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The symptoms vary and include profound fatigue and brain issues.

“It’s a new degree of extreme and debilitating fatigue and exhaustion, to the point where you can’t do your daily tasks,” says Geng, who is also the co-director of Stanford’s Post-Acute COVID-19 Syndrome Clinic.

“People can be so debilitated, they can't even do basic things, like the activities of daily living, let alone do their job, particularly if it's physically or mentally demanding.”

Patients can also have post-exertional malaise, where they feel especially bad and symptoms worsen when they exert themselves physically or mentally, Geng says. Compounding the issue for many long COVID patients is their trouble getting restful sleep. Those with brain fog have issues with memory, processing information, focused concentration, confusion, making mistakes, and multitasking. Pain is another debilitating symptom that can disrupt daily life and ability to work.

Long COVID Could Cost the Economy Trillions, Experts Predict

https://www.webmd.com/covid/news/20220928/long-covid-could-cost-economy-trillions-experts

Disability Rights Are Human Rights.

 

The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities in several areas, including employment, transportation, public accommodations, communications and access to state and local government’ programs and services.

 Reasonable Accommodations  

Office of Disability Employment Policy US Department of Labor

"The ADA requires reasonable accommodations as they relate to three aspects of employment: 1) ensuring equal opportunity in the application process; 2) enabling a qualified individual with a disability to perform the essential functions of a job; and 3) making it possible for an employee with a disability to enjoy equal benefits and privileges of employment.

Examples of reasonable accommodations include making existing facilities accessible; job restructuring; part-time or modified work schedules; acquiring or modifying equipment; changing tests, training materials, or policies; and providing qualified readers or interpreters. Here are some more examples. Many job accommodations cost very little and often involve minor changes to a work environment, schedule or work-related technologies:

  • Physical changes

    • Installing a ramp or modifying a rest room

    • Modifying the layout of a workspace

  • Accessible and assistive technologies

    • Ensuring computer software is accessible

    • Providing screen reader software

    • Using videophones to facilitate communications with colleagues who are deaf

  • Accessible communications

    • Providing sign language interpreters or closed captioning at meetings and events

    • Making materials available in Braille or large print

  • Policy enhancements

    • Modifying a policy to allow a service animal in a business setting

    • Adjusting work schedules so employees with chronic medical conditions can go to medical appointments and complete their work at alternate times or location"

"

Guidance on “Long COVID” as a Disability Under the ADA, Section 504, and Section 1557  https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html#:~:text=Can%20long%20COVID%20be%20a,or%20more%20major%20life%20activities.

"

In light of the rise of long COVID as a persistent and significant health issue, the Office for Civil Rights of the Department of Health and Human Services and the Civil Rights Division of the Department of Justice have joined together to provide this guidance. 

This guidance explains that long COVID can be a disability under Titles II (state and local government) and III (public accommodations) of the Americans with Disabilities Act (ADA),3  Section 504 of the Rehabilitation Act of 1973 (Section 504),4  and Section 1557 of the Patient Protection and Affordable Care Act (Section 1557).5   Each of these federal laws protects people with disabilities from discrimination.6   This guidance also provides resources for additional information and best practices.  This document focuses solely on long COVID, and does not address when COVID-19 may meet the legal definition of disability.

The civil rights protections and responsibilities of these federal laws apply even during emergencies.7   They cannot be waived."

"Can long COVID be a disability under the ADA, Section 504, and Section 1557?

Yes, long COVID can be a disability under the ADA, Section 504, and Section 1557 if it substantially limits one or more major life activities.9   These laws and their related rules define a person with a disability as an individual with a physical or mental impairment that substantially limits one or more of the major life activities of such individual (“actual disability”); a person with a record of such an impairment (“record of”); or a person who is regarded as having such an impairment (“regarded as”).10   A person with long COVID has a disability if the person’s condition or any of its symptoms is a “physical or mental” impairment that “substantially limits” one or more major life activities.

This guidance addresses the “actual disability” part of the disability definition.  The definition also covers individuals with a “record of” a substantially limiting impairment or those “regarded as” having a physical impairment (whether substantially limiting or not). This document does not address the “record of” or “regarded as” parts of the disability definition, which may also be relevant to claims regarding long COVID."

"a. Long COVID is a physical or mental impairment

A physical impairment includes any physiological disorder or condition affecting one or more body systems, including, among others, the neurological, respiratory, cardiovascular, and circulatory systems.  A mental impairment includes any mental or psychological disorder, such as an emotional or mental illness.11

Long COVID is a physiological condition affecting one or more body systems.  For example, some people with long COVID experience:

  • Lung damage

  • Heart damage, including inflammation of the heart muscle

  • Kidney damage

  • Neurological damage

  • Damage to the circulatory system resulting in poor blood flow

  • Lingering emotional illness and other mental health conditions

Accordingly, long COVID is a physical or mental impairment under the ADA, Section 504, and Section 1557.12"

"b. Long COVID can substantially limit one or more major life activities

“Major life activities” include a wide range of activities, such as caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, writing, communicating, interacting with others, and working.  The term also includes the operation of a major bodily function, such as the functions of the immune system, cardiovascular system, neurological system, circulatory system, or the operation of an organ.

The term “substantially limits” is construed broadly under these laws and should not demand extensive analysis.  The impairment does not need to prevent or significantly restrict an individual from performing a major life activity, and the limitations do not need to be severe, permanent, or long-term.  Whether an individual with long COVID is substantially limited in a major bodily function or other major life activity is determined without the benefit of any medication, treatment, or other measures used by the individual to lessen or compensate for symptoms.  Even if the impairment comes and goes, it is considered a disability if it would substantially limit a major life activity when the impairment is active.

Long COVID can substantially limit a major life activity.  The situations in which an individual with long COVID might be substantially limited in a major life activity are diverse.  Among possible examples, some include:

  • A person with long COVID who has lung damage that causes shortness of breath, fatigue, and related effects is substantially limited in respiratory function, among other major life activities. 

  • A person with long COVID who has symptoms of intestinal pain, vomiting, and nausea that have lingered for months is substantially limited in gastrointestinal function, among other major life activities.   

  • A person with long COVID who experiences memory lapses and “brain fog” is substantially limited in brain function, concentrating, and/or thinking."

"4. What rights do people whose long COVID qualifies as a disability have under the ADA, Section 504, and Section 1557?

People whose long COVID qualifies as a disability are entitled to the same protections from discrimination as any other person with a disability under the ADA, Section 504, and Section 1557.  Put simply, they are entitled to full and equal opportunities to participate in and enjoy all aspects of civic and commercial life. 

For example, this may mean that businesses or state or local governments will sometimes need to make changes to the way that they operate to accommodate a person’s long COVID-related limitations.  For people whose long COVID qualifies as a disability, these changes, or “reasonable modifications,” may include:

  • Providing additional time on a test for a student who has difficulty concentrating

  • Modifying procedures so a customer who finds it too tiring to stand in line can announce their presence and sit down without losing their place in line

  • Providing refueling assistance at a gas station for a customer whose joint or muscle pain prevents them from pumping their own gas

  • Modifying a policy to allow a person who experience dizziness when standing to be accompanied by their service animal that is trained to stabilize them

5. What federal resources are there for people with symptoms of long COVID?

Telework Reasonable Accommodations

https://www.telework.gov/guidance-legislation/telework-guidance/reasonable-accommodations

What is a Reasonable Accommodation?

A reasonable accommodation is defined as any change in the work environment (or in the way things are usually done) to help a person with a disability apply for a job, perform the duties of a job, or enjoy the benefits and privileges of employment.  Reasonable accommodations may include, but are not limited to: (a) making existing facilities readily accessible to individuals with disabilities; (b) job restructuring, modification of work schedules or place of work, extended leave, telework, reassignment to a vacant position; and (c) acquisition or modification of equipment or devices, including computer software and hardware, appropriate adjustments or modifications of examinations, training materials or policies, the provision of qualified readers and/or interpreters and other similar accommodations.

Long COVID is a Disability. Here’s How to Ask for Workplace Accommodations.

https://www.wsj.com/articles/long-covid-is-a-disability-heres-how-to-ask-for-workplace-accommodations-9b63fd90

Employment attorneys and other disability experts say workers should consider their individual situation when deciding whether to disclose a disability and ask for accommodations. They can make a request orally or in writing, and who they contact first is also up to them. Some people might feel more comfortable talking to their manager directly, while others might believe their HR department will better understand ADA law. 

In some cases, such as when a condition isn’t readily apparent, an employer may request documentation about the disability and need for accommodation. This can come from any appropriate medical professional—not just a physician, says Linda Carter Batiste, director of services and publications at the Job Accommodation Network, or JAN, which is funded by the U.S. Department of Labor’s Office of Disability Employment Policy.

“Employers cannot ask for medical information unrelated to the disability at issue,” Ms. Carter Batiste adds.

Most workplace accommodations for chronically ill people involve a policy change, such as such as allowing for rest breaks or remote work, or developing a plan of action for when symptoms suddenly flare. 

JAN research shows that more than half of accommodations cost employers nothing, while those requiring some expense typically cost about $500. Equipment-related accommodations can include creating an ergonomic workspace or adding antiglare screen protectors.

For those worried they were denied accommodations because of discrimination, disability lawyers say that workers can file complaints with appropriate state or local authorities, or the Equal Employment Opportunity Commission. It would be a misconception to think that accommodations are a form of preferential treatment, they add.

'That’s why I think a lot of employees are afraid,” says Nicole Buonocore Porter, a professor at the Chicago-Kent College of Law at the Illinois Institute of Technology. “It’s not a leg up. It’s saying, because of the manifestations of whatever my disability is, I need that accommodation just to be able to perform my job.'"

Disability Discrimination and Employment Decisions US Equal Opportunity Commission https://www.eeoc.gov/disability-discrimination-and-employment-decisions: Reasonable Accommodation and Undue Hardship

Some possible reasonable accommodations could be making the workplace accessible for wheelchair users, providing a reader or interpreter for someone who is blind or hearing impaired, making a schedule change, granting telework, allowing leave for disability-related treatment or symptoms, or reassignment to a vacant position where reasonable accommodation is not possible in the current job.

An employer doesn't have to provide an accommodation if doing so would cause undue hardship to the business.  Undue hardship means that the accommodation would be too difficult or too expensive to provide, in light of the employer's size, financial resources, and the needs of the business. An employer may not refuse to provide an accommodation, however, just because it involves some cost. An employer does not have to provide the accommodation the employee or job applicant wants, as long as it provides an effective reasonable accommodation.  If more than one accommodation effectively meets the disability-related needs, the employer may choose which one to provide

Definition of Disability

 Under the law, a person has a disability if the person:

  • Has a physical or mental condition that substantially limits a major life activity (such as walking, talking, seeing, hearing, or learning, or operation of a major bodily function, such as brain, musculoskeletal, respiratory, circulatory, or endocrine function).

  • Has a history of a disability.

  • Is subject to an adverse employment action because of a physical or mental impairment the individual actually has or is perceived to have, except if it is transitory (lasting or expected to last six months or less) and minor.

A medical condition does not need to be long-term, permanent, or severe to be substantially limiting.  Also, if symptoms come and go, what matters is how limiting the symptoms are when they are active.

Small Employers and Reasonable Accommodation

https://www.eeoc.gov/laws/guidance/small-employers-and-reasonable-accommodation

Requesting Reasonable Accommodation

  1. How must an individual request a reasonable accommodation?

    The individual must let the employer know that s/he needs an adjustment or change at work for a reason related to a medical condition. An individual may use "plain English" and need not mention the ADA or use the phrase "reasonable accommodation." Requests for reasonable accommodation do not need to be in writing, though an employer may choose to write a memorandum or letter confirming the request.

  2. What must an employer do after receiving a request for reasonable accommodation?

  3. When the disability and/or the need for accommodation is not obvious, the employer may ask the individual for reasonable documentation about his/her disability and functional limitations.

  4. The employer and the individual with a disability should engage in an informal process to clarify what the individual needs and identify the appropriate reasonable accommodation. The employer may ask the individual questions that will enable it to make an informed decision about the request. This includes asking what type of reasonable accommodation is needed.

  5. There are extensive public and private resources to help employers and individuals with disabilities who are not familiar with possible accommodations. (See the Appendix to this guide for a resource directory to help identify reasonable accommodations.)

  6. Must an employer provide the reasonable accommodation that the individual wants?

  7. The employer may choose among reasonable accommodations as long as the chosen accommodation is effective (i.e., it removes the workplace barrier at issue). The employer may offer alternative suggestions for reasonable accommodations to remove the workplace barrier in question. If there are two possible reasonable accommodations, and one costs more or is more difficult to provide, the employer may choose the one that is less expensive or easier to provide, as long as it is effective.

  8. How quickly must an employer respond to a request for reasonable accommodation?

  9. An employer should respond promptly to a request for reasonable accommodation. If the employer and the individual with a disability need to engage in an interactive process, this too should proceed as quickly as possible. Similarly, the employer should act promptly to provide the reasonable accommodation.

 

May an employer tell other employees that someone is receiving a reasonable accommodation?

No, because this usually amounts to a disclosure that the individual has a disability. The ADA specifically prohibits the disclosure of medical information except in certain limited situations, which do not include disclosure to coworkers.

An employer may certainly respond to a question from an employee about why a coworker is receiving what is perceived as "different" or "special" treatment by emphasizing its policy of assisting any employee who encounters difficulties in the workplace. The employer also may find it helpful to point out that many of the workplace issues encountered by employees are personal, and that, in these circumstances, it is the employer's policy to respect employee privacy. An employer may be able to make this point effectively by reassuring the employee asking the question that his/her privacy would similarly be respected if s/he found it necessary to ask the employer for some kind of workplace change for personal reasons. Employers might also find it helpful to provide all employees with information about various laws that require employers to meet certain employee needs (e.g., the ADA and the Family and Medical Leave Act), while also requiring them to protect the privacy of employees.

Small Employers and Reasonable Accommodation

Every request for reasonable accommodation should be evaluated separately to determine if it would impose an undue hardship, taking into account:

  • the nature and cost of the accommodation needed;

  • the overall financial resources of the business; the number of persons employed by the business; and the effect on expenses and resources of the business;

  • the impact of the accommodation on the business.

Long COVID Could Cost the Economy Trillions, Experts Predict

https://www.webmd.com/covid/news/20220928/long-covid-could-cost-economy-trillions-experts

Disability Insurance

To be sure, there is one piece of the puzzle that does not quite fit, according to Cutler and Bach. There is no sign yet of a large increase in federal disability insurance applications, and no one quite knows why. Publicly available government data shows that online applications actually dipped by about 4% each year between 2019 and 2021. Applications in 2022 appear on track to remain slightly below pre-pandemic levels. 

To qualify for Social Security Disability Insurance (SSDI), people need to have a disability that lasts at least a year. 

“If you're disabled with long COVID, who knows, right? You don't know,” says Bach. “Two of the most dominant symptoms of long COVID are fatigue and brain fog. So, I've heard from people that the process of going through an SSDI application is really hard.”

Some long COVID patients told Bach they simply assumed they would not get SSDI and did not even bother applying. She stressed that working Americans with debilitating long COVID should be aware that their condition is protected by the Americans with Disabilities Act. But the challenge, based on guidance issued by the government, is that not all cases of long COVID qualify as a disability and that individual assessments are necessary.

While more long COVID data is needed, Bach believes there is enough information for decisionmakers to go after the issue more aggressively. She pointed to the $1.15 billion in funding that Congress earmarked for the National Institutes of Health over the course of 4 years in support of research into the long-term health effects of COVID-19.

“Now, $250 million a year sounds like a lot of money until you start talking about the cost of lost wages – just lost wages,” Bach says.

“That's not lost productivity. That's not the cost of people whose family members are sick. Who have to reduce their own labor force participation. That's not medical costs. Suddenly, $250 million doesn't really sound like that much.”

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