Dr Nisreen Alwan has been writing about “long Covid” since the early days of the pandemic, when people first started reporting lingering symptoms from their initial encounter with the virus. At first, she was one of just a few in the scientific community taking it seriously, and one of the only people writing about it publicly. But over the next 18 months, long Covid went mainstream, with countless articles and interviews, as well as academic studies, dedicated to it. 

So by now you would think that Alwan would be able to have in-depth discussions about treatments and patient pathways during her media appearances and in her writing. It hasn’t turned out that way. Just last week, Alwan lamented on social media that many people are still not even convinced that long Covid exists.

“The continued dismissal of long Covid as an important outcome of mass infection with SARS-CoV-2 is largely based on the long-held traditional dismissal of chronic illnesses triggered by viruses,” the associate professor in public health at the University of Southampton tweeted. “It’s not reassurance or scepticism as projected, it’s merely lazy copying of the past.”

• Health warning: Long Covid rising fastest in teaching and education staff
• Covid: School staff more likely to catch Covid than other workers
• Omicron: Primaries tighten Covid rules as cases soar

Across the whole UK population, 14 per cent of people who have had Covid have reported long Covid symptoms four weeks later, according to the Office for National Statistics (ONS). In schools, the proportion is higher than in other work sectors, with the latest data showing that 3.14 per cent of those working in the education and teaching sector are suffering with self-reported long Covid of any duration. This compares with 1.9 per cent of the general population. 

Given the potential disproportionate impact on schools, how well equipped are they to support their staff suffering from long Covid, in light of the problems outlined in Alwan’s tweet?

The short answer is: not very. Tes has been investigating the problem of long Covid in schools for the past few months, and what we have discovered suggests that a combination of an absence of guidance, widespread scepticism, and legal and medical processes lagging behind events is causing schools - and those who work in them - serious problems. 

How long Covid is affecting staff in schools

Despite its growing prevalence, long Covid is still a largely misunderstood illness. For some, the symptoms can last for a few months, while others have experienced almost two years of debilitating symptoms. The symptoms that an individual can experience are also hugely varied.

According to the ONS, the long Covid symptoms most commonly reported are fatigue, loss of smell, shortness of breath and difficulty concentrating. However, a review completed by the National Institute for Health and Care Excellence (Nice) found that long-term symptoms can also include cardiovascular issues, such as chest pain and palpitations; gastrointestinal problems; musculoskeletal symptoms, such as joint and muscle pain; and dermatological complications, such as skin rashes and hair loss. The severity of these symptoms and the number of symptoms that a person suffers also varies.  

A survey of 4,000 people in March 2021 showed that more than one in 10 still had symptoms 12 weeks after falling ill with the virus. Since then, vaccines have reportedly reduced the chance of developing long Covid, but people who are fully vaccinated are still developing the illness after becoming infected: a report published by the ONS on 26 January 2022 revealed that having had a second dose of a Covid vaccination at least two weeks before infection was “associated with a 41 per cent decrease in the odds of self-reported long Covid at least 12 weeks later”. 

According to the ONS, the teaching profession has had one of the highest levels of Covid infections nationally. And even before the latest Omicron surge in schools, Dr Patrick Roach, general secretary of the NASUWT teaching union, suggested that for many this was resulting in continuous symptoms: he described the increasing number of teachers reporting long Covid as a “ticking time bomb”. 

Mark*, a headteacher in the UK, is one of those teachers with long Covid. He caught Covid at the end of the summer term last year. He tells Tes that he was frustrated that he caught it “after 16 months of doing everything we [in schools] could”.

He says his initial infection was enough to keep him away from work but it didn’t seem too serious at first. However, like many who go on to develop long Covid, Mark suffered a relapse a few months after his initial infection. It caused breathlessness, chronic fatigue and brain fog, which meant he was unable to leave his bed for most of the start of the autumn term.

A few months on, Mark says he is improving and feels lucky he was double vaccinated before he caught the coronavirus. Even now, though, he says his recall is sometimes difficult, and he tells Tes that he put together a list of bullet points before our call to ensure that he could keep his focus.

‘Apart from not feeling like I am firing on all cylinders, the worst effect for me is the brain fog’

Sue* is another teacher with long Covid. She explains that it is severely impacting her work.

“I often feel like I am chasing my tail,” she says. “Apart from not feeling like I am firing on all cylinders, the worst effect for me is the brain fog,” she says.

Sue says that she is coping now, but has to work more hours than before to “keep on top of things”.

Mark was lucky enough to get a diagnosis of long Covid - many others have not been so fortunate and, therefore, the true number of teachers suffering is difficult to predict.

Speaking in a Keele University webinar, Carolyn Chew-Graham, professor of general practice research at the university and a GP, said that many individuals initially found their symptoms were being dismissed as anxiety by their GPs. Chew-Graham also explained that one challenge is that there is “no prognostic guidance” for how long patients will suffer from long Covid.

Where there is no diagnosis, teachers can run out of sick pay without any long Covid-specific treatment or process in place, and there is no clear pathway for schools other than what they would do for any other illness, says Emma Hughes, who leads the HR practice and provides support to schools at law firm Browne Jacobson. 

“You would be following your absence procedure…you’d still be looking at what reasonable adjustments you can make” and how they can be brought back to work, she explains. 

What rights do teachers have?

However, even when there is a diagnosis, things are far from easy for the employee or their employer. There is, as yet, no government or clear employer guidance for schools on what they should do about the growing number of teachers with long Covid. 

The unions have tried to fill the gap. The NASUWT began a campaign calling for statutory recognition of the condition as a disability under the Equalities Act - something that the union umbrella group the TUC is also pushing on.

This would mean that teachers and other school staff would have the legal right to be protected from discrimination and to expect reasonable adjustments, like longer rest breaks and flexible hours. It would also mean that anyone who contracts long Covid through work could push for compensation for loss of income and injury.

Meanwhile, the NEU teaching union has published extensive guidance for its members on long Covid, stating that whether long Covid is classified as a disability should be decided on a “case-by-case basis” 

Ian Deakin, a partner at Browne Jacobson, told Tes that he had seen the debates around whether long Covid should be classified as a disability. 

“It won’t be classified as a disability on diagnosis in the way that cancer is or HIV is or MS because long Covid and its impact is likely to be a spectrum. It’s one of those things that some people get it and will recover - it might just take longer,” he says.

Faced with this difference of opinion, the Association of School and College Leaders (ASCL) is awaiting legal clarity over how to apply guidance. 

Without that guidance, schools are struggling. 

How are schools coping with long Covid?

Caroline Derbyshire, CEO of Saffron Academy Trust and chair of the Headteachers’ Roundtable, says that the issue needs national focus from the government. 

“I think there should be national help and guidance on this. And I absolutely think it should be considered in an Ofsted inspection…especially if the person impacted is the headteacher. It is the only compassionate way to act,” she says. 

She tells Tes that the exposure of school staff to Covid “has seemed inevitable” over the past two years, “no matter what mitigations are in place”. She explains that some staff have been left with long-term health implications, a “series of strange, ongoing symptoms which are debilitating, unrelenting and exhausting”.

Derbyshire adds: “Symptoms can come and go, unlike many other illnesses, which makes it difficult for employers to know how to help or manage their colleagues’ needs. Lessons and roles need covering for longer-than-expected periods and, because of the relative newness of the condition, support or understanding is hard to find yet.”

Hugh Greenway, CEO of the Elliot Foundation Academies Trust, says his organisation has already had to deal with long Covid among staff, but adds: “It’s difficult to know how much of a problem it will be as we are still in the teeth of the pandemic.”

‘Symptoms can come and go, which makes it difficult for employers to know how to help or manage their colleagues’ needs’

Without that national guidance, how are schools coping?

Hughes explains that “the policies and the law haven’t quite caught up with Covid”.

Currently, sick leave and pay entitlements are set out in the Burgundy Book for most teachers. This national agreement sets a minimum in its guidance and employers do have the ability to increase it in individual cases if they wish (or can afford) to. A “sliding scale” entitlement is set out, depending on the number of years of service. This runs from the first year of service, in which teachers are entitled to “full pay for 25 working days and, after completing four calendar months’ service, half pay for 50 working days”. During the fourth and successive years of service, teachers are entitled to a minimum of “full pay for 100 working days and half pay for 100 working days”. 

While some people suffering from long Covid symptoms may recover before their sick leave entitlement expires, many won’t. What happens at that point? 

This is at the heart of the NASUWT campaign for long Covid to be recognised as a disability - so that the Equality Act can help these teachers. 

Writing to then-women and equalities minister Liz Truss in June 2020, Roach said: “Regrettably, many teachers have reported to us that they have been met by employers that fail to offer appropriate support, recognition or reasonable adjustments.”

It took 18 months for the government to reply to him, with the letter finally arriving in December 2021. While the reply from Kemi Badenoch, minister for equalities and levelling up communities, agreed that employers should be making allowances for staff with long Covid, Badenoch said she was “not at present convinced that a compelling case exists for adding long Covid to the list of automatic disabilities”.

She said her decision was partly based on the fact that long Covid exists on a “spectrum”, and there was uncertainty over whether it would be a long-term condition for many sufferers. 

But the government has granted temporary guidance for the management of long-term Covid sickness absence elsewhere; emergency work guidance issued by the Department of Health and Social Care in September 2020 said that long Covid may be considered a disability under the terms of the Equalities Act. This guidance applies to NHS employers and includes a separate recording system for any Covid-related sick pay guidance. It sets out guidance to, if needed, make reasonable adjustments, support a phased return to the workplace and offer a “bespoke” and “individually tailored” approach.

When Tes asked the DfE if, given that the education sector currently has the second-highest level of long Covid after the health sector, it was looking at introducing similar guidance for teachers, a spokesperson said: “Long Covid should be treated in line with how other medium- to long-term health conditions are in employment law. Supporting staff on sick leave is a matter for schools as employers.”

Without that guidance, schools are having to make incredibly difficult decisions, says Deakin. 

“If you’ve got somebody that’s suffering badly with [long Covid] and there’s no realistic prospect of return, then the law says that employers are ultimately allowed to dismiss by reason of capability,” he explains. “It may seem cruel…but the law allows you to terminate employment in those circumstances.

“Ultimately, you’ve got teachers who have got long Covid and, despite their best efforts, just can’t return to work...it’s nobody’s fault and creates a cruel and horrible situation for the employee and the employer.”

Deakin explains that there is a condition in the Burgundy Book that means staff can get extra pay if their illness was caused at school, which would “in theory extend to Covid”. However, he explains that this would require certification from a medical practitioner that the infection was caused by being in school. 

He says that getting this would be “extremely challenging” as “Covid is and has been everywhere”. 

Hughes says that schools have also asked about ill-health retirement, which allows individuals to withdraw their pension early on the grounds of ill-health. However, she says this option also requires a medical opinion. 

“The medical opinion isn’t quite there yet with long Covid - we still don’t know enough about long Covid for a medical practitioner to actually pin their colours to the mast by saying, ‘This employee will never be able to return to work due to long Covid,’” she says. 

Sufferers struggling on in work

The result of this is teachers struggling on despite their symptoms. This is likely to result in “boom and bust”, according to Chew-Graham: essentially, a cycle of recovery and relapse.

In a blog post following his experience with long Covid, one 48-year-old, who contracted Covid in March 2020, said: “Long-haul Covid sufferers do not fit into the usual linear recovery expectations of normal illnesses. 

“It’s really hard to explain the boom-bust cycle to friends, colleagues and family. This is not helped by the calcified government line that this is a mild, flu-like illness.”

Because of the cynicism around long Covid that Alwan described above, “struggling on” can also be incredibly unpleasant mentally, says Emily*, the founder of Teachers with Covid, which was set up to support colleagues in the sector who were struggling.

When Emily returned to teaching in school after being absent with long Covid in May 2020, she says she encountered a “very hostile atmosphere”, and she still feels she is being punished for being away from work. Other members of the Facebook Teachers with Covid group also experienced ill-feeling from colleagues - one even said she overheard a colleague referring to her as a “lazy bitch”.

A lack of understanding was also experienced by teacher Kathleen when she returned to school in July 2020 after contracting the virus. She explains how the head of department “didn’t want to discuss” her symptoms. Kathleen also found that he was assessing how much work she had done against what he thought should be expected. “I was progressively made to feel worse”, she says.

Kathleen adds that there was no one in the department who would support her and it was almost as if they thought she wasn’t “pulling her weight”.

Hughes says that, regardless of whether incidents like this are long Covid-related or not, it is “just not good management sense”.

“If you’ve got somebody that’s back at work, suffering with long Covid, then line managers should be having regular conversations with that person, checking in on their wellbeing and checking in on their health, making sure that they’re supported in the workspace just as much as you would anybody else,” she explains. 

If an individual doesn’t feel supported, they could raise a grievance, and this is the advice Hughes would give. She adds: “in terms of legal action, I suppose it would depend on how severe things had got.”

Clearly, the legal, medical and HR processes are lagging behind the reality of long Covid in schools. Until they catch up, the official legal advice is similar to that in schools where staff with long Covid are properly supported: treat teachers with respect, believe what they are saying and listen to what they need. 

Elaine Brook, executive head of Langtons Junior and Chigwell Primary academies, says schools just need to be supportive as far as possible, and ensure that all colleagues have this view. 

“One member of our team who is completely dedicated to the school is suffering from long Covid - she wants to be able to work and feels like she is letting the team down,” she explains. “We’re doing everything we can - providing regular check-ins, allowing opportunities to work from home when possible, noticing when she is not 100 per cent and encouraging her to go home and rest, and supporting her more generally by removing some of her duties.”

‘I’m worried that once the acute infections have died down, we will have the silent pandemic of long Covid’

The trouble is, this is getting ever harder to achieve, she says. “It’s so very difficult right now - our team is amazing, but we are all at maximum capacity and there’s not a lot left in the tank. Staff are fragile and every day is unknown.” 

The reality is that schools need more help with long Covid not just for those affected but also because it is something that will exacerbate existing recruitment, funding and supply problems in the profession. The lack of any assistance from the government, and the absence of clear legal and medical help, is going to mean things get worse for all before they get better. Clearly, something needs to be done - and fast. 

“I’m worried that once the acute infections have died down, we will have the silent pandemic of long Covid, which will affect the economy and society for years to come,” says Elaine Maxwell, former scientific adviser at the National Institute for Health Research and now co-chair of the Long Covid Support Group. “Because we won’t have enough teachers, won’t have enough nurses and doctors…and those that are ill now we can’t afford to lose them. We need to find some way of supporting them in the hope they will be able to return.”

*Some names have been changed to respect anonymity