Background
Long Covid is a complex condition characterised by persistent multisystemic symptoms following a Covid-19 infection, which can influence an individual's capability to sustain employment. However, there is limited evidence of how diverse presentations of long Covid can shape employment and what support strategies might be useful for different groups.

Aim
To address this, we aimed to explore the experiences of employment changes among people living with long Covid in England and to identify the perceived barriers and enablers they face to cope with work.

Design and Methods
We conducted a qualitative analysis of data from the Real-time Assessment of Community Transmission (REACT) Study. Using a framework analysis approach, we analysed 60 semi-structured interviews with people who experienced persistent Covid-19 symptoms for 12 weeks or more.

Results
We identified three key themes: (1) Persistent Covid-19 symptoms at work; (2) Ripple effects of balancing work, identity and well-being with persistent Covid-19 symptoms; and (3) Employment changes to cope with and manage persistent Covid-19 symptoms. Participants identified multiple employment changes, including reduction of working hours, restructuring of roles and modification of responsibilities, and adapted ways of working. Drivers of employment changes included disruptive and fluctuating symptoms but also broader pandemic circumstances and the opportunities available for accessing organizational support and putting in place appropriate management strategies.

Conclusion
Our results provide a thorough understanding of the work changes experienced by people living with long Covid and highlight the need for intersectional, adaptable work accommodations to support their sustainable employment and overall well-being.

Patient and Public Contribution
Members of the public who are part of a Public Advisory Group (PAG) have provided ongoing input into various aspects of the umbrella cohort study, the Real-time Assessment of Community Transmission (REACT) Study, including the study design, data collection instruments and dissemination of findings. For this qualitative study, which draws on interview data from REACT Long COVID (REACT-LC), preliminary findings were presented to the PAG for feedback and suggestions, which helped refine the discussion. Additionally, two Public Advisors with lived experience of long Covid contributed to the writing and editing of this manuscript. In accordance with these contributions, they are included as authors.