Fabrice Eusani, 53 years old, undergoing rehabilitation at the Rehazenter. The bus driver should soon be back to work after more than a year away (Photo: Romain Gamba/Maison Moderne)

Fabrice Eusani, 53 years old, undergoing rehabilitation at the Rehazenter. The bus driver should soon be back to work after more than a year away (Photo: Romain Gamba/Maison Moderne)

At an average age of 47 years, according to the CHL, many patients suffering from “long covid” are in the middle of their professional career, raising questions on sick leave, a gradual return to work or even a career change. Here is a closer look at the rocky road of long covid sufferers.

“I am healed, but I am not recovered.” On 8 November 2020, Fabrice Eusani was hospitalised after contracting the coronavirus. He wound up staying there for seven months, before starting his rehabilitation at the Rehazenter, which is still ongoing. “We are starting to talk about recovery,” says the 53-year-old bus driver, whose stay was progressively extended until 3 December. He still has to be evaluated by an occupational physician, who will judge whether or not he can return to his current job. If not, he could be transferred to the drivers’ regulation office.

“I was in a coma for nine weeks, and I developed neuropathy in my lower limbs. My feet don’t work properly, I can’t get them up. I have orthoses to hold them up,” explains Eusani. This has enabled him to resume driving, although he wonders whether the company will want to give him responsibility for transporting other people for a long time. He does not expect to work full time again anyway, if only because of the two afternoons a week dedicated to his rehabilitation. His breathing has also been affected.

“After putting my daughter in the car, I have to give myself a break. When I go up the stairs to my room, when I get to the top, I have to sit down,” he says. “My lung capacity is at 70% today. It’s almost unhoped for to get back to 100%, my pneumologist says I can get to 85%." He is apprehensive about returning to work. “It’s a bit scary, I've been off work for a year. But it brings other satisfactions, you come back into society.”

Their first appointment at the CHL is a big step for them, they are told 'yes, your symptoms are real'.

Céline RezetteIn charge of setting up long covid consultations CHL

Alvaro Dinis Machado, 50, has just returned to work, a little over a week ago, at a gradual pace: “Two to three hours a day. After that, it gets hard, I’m tired, my feet and legs hurt and I find it hard to concentrate.” The heating business manager had been on halt since 8 March 2020. His lung capacity remains limited to 55%. For the return to work, he was able to arrange with his boss to choose his hours.

Machado only comes to the office on Tuesdays, Wednesdays and Fridays, Mondays and Thursdays being dedicated to his therapy at the Rehazenter. He’ll adapt his rhythm as he goes along to go to 4 hours a day, 6 hours, then 8 hours when he’s ready. In the meantime, the CNS still pays his salary. Even if the return to the office is tiring, he sees it as a step forward.

344 applications since July 2021

Until July, it was difficult to record the number of cases of long covid, as there was no specific path for it in Luxembourg. It was estimated at 700 people. From now on, the Centre Hospitalier de Luxembourg (CHL) will centralise consultations. Patients are referred there by their doctor when their symptoms persist three months after the Sars-CoV-2 infection. The hospital then redirects them to the Rehazenter for multidisciplinary care, to Mondorf for exercise rehabilitation, to the neuropsychiatric hospital centre (CHNP) for concentration difficulties and depression, and to the CHL’s clinic for mental health (CTE) to treat anxiety.

As of 9 November, 344 requests had been sent to the hospital’s long covid service since its launch on 7 July 2021. Their profiles are “not what you would expect,” says Arnaud Marguet, who, along with Céline Rezette, is in charge of setting up dedicated consultations at the hospital. They are on average 47 years old and three quarters of them are women. They are therefore people in active life. He estimates that 10% of long covid patients are off work and 10% are gradually returning to work.

“These are not necessarily the patients who have been in intensive care,” adds Rezette. This makes things “sometimes difficult to understand for the family and the employer. It’s difficult for the patients. Their first appointment at the CHL is a big step for them, we tell them ‘yes, your symptoms are real’.”

A 78-week limit on care

The long form of the virus is not a recognised disease in the National Health Fund (CNS) nomenclature. However, patients suffering from the disease may be reimbursed for treatment “on the recommendation of the attending physician and after approval by the social security medical control”, explains the CNS. For sick leave, too, validation is necessary. However, “several patients contact us to tell us that their sick leave has not been accepted,” says the CHL’s long covid service.

How long can a person remain on sick leave or part-time work? When asked, the CNS referred us to its . It states that in the event of incapacity for work, “the employee is entitled to continued salary from his employer until the end of the calendar month in which the 77th day of incapacity for work occurs”. After that, the CNS “takes over and the entitlement to financial compensation is limited to a total of 78 weeks”, including the first 77 days. What happens after that date? “Compensation from the CNS is no longer provided. However, there are other possibilities,” the health insurance fund replies. It mentions professional reclassification or invalidity.

Personalised exercise at the Rehazenter

The employee is no longer protected from dismissal after 26 weeks. “Some patients are fired because they are sick for six months,” says Joachim Renouprez, a doctor specialised in physical medicine and rehabilitation at the Rehazenter. Others return to work at the end of their therapy--that is, once “the objectives set at the start are achieved”--but sometimes come back because the return did not go as planned.

To make this work, the rehabilitation centre customises its exercises. “For example, we had a surgeon with a loss of strength: we worked specifically on precise movements with screws and nuts. For a waiter, we train to carry trays. A baker worked in our kitchen to relearn how to knead the dough, to redo movements close to those of pastry-making.”

Patients can also turn to a job conversion, as the CHL and the Rehazenter testify--statistics on this have not been released yet. The employment agency Adem does not have any statistics either and states that reclassification in cases of long covid is done like for any other case. The procedures are specified on its . For example, you must have been in your job for at least three years. A qualified occupational physician must establish the inability to perform the tasks, and then the joint commission will decide on internal or external professional reclassification.

Without prospects, it is difficult for patients with long covid to know whether they should wait or change jobs. The prime minister in his state of the nation address announced the launch of a Covalux project, “a scientific analysis of the long-term consequences of the coronavirus”, both physical and mental. Perhaps this will give sufferers more certainty for the future.

This story was first published in French on . It has been translated and edited for Delano.