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The cognitive effects of COVID-19

A little over one year into the COVID-19 pandemic, the overriding consensus is that this is far from over. As of February 25, 2021, more than 28 million people have been infected in the U.S. alone. And, while the vaccination rollout has accelerated in the past several weeks, widespread access to the vaccine is still months away.

Employers know this – and the virus continues to loom large in many workplaces. In fact, according to a survey by the Disability Management Employment Commission (DMEC), 90% of employers have made changes to their policies due to COVID-19. Thus, things like working from home, wearing masks and social distancing have become commonplace (if not the norm). The same survey noted that most organizations are still deciding whether their pandemic-related changes will become long term.

Long-term changes may make sense given that more and more COVID-19 survivors are experiencing a condition called Post-Acute COVID Syndrome (PACS). Dr. Anthony Fauci (director of the National Institute of Allergy and Infectious Diseases and chief medical advisor to President Joe Biden) discussed PACS (also called “long COVID-19”) in mid-February when speaking at the Duke University Global Health Institute.

Dr. Fauci said that a certain percentage of people who have symptomatic diseases like COVID-19, whether they've been hospitalized or not, have lingering symptoms for variable periods of time. And, according to Fauci, these symptoms can still be an issue long after the virus has cleared from the body.

People who continue to have COVID symptoms long after they are infected have been called “long-haulers,” and The Journal of American Medical Association (JAMA) estimates that 10% of all COVID-19 patients become long-haulers.

Of course, the virus is still relatively new and there are not yet any long-term studies. Thus, the outlook for the long-haulers is unknown. But here’s what we do know: Long-haulers continue to experience the physical symptoms we’ve been hearing about since COVID-19 first came on the scene (e.g., muscle aches and fatigue).

However, perhaps more troubling and mysterious than the physical symptoms that the long-haulers face is something that only more recently has come to light. Specifically, many patients experience an ongoing cognitive decline long after the virus leaves their bodies. Sometimes called “brain fog,” these symptoms manifest themselves in difficulty in focusing, concentrating and thinking.

This longer-term cognitive decline is borne out in another study. In a survey by Survivor Corps – a group of COVID-19 survivors – led by Natalie Lambert, MD, associate professor at Indiana University School of Medicine – researchers talked to more than 1,500 long-haulers about their symptoms. Startlingly, 59% reported difficulty in concentrating long after they are COVID-19 free.

This statistic, combined with the belief that 10% of COVID-19 patients become long-haulers, leads to an estimate that 6% of all of those who become infected with COVID-19 will experience brain fog long after the virus clears their bodies.

This “brain fog” can present several challenges for employers – including knowing when it may occur. After all, since many people experience an asymptomatic bout of COVID-19, they may not even know that they previously had the virus. In those cases, an employer certainly would be unaware as well.

What would a situation look like in the workplace? Well, let’s say, for example, that you have an employee whose job it is to deliver presentations and answer, sometimes on the fly, clients’ questions. And, you notice they are losing their train of thought or are having trouble remembering facts or clearly discussing things.

So, what should an employer do if they detect a newly evident inability of an employee to concentrate or focus, as described above? Well, as with any medical situation, an employer should avoid discussion of the suspected impairment and instead keep the conversation focused on performance. This is because the Americans with Disabilities Act (ADA) and similar state laws generally prohibit employers from asking questions that are likely to elicit information from an employee concerning a disability.

An employer should proceed as they would with any other employee who is not meeting performance expectations. Rather than saying, “Hey Joe, what’s wrong with your brain?” the supervisor should stick with the performance issues:

  • I noticed that, during the meeting with ACME company, you trailed off a few times while talking
  • I observed that, when presenting to Northern Products, you incorrectly stated our mission statement, which has been the same for years
  • I noticed that you have, several times recently, referred to Jennifer as Mary

This opens the door to a conversation about what may be causing the performance issues. This is called the interactive dialogue, a process in which you and the employee collaborate about the nature, severity and duration of the employee’s impairment (In this case, the “brain fog”) as well as the activity or activities that the impairment limits.

The purpose of the interactive dialogue is to determine if there is an accommodation that an employer can make that will allow the employee to perform the essential functions of their job. Workplace accommodations may include, among other things, providing additional resources, job restructuring, modifying work schedules or reassigning the individual to a vacant position.

During this process, an employer and employee can brainstorm solutions and hopefully agree on a reasonable accommodation. Some questions an employer may wish to consider when dialoguing with an employee:

  1. What limitations is the employee experiencing?
  2. How do these limitations affect the employee and the employee’s job performance?
  3. What specific job tasks are problematic as a result of these limitations?

And, while all situations are different, some workplace accommodations that may help include checklists, extra time to prepare, apps/software designed to help with organization, or extended breaks if the employee feels overwhelmed.

An additional note: If the employer and employee agree on a leave of absence rather than a workplace accommodation, the Family and Medical Leave Act (FMLA) entitlements – or those under a state-law equivalent – would kick in before ADA obligations apply (if the employee qualifies). In those situations, the interactive dialogue would resume when the leave benefits exhaust.

We are all still learning about COVID-19 and its downstream cognitive effects. However, if employers treat these situations similarly to how they approach performance issues with other employees, organizations and workers can come up with mutually beneficial solutions to navigate these uncharted waters.

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