The potential impact of post-COVID symptoms in the healthcare sector

Prevalence and symptoms of Long Covid-19 in the workplace

BACKGROUND

The symptoms of Long coronavirus disease 2019 (Covid-19) are heterogeneous, creating uncertainty for employers regarding the diagnosis. The prevalence of Long Covid-19 in the workforce is also unknown. Furthermore, workers affected by Long Covid-19 encounter considerable difficulties in ensuring work safety and returning to their jobs due to this condition.

AIMS

This review is aimed to identify the prevalence of Long Covid-19 in the workplace and to determine the various symptoms of Long Covid-19 experienced by the workers.

METHODS

A meta-analysis was conducted to calculate the pooled estimates for the prevalence of Long Covid-19. Heterogeneity among the estimates was evaluated using the I² statistic.

RESULTS

The pooled prevalence of Long Covid-19 among workers across the 11 studies was 38% (95% CI 23-56). A total of 43 symptoms associated with Long Covid-19 were identified in the workplace, with the top five symptoms being dyspnoea at moderate activity (51%, 95% CI 39-62), mental symptoms (38%, 95% CI 6-87), dyspnoea at mild activity (35%, 95% CI 25-47), fatigue (26%, 95% CI 3-78) and effort intolerance (24%, 95% CI 15-35).

CONCLUSIONS

The review indicates a significant burden of long-lasting symptoms within the workforce. The top five reported symptoms of Long Covid-19 were dyspnoea during mild and moderate activities, mental symptoms, fatigue and effort intolerance.

Global prevalence of long COVID and its most common symptoms among healthcare workers: a systematic review and meta-analysis

Objectives

Long COVID, a condition where symptoms persist after the acute phase of COVID-19, is a significant concern for healthcare workers (HCWs) due to their higher risk of infection. However, there is limited knowledge regarding the prevalence, symptoms and clustering of long COVID in HCWs. We aimed to estimate the pooled prevalence and identify the most common symptoms of long COVID among HCWs who were infected with SARS-CoV-2 virus globally, and investigate any differences by geographical region and other factors.

Design

Systematic review and meta-analysis (PROSPERO CRD42022312781).

Data sources

We searched MEDLINE, CINAHL, EMBASE, PsycINFO and the grey literature from 31 December 2019 until 18 February 2022.

Eligibility criteria

We included studies reporting primary data on long COVID prevalence and symptoms in adult HCWs who had SARS-CoV-2 infection.

Data extraction and synthesis

Methodological quality was assessed using the Joanna Briggs Institute checklist. Meta-analysis was performed for prevalence data of long COVID following SARS-CoV-2 infection.

Results

Out of 5737 articles, 28 met the inclusion criteria, with a combined sample size of 6 481 HCWs. 15 articles scored equal to or above the median score for methodological quality. The pooled prevalence of long COVID among HCWs who had SARS-CoV-2 infection was 40% (95% CI: 29% to 51%, I2: 97.2%; 12 studies), with a mean follow-up period of 22 weeks. The most prevalent symptoms reported were fatigue (35%), neurologic symptoms (25%), loss/decrease of smell and/or taste (25%), myalgia (22%) and shortness of breath (19%).

Conclusion

This review highlights the substantial burden of long COVID among HCWs worldwide. However, limitations in data quality and inconsistent definitions of long COVID impact the generalisability of these findings. To improve future interventions, we recommend enhanced cohort study designs for better characterisation of long COVID prevalence and symptoms in HCWs.

Prevalence and risk factors of long covid and its associated adverse work outcomes among workers in the manufacturing sector in Malaysia - a mixed-methods study protocol

BACKGROUND

The manufacturing sector in Malaysia has been severely impacted by the COVID-19 pandemic. This is further exacerbated by Long COVID-19 symptoms among the manufacturing workers, which are proven to influence work performance and quality of life. Of note, there is currently a lack of knowledge regarding the burden of Long COVID-19 in the Malaysian manufacturing sector. As such, our study aims to investigate the prevalence and risk factors of Long COVID-19 symptoms among the manufacturing workers, and subsequently assess the prevalence and risk factors of adverse work outcomes among the workers with Long Covid-19 symptoms.

METHODS

This is an exploratory mixed-methods study. In phase 1 (qualitative phase), three groups of participants (i.e., clinicians, employers, and workers) will be invited to participate to focus group discussions (FGDs) until thematic saturation. The aim of the FGDs is to explore the understanding, experience, and potential risk factors of Long Covid-19 among manufacturing workers. Findings from the FGDs will be analysed thematically. Themes generated from the FGDs will be used to generate items in a new questionnaire. The newly developed questionnaire will be validated using a fuzzy Delphi study, which will also be conducted among clinicians, employers, and workers. Phase 2 is a cross-sectional study that will be conducted among manufacturing workers across all states in Malaysia to identify the prevalence and risk factors of Long COVID-19, as well as the prevalence and risk factors of adverse work outcomes among workers with Long COVID-19. A multistage cluster sampling will be used to collect data from 4500 manufacturing workers in Malaysia. Logistic regression will be performed to determine the association between risk factors with both Long COVID-19 and adverse work outcomes.

CONCLUSION

Once the prevalence and risk factors of Long COVID and its associated adverse work outcome are identified, timely support and effective interventions could be provided to manufacturing workers to maintain their health and productivity.

ETHICAL CONSIDERATIONS

Ethical approval has been granted by the Research Ethics Committee of the National University of Malaysia (JEP-2023-607) and the Medical Research and Ethics Committee (MREC) Malaysia (NMRR ID-23-03310-H3E).

Long COVID among healthcare workers: a narrative review of definitions, prevalence, symptoms, risk factors and impacts

INTRODUCTION

Long COVID (LC) occurs when people experience symptoms for weeks, months or even years after a COVID-19 infection. This review looks at research exploring the LC definitions, prevalence, symptoms, risk factors, and associated impacts in research on healthcare workers (HCWs).

DATA SOURCES

We systematically searched five electronic databases (CINAHL, EMBASE, Medline, PsycInfo and PubMed) and compiled a narrative literature review based on 56 relevant studies.

AREAS OF AGREEMENT

LC is prevalent among HCWs who become infected by COVID-19. Many of the most frequent symptoms associated with LC in the general population are also reported among HCWs. Some risk factors for LC are also similar to those in the general population, such as female sex, older age, and having a pre-existing respiratory illness.

AREAS OF CONTROVERSY

The mechanism(s) responsible for LC remains unknown. A variety of terms, timeframes and symptoms are used to define LC, creating difficulties in comparing results across studies. Much of the research is cross-sectional and fails to explore the impacts that prolonged symptoms have on HCWs' personal and professional lives.

GROWING POINTS

The need to support HCWs with LC is clear. Identifying the mechanism(s) responsible for LC is a key priority, as this will inform treatments.

AREAS FOR DEVELOPING RESEARCH

Future research should move towards a standard definition for LC. Greater attention should be paid to longitudinal and qualitative studies, which could give insights into prognosis, lived experience and work participation. Finally, studies evaluating treatments suitable for people with LC are timely.

Factors influencing fatigue, mental workload and burnout among Chinese health care workers during public emergencies: an online cross-sectional study

OBJECTIVES

The purpose of this study was to investigate fatigue, mental workload, and burnout among health care workers (HCWs) and explore the possible underlying factors.

MATERIALS AND METHODS

An online cross-sectional survey design was used to collect data from HCWs in Chongqing, China. The online survey included the Fatigue Severity Scale, NASA Task Load Index, and Chinese version of the Maslach Burnout Inventory-General Survey to assess fatigue, mental workload, and burnout, respectively, and was conducted from February 1 to March 1, 2023.

RESULTS

In this study, the incidence of fatigue and burnout among HCWs was 76.40% and 89.14%, respectively, and the incidence of moderate to intolerable mental workloads was 90.26%. Work-family conflict, current symptoms, number of days of COVID-19 positivity, mental workload, burnout and reduced personal accomplishment were significantly associated with fatigue. Mental workload was affected by fatigue and reduced personal accomplishment. Furthermore, burnout was influenced by marital status and fatigue. Moreover, there was a correlation among mental workload, fatigue, and burnout.

CONCLUSIONS

Fatigue, mental workload and burnout had a high incidence and were influenced by multiple factors during COVID-19 public emergencies in China.

What is the impact of long-term COVID-19 on workers in healthcare settings? A rapid systematic review of current evidence

BACKGROUND

Long COVID is a devastating, long-term, debilitating illness which disproportionately affects healthcare workers, due to the nature of their work. There is currently limited evidence specific to healthcare workers about the experience of living with Long COVID, or its prevalence, pattern of recovery or impact on healthcare.

OBJECTIVE

Our objective was to assess the effects of Long COVID among healthcare workers and its impact on health status, working lives, personal circumstances, and use of health service resources.

METHODS

We conducted a systematic rapid review according to current methodological standards and reported it in adherence to the PRISMA 2020 and ENTREQ statements.

RESULTS

We searched relevant electronic databases and identified 3770 articles of which two studies providing qualitative evidence and 28 survey studies providing quantitative evidence were eligible. Thematic analysis of the two qualitative studies identified five themes: uncertainty about symptoms, difficulty accessing services, importance of being listened to and supported, patient versus professional identity and suggestions to improve communication and services for people with Long COVID. Common long-term symptoms in the survey studies included fatigue, headache, loss of taste and/or smell, breathlessness, dyspnoea, difficulty concentrating, depression and anxiety.

CONCLUSION

Healthcare workers struggled with their dual identity (patient/doctor) and felt dismissed or not taken seriously by their doctors. Our findings are in line with those in the literature showing that there are barriers to healthcare professionals accessing healthcare and highlighting the challenges of receiving care due to their professional role. A more representative approach in Long COVID research is needed to reflect the diverse nature of healthcare staff and their occupations. This rapid review was conducted using robust methods with the codicil that the pace of research into Long COVID may mean relevant evidence was not identified.

Impact of COVID-19 Infection on Work Functioning in Japanese Workers: A Prospective Cohort Study

Background

The impact of COVID-19 infection on workers' work function persists even after the acute phase of the infection. We studied this phenomenon in Japanese workers.

Methods

We conducted a one-year prospective cohort study online, starting with a baseline survey in December 2020. We tracked workers without baseline work functioning impairment and incorporated data from 14,421 eligible individuals into the analysis. We estimated the incidence rate ratio for new onset of work functioning impairment due to COVID-19 infection during follow-up, using mixed-effects Poisson regression analysis with robust variance.

Results

Participants reporting infection between January and December 2021 showed a significantly higher incidence of new work functioning impairment (adjusted incidence rate ratio: 2.18, 95% confidence interval: 1.75-2.71, p < 0.001). The formality of the recuperation environment correlated with a higher risk of work functioning deterioration in infected individuals (p for trend <0.001).

Conclusion

COVID-19-infected workers may continue to experience work difficulties due to persistent, post-acute infection symptoms. Companies and society must urgently provide rehabilitation and social support for people with persistent symptoms, recognizing that COVID-19 is not just a transient acute infection.

Systematic Review of the Prevalence of Long COVID

Background

Long COVID occurs in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) whose symptoms persist or develop beyond the acute phase. We conducted a systematic review to determine the prevalence of persistent symptoms, functional disability, or pathological changes in adults or children at least 12 weeks postinfection.

Methods

We searched key registers and databases from January 1, 2020 to November 2, 2021, limited to publications in English and studies with at least 100 participants. Studies in which all participants were critically ill were excluded. Long COVID was extracted as prevalence of at least 1 symptom or pathology, or prevalence of the most common symptom or pathology, at 12 weeks or later. Heterogeneity was quantified in absolute terms and as a proportion of total variation and explored across predefined subgroups (PROSPERO ID CRD42020218351).

Results

One hundred twenty studies in 130 publications were included. Length of follow-up varied between 12 weeks and 12 months. Few studies had low risk of bias. All complete and subgroup analyses except 1 had I² ≥90%, with prevalence of persistent symptoms range of 0%-93% (pooled estimate [PE], 42.1%; 95% prediction interval [PI], 6.8% to 87.9%). Studies using routine healthcare records tended to report lower prevalence (PE, 13.6%; PI, 1.2% to 68%) of persistent symptoms/pathology than self-report (PE, 43.9%; PI, 8.2% to 87.2%). However, studies systematically investigating pathology in all participants at follow up tended to report the highest estimates of all 3 (PE, 51.7%; PI, 12.3% to 89.1%). Studies of hospitalized cases had generally higher estimates than community-based studies.

Conclusions

The way in which Long COVID is defined and measured affects prevalence estimation. Given the widespread nature of SARS-CoV-2 infection globally, the burden of chronic illness is likely to be substantial even using the most conservative estimates.

Return to Work of Healthcare Workers after SARS-CoV-2 Infection: Determinants of Physical and Mental Health

Introduction. The SARS-CoV-2 pandemic has involved healthcare workers (HCWs) both as caregivers and as patients. This study is a retrospective cross-sectional analysis of the HCWs working in a third-level hospital in Central Italy who were infected with COVID-19 from March 2020 to April 2021. This research aims at identifying the physical and mental health outcomes of HCWs infected with COVID-19 who returned to work after the infection, the determinants of those outcomes, such as age and sex, and the identification of possible vulnerable professional groups. Methods. A questionnaire about the acute illness, the experience of returning to work, and health perceptions after the disease was administered to 427 healthcare workers 3 months after recovering from the SARS-CoV-2 infection. Results. The majority interviewed (84.5%) reported symptoms at the time of the positive test, with no significant differences regarding age or sex, while a significant difference in the mean age was found regarding hospitalization (p < 0.001). At 3 months after the infection, females (p = 0.001), older workers (p < 0.001), and healthcare assistants (p < 0.001) were more likely to report persistent symptoms. Sex (p = 0.02) and age (p = 0.006) influenced the quality of sleep after the infection. At work, the nurses group reported increase in workload (p = 0.03) and worse relationships (p = 0.028). At 3 months after the infection, female workers perceived worse physical (p = 0.002) and mental (p < 0.001) health status according to the SF-12. A negative correlation was found between age and PCS score (p < 0.001) but not MCS score (p = 0.86). A significant difference in PCS score was found between nurses and physicians (p = 0.04) and between residents and all other groups (p < 0.001). Finally, the group of workers reporting sleep alterations showed lower PCS and MCS scores (p < 0.001) and working relationships had an impact on MCS scores (p < 0.001). Conclusions. Age, sex, and type of job had an impact on physical and mental outcomes. Organizing specific interventions, also tailored to professional sub-groups, should be a target for healthcare systems to protect and boost the physical and mental health of their workers.

Some of the workforce face post COVID after the acute phase of the illness: The employer’s supportive role

BACKGROUND: A considerable proportion of workers that recover from an acute phase of COVID-19 are confronted with post COVID-19 symptoms of varying severity and duration. Employers have an important role in addressing this new condition. OBJECTIVE: The aim of this study was to review organisational practises that could help employees suffering from long COVID-19 return to work and to link these suggestions to theoretical frameworks from the field of work and organisational psychology. METHODS: Since scientific publications on post COVID-19 are published daily, but sound empirical studies are still scarce, the synthesis of the scientific and professional literature was performed in the form of a narrative review. RESULTS: The results were organised according to the healthy workplace model and explained through the lens of the job demands-resources theory. The role of the employer has three aspects: collaboration, instructional pillars, and key actors. The main guidelines for implementation of the policies are an individualised approach, flexibility, and support. Supportive policies, practises, and relationships might have a direct impact on workers’ psychological resources. CONCLUSIONS: The model could help employers understand the conditions and necessary adaptations for workers with post COVID-19, as well as advance research in work and organisational psychology.