Nisa Malli is Work Stream Manager for Innovative + Inclusive Economy at the Brookfield Institute for Innovation + Entrepreneurship.

In late March, a week after Ontario declared its first lockdown, I got sick and never fully recovered. I am among a growing contingent of “Long COVID” patients, who continue to experience prolonged symptoms and long-term complications.

As a labour researcher working remotely, I cannot stop thinking about the potential impacts of the rising case counts on our workforce and on workers, particularly those working in person and onsite, and how unprepared we are to deal with the potential health, social and economic fallout of high rates of long-term illness and disability. 

In Bergamo, Italy, once an epicentre of the pandemic, follow-up assessments with previously hospitalized patients found that almost half had not fully recovered six months later. Dr. Anthony Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases, has estimated that 25 to 35 per cent of all patients, including those who were not hospitalized, have lingering symptoms. Prolonged symptoms include cardio-respiratory issues, gastrointestinal symptoms, fatigue, fevers, and neurological and cognitive symptoms. 

Evidence from SARS, Epstein Barr, Ebola, Lyme and other infectious diseases makes it clear that COVID-19 is not exceptional in causing prolonged complications and long recoveries, and triggering other chronic illnesses post-infection. However, COVID-19’s sheer scale means that a phenomenon that was previously tragic and difficult for individuals, their families and communities, now has the potential to grow into a national and global crisis that could have a significant impact on our available workforce, long into the future. 

So far, Canada has reported more than 380,000 COVID-19 cases and more than 12,000 deaths. At a 35 per cent rate of long-term complications, we could already have more than 125,000 patients who will need a range of policies and resources to support their recovery – a number that will keep growing with every new daily case count.

Our governments’ pandemic approach to date has sought to manage caseloads, emergency rooms and hospitalization rates while enabling as many workers as possible to continue working. They have tried to find that balance by closing and reopening businesses and services and limiting gatherings and cross-household contact, implementing new restrictions at varying caseload and positivity benchmarks. But these closures are not designed to fully eliminate the virus or to allow individuals to make informed harm-reductive personal decisions. André Picard, writing in The Globe and Mail, described this approach as an ineffective half-measure, a “false dichotomy . . . that you can either protect people from the coronavirus or protect the economy.” He writes: “As long as we have high levels of circulating virus, the perpetually changing rules, and the anxiety and fretting that causes, the economy won’t thrive.”

The cost to workers

In Quebec, more than 50 per cent of COVID-19 outbreaks have been in workplaces. Of the nearly 1,900 workplaces with outbreaks since June, the most common sectors were manufacturing, retail, and restaurants and accommodation, with high numbers in “commercial and personal services” (e.g., gyms, hair salons, etc.), education and health care. Southern Ontario’s hard-hit Peel Region has had 137 workplace outbreaks, more than the number of outbreaks in the region’s long-term care homes, schools and childcare centres combined. Manufacturing, retail and food processing were the most affected sectors.

Many of these workers will experience prolonged and debilitating sickness, and they may unknowingly bring infection home to their families and into their communities – which will have a disproportionate impact on some demographic groups. Workers in many of the hardest-hit sectors are more likely to be low-wage earners who belong to racialized communities. In Toronto, as of September, 79 per cent of COVID cases were people of colour, 48 per cent were living in low-income households, and 25 per cent lived in households of five or more, all significantly higher than their representation in the general population. In Canada’s major cities, neighbourhoods with higher rates of low-wage workers, many of whom are still commuting and working in person, are seeing significantly higher levels of community spread. 

Among those who get sick at work – who are more likely to be those in higher-risk occupations – we can expect to see higher rates of post-traumatic stress disorder (as seen among sick health-care workers in Hong Kong after SARS) and workers who do not feel safe returning to the workplace. Regardless of where they were exposed, we can also expect COVID patients to show high rates of cognitive impairment, at least temporarily, affecting even workers whose jobs are not physically intensive. A U.K. preprint study reported significant cognitive decline, even for those who no longer had other symptoms: more pronounced than that seen among stroke survivors and equivalent to a 10-year decline in aging, including deficits in visual problem solving, visual attention, spatial working memory and executive function. At a COVID recovery clinic in New York, one doctor reported that 30 per cent of his patients were experiencing memory issues, such as trouble recalling phone numbers, words or basic traffic laws. 

For COVID patients who are out of the initial acute and contagious stage, recovery can be slow, complicated and nonlinear, with the majority reporting lingering symptoms that fluctuate in intensity and frequency, relapsing or intensifying after physical or mental exertion, requiring them to stagger their return to work

The cost to the workforce

In Canada, there are already worker shortages in a number of higher-risk frontline occupations. In long-term care, the CEO of the Ontario Long-Term Care Association reported an “acute staffing shortage” in October, with some homes reduced to 20 per cent of their pre-pandemic staff. Quebec has reported a similar shortage of nurses and auxiliary nurses. Both provinces have called in the Canadian Armed Forces as additional support and redeployed workers from other fields, including speech therapists, social workers and educators. 

In food processing, nearly 28,000 positions in Canada are empty, according to Dalhousie University professor Sylvain Charlebois. This includes a number in the meat processing sector, which has experienced multiple outbreaks. And accommodation, food services and retail trade already had more unfilled vacancies than any other sector in Canada in late 2019, with almost 150,000 vacancies between them. Some employers are now reporting ongoing challenges as businesses reopen. 

All of these jobs are physically taxing, requiring in-person work and often long hours. Many of them are low-wage, and lack employment security and employer-provided benefits.

How can policy address Long COVID?

Many “Long COVID” patients will need additional in-community and in-home help through months of recovery, along with extended and flexible income supports and extended health benefits. Patients and advocates have called for a range of supportive policies, including: 

To survive this pandemic, Canada needs creative, empathetic, supportive and evidence-based public policy. We need policies that enable the sick to stay home and rest beyond the acute stage and enable flexible returns to work. We need outpatient care and rehabilitation programs that address the multi-system impacts of acute and prolonged COVID-19. We need retraining programs that fill worker shortages and help those that cannot return to their old jobs move into something new. We need updated and accessible disability assistance programs that provide a living wage. We need better worker and public protection, including higher wages for higher-risk jobs and policies that reduce contagion based on the best available science, at work and in the community. We need publicly available data on outbreaks, recovery and the demographics and occupations of the sick. 

Above all, we need to prioritize worker and community protection over short-term economic recovery. Without this, we risk unnecessary deaths in our communities and workplaces, exacerbated worker shortages, and a growing group of survivors with long and difficult recoveries.

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