Winter is quickly approaching, marking yet another turn around the sun for the COVID-19 pandemic. But there is a silver lining when it comes to inoculation progress. More than 80% of the U.S. population has received at least one vaccine dose, and 10% have received a bivalent booster. But long COVID—a mysterious chronic condition affecting as many as 80% of COVID survivors—remains a significant business concern with broader workforce implications.

In late August, the Brookings Institute released a jaw-dropping report finding that long COVID has forced between 2 million to 4 million working-age Americans out of the workforce, accounting for at least $170 billion in lost wages annually. (More conservative estimates place the number of Americans out of work due to long COVID at 1 million.) Even more worrying, this number is only a fraction of the 6.8% of U.S. adults who currently report having long COVID symptoms.

Katie Bach, the report’s author, says it’s critical that employers address long COVID in their workforce, but adds, “It’s not immediately obvious how to accommodate someone with this.” The Equal Employment Opportunity Commission classified long COVID as a disability protected under the American With Disabilities Act in July 2021, requiring that employers provide long-haulers with reasonable accommodations. However, not all long COVID cases look the same. According to the CDC, symptoms can include chronic fatigue and worsening symptoms after physical or mental effort, respiratory issues like shortness of breath, and neurological issues like brain fog or dizziness. Another COVID wave will likely happen this winter, which combined with the flu and RSV could create a “tripledemic” and push even more Americans out of the workforce.

“It’s not something [HR leaders] can just ignore,” says Kara Ariail, a partner and employment law attorney at Holland & Knight. “Employers have a responsibility to make reasonable accommodations for qualified individuals with disabilities, which means that an employee can still perform the job as long as some accommodations are in place.”

It will also require that managers are aware of long COVID symptoms and have adequate training to accommodate employees’ prognoses.

Cecile Oger, managing director of people and culture at Business for Social Responsibility, says leaders must show empathy and leniency. But she’s seeing a shift from leaders treating COVID as a one-week ailment to a disease with a lasting, debilitating impact.

Long COVID patients could stand to benefit from flexible work, which the pandemic ironically accelerated. “Flexibility is a key accommodation that helps, whether it’s flexibility in schedule, deadlines, or providing a lot of advance notice,” says Ariail. For instance, a manager can excuse an employee whose long COVID symptoms include poor sleep and insomnia from taking calls before a certain time. Similarly, employers can provide deadline flexibility to workers with brain fog who find it difficult to work within time limits.

Some companies have set up enterprise-wide funds to pay for employee accommodations. The average accommodation costs no more than $500, says Jill Houghton, president and CEO of Disability:IN, noting, “In many instances, it doesn’t cost anything.” Disability:IN’s 2022 Disability Equality Index found that 55% of surveyed employers have a centralized accommodation fund or similar fund, up from 34% in 2019.

Companies participating in the Disability Equality Index that improved their disability inclusion over four years saw 28% higher revenue, doubled net income, and 30% higher economic profit margins compared to companies that hadn’t improved their practices, according to Disability:IN. “It pays for companies to be disability-inclusive,” Houghton says. “So we shouldn’t be debating what an employee needs to perform the job’s essential functions.”

Employers must also prepare for long-COVID-related leave requests under the Family and Medical Leave Act. Research shows that the sooner long COVID is addressed, the better the outcome.

“Employers who are covered under the FMLA need to make sure that they are following the requirements in terms of designating leave and informing employees of their rights,” Ariail says. Long COVID’s impact goes beyond white-collar workers. Essential and health care workers have long been vulnerable to worse COVID-19 outcomes, painting a grimmer picture for such individuals.

In the U.S., employers can terminate workers with disabilities if the termination is unrelated to the disability, employees do not meet the job requirements with or without reasonable accommodation, or workers pose a direct threat to health and safety in the workplace because of their disability.

A factory worker with memory issues responsible for safety oversight or running a machine could create an occupational risk for employers. But given the labor shortage caused by the pandemic, employers must stay on top of performance issues and rethink how they’re granting accommodations.

“Make sure you are in constant, regular contact with employees on performance issues,” says Ariail. “We don’t want to wait until someone has missed 10 deadlines, and it’s become a critical point, and a client or a team member wants them removed.” Separately, repeated reinfections increase the likelihood of developing health complications and could lead more employees to exit the workforce.

“If you’re an employer, and you have somebody on long-term sickness absence, that’s very costly,” Clare Rayner, a retired consultant occupational physician in England who developed long COVID, tells Fortune. “But what’s different with COVID is that we’ve got multiple people off sick for a long time, all at once. That’s never happened in my experience.”

But there are solutions. Suppose a long-hauler struggles to stand upright for long periods but works on their feet for hours. Employers can vary the worker’s time standing and sitting and allow adequate breaks and changes in position. ”If you want to get this person back in, you’ve got to ease them in gradually and make adjustments,” Rayner says. The likelihood of a worker on medical leave returning to work drops by 50% by their 12th week of absence. “You can’t leave it until someone’s 100% because they’ll never get back in.”

Despite the havoc long COVID and the pandemic wreaked on the workforce, there’s some good news: Workforce disability participation increased in the last two years thanks to remote and hybrid work offerings. Those same flexible arrangements can help retain long haulers.

“People with disabilities [have] been asking for flexible workplaces for decades,” says Houghton. “While it didn’t work for every single position and industry, we saw that companies were able to flip that switch and begin to offer these flexible workplace accommodations, which, when you’re talking about long COVID or disability, is one and the same.”

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