html 
  1. File a complaint. ADA. Accessed July 2, 2023. https://www.ada.gov/fact_on_complaint.htm  
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