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EU-OSHA Executive Director William Cockburn discusses long COVID and the vital role of rehabilitation and workplace adjustments in supporting affected workers returning to work. 

 

The COVID-19 pandemic may no longer dominate the headlines, but its shadow lingers - especially as growing evidence reveals its lasting impact on physical, cognitive, and mental health. For many, persistent long COVID symptoms can severely hinder their ability to work, posing significant risks to occupational safety and health (OSH). To ensure a smooth return to work, practical measures and clear guidance are essential, empowering organisations to assist workers effectively and build workplaces that are more resilient and adaptable.

 

Understanding long COVID
Long COVID is recognised as a condition affecting individuals following a probable or confirmed SARS-CoV-2 infection. Its effects can last from a matter of days to several months or even years and, crucially, the symptoms cannot be explained by any alternative medical diagnosis.

The condition manifests differently from person to person, but most common symptoms include fatigue, breathlessness, and cognitive difficulties, which can fluctuate in severity - easing, relapsing, or worsening over time. 

While anyone can be affected, those at higher risk include women of working age, people with pre-existing conditions, and those who had severe or hospitalised COVID-19.

The scale of the issue is considerable. The World Health Organisation (WHO) estimates around 36 million people in Europe may have experienced long COVID between 2020 and 2023.

Implications for workers and workplaces 
EU-OSHA has raised concerns over the impact of long COVID on OSH. Many affected workers face lasting impairments that limit their ability to perform job tasks or, in severe cases, prevent them from working altogether. Undiagnosed cases pose even greater risks - errors could occur when operating heavy machinery, or workers may struggle with balance while working at height, putting themselves and others in danger.

Recognition of long COVID as an occupational condition varies across Europe. Some countries, such as Bulgaria, Estonia, France, Poland, Portugal, Slovakia and Slovenia, classify it as an occupational disease. Italy and Spain treat it as a work accident, while Germany and several other states recognise both categories.

From symptoms to diagnosis
Long COVID is typically diagnosed by general practitioners (GPs) based on ongoing symptoms and a history of COVID-19 infection. In the workplace, occupational physicians play a key role in assessing how symptoms affect job performance and advising on adjustments or rehabilitation goals.

While there is no universally endorsed assessment tool from the WHO or EU, standardised scales like the Work Ability Index (WAI)[1] and Duke Activity Status Index (DASI)[2] can help examine overall work capacity and physical function. Regular re-evaluation is essential, as symptoms may fluctuate or relapse.

As understanding of long COVID evolves, it is also vital that occupational health professionals and rehabilitation specialists stay up-to-date to provide timely and effective support. 

Rehabilitation: a way back to work
Rehabilitation is often vital for workers with long COVID, but approaches must be tailored to each individual’s symptoms, severity, and recovery pace. Exercise-based therapy is a common foundation, ranging from self-managed routines for mild cases to structured programmes delivered by specialists, in person or via telemedicine. 

The ultimate goal is to restore overall health, wellbeing, and the level of activity before illness, allowing workers to return sustainably to their jobs. Nevertheless, access to rehabilitation can be hindered by delayed diagnosis or workers on lower incomes may struggle to access appropriate care. Long COVID symptoms can also interact in complex ways requiring multidisciplinary rehabilitation strategies.

Addressing long COVID – what good practice looks like

General principles
Long COVID impacts not only individual workers but also overall workplace dynamics, requiring a joint effort from employers and workers. Education and awareness are key to fostering a culture where symptoms are acknowledged and support is proactive. This includes providing information about long COVID – its symptoms and associated health conditions, expected duration, potential relapses, impact on a worker’s quality of life, as well as offering pathways to medical care, risk assessments, and rehabilitation services.

All stakeholders - employers, workers, managers, HR, occupational health, and rehabilitation teams - should collaborate on a tailored return-to-work plan and adjustments. Particular consideration should be given to those with severe or mental health symptoms, as well as to individuals in caregiving roles, ensuring no one is left behind. 

Support measures must be flexible and regularly reviewed to reflect changing health needs and worker feedback.

Physical health
Common physical symptoms of long COVID include fatigue that does not improve with rest, post-exertional malaise (PEM) - a delayed worsening of symptoms after minimal physical or mental activity, orthostatic intolerance - unstable blood pressure and heart rate when standing, breathing issues, and joint pain. 

Workplace measures such as phased return-to-work programmes offer gradual re-entry, together with adjustable workloads. Workers facing joint pain may need to avoid strenuous tasks altogether until their condition stabilises, while those with breathing difficulties should steer clear of jobs requiring respiratory protection. 

For someone managing orthostatic intolerance, certain workplace modifications, such as allowing regular seated breaks and avoiding prolonged standing, can reduce the risk of dizziness and falls. Others may benefit from flexible hours or telework options, helping to lower both physical and mental strain during recovery.

Self-rehabilitation is crucial for many patients managing such symptoms. Regarding fatigue and joint pain, for instance, the focus is on exercise that respects the individual’s current capacity and can be scaled up or down depending on symptom severity. Safe spaces for exercise at work can support this.

For those struggling with PEM, patients are encouraged to monitor their “energy envelope” - a concept that involves tracking personal thresholds for both physical and mental activity, often with the help of a daily symptom and activity diary. Individuals dealing with orthostatic intolerance may turn to low-barrier strategies like increasing salt intake or rising slowly from seated positions. Breathing impairments, meanwhile, are being met with techniques like controlled breathing or positional adjustments. 

Some cases may call for specialist rehabilitation. For example, patients with long-term fatigue may undergo baseline fitness testing to set safe, personalised goals. When joint pain is present, specialists may recommend aqua therapy, tai chi, or even anti-inflammatory medication. For those experiencing ongoing breathlessness, coordinated care between primary doctors and specialists can help uncover contributing factors - whether cardiovascular, related to mood disorders, or both. 

Cognitive health
Long COVID is not just a physical battle. For many, it also takes a toll on cognitive health, leaving workers struggling with what is typically referred to as “brain fog”. This condition manifests as difficulty focusing, impaired memory, poor decision-making, and slow thinking. 

Workplace adaptations should include flexible hours, adjusted workloads, and phased return-to-work plans. Starting with simpler tasks can help rebuild confidence before progressing to more complex ones. Breaking down activities into manageable steps can also prevent workers from feeling overwhelmed. Allowing time to process information, using tools like digital calendars, and training colleagues in supportive communication all help create an inclusive environment. Reducing stigma around cognitive symptoms in long COVID starts with understanding the condition, its causes, and available rehabilitation options.

When it comes to self-rehabilitation strategies, physical exercise has proven benefits for brain health and can be introduced gently into daily routines. Alongside physical activity, mental exercises - such as puzzles, quizzes, and games - can engage the brain and sharpen cognitive abilities. 

When specialist care is needed, various tailored rehabilitation approaches can be provided by cognitive rehabilitation experts, such as psychologists and neurologists. Techniques like cognitive strengthening or cognitive-behavioural training may be beneficial.

 

“Long COVID has brought mental health to the forefront of occupational safety and health. Many workers are not only coping with physical fatigue or cognitive fog, but also with anxiety, low mood, and isolation. These are not invisible struggles—they are workplace realities. Our upcoming Healthy Workplaces Campaign, Together for mental health at work, calls on all sectors to take action. We must create environments where mental wellbeing is protected, psychosocial risks are addressed, and no one is left behind in their recovery journey.” — William Cockburn

 

Mental health
Mental health challenges such as low mood, anxiety, and feelings of dread can be part of long COVID. 

Workplace adjustments may encompass reorganising work schedules to allow for flexible working hours or teleworking. Providing extra time to complete tasks, modifying assignments to reduce stress, and offering a phased return to work plan can all support workers during their recovery.

Similarly, mental health issues often go unreported due to negative social perception, especially among younger workers or those with low job security. Employers should offer mental health training, promote awareness, and establish open communication - engaging HR, managers, and occupational health professionals in the process. 

In terms of self-rehabilitation, addressing sleep quality, diet, and physical activity is key. Self-care, such as staying socially connected and engaging in relaxing activities, plays a vital role in managing stress and improving mood as well.

In some instances, clinical rehabilitation may be necessary. A recommended approach combines psychological support with physical activity, known as a “mind-body” strategy. Additionally, mindfulness techniques and peer support groups can help alleviate distress.

A path forward 
Ultimately, rehabilitation and workplace adaptations are two halves of the same equation. Recovery is most successful when workers feel supported not just by their physicians, but by their employers. Actions that accommodate physical, cognitive and mental health concerns can help workers with long COVID in successfully returning to work and maintaining their employment while managing their symptoms effectively.

Discover more:

• EU-OSHA’s Long COVID: identification and work ability assessment, workplace adaptation and rehabilitation. A practical short guide for occupational physicians, 2025.

• EU-OSHA’s Long COVID: assessing work ability, adapting the workplace and supporting rehabilitation. A practical short guide for the workplace, 2025.

• EU-OSHA’s COVID-19 infection and long COVID – guide for managers, 2023.

• EU-OSHA’s COVID-19 infection and long COVID – guide for workers, 2021.

• EU-OSHA’s Long COVID: worker rehabilitation, assessment of work ability and return to work support. Discussion paper, 2025.

• EU-OSHA’s Impact of Long Covid on workers and workplaces and the role of OSH. Discussion paper, 2022.

• OSHwiki article - Identification of long COVID, assessment of work ability, rehabilitation and workplace adaptations, 2025.

EU-OSHA is the European Union information agency for occupational safety and health, promoting a risk prevention culture to improve Europe’s working conditions. Set up by the EU in 1994 and based in Spain, EU-OSHA researches, develops and distributes reliable, balanced and impartial safety and health information, networking with organisations across Europe.

William Cockburn is the Executive Director of EU-OSHA, where he has worked since 1998, leading initiatives on research coordination, emerging risks, and the landmark ESENER enterprise survey on new and emerging risks at work. With a background in law and ergonomics, he brings decades of experience in occupational safety and health, including previous roles in academia and consultancy.