Long COVID and employment changes in England: A mixed-methods population based study

Abstract Long COVID is a complex health condition that can affect an individual's capability to sustain employment, yet little is known about how it has shaped work experiences across different groups. To address this gap, we used a parallel convergent mixed-methods approach to explore the employment experiences of people with Long COVID in England, drawing on data from the Real-time Assessment of Community Transmission (REACT) Study. We applied multivariable regression models to survey data from 52,649 participants to assess the association between Long COVID and changes in a participant's type and hours of paid work. We also conducted framework analysis on data from 60 semi-structured interviews to explore personal experiences of employment, challenges and workplace adaptations. Results indicate that between 2020 and 2022, 13% of participants changed their type of paid work and 12% changed their working hours due to health issues. Compared to asymptomatic individuals and those with short-lived COVID-19 infections, participants with ongoing Long COVID had higher odds of changing work type (OR 2.87, 95% CI 2.52-3.28) and working hours (OR 3.05, 95% CI 2.67-3.47). Odds were also higher among self-employed individuals and health care workers. We identified three themes from our qualitative analysis: 1) Persistent COVID-19 symptoms at work; 2) Ripple effects of balancing work, identity and wellbeing; and 3) Employment changes to cope with and manage persistent symptoms. Participants emphasized their job roles, social networks, and access to organizational and healthcare supports intersected to shape their opportunities for sustainable employment. They also underscored the importance of flexible work accommodations tailored to the nature of their symptoms and personal circumstances. Findings from this study provide a nuanced understanding of how Long COVID influences employment and highlight practical opportunities for improving support and wellbeing in the workplace. Key messages • A moderate proportion of participants with Long COVID had to change their job type or work hours due to health issues. However, many reported other employment adaptations (e.g., remote working). • Flexible work accommodations support employees with chronic conditions, including Long COVID. Their success requires an intersectional approach based on job expectations and personal circumstances.