The worst of COVID-19 may be behind us, but the negative impact on workplace human capital will be with companies for years to come, writes Dr Fundile Nyati
On the eve of the beginning of the year 2020, the 30th of December 2019 to be exact, the Chinese authorities announced to the world that there had been an outbreak of an apparently airborne respiratory illness or disease in their city of Wuhan, in the province of Hubei. There were some early similarities and comparisons of that Wuhan respiratory disease outbreak with the previous respiratory disease outbreaks of SARS (Sub-Acute Respiratory Syndrome) that spread and killed at least about 850 people globally in 2002, and the MERS (Middle East Respiratory Syndrome), which a decade later in 2012 gripped the Middle East, causing a death toll of about 750 people.
Both the 2002 and 2012 respiratory diseases outbreaks were later found to have been caused by a group of viruses, called coronaviruses, which can cause diseases in both animals and human beings. At the time of the respiratory disease outbreak announcement in Wuhan, the exact causative germ was not known, however, scientists that had experience in dealing with SARS and MERS diseases outbreaks quickly developed a hypothesis based on the cases clinical presentation and disease outcomes that another type of coronavirus could be the culprit behind the outbreak.
It was not long after the public announcement that the Chinese scientists confirmed to the world that another new coronavirus, like the initial SARS causing coronavirus was responsible for the new outbreak. Within a 3 months period since the outbreak announcement, the global scientific body that is tasked with naming new viruses resolved to name the new offending virus, SARS-Cov-2, a name that acknowledged the fact that it was a second version SARS-like coronavirus. Further, they named the disease that as it caused COVID-19, again meaning a coronavirus disease that was discovered in 2019.
Within weeks, the new respiratory disease outbreak had spread across to many provinces in China, then across China to neighbouring countries in Asia, across Europe, to the Americas, and to the rest of the world, eventually it hit South African shores on the 5th of March 2020, when a South African from KwaZulu-Natal who was part of a group of 10 South Africans who had just visited Italy, was the first South African to be confirmed that he had indeed tested positively for COVID-19 disease.
In early February, the World Health Organisation (WHO) had declared the new respiratory disease outbreak as the Disease Outbreak of International Concern, and by March they upgraded their assessment of the disease outbreak to a Pandemic, meaning a disease outbreak that had by then affected many countries and continents of the world, beyond an epidemic, which is a disease that affects a large number of people within a community, population or region.
The identification of this first or index case in South Africa caused collective public anxiety to rise abruptly and reach unimaginable levels, because by that time, through the global news networks, South Africans were aware that the SARS-Cov-2 caused COVID-19 disease left a trail of morbidity (ill health) and death (mortality) in all the countries that it visited, and therefore the same was most likely going to happen in South Africa. Indeed, within a month since the first COVID-19 case, the SARS-Cov-19 infection spread like wildfire, to all the South African provinces, causing many to be admitted for hospitalisation, and, unfortunately, others succumbed to the COVID-19 disease.
In the early days (First three months or so) of the pandemic, informed by the cumulative pandemic data to date then, the medical scientists and epidemiologists were largely of the view that COVID-19 was just a respiratory illness, but that view soon changed as many of the hospital admitted cases presented with extra-pulmonary (beyond respiratory system) symptoms and signs, affecting other systems like the kidney function, brain function, gastro-intestinal (digestive) function, cardiovascular (heart and blood vessel), etc.
Further scientific research revealed that for the SARS-Cov-2 germ to infect bodily cells within systems, it needs to attach to special landing sites on the surfaces of the various body cells, called ACE receptors. Once they attach to these landing spots, the virus would then start to attach, invade the covering cell wall, and continue to go and hijack the cell engine (nucleus), integrating itself with normally multiplying DNA to produce more of itself, thereby resulting in many new SARS-Cov-2 viruses, which then go on to infect other body cells, leaving that hijacked cell dead.
So, it became clear that the respiratory system cells contained lots of the ACE receptors (landing spots), more than any other body systems, however, there were other body systems that also contained a fair amount of these SARS-Cov-2 landing spots, which also made them vulnerable to the infection, causing them to also be diseased, hence the extra pulmonary presentations, which then made the COVID-19 disease to be viewed as a multisystemic disease, as opposed to the previous thinking that it was just a respiratory illness or disease.
In the human body, one of the important systems is the Immune or Defence System, a system that really functions as the defence system of a country. The function of the immune system is to protect the body against invading enemies (germs) by early identifying them, then mobilising all the defence troops (defence cells, defence proteins/antibodies etc.) in order to fight, neutralise, and remove the germ threat from the body.
So, the same fightback happens when the human defence system identifies the invasion by the SARS-Cov-2 germ. On recognition of the enemy, the immune system mobilises T-Helper cells (the immune system generals) to strategise and immediately deploy all ‘ground, air, and sea’ troops (cell mediated and antibodies mediated immunity) with the aim of overwhelming and ridding the body of the SARS-Cov-2 germ.
One of the insights that medical scientists realised was that in some people, the body has the ability to quickly mobilise an excessive response to the SARS-Cov-2 invasion, through a response called a “Cytokine Storm”, which in the course of aggressively fighting the invaders, unfortunately also collateral damage to some cells of the body, causing extensive damage to various bodily cells across many bodily systems, resulting in death or leaving a lot of scarring therein in the aftermath, which later causes other medium- to long-term problems in those bodily systems, long after the person has fortunately ‘recovered’ or been discharged from hospitals for those who had moderate to severe diseases.
The medium- to long-term symptoms and/or complications following an acute SARS Cov-2 induced illness (COVID-19 disease) is now commonly referred to as #LongCOVID (Post COVID Syndrome/Post Acute COVID Syndrome). This new and still poorly understood clinical phenomenon of #LongCOVID was relatively unknown by medical scientists in the early days of COVID-19 pandemic. By the end of the first six months, scientists in Wuhan and elsewhere began seeing many previously SARS-Cov-2 infected people who were presenting with prolongation of COVID-19 disease symptoms or were developing new symptoms/clinical presentations beyond four weeks from the initial COVID-19 onset.
Three years plus since the identification of #LongCOVID disease, there is a lot that medical scientists know more about this complication of Acute SARS-Cov-2 induced disease, yet it is still important to acknowledge that a lot is still unknown as well, especially how to treat and rehabilitate many of these cases. Therefore, this above acknowledgement takes us to what is known now about this complication of COVID-19 disease. What is known now is that in the South African context, at least 1 in 10 people (possible underestimate) who survived COVID-19 disease (mild, moderate or severe), are likely to suffer from #LongCOVID (Murray Dryden et al, NICD, Public Health Surveillance and Response).
It is now known that female survivors of SARS-Cov-19 infection (irrespective of severity) are more ‘at risk’ of suffering from #LongCOVID, and the theory behind that scientific observation is that female in-build Pregnancy Compensation Hypothesis enables females to mount a very aggressive immune response versus SARS-Cov-2 germ infection (Prof Akiko Iwasaki et al, Yale University-School of Medicine).
Also, another hypothesis behind the high prevalence of #LongCOVID is that it is an established fact that Autoimmune Disease response is more prevalent amongst females than males, and that is postulated to play another key role in the aggressive fightback by female immune system response against the SARS-Cov-2 germ, hence more women survived COVID-19 disease, but are left with complications of the aggressive response, as opposed to men who formed the majority of those who succumbed to the COVID-19 pandemic globally, and even here in SA.
It is also known that those people who had pre-existing respiratory health challenges, those who are older (50 years plus), those who are overweight or obese are more at risk of suffering from #LongCOVID. It is know also known that #LongCOVID can affect any system of the body, with more general systemic presentation (e.g., prolonged fatigue, muscular weakness, joint pains, and decline in quality of life) or more specific systemic problems as follows:
- Respiratory problems: Continued breathlessness; chronic cough; persistent oxygen dependence.
- Cardiovascular problems: Chronic palpitations; persistent over-clotting; chest pains.
- Kidney problems: Chronic kidney failure.
- Psychiatric problems: Anxiety; depression; sleep disturbances; PTSD.
- Neurological problems: Cognitive disturbances (so-called brain fog); debilitating headaches.
- Olfactory problems: Chronic inability to taste or smell.
#LongCOVID is a new, serious, and poorly understood clinical phenomenon, often results in prolonged or recurrent medical incapacity (clinical impairment) and/or inability of the sufferers to fulfil mental and/or physical duties of their own occupation (temporary or permanent occupational disability).
Some employees who are suffering from #LongCOVID my be so impacted that they can not even perform activities of daily living (wash themselves, feed themselves, dress themselves), or may be unable to perform some or all of the activities in line with their job responsibilities, presenting serious human capital management challenges for their employers.
The fact that there are no established or proven medical scientific treatment regimes, or expected time for recovery and return to productive work often places, many employers in a serious quandary as to how long they should keep these employees on sick leave benefits, how much reasonable accommodation can be provided, what is reasonable time for rehabilitation or recovery, and at what point should they be considered the employee for ill-health retirement?
In my employee health and wellness company’s experience, our multidisciplinary health professional team has made several practical recommendations on rehabilitation programmes for employees still at home or those back to work but not fully productive, and more often than not many of these employees had to be recommended for ill-health retirement as their physical or mental occupational disabilities made it impossible for them to return to full productive work, meaning premature loss of skills for companies concerned, as well as reduction in returns of training investments by their employers. Some of these employers had employed temporary or substitute staff at great cost, truly hoping that their much-valued employees would recover sufficiently, alas they had to get to grips with the fact that they were not improving sufficiently or not improving at all, all this resulting in financial losses.
Therefore, employers must do an in-depth assessment of current and potential risk of #LongCOVID amongst their workforce who survived COVID-19 disease and formulate clear human capital strategies on how to consistently handle #LongCOVID cases by developing coherent, well thought through policies, practices, and programmes within our existing labour legislative framework (LRA. OHSA, EEA) on matters of medical incapacity and occupational disability.
According to the study report by Dr Dryden et al mentioned earlier, the predicted impact of #LongCOVID will be:
- Reduction in work productivity and service delivery.
- Increased need for economic (and other) support to affected people.
- Additional burden to an already overloaded public health system.
In conclusion, Prof Jonny Peter, HoD of Allergology and Clinical Immunology from UCT and Groote Schuur, was reported on the same study article as saying, ‘#LongCOVID is going to be the next health disaster.
So, employers better plan better, as failure to plan adequately for this COVID-19 pandemic complication will cost them dearly in the long run (cumulative productivity and eventually staff losses).’
Dr Fundile Nyati is the Chairman and CEO of Proactive Health Solutions.