How should universities support students with long Covid?

Universities are planning to deliver the vast majority of their teaching and learning face-to-face – with most seminars, group study, practical work, extra-curricular activities, social events and sports taking place in-person.

That was the reassuring line issued by Universities UK to diffuse the row about “in-person” lectures.

But what if, having enrolled last September and moved into halls – catching Covid during Freshers’ week in the process – you’re now experiencing intermittent periods of being overwhelmed by tiredness? What if you’re regularly left gasping for breath, or unable to smell or taste anything, or suffering from regular chest pains and palpitations? What if, thanks to “long” Covid-19, you’re just unable to take part in “student life”? And what if there’s also plenty of people around that think you’re imagining it?

Estimates vary, but the Office for National Statistics (ONS) reckons that over 106,000 under-25s are living with long Covid in the UK – and when you have higher education participation rates as high as we do, it’s therefore clear that a substantial proportion of those young people either are or would like to be students.

Pinning down definitions is fraught with difficulty. The NHS says that common symptoms include sensory problems, such as loss of smell and taste, and cardiac-respiratory symptoms. “Brain fog” is also a big one – surely a major concern in a sector that’s all about learning.

But some studies go wider than these symptoms. A recent study of 2m insurance claims from the US organisation Fair Health found that under-18s, for example, were more likely to report “adjustment disorders” – emotional or behavioural reactions to stressful life events. In the context of deep and widespread concern about student mental health, that’s also a major red flag – particularly if, while everyone else is rebuilding theirs in sports clubs and seminars, some students are left behind.

Working assumptions

There has been considerable focus on long Covid in the workplace – partly because the symptoms are more likely to strike those older than the average student, and partly because of evidence that suggests that catching Covid itself has been an occupational hazard in several professions – given that various people faced higher levels of exposure to Covid-19 while keeping the country running during the pandemic.

Back in June, the TUC published some research from the Long Covid Support Employment Group, calling for the government to urgently recognise long Covid formally as a disability under the Equality Act. Given the Equality Act 2010 defines disability as a “physical or mental impairment…[that] has a substantial and long-term adverse effect on [their] ability to carry out normal day-to-day activities” – and government guidance makes clear that “long-term” means 12 months or more – the TUC argues that many who have long Covid already meet this criteria, and should therefore be protected under the law rather than forced to go through the stress of employment tribunals.

That, says the TUC, would mean that workers with long Covid would be protected – ensuring employers cannot legally discriminate against them. It would also put a duty on employers to make reasonable adjustments that remove, reduce or prevent any disadvantages that workers with long Covid face, as for any other enduring condition or disability.

In addition, it also called on ministers to recognise Covid-19 as an occupational disease – entitling employees and their dependents to protection and compensation if they contracted the virus while working.

That would all have interesting implications for students too given the protections in the Equality Act and the duties on universities both generally and as Public Sector bodies and providers of education specifically.

More research required

But declaring long Covid as a disability in practice might prove tricky. Asked to take a view on it back in April, ACAS raised issues about diagnosis, symptom consistency and the length of time someone might suffer for:

Long Covid is a new illness and it may take time to understand it fully … it is currently understood that it can last or come and go for several months“

You’ll see that “several months” is notably some way short of twelve. The implication is – it’s hard to diagnose, and that the current wisdom appears to be that long Covid will not last, or can’t currently be expected to last, for long enough to constitute a disability by itself.

So legal experts argue that while there are probably cases of early Covid sufferers whose long Covid has now lasted twelve months – and that might mean that they as individuals could count as disabled – that does not mean that all long Covid victims are thereby disabled, or that the misfortune of a few suggests that long Covid can be expected to last so long as a general rule. With our current state of medical knowledge, the vast majority of long Covid sufferers will therefore not count as disabled in law.

For students, this becomes exceptionally problematic. Generally, the protections in law for disabled students are much weaker than those for employees and are hard to enforce. And despite the fact that the duty to not discriminate and make reasonable adjustments is supposed to be anticipatory, disabled students tend to report that they have to go through the process of proving, and repeatedly asserting their status before they can get the adjustments and support they need.

The conveyor-belt model of higher education in use in the UK, coupled with a high, binary bar to reach to be defined as “disabled” for the purposes of things like disabled students allowance create particular problems. The high bar is difficult for some students to reach in general, but for a condition still not fully understood, contested as real by some and that general opinion seems to argue fades, the bar is unlikely to be reached in the eyes of a “medical professional” making a judgement.

And the nature of the thing is a big issue – symptoms come and go and may not meet the legal definition of “long term”, yet can make up a significant portion of an academic year or hit at a pivotal point. Unlike, for example, in several European countries, we’re generally pretty unforgiving of a student achieving and completing at their own pace. A disease like long Covid exacerbates that problem.

Life gets in the way

It’s also the case, by the way, that disabled people are more likely to report suffering from long Covid and to report that its symptoms are more persistent or debilitating. So even if it doesn’t reach the legal bar of “disability” or “long term condition”, ignoring it can have a disproportionate impact on already disabled people.

Oh – and if we look back at that broader “student life” issue, it’s not actually clear that recognising long Covid would help much anyway. The bits in the Equality Act 2010 on further and higher education don’t directly apply to SUs and so (for example) disabled students get very little support to (for example) take part in SU/extra curricular activities. On SUs, EHRC says:

Although these are often thought of as educational provision, they are in fact service providers under the Act and their legal obligations towards students are covered by the services provisions of the Act accordingly (see Services Guidance).

That’s an interesting interpretation. I can see why the duty might not be directly on the SU. But why doesn’t the duty to make sure the education/benefits that come from extra and co-curricular participation extend to universities making sure that students can participate in that stuff? They’re clearly benefits “offered” by the university, and are clearly educational.

Testing times

Almost all policies of this sort inevitably involve a carefully struck balance between trust (to encourage students to come forward and declare things) and suspicion (to deter and prevent cheating). I’d almost always argue for the former – but I’m also a realist. One thing likely to assist students attempting to later prove their (long) Covid case in the face of institutional suspicion is being PCR tested.

There’s a WP angle here. Coming from a deprived neighbourhood increases long Covid risks. To the degree the same background factor also decreases the vaccination likelihood, that also increases the long Covid risk.

When they have symptoms, there’s lots of anecdotal evidence of students either not bothering to get formally PCR tested or even specifically avoiding it – partly because of the perceived low risk to them and partly because of the way in which the self-isolation rules generated FOMO fear, personal hassle (and hassle for contacts) and loss of income from PT work. But for once getting tested isn’t about some self-sacrifice to help others – it’s insurance in the event of long Covid. Efforts should be stepped up to encourage students to get tested in light of the new isolation rules, and universities should ensure they’re visibly ready to support those self-isolating to remove the barrier.

Doing the right thing

Overall, it strikes me that what long Covid does is shine a harsh and unforgiving spotlight on the way we treat both chronic and post-viral illness amongst students in higher education. Our archaic systems and cultures are all about the binaries of disability or doctors’ notes – and neither make much sense in these types of contexts.

Specifically, the sector faces an interesting set of choices over long Covid. What it could do is ignore it and wait – for cases to emerge, for the courts to decide, for individuals to battle the system and argue that their tutor dismissed their “long Covid” excuse for a late essay, and for guidance to eventually emerge that EDI units know well but the rest of the university is only vaguely aware of.

Or it could treat this one differently. It could proactively recognise that there will be students who are experiencing long Covid and anticipate some of the support and adjustments they’ll need. It could work with Government to invent a temporary new kind of DSA that properly recognises the sort of additional financial support that someone might need with even temporary but seriously debilitating conditions. It could work with the SU to make sure that students with long Covid aren’t abandoned in the year ahead. And it could take steps to err on the side of “benefit of the doubt” when it comes to the sorts of debates that have dogged the veracity of the claims of ME sufferers over the years – signalling a clear acceptance of the issue and the sort of adjustments and support on offer if students declare.

If that Covid was caught in a “Covid secure” hall of residence running at 100 per cent capacity while the lecture theatres were running at under half that last September, it really is surely the least the sector should do.